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iPM-9800
Patient Monitor
Operator’s Manual
© Copyright 2009-2010 Shenzhen Mindray Bio-Medical Electronics Co., Ltd. All rights
reserved.
For this Operator’s Manual, the issue date is 2010-06.
I
Intellectual Property Statement
SHENZHEN MINDRAY BIO-MEDICAL ELECTRONICS CO., LTD. (hereinafter called
Mindray) owns the intellectual property rights to this Mindray product and this manual. This
manual may refer to information protected by copyright or patents and does not convey any
license under the patent rights or copyright of Mindray, or of others.
Mindray intends to maintain the contents of this manual as confidential information.
Disclosure of the information in this manual in any manner whatsoever without the written
permission of Mindray is strictly forbidden. Release, amendment, reproduction, distribution,
rental, adaptation, translation or any other derivative work of this manual in any manner
whatsoever without the written permission of Mindray is strictly forbidden.
,
and
are the registered trademarks or trademarks owned
by Mindray in China and other countries. All other trademarks that appear in this manual are
used only for editorial purposes without the intention of improperly using them. They are the
property of their respective owners.
II
Responsibility on the Manufacturer
Party
Contents of this manual are subject to change without prior notice.
All information contained in this manual is believed to be correct. Mindray shall not be liable
for errors contained herein or for incidental or consequential damages in connection with the
furnishing, performance, or use of this manual.
Mindray is responsible for the effects on safety, reliability and performance of this product,
only if:
„
all installation operations, expansions, changes, modifications and repairs of this product
are conducted by Mindray authorized personnel;
„
the electrical installation of the relevant room complies with the applicable national and
local requirements;and
„
the product is used in accordance with the instructions for use.
NOTE
z
This equipment must be operated by skilled/trained clinical professionals.
WARNING
z
It is important for the hospital or organization that employs this equipment to
carry out a reasonable service/maintenance plan. Neglect of this may result in
machine breakdown or personal injury.
III
Warranty
THIS WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER WARRANTIES,
EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR ANY PARTICULAR PURPOSE.
Exemptions
Mindray's obligation or liability under this warranty does not include any transportation or
other charges or liability for direct, indirect or consequential damages or delay resulting from
the improper use or application of the product or the use of parts or accessories not approved
by Mindray or repairs by people other than Mindray authorized personnel.
This warranty shall not extend to:
„
Malfunction or damage caused by improper use or man-made failure.
„
Malfunction or damage caused by unstable or out-of-range power input.
„
Malfunction or damage caused by force majeure such as fire and earthquake.
„
Malfunction or damage caused by improper operation or repair by unqualified or
unauthorized service people.
„
Malfunction of the instrument or part whose serial number is not legible enough.
„
Others not caused by instrument or part itself.
IV
Company Contact
Manufacturer:
Shenzhen Mindray Bio-Medical Electronics Co., Ltd.
E-mail Address:
[email protected]
Tel:
+86 755 26582479 26582888
Fax:
+86 755 26582934 26582500
EC-Representative:
Shanghai International Holding Corp. GmbH(Europe)
Address:
Eiffestraβe 80, Hamburg 20537, Germany
Tel:
0049-40-2513175
Fax:
0049-40-255726
V
Preface
Manual Purpose
This manual contains the instructions necessary to operate the product safely and in
accordance with its function and intended use. Observance of this manual is a prerequisite for
proper product performance and correct operation and ensures patient and operator safety.
This manual is based on the maximum configuration and therefore some contents may not
apply to your product. If you have any question, please contact us.
This manual is an integral part of the product. It should always be kept close to the equipment
so that it can be obtained conveniently when needed.
Intended Audience
This manual is geared for clinical professionals who are expected to have a working
knowledge of medical procedures, practices and terminology as required for monitoring of
critically ill patients.
Illustrations
All illustrations in this manual serve as examples only. They may not necessarily reflect the
setup or data displayed on your patient monitor.
Conventions
„
Italic text is used in this manual to quote the referenced chapters or sections.
„
[ ] is used to enclose screen texts.
„
→ is used to indicate operational procedures.
VI
Content
1 Safety ................................................................................................................................. 1-1
1.1 Safety Information .......................................................................................................... 1-1
1.1.1 Dangers .............................................................................................................. 1-2
1.1.2 Warnings............................................................................................................. 1-2
1.1.3 Cautions ............................................................................................................. 1-3
1.1.4 Notes .................................................................................................................. 1-3
1.2 Equipment Symbols ........................................................................................................ 1-4
2 The Basics ......................................................................................................................... 2-1
2.1 Monitor Description ........................................................................................................ 2-1
2.1.1 Intended Use....................................................................................................... 2-1
2.1.2 Contraindications ............................................................................................... 2-1
2.1.3 Components ....................................................................................................... 2-1
2.2 Main unit ......................................................................................................................... 2-2
2.2.1 Front View.......................................................................................................... 2-2
2.2.2 Side View ........................................................................................................... 2-4
2.2.3 Rear View........................................................................................................... 2-5
2.3 Display Screen ................................................................................................................ 2-6
2.4 QuickKeys....................................................................................................................... 2-8
3 Basic Operations .............................................................................................................. 3-1
3.1 Installation....................................................................................................................... 3-1
3.1.1 Unpacking and Checking ................................................................................... 3-2
3.1.2 Environmental Requirements............................................................................. 3-2
3.2 Getting Started ................................................................................................................ 3-3
3.2.1 Inspecting the Monitor ....................................................................................... 3-3
3.2.2 Switching On...................................................................................................... 3-3
3.2.3 Starting Monitoring ............................................................................................ 3-3
3.3 Disconnecting from Power.............................................................................................. 3-4
3.4 Operating and Navigating ............................................................................................... 3-4
3.4.1 Using the Knob .................................................................................................. 3-4
3.4.2 Using Keys ......................................................................................................... 3-5
3.4.3 Using the Touchscreen ....................................................................................... 3-5
3.4.4 Using the On-Screen Keyboard.......................................................................... 3-5
3.4.5 Using the Main Menu......................................................................................... 3-6
3.5 Operating Modes............................................................................................................. 3-7
3.6 Using an External Storage Device................................................................................... 3-8
3.7 Using an External Display .............................................................................................. 3-9
3.8 Changing General Measurement Settings ....................................................................... 3-9
1
3.8.1 Switching On/Off Modules ................................................................................ 3-9
3.8.2 Changing Measurement Settings...................................................................... 3-10
3.8.3 Changing Waveform Settings........................................................................... 3-10
3.9 Changing General Settings............................................................................................ 3-10
3.9.1 Setting up a Monitor..........................................................................................3-11
3.9.2 Changing Language ..........................................................................................3-11
3.9.3 Setting DIAP Baud Rate....................................................................................3-11
3.9.4 Adjusting the Screen Brightness .......................................................................3-11
3.9.5 Setting the Date and Time ................................................................................ 3-12
3.9.6 Adjusting Volume ............................................................................................. 3-13
4 Managing Patients............................................................................................................ 4-1
4.1 Admitting a Patient.......................................................................................................... 4-1
4.2 Editing Patient Information............................................................................................. 4-2
4.3 Discharging a Patient ...................................................................................................... 4-2
4.4 Switching between Wire and Wireless Networks............................................................ 4-3
4.5 Transferring Patient Data ................................................................................................ 4-3
4.6 Connecting to a Central Monitoring System................................................................... 4-5
5 Managing Configurations................................................................................................ 5-1
5.1 Introduction..................................................................................................................... 5-1
5.2 Entering and Exiting the Configuration Mode ................................................................ 5-2
5.3 Viewing and Changing Configurations ........................................................................... 5-3
5.4 Adding a Configuration................................................................................................... 5-4
5.5 Deleting a Configuration................................................................................................. 5-4
5.6 Loading a Configuration ................................................................................................. 5-5
5.7 Setting Default Configuration at Startup......................................................................... 5-5
5.8 Loading the Latest Configuration Automatically............................................................ 5-6
5.9 Transferring a Configuration........................................................................................... 5-7
6 User Screens...................................................................................................................... 6-1
6.1 Tailoring Your Screens .................................................................................................... 6-1
6.1.1 Setting the Waveform Sweep Mode ................................................................... 6-1
6.1.2 Changing the Wave Line Size ............................................................................ 6-1
6.1.3 Choosing the Way to Draw Waves ..................................................................... 6-1
6.1.4 Changing Parameter and Waveform Colors ....................................................... 6-2
6.1.5 Selecting Waveforms for Display....................................................................... 6-2
6.1.6 Changing Screen Layout .................................................................................... 6-2
6.2 Viewing Minitrends......................................................................................................... 6-3
6.2.1 Having a Split-Screen View of Minitrends ........................................................ 6-3
6.2.2 Changing Minitrend Length ............................................................................... 6-4
6.2.3 Changing a Parameter for Viewing .................................................................... 6-4
6.3 Viewing oxyCRG ............................................................................................................ 6-5
6.4 Viewing Other Patients.................................................................................................... 6-6
2
6.4.1 Care Group ......................................................................................................... 6-6
6.4.2 Viewing the Care Group Overview Bar ............................................................. 6-6
6.4.3 Understanding the View Other Patient Window ................................................ 6-7
6.5 Understanding the Big Numerics Screen ........................................................................ 6-8
7 Alarms ............................................................................................................................... 7-1
7.1 Alarm Categories............................................................................................................. 7-1
7.2 Alarm Levels ................................................................................................................... 7-2
7.3 Alarm Indicators.............................................................................................................. 7-2
7.3.1 Alarm Lamp ....................................................................................................... 7-3
7.3.2 Alarm Message................................................................................................... 7-3
7.3.3 Flashing Numeric ............................................................................................... 7-3
7.3.4 Audible Alarm Tones.......................................................................................... 7-3
7.3.5 Reminder Tones.................................................................................................. 7-4
7.4 Understanding Alarm Statuses ........................................................................................ 7-4
7.4.1 Pausing Alarms................................................................................................... 7-4
7.4.2 Switching Off Alarms......................................................................................... 7-5
7.4.3 Silencing the Alarm Sound................................................................................. 7-5
7.4.4 Switching off Alarm Sound................................................................................ 7-6
7.5 Alarm Configuration ....................................................................................................... 7-6
7.5.1 Alarm Tone Configuration.................................................................................. 7-6
7.5.2 Displaying Alarm Limits.................................................................................... 7-7
7.5.3 Setting Alarm Delay Time.................................................................................. 7-7
7.5.4 Using Alarms...................................................................................................... 7-7
7.5.5 Mass Alarm Setup .............................................................................................. 7-9
7.5.6 Adjusting Alarm Limits Automatically .............................................................. 7-9
7.6 Latching Alarms .............................................................................................................. 7-9
7.7 Clearing Technical Alarms ............................................................................................ 7-10
7.8 Testing Alarms .............................................................................................................. 7-10
7.9 When an Alarm Occurs ................................................................................................. 7-10
7.10 Using Care Group Alarms ............................................................................................7-11
7.10.1 Care Group Auto Alarms.................................................................................7-11
7.10.2 Viewing Alarm Information ............................................................................7-11
7.10.3 Silencing Care Group Alarms ........................................................................ 7-12
8 Monitoring ECG .............................................................................................................. 8-1
8.1 Introduction..................................................................................................................... 8-1
8.2 Safety .............................................................................................................................. 8-1
8.3 Preparing to Monitor ECG .............................................................................................. 8-2
8.3.1 Preparing the Patient and Placing the Electrodes ............................................... 8-2
8.3.2 Choosing a Lead Set and AHA or IEC Lead Placement .................................... 8-2
8.3.3 ECG Lead Placements........................................................................................ 8-3
8.3.4 Switching ECG Lead Set.................................................................................... 8-5
8.3.5 Checking Paced Status ....................................................................................... 8-6
3
8.4 Understanding the ECG Display ..................................................................................... 8-7
8.5 Changing ECG Settings .................................................................................................. 8-8
8.5.1 Setting Pacemaker Rate (For Mortara Only)...................................................... 8-8
8.5.2 Choosing the Alarm Source................................................................................ 8-8
8.5.3 Choosing a 5-Lead ECG Display Screen ........................................................... 8-8
8.5.4 Changing the ECG Filter Settings...................................................................... 8-9
8.5.5 Switching the Notch Filter On or Off................................................................. 8-9
8.5.6 Switching Defibrillator Synchronization On/Off ............................................. 8-10
8.5.7 Selecting ECG Waves for Display ....................................................................8-11
8.5.8 Changing ECG Wave Settings ..........................................................................8-11
8.5.9 Choosing an ECG Lead for HR Computing and Arrh. Monitoring...................8-11
8.5.10 Adjusting QRS Volume .................................................................................. 8-12
8.6 About ST Monitoring .................................................................................................... 8-12
8.6.1 Switching ST On and Off................................................................................. 8-12
8.6.2 Changing ST Filter Settings ............................................................................. 8-13
8.6.3 Understanding the ST Display ......................................................................... 8-13
8.6.4 Changing the ST Unit....................................................................................... 8-13
8.6.5 Changing the ST Alarm Limits ........................................................................ 8-13
8.6.6 Setting ST Alarm Delay Time .......................................................................... 8-14
8.6.7 Adjusting ST Measurement Points ................................................................... 8-14
8.7 About Arrhythmia Monitoring ...................................................................................... 8-15
8.7.1 Understanding the Arrhythmia Events ............................................................. 8-16
8.7.2 Switching Arrhythmia Analysis On and Off .................................................... 8-18
8.7.3 Changing Arrhythmia Alarm Settings .............................................................. 8-18
8.7.4 Changing Arrhythmia Threshold Settings (For Mortara Only) ........................ 8-18
8.7.5 Initiating Arrhythmia Relearning Manually ..................................................... 8-19
8.7.6 Automatic Arrhythmia Relearn ........................................................................ 8-20
8.7.7 Reviewing Arrhythmia Events ......................................................................... 8-20
8.8 12-Lead ECG Monitoring ............................................................................................. 8-21
8.8.1 Entering the 12-lead ECG Monitoring Screen ................................................. 8-21
8.8.2 Interpretation of resting 12-Lead ECG............................................................. 8-22
8.8.3 Reviewing Interpretation of resting 12-Lead ECG Results.............................. 8-23
9 Monitoring Respiration (Resp) ....................................................................................... 9-1
9.1 Introduction..................................................................................................................... 9-1
9.2 Safety .............................................................................................................................. 9-1
9.3 Placing Resp Electrodes.................................................................................................. 9-1
9.3.1 Optimizing Lead Placement for Resp ................................................................ 9-2
9.3.2 Cardiac Overlay ................................................................................................. 9-2
9.3.3 Abdominal Breathing ......................................................................................... 9-2
9.3.4 Lateral Chest Expansion..................................................................................... 9-3
9.4 Understanding the Resp Display ..................................................................................... 9-3
9.5 Changing Resp Settings .................................................................................................. 9-3
9.5.1 Choosing the Respiration Lead .......................................................................... 9-3
4
9.5.2 Setting the Apnea Alarm Delay .......................................................................... 9-3
9.5.3 Changing Resp Detection Mode ........................................................................ 9-4
9.5.4 Changing the Size of the Resp Wave ................................................................. 9-5
10 Monitoring PR.............................................................................................................. 10-1
10.1 Introduction................................................................................................................. 10-1
10.2 Changing PR Settings ................................................................................................. 10-1
10.2.1 Setting the PR Source..................................................................................... 10-1
10.2.2 Selecting the Active Alarm Source................................................................. 10-2
10.2.3 Adjusting QRS Volume .................................................................................. 10-2
11 Monitoring SpO2 ...........................................................................................................11-1
11.1 Introduction ..................................................................................................................11-1
11.2 Safety............................................................................................................................11-2
11.3 Identifying SpO2 Modules............................................................................................11-2
11.4 Applying the Sensor .....................................................................................................11-2
11.5 Changing SpO2 Settings ...............................................................................................11-3
11.5.1 Adjusting the Desat Alarm Limit.....................................................................11-3
11.5.2 Setting SpO2 Sensitivity ..................................................................................11-3
11.5.3 Changing Averaging Time...............................................................................11-3
11.5.4 Monitoring SpO2 and NIBP Simultaneously...................................................11-4
11.5.5 Sat-Seconds Alarm Management ....................................................................11-4
11.5.6 Pitch Tone........................................................................................................11-5
11.6 Measurement Limitations.............................................................................................11-6
11.7 Masimo Information.....................................................................................................11-6
11.8 Nellcor Information......................................................................................................11-7
12 Monitoring NIBP.......................................................................................................... 12-1
12.1 Introduction................................................................................................................. 12-1
12.2 Safety .......................................................................................................................... 12-2
12.3 Measurement Limitations............................................................................................ 12-2
12.4 Setting Up the NIBP Measurement ............................................................................. 12-3
12.4.1 Preparing to Measure NIBP ........................................................................... 12-3
12.4.2 Starting and Stopping Measurements............................................................. 12-3
12.4.3 Correcting the Measurement if Limb is not at Heart Level............................ 12-3
12.5 Measurement Methods ................................................................................................ 12-4
12.5.1 Enabling NIBP Auto Cycling and Setting the Interval................................... 12-4
12.5.2 Starting a STAT Measurement........................................................................ 12-4
12.6 Understanding the NIBP Numerics ............................................................................. 12-5
12.7 Changing NIBP Settings ............................................................................................. 12-6
12.7.1 Choosing NIBP Alarm Source ....................................................................... 12-6
12.7.2 Displaying NIBP Measurements .................................................................... 12-6
12.7.3 Setting the Pressure Unit ................................................................................ 12-6
12.7.4 Setting the cuff inflation pressure .................................................................. 12-7
5
12.8 Assisting Venous Puncture .......................................................................................... 12-7
12.9 Resetting NIBP ........................................................................................................... 12-7
12.10 NIBP Leakage Test.................................................................................................... 12-7
12.11 NIBP Accuracy Test .................................................................................................. 12-8
12.12 Calibrating NIBP....................................................................................................... 12-9
13 Monitoring Temp.......................................................................................................... 13-1
13.1 Introduction................................................................................................................. 13-1
13.2 Safety .......................................................................................................................... 13-1
13.3 Making a Temp Measurement..................................................................................... 13-1
13.4 Understanding the Temp Display ................................................................................ 13-2
13.5 Setting the Temperature Unit ...................................................................................... 13-2
14 Monitoring IBP ............................................................................................................ 14-1
14.1 Introduction................................................................................................................. 14-1
14.2 Safety .......................................................................................................................... 14-1
14.3 Setting Up the Pressure Measurement ........................................................................ 14-1
14.4 Understanding the IBP Display................................................................................... 14-3
14.5 Changing IBP Settings ................................................................................................ 14-4
14.5.1 Changing a Pressure for Monitoring .............................................................. 14-4
14.5.2 Choosing the Pressure Alarm Source ............................................................. 14-4
14.5.3 Changing Averaging Time.............................................................................. 14-5
14.5.4 Setting the Pressure Unit ................................................................................ 14-5
14.5.5 Setting Wave Overlapping.............................................................................. 14-5
14.5.6 Setting Up the IBP Wave................................................................................ 14-5
14.6 Measuring PAWP ........................................................................................................ 14-6
14.6.1 Preparing to Measure PAWP .......................................................................... 14-6
14.6.2 Setting Up the PAWP Measurement............................................................... 14-8
14.7 Zeroing the Transducer ............................................................................................... 14-9
15 Monitoring Cardiac Output ........................................................................................ 15-1
15.1 Introduction................................................................................................................. 15-1
15.2 Understanding the C.O. Display ................................................................................. 15-1
15.3 Influencing Factors...................................................................................................... 15-2
15.4 Setting Up the C.O. Measurement .............................................................................. 15-2
15.5 Measuring the Blood Temperature .............................................................................. 15-5
15.6 Changing C.O. Settings............................................................................................... 15-6
15.6.1 Setting the Temperature Unit ......................................................................... 15-6
15.6.2 Setting the Interval between Measurements................................................... 15-6
16 Monitoring Carbon Dioxide ........................................................................................ 16-1
16.1 Introduction................................................................................................................. 16-1
16.2 Preparing to Measure CO2 .......................................................................................... 16-2
16.2.1 Using a Sidestream CO2 Module ................................................................... 16-2
6
16.2.2 Using a Microstream CO2 module ................................................................. 16-3
16.2.3 Using a Mainstream CO2 module................................................................... 16-4
16.3 Changing CO2 Settings ............................................................................................... 16-5
16.3.1 Entering the Standby Mode............................................................................ 16-5
16.3.2 Setting the Pressure Unit ................................................................................ 16-5
16.3.3 Setting up Gas Compensations....................................................................... 16-5
16.3.4 Setting up Humidity Compensation ............................................................... 16-6
16.3.5 Setting the Apnea Alarm Delay ...................................................................... 16-7
16.3.6 Choosing a Time Interval for Peak-Picking ................................................... 16-7
16.3.7 Setting the Flow Rate ..................................................................................... 16-7
16.3.8 Setting up the CO2 Wave................................................................................ 16-7
16.4 Setting Barometric Pressure Compensation ................................................................ 16-8
16.5 Measurement Limitations............................................................................................ 16-8
16.6 Troubleshooting the Sidestream CO2 Sampling System ............................................. 16-8
16.7 Removing Exhaust Gases from the System ................................................................ 16-9
16.8 Zeroing the Sensor ...................................................................................................... 16-9
16.8.1 For Sidestream and Microstream CO2 Modules............................................. 16-9
16.8.2 For Mainstream CO2 Modules ....................................................................... 16-9
16.9 Calibrating the Sensor ............................................................................................... 16-10
16.10 Oridion Information ................................................................................................ 16-10
17 Monitoring AG ............................................................................................................. 17-1
17.1 Introduction................................................................................................................. 17-1
17.2 Preparing to Measure AG............................................................................................ 17-2
17.3 Understanding the AG Display ................................................................................... 17-4
17.4 MAC Values ................................................................................................................ 17-5
17.5 Changing AG Settings................................................................................................. 17-6
17.5.1 Selecting an Anesthetic Gas for Monitoring .................................................. 17-6
17.5.2 Setting Gas Unit ............................................................................................. 17-6
17.5.3 Setting the Apnea Alarm Delay ...................................................................... 17-6
17.5.4 Changing the Sample Flow Rate.................................................................... 17-6
17.5.5 Setting up the O2 Compensation .................................................................... 17-6
17.5.6 Entering the Standby Mode............................................................................ 17-7
17.5.7 Setting up the AG Wave ................................................................................. 17-7
17.6 Changing the Anesthetic Agent ................................................................................... 17-7
17.7 Measurement Limitations............................................................................................ 17-8
17.8 Troubleshooting .......................................................................................................... 17-8
17.8.1 When the Gas Inlet is Blocked ....................................................................... 17-8
17.8.2 When an Internal Occlusion Occurs............................................................... 17-8
17.9 Removing Exhaust Gases from the System ................................................................ 17-9
18 Freezing Waveforms .................................................................................................... 18-1
18.1 Freezing Waveforms ................................................................................................... 18-1
18.2 Viewing Frozen Waveforms ........................................................................................ 18-1
7
18.3 Unfreezing Waveforms................................................................................................ 18-2
18.4 Recording Frozen Waveforms..................................................................................... 18-2
19 Review ........................................................................................................................... 19-1
19.1 Accessing Respective Review Windows..................................................................... 19-1
19.2 Reviewing Graphic Trends.......................................................................................... 19-2
19.3 Reviewing Tabular Trends .......................................................................................... 19-4
19.4 Reviewing NIBP Measurements ................................................................................. 19-6
19.5 Reviewing Alarms....................................................................................................... 19-7
19.6 Reviewing Waveforms ................................................................................................ 19-8
20 Calculations .................................................................................................................. 20-1
20.1 Introduction................................................................................................................. 20-1
20.2 Dose Calculations........................................................................................................ 20-2
20.2.1 Performing Calculations................................................................................. 20-2
20.2.2 Selecting the Proper Drug Unit ...................................................................... 20-2
20.2.3 Titration Table ................................................................................................ 20-3
20.3 Oxygenation Calculations ........................................................................................... 20-3
20.3.1 Performing Calculations................................................................................. 20-3
20.3.2 Entered Parameters......................................................................................... 20-4
20.3.3 Calculated Parameters .................................................................................... 20-4
20.4 Ventilation Calculations .............................................................................................. 20-5
20.4.1 Performing Calculations................................................................................. 20-5
20.4.2 Entered Parameters......................................................................................... 20-5
20.4.3 Calculated Parameters .................................................................................... 20-6
20.5 Hemodynamic Calculations ........................................................................................ 20-6
20.5.1 Performing Calculations................................................................................. 20-6
20.5.2 Entered Parameters......................................................................................... 20-7
20.5.3 Calculated Parameters .................................................................................... 20-7
20.6 Renal Calculations ...................................................................................................... 20-8
20.6.1 Performing Calculations................................................................................. 20-8
20.6.2 Entered Parameters......................................................................................... 20-8
20.6.3 Calculated Parameters .................................................................................... 20-9
20.7 Understanding the Review Window............................................................................ 20-9
21 Recording...................................................................................................................... 21-1
21.1 Using a Recorder......................................................................................................... 21-1
21.2 Overview of Recording Types..................................................................................... 21-2
21.3 Starting and Stopping Recordings............................................................................... 21-3
21.4 Setting up the Recorder............................................................................................... 21-3
21.4.1 Accessing the Record Setup Menu................................................................. 21-3
21.4.2 Selecting Waveforms for Recording .............................................................. 21-3
21.4.3 Setting the Realtime Recording Length ......................................................... 21-4
21.4.4 Setting the Interval between Timed Recordings............................................. 21-4
8
21.4.5 Changing the Recording Speed ...................................................................... 21-4
21.4.6 Switching Gridlines On or Off ....................................................................... 21-4
21.4.7 Clearing Recording Tasks .............................................................................. 21-4
21.5 Loading Paper ............................................................................................................. 21-4
21.6 Removing Paper Jam................................................................................................... 21-5
21.7 Cleaning the Recorder Printhead................................................................................. 21-6
22 Printing ......................................................................................................................... 22-1
22.1 Printer.......................................................................................................................... 22-1
22.2 Connecting a Printer.................................................................................................... 22-1
22.3 Setting Up the Printer.................................................................................................. 22-1
22.4 Starting Report Printouts............................................................................................. 22-2
22.5 Stopping Report Printouts ........................................................................................... 22-3
22.6 Setting Up Reports ...................................................................................................... 22-3
22.6.1 Setting Up ECG Reports ................................................................................ 22-3
22.6.2 Setting Up Tabular Trends Reports ................................................................ 22-3
22.6.3 Setting Up Graphic Trends Reports ............................................................... 22-4
22.6.4 Setting Up Realtime Reports.......................................................................... 22-4
22.7 End Case Reports ........................................................................................................ 22-4
22.8 Printer Statuses............................................................................................................ 22-5
22.8.1 Printer Out of Paper ....................................................................................... 22-5
22.8.2 Printer Status Message ................................................................................... 22-5
23 Other Functions............................................................................................................ 23-1
23.1 Marking Events ........................................................................................................... 23-1
23.2 Analog Output ............................................................................................................. 23-1
23.3 Transferring Data ........................................................................................................ 23-2
23.3.1 Data Export System........................................................................................ 23-2
23.3.2 Transferring Data by Different Means ........................................................... 23-2
23.4 Nurse Call ................................................................................................................... 23-3
23.5 Wireless Network ........................................................................................................ 23-5
24 Batteries ........................................................................................................................ 24-1
24.1 Overview..................................................................................................................... 24-1
24.2 Installing or Replacing a Battery................................................................................. 24-2
24.3 Battery Guidelines....................................................................................................... 24-3
24.4 Battery Maintenance ................................................................................................... 24-4
24.5 Battery Recycling........................................................................................................ 24-5
25 Care and Cleaning........................................................................................................ 25-1
25.1 Introduction................................................................................................................. 25-1
25.2 Cleaning ...................................................................................................................... 25-2
25.3 Disinfecting................................................................................................................. 25-2
9
26 Maintenance ................................................................................................................. 26-1
26.1 Safety Checks.............................................................................................................. 26-1
26.2 Service Tasks............................................................................................................... 26-2
26.3 Checking Monitor and Module Information ............................................................... 26-2
26.4 Calibrating ECG.......................................................................................................... 26-3
26.5 Calibrating the Touchscreen........................................................................................ 26-3
26.6 Calibrating CO2 .......................................................................................................... 26-4
26.7 Calibrating AG ............................................................................................................ 26-5
26.8 Setting up IP Address .................................................................................................. 26-6
26.9 Entering/Exiting Demo Mode ..................................................................................... 26-6
27 Accessories .................................................................................................................... 27-1
27.1 ECG Accessories......................................................................................................... 27-1
27.2 SpO2 Accessories........................................................................................................ 27-3
27.3 NIBP Accessories........................................................................................................ 27-5
27.4 Temp Accessories........................................................................................................ 27-6
27.5 IBP/ICP Accessories ................................................................................................... 27-6
27.6 C.O. Accessories ......................................................................................................... 27-8
27.7 CO2 Accessories .......................................................................................................... 27-8
27.8 AG Accessories ..........................................................................................................27-11
27.9 Others ........................................................................................................................ 27-12
10
1 Safety
1.1 Safety Information
DANGER
z
Indicates an imminent hazard that, if not avoided, will result in death or serious
injury.
WARNING
z
Indicates a potential hazard or unsafe practice that, if not avoided, could result in
death or serious injury.
CAUTION
z
Indicates a potential hazard or unsafe practice that, if not avoided, could result in
minor personal injury or product/property damage.
NOTE
z
Provides application tips or other useful information to ensure that you get the
most from your product.
1-1
1.1.1 Dangers
There are no dangers that refer to the product in general. Specific “Danger” statements may
be given in the respective sections of this manual.
1.1.2 Warnings
WARNINGS
z
Before putting the system into operation, the operator must verify that the
equipment, connecting cables and accessories are in correct working order and
operating condition.
z
The equipment must be connected to a properly installed power outlet with
protective earth contacts only. If the installation does not provide for a protective
earth conductor, disconnect it from the power line and operate it on battery power,
if possible.
z
To avoid explosion hazard, do not use the equipment in the presence of flammable
anesthetics, vapors or liquids.
z
Do not open the equipment housings. All servicing and future upgrades must be
carried out by the personnel trained and authorized by Mindray only.
z
Do not come into contact with patients during defibrillation. Otherwise serious
injury or death could result.
z
Do not rely exclusively on the audible alarm system for patient monitoring.
Adjustment of alarm volume to a low level or off may result in a hazard to the
patient. Remember that alarm settings should be customized according to different
patient situations and always keeping the patient under close surveillance is the
most reliable way for safe patient monitoring.
z
The physiological data and alarm messages displayed on the equipment are for
reference only and cannot be directly used for diagnostic interpretation.
z
To avoid inadvertent disconnection, route all cables in a way to prevent a
stumbling hazard. Wrap and secure excess cabling to reduce risk of entanglement
or strangulation by patients or personnel.
z
Dispose of the package material, observing the applicable waste control regulations
and keeping it out of children’s reach. Keep the battery out of children’s reach.
1-2
1.1.3 Cautions
CAUTIONS
z
To ensure patient safety, use only parts and accessories specified in this manual.
z
At the end of its service life, the equipment, as well as its accessories, must be
disposed of in compliance with the guidelines regulating the disposal of such
products. If you have any questions concerning disposal of the equipment, please
contact us.
z
Electromagnetic field is capable of interfering with the proper performance of the
equipment. For this reason make sure that all external devices operated in the
vicinity of the equipment comply with the relevant EMC requirements. Mobile
phone, X-ray equipment or MRI devices are a possible source of interference as
they may emit higher levels of electromagnetic radiation.
z
Before connecting the equipment to the power line, check that the voltage and
frequency ratings of the power line are the same as those indicated on the
equipment’s label or in this manual.
z
Always install or carry the equipment properly to avoid damage caused by drop,
impact, strong vibration or other mechanical force.
1.1.4 Notes
NOTES
z
Put the equipment in a location where you can easily see the screen and access the
operating controls.
z
Keep this manual in the vicinity of the equipment so that it can be obtained
conveniently when needed.
z
The software was developed in compliance with IEC60601-1-4. The possibility of
hazards arising from software errors is minimized.
z
This manual describes all features and options. Your equipment may not have all
of them.
1-3
1.2 Equipment Symbols
Some symbols may not appear on your equipment.
Attention: Consult accompanying documents (this manual).
Power ON/OFF (for a part
of the equipment)
Battery indicator
Alternating current (AC)
Alarm silenced.
Alarms paused
Record
Freeze/unfreeze waveforms
Main menu
NIBP start/stop key
Video output
Equipotential grounding
Network Connector
USB Connector
Auxiliary output connector
Signal input/output
Gas outlet
Serial number
Manufacture date
European community representative
ESD warning symbol for electrostatic sensitive devices.
Type CF applied part. Defibrillator-proof protection against electric shock.
Type BF applied part. Defibrillator-proof protection against electric shock.
The product bears CE mark indicating its conformity with the provisions of the
Council Directive 93/42/EEC concerning medical devices and fulfils the essential
requirements of Annex I of this directive.
The following definition of the WEEE label applies to EU member states only.
This symbol indicates that this product should not be treated as household waste.
By ensuring that this product is disposed of correctly, you will help prevent
bringing potential negative consequences to the environment and human health.
For more detailed information with regard to returning and recycling this product,
please consult the distributor from whom you purchased it.
* For system products, this label may be attached to the main unit only.
1-4
2 The Basics
2.1 Monitor Description
2.1.1 Intended Use
This patient monitor is intended to be used for monitoring, displaying, reviewing, storing
and transferring of multiple physiological parameters including ECG, respiration (Resp),
temperature (Temp), SpO2, pulse rate (PR), non-invasive blood pressure (NIBP), invasive
blood pressure (IBP), cardiac output (C.O.), End tidal CO2 value (EtCO2) and anesthetic gas
(AG) of single adult, pediatric and neonatal patients.
This monitor is to be used in healthcare facilities by clinical professionals or under their
direction. It is not intended for helicopter transport or home use.
WARNING
z
This patient monitor is intended for use only by clinical professionals or under
their guidance. It must only be used by persons who have received adequate
training in its use. Anyone unauthorized or untrained must not perform any
operation on it.
2.1.2 Contraindications
None
2.1.3 Components
This patient monitor consists of a main unit, display, ECG cables, SpO2 sensor, NIBP cuff,
Temp sensor, IBP cables, C.O. cables, CO2 components, AG components, etc.
2-1
2.2 Main unit
2.2.1 Front View
1.
Alarm lamp
When a physiological or technical alarm occurs, this lamp will flash as defined below.
‹
High level alarms:
the lamp flashes quickly in red.
‹
Medium level alarms:
the lamp flashes slowly in yellow.
‹
Low level alarms:
the lamp lights yellow without flashing.
2.
Handle
3.
Display Screen
2-2
4.
Power On/Off Switch
Press this switch to turn the patient monitor on. Press it again and hold for 2 seconds to
turn the patient monitor off. An indicator is built in this switch. It turns on when the
patient monitor is on and turns off when the patient monitor is off.
5.
6.
Battery LED
‹
On:
when the battery is being charged or already fully charged.
‹
Off:
when no battery is installed or no AC source is connected.
‹
Flashes: when the patient monitor operates on battery power.
AC power LED
It turns on when AC power is connected.
7.
Press to silence or restore all alarm sounds or clear alarms.
8.
Press to pause or restore alarms.
9.
Press to freeze or unfreeze waveforms.
10.
Press to start or stop recordings.
11.
Press to start or stop NIBP measurements.
12.
If no menu is displayed on the screen, pressing it will enter the main menu. If there is a
menu displayed on the screen, pressing it will close that menu.
13. Knob
Rotate the Knob clockwise or anti-clockwise. With each click, the highlight jumps to
the neighboring item. When you reach your desired item, press the Knob to select it.
2-3
2.2.2 Side View
5
6
1
2
7
3
8
4
9
1.
SpO2 connector
2.
ECG connector
3.
IBP connector (four channels)
4.
C.O. connector
5.
NIBP connector
6.
Temp connector (double channels)
7.
Exhaust gas outlet of CO2 module or AG module
8.
Watertrap connector (sidestream CO2 module or AG module)
This connector is also optional for microstream or mainstream CO2 module.
9.
10
3
Battery door
10. CF storage card slot cover
11. Recorder
2-4
11
2.2.3 Rear View
1
2
3
4
5
6
7
1.
Network Connector
It is a standard RJ45 connector, through which the patient monitor can be networked.
2.
Video Connector
It connects a standard VGA color monitor, which extends the display capability of
your monitor. The contents displayed on the secondary display screen accord with
those displayed on the monitor screen.
3.
Auxiliary Output
It is a standard BNC connector, through which analog signals, alarm signals or
synchronization signals can be outputted, depending on how your monitor is
configured.
4.
RS232 serial port
It is a DB9 connector, used to connect a PC for data or a compatible device, and
supports DIAP communication protocol.
5.
USB Connectors
They connect external storage devices.
6.
AC Power Input
7.
Equipotential Grounding Terminal
When the patient monitor and other devices are to be used together, their equipotential
grounding terminals should be connected together, eliminating the potential difference
between them.
2-5
2.3 Display Screen
This patient monitor adopts a high-resolution TFT LCD to display patient parameters and
waveforms. A typical display screen is shown below.
1
2
3
4
5
6
7
8
1.
9
Patient Information Area
This area shows the patient information such as department, bed number, patient name,
patient category and paced status.
‹
: indicates that no patient is admitted or the patient information is incomplete.
‹
: indicates that the patient has a pacer.
If no patient is admitted, selecting this area will enter the [Patient Setup] menu. If a
patient has been admitted, selecting this area will enter the [Patient Demographics]
menu.
2.
Date and Time
This area shows the system time of the patient monitor. By selecting this area, you can
enter the [System Time] setup menu.
3.Alarm Symbols
indicates alarms are paused.
indicates alarms are turned off.
indicates alarm sounds are silenced.
indicates alarm sounds are turned off.
2-6
4.
Technical Alarm Area
This area shows technical alarm messages and prompt messages. When multiple
messages come, they will be displayed circularly. Select this area and the technical
alarm list will be displayed.
5.
Physiological Alarm Area
This area shows physiological alarm messages. When multiple alarms occur, they will
be displayed circularly. Select this area and the physiological alarm list will be
displayed.
6.
Waveform Area
This area shows measurement waveforms. The waveform name is displayed at the
upper left corner of the waveform. Select this area and the corresponding waveform
setup menu will be displayed.
7.
Parameter Area
This area shows measurement parameters. Each monitored parameter has a parameter
window and the parameter name is displayed at the upper left corner. When this area
cannot accommodate all parameters, the excess parameters will automatically occupy
the waveform area from bottom to top. Select this area and the corresponding
measurement setup menu will be displayed.
8.
Prompt Message Area
This area shows the prompt messages, network status icons, battery status icons, etc.
For details about battery status symbols, refer to the chapter Batteries.
indicates the patient monitor is connected to a wired network successfully.
indicates the wireless function is working.
indicates the patient monitor has failed to connect a wired network.
indicates the wireless function is not working.
indicates a CF storage card is inserted.
indicates an USB storage card is inserted.
9.
QuickKeys Area
This area contains QuickKeys that give you fast access to functions.
2-7
2.4 QuickKeys
A QuickKey is a configurable graphical key, located at the bottom of the main screen. They
give you fast access to functions. Their availability and the order in which they appear on
your screen, depend on how your patient monitor is configured.
By default, there are two QuickKeys that remain on the screen all the time to give you fast
access to functions.
Review tabular trends
Return to the main screen
Besides, you can have four more QuickKeys as shown below.
By selecting
or
, you can unfold or fold the four QuickKeys. When there is no
operation on the four QuickKeys for 15 seconds after they are unfolded, they will be folded
automatically. Besides, you can set the four QuickKeys in configuration mode:
1.
Enter the configuration mode. Select [Others] in either configuration.
2.
In the [Select QuickKeys] area, select your desired QuickKeys 1-4.
3.
Save the configuration.
The following QuickKeys can be selected:
Enter standby mode
Alarm Limits Setup
Change screen
Start Auto NIBP measurement
Zero IBP
Perform calculations
Mark Event
Discharge a Patient
2-8
3 Basic Operations
3.1 Installation
WARNING
z
The equipment shall be installed by personnel authorized by Mindray.
z
The software copyright of the equipment is solely owned by Mindray. No
organization or individual shall resort to juggling, copying, or exchanging it or to
any other infringement on it in any form or by any means without due permission.
z
Devices connected to the equipment must meet the requirements of the applicable
IEC standards (e.g. IEC 60950 safety standards for information technology
equipment and IEC 60601-1 safety standards for medical electrical equipment).
The system configuration must meet the requirements of the IEC 60601-1-1
medical electrical systems standard. Any personnel who connect devices to the
equipment’s signal input/output port is responsible for providing evidence that the
safety certification of the devices has been performed in accordance to the IEC
60601-1-1.If you have any question, please contact us.
z
If it is not evident from the equipment specifications whether a particular
combination is hazardous, for example, due to summation of leakage currents,
consult the manufacturers or else an expert in the field, to ensure the necessary
safety of all devices concerned will not be impaired by the proposed combination.
z
Combinations of medical equipment with non-medical equipment must comply
with IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord
when combining equipment unless the socket outlet is supplied specifically for use
with that equipment.
3-1
3.1.1 Unpacking and Checking
Before unpacking, examine the packing case carefully for signs of damage. If any damage is
detected, contact the carrier or us. If the packing case is intact, open the package and remove
the equipment and accessories carefully. Check all materials against the packing list and
check for any mechanical damage. Contact us in case of any problem.
NOTE
z
Save the packing case and packaging material as they can be used if the equipment
must be reshipped.
WARNING
z
When disposing of the packaging material, be sure to observe the applicable waste
control regulations and keep it out of children’s reach.
z
The equipment might be contaminated during storage and transport. Before use,
please verify whether the packages are intact, especially the packages of single use
accessories. In case of any damage, do not apply it to patients.
3.1.2 Environmental Requirements
The operating environment of the equipment must meet the requirements specified in this
manual.
The environment where the equipment is used shall be reasonably free from noises, vibration,
dust, corrosive, flammable and explosive substances. If the equipment is installed in a cabinet,
sufficient space in front and behind shall be left for convenient operation, maintenance and
repair. Moreover, to maintain good ventilation, the equipment shall be at least 2 inches (5cm)
away from around the cabinet.
When the equipment is moved from one place to another, condensation may occur as a result
of temperature or humidity difference. In this case, never start the system before the
condensation disappears.
WARNING
z
Make sure that the operating environment of the equipment meets the specific
requirements. Otherwise unexpected consequences, e.g. damage to the equipment,
could result.
3-2
3.2 Getting Started
3.2.1 Inspecting the Monitor
WARNING
z
Do not use the patient monitor for any monitoring procedure on a patient if you
suspect it is not working properly, or if it is mechanically damaged. Contact your
service personnel or us.
1.
Before you start to make measurements, check the patient monitor for any mechanical
damage and make sure that all external cables, plug-ins and accessories are properly
connected.
2.
Plug the power cord into the AC power source. If you run the patient monitor on battery
power, ensure that the battery is sufficiently charged.
3.
Check all functions you need to monitor your patient, and ensure that the monitor is in
good working order.
3.2.2 Switching On
After the inspection is finished, you can switch on the monitor:
1.
Press the power on/off switch on the monitor’s front. The monitor performs a self test.
The system gives a beep, and at the same time, the alarm lamp turns yellow and then red.
The start-up screen is displayed.
2.
The monitor enters the main screen.
3.2.3 Starting Monitoring
1.
Check that the patient cables and sensors are correctly connected.
2.
Check that the patient settings such as [Patient Cat.], [Paced], etc, are appropriate for
your patient.
3.
Refer to corresponding measurement sections for details of how to perform the
measurements you want to make.
3-3
3.3 Disconnecting from Power
To disconnect the patient monitor from the AC power source, follow this procedure:
1.
Disconnect the patient cables and sensors from the patient.
2.
Press and hold the power on/off switch for above 2 seconds. The patient monitor shuts
down and you can unplug the power cable.
CAUTION
z
Although not recommended, you can press and hold the power on/off switch for 4
seconds to forcibly shut down the monitor when it could not be shut down
normally or under some special situations. This may cause loss of data of the
patient monitor.
3.4 Operating and Navigating
3.4.1 Using the Knob
Rotate the Knob clockwise or counter-clockwise. With each click, the highlight jumps to the
neighboring item. When you reach your desired item, press the Knob to select it.
When you rotate the knob, a cursor moves across the screen, following the direction of the
knob. You can position the cursor by rotating the knob so as to perform the desired operation.
3-4
3.4.2 Using Keys
The monitor has three types of keys:
„
Softkey: A softkey is a graphic key on the screen, giving you fast access to certain
menus or functions. The monitor has three types of softkeys:
‹
Waveform keys: Each waveform area can be seen as a softkey. You can enter a
waveform setup menu by selecting its corresponding waveform area.
‹
Parameter keys: Each parameter area can be seen as a softkey. You can enter a
parameter setup menu by selecting its corresponding parameter area.
‹
QuickKeys: QuickKeys are configurable graphical keys, located at the bottom of
the main screen. For details, refer to the section QuickKeys.
„
Hardkeys: A hardkey is a physical key on a monitoring device, such as the main menu
hardkey on the monitor’s front.
„
Pop-Up Keys: Pop-up keys are task-related keys that appear automatically on the
monitor screen when required. For example, the confirm pop-up key appears only when
you need to confirm a change.
3.4.3 Using the Touchscreen
Select screen items by pressing them directly on the patient monitor’s screen.
You can enable or disable touchscreen operations by pressing and holding the [Home]
QuickKey at the lower right corner of the screen for 3 seconds. A red padlock symbol
displayed if touchscreen operations are disabled.
3.4.4 Using the On-Screen Keyboard
The on-screen keyboard enables you to enter information. Use the [Back] key to delete the
previously entered character. Use the [Caps] to toggle between uppercase and lowercase
letters. Select [Enter] to confirm what you have entered and close the on-screen keyboard.
3-5
is
3.4.5 Using the Main Menu
To enter the main menu, select the
hardkey on the monitor’s front. Most of monitor
operations and settings can be performed through the main menu.
1
2
3
4
Other menus are similar to the main menu and contain the following parts:
1.
Heading: gives a sum-up for the current menu.
2.
Main body: displays options, buttons, prompt messages, etc. The menu button with
“>>’’ enlarges a secondary window to reveal more options or information.
3.
Online help area: displays help information for the highlighted menu item.
4.
Confirm button area: accommodates confirm buttons such as [Previous Menu], [Ok],
[Exit], [Cancel], etc., which allows you to confirm menu operations.
3-6
3.5 Operating Modes
Your monitor has four operating modes. Some are password protected.
„
Monitoring Mode:
This is the normal, every day working mode that you use for monitoring patients. You can
change elements such as alarm limits, parameter units and so forth. When you discharge the
patient, these elements return to their default values.
„
Configuration Mode:
Password protected, this mode is for clinical professionals in configuration tasks. For details,
refer to the Managing Configuration section.
„
Maintenance Mode:
Password protected, this is for professional service personnel in the tasks of maintenance,
repair, basic information setup and calibration.
„
Demonstration Mode:
Password protected, this is for demonstration purposes only.
Standby Mode:
Standby mode can be used when you want to temporarily interrupt monitoring.
To enter standby mode,
„
unfold the QuickKeys area to select the [Standby] QuickKey, or
„
select [Standby] when you want to discharge a patient. The monitor enters the standby
mode after discharging the current patient.
Standby suspends patient monitoring. All waves and numerics disappear from the display but
all settings and patient data information are retained. A standby screen is displayed.
To exit the standby mode, click anywhere on the screen or press any key. You can select [Yes]
or [No] from the popup dialog box.
„
[Yes]: The monitor enters the monitoring mode after discharging the current patient or
clearing the current patient’s data.
„
[No]: The monitor enters the monitoring mode and continues monitoring the current
patient.
3-7
3.6 Using an External Storage Device
An external storage device is used to prevent data loss in case of a sudden power failure. The
patient data such as trend data, waveform data, etc., will be automatically saved into the
external storage device during patient monitoring. In case of a sudden power failure, the
patient data can be retrieved from the external storage device after the patient monitor restarts.
So far only CF storage card is supported.
CF storage card can also be used to transfer patient data. USB storage card can be used to
transfer monitor configuration. Please refer to the corresponding sections for details.
To insert a CF storage card, open the compartment and then insert the card until the button
flips out.
To remove the CF storage card, follow this procedure:
1.
In the main menu, select [Unload CF Storage Card].
2.
Select [Ok] from the popup menu to unload the CF storage card. A status message
shown in the prompt message area will report completion of the unloading.
3.
Press the button until the CF storage card flips out.
To browse the data saved in the CF storage card, follow this procedure:
1.
In the main menu, select [Archives >>].
‹
If the [Archives Access] is set as [Direct], you can directly enter into the [Patient
Data] menu.
‹
If the [Archives Access] is set as [Password], you need a password to enter into
the [Patient Data] menu. This password is the same as the one for entering the
configuration mode.
2.
Select [History Data >>]. Select a patient whose data you want to view from the
[Patient Data List] and then select [Review].
3.
In the [Review] menu, select the data you want to review.
The monitor allows only the history data saved in the CF storage card to be reviewed so far.
As reviewing the history patient’s data is just like reviewing the current patient’s data, you
can refer to the chapter Review for details.
3-8
NOTE
z
Data may be unable to be saved into the CF storage card shortly after the card is
inserted.
z
If no CF storage card is used or the card has been removed, all the data saved will
get lost in case that the monitor shuts down or a sudden power interrupt occurs.
z
Admitting too many patients will affect the read-write speed of the CF storage
card. Please clear the patients’ data in time.
CAUTION
z
Unload the CF storage card before removing it from the patient monitor.
Otherwise it may cause damage to the data in the card.
z
Use only the CF storage card specified by Mindray.
3.7 Using an External Display
An external display, showing the same screen as the host display, can be connected to the
monitor through the video output connector, for viewing only.
The recommended specification is as below.
External display
Screen type
Medical-grade VGA monitor
Resolution
800×600 pixels or above
EMC
MPR II, CISPR 11B
Third certificate
UL, C-UL, TUV, CE, FCC
3.8 Changing General Measurement Settings
This chapter covers only general measurement settings in monitoring mode. Other specific
measurement settings can be referred to in respective sections.
3.8.1 Switching On/Off Modules
You can switch on or off measurement modules as required.
In the main menu, select [Others>>]→ [Module Switch]. Select parameters for measuring,
and then select [Exit] to save the settings.
3-9
3.8.2 Changing Measurement Settings
Each measurement has a setup menu in which you can adjust all of its settings. You can enter
a setup menu by selecting a certain measurement numeric. For example, by selecting the
ECG numeric, you can access the [ECG Setup] menu.
This menu displays numeric-related measurement settings, such as alarm limits, alarm switch
and so forth. You can set each measurement as required.
3.8.3 Changing Waveform Settings
Accessing the Waveform Setup Menu
Each wave-related measurement has a waveform setup menu. You can enter a setup menu by
selecting a certain measurement waveform. This menu displays wave-related measurement
settings, such as gain, wave speed and so forth. You can set each measurement’s waveform as
required.
For example, by selecting the Art wave, you can adjust its wave speed, scale and so forth in
the [Art Waveform] setup menu.
Changing a Wave Speed
In waveform setup menu for your desired measurement, select [Sweep] and then select the
appropriate setting. Lowering the wave speed compresses the wave and lets you view a
longer time period. Increasing the speed expands the waveform, giving you a more detailed
view.
3.9 Changing General Settings
General settings refer to the settings regarding how the monitor works, e.g. alarm volume,
brightness and so forth. Most general settings can be carried out in configuration mode. This
chapter covers some general settings that can be carried out in monitoring or maintenance
mode.
3-10
3.9.1 Setting up a Monitor
In situations where you install a patient monitor or change the patient monitor’s application
site, you need to setup the patient monitor as follows:
1.
In the main menu, select [Maintenance >>] → [User Maintenance >>] → enter the
required password.
2.
Select [Device Setup>>]. In the pop-up menu, select, in turn, [Monitor Name],
[Institution Name], [Department] and [Bed No.], and then change their settings.
3.9.2 Changing Language
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Device Setup >>].
2.
In the [Device Setup] menu, select [Language] and then select the desired language.
3.
Restart the patient monitor.
3.9.3 Setting DIAP Baud Rate
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Device Setup >>].
2.
Select [DIAP Baud Rate] and then select the desired baud rate.
WARNING
z
When connecting compatible devices to the patient monitor via RS232 serial port,
make sure the baud rate of the compatible devices is consistent with that of the
patient monitor. Otherwise, the compatible devices can’t communicate with the
patient monitor.
3.9.4 Adjusting the Screen Brightness
1.
In the main menu, select [Others >>].
2.
Select [Brightness].Select the appropriate setting for the screen brightness. 10 is the
brightest, and 1 is the least bright. If the patient monitor operates on battery power, you
can set a less bright screen to prolong the operating time of the battery.
3-11
3.9.5 Setting the Date and Time
1.
In the main menu, select [Maintenance >>] → [System Time>>].
2.
Set [Year], [Month], [Day], [Hour], [Minute] and [Second].
To set the date format and the time format,
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Device Setup >>].
2.
Select [Date Format] and toggle between [yyyy-mm-dd], [mm-dd-yyyy] and
[dd-mm-yyyy].
3.
Select [Time Format] and toggle between [24h] and [12h].
WARNING
z
When connecting compatible devices to the patient monitor via RS232 serial port,
make sure that the baud rate of the compatible devices is consistent with that of the
patient monitor. Otherwise, the compatible devices fail to communicate with the
patient monitor properly.
3-12
3.9.6 Adjusting Volume
Alarm Volume
1.
In the main menu, select [Alarm Setup >>].
2.
Select the appropriate volume from [Alm Volume]: X-10, in which X is the minimum
volume, depending on the set minimum alarm volume (refer to the chapter Alarm), and
10 the maximum volume.
Key Volume
1.
In the main menu, select [Others >>].
2.
Select [Key Volume] and then select the appropriate volume.0 means off, and 10 the
maximum volume.
QRS Volume
The QRS tone is derived from either the HR or PR, depending on which is currently selected
as the alarm source in the ECG setup menu.When monitoring SpO2, there is a variable pitch
tone which changes as the patient’s saturation level changes. The pitch of the tone rises as the
saturation level increases and falls as the saturation level decreases. The volume of this tone
is user adjustable. Take PR as an example, to adjust QRS volume,
1.
Select the PR parameter window. you can access the [PR Setup] menu.
2.
Select [Beat Vol] and then select the appropriate volume. 0 means off, and 10 the
maximum volume.
3-13
FOR YOUR NOTES
3-14
4 Managing Patients
4.1 Admitting a Patient
The patient monitor displays physiological data and stores them in the trends as soon as a
patient is connected. This allows you to monitor a patient that is not admitted yet. However, it
is recommended that you fully admit a patient so that you can clearly identify your patient, on
recordings, reports and networked devices.
If the patient monitor already admits a patient, it is recommended to discharge this patient
before admitting a new patient. Otherwise, the new patient’s data will be stored into that
patient’s data.
To admit a patient:
1.
In the main menu, select [Patient Setup >>].
2.
Select [Admit Patient]. If there is a patient currently in your monitor, select [Ok] from
the popup menu to discharge the current patient. Otherwise, select either:
3.
4.
‹
[Yes] to apply the data in your patient monitor to the new patient, or
‹
[No] to clear any previous patient data.
In the [Patient Demographics] menu, enter the demographic details, of which:
‹
[Patient Cat.] determines the way your patient monitor processes and calculates
some measurements, and what safety and alarm limits apply for your patient.
‹
[Paced] determines whether to show pace pulse marks on the ECG waveform.
When the [Paced] is set to [No], pace pulse marks are not shown in the ECG
waveform.
Select [Ok].
4-1
WARNING
z
[Patient Cat.] and [Paced] will always contain a value, regardless of whether the
patient is fully admitted or not. If you do not specify settings for these fields, the
patient monitor uses the default settings from the current configuration, which
might not be correct for your patient.
z
For paced patients, you must set [Paced] to [Yes]. If it is incorrectly set to [No], the
patient monitor could mistake a pace pulse for a QRS and fail to alarm when the
ECG signal is too weak.
z
For non-paced patients, you must set [Paced] to [No].If it is incorrectly set to [Yes],
the patient monitor may be unable to detect premature ventricular beats (including
PVCs) and perform ST segment analysis.
4.2 Editing Patient Information
To edit the patient information after a patient has been admitted, or when the patient
information is incomplete, or when you want to change the patient information:
1.
In the main menu, select [Patient Setup >>].
2.
Select [Patient Demographics] and then make the required changes.
3.
Select [Ok].
4.3 Discharging a Patient
To discharge a patient:
1.
In the main menu, select [Patient Setup >>].
2.
Select [Discharge Patient] or [Clear Patient Data]. In the popup menu, you can:
3.
‹
Directly select [Ok] to discharge the current patient, or
‹
Select [Standby] then [Ok]. The patient monitor enters the standby mode after
discharging the current patient, or
‹
Select [Cancel] to exit without discharging the patient.
If a printer is connected to your patient monitor, you can select [Print End Case Report]
to print all contents that you are setting up to print as an End Case report before
discharging the patient. After printing is completed, the patient monitor will
automatically enter the standby mode or return to the main screen, depending on your
previous setting.
4-2
NOTE
z
Discharging a patient clears all history data in the monitor.
4.4 Switching between Wire and Wireless Networks
To switch between wire and wireless networks:
1.
In the main menu, select [Maintenance >>]→ [User Maintenance >>].
2.
Enter the required password.
3.
In the user maintenance menu, select [Network Setup]
4.
In the network setup menu, select the [Network Type] drop-down box and then toggle
between [Wire] and [Wireless].
NOTE
z
If the [Network Type] option is grey, it indicates your monitor is not configured
with a wireless network card. You cannot switch to the wireless network.
4.5 Transferring Patient Data
You can transfer patient data between monitors with a CF storage card without re-entering the
patient demographic information. Transferring of patient data enables you to understand the
patient’s history condition. The patient data that can be transferred includes: patient
demographics, trend data, alarm events and parameters alarm limits.
To transfer the current patient data from the source monitor to the CF storage card:
1.
In the main menu, select [Patient Setup >>].
2.
Select [Transfer Patient Data]. Then select [Ok] in the popup menu to transfer patient
data and unload the CF storage card.
3.
Remove the card after the message [CF Storage Card Unloaded Successfully]
displays.
To transfer the patient data from the CF storage card to the receiving monitor:
1.
Insert the card into the receiving monitor.
4-3
2.
3.
In the popup [Transfer Patient Data] menu, you can:
‹
Select [Transfer Patient] to transfer the patient data to the monitor, or
‹
Select [Cancel Transfer] to cancel the operation of transferring patient data. Then
the patient data to be transferred becomes archived patient data. The current patient
data starts to be saved in the card.
‹
Select [Unload CF Storage Card] to not transfer the patient data and to unload the
card. The current patient data will not be saved in the card.
When you select [Transfer Patient], the monitor compares the patient information stored
in both the CF storage card and the monitor and deals with the patient data based on the
following.
‹
Different
Patients:
The monitor erases all the current patient data, transfers the patient
data from the CF storage card, and loads the configuration according
to the patient category.
‹
Same
Patient:
In the popup dialog box, you can:
Select [Yes] to merge the patient data in the monitor and CF storage
card.
Select [No] to erase all the current patient data in the monitor and to
transfer the patient data from the CF storage card.
Please notice that only the patient data in the past specified number of hours can be
transferred from the CF storage card. The number of hours is called [Transferred Data
Length] and can be specified in the configuration mode. If the latest patient data stored on
the card has a time stamp newer than the time displayed on the receiving monitor, data
transfer will be prohibited.
WARNING
z
After a patient is successfully transferred, check if the patient settings (especially
patient category, paced status and alarm limits settings, etc.) on the monitor are
appropriate for this patient.
4-4
4.6 Connecting to a Central Monitoring System
If your patient monitor is connected to a central monitoring system (CMS):
1.
All patient information, measurement data and settings on the patient monitor can be
transferred to the CMS.
2.
All patient information, measurement data and settings can be displayed simultaneously
on the patient monitor and CMS. For some functions such as editing patient information,
admitting a patient, discharging a patient, starting/stopping NIBP measurements, etc.,
bi-directional control can be achieved between your patient monitor and the CMS.
For details, refer to the CMS’s instructions for use.
4-5
FOR YOUR NOTES
4-6
5 Managing Configurations
5.1 Introduction
When performing continuous monitoring on a patient, the clinical professional often needs
to adjust the monitor’s settings according to the patient’s condition. The collection of all
these settings is called a configuration. Allowing you to configure the monitor more
efficiently, the monitor offers different sets of configuration to suit different patient
categories and departments. You can change some settings from a certain set of
configuration and then save the changed configuration as a user configuration.
The default configurations provided for your monitor are department-oriented. You can
choose either from:
„
General
„
OR
„
ICU
„
NICU
„
CCU
Each department has three different sets of configurations tailored for adult, pediatric and
neonatal patients.
WARNING
z
The configuration management function is password protected. The configuration
management tasks must be performed by clinical professionals.
The system configuration items can be classified as:
„
Global configuration items
These items can affect all the monitor settings. Most global configuration items, such as
monitor name, system time, etc., can be set in maintenance mode. The global configuration
items that need to be set in configuration mode include default patient category, whether to
load the selected configuration at startup, etc., which are usually displayed on the system
configuration-main screen.
„
Parameter configuration items
These items relates to parameters, e.g., waveform gain, alarm switch, alarm limits..
5-1
„
Conventional configuration items
These items define how the monitor works, e.g., screen layout, record, print and alarm
settings.
For all the configuration items and their default values, see appendix Configuration Default
Information.
5.2 Entering and Exiting the Configuration Mode
To enter the configuration mode,
1.
Press the
2.
Select [Manage Configuration >>] → [Configuration >>]. Enter the required
password and then select [Ok].
hardkey on the monitor’s front to enter the main menu.
To exit the configuration mode,
1.
Select [Exit] in the system configuration-main screen.
2.
Then select [Ok] from the popup dialog box. The monitor will restart and the modified
configuration will take effect afterwards.
5-2
5.3 Viewing and Changing Configurations
In configuration mode, you can view, change and save all the configuration items for each
department.
1.
After entering the configuration mode, verify that the current department is the one you
desire.
2.
In the system configuration-main screen, select the desired configuration and then
select [View Config.].
3.
As shown below, in the configuration category menu, you can view all the parameters
and conventional configuration items.
4.
Select to enter a certain configuration category, e.g. ECG, then you can view all the
related configuration items by selecting [Prev Page] or [Next Page] and change them
if necessary.
5.
After the change is done, select [Save Config.] to save the changed configuration. If
you have made some changes when viewing the default configuration of a certain
department, you can specify a name in the popup name configuration window to save
the changed configuration.
If the current department configuration is not the one you want to view, you can select
[Change Department >>] in the system configuration-main screen and then choose the one
you want for viewing as shown below. After returning to the main screen, you can still view
and change the configuration following the above steps.
5-3
NOTE
z
Changing the department will delete all the saved user configurations
automatically. Please act with caution.
5.4 Adding a Configuration
You can change monitor settings as required and then save the changed settings into a user
configuration. You can specify a name for the saved user configuration. The monitor can
save up to 3 sets of user configuration for the current department.
1.
Select [Add Config.] in the system configuration-main screen.
2.
In the load configuration menu, select a configuration as template.
‹
[Defaults]: factory default configurations for each department.
‹
user customized configuration: already saved user configuration
‹
[Latest Settings under Monitor Mode]: If you have changed some settings
before entering the configuration mode, you can import these settings to your
newly added user configuration by selecting [Latest Settings under Monitor
Mode].
3.
Enter a name and then select [Ok].
4.
Change the settings if necessary and make sure that the settings are appropriate for
your patient.
5.
After the change is done, select [Save Config.] or [Main] and then [Ok].
5.5 Deleting a Configuration
You can delete an already saved user configuration.
1.
Select [Delete Config.] in the system configuration-main screen.
5-4
2.
In the select user configuration menu, select the user configurations you want to delete
and then select [Ok].
3.
Select [Ok] in the popup dialog box.
5.6 Loading a Configuration
You may make changes to some settings during operation. However, these changes or the
pre-selected configuration may not be appropriate for the newly admitted patient. Therefore,
the monitor allows you to load aother user configuration of the current department under
monitoring mode so as to ensure that all the settings are appropriate for your patient.
To load a configuration,
1.
In monitoring mode, select [Manage Configuration >>] from the main menu.
2.
Select the default configuration or a certain user configuration according to the
patient’s condition.
3.
Select [Ok].
NOTE
z
In monitoring mode, only the default configuration of the current department or
the already saved user configuration can be loaded. You can only change the
department in configuration mode.
5.7 Setting Default Configuration at Startup
When the monitor restarts after quitting for over 120 seconds, it will load the pre-set default
configuration to restore the system configuration. The default configuration can be the latest
configuration, or a factory default configuration or user configuration.
5-5
To set the default configuration at startup,
1.
Enter the configuration mode.
2.
In the load configuration area, select a factory default configuration of the current
department or a user configuration as the default configuration.
3.
Select [Adu] or [Ped] or [Neo] from the [Patient Cat.] as the default patient category.
4.
You can change the department by selecting [Change Department >>]. But this will
delete all the saved user configurations.
5.
Set the [Load Selected Config at Startup] option:
‹
Selected: When the monitor restarts after quitting for over 120 seconds, it will
load the configuration you have selected in the load configuration area.
‹
Deselected: The monitor will load the latest configuration at startup no matter
how long it has been quitted.
NOTE
z
To find out which configuration has been loaded when the monitor starts, check
the message (lasting for about 10 seconds) displayed at the bottom of the screen
after the main screen comes out.
5.8 Loading the Latest Configuration Automatically
During operation, you may make changes to some settings. These changes may not be saved
as user configuration. To prevent the changes from loss in case of a sudden power failure,
the monitor stores the configuration in real time. The stored configuration is the latest
configuration.
If [Load Selected Config. at Startup] is selected, the monitor will load the latest
configuration if restarts within 60 seconds after the power failure. And it will load the
default configuration rather than the latest configuration if restarts 120 seconds later after
the power failure. The monitor may load either the latest configuration or the default
configuration if restarts from 60 to 120 seconds after the power failure.
If [Load Selected Config. at Startup] is not selected, the monitor will load the latest
configuration at startup.
5-6
5.9 Transferring a Configuration
When installing several monitors with identical user configuration it is not necessary to set
each unit separately. An USB storage card may be used to transfer the configuration from
monitor to monitor.
To export the current monitor’s configuration:
1.
Insert the USB storage card into the monitor’s USB port.
2.
Select [Transfer Config.] in the system configuration-main screen.
3.
Select [Export Config.>>] in the transfer config menu and then select [Ok] in the
popup dialog box. A status message will report completion of the transfer.
To import the configuration in the card to the monitor:
1.
Insert the USB storage card into the monitor’s USB port.
2.
Select [Transfer Config.] in the system configuration-main screen.
3.
Select [Import Config.>>] in the transfer config menu and then select [Ok] in the
popup dialog box. A status message will report completion of the transfer.
5-7
FOR YOUR NOTES
5-8
6 User Screens
6.1 Tailoring Your Screens
You can tailor your patient monitor’s screens by setting:
„
Waveform sweep mode
„
Wave line size
„
The way to draw waves
„
The color in which each measurement’s numerics and waveform are displayed
„
The waveforms to be displayed and their display order.
Some settings can be changed manually in monitoring mode. For details about
configuration mode, refer to the Managing Configuration chapter.
6.1.1 Setting the Waveform Sweep Mode
1.
In the main menu, select [Others >>] or select [Waveform] in configuration mode.
2.
Select [Sweep Mode] and toggle between [Refresh] and [Scroll].
‹
[Refresh]: The waveforms keep stationary, being refreshed from left to right by a
moving “erase bar”.
‹
[Scroll]: The waveforms move from the right to the left with time passing by.
6.1.2 Changing the Wave Line Size
1.
Select [Waveform] in configuration mode.
2.
Select [Wave Line] and toggle between [Thick], [Med] and [Thin].
6.1.3 Choosing the Way to Draw Waves
1.
Select [Waveform] in configuration mode.
2.
Select [Draw Wave] and then toggle between [Color] and [Mono]:
‹
[Color]: The waveform is optimized by the system and appears smooth.
‹
[Mono]: The waveform is unsmoothed.
6-1
6.1.4 Changing Parameter and Waveform Colors
1.
Select [Waveform] in configuration mode.
2.
In the [Parameter/Wave Color] area, you can set color for each parameter and
waveform. Selecting [Next Page] allows you to set color for more parameters and
waveforms.
6.1.5 Selecting Waveforms for Display
Your can select waveforms for display on the screen:
1.
In the main menu, select [Others >>]→[Wave Setup >>]→[Select Waves >>].
2.
In the [Select Waves] menu, select the waveforms you want for display on the screen.
3.
Select [Exit]. Your selections will take effect automatically.
Additionally, you can change the order the waveforms are displayed on the screen if needed.
1.
In the main menu, select [Others >>]→[Wave Setup >>].
2.
In the [Wave Sequence] menu, you can sequence the waveforms displayed on the
screen.
3.
Select [Exit]. Your change will take effect automatically.
Select [Screens] in configuration mode, and you can also change the order in which all
waveforms are displayed on the all parameters screen.
6.1.6 Changing Screen Layout
1.
In the main menu, select [Screen Layout >>].
2.
Select a normal screen, such as all parameters screen, big numerics screen, etc.
3.
You can also select a split-screen functional view if necessary, such as minitrends,
others, etc. But the functional view is available only with the all parameters screen.
You can select [Screens] in configuration mode and select your desired screen. Then, your
selected screen will be displayed when the configuration is applied.
6-2
6.2 Viewing Minitrends
6.2.1 Having a Split-Screen View of Minitrends
You can split the all parameters screen so that one part of the screen, on the left hand side,
continuously shows graphic minitrends beside waveforms as shown in the figure below.
To have a split-screen view of minitrends, you can:
In the main menu, select [Screen Layout >>]→[Minitrends]→[Ok].
Minitrend view
The split-screen view provides minitrends for multiple parameters. In each field, the label,
scale and time are respectively displayed at the top, left, and bottom as shown below.
6-3
6.2.2 Changing Minitrend Length
The minitrend length cannot be chosen for individual parameters. You can only change the
minitrend length for all parameters:
1.
Select either parameter’s minitrend field.
2.
In the [Minitrend Setup] menu, select [Minitrend Length] and then select your
desired setting.
3.
Select [Exit]. Your change will take effect automatically.
6.2.3 Changing a Parameter for Viewing
You can also select your desired parameters to view their minitrends.
1.
Select either parameter’s minitrend field.
2.
In the [Minitrend Setup] menu, you can select your desired parameter from the select
parameter area. If you want to select other parameter, select [Other Parameters >>]
and then select your desired parameters.
3.
Select [Ok].
6-4
6.3 Viewing oxyCRG
To have a split screen view of oxyCRG, you can:
„
In the main menu, select [Screen Layout >>].
„
Select [oxyCRG]→[Ok].
1
2
3
4
The split-screen view covers the lower part of the waveform area and shows HR trend,
SpO2 trend and RR trend (or Resp Wave). At the bottom, there are controls:
1.
Trend length list box
In the trend length list box, you can select [1 min], [2 min], [4 min], or [8 min].
2
Resp Wave (or RR Trend) list box
From this list box, you can select either [Resp Wave] or [RR Trend] for display.
3.
Record
Through this button, you can print out the currently displayed oxyCRG trends by the
recorder.
4.
Exit
You can select it to exit the oxyCRG screen and return to the all parameters screen.
6-5
6.4 Viewing Other Patients
6.4.1 Care Group
If your patient monitor is connected to a central monitoring system, you can select up to 8
bedside monitors into a Care Group. This lets you:
„
View information on the monitor screen from another bed in the same Care Group.
„
Be notified of physiological and technical alarm conditions at the other beds in the
same Care Group.
To have a Care Group:
1.
Select [Screens] QuickKey or select [Screen Layout >>] in the main menu. Then,
select [Others] and [Ok] from the popup menu.
2.
In the [View Other Patient] window, select the care group setup button.
3.
Select the desired bedside monitors from the [Connected Monitor List], and then
select the [Exit] button.
6.4.2 Viewing the Care Group Overview Bar
The Care Group overview bar locates at the bottom of the [View Other Patient] window. In
the overview bar, the department and bed label for any Care Group beds are displayed. The
color in which a Care Group bed appears matches its status:
„
Red: indicates the bed is giving high-level physiological alarms.
„
Yellow: indicates the bed is giving medium- or low-level physiological alarms, or
medium-level technical alarms.
„
Blue: indicates the bed is giving low-level technical alarms.
„
Grey: indicates the bed fails to be networked (bright grey) or stays in the standby mode
(dark grey).
„
Black: indicates the bed is networked but gives no alarms.
When multiple alarms occur to a Care Group bed, the Care Group bed appears in the color
that matches the highest level alarm.
You can view a Care Group bed’s alarms by selecting it from the care group, and as well
you can select the [View This Patient] button to view this bed in the [View Other Patient]
window.
For more details about Care Group alarms, refer to the Alarms chapter.
6-6
6.4.3 Understanding the View Other Patient Window
When you first open the [View Other Patient] window, the patient monitor automatically
selects a monitor from the network to display in the [View Other Patient] window.
4
5
6
1
2
3
The view other patient window covers the lower part of the waveform area and consists of:
1.
Information Area: shows the patient information (including department, bed number,
patient name, etc.) and network status symbols.
2.
View Area: shows physiological waveforms and parameters. You can switch a
waveform area to a parameter area by selecting your desired waveform area and then
selecting [Switch to Parameter Area], or switch a parameter area to a waveform area
by selecting your desired parameter area and then selecting [Switch to Waveform
Area].
3.
Care Group Overview Bar.
4.
Message Area: shows physiological and technical messages from the currently viewed
bed. By selecting this area, you can enter the [Alarm Information List] to view all
physiological and technical messages coming from the currently viewed bed.
5.
Alarm Silence Control Button: allows you to control the currently viewed bed to enter
or exit the alarm silence status. For details, refer to the Alarms chapter.
6.
Care Group Setup Button: allows you to enter the [Connected Monitor List] and
select monitors into your Care Group.
6-7
Additionally, you can change a waveform or parameter for viewing.
„
To change a waveform for viewing, select the waveform segment where you want a
new waveform to appear and then select the waveform you want from the popup menu.
„
To change a parameter for viewing, select the parameter window where you want a
new parameter to appear and then select the parameter you want from the popup menu.
6.5 Understanding the Big Numerics Screen
To enter the big numerics screen:
1.
In the main menu, select [Screen Layout >>].
2.
Select [Big Numerics] and then [Ok].
You can select your desired parameters to display in this screen: select the [Para. Setup]
QuickKey and then select the parameters you want. For parameters having a waveform, the
waveform will also be displayed.
6-8
7 Alarms
Alarms, triggered by a vital sign that appears abnormal or by technical problems of the
patient monitor, are indicated to the user by visual and audible alarm indications.
WARNING
z
A potential hazard can exist if different alarm presets are used for the same or
similar equipment in any single area, e.g. an intensive care unit or cardiac
operating room.
z
If your patient monitor is connected to a CMS, remote suspension, inhibition,
silence and reset of monitor alarms via the CMS may cause a potential hazard.
7.1 Alarm Categories
By nature, the patient monitor’s alarms can be classified into three categories: physiological
alarms, technical alarms and prompt messages.
1.
Physiological alarms
Physiological alarms, also called patient status alarms, are triggered by a monitored
parameter value that violates set alarm limits or an abnormal patient condition.
Physiological alarm messages are displayed in the physiological alarm area.
2.
Technical alarms
Technical alarms, also called system status alarms, are triggered by a device
malfunction or a patient data distortion due to improper operation or mechanical
problems. Technical alarm messages are displayed in the technical alarm area.
3.
Prompt messages
As a matter of fact, prompt messages are not alarm messages. Apart from the
physiological and technical alarm messages, the patient monitor will show some
messages telling the system status. Messages of this kind are included into the prompt
message category and usually displayed in the prompt information area. But for some
measurements, their related prompt messages are displayed in their respective
parameter windows.
7-1
7.2 Alarm Levels
By severity, the patient monitor’s alarms can be classified into three categories: high level,
medium level and low level.
Physiological alarms
Technical alarms
High
level
Indicate that your patient is in a
life threatening situation, such
as Asystole, Vfib/Vtac and so
forth, and an emergency
treatment is demanded.
Indicate a severe device malfunction or an
improper operation, which could make it possible
that the monitor cannot detect critical patient status
and thus threaten the patient’s life, such as low
battery and so forth.
Medium
level
Indicate that your patient’s vital
signs appear abnormal and an
immediate treatment is
required.
Indicate a device malfunction or an improper
operation, such as ECG/SpO2 lead off, which may
not threaten the patient’s life but may compromise
the monitoring of vital physiological parameters.
Low
level
Indicate that you patient’s vital
signs appear abnormal and an
immediate treatment may be
required.
Indicate a device malfunction or an improper
operation, which may compromise a certain
monitoring function but will not threaten the
patient’s life.
The level for some alarms, such as Asystole, Vfib/Vtac, etc., is predefined before the patient
monitor leaves the factory and cannot be changed. However, for most of the other
physiological alarms, alarm settings are user adjustable, e.g. alarm limits. For some
technical alarms, the alarm level is also user adjustable.
7.3 Alarm Indicators
When an alarm occurs, the patient monitor will indicate it to the user through visual or
audible alarm indications.
„
Alarm lamp
„
Alarm message
„
Flashing numeric
„
Audible alarm tones
„
Reminder tones
7-2
7.3.1 Alarm Lamp
If an alarm occurs, the alarm lamp will flash. The flashing color and frequency match the
alarm level as follows:
„
High level alarms:
the lamp flashes quickly in red.
„
Medium level alarms:
the lamp flashes slowly in yellow.
„
Low level alarms:
the lamp turns yellow without flashing.
7.3.2 Alarm Message
When an alarm occurs, an alarm message will appear in the technical or physiological alarm
area. For physiological alarms, the asterisk symbols (*) before the alarm message match the
alarm level as follows:
„
High level alarms:
***
„
Medium level alarms:
**
„
Low level alarms:
*
Additionally, the alarm message uses different background color to match the alarm level:
„
High level alarms:
red
„
Medium level alarms:
yellow
„
Low level physiological alarms:
yellow
„
Low level technical alarms:
light blue
You can view the alarm messages by selecting the physiological or technical alarm area.
7.3.3 Flashing Numeric
If an alarm triggered by an alarm limit violation occurs, the numeric of the measurement in
alarm will flash every second, and the corresponding alarm limit will also flash at the same
frequency indicating the high or low alarm limit is violated.
7.3.4 Audible Alarm Tones
The patient monitor uses different alarm tone patterns to match the alarm level:
„
High level alarms:
triple+double+triple+double beep.
„
Medium level alarms:
triple beep.
„
Low level alarms:
single beep.
7-3
NOTE
z
When multiple alarms of different levels occur simultaneously, the patient monitor
will select the alarm of the highest level and give visual and audible alarm
indications accordingly.
7.3.5 Reminder Tones
When alarms are turned off or alarm tones are paused or turned off, the patient monitor will
give a single beep as the reminder tone in case of an active alarm condition. You can set the
reminder volume as [High], [Med] or [Low] in the [Alarm Setup] menu and set the
reminder interval as [1 min], [2 min] or [3 min] in configuration mode. You can only
switch on/off the reminder tone in configuration mode.
7.4 Understanding Alarm Statuses
You can set your monitor to one of the following four alarm statuses. The alarm symbols
match the alarm statuses as follows.
Alarms paused
Alarms off
Alarm sound silenced
Alarm sound off
7.4.1 Pausing Alarms
If you want to temporarily prevent alarms from sounding, you can pause alarms by pressing
the
hardkey on the monitor’s front.
„
No physiological alarm lamps flash and no alarms are sounded. No alarm messages are
shown.
„
No numeric and alarm limit flash.
„
The remaining pause time is displayed in the physiological alarm area.
„
For technical alarms, no alarms are sounded. The alarm lamps and alarm messages
remain active.
„
The
alarms paused symbol is displayed in the alarm status symbol area.
7-4
When the alarm pause time expires, the alarm paused status is automatically cancelled and
the alarm tone will sound. You can also cancel the alarm paused status by pressing the
hardkey.
You can set the alarm pause time as desired in configuration mode. The default alarm pause
time is 2 minutes.
7.4.2 Switching Off Alarms
If you have set the alarm pause time as permanent, the monitor will enter the alarm off
status when you press the
hardkey. Besides the characteristics of the alarm pause status,
the alarm off status has the following characteristics.
„
[Alarm Off] is displayed in the physiological alarm area.
„
The
alarm off symbol is displayed in the alarm status symbol area.
You can cancel the alarm off status by pressing the
hardkey.
If a high level technical alarm, such as low battery, occurs, the alarm pause and alarm off
statuses are all automatically cancelled.
WARNING
z
Pausing or switching off alarms may result in a hazard to the patient. Please be
very careful.
7.4.3 Silencing the Alarm Sound
You can silence all alarm sounds temporarily by pressing the
hardkey on the monitor’s
front. In that case, the alarm lamps and alarm messages remain active and
appears in
the alarm status symbol area.
If the monitor switches to other alarm status or a new alarm occurs, the alarm sound
silenced status is automatically cancelled. You can also cancel the alarm sound silenced
status by pressing the
hardkey.
7-5
7.4.4 Switching off Alarm Sound
In configuration mode, you can set the minimum alarm volume. The minimum alarm
volume refers to the minimum value you can set for the alarm volume.
When the alarm volume is set to 0, the monitor stays in alarm sound off status and a
symbol appears on the screen.
The alarm sound off status is cancelled and the alarm volume returns to the factory default
value automatically when:
„
The monitor shuts down and then restarts.
„
The monitor changes to other alarm status, such as alarms paused status or alarms off
status.
„
The alarm volume restores the default value after the monitor reloads the
configuration.
WARNING
z
When the alarm sound is switched off, the patient monitor will give no audible
alarm tones even if a new alarm occurs. Therefore the user should be very careful
about whether to switch off the alarm sound or not.
7.5 Alarm Configuration
7.5.1 Alarm Tone Configuration
Changing the Alarm Volume
1.
In the main menu, select [Alarm Setup >>].
2.
Select the appropriate volume from [Alm Volume]: X-10, in which X is the minimum
volume, depending on the set minimum alarm volume, and 10 the maximum volume.
Setting the Alarm Tone Interval
You can set the interval between alarm tones for high-level, medium-level and low-level
alarms. For details, refer to the chapter Managing Configuration.
WARNING
z
Do not rely exclusively on the audible alarm system for patient monitoring.
Adjustment of alarm volume to a low level may result in a hazard to the patient.
Always keep the patient under close surveillance.
7-6
7.5.2 Displaying Alarm Limits
To have a better view of measurement numerics, you can choose not to display alarm limits
in the parameter window by switching off displaying alarm limits in configuration mode.
For details, refer to the chapter Managing Configuration.
7.5.3 Setting Alarm Delay Time
You can set the alarm delay time for over-limit alarms of continuously measured parameters.
If the alarm triggered condition disappears within the delay time, the patient monitor will
not issue the alarm. You can select [Alarm Setup>>] from [Main Menu] and then set
[Alarm Delay].
In the configuration mode, you can follow these steps to set [Alarm Delay] and [ST Alarm
Delay] respectively.
hardkey on the monitor’s front to enter the main menu.
1.
Press the
2.
Select [Manage Configuration >>] → [Configuration >>]. Enter the required
password and then select [Ok].
3.
Select [View Config.]→ [Alarm] and set [Alarm Delay] and [ST Alarm Delay].
NOTE
z
The alarm delay time can not be set in case of the following physiological alarms:
Resp Apnea (The apnea time needs to be set independently), ST Alarm (The delay
time needs to be set independently), Arrh. Alarm, PVCs Too High, ECG Weak
Signal, Resp Artifact, SpO2 Desat, No pulse, Nellcor SpO2 over-limit alarm, FiO2
Too Low, over-limit alarms of discontinuously measured parameters and MAC >3.
7.5.4 Using Alarms
Switching Individual Measurement Alarms On/Off
1.
Select the parameter window for your desired measurement to enter its setup menu.
2.
Select [Alarm] and toggle between [On] and [Off].
‹
[On]: The patient monitor gives alarm indications in accordance with the preset
alarm level and stores the related waveforms and parameters.
‹
[Off]: The alarm off symbol “
” is displayed in the measurement parameter
window.
7-7
Setting the Alarm Level
1.
Select the parameter window for your desired measurement to enter its setup menu.
2.
Select [Alm Lev] and toggle between [High], [Med] and [Low].
You can also set alarm levels for all alarms together:
1.
In the main menu, select [Alarm Setup >>]→[Alarm Levels Setup >>].
2.
You can view and set alarm levels for all the ongoing measurements in the popup
menu.
Adjusting Alarm Limits
To adjust alarm limits for individual measurements,
1.
Select the parameter window for your desired measurement to enter its setup menu.
2.
In the setup menu, select the alarm limit you want to change and then select the
appropriate setting.
WARNING
z
Make sure that the alarm limits settings are appropriate for your patient before
monitoring.
z
Setting alarm limits to extreme values may cause the alarm system to become
ineffective. For example, High oxygen levels may predispose a premature infant to
retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to
100%, which is equivalent to switching the alarm off.
Recording Alarms Automatically
When a measurement alarm occurs, automatic recording of all the measurement numerics
and related waveforms is possible when the measurement’s [Alarm] and [Alm Rec] are set
on.
To enable or disable automatic start of alarm recordings for individual measurements, you
can select [Alm Rec] and toggle between [On] and [Off] in the setup menu for your desired
measurement.
Additionally, you can change the length of the recorded waveforms. In the [Alarm Setup]
menu, select [Recording Length] and toggle between [8 s], [16 s] and [32 s]:
„
[8 s]: 4 seconds respectively before and after the alarm trigger moment.
„
[16 s]: 8 seconds respectively before and after the alarm trigger moment.
„
[32 s]: 16 seconds respectively before and after the alarm trigger moment.
7-8
7.5.5 Mass Alarm Setup
In the main menu, select [Alarm Setup >>]→[Mass Alarm Setup>>]. You can review and
set alarm limits, alarm switches and alarm recordings for all parameters.
7.5.6 Adjusting Alarm Limits Automatically
The monitor can automatically adjust alarm limits according to the measured vital signs,
using the auto limits function. When auto limits are selected, the monitor calculates safe
auto limits based on the latest measured values.
To get accurate auto alarm limits, you need to collect a set of measured vital signs as a
baseline. Then, in the main menu, select [Alarm Setup >>]→[Mass Alarm
Setup>>]→[Auto Limits]. The monitor will create new alarm limits based on the measured
values.
Before applying these automatically created alarm limits, confirm if they are appropriate for
your patient in the mass alarm setup menu. If not, you can adjust them manually. These
alarm limits will remain unchanged until you select auto limits again or adjust them
manually.
7.6 Latching Alarms
The alarm latching setting for your patient monitor defines how the alarm indicators behave
when you do not acknowledge them. When alarms are set to non-latching, their alarm
indications end when the alarm condition ends. If you switch alarm latching on, all visual
and audible alarm indications last until you acknowledge the alarms, except that the
measurement numeric and violated alarm limit stop flashing as soon as the alarm condition
goes away.
You can switch alarm latching on or off in configuration mode. For details, refer to the
chapter Managing Configuration.
You can clear the latched alarms by pressing the
7-9
hardkey.
7.7 Clearing Technical Alarms
For some technical alarms, their alarm lamp flashing and alarm tones are cleared and the
alarm messages change to prompt messages after the
hardkey is pressed. After the
patient monitor restores the normal alarm status, it can give alarm indications correctly in
case these alarms are triggered again.
For some technical alarms, all their alarm indications are cleared after the
hardkey is
pressed. After the patient monitor restores the normal alarm status, it can give alarm
indications correctly in case these alarms are triggered again.
For others, their alarm tones are cleared but the alarm lamp flashing and alarm messages
remain after the
hardkey is pressed. After the patient monitor restores the normal alarm
status, all the alarm indications will continue if the alarm conditions still present.
7.8 Testing Alarms
When the monitor starts up, a self-test will be performed automatically. The system gives a
beep indicating that the visible and audible alarm indicators are functioning correctly. In the
meantime, the alarm lamp turns yellow then red. The start-up screen is displayed.
For further testing of individual measurement alarms, perform the measurement on yourself
(for example SpO2 or CO2) or using a simulator. Adjust alarm limits and check if alarms
behave correctly.
7.9 When an Alarm Occurs
When an alarm occurs, observe the following steps and take proper actions:
1.
Check the patient’s condition.
2.
Confirm the alarming parameter or alarm category.
3.
Identify the source of the alarm.
4.
Take proper action to eliminate the alarm condition.
5.
Make sure the alarm condition is corrected.
For troubleshooting specific alarms, see appendix Alarm Messages.
7-10
7.10 Using Care Group Alarms
7.10.1 Care Group Auto Alarms
When auto alarm is set on for viewing other patient and a Care Group is set up on your
monitor, a flashing symbol will appear beside the QuickKeys area if any monitor in your
Care Group, which is not currently viewed by your monitor, is alarming. The alarm symbol
is shown as below.
The department and bed label of the alarming monitor appear on the symbol. You can enter
the view other patient window by pressing this symbol.
To switch auto alarm on or off for viewing other patient:
1.
Select [Screen Layout >>] in the main menu. Then, select [Others] and [Ok] from the
popup menu.
2.
In the view other patient window, select the care group setup button. Then, select
[Auto Alarm] and toggle between [On] and [Off].
7.10.2 Viewing Alarm Information
You can view the alarm information from the currently viewed bed by selecting the message
area in the view other patient window.
The Care Group overview bar locates at the bottom of the View Other Patient window. In
the overview bar, the department and bed label for any Care Group beds are displayed. The
colour in which a Care Group bed appears matches its status. For details, refer to the
Viewing Other Patients chapter. You can view the alarm information from other Care Group
bed by selecting the department and bed label key in the Care Group Overview Bar.
7-11
7.10.3 Silencing Care Group Alarms
You can silence the alarm sound of the currently viewed bed in the view other patient
window. This function can be set in configuration mode only.
When the alarm silence function for other patients is active and the currently viewed bed is
in normal alarm status or alarm sound off status, press the
button in the view other
patient window. The currently viewed bed will then enter into the alarm silenced status.
Pressing this button again returns to the normal alarm status.
Note that this button is disabled when the currently viewed bed is in alarms off or paused
status.
7-12
8 Monitoring ECG
8.1 Introduction
The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on
the patient monitor as a waveform and a numeric. ECG monitoring provides two
algorithms:
1.
Basic algorithm
The Basic algorithm enables 3-, 5- or 12-lead ECG monitoring, ST-segment analysis,
arrhythmia analysis and interpretation of resting 12-lead ECG.
2.
Mortara algorithm
The Mortara algorithm enables 3-, 5- or 12-lead ECG monitoring, ST-segment analysis
and arrhythmia analysis.
You can select either algorithm as required. For the patient monitor incorporating the
Mortara algorithm, interpretation of resting 12-lead ECG in the Basic algorithm is optional.
For the patient monitor incorporating the Mortara algorithm, there is a Mortara logo at the
monitor’s front.
8.2 Safety
WARNING
z
Use only ECG electrodes and cables specified in this manual.
z
When connecting electrodes and/or patient cables, make sure that the connectors
never come into contact with other conductive parts, or with earth. In particular,
make sure that all of the ECG electrodes are attached to the patient, to prevent
them from contacting conductive parts or earth.
z
Periodically inspect the electrode application site to ensure skin quality. If the skin
quality changes, replace the electrodes or change the application site.
z
Use defibrillator-proof ECG cables during defibrillation.
z
Do not touch the patient, or table, or instruments during defibrillation.
z
After defibrillation, the screen display recovers within 10 seconds if the correct
electrodes are used and applied in accordance with the manufacturer’s instructions
for use.
z
Interference from a non-grounded instrument near the patient and electrosurgery
interference can cause problems with the waveform.
8-1
8.3 Preparing to Monitor ECG
8.3.1 Preparing the Patient and Placing the Electrodes
1.
Prepare the patient’s skin. Proper skin preparation is necessary for good signal quality
at the electrode, as the skin is a poor conductor of electricity. To properly prepare the
skin, choose flat, non-muscular areas and then follow this procedure:
‹
Shave hair from skin at chosen sites.
‹
Gently rub skin surface at sites to remove dead skin cells.
‹
Thoroughly cleanse the site with a mild soap and water solution. We do not
recommend using ether or pure alcohol, because this dries the skin and increases
the resistance.
‹
Dry the skin completely before applying the electrodes.
2.
Attach the clips or snaps to the electrodes before placing them.
3.
Place the electrodes on the patient.
4.
Attach the electrode cable to the patient cable and then plug the patient cable into the
ECG connector.
8.3.2 Choosing a Lead Set and AHA or IEC Lead Placement
1.
Select the ECG parameter window to enter the [ECG Setup] menu.
2.
Select [Lead Set] and then select [Auto], [3-lead], [5-lead] or [12-lead] according to
the applied electrodes.
Besides, you need to choose a standard that applies for your ECG lead placement in
maintenance mode:
1.
In the main menu, Select [Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
Select [Device Setup >>]→[ECG Standard] and then select [AHA] or [IEC]
according to the standard that is applied for your hospital.
8-2
8.3.3 ECG Lead Placements
The electrode placement illustrations in this chapter adopt the AHA standard.
3-Leadwire Electrode Placement
Following is an electrode configuration when using 3 leadwires:
„
RA placement: directly below the clavicle and near the right shoulder.
„
LA placement: directly below the clavicle and near the left shoulder.
„
LL placement: on the left lower abdomen.
5-Leadwire Electrode Placement
Following is an electrode configuration when using 5 leadwires:
„
RA placement: directly below the clavicle and near the right shoulder.
„
LA placement: directly below the clavicle and near the left shoulder.
„
RL placement: on the right lower abdomen.
„
LL placement: on the left lower abdomen.
„
V placement: on the chest.
8-3
The chest (V) electrode can be placed on one of the following positions:
„
V1 placement: on the fourth intercostal space at the right sternal border.
„
V2 placement: on the fourth intercostal space at the left sternal border.
„
V3 placement: midway between the V2 and V4 electrode positions.
„
V4 placement: on the fifth intercostal space at the left midclavicular line.
„
V5 placement: on the left anterior axillary line, horizontal with the V4 electrode
position.
„
V6 placement: on the left midaxillary line, horizontal with the V4 electrode position.
„
V3R-V6R placement: on the right side of the chest in positions corresponding to those
on the left.
„
VE placement: over the xiphoid process.
„
V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal
space.
„
V7R placement: on posterior chest at the right posterior axillary line in the fifth
intercostal space.
12-Leadwire Electrode Placement
12-lead ECG uses 10 electrodes, which are
placed on the patient’s four limbs and chest.
The limb electrodes should be placed on the
soft skin and the chest electrodes placed
according to the physician’s preference.
Lead Placement for Surgical
Patients
The surgical site should be taken into
consideration when placing electrodes on a
surgical patient. e.g. for open-chest surgery,
the chest electrodes can be placed on the
lateral chest or back. To reduce artifacts and
interference from electrosurgical units, you
can place the limb electrodes close to the
shoulders and lower abdomen and the chest
electrodes on the left side of the mid-chest.
Do not place the electrodes on the upper arm.
Otherwise, the ECG waveform will be very
small.
8-4
WARNING
z
When using electrosurgical units (ESU), patient leads should be placed in a
position that is equal distance from the Electrosurgery electrotome and the
grounding plate to avoid burns to the patient. Never entangle the ESU cable and
the ECG cable together.
z
When using electrosurgical units (ESU), never place ECG electrodes near to the
grounding plate of the ESU, as this can cause a lot of interference on the ECG
signal.
8.3.4 Switching ECG Lead Set
When [Lead Set] is set to [Auto], the patient monitor can switch from 3-lead ECG to 5-lead
ECG, or from 5-lead ECG to 12-lead ECG automatically. The following table describes the
contions of the lead switch.
Switch from 3-lead to 5-lead
RL and any two of limb leads (RA, LL, LA)
are connected to a patient for 5 seconds.
Switch from 5-lead to 3-lead
RA, LA, LL, and V are all disconnected or
RL is disconnected from a patient and the
disconnection lasts for 10 seconds.
Switch from 12-lead to 3-lead
All the leads are disconnected or RL is
disconnected from a patient and the
disconnection lasts for 10 seconds.
Switch from 5-lead to12-lead
RA, LA, RL, and LL are connected to a
patient properly, any lead from V2 to V6 is
connected properly and the connection lasts
for 5 seconds.
8-5
8.3.5 Checking Paced Status
It is important to set the paced status correctly when you start monitoring ECG. The paced
symbol
is displayed when the [Paced] status is set to [Yes]. The pace pulse markers “|”
are shown on the ECG wave when the patient has a paced signal.
To change the paced status, you can select either:
„
the patient information area, or
„
[Patient Setup >>] in the main menu and then [Patient Demographics], or,
„
the ECG parameter window,
and then, select [Paced] from the popup menu and toggle between [Yes] and [No].
WARNING
z
For paced patients, you must set [Paced] to [Yes]. If it is incorrectly set to [No], the
patient monitor could mistake a pace pulse for a QRS and fail to alarm when the
ECG signal is too weak. Do not rely entirely on rate meter alarms when monitoring
patients with pacemakers. Always keep these patients under close surveillance.
z
For non-paced patients, you must set [Paced] to [No]. If it is incorrectly set to [Yes],
the patient monitor may be unable to detect premature ventricular beats (including
PVCs) and perform ST segment analysis.
8-6
8.4 Understanding the ECG Display
In the all parameters screen, the patient monitor allows up to three ECG to be displayed
simultaneously. Following is an ECG display screen with 5-lead set and for reference only.
Your display may be configured to look slightly different.
1
2
3
4
1.
Lead label of the displayed wave
2.
ECG gain
3.
ECG filter label
4.
Notch filter status
Besides, pace pulse marks “|” are shown above the ECG wave if the [Paced] is set to [Yes]
and the patient has a paced signal.
2
1
3
1.
Current heart rate alarm limits
2.
Heart beat symbol
3.
Current heart rate
For 12-lead ECG display screen, refer to the section 12-Lead ECG Monitoring.
8-7
8.5 Changing ECG Settings
8.5.1 Setting Pacemaker Rate (For Mortara Only)
Some pacemaker pulses cannot be rejected. When this happens, the pulses are counted as a
QRS complex and could result in an incorrect HR and a failure in detecting some
arrhythmias. Select [ECG Setup]→[Others >>], and you can set [Pacemaker Rate] to the
pacemaker’s rate in the popup menu. In this way, the patient monitor can calculate HR and
detect arrhythmias more accurately. When [Paced] is set to [No], the pacemaker rate cannot
be set.
8.5.2 Choosing the Alarm Source
In most cases the HR and PR numerics are identical. In order to avoid simultaneous alarms
on HR and PR, the monitor uses either HR or PR as its active alarm source. To change the
alarm source, select [Alm Source] in the [ECG Setup] menu and then select either:
„
[HR]: if you want the HR to be the alarm source for HR/PR.
„
[PR]: if you want the PR to be the alarm source for HR/PR.
„
[Auto]: If the [Alm Source] is set to [Auto], the monitor will use the heart rate from
the ECG measurement as the alarm source whenever the ECG measurement is
switched on and a valid heart rate is available. If the heart rate becomes unavailable,
for example if leads becomes disconnected, and a pulse source is switch on and
available, the monitor will automatically switch to Pulse as the alarm source. When the
Leads Off condition is corrected, the monitor will automatically switch back to the
heart rate as the alarm source.
8.5.3 Choosing a 5-Lead ECG Display Screen
When monitoring with a 5-lead set, you can, in the [ECG Setup] menu, set the [ECG
Display] screen to:
„
[Normal]: The ECG waveform area shows 2 ECG waveforms by default. You can
select 3 ECG waveforms for display.
„
[Full-Screen]: The whole waveform area shows 7 ECG waveforms only.
„
[Half-Screen]: The upper half part of the whole waveform area displays 7 ECG
waveforms.
8-8
When [ECG Display] is set to [Normal] and [Sweep Mode] is set to [Refresh], cascaded
ECG waveforms can be displayed. To cascade ECG waveforms:
1.
Select either ECG wave to enter its lead menu.
2.
Select [Cascade] and then select [On]. A cascaded waveform is displayed in two
waveform positions.
8.5.4 Changing the ECG Filter Settings
The ECG filter setting defines how ECG waves are smoothed. The default filter mode is
different for different departments. To change the filter mode which will be applied for all
ECG waveforms, select either ECG wave to enter its lead menu and then set [Filter] to:
„
[Monitor]: Use under normal measurement conditions.
„
[Diagnostic]: Use when diagnostic quality is required. The unfiltered ECG wave is
displayed so that changes such as R-wave notching or discrete elevation or depression
of the ST segment are visible.
„
[Surgery]: Use when the signal is distorted by high frequency or low frequency
interference. High frequency interference usually results in large amplitude spikes
making the ECG signal look irregular. Low frequency interference usually leads to
wandering or rough baseline. In the operating room, the surgery filter reduces artifacts
and interference from electrosurgical units. Under normal measurement conditions,
selecting [Surgery] may suppress the QRS complexes too much and then interfere
with ECG analysis.
NOTE
z
As the [Monitor] or [Surgery] filter may cause ECG waveform distortions, try to
use the [Diagnostic] filter for ST analysis as possible as you can. Besides, the
[Surgery] filter may also affect arrhythmia analysis results.
8.5.5 Switching the Notch Filter On or Off
The notch filter removes the line frequency interference. When [Filter] is not set to
[Diagnostic], the notch filter always stays on. When [Filter] is set to [Diagnostic], you can
switch the notch filter on or off as required.
1.
Select the ECG parameter window to enter its setup menu and then select [Others >>].
2.
Select [Notch Filter] and toggle between [On] and [Off]. Switching the notch filter on
is recommended when there is interference (such as spikes) with the waveform.
8-9
Besides, you can set the notch frequency in maintenance mode:
1.
In the main menu, Select [Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
Select [Device Setup >>] and then set [Notch Filter] to [50Hz] or [60Hz] according
to the power line frequency.
8.5.6 Switching Defibrillator Synchronization On/Off
As defibrillator synchronization, analog output and nurse call share the same signal output
port, you need to set the port for defibrillator synchronization before getting the monitor and
defibrillator synchronized. To set the port for defibrillator synchronization:
1.
In the main menu, Select [Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
Select [Device Setup >>] to access the [Device Setup] menu.
3.
Select [Auxiliary Output] and then [Defib. Sync].
To switch defibrillator synchronization on or off:
1.
Select the ECG parameter window and then select [Others >>].
2.
Select [Defib. Sync] and toggle between [On] and [Off].
If a defibrillator is connected, a defibrillator synchronization pulse (100 ms, +5V) is
outputted through the Defib. Sync connector every time when the patient monitor detects an
R-wave. When [Defib. Sync] is set on, the message [Defib Sync On] is displayed in the
technical alarm area.
WARNING
z
Improper use of a defibrillator may cause injury to the patient. The user should
determine whether to perform defibrillation or not according to the patient’s
condition.
z
Before defibrillation, the user must ensure both defibrillator and monitor has
passed the system test and can be safely used jointly.
z
Before defibrillation, make sure that [Defib. Sync] is set to [On] and the [Filter] is
set to [Diagnostic].
z
After defibrillation is finished, set [Defib. Sync] to [Off] and select the filter mode
as required.
8-10
8.5.7 Selecting ECG Waves for Display
In the all parameters screen, the patient monitor allows up to three ECG to be displayed
simultaneously.
When monitoring with a 5-lead set, you can select [Waveforms] in the ECG setup menu
and then select either one, or two, or three waves for display. When you select three ECG
waves for display, there must be one ECG wave that will be displayed permanently on the
screen. For 5-lead ECG monitoring, the permanently displayed ECG wave is lead V, and for
12-lead ECG monitoring, the permanently displayed one is lead V1.
8.5.8 Changing ECG Wave Settings
To change a wave’s settings, select the wave you want to change to enter its lead menu.
„
If the wave is too small or clipped, you can change its size by selecting an appropriate
[Gain] setting. If you select [Auto] from [Gain], the patient monitor will automatically
adjust the size of the ECG waves. In the all parameters screen, only the selected ECG
wave’s size is adjusted. In other screens, all ECG waves’ size is adjusted
simultaneously.
„
You can adjust a wave’s position by adjusting the
Wave] button.
„
You can restore a wave to its original position by selecting [Back to Default].
or
button beside [Adjust
8.5.9 Choosing an ECG Lead for HR Computing and Arrh.
Monitoring
For the Basic algorithm, to compute HR and to analyze and detect arrhythmia more
accurately, you can choose a lead of best quality signals as the HR lead. To select a lead as
the HR lead, in the all parameters screen, select the wave corresponding to the HR
parameter to enter its lead menu. In the lead menu, select [HR Source] and then select the
lead you want.
The selected lead should have the following characteristics:
„
The QRS should be tall and narrow, with no notch
„
R-wave should be either completely above or below the baseline and it should not be
biphasic.
„
The height of pace pulses should not be above R-wave
„
T-wave should be smaller than 1/3 R-wave height.
„
The P-wave should much smaller than the T-wave.
8-11
For the Mortara algorithm, the system will analyze ECG waveforms from multiple channels
simultaneously so as to compute HR and to analyze and detect arrhythmia.
8.5.10 Adjusting QRS Volume
When HR is selected as the alarm source, QRS sounds are produced based on the HR. To
adjust the QRS volume, select [Beat Vol] in the [ECG Setup] menu and select the
appropriate setting. When a valid SpO2 measured value is available, the system adjusts the
pitch tone of QRS volume based on the SpO2 value.
8.6 About ST Monitoring
„
ST segment analysis is intended for adult patients. The default setting is off.
„
ST segment analysis calculates ST segment elevations and depressions for a specified
lead.
„
Measurement unit of the ST segment: mm or mV.
„
A positive value indicates ST segment elevation; a negative value indicates ST
segment depression.
„
Measurement range of the ST segment: -2.0 mV to +2.0 mV.
WARNING
z
The ST algorithm has been tested for accuracy of the ST segment data. The
significance of the ST segment changes needs to be determined by a clinician.
8.6.1 Switching ST On and Off
To switch ST monitoring on or off:
1.
Select the ECG parameter window and then select [ST Analysis >>] from the popup
menu.
2.
Select [ST Analysis] to toggle between [On] and [Off].
Reliable ST monitoring can hardly be ensured if:
„
You are unable to get a lead that is not noisy.
„
Arrhythmias such as atrial fib/flutter cause irregular baseline.
„
The patient is continuously and ventricularly paced.
„
The patient has left bundle branch block.
In these cases, you may consider switching ST monitoring off.
8-12
8.6.2 Changing ST Filter Settings
When ST-segment analysis is performed, dedicated filters are used to ensure the diagnostic
quality. When ST-segment analysis is switched on, [Filter] switches to [Diagnostic]
automatically when it is not in the diagnostic mode.
8.6.3 Understanding the ST Display
This example shows ST numerics with 5-lead ECG. Your monitor screen may look slightly
different from the illustration.
By selecting the ST parameter window, you can enter the [ST Analysis] menu.
8.6.4 Changing the ST Unit
In the [ST Analysis] menu, you can select [ST Unit] menu to toggle between [mm] and
[mV]. You can also change the ST unit in configuration mode.
8.6.5 Changing the ST Alarm Limits
For 3-lead ECG monitoring, you can directly change the ST alarm limits in the [ST
Analysis] menu. For 5- or 12-lead ECG monitoring, you can select [Adjust ST Limits >>]
from [ST Analysis] and then set the ST alarm limits for each lead.
8-13
8.6.6 Setting ST Alarm Delay Time
You can set ST alarm delay time by selecting [ST Alarm Delay] from [ST Analysis>>].
The following ST alarm delay time is optional: 30s (default), 45s, 1min, 1.5min, 2 min, and
3min.
8.6.7 Adjusting ST Measurement Points
As shown in the figure below, the ST measurement for each beat complex is the vertical
difference between two measurement points with the R-wave peak as the baseline for the
measurement.
R-wave peak
T
P
Isoelectric point
ST measurement point
Difference=ST value
The ISO and ST points need to be adjusted when you start monitoring or if the patient’s
heart rate or ECG morphology changes significantly. Exceptional QRS complexes are not
considered for ST-segment analysis.
WARNING
z
Always make sure that the positions of ST measurement points are appropriate for
your patient.
Basic algorithm
To adjust ST measurement points:
1.
In the [ST Analysis] menu, select [Adjust ST Points >>]. In the [Adjust ST Points]
window, two vertical lines represent the ISO and ST point positions respectively.
2.
Select the
points.
and
arrow keys beside the [ISO] or [ST] to move the measurement
‹
ISO-point (isoelectric): provides baseline for the measurement.
‹
ST: marks the end point of the ST segment analysis.
8-14
Mortara algorithm
1.
In the [ST Analysis] menu, select [Adjust ST Points >>]. In the [Adjust ST Points]
window, three vertical lines represent the ISO, J and ST points’ positions respectively.
2.
Select [View Leads] and use the Knob to select an ECG lead with obvious J point and
R wave.
3.
Select [ISO], [J] or [ST] and then use the Knob to adjust the position of each point.
‹
The ISO-point (isoelectric) position is given relative to the R-wave peak. Position
the ISO-point in the middle of the flattest part of the baseline (between the P and
Q waves or in front of the P wave).
‹
The J-point position is given relative to the R-wave peak and helps locating the
ST-point. Position the J-point at the end of the QRS complex and the beginning of
the ST segment.
‹
The ST-point is positioned a fixed distance from the J-point. Move the J-point to
position the ST-point at the midpoint of the ST segment. Position the ST-point
relative to the J-point at either J+60 or J+80.
8.7 About Arrhythmia Monitoring
Arrhythmia analysis provides information about your patient’s condition, including heart
rate, PVC rate, rhythm and ectopics. The arrhythmia detection is intended for adult and
pediatric patients.
WARNING
z
Arrhythmia analysis program is intended to detect ventricular arrhythmias. It is
not designed to detect atrial or supraventricular arrhythmias. It may incorrectly
identify the presence or absence of an arrhythmia. Therefore, a physician must
analyze the arrhythmia information with other clinical findings.
8-15
8.7.1 Understanding the Arrhythmia Events
Basic algorithm
Arrhythmia message
Description
Asystole
No QRS complex for 4 consecutive seconds (in absence of ventricular
fibrillation or chaotic signals).
Vfib/Vtac
A fibrillatory wave for 4 consecutive seconds. A dominant rhythm of
adjacent Vs and a HR > the V-Tach Heart Rate Limit.
PNP
No pace pulse detected for 1.75 x average R-to-R intervals following a
QRS complex (for paced patients only).
PNC
No QRS complex detected for 300 milliseconds following a pace pulse
(for paced patients only).
PVC
One PVC detected in normal heartbeats.
Couplet
Paired PVCs detected in normal heartbeats.
VT>2
More than 2 consecutive PVCs within the last minute.
Bigeminy
A dominant rhythm of N, V, N, V, N, V.
Trigeminy
A dominant rhythm of N, N, V,N, N, V, N, N, V.
R on T
R on T detected in normal heartbeats.
Missed Beats
No beat detected for 1.75 x average R-R interval for HR <120, or No
beat for 1 second with HR >120 (for non-paced patients only), or No
beat detected for more than the set pause threshold.
Brady
The average heart rate is less than 60 bpm.
Tachy
The average heart rate is greater than 100 bpm.
8-16
Mortara algorithm
Arrhythmia message
Description
Asystole
No QRS complex for 4 consecutive seconds (in absence of ventricular
fibrillation or chaotic signals).
Vfib
Ventricular fibrillation occurs and persists for 6 seconds.
Vtac
Ventricular HR is greater or equal to the preset threshold and the
number of consecutive PVCs is greater than the preset threshold.
PNP
No pace pulse detected for (60*1000/pace rate +90) milliseconds
following a QRS complex or a pacer pulse (for paced patients only).
PNC
No QRS complex detected for 300 milliseconds following a pace pulse
(for paced patients only).
Multif. PVC
More than 2 PVCs of different forms occur in the predefined search
window (3-31).
Couplet
Paired PVCs detected in normal heartbeats.
VT>2
Ventricular HR is greater than or equal to the preset threshold and the
number of PVCs is greater than or equal to 3 but less than the preset
threshold.
Vent. Rhythm
Ventricular HR is less than the preset threshold and the number of
PVCs is greater than or equal to 3.
Bigeminy
A dominant rhythm of N, V, N, V, N, V.
Trigeminy
A dominant rhythm of N, N, V,N, N, V, N, N, V.
R on T
R on T is detected.
Irr. Rhythm
Consistently irregular rhythm
Missed Beats
No beat detected for 1.75x average R-R interval for HR <120, or No
beat for 1 second with HR >120 (for non-paced patients only), or No
beat detected for more than the set pause threshold.
Brady
The HR is less than the set bradycardia low limit.
Tachy
The HR is greater than the set tachycardia high limit.
8-17
8.7.2 Switching Arrhythmia Analysis On and Off
To switch arrhythmia analysis on or off:
1.
Select the ECG parameter window and then select [Arrh. Analysis >>] from the
popup menu.
2.
Select [Arrh. Analysis] to toggle between [On] and [Off].
PVC numeric
When arrhythmia analysis is turned off, the PVC numeric will not be displayed.
8.7.3 Changing Arrhythmia Alarm Settings
To change arrhythmia alarm settings, select the ECG parameter area and then select [Arrh.
Analysis >>]. In the [Arrh. Analysis] menu, you can:
„
switch on or off the alarm for PVCs by selecting [PVCs] and then toggling between
[On] and [Off].
„
set the alarm level, alarm record, and alarm limit for PVCs by selecting [Alm Lev],
[Alm Rec] and [PVCs High] respectively and then selecting the appropriate settings.
„
select [Arrh. Alarm Setup >>] to change alarm settings for individual arrhythmia
events. For Mortara algorithm, Asystole, Vfib and Vtac are exclusively high-level
alarms and their alarm level is unchangeable. Furthermore, these alarms will be
triggered only if their alarm conditions are active, regardless of whether arrhythmia
analysis is switched on.
8.7.4 Changing Arrhythmia Threshold Settings (For Mortara
Only)
Select the ECG parameter window→[Arrh. Analysis >>]→[Arrh. Threshold Setup], and
you can then change threshold settings for some arrhythmia alarms. In case an arrhythmia
violates its threshold, an alarm will be triggered. The asystole delay time relates to
arrhythmia relearning. When HR is less than 30 bpm, it is recommended to set the asystole
delay time to 10 seconds.
8-18
Mortara algorithm
Arrh. event
Range
Default configurations
Interval
Unit
Asys. Delay
2 to 10
NICU: 3
Other departments: 5
1
s
Vtac Rate
100 to 200
NICU: 150
Other departments: 130
5
bpm
Vtac PVC
3 to12
6
1
beats
Multif. PVC’s
Window
3 to 31
15
1
beats
Tachy High
Adult: 100 to 300
Pediatric: 160 to 300
Neonate: 180 to 350
Adult: 100
Pediatric: 160
Neonate: 180
5
bpm
Brady Low
Adult: 15 to 60
Pediatric: 15 to 80
Neonate: 15 to 90
Adult: 60
Pediatric: 80
Neonate: 90
5
bpm
8.7.5 Initiating Arrhythmia Relearning Manually
During ECG monitoring, you may need to initiate an arrhythmia relearning when the
patient’s ECG template changes dramatically. A change in the ECG template could result in:
„
incorrect arrhythmia alarms
„
loss of ST measurement, and/or
„
inaccurate heart rate
Arrhythmia relearning allows the monitor to learn the new ECG template so as to correct
arrhythmia alarms and HR value, and restore ST measurements. To initiate a relearning
manually, select the ECG parameter window→[Arrh. Analysis >>]→[Relearn Arrh.].
When the patient monitor is learning, the message [Arrh. Learning] is displayed in the
technical alarm area.
CAUTION
z
Take care to initiate arrhythmia relearning only during periods of predominantly
normal rhythm and when the ECG signal is relatively noise-free. If arrhythmia
learning takes place during ventricular rhythm, the ectopics may be incorrectly
learned as the normal QRS complex. This may result in missed detection of
subsequent events of V-Tach and V-Fib.
8-19
8.7.6 Automatic Arrhythmia Relearn
Arrhythmia relearning is initiated automatically whenever:
„
The ECG lead or lead label is changed
„
The HR computing lead is changed.
„
The ECG lead is re-connected
„
A new patient is admitted
„
The paced status setting is changed
„
Arrhythmia analysis is switched on.
„
The ECG module becomes active.
„
After the calibration is completed, select [Stop Calibrating ECG]
8.7.7 Reviewing Arrhythmia Events
To review previously happened arrhythmia events, in the [ECG Setup] menu, select [Arrh.
Analysis >>]→[Arrh. Review >>].
In the [Arrh. Review] window, you can:
„
Select [Index] and then set a time as the index for finding your desired arrhythmia
events.
„
Rename an arrhythmia event by selecting the arrhythmia event you want to rename and
then selecting [Rename] to enter a new name for it.
„
Delete an arrhythmia event by selecting the one you want to delete and then selecting
[Delete Event].
„
Have more event selections by selecting
„
After an event is selected, select [Waveforms] and then select
[Scroll] to navigate through the waveforms.
„
Print out the currently displayed arrhythmia waveforms and numerics through the
recorder by selecting [Record].
„
Print out the currently displayed arrhythmia waveforms and numerics through the
printer by selecting [Print].
8-20
,
,
or
.
or
beside
8.8 12-Lead ECG Monitoring
8.8.1 Entering the 12-lead ECG Monitoring Screen
1.
Refer to the section 8.3.3 ECG Lead Placement for placing the electrodes.
2.
Select the ECG parameter window and then set [Lead Set] to [12-Lead], and [ECG
Display] to [12-Lead] in the popup menu.
There are totally 12 ECG waves and 1 rhythm wave displayed on the screen. The rhythm
lead is the HR-derived lead before entering the 12-lead ECG monitoring screen. The ST
numerics are displayed in three groups:
„
ST Ant (anterior): V1, V2, V3, V4
„
ST Inf (inferior):
II, III, aVF, (aVR)
„
ST Lat (lateral):
I, aVL, V5, V6
Although aVR is displayed in the ST Inf group, it is not an inferior lead.
Additionally, the 12-lead ECG monitoring has the following features:
„
The [Filter] mode is fixed to [Diagnostic] and cannot be changed.
„
The
hardkey on the monitor’s front is disabled.
8-21
8.8.2 Interpretation of resting 12-Lead ECG
Interpretation of resting 12-lead ECG is intended for adult patients.
You can only start an interpretation of resting 12-lead ECG 11 seconds after entering the
12-lead ECG monitoring screen. Otherwise, the prompt message [Not enough data.
Cannot analyze.] will be displayed. To start an interpretation of resting 12-lead ECG, select
[Freeze] and then [Analyze]. Then, the following screen will be displayed. In this screen,
you can:
„
Select [Record Result] to print out the interpretation of resting 12-lead ECG results by
the recorder.
„
Select [Record Wave] to print out the interpretation of resting 12-lead ECG results
and waves by the recorder.
„
Select [Print Report] to print out the interpretation of resting 12-lead ECG report by
the printer.
Besides, after selecting [Freeze], you can:
„
Browse the frozen ECG waves by selecting [Scroll] and rotating the Knob, or selecting
the
or
button beside [Scroll].
„
Print out the currently frozen waves by selecting [Record].
8-22
8.8.3 Reviewing Interpretation of resting 12-Lead ECG Results
In the 12-lead ECG monitoring screen, you can review previous interpretation of resting
12-lead ECG results by selecting [Review].
In this review window, you can:
„
Switch between [Results] and [Waveforms] for review.
„
Select
or
to view more results.
„
Select
or
beside [Scroll] to navigate through the waveforms.
„
Delete the currently displayed interpretation of resting 12-lead ECG results by
selecting [Delete].
„
Select [Record] to print out the currently displayed interpretation of resting 12-lead
ECG results by the recorder.
„
Select [Print] to print out the currently displayed interpretation of resting 12-lead ECG
results by the printer.
8-23
FOR YOUR NOTES
8-24
9 Monitoring Respiration (Resp)
9.1 Introduction
Impedance respiration is measured across the thorax. When the patient is breathing, the
volume of air changes in the lungs, resulting in impedance changes between the electrodes.
Respiration rate (RR) is calculated from these impedance changes, and a respiration
waveform appears on the patient monitor screen.
9.2 Safety
WARNING
z
When monitoring the patient’s respiration, do not use ESU-proof ECG cables.
z
If you do not set the detection level for the respiration correctly in manual
detection mode, it may not be possible for the monitor to detect apnea. If you set
the detection level too low, the monitor is more likely to detect cardiac activity, and
to falsely interpret cardiac activity as respiratory activity in the case of apnea.
z
The respiration measurement does not recognize obstructive and mixed apneas. It
only indicates an alarm when a preset time had elapsed since the last detected
breath. Therefore, it cannot be used for diagnostic purpose.
9.3 Placing Resp Electrodes
As the skin is a poor conductor of electricity, preparing the skin is necessary for a good
Respiration signal. You can refer to the ECG section for how to prepare the skin.
As the respiration measurement adopts the standard ECG electrode placement, you can use
different ECG cables (3-lead, 5-lead or 12-lead). Since the respiration signal is measured
between two ECG electrodes, if a standard ECG electrode placement is applied, the two
electrodes should be RA and LA of ECG Lead I, or RA and LL of ECG Lead II.
NOTE
z
To optimize the respiration waveform, place the RA and LA electrodes
horizontally when monitoring respiration with ECG Lead I; place the RA and LL
electrodes diagonally when monitoring respiration with ECG Lead II.
9-1
Lead I
Lead II
9.3.1 Optimizing Lead Placement for Resp
If you want to measure Resp when you are measuring ECG, you may need to optimize the
placement of the two electrodes between which Resp will be measured. Repositioning ECG
electrodes from standard positions results in changes in the ECG waveform and may
influence ST and arrhythmia interpretation.
9.3.2 Cardiac Overlay
Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the
Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct
electrodes placement can help to reduce cardiac overlay: avoid the liver area and the
ventricles of the heart in the line between the respiratory electrodes. This is particularly
important for neonates.
9.3.3 Abdominal Breathing
Some patients with restricted movement breathe mainly abdominally. In these cases, you may
need to place the left leg electrode on the left abdomen at the point of maximum abdominal
expansion to optimize the respiratory wave.
9-2
9.3.4 Lateral Chest Expansion
In clinical applications, some patients (especially neonates) expand their chests laterally,
causing a negative intrathoracic pressure. In these cases, it is better to place the two
respiration electrodes in the right midaxillary and the left lateral chest areas at the patient’s
maximum point of the breathing movement to optimize the respiratory waveform.
9.4 Understanding the Resp Display
Gain
Resp lead label
Respiration rate
The waveform area and the parameter area are unnecessarily in horizontally parallel. By
selecting the waveform area, you can enter the [Resp Waveform] menu. By selecting the
Resp parameter window, you can enter the [Resp Setup] menu.
NOTE
z
Respiration monitoring is not for use on the patients who are very active, as this
will cause false alarms.
9.5 Changing Resp Settings
9.5.1 Choosing the Respiration Lead
In the [Resp Waveform] menu, select [Lead] and toggle between [I] and [II].
9.5.2 Setting the Apnea Alarm Delay
The apnea alarm is a high-level alarm used to detect apneas. You can set the apnea alarm
delay time after which the patient monitor alarms if the patient stops breathing. In the [Resp
Setup] menu, select [Apnea Time] and then select the appropriate setting.
9-3
9.5.3 Changing Resp Detection Mode
In the [Resp Waveform] menu, select [Detection Mode] and toggle between [Auto] and
[Manual].
„
In auto detection mode, the patient monitor adjusts the detection level automatically,
depending on the wave height and the presence of cardiac artifact. Note that in auto
detection mode, the detection level (a dotted line) is not displayed on the waveform.
Use auto detection mode for situations where:
„
‹
The respiration rate is not close to the heart rate.
‹
Breathing is spontaneous, with or without continuous positive airway pressure
(CPAP).
‹
Patients are ventilated, except patients with intermittent mandatory ventilation
(IMV).
In manual detection mode, you adjust the dotted detection level line to the desired level
by selecting [Upper Line] or [Lower Line] and then selecting
or
beside them.
Once set, the detection level will not adapt automatically to different respiration depths.
It is important to remember that if the depth of breathing changes, you may need to
change the detection level.
Use manual detection mode for situations where:
‹
The respiration rate and the heart rate are close.
‹
Patients have intermittent mandatory ventilation.
‹
Respiration is weak. Try repositioning the electrodes to improve the signal.
In Auto Detection Mode, if you are monitoring Resp and ECG is switched off, the monitor
cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection
level is automatically set higher to prevent the detection of cardiac overlay as respiration.
In Manual Detection Mode, cardiac overlay can in certain situations trigger the respiration
counter. This may lead to an false indication of a high respiration or an undetected apnea
condition. If you suspect that cardica overlay is being registered as breathing activity, raise
the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising
the detection level is not possible, you may need to optimize the electrode placement as
described in the section "Lateral Chest Expansion".
9-4
9.5.4 Changing the Size of the Resp Wave
WARNING
z
When monitoring in manual detection mode, make sure to check the respiration
detection level after you have increased or decreased the size of the respiration
wave.
Select the Resp wave to enter the [Resp Waveform] menu. Then, you can select [Gain] and
then select an appropriate setting. The bigger the gain is, the larger the wave amplitude is.
9-5
FOR YOUR NOTES
9-6
10 Monitoring PR
10.1 Introduction
The pulse numeric counts the arterial pulsations that result from the mechanical activity of
the heart. You can display a pulse from any measured SpO2 or any arterial pressure (see the
IBP section). The displayed pulse numeric is color-coded to match its source.
2
1
3
1.
Alarm Limits
2.
PR Source
3.
PR: detected pulsations per minute.
10.2 Changing PR Settings
10.2.1 Setting the PR Source
The current pulse source is displayed in the PR parameter area. The pulse rate chosen as
pulse source:
„
is monitored as system pulse and generates alarms when you select PR as the active
alarm source.
„
is stored in the monitor’s database and reviewed in the graphic/tabular trends. In trend
graphs, as the PR curve is in the same color with the PR source, it is unlikely to
distinguish the PR source.
„
is sent via the network to the central monitoring system, if available.
To set which pulse rate as PR source:
1.
Enter the [PR Setup] menu.
2.
Select [PR Source] and then select a label or [Auto] from the popup menu.
The popup menu displays the currently available PR sources from top to bottom by priority.
When you select [Auto], the system will automatically select the first option as the PR source
from the popup menu. When the current PR source is switched off, the system will
automatically switch [PR Source] to [Auto]. When you select [IBP], the system will
automatically select the first pressure label as the PR source from the popup menu.
10-1
10.2.2 Selecting the Active Alarm Source
In most cases the HR and PR numerics are identical. In order to avoid simultaneous alarms
on HR and Pulse, the monitor uses either HR or Pulse as its active alarm source. To change
the alarm source, select [Alm Source] in the [ECG Setup] or [PR Setup] menu and then
select either:
„
[HR]: if you want the HR to be the alarm source for HR/PR.
„
[PR]: if you want the PR to be the alarm source for HR/PR.
„
[Auto]: If the [Alm Source] is set to [Auto], the monitor will use the heart rate from the
ECG measurement as the alarm source whenever the ECG measurement is switched on
and a valid heart rate is available. If the heart rate becomes unavailable, for example if
leads becomes disconnected, and a pulse source is switch on and available, the monitor
will automatically switch to Pulse as the alarm source. When the Leads Off condition is
corrected, the monitor will automatically switch back to the heart rate as the alarm
source.
10.2.3 Adjusting QRS Volume
When PR is used as the alarm source, the PR source will be used as a source for the QRS
tone. You can change the QRS volume by adjusting [Beat Vol] in the [PR Setup] menu.
When a valid SpO2 value exists, the system will adjust the pitch of QRS tone according to the
SpO2 value.
10-2
11 Monitoring SpO
2
11.1 Introduction
SpO2 monitoring is a non-invasive technique used to measure the amount of oxygenated
haemoglobin and pulse rate by measuring the absorption of selected wavelengths of light.
The light generated in the probe passes through the tissue and is converted into electrical
signals by the photodetector in the probe. The SpO2 module processes the electrical signal
and displays a waveform and digital values for SpO2 and pulse rate. This device is calibrated
to display functional oxygen saturation. It provides four measurements:
1
2
3
4
1.
Pleth waveform (Pleth): visual indication of patient’s pulse. The waveform is
normalized.
2.
Oxygen saturation of arterial blood (SpO2): percentage of oxygenated hemoglobin in
relation to the sum of oxyhemoglobin and deoxyhemoglobin.
3.
Perfusion indicator: the pulsatile portion of the measured signal caused by arterial
pulsation.
4.
Pulse rate (derived from pleth wave): detected pulsations per minute.
11-1
11.2 Safety
WARNING
z
Use only SpO2 sensors specified in this manual. Follow the SpO2 sensor’s
instructions for use and adhere to all warnings and cautions.
z
When a trend toward patient deoxygenation is indicated, blood samples should be
analyzed by a laboratory co-oximeter to completely understand the patient’s
condition.
z
Do not use SpO2 sensors during magnetic resonance imaging (MRI). Induced
current could potentially cause burns.
z
Inspect the sensor site every two hours and move the sensor if the skin quality
changes. For neonates, or patients with poor peripheral blood circulation or
sensitive skin, inspect the sensor site more frequently. Prolonged continuous
monitoring may increase the risk of undesirable changes in skin characteristics,
such as irritation, reddening, blistering or necrosis.
11.3 Identifying SpO2 Modules
To identify which SpO2 module is incorporated into your patient monitor, see the company
logo located at the lower left corner on your monitor’s front. If it is:
„
Mindray SpO2 module, there is no logo.
„
Masimo SpO2 module, there is the Masimo SET logo.
„
Nellcor SpO2 module, there is the Nellcor logo.
The connectors for these three SpO2 sensors are mutually exclusive.
11.4 Applying the Sensor
1.
Select an appropriate sensor according to the module type, patient category and weight.
2.
Remove colored nail polish from the application site.
3.
Apply the sensor to the patient.
4.
Select an appropriate adapter cable according to the connector type and plug this cable
into the patient monitor.
5.
Connect the sensor cable to the adapter cable.
11-2
11.5 Changing SpO2 Settings
11.5.1 Adjusting the Desat Alarm Limit
The desat alarm is a high level alarm notifying you of potentially life threatening drops in
oxygen saturation. To adjust the desat alarm limit, select [Desat Limit] in the [SpO2 Setup]
menu and then adjust the limit. When the SpO2 value is below the desat alarm limit, the
message [SpO2 Desat] is displayed.
11.5.2 Setting SpO2 Sensitivity
For Masimo SpO2 module, you can set [Sensitivity] to [Normal] or [Maximum] in the
[SpO2 Setup] menu. When the [Sensitivity] is set to [Maximum], the patient monitor is
more sensitive to minor signals. When monitoring critically ill patients whose pulsations are
very weak, it is strongly recommended that the sensitivity is set to [Maximum]. When
monitoring neonatal or non-critically ill patients who tends to move a lot, noise or invalid
signals may be caused. In this case, it is recommended that the sensitivity is set to [Normal]
so that the interference caused by movement can be filtered and therefore the measurement
stability can be ensured.
11.5.3 Changing Averaging Time
The SpO2 value displayed on the monitor screen is the average of data collected within a
specific time. The shorter the averaging time is, the quicker the patient monitor responds to
changes in the patient’s oxygen saturation level. Contrarily, the longer the averaging time is,
the slower the patient monitor responds to changes in the patient’s oxygen saturation level,
but the measurement accuracy will be better. When monitoring critically ill patients, selecting
shorter averaging time will help understanding the patient’s state.
To set the averaging time:
„
For Mindray SpO2 module, select [Sensitivity] in the [SpO2 Setup] menu and then
toggle between [High], [Med] and [Low], which respectively correspond to 7 s, 9 s and
11 s.
„
For Masimo SpO2 module, select [Averaging] in the [SpO2 Setup] menu and then
toggle between [2-4 s], [4-6 s], [8 s], [10 s], [12 s], [14 s] and [16 s].
„
For Nellcor SpO2 module, select [Averaging] in the [SpO2 Setup] menu and then
toggle between [8 s] and [16 s].
11-3
11.5.4 Monitoring SpO2 and NIBP Simultaneously
When monitoring SpO2 and NIBP on the same limb simultaneously, you can switch [NIBP
Simul] on in the [SpO2 Setup] menu to lock the SpO2 alarm status until the NIBP
measurement ends. If you switch [NIBP Simul] off, low perfusion caused by NIBP
measurement may lead to inaccurate SpO2 readings and therefore cause false physiological
alarms.
11.5.5 Sat-Seconds Alarm Management
With traditional pulse oximetry alarm management, high and low alarm limits are set for
monitoring oxygen saturation. During monitoring, as soon as a limit is violated, an alarm is
triggered. When the patient % SpO2 fluctuates near an alarm limit, the alarm sounds each
time the limit is violated. Such frequent alarm can be distracting. Nellcor’s Sat-Seconds
alarm management technique is used to reduce these nuisance alarms.
The Sat-Seconds feature is available with the Nellcor SpO2 module to decrease the likelihood
of false alarms caused by motion artifacts. To set the Sat-Seconds limit, select [Sat-Seconds]
in the [SpO2 Setup] menu and then select the appropriate setting.
With Sat-Seconds alarm management, high and low alarm limits are set in the same way as
traditional alarm management. A Sat-Seconds limit is also set. The Sat-Seconds limit controls
the amount of time that SpO2 saturation may be outside the set limits before an alarm sounds.
The method of calculation is as follows: the number of percentage points that the SpO2
saturation falls outside the alarm limit is multiplied by the number of seconds that it remains
outside the limit. This can be stated as the equation:
Sat-Seconds= Points × Seconds
Only when the Sat-Seconds limit is reached, the monitor gives a Sat-Seconds alarm. For
example, the figure below demonstrates the alarm response time with a Sat-Seconds limit set
at 50 and a low SpO2 limit set at 90%. In this example, the patient % SpO2 drops to 88% (2
points) and remains there for 2 seconds. Then it drops to 86% (4 points) for 3 seconds, and
then to 84% (6 points) for 6 seconds. The resulting Sat-Seconds are:
% SpO2
2×
4×
6×
Seconds
2=
3=
6=
Sat-Seconds
4
12
36
Total Sat-Seconds=
52
11-4
After approximately 10.9 seconds, a Sat-Second alarm would sound, because the limit of 50
Sat-Seconds would have been exceeded.
SpO2%
Seconds
Saturation levels may fluctuate rather than remaining steady for several seconds. Often, the
patient % SpO2 may fluctuate above and below an alarm limit, re-entering the non-alarm
range several times. During such fluctuation, the monitor integrates the number of %SpO2
points, both positive and negative, until either the Sat-Seconds limit is reached, or the
patient%SpO2 re-enters the non-alarm range and remains there.
11.5.6 Pitch Tone
The pitch tone function enables the patient monitor to give a variable pitch of the heart beat
tone or pulse beat tone as the patient’s saturation level changes. This monitor provides 22
levels of pitch tone. The pitch of the heart rate tone or pulse rate tone rises as the saturation
level increases and falls as the saturation level descreases. There are two pitch tone modes:
[Mode 1] and [Mode 2], of which you can select either in configuration mode. The pitch tone
volume can be changed in certain measurements’ setup menu. If PR is selected as the alarm
source in the [ECG Setup] menu, the pitch tone volume is subject to the pulse beat tone.
Otherwise, the pitch tone volume is subject to the heart beat tone. When either the pulse beat
tone or the heart beat tone is set to 0, the pitch tone volume will be muted. If the SpO2 is
disabled, the pitch tone function will be disabled also.
11-5
11.6 Measurement Limitations
If you doubt the measured SpO2, check patient vital signs first. Then check the patient
monitor and SpO2 sensor. The following factors may influence the accuracy of measurement:
„
Ambient light
„
Physical movement (patient and imposed motion)
„
Diagnostic testing
„
Low perfusion
„
Electromagnetic interference, such as MRI environment
„
Electrosurgical units
„
Dysfunctional haemoglobin, such as carboxyhemoglobin (COHb)and methemoglobin
(MetHb)
„
Presence of certain dyes, such as methylene and indigo carmine
„
Inappropriate positioning of the SpO2 sensor, or use of incorrect SpO2
„
Drop of arterial blood flow to unmeaurable level caused by shock, anemia, low
temperature or vasoconstrictor.
11.7 Masimo Information
„
Masimo Patents
This device is covered under one or more of the following U.S.A. patents: 5,758,644,
5,823,950, 6,011,986, 6,157,850, 6,263,222, 6,501,975, 7,469,157 and other applicable
patents listed at: www.masimo.com/patents.htm.
„
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with unauthorized sensors or cables which would, alone, or in combination with
this device, fall within the scope of one or more of the patents relating to this device.
11-6
11.8 Nellcor Information
„
Nellcor Patents
This device is covered under one or more the following U.S. Patents: 4,802,486; 4,869,254;
4,928,692; 4,934,372; 5,078,136; 5,351,685; 5,485,847; 5,533,507; 5,577,500; 5,803,910;
5,853,364; 5,865,736; 6,083,172; 6,463,310; 6,591,123; 6,708,049; Re.35,122 and
international equivalents. U.S.A international patents pending.
„
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with unauthorized replacement parts which would, alone, or in combination with
this device, fall within the scope of one or more of the patents relating to this device.
11-7
FOR YOUR NOTES
11-8
12 Monitoring NIBP
12.1 Introduction
This monitor uses the oscillometric method for measuring the non-invasive blood pressure
(NIBP). This measurement can be used for adults, pediatrics and neonates.
Automatic non-invasive blood pressure monitoring uses the oscillometric method of
measurement. To understand how this method works, we’ll compare it to the auscultative
method. With auscultation, the clinician listens to the blood pressure and determines the
systolic and diastolic pressures. The mean pressure can then be calculated with reference to
these pressures as long as the arterial pressure curve is normal.
Since the monitor cannot hear the blood pressure, it measures cuff pressure oscillation
amplitudes. Oscillations are caused by blood pressure pulses against the cuff. The oscillation
with the greatest amplitude is the mean pressure. This is the most accurate parameter
measured by the oscillometric method. Once the mean pressure is determined, the systolic
and diastolic pressures are calculated with reference to the mean.
Simply stated, auscultation measures systolic and diastolic pressures and the mean pressure is
calculated. The oscillometric method measures the mean pressure and determines the systolic
and diastolic pressures.
As specified by IEC 60601-2-30/EN60601-2-30, NIBP measurement can be performed
during electro-surgery and discharge of defibrillator.
NIBP diagnostic significance must be decided by the doctor who performs the measurement.
NOTE
z
Blood pressure measurements determined with this device are equivalent to those
obtained by a trained observer using the cuff/stethoscope auscultatory method or
an intra-arterial blood pressure measurement device, within the limits prescribed
by the American National Standard, Manual, electronic, or automated
sphygmomanometers.
12-1
12.2 Safety
WARNING
z
Be sure to select the correct patient category setting for your patient before
measurement. Do not apply the higher adult settings for pediatric or neonatal
patients. Otherwise it may present a safety hazard.
z
Do not measure NIBP on patients with sickle-cell disease or any condition where
skin damage has occurred or is expected.
z
Use clinical judgment to determine whether to perform frequent unattended blood
pressure measurements on patients with severe blood clotting disorders because of
the risk of hematoma in the limb fitted with the cuff.
z
Do not use the NIBP cuff on a limb with an intravenous infusion or arterial
catheter in place. This could cause tissue damage around the catheter when the
infusion is slowed or blocked during cuff inflation.
z
If you doubt the NIBP readings, determines the patient’s vital signs by alternative
means and then verify that the monitor is working correctly.
12.3 Measurement Limitations
Measurements are impossible with heart rate extremes of less than 40bpm or greater than
240bpm, or if the patient is on a heart-lung machine.
The measurement may be inaccurate or impossible:
„
If a regular arterial pressure pulse is hard to detect
„
With excessive and continuous patient movement such as shivering or convulsions
„
With cardiac arrhythmias
„
Rapid blood pressure changes
„
Severe shock or hypothermia that reduces blood flow to the peripheries
„
Obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming
from the artery
12-2
12.4 Setting Up the NIBP Measurement
12.4.1 Preparing to Measure NIBP
1.
Power on the monitor.
2.
Verify that the patient category is correct. Change it if necessary.
3.
Plug the air tubing into the NIBP connector.
4.
Select a correct sized cuff and then apply it as follows:
5.
‹
Determine the patient’s limb circumference.
‹
Select an appropriate cuff by referring to the limb circumference marked on the
cuff. The width of the cuff should be 40% (50% for neonates) of the limb
circumference, or 2/3 of the upper arm’s length. The inflatable part of the cuff
should be long enough to encircle at least 50% to 80% of the limb.
‹
Apply the cuff to an upper arm or leg of the patient and make sure the Φ marking
on the cuff matches the artery location. Do not wrap the cuff too tightly around the
limb. It may cause discoloration, and ischemia of the extremities. Make sure that
the cuff edge falls within the marked range. If it does not, use a larger or smaller
cuff that will fit better.
Connect the cuff to the air tubing and make sure that the bladder inside the cover is not
folded and twisted.
NOTE
z
The use of the equipment is restricted to one patient at a time.
12.4.2 Starting and Stopping Measurements
You can start and stop measurements by using the
hardkey on the monitor’s front.
12.4.3 Correcting the Measurement if Limb is not at Heart
Level
The cuff should be applied to a limb at the same level as the patient’s heart. If the limb is not
at the heart level, to the displayed value:
„
Add 0.75 mmHg (0.10 kPa) for each centimeter higher, or
„
Deduct 0.75 mmHg (0.10 kPa) for each centimeter lower.
12-3
12.5 Measurement Methods
There are three methods of measuring NIBP:
„
Manual: measurement on demand.
„
Auto: continually repeated measurements at set intervals.
„
STAT: continually rapid series of measurements over a five minute period, then return
to the previous mode.
12.5.1 Enabling NIBP Auto Cycling and Setting the Interval
1.
Select the NIBP parameter window to enter the [NIBP Setup] menu.
2.
Select [Interval] and then select a desired time interval. Selecting [Manual] switches to
manual mode.
3.
Start a measurement manually. The monitor will then automatically repeat NIBP
measurements at the set time interval.
You can also start a measurement by pressing the [Auto NIBP] QuickKey. Then monitor will
then automatically repeat NIBP measurements at the set time interval per current settings.
12.5.2 Starting a STAT Measurement
1.
Select the NIBP parameter window to enter the [NIBP Setup] menu.
2.
Select [NIBP STAT]. The STAT mode initiates 5 minutes of continuous, sequential,
automatic NIBP measurements.
WARNING
z
Continuous non-invasive blood pressure measurements may cause purpura,
ischemia and neuropathy in the limb with the cuff. Inspect the application site
regularly to ensure skin quality and inspect the extremity of the cuffed limb for
normal color, warmth and sensitivity. If any abnormity occurs, move the cuff to
another site or stop the blood pressure measurements immediately.
12-4
12.6 Understanding the NIBP Numerics
The NIBP display shows numerics only as below. Your display may be configured to look
slightly different.
1
4
3
2
5
6
7
8
9
10
1.
Time of last measurement
2.
Time remaining to next measurement
3.
Measurement mode
4.
Unit of pressure: mmHg or kPa
5.
Alarm Limits
6.
Prompt message area: shows NIBP-related prompt messages
7
Systolic pressure
8.
Mean pressure
9.
Diastolic pressure
10. If you have chosen to display PR from NIBP in configuration mode, the PR value will
be displayed at this position after each measurement ends. During the measurement, the
cuff pressure is displayed at this position.
12-5
12.7 Changing NIBP Settings
12.7.1 Choosing NIBP Alarm Source
You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or
in parallel. In the [NIBP Setup], select [Alm Source] and choose from:
„
[Sys]: alarms are given only when the systolic pressure violates the alarm limits.
„
[Dia]: alarms are given only when the diastolic pressure violates the alarm limits.
„
[Mean]: alarms are given only when the mean pressure violates the alarm limits.
„
[Sys&Mean]: alarms are given when the systolic or mean pressure violates the alarm
limits.
„
[Mean&Dia]: alarms are given when the mean or diastolic pressure violates the alarm
limits.
„
[Sys&Dia]: alarms are given when the systolic or diastolic pressure violates the alarm
limits.
„
[All]: alarms are given when the systolic or mean or diastolic pressure violates the alarm
limits.
12.7.2 Displaying NIBP Measurements
You can display one set or multiple sets of NIBP measurements simultaneously. In the [NIBP
Setup] menu, select [Display NIBP] and toggle between [Single-Group] and
[Multi-Group]:
„
[Single-Group]: only the latest set of NIBP measurements is displayed in the NIBP
parameter window.
„
[Multi-Group]: multiple sets of most recent NIBP measurements are displayed below
the waveform area. And PR displayed is derived from NIBP.
You can not display multiple sets of NIBP measurements in some screens such as the big
numerics screen and the 12-lead ECG analysis screen.
12.7.3 Setting the Pressure Unit
In the [NIBP Setup] menu, select [Press. Unit] and toggle between [mmHg] and [kPa].
12-6
12.7.4 Setting the cuff inflation pressure
You can set the initialcuff inflation pressure . In the [NIBP Setup] menu, select [Inflation
Pressure] and then select the appropriate setting.
12.8 Assisting Venous Puncture
You can use the NIBP cuff to cause sub-diastolic pressure to block the venous blood vessel
and therefore help venous puncture.
1.
In the [NIBP Setup] menu, verify that the [Cuff Press.] value is appropriate. Change it
if necessary.
2.
Select [VeniPuncture]
3.
Puncture vein and draw blood sample.
4.
Reselect either [VeniPuncture] or the
hardkey to deflate the cuff. The cuff deflates
automatically after a set time if you do not deflate it.
During measurement, the NIBP display shows the inflation pressure of the cuff and the
remaining time in venous puncture mode.
12.9 Resetting NIBP
If the blood pressure pump works incorrectly but the monitor does not alarm for it, you can
check the pump by resetting it. To reset the pump, select [Reset] from [NIBP Setup].
12.10 NIBP Leakage Test
The NIBP leakage test checks the integrity of the system and of the valve. It is required at
least once every two years or when you doubt the measured NIBP. If the test failed,
corresponding prompt messages will be given. If no message is displayed, it means no
leakage is detected.
Tools required:
„
An adult cuff
„
An air tubing
„
A correct sized cylinder
12-7
Follow this procedure to perform the leakage test:
1.
Set the patient category to [Adu].
2.
Connect the cuff to the NIBP connector on the monitor.
3.
Wrap the cuff around the cylinder as shown below.
Cylinder
Monitor
Connector for
NIBP cuff
Air tubing
Cuff
4.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Maintain NIBP]→[NIBP Leakage Test]. Then,
[Leakage Testing…] is displayed in the NIBP parameter area.
5.
After about 20 seconds, the monitor will automatically deflate. This means the test is
completed.
6.
If the message [NIBP Pneumatic Leak] is displayed, it indicates that the NIBP airway
may have leakages. Check the tubing and connections for leakages. If you ensure that
the tubing and connections are all correct, perform a leakage test again.
If the problem persists, contact your service personnel.
NOTE
z
The leakage test is intended for use to simply determine whether there are leakages
in the NIBP airway. It is not the same as that specified in the EN 1060-3 standard.
12.11 NIBP Accuracy Test
The NIBP accuracy test is required at least once every two years or when you doubt the
measured NIBP.
Tools required:
„
T-shape connector
„
Appropriate tubing
„
Balloon pump
„
Metal Vessel (volume 500±25 ml)
„
Reference manometer (calibrated with accuracy higher than 1 mmHg)
12-8
Follow this procedure to perform the accuracy test:
1.
Connect the equipment as shown.
Manometer
Monitor
Connector for
NIBP cuff
Tubing
Balloon pump
Metal vessel
2.
Before inflation, the reading of the manometer should be 0.If not, disconnect the airway
and reconnect it until the readings is 0.
3.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Maintain NIBP]→[NIBP Accuracy Test].
4.
Compare the manometer values with the displayed values. The difference between the
manometer and displayed values should not be greater than 3 mmHg.
5.
Raise the pressure in the metal vessel to 50 mmHg with the balloon pump. Repeat step 3
and 4.
6.
Raise the pressure in the metal vessel to 200 mmHg with the balloon pump. Repeat step
3 and 4.
If the difference between the manometer and displayed values is greater than 3 mmHg,
contact your service personnel.
12.12 Calibrating NIBP
NIBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated once
every two years by a qualified service professional. Contact your service personnel when a
calibration is necessary.
12-9
FOR YOUR NOTES
12-10
13 Monitoring Temp
13.1 Introduction
This patient monitor allows you to monitor two temperature sites simultaneously and
calculate the temperature difference between them.
13.2 Safety
WARNING
z
Verify that the probe detection program works correctly before monitoring.
Besides, make sure that if you plug out the temperature probe cable from the T1 or
T2 connector, the monitor will trigger a technical alarm and give the alarm
message [T1 Sensor Off] or [T2 Sensor Off] correctly.
z
The temperature measurement functioning should be calibrated every two years,
or as indicated by your standard hospital procedure.
13.3 Making a Temp Measurement
1.
Select an appropriate probe for your patient.
2.
If you are using a disposable probe, connect the probe to the temperature cable.
3
Plug the probe or temperature cable to the temperature connector.
4.
Attach the probe to the patient correctly.
5.
Check that the alarm settings are appropriate for your patient.
13-1
13.4 Understanding the Temp Display
The temperature monitoring is displayed on the monitor as three numerics: T1, T2 and TD.
By selecting this area, you can enter the [Temp Setup] menu.
13.5 Setting the Temperature Unit
In the [Temp Setup] menu, select [Unit] and toggle between [ºC] and [ºF].
13-2
14 Monitoring IBP
14.1 Introduction
The monitor can monitor up to 4 invasive blood pressures and displays the systolic,
diastolic and mean pressures and a waveform for each pressure.
14.2 Safety
WARNING
z
Use only pressure transducers specified in this manual. Never reuse disposable
pressure transducers.
z
Make sure that the applied parts never come into contact with other electric
devices.
z
To reduce the hazard of burns during high-frequency surgical procedure, ensure
that the monitor’s cables and transducers never come into contact with the
high-frequency surgical units.
z
When using accessories, their operating temperature should be taken into
consideration. For details, refer to instructions for use of accessories.
14.3 Setting Up the Pressure Measurement
1.
Plug the pressure cable into the IBP connector.
2.
Prepare the flush solution.
3.
Flush the system to exhaust all air from the tubing. Ensure that the transducer and
stopcocks are free of air bubbles.
WARNING
z
If air bubbles appear in the tubing system, flush the system with the infusion
solution again. Air bubble may lead to wrong pressure reading.
14-1
4.
Connect the pressure line to the patient catheter.
5.
Position the transducer so that it is level with the heart, approximately at the level of
the midaxillary line.
6.
Select the appropriate label.
7.
Zero the transducer. After a successful zeroing, turn off the stopcock to the atmosphere
and turn on the stopcock to the patient.
Heparinised
fluid bag
Pressure
transduce
Valve
Stopcock
Flushing set
Adapter cable for using
disposable transducers
Pressure line
Monitor
WARNING
z
If measuring intracranial pressure (ICP) with a sitting patient, level the transducer
with the top of the patient’s ear. Incorrect leveling may give incorrect values.
14-2
14.4 Understanding the IBP Display
The IBP measurement is displayed on the monitor as a waveform and numeric pressures.
The figure below shows the waveform and numerics for the Art pressure. For different
pressures, this display may be slightly different.
1
1.
2
Waveform
4.
Mean pressure
2.
4
5
Systolic pressure
5.
Pressure unit
3
3.
Diastolic pressure
For venous pressures, the parameter window shows the mean pressure only. For different
pressures, their default units may be different.
When multiple IBP signals are measured, IBP waveforms can be displayed overlappingly in
a two-channel waveform area. All the overlapped waveforms use the same upper, middle,
lower gridline and the same pressure unit. The labels and scale of arterial pressures (except
for PA) are displayed at the left side of the waveform area, and the labels and scale of
venous pressures at the right side of the waveform area.
If ICP and one or more of Art, Ao, BAP, FAP pressures are measured simultaneously, the
ICP parameter area will display numeric cerebral perfusion pressure (CPP), which is
obtained by subtracting ICP from the mean pressure of one of the above-mentioned arterial
pressures.
14-3
14.5 Changing IBP Settings
14.5.1 Changing a Pressure for Monitoring
1.
Select the pressure you want to change to enter its setup menu.
2.
Select [Label] and then select your desired label from the list. The already displayed
labels cannot be selected.
Label
Description
Label
Description
PA
Pulmonary artery pressure
CVP
Central venous pressure
Ao
Aortic pressure
LAP
Left atrial pressure
UAP
Umbilical arterial pressure
RAP
Right atrial pressure
BAP
Brachial arterial pressure
ICP
Intracranial pressure
FAP
Femoral arterial pressure
UVP
Umbilical venous pressure
Art
Arterial blood pressure
P1 to P4
Non-specific pressure label
14.5.2 Choosing the Pressure Alarm Source
You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly
or in parallel. In the setup menu for the pressure, select [Alm Source] and choose from:
„
[Sys]: alarms are given only when the systolic pressure violates the alarm limits.
„
[Dia]: alarms are given only when the diastolic pressure violates the alarm limits.
„
[Mean]: alarms are given only when the mean pressure violates the alarm limits.
„
[Sys&Mean]: alarms are given when the systolic or mean pressure violates the alarm
limits.
„
[Mean&Dia]: alarms are given when the mean or diastolic pressure violates the alarm
limits.
„
[Sys&Dia]: alarms are given when the systolic or diastolic pressure violates the alarm
limits.
„
[All]: alarms are given when the systolic or mean or diastolic pressure violates the
alarm limits.
14-4
14.5.3 Changing Averaging Time
The IBP value displayed on the monitor screen is the average of data collected within a
specific time. The shorter the averaging time is, the quicker the patient monitor responds to
changes in the patient’s blood pressure. Contrarily, the longer the averaging time is, the
slower the patient monitor responds to changes in the patient’s blood pressure, but the
measurement accuracy will be improved. For critically ill patients, selecting shorter
averaging time will help understanding the patient’s state.
To set the averaging time, in the setup menu for the pressure, select [Response] and toggle
between [High], [Med] and [Low]. The corresponding averaging time is about 1 s, 8 s and
12 s respectively.
14.5.4 Setting the Pressure Unit
In the setup menu for the pressure, select [Unit] and toggle between [mmHg], [cmH2O]
and [kPa].
14.5.5 Setting Wave Overlapping
When two or more IBP channels are used, you can have IBP waves overlapped in the same
area for a better view.
In the waveform menu for the pressure, set [Wave Overlapping] as [On].
14.5.6 Setting Up the IBP Wave
In the waveform menu for the pressure, you can:
„
Change the size of the pressure’s waveform by adjusting [Upper Scale], [Middle
Scale] or [Lower Scale].
„
When [Auto Scaling] is set on, the size of the pressure’s waveform will be adjusted
automatically.
When IBP waveforms are overlapped, you can select the overlapped waveforms to enter the
[Overlap IBP Waves] menu. In the [Overlap IBP Waves] menu, you can:
„
In the [Arterial Pressure] and [Venous Pressure] area, adjust [Upper Scale],
[Middle Scale] or [Lower Scale].
„
In the [Select Wave] area, select the IBP waveforms you want to overlap.
14-5
14.6 Measuring PAWP
Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are
affected by fluid status, myocardial contractility, and valve and pulmonary circulation
integrity.
Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter
into the pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the
inflated balloon occludes the artery allowing the monitor to record changes in the
intrathoracic pressures that occur throughout the respiration cycle.
The pulmonary wedge pressure is the left ventricular end diastolic pressure when the airway
pressure and valve function are normal. The most accurate PAWP values are obtained at the
end of the respiration cycle when the intrathoracic pressure is fairly constant and the artifact
caused by respiration is minimal.
14.6.1 Preparing to Measure PAWP
1.
Prepare the same accessories as in the C.O. measurement. Connect the parts such as
catheter, syringe, etc. following the C.O. measurement steps and use the balloon
inflation port.
2.
Connect the PAWP cable into the IBP connector on the monitor. Since PAWP is
measured on PA, selecting [PA] as the IBP label is recommended.
3.
Select the PA parameter window to enter its setup menu. Then, select [PAWP] to enter
the PAWP measurement window. You can also enter the PAWP measurement window
from the P1-P4 parameter window.
14-6
NOTE
z
After entering the PAWP measurement window, the monitor will turn off the PA
alarm automatically.
14-7
14.6.2 Setting Up the PAWP Measurement
1.
Wedge the flotation catheter into the pulmonary artery. Then inflate the balloon and
pay attention to PA waveform changes on the screen.
2.
After obtaining a stable PAWP waveform, press the [Freeze] key to freeze the
waveform and deflate the balloon.
3.
or
You can adjust the PAWP scale to an appropriate position by adjusting
beside the [Adjust] button. Press the [Confirm] key to save one PAWP measurement.
4.
If you need to start a new measurement, select [Next Measure].
WARNING
z
Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate
the balloon for the minimum time necessary to get an accurate measurement.
z
If the PAWP is greater than the PA (systolic), deflate the balloon and report the
incident in accordance with hospital policy. Because the pulmonary artery could be
accidentally ruptured, and the PAWP value derived will not reflect the patient’s
hemodynamic state, but will merely reflect the pressure in the catheter or balloon.
14-8
14.7 Zeroing the Transducer
To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer
in accordance with your hospital policy (at least once per day).Zero whenever:
„
A new transducer or adapter cable is used.
„
You reconnect the transducer cable to the monitor.
„
The monitor restarts.
„
You doubt the readings.
1.
Turn off the stopcock to the patient.
Pressure transducer
3-way stopcock
Pressure adapter cable
Monitor
2.
Vent the transducer to the atmospheric pressure by turning on the stopcock to the air.
3.
In the setup menu for the pressure (e.g. Art), select [Zero Art >>]→[Zero]. During
zero calibration, the [Zero] button appears dimmed. It recovers after the zero
calibration is completed.
4.
After the zero calibration is completed, close the stopcock to the air and open the
stopcock to the patient.
NOTE
z
Your hospital policy may recommend that the ICP transducer is zeroed less
frequently than other transducers.
14-9
FOR YOUR NOTES
14-10
15 Monitoring Cardiac Output
15.1 Introduction
The cardiac output (C.O.) measurement invasively measures cardiac output and other
hemodynamic parameters using the right heart (atria) thermodilution method. A cold
solution of known volume and temperature is injected into the right atrium through the
proximal port of a pulmonary artery (PA) catheter. The cold solution mixes with the blood
in the right ventricle and the change in blood temperature is measured with a thermistor at
the distal end of the catheter in the pulmonary artery. The temperature change is displayed
as a curve in the C.O. split screen, and the monitor calculates the C.O. value from this curve.
The C.O. value is inversely proportional to the area under the curve. As cardiac output
varies continuously, a series of measurements must be carried out to achieve a reliable C.O.
average value. Always use the average of multiple thermodilution measurements for therapy
decisions. The monitor is capable of storing 6 measurements. C.O. monitoring is restricted
to adult patients only.
15.2 Understanding the C.O. Display
The C.O. measurement is displayed on the monitor as numeric C.O. and TB in the C.O.
parameter window as shown below. To enter the [C.O. Setup] menu, select the C.O.
parameter window.
Cardiac output
Temperature unit
Blood temperature
15-1
15.3 Influencing Factors
The factors that affect cardiac output are:
„
temperature of injectate solution,
„
volume of injectate solution,
„
patient’s baseline blood temperature,
„
patient’s inspiratory/expiratory cycle,
„
The degree of the catheter’s distal end in close proximity to the lung,
„
the catheter itself,
„
the patient rhythm and hemodynamic status, and
„
any other rapid IV solutions which are infused while the C.O. measurement is being
performed.
Followings are some technique suggestions to obtain accurate C.O.:
„
Injectate solution must be cooler than the patient’s blood.
„
Inject solution rapidly and smoothly.
„
Inject at end expiration.
„
Wait 1 minute between injections to allow baseline to become stabilized.
15.4 Setting Up the C.O. Measurement
WARNING
z
Use only accessories specified in this manual. Make sure that the accessories never
come into contact with conductive parts.
1.
Connect the C.O. cable to the C.O. connector on the monitor.
2.
Interconnect the patient monitor, catheter and syringe as shown below.
15-2
Injectate
C.O. cable
Patient monitor
PA catheter
Syringe
Stopcock
Hole
In-line probe
Balloon inflation port
Ice water
3.
Check if the height and weight are appropriate for your patient in the [Patient
Demographics] menu. Change if necessary.
4. Select the C.O. parameter window to enter the [C.O. Setup] menu. In the [C.O. Setup]
menu:
5.
‹
Check that the correct computation constant is entered. To change the
computation constant, select [Comp. Const] and then enter the correct value.
When a new catheter is used, the computation constant should be adjusted in
accordance with the manufacturer’s instructions for use.
‹
Switch [Auto Ti] on and the injectate temperature is automatically obtained.
‹
When [Auto Ti] is switched off, you can enter the injectate temperature in the
[Manual Ti] field.
Select [C.O. Measure] to enter the C.O. measurements window.
15-3
E
A
F
B
C
D
A.
Currently measured numeric
B.
Currently measured C.O. curve
C.
Prompt message area
D.
Buttons
E.
Averaged values
F.
Measurement windows
6.
When you see the message [Ready for New Measurement], select the [Start] button
and then inject the solution within 4 seconds. As shown in the figure above, during the
measurement, the currently measured thermodilution curve is displayed. At the end of
the measurement, the thermodilution curve is transferred to one of the 6 measurement
windows and the monitor prompts you to wait for a certain period of time before
starting a new measurement.
7.
Repeat step 6 until you have completed the measurements you want to perform. A
maximum of 6 measurements can be stored. If you perform more than six
measurements without rejecting any, the oldest will be automatically deleted when a
seventh curve is stored. After the measurements are completed, you can select from the
6 measurement curves. Then, the system will automatically calculate and display the
averaged C.O. and C.I. values.
When injecting, the stopcock to the PA catheter is open and the stopcock to the injectate
solution is closed. After the measurement is completed, turn off the stopcock to the PA
catheter and turn on the stopcock to the injectate solution, and then draw the injectate
solution into the injectate syringe.
15-4
In the buttons area, you can:
„
Select [Start] to start a C.O. measurement.
„
Select [Stop] to stop the current measurement.
„
Select [Cancel] during a measurement to cancel the measurement. Selecting it after a
measurement deletes the measured results.
„
Select [X-Scale] to adjust the scale of the X-axis. Options for scale range are 30 s and
60 s.
„
Select [Y-Scale] to adjust the scale of the Y-axis. Options for scale range are 0.5ºC,
1ºC and 2.0ºC.
„
Select [Record] to print out the most recently-measured curve and numerics by the
recorder.
„
Select [Setup >>] to access the [C.O. Setup] menu.
„
Select [Calc >>] to access the [Hemodynamic Calculation] menu.
NOTE
z
During the cardiac output measurement, blood temperature alarms are inactive.
15.5 Measuring the Blood Temperature
As shown below, the blood temperature is measured with a thermistor at the distal end of
the catheter in the pulmonary artery. During C.O. measurements, blood temperature alarms
are suppressed to avoid false alarms. They will automatically recover as soon as the C.O.
measurements are completed.
Pulmonary artery
PA catheter
Balloon
Right atrium
Thermistor
Right ventricle
15-5
15.6 Changing C.O. Settings
15.6.1 Setting the Temperature Unit
In the [C.O. Setup] menu, select [Temp Unit] to toggle between [ºC] and [ºF].
15.6.2 Setting the Interval between Measurements
To avoid inaccurate measurements, a certain period of time should be allowed for the blood
temperature to become stable before starting a new measurement. To set the interval
between two measurements, in the [C.O. Setup] menu, select [Interval (s)] and enter an
appropriate value. Every time when a measurement is completed, the monitor will count
down the remaining time and give corresponding prompt messages. A new measurement
will not start until the time is elapsed.
15-6
16 Monitoring Carbon Dioxide
16.1 Introduction
CO2 monitoring is a continuous, non-invasive technique for determining the concentration of
CO2 in the patient’ airway by measuring the absorption of infrared (IR) light of specific
wavelengths. The CO2 has its own absorption characteristic and the amount of light passing
the gas probe depends on the concentration of the measured CO2. When a specific band of IR
light is passed through respiratory gas samples, some of IR light will be absorbed by the CO2
molecules. The amount of IR light transmitted after it has been passed through the respiratory
gas sample is measured with a photodetector. From the amount of IR light measured, the
concentration of CO2 is calculated
There are two methods for measuring CO2 in the patient’s airway:
1.
Mainstream measurement uses a CO2 sensor attached to an airway adapter directly
inserted into the patient’s breathing system.
2.
Sidestream/Microstream measurement samples expired patient gas at a constant sample
flow from the patient’s airway and analyzes it with a CO2 sensor built into the CO2
module.
The measurement provides:
1.
A CO2 waveform.
2.
End tidal CO2 value (EtCO2): the CO2 value measured at the end of the expiration phase.
3.
Fraction of inspired CO2 (FiCO2): the smallest CO2 value measured during inspiration.
4.
Airway respiration rate (awRR): the number of breaths per minute, calculated from the
CO2 waveform.
16-1
16.2 Preparing to Measure CO2
16.2.1 Using a Sidestream CO2 Module
1.
Attach the watertrap to the module and then connect the CO2 components as shown
below.
Watertrap fixer
Sampling line
Watertrap
2.
By default, the sidestream CO2 module is in standby mode. Access the [CO2 Setup]
menu to set [Operating Mode] to [Measure]. The [CO2 Startup] message appears on
the screen.
3.
After start-up is finished, the CO2 module needs time to warm up to reach the operating
temperature. The message [CO2 Sensor Warmup] is displayed. If you perform CO2
measurements during warm-up, the measurement accuracy may be compromised.
4.
After warm-up is finished, you can perform CO2 measurements.
NOTE
z
To extend the lifetime of the watertrap and module, disconnect the watertrap and
set the operating mode to standby mode when CO2 monitoring is not required.
16-2
CAUTION
z
The watertrap collects water drops condensed in the sampling line and therefore
prevents them from entering the module. If the collected water reaches a certain
amount, you should drain it to avoid blocking the airway.
z
The watertrap has a filter preventing bacterium, water and secretions from
entering the module. After a long-term use, dust or other substances may
compromise the performance of the filter or even block the airway. In this case,
replace the watertrap. It is recommended to replace the watertrap once every two
months, or when the watertrap is found leaky, damaged or contaminated.
16.2.2 Using a Microstream CO2 module
1.
Connect the sampling line to the module and then connect the CO2 components as
shown below.
Connector for sampling line
Sampling line
2.
By default, the microstream CO2 module is in measure mode. The message [CO2
Sensor Warmup] appears on the screen when the CO2 module is plugged.
3.
After warm-up, you can perform CO2 measurements.
16-3
16.2.3 Using a Mainstream CO2 module
1.
Connect the sensor to the module.
2.
By default, the microstream CO2 module is in measure mode. The message [CO2
Sensor Warmup] appears on the screen when the CO2 module is plugged.
3.
After warm-up is finished, connect the transducer to the airway adapter.
4.
Perform a zero calibration per the Zeroing the Sensor section.
5.
After the zero calibration is finished, connect the airway as shown below.
Connect to the
monitor
Sensor
Airway adapter
Connect to the patient
6.
Make sure there are no leakages in the airway and then start a measurement.
NOTE
z
Always position the sensor with the adapter in an upright position to avoid
collection of fluids on the windows of the adapter. Large concentrations of fluids at
this point will obstruct gas analysis.
16-4
16.3 Changing CO2 Settings
16.3.1 Entering the Standby Mode
The standby mode of the CO2 module relates to the standby mode of the monitor as follows:
„
If the monitor enters the standby mode, the CO2 module will also enter the standby
mode.
„
If the monitor exits the standby mode, the CO2 module will also exit the standby mode.
„
If the CO2 module enters or exits the standby mode, it will not affect the monitor.
To enter or exit the standby mode manually, select [Operating Mode] in the [CO2 Setup]
menu and toggle between [Standby] and [Measure].
For the microstream CO2 module, you can set a period of time after which the CO2 module
enters the standby mode if no breath is detected since the CO2 module is powered on or the
CO2 module switches to the measure mode or the automatic standby time is re-set. To set the
standby time, in the [CO2 Setup] menu, select [Auto Standby (min)] and then select the
appropriate setting.
16.3.2 Setting the Pressure Unit
In the [CO2 Setup] menu, select [Press. Unit] and toggle between [mmHg], [%] and [kPa].
16.3.3 Setting up Gas Compensations
WARNING
z
Make sure that the appropriate compensations are used. Inappropriate
compensations may cause inaccurate measurement values and result in
misdiagnosis.
For the sidestream CO2 module:
1.
Select [CO2 Setup].
2.
According to the actual condition, set the concentration required for the following
compensations:
‹
[O2 Compen]
‹
[N2O Compen]
‹
[Des Compen]
16-5
For the microstream CO2 module, gas compensations are not required.
For the maintream CO2 module, in the [CO2 Setup] menu, respectively select:
„
[Balance Gas] and toggle between [Room Air], [N2O] and [He]. Select [Room Air]
when air predominates in the ventilation gas mixture, [N2O] when N2O predominates in
the ventilation gas mixture, and [He] when He predominates in the ventilation gas
mixture.
„
[O2 Compen] and then select [Off] or an appropriate setting according to the amount of
O2 in the ventilation gas mixture. When the amount of O2 is less than 30%, you’d better
switch this compensation off.
„
[AG Compen] and enter the concentration of anesthetic gas present in the ventilation
gas mixture. This could compensate for the effect of AG on the readings.
16.3.4 Setting up Humidity Compensation
Sidestream and microstream CO2 modules are configured to compensate CO2 readings for
either Body Temperature and Pressure, Saturated Gas (BTPS), to account for humidity in the
patient’s breath, or Ambient Temperature and Pressure, Dry Gas (ATPD).
1.
ATPD:
Pco 2 (mmHg) = CO2 (vol%) × Pamb / 100
2.
BTPS:
PCO 2 ( mmHg ) = CO2 (vol %) × ( Pamb − 47 ) / 100
Where, PCO 2 = partial pressure, vol % = CO2 concentration, Pamb = ambient pressure, and
unit is mmHg.
As the mainstream CO2 module has a built-in heating component to prevent water vapor from
condensing, setting humidity compensation is not needed. For the sidestream and
microstream CO2 module, you can set the humidity compensation on or off according to the
actual condition. To set the humidity compensation::
1.
In the [CO2 Setup] menu, select [Humidity Compen].
2.
Select either [On] for BTPS or [Off] for ATPD, depending on which compensation
applies.
16-6
16.3.5 Setting the Apnea Alarm Delay
In the [CO2 Setup] menu, select [Adjust CO2 Limits >>] → [Apnea Time] and then select
the appropriate setting. The monitor will alarm if the patient has stopped breathing for longer
than the preset apnea time.
16.3.6 Choosing a Time Interval for Peak-Picking
For microstream and mainstream CO2 modules, you can select a time interval for picking the
highest CO2 as the EtCO2 and the lowest one as the FiCO2.
In the [CO2 Setup] menu, select [Max Hold] and toggle between [Single Breath], [10 s],
[20 s] and [30 s].
„
[Single Breath]: EtCO2 and FiCO2 are calculated for every breath.
„
[10 s], [20 s] or [30 s]: EtCO2 and FiCO2 are calculated using 10, 20 or 30 seconds of
data.
16.3.7 Setting the Flow Rate
For the sidestream CO2 module, you can change the sampling rate of respiratory gas in the
patient’s airway by setting the flow rate. To set the flow rate, enter the [CO2 Setup] menu
and select an appropriate setting from [Flow Rate].
WARNING
z
Consider the patient’s actual bearing capability and select the appropriate flow
rate when setting the flow rate.
16.3.8 Setting up the CO2 Wave
In the [CO2 Waveform] menu, you can:
„
„
Select [Wave Type] and toggle between [Draw] and [Fill].
‹
[Draw]: The CO2 wave is displayed as a curved line.
‹
[Fill]: The CO2 wave is displayed as a filled area.
Change the size of the CO2 waveform by adjusting the wave [Scale].
16-7
16.4 Setting Barometric Pressure Compensation
The mainstream CO2 module does not have the function of automatic barometric pressure
compensation. For the mainstream CO2 module, the default barometric pressure is 760 mmHg.
You must modify the barometric pressure based on the actual situation as follows:
1.
In the main menu, select [Maintenance >>] → [User Maintenance >>] → enter the
required password and then select [Maintain CO2] from the popup menu.
2.
Select [Barometric Pressure] and then enter the value of barometric pressure to which
the patient monitor is exposed to.
WARNING
z
Be sure to set the altitude properly before using the mainstream CO2 module.
Improper settings will result in erroneous CO2 reading.
NOTE
z
Both sidestream and microstream CO2 modules are configured with automatic
barometric pressure compensation function.
16.5 Measurement Limitations
The following factors may influence the accuracy of measurement:
„
Leaks or internal venting of sampled gas
„
Mechanical shock
„
Cyclic pressure up to 10 kPa (100 cmH2O)
„
Other sources of interference, if any
16.6 Troubleshooting the Sidestream CO2 Sampling
System
When the sampling system of the sidestream CO2 module works incorrectly, check if the
sampling line is kinked. If not, remove it from the watertrap. If the monitor gives a message
indicating the airway still works incorrectly, it indicates that the watertrap must have been
blocked, and you should replace with a new one. Otherwise, you can determine that the
sampling line must have been blocked. Replace with a new sampling line.
16-8
16.7 Removing Exhaust Gases from the System
WARNING
z
Anesthetics: When using the Sidestream or Microstream CO2 measurement on
patients who are receiving or have recently received anesthetics, connect the outlet
to a scavenging system, or to the anesthesia machine/ventilator, to avoid exposing
medical staff to anesthetics.
To remove the sample gas to a scavenging system, connect an exhaust tube to the gas outlet
connector of the module.
16.8 Zeroing the Sensor
The zero calibration eliminates the effect of baseline drift during CO2 measurement exerted
on the readings and therefore maintains the accuracy of the CO2 measurements.
16.8.1 For Sidestream and Microstream CO2 Modules
For sidestream and microstream CO2 modules, a zero calibration is carried out automatically
when necessary. You can also start a manual zero calibration if necessary. To manually start a
zero calibration, select [Start Zero Cal.] in the [CO2 Setup] menu. Disconnecting the patient
airway is not required when performing a zero calibration.
16.8.2 For Mainstream CO2 Modules
For mainstream CO2 modules, zero the sensor whenever:
1.
A new adapter is used;
2.
You reconnect the sensor to the module;
3.
You see the message [CO2 Zero Required].In this case, check the airway adapter for
any blockage, e.g. mucus, etc. If a blockage is detected, clear or replace the adapter.
To zero the sensor, follow this procedure:
1.
Connect the sensor to the module.
2.
In the [CO2 Setup] menu, set the [Operating Mode] to [Measure]. The message [CO2
Sensor Warmup] is displayed.
16-9
3.
After warm-up is finished, connect the sensor to a clean, dry airway adapter. The adapter
should be vented to the air and isolated from CO2 sources, such as ventilator, the
patient’s breathing, your own breathing, etc.
4.
Select [Start Zero Cal.] in the [CO2 Setup] menu. The message [CO2 Zero Running]
is displayed.
5.
It takes about 15 to 20 seconds. The message disappears when the zero calibration is
completed.
WARNING
z
When perform a zero calibration during the measurement, disconnect the
transducer from the patient’s airway first.
16.9 Calibrating the Sensor
For sidestream or microstream CO2 modules, a calibration should be performed once every
year or when the readings go far beyond the range. For maintream CO2 module, no
calibration is needed. For details, refer to the chapter Maintenance.
16.10 Oridion Information
This trademark is registered in Israel, Japan, German and America.
Oridion Patents
This device and the CO2 sampling consumables designed for use herewith is covered by one
or more of the following USA patents: 4,755,675; 5,300,859; 5,657,750; 5,857,461 and
international equivalents. USA and international patents pending.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with unauthorized CO2 sampling consumables which would, alone, or in
combination with this device, fall within the scope of one or more of the patents relating to
this device and/or CO2 sampling consumable.
16-10
17 Monitoring AG
17.1 Introduction
The anesthetic gas (AG) module measures the patient’s anesthetic and respiratory gases, and
can be integrated into the optional O2 module.
The AG module determines the concentration of certain gases using the infrared (IR) light
absorption measurement. The gases that can be measured by the AG module absorb IR light.
Each gas has its own absorption characteristic. The gas is transported into a sample cell, and
an optical IR filter selects a specific band of IR light to pass through the gas. For multiple gas
measurement, there are multiple IR filters. The higher the concentration of gas in a given
volume the more IR light is absorbed. This means that higher concentration of IR absorbing
gas cause a lower transmission of IR light. The amount of IR light transmitted after it has
been passed though an IR absorbing gas is measured. From the amount of IR light measured,
the concentration of gas present can be calculated.
Oxygen does not absorb IR light as other breathing gases and is therefore measured relying
on its paramagnetic properties.Inside the O2 sensor are two nitrogen-filled glass spheres
mounted on a strong rare metal taut-band suspension. This assembly is suspended in a
symmetrical non-uniform magnetic field. In the presence of paramagnetic oxygen, the glass
spheres are pushed further away from the strongest part of the magnetic field. The strength of
the torque acting on the suspension is proportional to the oxygen concentration. From the
strength of the torque, the concentration of oxygen is calculated.
There are two types of AG modules:
„
AION 02 type, which cannot identify anesthetic gases automatically.
„
AION 03 type, which can identify two anesthetic gases in a mixture automatically and
distinguish between them according to their proportion for display as the primary and
secondary anesthetis agent.
The AG module provides end tidal (Et) and inspired (Fi) values for the following gases:
„
End tidal CO2 value (EtCO2): the CO2 value measured at the end of the expiration phase.
„
N2O.
„
O2 : optional.
„
AA: represents Des (desflurane), Iso (isoflurane), Enf (enflurane), Sev (sevoflurane), or
Hal (halothane).
„
Airway respiration rate (AwRR): the number of breaths per minute (rpm).
17-1
WARNING
z
To avoid explosion hazard, do not use flammable anesthetic agent such as ether
and cyclopropane for this equipment.
NOTE
z
The AG module is configured with automatic barometric pressure compensation
function.
17.2 Preparing to Measure AG
1.
Select an appropriate watertrap according to patient category and attach it to the module.
2.
Connect the gas sample line to the connector of the watertrap.
3.
Connect the other end of the gas sampling line to the patient via the airway adapter.
4.
Connect the exhaust tube to the gas outlet on the module to scavenge the sample gas to
the waste gas disposal system.
AG module
Patient monitor
Airway adapter
Exhaust tube
Gas sampling line
Vent to the patient
5.
The patient monitor prompts [AG Startup].After startup is finished, [AG Warmup] is
prompted. Then the AG module enters the warm up status. After warm-up is finished,
you can perform AG measurements.
17-2
CAUTION
z
Position the airway adapter so that the part connecting to the gas sample line is
pointing upwards. This prevents condensed water from passing into the gas sample
line and causing an occlusion.
z
The watertrap collects water drops condensed in the sampling line and therefore
prevents them from entering the module. If the collected water reaches the time to
empty the watertrap , you should drain it to avoid blocking the airway.
z
The watertrap has a filter preventing bacterium, water and secretions from
entering the module. After a long-term use, dust or other substances may
compromise the performance of the filter or even block the airway. In this case,
replace the watertrap. Replacing the watertrap once a month is recommended.
WARNING
z
Do not apply adult watertrap to the neonate patient. Otherwise, patient injury
could result.
z
Make sure that the connections are tight. Any leak in the system can result in
erroneous readings due to ambient air mixing with patient gases.
z
Using high frequency electrosurgical equipment may increase the risk of skin
burns. In this case, be careful to use antistatic or conductive masks or breathing
tubes.
17-3
17.3 Understanding the AG Display
The AG module can send waves and numerics for all measured anesthetic gases for display
on the monitor, including:
„
CO2, O2, N2O and AA waves
„
awRR: airway respiratory rate
„
MAC: minimal alveolar concentration
„
End tidal (Et) and fraction of inspired (Fi) numerics for CO2, O2, N2O and AA
The patient monitor can display up to four anesthetic gas waveforms simultaneously, which
are CO2, AA, O2 and N2O. When the AG module is AION 03, the AA waveform area displays
the primary anesthetic gas’s waveform, and the parameter area displays end tidal (Et) and
inspired (Fi) values for two anesthetic gases.
When O2 module does not exist, no O2 waveform will be displayed. When O2 module exists,
the O2 waveform will be displayed only when the O2 waveform is currently switched on.
When too many other waveforms are displayed, O2 waveform will not be displayed even if
the O2 waveform is switched on. In this case, you may need to switch off some other
waveforms.
17-4
17.4 MAC Values
Minimum alveolar concentration (MAC) is the minimum concentration of the agent in the
alveoli. It is a basic index to indicate the depth of anesthesia. The standard ISO 21647 defines
MAC as this: alveolar concentration of an inhaled anesthetic agent that, in the absence of
other anesthetic agents and at equilibrium, prevents 50% of patients from moving in response
to a standard surgical stimulus.
Minimum alveolar concentration (MAC) values are listed below:
Agent
DES
ISO
ENF
SEV
HAL
N2O
1 MAC
7.3%*
1.15%
1.7%
2.1%
0.77%
105%**
* The data is taken from a patient of 25 years old.
** indicates 1 MAC nitrous oxide can only be reached in hyperbaric chamber.
NOTE
z
The MAC values shown in the table above are those published by the U.S. Food
and Drug Administration for a healthy 40-year-old adult male patient.
z
In actual applications, the MAC value may be affected by age, weight and other
factors.
The formula to calculate the MAC value is as follows:
N −1
MAC = ∑
i =0
EtAgent i
AgentVoli
Where N is the number of all agents (including N2O) that the AG module can measure,
EtAgenti is the concentration of each agent and AgentVoli is the concentration of each agent
at 1 MAC.
For example, the AG module measures there are 4% of Des, 0.5% of Hal and 50% of N2O in
the patient’s end-tidal gas:
MAC =
4.0% 0.5% 50%
+
+
= 1.67
7.3% 0.77% 105%
NOTE
z
The formula mentioned above is intended for adult patients only.
17-5
17.5 Changing AG Settings
17.5.1 Selecting an Anesthetic Gas for Monitoring
As the AION 02-type module cannot automatically identify 5 anesthetic gases, you need to
select an anesthetic gas before use. To select the anesthetic gas, in the [Gas Setup] menu,
select [Agent] and then select the appropriate setting.
17.5.2 Setting Gas Unit
For N2O and AA, the unit of the measured gas is fixed to “%”.
For EtCO2, select [CO2 Unit] from the [CO2 Setup] menu and toggle between [mmHg], [%]
and [kPa].
For AG module integrating O2 module, you can set [O2 unit] in the [Gas Setup] menu to
[mmHg], [%] or [kPa].
17.5.3 Setting the Apnea Alarm Delay
In the setup menu for any gas, select [Apnea Time] and select the appropriate setting. The
monitor will alarm if the patient has stopped breathing for longer than the preset apnea time.
17.5.4 Changing the Sample Flow Rate
In the setup menu for any gas, select [Flow Rate] and then choose:
„
[200 ml/min], [150 ml/min] or [120 ml/min] for adult and pediatric patients;
„
[120 ml/min], [90 ml/min] or [70 ml/min] for neonatal patients.
17.5.5 Setting up the O2 Compensation
If the AG module does not incorporate the O2 module, you need to manually select [O2
Compen] and then select [Off] or an appropriate setting according to the amount of O2 in the
ventilation gas mixture. When the amount of O2 is less than 30%, you’d better switch this
compensation off.
If the AG module incorporates the O2 module, the system will directly use the O2
concentration detected by the O2 module to make compensation. At this time, the [O2
Compen] in the setup menu for any gas is fixed to [Off].
17-6
17.5.6 Entering the Standby Mode
For the AG module, the default operating mode is measure. When you set the AG module to
the standby mode, the AG gas sample intake pump automatically sets the sample flow rate to
zero. When exiting the standby mode, the AG module continues to work at preset sample
flow rate with no need to warm up again. After nearly 1 minute, the module enters the full
accuracy mode. The standby mode of the CO2 module relates to the standby mode of the
monitor as follows:
„
If the monitor enters the standby mode, the AG module will also enter the standby
mode.
„
If the monitor exits the standby mode, the AG module will also exit the standby mode.
„
If the CO2 module enters or exits the standby mode, it will not affect the monitor.
To enter or exit the standby mode manually, in the agent’s setup menu, select [Operating
Mode] and then toggle between [Standby] and [Measure].You can also set a period of time
after which the AG module enters the standby mode automatically if no breath is detected
since the last detected breath. .To set the standby time, in the agent’s setup menu, select
[Auto Standby] and then select the appropriate setting.
17.5.7 Setting up the AG Wave
Select a gas’ waveform area to enter its waveform menu. In this menu, you can:
„
„
Select [Wave Type] and toggle between [Draw] and [Fill].
‹
[Draw]: The CO2 wave is displayed as a curved line.
‹
[Fill]: The CO2 wave is displayed as a filled area.
Change the size of the waveform by adjusting the [Scale].
17.6 Changing the Anesthetic Agent
If the anesthetic agent administered to the patient changes, a mixture of both gases is detected
by the AG module during the transition. The time needed to complete the exchange depends
on the type of anesthesia (low flow or high flow), and the characteristics of the agents
administered (pharmacokinetics). During the exchange, no prompt message will be given and
MAC value may be inaccurate.
The AION 02-type AG module cannot identify anesthetic agents automatically. Accordingly,
you must change the setting of [Agent] in the corresponding menu to achieve the consistency
between the preset anesthetic agent and the actually used one.
17-7
The AION 03-type AG module can identify two anesthetic agents automatically. When the
proportion of the primary and secondary anesthetic agents in the mixture changes and the
secondary anesthetic agent becomes dominant, the primary and seconday anesthetic agents
will be exchanged for display and a physiological alarm may be triggered.
17.7 Measurement Limitations
The following factors may influence the accuracy of measurement:
„
Leaks or internal venting of sampled gas
„
Mechanical shock
„
Cyclic pressure up to 10 kPa (100 cmH2O)
„
Other sources of interference, if any
17.8 Troubleshooting
17.8.1 When the Gas Inlet is Blocked
If the gas inlet (including watertrap, sampling line and airway adapter) is occluded by
condensed water, the message [AG Airway Occluded] will appear.
To remove the occlusion:
„
Check the airway adapter for an occlusion and replace if necessary.
„
Check the sampling line for an occlusion or kinking and replace if necessary.
„
Check the watertrap for a build up of water. Empty the watertrap. If the problem persists,
replace the watertrap.
17.8.2 When an Internal Occlusion Occurs
Condensed water may enter the module and cause contamination and/or internal occlusions.
In this case, the message [AG Airway Occluded] will be displayed.
To remove the occlusion:
„
Check for any occlusion in the gas inlet and/or outlet system.
„
If the problem persists, internal occlusions may exist. Contact your service personnel.
17-8
17.9 Removing Exhaust Gases from the System
WARNING
z
Anesthetics: When using the AG measurement on patients who are receiving or
have recently received anesthetics, connect the outlet to a scavenging system, or to
the anesthesia machine/ventilator, to avoid exposing medical staff to anesthetics.
To remove the sample gas to a scavenging system, connect an exhaust tube to the gas outlet
connector of the module.
17-9
FOR YOUR NOTES
17-10
18 Freezing Waveforms
During patient monitoring, the freeze feature allows you to freeze the currently displayed
waveforms on the screen so that you can have a close examination of the patient’s status.
Besides, you can select any frozen waveform for recording.
18.1 Freezing Waveforms
1.
To freeze waveforms, select the
hardkey on the monitor’s front,
2.
The system closes the displayed menu (if any), and opens the [Freeze] menu.
3. All displayed waveforms are frozen, i.e. the waveforms stop being refreshed or scrolling.
Data in the parameter area update as usual.
The freeze feature exerts no effect on the split-screen view of minitrends, oxyCRG and other
patients.
18.2 Viewing Frozen Waveforms
To view the frozen waveforms, you can either:
„
Select the [Scroll] button and then rotate the Knob clockwise or counter-clockwise, or
„
Directly select the
touchscreen.
or
beside the [Scroll] button using a mouse or through the
The frozen waveforms will scroll left or right accordingly. And meanwhile, at the lower right
corner of the bottommost waveform, there is an upward arrow. The freeze time is displayed
below the arrow and the initial frozen time is [0 s]. With the waveforms scrolling, the freeze
time changes at intervals of 1 second. This change will be applied for all waveforms on the
screen.
18-1
18.3 Unfreezing Waveforms
To unfreeze the frozen waveforms, you can either:
„
Select [Exit] in the [Freeze] menu,
„
Select the
„
Perform any operation through which the screen will re-arrange or a menu will pop up,
hardkey on the monitor’s front, or
such as plugging in or out a module, pressing the
hardkey, etc.
18.4 Recording Frozen Waveforms
1.
In the [Freeze] menu, select, in turn, [Wave 1], [Wave 2] and [Wave 3] and then select
your desired waveforms.
2.
Select the [Record] button. The selected waveforms and all numerics at the freeze time
are printed out by the recorder.
18-2
19 Review
19.1 Accessing Respective Review Windows
1.
In the main menu, select [Review >>].
2.
Select [Graphic Trends], [Tabular Trends], [NIBP], [Arrh. Events], [Alarms],
[Full Disclosure] or [12-Lead Analysis] to access their respective review windows.
For details about reviewing arrhythmia events and interpretation of resting 12-lead ECG
results, refer to the chapter Monitoring ECG.
19-1
19.2 Reviewing Graphic Trends
In the [Review] menu, select [Graphic Trends] to access the following window.
B
A
C
D
E
F
A.
Parameter combo box
B.
Slider
C.
Parameter value
D.
Parameter scale
E.
Graphic trends
F.
Time axis
In this review window:
„
„
To select parameters for viewing, you can either:
‹
Select respective parameter combo boxes and then select your desired parameters,
or
‹
Select [Trend Group] and then select a group from the popup list, or
‹
Select [Select Parameter>>] and then select your desired parameters from the
popup menu.
You can set the start time of the trends you want to view by selecting [Start Time].
19-2
„
„
You can change the resolution of the trend data by selecting [Interval] and then
selecting the appropriate setting:
‹
[1 s]: select to view up to 1 hours of graphic trends at 1-second resolution.
‹
[5 s]: select to view up to 8 hours of graphic trends at 5-second resolution.
‹
[1 min], [5 min] or [10 min]: select to view up to 96 hours of graphic trends at 1-,
5-, or 10-minute resolution.
To browse the graphic trends, you can either:
‹
Select
or
to move the cursor one step to the left or right to navigate through
the graphic trends, or
‹
Select
or
to move the cursor one page to the left or right to navigate
through the graphic trends.
A time indicating your current position is displayed above the cursor. Measurement
numerics corresponding to the cursor location appear at the left side of the [Graphic
Trends] window, and change as the cursor moves.
„
By selecting the [Record] button, you can print out the currently displayed graphic
trends by the recorder.
„
By selecting the [Print] button, you can print out the currently displayed graphic
trends by the printer.
19-3
19.3 Reviewing Tabular Trends
In the [Review] menu, select [Tabular Trends] to access the following window.
„
„
In this review window: To select parameters for viewing, you can either:
‹
Select [Trend Group] and then select a group from the popup list, or
‹
Select the [Define Group>>] button and then select the parameters you want to
view from the popup menu.
You can set the start time of the trends you want to view by selecting [Start Time].
19-4
„
„
You can change the resolution of the trend data by selecting [Interval] and then
selecting the appropriate setting:
‹
[5 s] or [30 s]: select to view up to 8 hours of tabular trends at 5- or 30-second
resolution.
‹
[1 min], [5 min], [10 min], [30 min] or [1 h]: select to view up to 96 hours of
tabular trends at your selected resolution.
To browse the tabular trends, you can either:
‹
Select
or
beside the horizontal scrollbar to drag the scrollbar left or right to
navigate through the trend database, or
‹
Select
‹
Select
or
beside the vertical scrollbar to drag the scrollbar up or down to
view more measurement values, or
‹
Select
or
or
to scroll left or right to navigate through the trend database.
to scroll up or down to view more measurement values.
„
By selecting the [Record] button, you can print out the currently displayed tabular
trends by the recorder.
„
By selecting
beside the [Record] button, you can access the [Record Setup]
menu and set the start and end time of the tabular trends you want to record. This
feature is not available when reviewing a history patient.
„
By selecting the [Print] button, you can print out the currently displayed tabular trends
by the printer.
19-5
19.4 Reviewing NIBP Measurements
In the [Review] menu, select [NIBP] to access the following window. This window displays
systolic pressure, diastolic pressure, mean pressure, pulse rate and time for each
measurement. Among them, pulse rate comes from NIBP measurements. Besides, the total
number of measurements is displayed at the lower left corner.
In this review window:
„
Up to 6 measurements can be displayed at a time. You can select
the [Scroll] button to view more measurements.
„
By selecting the [Record] button, you can print out the currently displayed NIBP
measurements by the recorder.
„
beside the [Record] button, you can access the [Record Setup]
By selecting
menu and set the start and end time of the tabular trends you want to record. This
feature is not available when reviewing a history patient.
19-6
or
beside
19.5 Reviewing Alarms
When a measurement alarm occurs, all relative measurement numerics at the alarm time and
related waveforms 2, 4 or 8 seconds respectively before and after the alarm trigger time are
stored. To review the stored alarms, select [Review]→[Alarms] to access the following
window. In this window:
„
You can set a time as the index for finding your desired alarm event. If you set a time
that is too early, the earliest alarm event will be recalled. If you set a time that is too
late, the last alarm event will be recalled.
„
You can view the desired measurement alarms by selecting [Event] and then selecting
the measurement whose alarms you want to view. [All] includes all measurements.
„
To select an alarm event for viewing, you can either:
„
‹
Select the
or
button, or
‹
Directly select your desired alarm event on the screen.
Select an alarm event then [Waveforms], and you can enter the following window.
The waveforms related to this alarm event are displayed in the waveform area, and the
parameter values happened at the event moment are displayed in the parameter area.
1
2
1. Waveform area
2. Parameter area
19-7
„
You can select
„
By selecting the [Record] button, you can print out the currently displayed alarm
events by the recorder.
„
By selecting the [Print] button, you can print out the currently displayed alarm events
by the printer.
„
You can select [Full Disclosure] to access the waveform review window. However, if
you do not save waveforms beforehand, the message [Searching Data Failed!] will be
displayed.
or
beside [Scroll] to navigate through the waveforms.
19.6 Reviewing Waveforms
In the [Review] menu, select [Full Disclosure] to access the following window.
A
B
D
C
E
A.
Parameter combo box
B.
Slider
D.
Full-disclosure waveforms
E.
Time axis
19-8
C.
Parameter value
In this review window:
„
Before reviewing full-disclosure waveforms, your monitor must be equipped with an
external storage card (only the CF storage card is supported so far) and you need to
save waveforms first. To review full-disclosure waveforms, select [Save Waves >>]
and then select the parameters whose waveforms you want to view.
„
You can set the start time of the trends you want to view by selecting [Start Time].
„
You can select a waveform you want to view from either parameter combo box.
„
To view the waveforms, you can either:
‹
Select
or
beside the [Scroll] button to move the cursor one step left or right
to navigate through the waveforms, or
‹
Select
or
the waveforms.
to move the cursor one page left or right to navigate through
A time indicating your current position is displayed above the cursor. Measurement
numerics corresponding to the cursor location are displayed at the left side of the
[Waveforms] window, and change as the cursor is moved.
„
You can change the wave gain by selecting [Gain] and then selecting the appropriate
setting. The number of waveforms displayed in this window is subject to the wave
gain.
„
You can change the waveform sweep speed by selecting [Sweep] and then selecting
the appropriate setting.
„
By selecting the [Record] button, you can print out the first three waveforms and
measurement numerics by the recorder.
„
By selecting the [Print] button, you can print out the waveforms and measurement
numerics by the printer.
19-9
FOR YOUR NOTES
19-10
20 Calculations
20.1 Introduction
The calculation feature is available with your patient monitor. The calculated values, which
are not directly measured, are computed based on the values you provide.
Your can perform the following calculations:
„
Dose Calculations
„
Oxygenation Calculations
„
Ventilation Calculations
„
Hemodynamic Calculations
„
Renal Calculations
To perform a calculation, select [Calc >>] in the main menu or the [Calc] QuickKey and
then select the calculation you want to perform.
NOTE
z
The calculation feature is independent of other monitoring functions and can be
therefore used for patients being monitored by other monitors. Any operation in a
calculation window does not affect the patient monitoring by the local patient
monitor.
WARNING
z
After the calculation is finished, verify the entered values are correct and the
calculated values are appropriate. We assume no responsibility for any
consequences caused by wrong entries and improper operations.
20-1
20.2 Dose Calculations
20.2.1 Performing Calculations
1.
In the main menu, select [Calc >>]→[Dose >>].
2.
Select, in turn, [Patient Cat.] and [Drug Name] and then select the appropriate
settings. The dose calculation program has a library of commonly used drugs, of which
Drug A through Drug E are for those not specified in this library.
‹
Drug A, B, C, D, E
‹
Isuprel
‹
Aminophylline
‹
Lidocaine
‹
Dobutamine
‹
Nipride
‹
Dopamine
‹
NItroglycerin
‹
Epinephrine
‹
Pitocin
‹
Heparin
3.
The system gives a set of default values when the above steps are finished. However,
these values cannot be used as the calculated values. The user must enter values
following the doctor’s instructions, and then the calculated values can only be used
4.
Enter the patient’s weight.
5.
Enter other values.
6.
Verify if the calculated values are correct.
20.2.2 Selecting the Proper Drug Unit
Each drug has its fixed unit or unit series. Among a unit series, one unit may change to
another automatically depending on the entered value.
The units for each drug are as follows:
„
Drug A, B, C, Aminophylline, Dobutamine, Dopamine, Epinephrine, Isuprel,
Lidocaine, Nipride and NItroglycerin use the unit series: g, mg and mcg.
„
Drug D, Heparin and Pitocin use the unit series: Unit, KU (kilo units) and MU (million
units).
„
Drug E uses the unit: mEq (milli-equivalents).
You must select the proper drug name (A, B, C, D or E) according to the units when you
define a drug not listed in this library.
20-2
20.2.3 Titration Table
To open the titration table, select [Titration Table >>] in the dose calculation window after
the dose calculation is finished.
In the titration table, when you change:
„
[Reference]
„
[Interval]
„
[Dose Type]
The titrated values change accordingly.
You can also:
„
Select
„
Select [Record] to print out the currently displayed titrated values by the recorder.
or
, or
or
beside the vertical scrollbar to view more values.
20.3 Oxygenation Calculations
20.3.1 Performing Calculations
1.
In the main menu, select [Calc >>]→[Oxygenation >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
The values that exceed the range are displayed in yellow background. You can
select [Range] to view its normal range in the unit field. For those who are within
the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Oxygenation Calculation] window, you can:
„
Change the pressure unit, Hb unit and oxygen content unit by selecting [Press. Unit],
[Hb Unit] and [OxyCont Unit] and then selecting the appropriate settings. The
changes take effect automatically.
„
Trigger a recording by selecting the [Record] button. The currently displayed renal
calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20-3
20.3.2 Entered Parameters
Abbreviation
Unit
Full spelling
C.O.
L/min
cardiac output
FiO2
%
percentage fraction of inspired oxygen
PaO2
mmHg
partial pressure of oxygen in the arteries
PaCO2
mmHg
partial pressure of carbon dioxide in the arteries
SaO2
%
arterial oxygen saturation
PvO2
mmHg
partial pressure of oxygen in venous blood
SvO2
%
venous oxygen saturation
Hb
g/L
hemoglobin
CaO2
ml/L
arterial oxygen content
CvO2
ml/L
venous oxygen content
VO2
ml/min
oxygen consumption
RQ
None
respiratory quotient
ATMP
mmHg
atmospheric pressure
Height
cm
height
Weight
kg
weight
20.3.3 Calculated Parameters
Abbreviation
Unit
Full spelling
BSA
m2
body surface area
VO2 calc
ml/min
oxygen consumption
C(a-v)O2
ml/L
arteriovenous oxygen content difference
O2ER
%
oxygen extraction ratio
DO2
ml/min
oxygen transport
PAO2
mmHg
partial pressure of oxygen in the alveoli
AaDO2
mmHg
alveolar-arterial oxygen difference
CcO2
ml/L
capillary oxygen content
Qs/Qt
%
venous admixture
C.O. calc
L/min
calculated cardiac output
20-4
20.4 Ventilation Calculations
20.4.1 Performing Calculations
1.
In the main menu, select [Calc >>]→[Ventilation >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
The values that exceed the range are displayed in yellow background. You can
select [Range] to view its normal range in the unit field. For those who are within
the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Ventilation Calculation] window, you can:
„
Change the pressure unit by selecting [Press. Unit] and then selecting the appropriate
setting. Corresponding pressure values shall convert and update automatically.
„
Trigger a recording by selecting the [Record] button. The currently displayed renal
calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20.4.2 Entered Parameters
Abbreviation
Unit
Full spelling
FiO2
%
percentage fraction of inspired oxygen
RR
rpm
respiration rate
PeCO2
mmHg
partial pressure of mixed expiratory CO2
PaCO2
mmHg
partial pressure of carbon dioxide in the arteries
PaO2
mmHg
partial pressure of oxygen in the arteries
TV
ml
tidal volume
RQ
None
respiratory quotient
ATMP
mmHg
atmospheric pressure
20-5
20.4.3 Calculated Parameters
Abbreviation
Unit
Full spelling
PAO2
mmHg
partial pressure of oxygen in the alveoli
AaDO2
mmHg
alveolar-arterial oxygen difference
Pa/FiO2
mmHg
oxygenation ratio
a/AO2
%
arterial to alveolar oxygen ratio
MV
L/min
minute volume
Vd
ml
volume of physiological dead space
Vd/Vt
%
physiologic dead space in percent of tidal volume
VA
L/min
alveolar volume
20.5 Hemodynamic Calculations
20.5.1 Performing Calculations
1.
In the main menu, select [Calc >>]→[Hemodynamic >>].
2.
Enter values for calculation.
3.
‹
For a patient who is being monitored, [HR], [Art mean], [PA mean] and [CVP]
are automatically taken from the currently measured values. If you just have
performed C.O. measurements, [C.O.] is the average of multiple thermodilution
measurements. [Height] and [Weight] are the patient’s height and weight you
have entered. If the monitor does not provide these values, their fields appear
blank.
‹
For a patient who is not being monitored, confirm the values you have entered.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
The values that exceed the range are displayed in yellow background. You can
select [Range] to view its normal range in the unit field. For those who are within
the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Hemodynamic Calculation] window, you can:
„
Trigger a recording by selecting the [Record] button. The currently displayed renal
calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20-6
20.5.2 Entered Parameters
Abbreviation
Unit
Full spelling
C.O.
L/min
cardiac output
HR
bpm
heart rate
PAWP
mmHg
pulmonary artery wedge pressure
Art Mean
mmHg
artery mean pressure
PA Mean
mmHg
pulmonary artery mean pressure
CVP
mmHg
central venous pressure
EDV
ml
end-diastolic volume
Height
cm
height
Weight
kg
weight
20.5.3 Calculated Parameters
Abbreviation
C.I.
Unit
Full spelling
2
L/min/m
cardiac index
2
BSA
m
body surface area
SV
ml
stroke volume
SI
ml/m2
stroke index
SVR
DS/cm5
SVRI
2
systemic vascular resistance
5
DS·m /cm
5
systemic vascular resistance index
PVR
DS/cm
pulmonary vascular resistance
PVRI
DS·m2/cm5
pulmonary vascular resistance index
LCW
kg·m
left cardiac work
LCWI
kg·m/m2
left cardiac work index
LVSW
g·m
left ventricular stroke work
2
LVSWI
g·m/m
left ventricular stroke work index
RCW
kg·m
right cardiac work
RCWI
kg·m/m2
right cardiac work index
RVSW
g·m
right ventricular stroke work
2
RVSWI
g·m/m
right ventricular stroke work index
EF
%
ejection fraction
20-7
20.6 Renal Calculations
20.6.1 Performing Calculations
1.
In the main menu, select [Calc >>]→[Renal >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
The values that exceed the range are displayed in yellow background. You can
select [Range] to view its normal range in the unit field. For those who are within
the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Renal Calculation] window, you can:
„
Trigger a recording by selecting the [Record] button. The currently displayed renal
calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20.6.2 Entered Parameters
Abbreviation
Unit
Full spelling
URK
mmol/L
urine pstassium
URNa
mmol/L
urinary sodium
Urine
ml/24h
urine
Posm
mOsm/ kgH2O
plasm osmolality
Uosm
mOsm/ kgH2O
urine osmolality
SerNa
mmol/L
serum sodium
Cr
μmol/L
creatinine
UCr
μmol/L
urine creatinine
BUN
mmol/L
blood urea nitrogen
Height
cm
height
Weight
kg
weight
20-8
20.6.3 Calculated Parameters
Abbreviation
Unit
Full spelling
URNaEx
mmol/24h
urine sodium excretion
URKEx
mmol/24h
urine potassium excretion
Na/K
%
sodium potassium ratio
CNa
ml/24h
clearance of sodium
Clcr
ml/min
creatinine clearance rate
FENa
%
fractional excretion of sodium
Cosm
ml/min
osmolar clearance
CH2O
ml/h
free water clearance
U/P osm
None
urine to plasma osmolality ratio
BUN/Cr
None
blood urea nitrogen creatinine ratio
U/Cr
None
urine-serum creatinine ratio
*:BUN/Cr is a ratio under the unit of mol.
20.7 Understanding the Review Window
With the review feature, you can review oxygenation, ventilation, hemodynamic and renal
calculations. The review window for each calculation is similar. Take the hemodynamic
calculations review window for example, you can access it by selecting [Review] in the
[Hemodynamic Calculation] window.
In this review window:
„
You can select
„
The values that exceed the range are displayed in yellow background. The [Unit] field
displays parameter units. If some parameter values are outside of their normal ranges,
you can view their normal range in the [Unit] field by selecting [Range].
„
You can review an individual calculation by selecting its corresponding column and
then selecting [Original Calc]. You can record the currently displayed calculations or
perform another calculation is this window.
,
or
to view more values.
20-9
FOR YOUR NOTES
20-10
21 Recording
21.1 Using a Recorder
The thermal recorder records patient information, measurement numerics, up to three
waveforms, etc.
2
1
5
3
4
1.
Start/Stop key: press to start a recording or stop the current recording.
2.
Indicator
‹
On: when the recorder works correctly.
‹
Off: when the monitor is switched off.
‹
Flashes: if an error occurred to the recorder, e.g., the recorder runs out of paper.
3.
Paper outlet
4.
Recorder door
5.
Latch
21-1
21.2 Overview of Recording Types
By the way recordings are triggered, the recordings can be classified into the following
categories:
1.
Manually-triggered realtime recordings.
2.
Timed recordings.
3.
Alarm recordings triggered by an alarm limit violation or an arrhythmia event.
4.
Manually-triggered, task-related recordings.
The task-related recordings include:
„
Frozen wave recording
„
Graphic trends recording
„
Tabular trends recording
„
NIBP measurements
„
Parameter alarms
„
Arrh. alarm recording
„
Full-disclosure waveforms
„
12-lead ECG waveforms and analysis results
„
Titration Table
„
Hemodynamic calculations recording
„
Oxygenation calculations recording
„
Ventilation calculations recording
„
Renal calculations recording
„
oxyCRG recording
„
C.O. curve recording
„
PAWP measurements
„
Monitor information recording
NOTE
z
For details about alarm recording, refer to the Alarms chapter.
z
For details about task-related recordings, refer to respective sections of this
manual.
21-2
21.3 Starting and Stopping Recordings
To manually start a recording, you can either:
„
Select the
or
„
Select the [Record] button from the current menu or window.
hardkey on the front of either the patient monitor or the recorder module,
Automatic recordings will be triggered in the following conditions:
„
Timed recordings will start automatically at preset intervals.
„
If both [Alarm] and [Alm Rec] for a measurement are set on, an alarm recording will be
triggered automatically as alarms occur.
To manually stop a recording, you can either:
„
Select the
„
Select [Clear All Tasks] in the [Record Setup] menu.
hardkey again, or
Recordings stop automatically when:
„
The runtime is over.
„
The recorder runs out of paper.
„
When the recorder has an alarm condition.
21.4 Setting up the Recorder
21.4.1 Accessing the Record Setup Menu
Select [Record Setup >>] in the main menu, and you can access the [Record Setup] menu.
21.4.2 Selecting Waveforms for Recording
The recorder can record up to 3 waveforms at a time. You can select, in turn, [Waveform 1],
[Waveform 2] and [Waveform 3] in the record setup menu, and then select the waveforms
you want. You can also turn off a waveform recording by selecting [Off]. These settings are
intended for realtime and scheduled recordings.
21-3
21.4.3 Setting the Realtime Recording Length
The recording time depends on your monitor’s settings when a realtime recording is started.
In the [Record Setup] menu, select [Realtime Rec. Length] and toggle between [8 s] and
[Continuous].
1.
[8 s]: record 8-second waveforms from the current moment.
2.
[Continuous]: record the waveforms from the current moment until stopped manually.
21.4.4 Setting the Interval between Timed Recordings
Timed recordings start automatically at preset intervals. Each recording lasts 8 seconds. To
set the interval between timed recordings, in the [Record Setup] menu, select [Interval] and
then select the appropriate setting.
21.4.5 Changing the Recording Speed
In the [Record Setup] menu, select [Paper Speed] and toggle between [25 mm/s] and [50
mm/s].This setting is for all recordings containing waveforms.
21.4.6 Switching Gridlines On or Off
In the [Record Setup] menu, select [Gridlines] and toggle between [On] and [Off].
1.
[On]: show gridlines when recording waveforms.
2.
[Off]: hide gridlines when recording waveforms.
This setting is for all recordings containing waveforms.
21.4.7 Clearing Recording Tasks
In the [Record Setup] menu, select [Clear All Tasks]. All queued recording tasks are cleared
and the current recording is stopped.
21.5 Loading Paper
1.
Use the latch at the upper right corner of the recorder door to pull the door open.
2.
Insert a new roll into the compartment as shown below.
3.
Close the recorder door.
4.
Check if paper is loaded correctly and the paper end is feeding from the top.
21-4
Paper roll
CAUTION
z
Use only specified thermal paper. Otherwise, it may cause damage to the
recorder’s printhead, the recorder may be unable to print, or poor print quality
may result.
z
Never pull the recorder paper with force when a recording is in process.
Otherwise, it may cause damage to the recorder.
z
Do not leave the recorder door open unless you reload paper or remove troubles.
21.6 Removing Paper Jam
If the recorder works incorrectly or produces unusual sounds, check if there is a paper jam
first. If a paper jam is detected, follow this procedure to remove it:
1.
Open the recorder door.
2.
Take out the paper and tear off the draped part.
3.
Reload the paper and close the recorder door.
21-5
21.7 Cleaning the Recorder Printhead
If the recorder has been used for a long time, deposits of paper debris may collect on the
printhead compromising the print quality and shortening the lifetime of the roller. Follow this
procedure to clean the printhead:
1.
Take measures against the static electricity such as Disposable Wrist Strap for the work.
2.
Open the recorder door and take out the paper.
3.
Gently wipe around the printhead using cotton swabs dampened with alcohol.
4.
After the alcohol has completely been dried, reload the paper and close the recorder
door.
CAUTION
z
Do not use anything that may destroy the thermal element.
z
Do not add unnecessary force to the thermal head.
21-6
22 Printing
22.1 Printer
The monitor can output patient reports via a connected printer. So far, the monitor supports
the following printer:
„
HP LaserJet 1606N
„
HP LaserJet 2035N
„
HP LaserJet 4015N
„
HP LaserJet 1505N
The specifications of the reports the monitor prints are:
„
Paper: A4, Letter
„
Resolution: 300 dpi
„
Print on One/Both Sides: printing on one and both sides are supported if the printer
supports
For more details about the printer, see the document accompanying the printer. With the
upgrading of products, the monitor will support more printers and no prior notice will be
given. If you have any doubt about the printer you have purchased, contact our company.
22.2 Connecting a Printer
To print the reports or the trend data of a patient, you can choose either:
„
the local printer
Connect the printer and the patient monitor using a network cable, and then start printing
what you want, or
„
the Central Monitoring System
If your monitor is connected to a central monitoring system, it is recommended to use
the central monitoring system for printing.
22.3 Setting Up the Printer
To set the printer’s properties, select[Print Setup >>]→[Printer Setup >>] in the main menu.
In the [Printer Setup] menu, you can:
22-1
„
Select a connected printer
Select [Printer] and then select a connected printer as the monitor’s printer.
„
Search for a printer
If your selected printer is not in the list or a new printer is added into the network, you
can select the [Search Printer] to re-search for all printers in the network.
„
Set up the paper
Select [Paper Size] and toggle between [A4] and [Letter].
„
Print on both sides
By default, the monitor prints out patient reports on one side. If you set [Print On Both
Sides] to [On], the monitor will print out patient reports on both sides.
22.4 Starting Report Printouts
Reports
Contents
Procedures
ECG reports
ECG waveforms and relevant
parameter values
Select [Print Setup >>]→[ECG Reports
>>]→[Print] in the main menu.
Tabular trends
Depend on the selected
parameter group, resolution
and time period
Select [Print Setup >>]→[Tabular Trends
Reports >>]→[Print] in the main menu, or
select[Review >>]→[Tabular
Trends]→[Print]→[Print] also in the main
menu.
Graphic trends
Depend on the selected
parameter group, resolution
and time period
Select[Print Setup >>]→[Graphic Trends
Reports >>]→[Print] in the main menu, or
select[Review >>]→[Graphic
Trends]→[Print]→[Print] also in the main
menu.
Arrhythmia
events review
ECG waveforms and relevant
parameter values
Select [Print] in [Arrh. Events]
Parameter alarms
review
Depend on the selected alarms
Select [Review >>]→[Alarms]→[Print] in
the main menu.
Interpretation of
resting 12-lead
ECG
12-lead ECG waveforms and
analysis results
Select [12-Lead Analysis]→[Print Report]
when an interpretation of resting 12-lead
ECG is completed, or select [Review
>>]→[12-Lead Analysis]→[Print] in the
main menu.
Realtime waves
Depend on the selected
waveforms
Select [Print Setup >>]→[ECG Reports
>>]→[Print] in the main menu.
22-2
22.5 Stopping Report Printouts
To stop report printouts, select[Print Setup >>]→[Stop All Reports] in the main menu.
22.6 Setting Up Reports
22.6.1 Setting Up ECG Reports
You can print out ECG reports only under full-screen, half-screen or 12-lead monitoring
screen. To set up ECG reports, select [Print Setup >>]→[ECG Reports >>] in the main
menu.
„
[Amplitude]: set the amplitude of the ECG waveforms.
„
[Sweep]: set the wave print speed.
„
[Auto Interval]: If [Auto Interval] is set to [On], the system will automatically adjust
the space between waveforms to avoid overlapping.
„
[Gridlines]: choose whether to show gridlines.
„
[12-Lead Format]: If you select [12X1], 12 waveforms will be printed on a paper from
top to bottom. If you select [6X2], 12 waveforms will be printed from left to right with 6
waveforms on each side and a rhythm waveform will be printed at the bottommost.
22.6.2 Setting Up Tabular Trends Reports
To set up tabular trends reports, select [Print Setup >>]→[Tabular Trends Reports >>] in
the main menu.
„
Start time: You can set a time period whose trend data will be printed out by setting
[From] and [Back]. For example, if you set [From] as 2007-4-2 10:00:00 and [Back] as
[2 h], the outputted data will be from 2007-4-2 08:00:00 to 2007-4-2 10:00:00. In
addition, the [Back] can be set to either:
‹
[Auto]: If [Report Layout] is set to [Time Oriented], the report will be printed by
time. If [Report Layout] is set to [Parameter Oriented], the report will be printed
by parameters.
‹
[All]: If you select [All], all trend data will be printed out. In this case, it is no need
to set [From].
„
[Resolution]: choose the resolution of the tabular trends printed on the report.
„
[Report Layout]: If you select [Time Oriented], the report will be printed by time. If
you select [Parameter Oriented], the report will be printed by parameters.
22-3
„
[Select Parameter >>]: from the popup menu, you can:
‹
[Currently Displayed Trended Parameters]: print the parameter trend data
selected from the [Tabular Trends].
‹
[Standard Parameter Group]: select the standard parameter group for printing.
‹
[Custom]: You can define a parameter group for printing from the parameters
displayed in the low part of the menu.
22.6.3 Setting Up Graphic Trends Reports
To set up graphic trends reports, select [Print Setup >>]→[Graphic Trends Reports >>] in
the main menu. As setting up graphic trends reports is similar with tabular trends reports, you
can refer to the Setting Up Tabular Trend Reports section for details.
22.6.4 Setting Up Realtime Reports
To set up realtime reports, select [Print Setup >>]→[Realtime Reports >>] in the main
menu.
„
[Sweep]: set the wave print speed.
„
[Select Wave >>]: from the popup menu, you can:
‹
[Current]: select the currently displayed waves for printing.
‹
[Select Wave]: select the desired waves for printing.
22.7 End Case Reports
ECG reports, tabular trends reports, graphic trends reports, NIBP review reports and realtime
reports can be set as end case reports. When you discharge a patient, the system will
automatically print out all contents that are set as end case reports.
For example, to set ECG report as end case report:
1.
select [Print Setup >>]→[ECG Report >>] in the main menu.
2.
select [End Case Report]→[Set as End Case Report] and then select [Ok] from the
popup dialog box.
3.
set as described in the Setting Up ECG Reports section.
22-4
22.8 Printer Statuses
22.8.1 Printer Out of Paper
When the printer runs out of paper, the print request will not be responded. If there are too
many print jobs that are not responded, a printer error may occur. In these cases, you need to
install paper and then re-send the print request. Restart the printer if necessary.
Therefore, you’d better ensure that there is enough paper in the printer before sending a print
request.
22.8.2 Printer Status Message
Printer Status Message
Possible causes and suggested action
Printer unavailable
The selected printer is not available. Check if the printer is switched
on or correctly connected or installed with paper.
22-5
FOR YOUR NOTES
22-6
23 Other Functions
23.1 Marking Events
During patient monitoring, some events may exert effects on the patient and as a result
change the waveforms or numerics displayed on the monitor. To help analyzing the
waveforms or numerics at that time, you can mark these events.
To mark an event,
1.
Select [Mark Event] QuickKey, or select [Mark Event >>] in the main menu.
2.
Select [Event A] and the symbol [@] is displayed on the option.
When you are reviewing graphic trends, tabular trends or full-disclosure waveforms, the
event symbols such as A, B, C and D are displayed at the time the event is triggered.
23.2 Analog Output
The patient monitor provides analog output signals to accessory equipment via the Auxiliary
Output connector on the rear of the monitor. To obtain analog output signals, connect the
accessory equipment such as an oscillograph, etc. to the monitor and then follow this
procedure:
1.
In the main menu, Select [Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
Select [Device Setup >>] to enter the [Device Setup] menu.
3.
Select [Auxiliary Output] and then select [Analog Out.].
4.
In the main menu, select [Others >>]→[Analog Output Setup >>].
5.
Select [Analog Out.] and then select [On].
6.
Select [Waveform] and then select a waveform you want to output.
NOTE
z
The analog output feature is seldom applied in clinical applications. You can
contact your service personnel for more details.
23-1
23.3 Transferring Data
You can transfer the patient data saved in the monitor to a PC via a crossover network cable
or an external storage card, or within a LAN for data management, review or print.
23.3.1 Data Export System
You must install the data export system on the intended PC before performing the data
transfer operation. Refer to the document accompanying the installation CD-ROM for
installation instructions.
The data transfer feature also supports patient management, data review, data format
conversion, print, etc. Refer to the help file of the system software for more details.
23.3.2 Transferring Data by Different Means
NOTE
z
Never enter the data transfer mode when the patient monitor is in normal
operation or performs monitoring. You must re-start the patient monitor to exit
the data transfer mode.
Transfer data via a crossover network cable
Before transferring data using a crossover network cable, do as follows:
1.
Connect one end of the crossover network cable to the patient monitor and the other end
to the PC.
2.
Set the IP address of the PC. This IP address must be in the same network segment with
that of the patient monitor.
3.
Make sure that the data export system is active on the PC.
Then, follow this procedure to transfer data:
1.
In the main menu, select [Archives>>]. You may need a password to enter the
[Archives] menu, depending on the [Archives Access] setting in configuration mode.
Then select [Export Data] from the [Archives] menu.
2.
Select [Yes] from the popup message box and enter the [Data Export] window.
3.
Input the IP address already set on the PC.
4.
Select [Start] to start transferring data.
23-2
Transfer data within a LAN
Before transferring data within a LAN, do as follows:
1.
Connect the patient monitor and the intended PC into the same LAN and acquire the
PC’s IP address.
2.
Make sure that the data export system is active on the PC.
Follow the same procedure as via a crossover network cable to transfer data.
Transfer data via an external storage card
So far data can be transferred via CF storage card only.
1.
Remove the external storage card from the patient monitor. For details, refer to the
Basic Operations section.
2.
Run the data export system on the PC.
3.
Insert the external storage card into the card reader that connects the PC.
4.
Perform the data transfer operation following the help file of the system software.
23.4 Nurse Call
The patient monitor also provides nurse call signals to a nurse call system connected to the
monitor via the Auxiliary Output connector. To obtain nurse call signals, connect a nurse call
system to the monitor and then follow this procedure:
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
Select [Device Setup >>] to access the [Device Setup] menu.
3.
Select [Auxiliary Output] and then [Nurse Call]. Then, you can change the following
settings:
„
Select [Signal Type] and toggle between [Pulse] and [Continuous].
‹
[Pulse]: the nurse call signals are pulse signals and each pulse lasts 1 second. When
multiple alarms occur simultaneously, only one pulse signal is outputted. If an
alarm occurs but the previous one is not cleared yet, a new pulse signal will also be
outputted.
‹
[Continuous]: the nurse call signal lasts until the alarm ends, i.e. the duration of a
nurse call signal equals to that of the alarm condition.
23-3
„
Select [Contact Type] and toggle between [Normally Open] and [Normally Closed].
‹
[Normally Open]: select if your hospital’s nurse call relay contact is normally
open.
‹
[Normally Closed]: select if your hospital’s nurse call relay contact is normally
closed.
Another two options, [Alm Lev] and [Alarm Cat.], must be set in configuration mode. [Alm
Lev] defines the alarm level for nurse call-triggering alarms, and [Alarm Cat.] defines the
category within which the nurse call-triggering alarms fall.
Alarm conditions are indicated to nurses only when:
„
The nurse call system is enabled,
„
An alarm that meets your preset requirements occurs, and
„
The monitor is not in the alarm paused or silence status.
NOTE
z
If no setting is selected from [Alm Lev] or [Alarm Cat.], no nurse call signal will be
triggered whatever alarms occur.
WARNING
z
Do not rely exclusively on the nurse call system for alarm notification. Remember
that the most reliable alarm notification combines audible and visual alarm
indications with the patient’s clinical condition.
23-4
23.5 Wireless Network
The patient monitors, each equipped with a wireless network card, constitute a wireless
network via AP (access point).The designated service engineer or personnel shall be
responsible for installing and configuring the wireless network for you and perform relative
performance tests as well.
The radio device used in the monitor is in compliance with the essential requirements and
other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications
Terminal Equipment Directive).
NOTE
z
The design, installation, reconstruction and maintenance of the wireless network’s
distribution shall be performed by authorized service personnel of our company.
z
The existence of obstacles (such as wall) will exert impact on data transferring or
even cause network interruption.
z
The Central Monitoring System is capable of connecting up to 16 bedside monitors
via the wireless network.
23-5
FOR YOUR NOTES
23-6
24 Batteries
24.1 Overview
This monitor is designed to operate on battery (sealed lead-acid or Lithium Ion battery)
power during intra-hospital patient transfer or whenever the power supply is interrupted.
The battery is charged automatically when the monitor is connected to AC power, no matter
the monitor is powered on or not. Whenever the AC power is interrupted during patient
monitoring, the patient monitor will automatically run power from the internal batteries.
Sealed acid batteries and Lithium Ion batteries are differentiated by their contacts, as shown
below.
Sealed lead-acid battery Lithium Ion battery Lithium Ion battery
On-screen battery symbols indicate the battery status as follows:
„
Indicates that batteries work correctly. The solid portion represents the
current charge level of the batteries in proportion to its maximum charge level.
„
Indicates that the batteries have low charge level and need to be charged. In
this case, the patient monitor provides an alarm message.
„
Indicates that the batteries are almost depleted and need to be charged
immediately. Otherwise, the patient monitor will shut down automatically.
„
Indicates that no batteries are installed.
The capacity of the internal battery is limited. If the battery capacity is too low, a technical
alarm will be triggered and the [Battery Depleted] message displayed. At this moment,
apply AC power to the patient monitor. Otherwise, the patient monitor will power off
automatically before the battery is completely depleted.
24-1
24.2 Installing or Replacing a Battery
The patient monitor uses two battery packs. One battery pack can be easily exchanged while
the monitor operates from the other. If the patient monitor uses one battery pack, you should
insert a new battery pack before the old one depletes.
To install or replace a battery, follow this procedure:
1.
Open the battery door.
2.
Push aside the latch fixing the battery to be replaced and remove the battery.
3.
Insert a battery into the slot with its face up and its contact point inward. Then restore
the latch to the original position.
4.
If necessary, repeat the steps above to replace the other battery.
5.
Close the battery door.
24-2
24.3 Battery Guidelines
Life expectancy of a battery depends on how frequent and how long it is used. For a
properly maintained and stored lead-acid or lithium ion battery, its life expectancy is about
2 or 3 years respectively. For more aggressive use models, life expectancy can be less. We
recommend replacing lead acid batteries every 2 years and lithium ion batteries every 3
years.
To get the most out of the battery, observe the following guidelines:
„
The battery performance test must be performed every two years, before monitor
repairs, or whenever the battery is suspected as being the source of the problems.
„
Condition a battery once when it is used or stored for 3 months, or when its operating
time becomes noticeably shorter.
„
Take out the battery before the monitor is transported or will not be used for more than
3 months.
„
Remove the battery from the monitor if it is not being used regularly. (Leaving the
battery in a monitor that is not in regular use will shorten the life of the battery).
„
The shelf-life of a fully charged sealed lead acid battery is about 6 months and in 6
months the battery must be fully charged for storage. The shelf life of a Lithium Ion
battery is about 6 months when the battery is stored with the battery power being 50%
of the total power. In 6 months the battery power must be depleted before the Lithium
Ion battery is fully charged. Then run the monitor on this fully charged battery .When
its battery power becomes 50% of the total power, take out the battery from the
monitor and store it.
WARNING
z
Keep the battery out of the reach of children.
z
Use only the battery specified by the manufacturer.
z
If the battery shows signs of damage or signs of leakage, replace it immediately. Do
not use a faulty battery in the monitor.
24-3
24.4 Battery Maintenance
Conditioning a Battery
A battery should be conditioned before it is used for the first time. A battery conditioning
cycle is one uninterrupted charge of the battery, followed by an uninterrupted battery
discharge and charge. . Batteries should be conditioned regularly to maintain their useful
life.
NOTE
z
Condition a battery once when it is used or stored for 3 months, or when its
operating time becomes noticeably shorter.
z
The actual battery capacity will decrease over time with use of batteries. When a
monitor operates on batteries that have been used before, the full capacity battery
symbol does not indicate the capacity and operating time of this battery can still
fulfill battery specifications in the operator’s manual. When conditioning a
battery, please replace the battery if its operating time is significantly lower than
the specified time.
To condition a battery, follow this procedure:
1.
Disconnect the monitor from the patient and stop all monitoring or measuring.
2.
Insert the battery in need of conditioning in the battery slot of the monitor, and leave
the other slot empty if your monitor has two slots.
3.
Apply AC power to the monitor and allow the battery to charge uninterrupted for 10
hours.
4.
Remove AC power and allow the monitor to run from the battery until it shuts off.
5.
Apply AC power again to the monitor and allow the battery to charge uninterrupted for
10 hours.
6.
This battery is now conditioned and the monitor can be returned to service.
24-4
Checking a Battery
The battery performance test must be performed every two years, before monitor repairs, or
whenever the battery is suspected as being the source of the problems.The performance of a
rechargeable battery may deteriorate over time. To check the performance of a battery,
follow this procedure:
1.
Disconnect the monitor from the patient and stop all monitoring or measuring.
2.
Apply AC power to the monitor and allow the battery to charge uninterrupted for 10
hours.
3.
Remove AC power and allow the monitor to run from the battery until it shuts off.
4.
The operating time of battery reflects its performance directly.
If your monitor has two battery slots, you can check two batteries at the same time. Please
replace the battery or contact with the maintenance personnel if its operating time is
significantly lower than the specified time.
NOTE
z
The battery might be damaged or malfunctioned if its operating time is too short
after being fully charged. The operating time depends on the configuration and
operation. For example, measuring NIBP more frequently will also shorten the
operating time.
z
When a battery has visual signs of damage, or no longer holds a charge, it should
be replaced. Remove the old battery from the monitor and recycle it properly.
24.5 Battery Recycling
When a battery has visual signs of damage, or no longer holds a charge, it should be
replaced. Remove the old battery from the monitor and recycle it properly. To dispose of the
batteries, follow local laws for proper disposal.
WARNING
z
Do not disassemble batteries, or dispose of them in fire, or cause them to short
circuit. They may ignite, explode, leak or heat up, causing personal injury.
24-5
FOR YOUR NOTES
24-6
25 Care and Cleaning
Use only the substances approved by us and methods listed in this chapter to clean or
disinfect your equipment. Warranty does not cover damage caused by unapproved substances
or methods.
We make no claims regarding the efficacy of the listed chemicals or methods as a means for
controlling infection. For the method to control infection, consult your hospital’s Infection
Control Officer or Epidemiologist.
25.1 Introduction
Keep you equipment and accessories free of dust and dirt. To avoid damage to the equipment,
follow these rules:
„
Always dilute according the manufacturer’s instructions or use lowest possible
concentration.
„
Do not immerse part of the equipment into liquid.
„
Do not pour liquid onto the equipment or accessories.
„
Do not allow liquid to enter the case.
„
Never use abrasive materials (such as steel wool or silver polish), or erosive cleaners
(such as acetone or acetone-based cleaners).
WARNING
z
Be sure to shut down the system and disconnect all power cables from the outlets
before cleaning the equipment.
CAUTION
z
If you spill liquid on the equipment or accessories, contact us or your service
personnel.
NOTE
z
To clean or disinfect reusable accessories, refer to the instructions accompanying
the accessories.
25-1
25.2 Cleaning
Your equipment should be cleaned on a regular basis. If there is heavy pollution or lots of
dust and sand in your place, the equipment should be cleaned more frequently. Before
cleaning the equipment, consult your hospital’s regulations for cleaning the equipment.
Recommended cleaning agents are:
„
mild soap (diluted)
„
ammonia (diluted)
„
sodium hypochlorite bleach (diluted)
„
Hydrogen peroxide (3%)
„
Ethanol (70%)
„
Isopropanol (70%)
To clean your equipment, follow these rules:
1.
Shut down the patient monitor and disconnect it from the power line.
2.
Clean the display screen using a soft, clean cloth dampened with a glass cleaner.
3.
Clean the exterior surface of the equipment using a soft cloth dampened with the
cleaner.
4.
Wipe off all the cleaning solution with a dry cloth after cleaning if necessary.
5.
Dry your equipment in a ventilated, cool place.
If you want to clean the touchscreen during patient monitoring, lock the touchscreen first.
25.3 Disinfecting
Disinfection may cause damage to the equipment and is therefore not recommended for this
patient monitor unless otherwise indicated in your hospital’s servicing schedule. Cleaning
equipment before disinfecting is recommended.
The recommended disinfectants include: ethanol 70%, isopropanol 70%, glutaraldehyde-type
2% liquid disinfectants
CAUTION
z
Never use EtO or formaldehyde for disinfection.
25-2
26 Maintenance
WARNING
z
Failure on the part of the responsible individual hospital or institution employing
the use of this equipment to implement a satisfactory maintenance schedule may
cause undue equipment failure and possible health hazards.
z
The safety checks or maintenance involving any disassembly of the equipment
should be performed by professional servicing personnel. Otherwise, undue
equipment failure and possible health hazards could result.
z
If you discover a problem with any of the equipment, contact your service
personnel or us.
26.1 Safety Checks
Before every use, after your patient monitor has been used for 6 to 12 months, or whenever
your patient monitor is repaired or upgraded, a thorough inspection should be performed by
qualified service personnel to ensure the reliability.
Follow these guidelines when inspecting the equipment:
„
Make sure that the environment and power supply meet the requirements.
„
Inspect the equipment and its accessories for mechanical damage.
„
Inspect all power cords for damage, and make sure that their insulation is in good
condition.
„
Make sure that only specified accessories are applied.
„
Inspect if the alarm system functions correctly.
„
Make sure that the recorder functions correctly and the recorder paper meets the
requirements.
„
Make sure that the batteries meet the performance requirements.
„
Make sure that the patient monitor is in good working condition.
„
Make sure that the grounding resistance and leakage current meet the requirement.
In case of any damage or abnormity, do not use the patient monitor. Contact the hospital’s
biomedical engineers or your service personnel immediately.
26-1
26.2 Service Tasks
The following tasks are for our qualified service professionals only. Contact a qualified
service provider if your patient monitor needs the following services. Clean and disinfect
equipment to decontaminate it before testing or maintaining it.
Maintenance schedule
Frequency
Safety checks according to
IEC60601-1
At least once every two years, after any repairs where the
power supply is replaced, or if the patient monitor has been
dropped.
Performance assurance for all
measurements not listed below
At least once every two years, or if you doubt the measured
values.
Defibrillator synchronization
At least once every two years, or as needed.
NIBP leakage test
At least once every two years, or by your hospital policy.
NIBP accuracy test
At least once every two years, or by your hospital policy.
NIBP calibration
At least once every two years, or by your hospital policy.
CO2 calibration and performance
test
At least once a year, or if you doubt the measured values.
AG calibration
At least once a year, or if you doubt the measured values.
AG preventative maintenance
(pump check, internal fan check,
ambient pressure check and so forth
as described in the service manual)
At least once a year, or if you doubt the measured values.
26.3 Checking Monitor and Module Information
In the main menu, select [Maintenance >>]→[System Status >>]. You can view the
information about system start time, selftest, etc. from the popup menu. You can print out the
information for the convenience of troubleshooting. The information will not be saved during
shut down.
You can also view the information about the monitor configuration and system software
version by selecting [Maintenance >>]→[Software Version >>] in the main menu.
26-2
26.4 Calibrating ECG
The ECG signal may be inaccurate due to hardware or software problems. As a result, the
ECG wave amplitude becomes greater or smaller. In that case, you need to calibrate the ECG
module.
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Calibrate ECG] from the popup menu. A square
wave appears on the screen and the message [ECG Calibrating] is displayed in the
ECG waveform area.
2.
Compare the amplitude of the square wave with the wave scale. The difference should
be within 5%.
3.
After the calibration is completed, select [Stop Calibrating ECG].
You can print out the square wave and wave scale and then measure the difference between
them if necessary. If the difference exceeds 5%, contact your service personnel.
26.5 Calibrating the Touchscreen
1.
2.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Cal. Touchscreen] from the popup menu.
will, in turn, appear at different positions of the screen.
3.
Select each
4.
After the calibration is completed, the message [Screen Calibration Completed!] is
displayed. Select [Ok] to confirm the completion of the calibration.
as it appears on the screen.
26-3
26.6 Calibrating CO2
For sidestream and microstream CO2 modules, a calibration is needed every year or when the
measured values have a great deviation. For maintream CO2 module, no calibration is
needed.
Tools required:
„
Gas bottle, with 4%, 5% or 6% of CO2.
„
T-shape connector
„
Tubing
Follow this procedure to perform a calibration:
1.
Make sure that the CO2 module has been warmed up or started up.
2.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Maintain CO2 >>] from the popup menu.
3.
In the [Maintain CO2] menu, select [Zero].
4.
Connect the gas bottle with the tubing using a T-shape connector as shown below.
Check the airway and make sure there are no leaks.
Open to the air
Tubing
Gas valve
Monitor
Gas bottle
5.
Open the gas valve and vent CO2 into the tubing.
6.
In the [Calibrate CO2] menu, enter the vented CO2 concentration in the [CO2] field.
7.
In the [Maintain CO2] menu, the measured CO2 concentration, barometric pressure,
sensor temperature and current flowrate are displayed. After the measured CO2
concentration becomes stable, select [Calibrate CO2] to calibrate the CO2 module.
8.
If the calibration is finished successfully, the message [Calibration Completed!] is
displayed. If the calibration failed, the message [Calibration Failed!] is displayed.
Perform another calibration.
9.
Select [Exit] to exit the current menu.
26-4
26.7 Calibrating AG
Calibrate the AG module every year or when the measured value has a great deviation.
Tools required:
„
Gas bottle, with a certain standard gas or mixture gas. Gas concentration should meet
the following requirements: AA>1.5%, CO2>1.5%, N2O>40%, O2>40%, of which AA
represents an anesthetic agent.
„
T-shape connector
„
Tubing
„
Reservoir bag
Follow this procedure to perform a calibration:
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Calibrate AG >>] from the popup menu.
2.
Check the airway and make sure that there are no occlusions or leaks.
‹
Vent the tubing to the air and check if the [Current FlowRate] and [Set FlowRate]
are approximately the same. If the deviation is great, it indicates that there is an
occlusion in the tubing. Check the tubing for an occlusion.
‹
Block the gas inlet of the tubing. The [Current FlowRate] shall fall rapidly and
the system prompts that the tubing is blocked. Otherwise, it indicates that there are
leakages in the tubing. Check the tubing for leakages.
3.
Connect the gas bottle, reservoir bag and the tubing using a T-shape connector as shown
in the figure below. Check the airway and make sure there are no leaks.
4.
Open the gas valve and vent a certain standard gas or mixture gas into the tubing.
Gas valve
Tubing
AG module
Reservoir bag
Gas bottle
5.
In the [Calibrate AG] menu, the concentration and flowrate of each measured gas are
displayed
‹
If the difference between the measured gas concentration and the actual one is very
small, a calibration is not needed.
‹
If the difference is great, you should perform a calibration. Select [Calibrate >>] to
enter the calibrate menu.
26-5
6.
Enter the vented gas concentration. If you use only one gas for calibration, set other
gases’ concentration to 0.
7.
Select [Start] to start calibration.
8.
If the calibration is finished successfully, the message [Calibration Completed!] is
displayed. If the calibration failed, the message [AG Cal. Failed] is displayed. Perform
another calibration.
9.
Select [Exit] to exit the current menu.
26.8 Setting up IP Address
1.
In the main menu, select [Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Network Setup >>] from the popup menu.
2. If your monitor is equipped with a wireless AP, you can set [Network Type] to [WLAN]
in the network setup menu. Otherwise, the default setting is [LAN].
3.
Set the IP Address and subnet mask through [IP Address] and [Subnet Mask].
If the patient monitor is connected to a CMS, its IP address should be set up. The user should
not change the patient monitor’s IP address randomly. If you want to know details about IP
address setup, contact the technical personnel in charge of the CMS.
26.9 Entering/Exiting Demo Mode
To enter the Demo mode:
1.
In the main menu, select [Maintenance >>].
2.
Select [Demo >>]. Enter the required password and then select [Ok].
To exit the Demo mode:
1.
In the main menu, select [Maintenance >>].
2.
Select [Exit Demo] and then select [Ok].
3.
The patient monitor exits the Demo mode.
WARNING
z
The Demo mode is for demonstration purpose only. To avoid that the simulated
data are mistaken for the monitored patient’s data, you must not change into
Demo mode during monitoring. Otherwise, improper patient monitoring and
delayed treatment could result.
26-6
27 Accessories
WARNING
z
Use accessories specified in this chapter. Using other accessories may cause
damage to the patient monitor or not meet the claimed specifications.
z
Single-use accessories are not designed to be reused. Reuse may cause a risk of
contamination and affect the measurement accuracy.
z
Check the accessories and their packages for any sign of damage. Do not use them
if any damage is detected.
27.1 ECG Accessories
ECG Electrodes
Model
Quantity
Patient Category
Part No.
210
10 pieces
Adult
0010-10-12304
2245
50 pieces
Pediatric
9000-10-07469
2258-3
3 pieces
Neonate
900E-10-04880
12-Pin Separable Trunk Cables
Leadwire
supported
Compatible
with
Type
Patient
Category
3-leadwire
AHA, IEC
Defibrillator-proof
3-leadwire
AHA, IEC
ESU-proof
3/5-leadwire
AHA, IEC
Defibrillator-proof
3/5-leadwire
AHA, IEC
ESU-proof
10-leadwire
AHA
Defibrillator-proof
10-leadwire
IEC
Defibrillator-proof
27-1
Length
0010-30-42720
Pediatric,
neonate
Adult,
pediatric
Part No.
0010-30-42724
2.9 m
0010-30-42719
0010-30-42723
0010-30-42721
0010-30-42722
Cable Sets
3-Electrode Cable Sets
Type
Compatible
with
Model
EL6302A
IEC
Clip
EL6304A
IEC
Snap
AHA
Adult, pediatric
Length
Part No.
Remark
0.6 m
0010-30-42725
/
1m
0010-30-42732
Long
EL6306A
Neonate
0.6 m
0010-30-42897
/
EL6308A
Pediatric
0.6 m
0010-30-42899
/
0.6 m
0010-30-42726
/
1m
0010-30-42731
Long
EL6301A
AHA
Patient Category
EL6303A
Adult, pediatric
EL6305A
Neonate
0.6 m
0010-30-42896
/
EL6307A
Pediatric
0.6 m
0010-30-42898
/
EL6302B
Adult, pediatric
0010-30-42733
/
EL6308B
Pediatric
0010-30-42901
/
EL6301B
Adult, pediatric
0010-30-42734
/
EL6307B
Pediatric
0010-30-42900
/
Model
Patient Category
Length
Part No.
Remark
EL6502A
0.6 m
0010-30-42728
/
EL6504A
1 to 1.4 m
0010-30-42730
Long
0.6 m
0010-30-42727
/
1 to 1.4 m
0010-30-42729
Long
0.6 m
5-Electrode Cable Sets
Type
Compatible
with
IEC
Clip
AHA
Snap
EL6501A
EL6503A
Adult, pediatric,
neonate
IEC
EL6502B
0.6 m
0010-30-42736
/
AHA
EL6501B
0.6 m
0010-30-42735
/
Length
Part No.
Remark
EL6802A
0.8 m
0010-30-42903
Limb
EL6804A
0.6 m
0010-30-42905
Chest
EL6801A
0.8 m
0010-30-42902
Limb
0.6 m
0010-30-42904
Chest
0.8 m
0010-30-42907
Limb
EL6804B
0.6 m
0010-30-42909
Chest
EL6801B
0.8 m
0010-30-42906
Limb
EL6803B
0.6 m
0010-30-42908
Chest
10-Electrode Cable Sets
Type
Compatible
with
IEC
Clip
AHA
IEC
Snap
AHA
Model
EL6803A
EL6802B
Patient Category
Adult, pediatric
27-2
27.2 SpO2 Accessories
Extension Cable
Module
type
Patient Category
Mindray
Masimo
Adult, pediatric, neonate
Nellcor
Length
Remark
Part No.
3m
/
0010-20-42710
8 pins, purple connector
040-000332-00
7 pins, white connector
0010-30-42738
/
0010-20-42712
2.9m
2.5 m
SpO2 Sensors
The SpO2 sensor materials that patients or other staff will come into contact with have
undertaken the bio-compatibility test and are verified to be in compliance with ISO 10993-1.
Mindray SpO2 Module
Type
Disposable
Single
patient use
Reusable
Model
Patient Category
MAX-A
Adult (>30Kg)
MAX-P
Pediatric (10 to 50Kg)
MAX-I
Infant (3 to 20Kg)
MAX-N
Neonate (<3Kg), Adult (>40Kg)
0010-10-12205
520A
Adult
520A-30-64101
520P
Pediatric
520I
Infant
520N
Neonate
520N-30-64401
DS-100A
Adult
9000-10-05161
OXI-P/I
Pediatric, infant
OXI-A/N
Adult, neonate
518B
Adult, pediatric, neonate (Multi-sites)
512E
512F
512G
512H
Length
Part No.
0010-10-12202
/
1m
/
Adult (Finger type)
Pediatric (Finger type)
27-3
0010-10-12203
0010-10-12204
520P-30-64201
520I-30-64301
9000-10-07308
9000-10-07336
518B-30-72107
1.2 m
512E-30-90390
/
512F-30-28263
1.2 m
512G-30-90607
/
512H-30-79061
Masimo SpO2 Module
Type
Disposable
Reusable
Model
Patient Category
Remark
Part No.
FPS-1901
Pediatric, neonate (banding
type)
LNCS-NeoPt-L
0010-10-42626
FPS-1862
Neonate (banding type)
LNCS-Neo-L
0010-10-42627
FPS-1861
Infant (banding type)
LNCS-Inf-L
0010-10-42628
FPS-1860
Pediatric (banding type)
LNCS-Pdt
0010-10-42629
FPS-1859
Adult (banding type)
LNCS-Adt
0010-10-42630
FPS-1863
Adult (finger type)
LNCS DC-I
0010-10-42600
FPS-1864
Pediatric (finger type)
LNCS-DCIP
0010-10-42634
2258
Adult, pediatric, neonate
LNCS YI
0010-10-43016
Nellcor SpO2 Module
Type
Disposable
Reusable
Model
Patient Category
Part No.
MAX-A
Adult (>30Kg) (banding type)
0010-10-12202
MAX-P
Pediatric (10 to 50Kg) (banding type)
0010-10-12203
MAX-I
Infant (3 to 20Kg) (banding type)
0010-10-12204
MAX-N
Neonate (<3Kg), Adult (>40Kg) (banding type)
0010-10-12205
DS-100A
Adult
9000-10-05161
OXI-P/I
Pediatric, infant (finger type)
9000-10-07308
OXI-A/N
Adult, neonate (finger type)
9000-10-07336
„
Wavelength emiited by the sensors intended for Mindray SpO2 module: red right: 660
nm, infrared light: 905 nm.
„
Wavelength emitted by the sensors intended for Masimo SpO2 module: red light: 660
nm, infrared light: 940 nm.
„
Wavelength emitted by the sensors intended for Nellcor SpO2 module: red light: 660 nm,
infrared light: 890 nm.
„
The maximum photic output consumption of the sensor is less than 18 mW.
The information about the wavelength range and maximum photic output consumption can
be especially useful to clinicians, for example, clinicians performing photodynamic therapy.
27-4
27.3 NIBP Accessories
Tubing
Type
Reusable
Patient Category
Length
Part No.
Adult, pediatric
3m
6200-30-09688
Neonate
1.5 m
6200-30-11560
Reusable Cuff
Model
Patient
Category
CM1201
Infant
CM1202
Pediatric
CM1203
Adult
CM1204
Large adult
CM1205
Thigh
Measurement
Site
Arm
Thigh
Limb Circumference
(cm)
Bladder
Width (cm)
Part No.
10 to 19
9.2
0010-30-12157
18 to 26
12.2
0010-30-12158
24 to 35
15.1
0010-30-12159
33 to 47
18.3
0010-30-12160
46 to 66
22.5
0010-30-12161
Single-Patient Cuff
Model
Patient
Category
Measurement
Site
CM1500A
CM1500B
CM1500C
Neonate
CM1500D
Arm
Limb
Circumference (cm)
Bladder
Width (cm)
Part No.
3.1 to 5.7
2.2
001B-30-70692
4.3 to 8.0
2.9
001B-30-70693
5.8 to 10.9
3.8
001B-30-70694
7.1 to 13.1
4.8
001B-30-70695
10 to 19
7.2
001B-30-70697
CM1501
Infant
CM1502
Pediatric
18 to 26
9.8
001B-30-70698
CM1503
Adult
25 to 35
13.1
001B-30-70699
CM1504
Large adult
33 to 47
16.5
001B-30-70700
CM1505
Adult
46 to 66
20.5
001B-30-70701
Thigh
Disposable Cuff
Model
Patient
Category
Measurement
Site
M1872A
M1870A
M1868A
M1866A
Neonate
Arm
Limb Circumference
(cm)
Bladder
Width (cm)
Part No.
7.1 to 13.1
5.1
900E-10-04873
5.8 to 10.9
4.3
900E-10-04874
4.3 to 8.0
3.2
900E-10-04875
3.1 to 5.7
2.5
900E-10-04876
27-5
27.4 Temp Accessories
Extension Cable
Type
Model
Temp probe
Length
Part No.
Reusable
MR420B
MR411, MR412
3m
0011-30-37391
Temp Probes
Type
Model
MR401B
Reusable
MR403B
MR402B
MR404B
Disposable
MR411
MR412
Patient Category
Adult
Pediatric, neonate
Adult, pediatric,
neonate
Measurement
Site
Length
Part No.
Esophageal/Rectal
3m
0011-30-37392
Skin
3.8 m
0011-30-37393
Esophageal/Rectal
3m
0011-30-37394
Skin
3.8 m
0011-30-37395
Esophageal/Rectal
/
0011-30-37398
Skin
/
0011-30-37397
27.5 IBP/ICP Accessories
Accessories
Kit No.
6800-30-50616
(Hospira)
6800-30-50877
(BD)
Components
Length
Part No.
IM2201 12Pin IBP Cable Kit (Hospira)
4.6 ± 1.0 m
001C-30-70759
Disposable Pressure Transducer
0010-10-42638
Steady Rest for IBP Transducer and Clamp
M90-000133---
Steady Rest for IBP Transducer and Clamp
M90-000134---
IBP accessories instructions for use
(ABBOTT)
0010-20-42913
Bar code printing paper (100×150 mm)
A30-000010---
Packaging box
0850-20-30715
IM2202 12Pin IBP Cable Kit (BD)
3.8 m
001C-30-70757
Disposable Transducer
6000-10-02107
Transducer/Manifold Mount
0010-10-12156
IBP accessories instructions for use (BD)
0010-20-42914
Bar code printing paper (100×150 mm)
A30-000010---
Module packaging box
6000-20-02055
27-6
ICP Model
Material
Part No.
Gaeltec TYPE.S13
12Pin ICP cable
0010-30-42742
Gaeltec ICT/B
Intracranial Pressure Transducer
6800-30-50759
Intracranial Pressure Transducer (global)
0010-10-12151
It is proved through tests that the following accessories are compatible with the patient
monitor. Only the accessories proceeded by “*” are available from our company. If you want
to purchase other accessories, contact respective manufacturers and make sure if these
accessories are approved for sale in local.
Manufacturer
Accessories
Smith Medical
(Medex)
MX961Z14 Logical Cable, to be used in connection with the Adapter Cable
(0010-20-42795)
MX960 Reusable Transducer Kit
MX9605A Logical 84in(213cm) Single Monitoring Kit
MX960 Logical Transducer Mounting Plate
MX261 Logical Clamp For Transducer Bracket
MX262 Logical Clamp For 2 Transducer Mount Plates
(More Logical Clamps are available from Medex. For detailed information,
contact Medex.)
Braun
IBP Reusable Cable (REF: 5203511), to be used in connection with the
Adapter Cable (0010-20-42795)
Combitrans Monitoring Set (contact Braun for detailed information)
Combitrans Attachment Plate Holder (REF: 5215800)
Combitrans Attachment Plate (contact Braun for detailed information)
Memscap
*Truck cable (0010-21-43082)
SP844 Physiological Pressure Transducer
844-26 Monitoring Line Set
84X-49 Mounting Bracket
Utah
Reusable Blood Pressure Monitor Interface Cable (REF: 650-206)
Deltran Disposable Pressure Transducer System
(More Deltran sensors are available from Utah. For detailed information,
contact Utah.)
Pole Mount Unit (ERF: 650-150)
Deltran Three Slot Organizer, Attaches to I.V. Pole Mount (REF: 650-100)
Deltran Four Slot Organizer, Attaches to I.V. Pole Mount (REF: 650-105)
Edwards
* IBP Truwave Reusable Cable (0010-21-12179)
Pressure Monitoring Kit With Truwave Disposable Pressure Transducer.
(More Truwave sensors are available from Edwards. For detailed
information, contact Edwards.)
DTSC IV Pole Clamp for Model DTH4 BackPlate Holder
DTH4 Disposable Holder for DPT
27-7
27.6 C.O. Accessories
Model
Material
PN
COC-001-SL
12Pin C.O. cable.
0010-30-42743
SP4042
IT Sensor
6000-10-02079
SP5045
IT Sensor Housing
6000-10-02080
12CC
12CC Control Syringe W/1CC Stop W/Rotator
6000-10-02081
131HF7
Dilution Hose
6000-10-02183
CO accessories
package
12Pin cable:1
IT Sensor:1
IT Sensor Housing:2
12CC Control Syringe W/1CC Stop W/Rotator:2
6800-30-50617
27.7 CO2 Accessories
Sidestream CO2 module
Material
Patient Category
DRYLINE Watertrap
Adult, pediatric
DRYLINE Watertrap
Neonate
Sampling Line
Adult, pediatric
9200-10-10533
Sampling Line, 2.5m
Neonate
9200-10-10555
Nasal CO2 Sample
Cannula
Adult
Nasal CO2 Sample
Cannula
Pediatric
DRYLINE Airway
Adapter
Adult, pediatric,
neonate
Straight
9000-10-07486
Adult, pediatric
Airway adapter: 2
Adult/pediatric watertrap: 2
Adult/pediatric Sampling line: 2
Adult Nasal CO2 Sample
Cannula: 2
Pediatric Nasal CO2 Sample
Cannula: 2
6800-30-50618
Neonate
Airway adapter: 2
Neonate watertrap: 2
Neonate sampling line: 2
Neonate Nasal CO2 Sample
Cannula: 2
Sidestream CO2 accessories
instructions for use
6800-30-50467
Mindray CO2
accessories package
(M02A)
Mindray CO2
accessories package
(neonate)
Remark
Reusable
Disposable
Part No.
9200-10-10530
9200-10-10574
M02A-10-25937
M02A-10-25938
27-8
Microstream CO2 Module
Disposable Airway Sampling Line
Model
Patient Category
Remark
Part No.
/
0010-10-42560
Humidified
0010-10-42561
Long
0010-10-42563
Long, humidified
0010-10-42564
Humidified
0010-10-42562
Long, humidified
0010-10-42565
Remark
Part No.
/
0010-10-42566
Plus O2
0010-10-42568
Long, plus O2
0010-10-42570
/
0010-10-42577
Humidified
0010-10-42572
8180
Humidified, plus O2
0010-10-42575
7266
/
0010-10-42567
8175
/
0010-10-42578
Humidified
0010-10-42573
Humidified, plus O2
0010-10-42576
7269
Plus O2
0010-10-42569
7743
Long, plus O2
0010-10-42571
Infant, Neonate
Humidified
0010-10-42574
Name
Patient Category
Remark
PN
Microstream CO2
accessories package
Adult, pediatric
Adult/pediatric Sampling line:1
Adult Nasal CO2 Sample Cannula:1
6800-30-50619
XS04620
XS04624
7768
Adult, pediatric
7737
6324
7738
Infant, Neonate
Disposable Nasal Sampling Line
Model
9818
9822
9826
Patient Category
Adult,
intermediate
8174
8177
8178
8181
8179
Adult
Pediatric
Accessories package
27-9
Mainstream CO2 Module
Material
Model
Airway
adapter
6421
9960STD
Mask
9960LGE
Patient Category
Remark
Part No.
Adult
Disposable, with mouthpiece
0010-10-42663
/
0010-10-42670
Large
0010-10-42671
Adult
9960PED
Pediatric
/
0010-10-42669
Cable
management
straps
/
/
/
0010-10-42667
Sensor
holding clips
/
/
/
0010-10-42668
Sensor
Capnostat5
Adult, pediatric,
neonate
Reusable
6800-30-50760
Adult, pediatric,
neonate
Disposable adult/pediatric
airway adapter:1
Disposable pediatric/neonate
airway adapter:1
Mainstream CO2 sensor:1
Mainstream CO2 accessories
instructions for use
6800-30-50613
Mainstream
CO2
accessories
package
/
27-10
27.8 AG Accessories
Material
Watertrap
Sampling line
Airway
adapter
AG module
accessories
package
(domestic)
AG module
accessories
package
(abroad)
Patient Category
Adult, pediatric
Neonate
Adult, pediatric
Neonate
Remark
Reusable
Disposable
Part No.
9200-10-10530
9200-10-10574
9200-10-10533
9200-10-10555
Adult, pediatric, neonate
Disposable, straight
9000-10-07486
Adult, pediatric, neonate
Disposable, elbow
9000-10-07487
Adult, pediatric
Straight airway adapter:2
Elbow airway adapter:2
Adult/pediatric watertrap: 5
Adult sampling line:4
AG accessories instructions for use
6800-30-50620
Adult, pediatric, neonate
Straight airway adapter:2
Elbow airway adapter:2
Adult/pediatric watertrap: 5
Adult sampling line:4
Adult/pediatric watertrap: 5
Neonate sampling line:4
Neonate watertrap:4
AG accessories instructions for use
6800-30-50621
27-11
27.9 Others
Material
Part No.
Lead-acid battery
M05-302R3R---
Lithium battery
M05-010001-06 (black)
0146-00-0099
3-core power cord
509B-10-05996
3-core power cord (V3203C-V1625)
0000-10-10903
Grounding cable
1000-21-00122
Defibrillator synchronization cable
6800-20-50781
Nurse call cable
8000-21-10361
CF storage card
023-000067-00
Recorder
TR6F-30-67306
Recorder paper (48 mm)
A30-000001---
Recorder for update (installed on the device)
TR6F-30-67317
Wireless network card
6802-30-66686
Main unit wall mount bracket
Trolly bracket
0010-30-43034
0010-30-42860
0010-30-43033
0010-30-42843
27-12
(gray)
A Product Specifications
A.1 Monitor Safety Specifications
A.1.1 Classifications
The patient monitor is classified, according to IEC60601-1:
Classification Name
Specifications
Class I equipment, with both internal and external power supply
Type of protection
against electric shock
When you doubt the integrity of the external protective earth (ground)
or the protective earth conductor, switch the equipment to the internal
power supply (batteries).
Degree of protection
against electric shock
CO2/AG:
BF (defibrillation proof)
ECG/RESP/SpO2/NIBP/TEMP/IBP/CO:
CF (defibrillation proof)
Degree of protection
against hazards of
explosion
Degree of protection
against harmful ingress
of water
Not protected (ordinary)
In accordance with IPX1
Tested safety from vertically dripping water (DRIP-PROOF)
Mode of operation
Continuous
Equipment type
Portable
A-1
A.1.2 Environmental Specifications
Operating conditions
0 to 40
Temperature (ºC)
5 to 40 (with Sidestream CO2 module)
0 to 40 (with Microstream CO2 module)
10 to 40 (with Mainstream CO2 module or AG module)
Relative humidity
(noncondensing)
15% to 95%
428.6-808.3 mmHg(57.0-107.5 kPa)
428 to 790mmHg (with Sidestream CO2 module)
Altitude
430 to 795mmHg (with Microstream CO2 module)
400 to 850 mmHg (with Mainstream CO2 module)
525 to 900 mmHg (with AG module)
Storage conditions
Temperature (ºC)
-20 to 60
Relative humidity
(noncondensing)
10% to 95%
122.6-808.3 mmHg(16.3-107.5 kPa)
428 to 790mmHg (with Sidestream CO2 module)
Altitude
430 to 795mmHg (with Microstream CO2 module)
400 to 850 mmHg (with Mainstream CO2 module)
525 to 900 mmHg (with AG module)
A-2
A.1.3 Power requirements
Parameter
Specifications
AC Power Supply Specifications
Line Voltage
100 to 240 ~
Current
1.3 to 0.5 A
Frequency
50/60 Hz
Fuse
T3.15 A H, 250 V
Internal battery
Number of batteries
2
Type
Sealed lead-acid battery or lithium-ion battery
Time to shutdown
>5 min (after the first low-power alarm)
Sealed lead-acid battery
Rated voltage
12 VDC
Capacity
2.3 Ah
Minimum operating time
90 minutes or 210 minutes when powered by one or two new
fully-charged batteries respectively (25℃, ECG, SpO2, Auto
NIBP measurements at intervals of 15 minutes, Screen brightness
is 1)
Charge time
Shut-down: nearly 4 h to 90%, 6 h to 100%
Operating: nearly 6 h to 90%, 8 h to 100%
Lithium battery
Rated voltage
11.1 VDC
Capacity
4.4 Ah
Minimum operating time
210 minutes or 450 minutes when powered by one or two new
fully-charged batteries respectively (25℃, ECG, SpO2, Auto
NIBP measurements at intervals of 15 minutes, Screen brightness
is 1)
Charge time
Shut-down: nearly 3 h to 90%, 4 h to 100%
Operating: nearly 8 h to 90%, 12 h to 100%
A-3
A.2 Hardware specifications
A.2.1 Physical Specifications
Size
320×270×180mm (width×height×depth)
Weight
Standard configuration: <5.0kg (without batteries and recorder)
A.2.2 Display
Host display
Screen type
Colour TFT LCD
Screen Size (diagonal)
12.1"
Resolution
800×600 pixels
A.2.3 Recorder
Method
Thermal dot array
Horizontal resolution
16 dots/mm (25 mm/s paper speed)
Vertical resolution
8 dots/mm
Paper width
48 mm
Paper length
20 m
Paper speed
25 mm/s, 50 mm/s
Number of waveform channels
1, 2, or 3 (optional)
A.2.4 LEDs
Alarm lamp
1 (two colour coded: yellow and red)
Operating status indicator
1 (green)
AC power LED
1 (yellow green)
Battery LED
1 (yellow green)
A-4
A.2.5 Audio Indicator
Speaker
Give alarm tones (45 to 85 dB), key tones, QRS tones; support
PITCH TONE and multi-level tone modulation; alarm tones
comply with IEC60601-1-8.
A.2.6 Alarm Signal
Alarm output delay
Less than 1 second
Pause duration
1, 2, 3, 5, 10, 15 minutes or infinite, depending on configuration
A.2.7 Monitor Interface Specifications
Power
1 AC power input connector
Measurements
ECG, RESP, TEMP, SpO2, NIBP, IBP, CO, CO2, AG
Wire network
1 RJ45 connector, 100 Base-TX, IEEE 802.3
USB (optional)
2 connectors, USB 1.1
CF
50-pin CF revision 2.0 connector
Video interface
1 standard colour VGA monitor connector
Auxiliary output
1 connector, standard BNC, the common connector of nurse call
signals, analog output signals and defibrillator synchronization
signals
Equipotential Grounding
Terminal
1
RS232 connector
1 connector, supports DIAP communication protocol
A-5
A.2.8 Signal Output
Auxiliary Output
Standard
Meets the requirements of EC60601-1 for short-circuit
protection and leakage current
ECG Analog Output
Bandwidth (-3dB; reference
frequency:10Hz)
Diagnostic mode:
0.05 to 150 Hz
Monitor mode:
0.5 to 40 Hz
Surgical mode:
1 to 20 Hz
Max transmission delay
25 ms (in diagnostic mode, and with Notch off)
Sensitivity
1 V/mV ±5%
PACE rejection/enhancement
No pace rejection or enhancement
IBP Analog Output
Bandwidth (-3dB; reference
frequency:1Hz)
8 Hz, 12.5 Hz and 20 Hz are optional.
Max transmission delay
60 ms (with Notch off)
Sensitivity
1 V/100 mmHg ±5%
Nurse Call Signal
Output mode
Relay
Electrical requirements
≤60W, ≤2A, ≤36VDC, ≤25VAC
Conducting impedance
<1 Ω
Isolation voltage
1500 VAC
Contact type
Normally open or normally contact (optional)
Defib Sync Pulse
Max time delay
35 ms (R-wave peak to leading edge of pulse)
Amplitude
High level: 3.5 to 5 V, providing a maximum of 1 mA output
current;
Low level: < 0.5 V, receiving a maximum of 5 mA input current.
Pulse width
100 ms ±10%
Output impedance
50Ω
Rising and falling time
<3 ms
VGA
Video signals
RGB: 0.7 Vp-p/75Ω;
Horizontal/vertical synchronization: TTL level
A-6
A.3 Data Storage
Trends
Trends: 96 hours, at 1 min resolution
Minitrends: 1 hour, at 1 s resolution
Parameter alarms
100 alarms and related parameter waveforms. The waveform
recording length can be 8s, 16s or 32s.
Arrh. events
80 arrhythmia events and relate waveforms. The waveform
recording length can be 8s, 16s or 32s.
NIBP measurements
1000 sets
12-lead ECG analysis results
10 sets
Full-disclosure waveforms
48 hours at maximum. The specific storage time depends on
the waveforms stored and the number of stored waveforms.
A.4 Wireless Network
Standards
IEEE 802.11b/g
Frequency range
2.412 to 2.462 GHz
A.5 Measurement Specifications
The adjustable range of alarm limits is the same with the measurement range of signals
unless otherwise specified.
A-7
A.5.1 ECG
ECG
Standards
Meet standards of EC11, EC13, EN60601-2-27/IEC60601-2-27,
IEC60601-2-25, YY91079, GB9706.25
3-lead: I, II, III
Lead set
5-lead: I, II, III, aVR, aVL, aVF, V
12-lead: I, II, III, aVR, aVL, aVF, V1 to V6
ECG standard
AHA, IEC
Display sensitivity
1.25 mm/mV (X0.125), 2.5 mm/mV (X0.25), 5 mm/mV (X0.5),
10 mm/mV (X1), 20 mm/mV (X2), 40mm/mV (X4), Auto
Sweep speed
12.5 mm/s, 25 mm/s, 50 mm/s
Bandwidth (-3dB)
Common mode rejection ratio
(with Notch off)
Diagnostic mode:
0.05 to 150 Hz
Monitor mode:
0.5 to 40 Hz
Surgical mode:
1 to 20 Hz
Diagnostic mode:
>90 dB
Monitor mode:
>105 dB
Surgical mode:
>105 dB
50/60 Hz
Notch
Monitor and surgical mode: Notch turns on automatically.
Diagnostic mode: Notch is turned on/off manually
Differential input impedance
>5 MΩ
Input signal range
±8 mV (peak-to-peak value)
Electrode offset potential
tolerance
±500 mV
Input offset current
≤0.1 μA (except for the driving lead)
Baseline recovery time
<5 s (after defibrillation)
Calibration signal
1mV (peak-to-peak value)
Cut mode: 300 W
Coagulate mode: 100 W
ESU protection
Recovery time: ≤10 s
In compliance with the requirements in clause 4.2.9.14 of
ANSI/AAMI EC 13
ESU noise suppression
Based on the test method in clause 5.2.9.14 of EC 13, use ECG
lead wires which are in compliance with AAMI. Compared with
ECG baseline, the noise of peak to peak value ≤2 mV.
A-8
Pace Pulse
Pace pulses meeting the following conditions are labelled with a
PACE marker:
Pace pulse markers
Amplitude:
±2 to ±700 mV
Width:
0.1 to 2 ms
Rise time:
10 to 100 µs
When tested in accordance with the ANSI/AAMI EC13:
Sections 4.1.4.1 and 4.1.4.3, the heart rate meter rejects all
pulses meeting the following conditions.
Pace pulse rejection
Alarm limit
Amplitude:
±2 to ±700 mV
Width:
0.1 to 2 ms
Rise time:
10 to 100 µs
Minimum input slew rate:
50 V/s RTI
Range (bpm)
HR High
HR Low
Step (bpm)
Adult:
(low limit+2) to 300
Pediatric, Neonate:
(low limit+2) to 350
15 to
1
(high limit-2)
Basic algorithm
HR
3-, 5-, and 12-lead ECG
Measurement range
Interpretation of resting
12-lead ECG
Resolution
Accuracy
Sensitivity
Neonate:
15 to 350 bpm
Pediatric:
15 to 350 bpm
Adult:
15 to 300 bpm
Adult:
30 to 120 bpm
1 bpm
3-, 5-, and 12-lead ECG: ±1 bpm or ±1%, whichever is greater.
Interpretation of resting 12-lead ECG: ±2 bpm
200μV (lead II)
A-9
In compliance with the requirements in Clause 4.1.2.1 d) of
ANSI/AAMI EC13, the following method is used:
HR averaging method
If the last 3 consecutive RR intervals are greater than 1200 ms, the 4
most recent RR intervals are averaged to compute the HR. Otherwise,
heart rate is computed by subtracting the maximum and minimum ones
from the most recent 12 RR intervals and then averaging them.
The HR value displayed on the monitor screen is updated every second.
Response to irregular
rhythm
In compliance with the requirements in Clause 4.1.2.1 e) of
ANSI/AAMI EC13, the heart rate after 20 seconds of stabilization is
displayed as follows:
Ventricular bigeminy (3a): -80±1 bpm
Slow alternating ventricular bigeminy (3b): -60±1 bpm
Rapid alternating ventricular bigeminy (3c): -120±1 bpm
Bidirectional systoles (3d): -90±2 bpm
Response time to heart
rate change
Meets the requirements of ANSI/AAMI EC13: Section 4.1.2.1 f).
From 80 to 120 bpm: less than 12 s
From 80 to 40 bpm: less than 12 s
Meets the requirements of ANSI/AAMI EC13: section 4.1.2.1 g).
Waveform
Time to alarm for
tachycardia
4ah - range:
11 s
4a - range:
11 s
4ad - range:
11 s
Waveform 4bh - range:
11 s
4b - range:
11 s
4bd - range:
11 s
Tall T-wave rejection
capability
Meets the requirements of part 4.1.2.1 c) of ANSI/AAMI EC 13 The
heart rate meter rejects all 100 ms QRS complexes with less than 1.2
mV of amplitude, and T waves with T-wave interval of 180 ms and
those with Q-T interval of 350 ms.
Arrhythmia Analysis
Classifications
Asystole, VFib/VTac, Couplet, Bigeminy, Trigeminy, R on T, VT>2,
PVC, Tachy, Brady, Missed Beats, PNP, PNC
ST Segment Analysis
Measurement range
Accuracy
Refreshing rate
-2.0 to 2.0 mV
-0.8 to 0.8 mV:
±0.02 mV or ±10%, whichever is greater.
Beyond this range:
Not specified.
10 s
A-10
Mortara algorithm
Only the differences from the Basic algorithm are listed.
HR
In compliance with the requirements in Clause 4.1.2.1 d) of
ANSI/AAMI EC13, the following method is used:
HR averaging method
Heart rate is computed by averaging the most recent 16 RR
intervals, unless the HR by averaging the most recent 4 heart
beats is less than or equals to 48 bpm.
The HR value displayed on the monitor screen is updated every
second.
Arrhythmia Analysis
Classifications
Asystole, Vfib, Vtac, Vent. Rhythm, Couplet, VT>2, Bigeminy,
Trigeminy, R on T, Multif. PVC, Irr. Rhythm, Tachy, Brady,
Missed Beats, PNP, PNC
ST Segment Analysis
Refreshing rate
per 16 heartbeats
A.5.2 Resp
Technique
Trans-thoracic impedance
Lead
Options are lead I and II. The default is lead II.
Waveform gain
X 0.25, X 0.5, X 1, X 2, X 3, X 4, X 5
Excitation current
<620 μA RMS
Respiration impedance range
0.3 to 5Ω
Baseline impedance range
200 to 2500Ω (without the 1kΩ resistance of the ECG cable)
Linear signal range
At least 3 Ω p-p
Minimum detection height
It changes according to the settings of display ratio. It is 0.3 Ω
when the display ratio is ×5.
Differential input impedance
>5 MΩ
Bandwidth
0.2 to 2 Hz (-3 dB)
Noise
<0.1 Ω (peak value) (using standard ECG cable, patient
impedance 500Ω)
Sweep speed
6.25 mm/s, 12.5 mm/s or 25 mm/s
A-11
Respiration Rate
Measurement range
Resolution
Adult:
0 to 120 rpm
Pediatric, neonate:
0 to 150 rpm
1 rpm
Accuracy
7 to 150 rpm:
±2 rpm or ±2%, whichever is greater
0 to 6 rpm:
Not specified.
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range (rpm)
RR High
(low limit + 2) to 100
RR Low
0 to (high limit – 2)
Step (rpm)
1
A.5.3 SpO2
Alarm limit
Range (%)
SpO2 High
(low limit + 1) to 100
SpO2 Low
Desat to (high limit – 1)
Desat
50 to (high limit – 1)
Step (%)
Delay (s)
1
10
Mindray SpO2 Module
Standards
Meet standards of ISO9919
*Measurement accuracy verification: The SpO2 accuracy has been verified in human
experiments by comparing with arterial blood sample reference measured with a CO-oximeter.
Pulse oximeter measurements are statistically distributed and about two-thirds of the
measurements are expected to come within the specified accuracy range compared to CO-oximeter
measurements.
Measurement range
0 to 100%
Resolution
1%
70 to 100%: ±2% (measured in adult/pediatric mode)
Accuracy
70 to 100%: ±3% (measured in neonate mode)
0% to 69%: Not specified.
*Studies were performed to validate the accuracy of Pulse Oximeter with neonatal SpO2 sensors
by contrast with a CO-Oximeter. Some neonates aged from 1 day to 30 days with a gestation age
of 22 weeks to full term were involved in this study. The statistical analysis of data of this study
shows the accuracy (Arms) is within the stated accuracy specification. Please see the following
table.
A-12
Sensor type
Totally neonates
Data
Arms
518B
97 (51 male & 46 female)
200 pairs
2.38%
520N
122 (65 male & 57 female)
200 pairs
2.88%
The Pulse Oximeter with neonatal SpO2 sensors was also validated on adult subjects.
Refreshing rate
2s
7 s (When the sensitivity is set to High)
SpO2 averaging time
9 s (When the sensitivity is set to Medium)
11 s (When the sensitivity is set to Low)
Masimo SpO2 Module
SpO2
Standards
Meet standards of ISO9919
Measurement range
1 to 100%
Resolution
1%
70 to 100%: ±2% (measured without motion in adult/pediatric
mode)
Accuracy
70 to 100%: ±3% (measured without motion in neonate mode)
70 to 100%: ±3% (measured with motion)
1% to 69%: Not specified.
Refreshing rate
1s
SpO2 averaging time
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
Low perfusion conditions
Low perfusion SpO2 accuracy
Pulse amplitude: >0.02%
Light penetration: >5%
±2%
A-13
Nellcor SpO2 Module
Parameter
Specifications
Standards
Meet standards of ISO9919
Measurement range
1 to 100%
70 to 100%: ±2% (measured in adult/pediatric mode)
Accuracy
70 to 100%: ±3% (measured in neonate mode)
0% to 69%: Not specified.
Refreshing rate
1s
SPO2 averaging time
8 s, 16 s
*: When the SpO2 sensor is applied for neonatal patients as indicated, the specified accuracy range
is increased by ±1%, to compensate for the theoretical effect on oximeter measurements of fetal
hemoglobin in neonatal blood.
A.5.4 PR
Alarm limit
Range (bpm)
PR High
(low limit +2) to 240
PR Low
25 to (high limit-2)
Step (bpm)
1
PR from Mindray SpO2 Module
Measurement range
20 to 254 bpm
Resolution
1 bpm
Accuracy
±3 bpm
Refreshing rate
2s
7 s (when sensitivity is set to High)
SPO2 averaging time
9 s (when sensitivity is set to Medium)
11 s (when sensitivity is set to Low)
PR from Masimo SpO2 Module
Measurement range
25 to 240 bpm
Resolution
1 bpm
Accuracy
±3 bpm (measured without motion)
±5 bpm (measured with motion)
Refreshing rate
1s
SPO2 averaging time
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
A-14
PR from Nellcor SpO2 Module
Measurement range
20 to 300 bpm
Resolution
1 bpm
Accuracy
20 to 250 bpm: ±3 bpm
251 to 300 bpm, not specified
Refreshing rate
1s
SPO2 averaging time
8 s, 16 s
PR from IBP Module
Measurement range
25 to 350 bpm
Resolution
1 bpm
Accuracy
±1 bpm or ±1%, whichever is greater
Refreshing rate
1s
A-15
A.5.5 NIBP
Standards
Meet standards of EN60601-2-30/IEC60601-2-30, EN1060-1,
EN1060-3, EN1060-4 and SP10
Technique
Oscillometry
Mode of operation
Manual, Auto and STAT
Auto mode repetition intervals
1, 2, 3, 4, 5, 10, 15, 30, 60, 90, 120, 180, 240 or 480 min
Typical measurement time
20 to 40 s (depending on the heart rate and motion artifact)
STAT mode cycle time
5 min
Measurement time protection
Adult, pediatric:
180 s
Neonate:
90 s
Adult
Pediatric
Neonate
Measurement ranges
Systolic:
40 to 270
40 to 200
40 to 135
(mmHg)
Diastolic:
10 to 210
10 to 150
10 to 100
Mean:
20 to 230
20 to 165
20 to 110
Accuracy
Resolution
Cuff inflation pressure
Software overpressure
protection
Max mean error: ±5 mmHg
Max standard deviation: 8 mmHg
1mmHg
Defaults
Range
Adult
160 mmHg
80 to 280
Pediatric
140 mmHg
80 to 210
Neonate
90 mmHg
60 to 140
Adult:
297±3 mmHg
Pediatric:
240±3 mmHg
Neonate:
147±3 mmHg
PR
Measurement range
40 to 240 bpm
Resolution
1 bpm
Accuracy
±2bpm or ±2%, whichever is greater
Assisting Venous Puncture
Pressure range
Duration
Adult:
20 to 120 mmHg
Pediatric:
20 to 80 mmHg
Neonate:
20 to 50 mmHg
Adult/Pediatric:
170 s
Neonate:
85 s
A-16
Step
10 mmHg
Alarm limit
Range (mmHg)
Step (mmHg)
Adult: (low limit+5) to 270
Sys High
Pediatric: (low limit+5) to 200
Neonate: (low limit+5) to 135
Sys Low
40 to (high limit-5)
Adult: (low limit+5) to 230
Mean High
Pediatric: (low limit+5) to 165
Neonate: (low limit+5) to 110
Mean Low
5
20 to (high limit-5)
Adult: (low limit+5) to 210
Dia High
Pediatric: (low limit+5) to 150
Neonate: (low limit+5) to 100
Dia Low
10 to (high limit-5)
*Measurement accuracy verification: In adult and pediatric modes, the blood pressure
measurements measured with this device are in compliance with the American National Standard
for Electronic or Automated Sphymomanometers (ANSI/AAMI SP10-1992) in terms of mean
error and stardard deviation by comparing with intra-arterial or auscultatory measurements
(depending on the configuration) in a typical patient population. For auscultatory reference, the
5th Korotkoff sound was used to determine the diastolic pressure.
In neonatal mode, the blood pressure measurements measured with this device are in compliance
with the American National Standard for Electronic or Automated Sphymomanometers
(ANSI/AAMI SP10-1992 and AAMI/ANSI SP10A-1996) in terms of mean error and stardard
deviation by comparing with intra-arterial measurements (depending on the configuration) in a
typical patient population.
A-17
A.5.6 Temp
Standards
Meet standard of EN12470-4
Technique
Thermal resistance
Measurement range
0 to 50 °C (32 to 122 °F)
Resolution
0.1 °C
Accuracy
±0.1 °C or ±0.2 °F (without probe)
Refreshing rate
1s
Time for accurate
measurement
Body surface: <100 s
Alarm limit
Range
T1/T2 High
T1/T2 Low
TD High
Body cavity: <80 s
Step
(low limit +1) to 50 °C
(low limit +1.8) to 122 °F
0 to (high limit -1) °C
0.1 °C
32 to (high limit -1.8) °F
0.1 °F
0 to 50 °C
0 to 90 °F
A.5.7 IBP
Standards
Meet standard of EN60601-2-34/IEC60601-2-34.
Technique
Direct invasive measurement
IBP
Measurement range
-50 to 300 mmHg
Resolution
1 mmHg
Accuracy
±2% or ±1 mmHg, whichever is greater (without sensor)
Refreshing rate
1s
Zero adjustment
Range:
±200 mmHg
Accuracy:
±1 mmHg
Drift:
<0.15 mmHg/°C;
Less than ±1 mmHg within 24 hours
Pressure transducer
Excitement voltage
5 VDC, ±2%
Sensitivity
5 µV/V/mmHg
Impedance range
300 to 3000Ω
A-18
Alarm limit
Range (mmHg)
ART
Sys High
Ao
Mean High
FAP
Dia High
BAP
UAP
Step (mmHg)
(low limit + 2) to 300
1
Sys Low
0 to (high limit – 2)
Mean Low
Dia Low
PA
Sys High
(low limit + 2) to 120
Mean High
Dia High
1
Sys Low
-6 to (high limit – 2)
Mean Low
Dia Low
CVP, LAP
Mean High
(low limit + 2) to 40
RAP, ICP,
UVP
Mean Low
-10 to (high limit – 2)
P1 to P4
Sys High
1
(low limit + 2) to 300
Mean High
Dia High
1
Sys Low
-50 to (high limit – 2)
Mean Low
Dia Low
A.5.8 C.O.
Measurement method
Measurement range
Resolution
Accuracy
Alarm range
Thermodilution method
C.O.:
0.1 to 20 L/min
TB:
23 to 43°C
TI:
0 to 27°C
C.O.:
0.1 L/min
TB, TI:
0.1°C
C.O.:
±5% or ±0.1 L /min, whichever is greater
TB, TI:
±0.1°C (without sensor)
BT:
23 to 43°C
A-19
Alarm limit
TB High
TB Low
Range
Step
(low limit + 1) to 43 °C
(low limit + 1.8) to 109.4 °F
0.1 °C
23 to (high limit - 1) °C
0.1 °F
73.4 to (high limit - 1.8) °F
A.5.9 CO2
Standard
Meet standard of ISO 21647
Measurement mode
Sidestream, microstream, mainstream
Technique
Infrared absorption
Sidestream CO2 Module
CO2 Measurement range
Accuracy*
0 to 99 mmHg
0 to 40 mmHg:
±2 mmHg
41 to 76 mmHg:
±5% of the reading
77 to 99 mmHg:
±10% of the reading
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Resolution
1 mmHg
Sample flowrate
70 ml/min, 100 ml/min 120 ml/min, 150 ml/min
Sample flowrate tolerance
±15% or ±15 ml/min, whichever is greater.
Warm-up time
1 min
Response time
Measured with a neonatal watertrap and a 2.5-meter neonatal
sampling line:
<3 s @ 150 ml/min
<3 s @ 120 ml/min
<3.5 s @ 100 ml/min
<4 s @ 70 ml/min
Measured with a neonatal watertrap and a 2.5-meter adult
sampling line:
<4.5 s @ 150 ml/min
<5.5 s @ 120 ml/min
<5.5 s @ 100 ml/min
<7 s @ 70 ml/min
Gas sampling delay time
Measured with a neonatal watertrap and a 2.5-meter neonatal
sampling line:
<2.5 s @ 150 ml/min
<3 s @ 120 ml/min
<3 s @ 100 ml/min
<3.5 s @ 70 ml/min
A-20
Measured with a neonatal watertrap and a 2.5-meter adult
sampling line:
<4 s @ 150 ml/min
<5 s @ 120 ml/min
<5 s @ 100 ml/min
<6.5 s @ 70 ml/min
awRR measurement range
0 to 120 rpm
awRR measurement precision
±2 rpm
Apnea time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Effect of interference gases on CO2 measurements
Gas
Concentration (% )
N2O
≤60
Hal
≤4
Sev
≤5
Iso
≤5
Enf
≤5
Des
≤15
Quantitive effect*
±1 mmHg
±2 mmHg
*: means an extra error should be added in case of gas interference when CO2 measurements are
performed under 0-40mmHg.
Alarm limit
Range
Step
EtCO2 High
(low limit + 2) to 99 mmHg
EtCO2 Low
0 to (high limit - 2)mmHg
FiCO2 High
0 to 99 mmHg
awRR High
(low limit + 2) to 100 rpm
awRR Low
6 to (high limit - 2) rpm
1 mmHg
1 rpm
* Accuracy applies for the following conditions:
1.
Measurements begin after the CO2 module warms up;
2.
Ambient pressure is from 750 to 760 mmHg, and ambient temperature from 22 to
28ºC;
3.
The measured gas is a dry gas and the balance gas N2;
4.
Gas sample flow rate is 100 ml/min, respiration rate is 50 rpm with a fluctuation
between ±3 rpm, and I:E is 1:2.
When the operating temperature (near the module detector) is 5-25°C or 50-55°C, or the
respiration rate is greater than 50 rpm, the measurement accuracy is: ±4 mmHg (0 to 40
mmHg) or 12% of the reading (41 to 99 mmHg).
A-21
Microstream CO2 Module
CO2 Measurement range
Accuracy*
Accuracy drift
0 to 99 mmHg
0 to 38 mmHg:
±2 mmHg
39 to 99 mmHg:
±5% of the reading+0.08% of (the reading-38)
Meet the requirement for measurement accuracy within 6 hours
* Accuracy applies for respiration rate up to 80 rpm. For respiration rate above 80 rpm, the
accuracy is 4 mmHg or ±12% of the reading, whichever is greater. for EtCO2 exceeding 18
mmHg. For respiration rate above 60 rpm, the above accuracy can be achieved by using the
CapnoLine H Set for Infant/Neonatal. In the presence of interfering gases, the above accuracy is
maintained to within 4%.
Resolution
1 mmHg
Sample flow rate
50−+7.5
15 ml/min
Initialization time
30 s (typical)
4.5 s (typical)
Response time
(The response time is the sum of the rise time and the delay time
when using a FilterLine of standard length)
Rise time: <190 ms (10% to 90%)
Delay time: 2.7 s (typical)
awRR measurement range
awRR measurement accuracy
0 to 150 rpm
0 to 70 rpm:
±1 rpm
71 to 120 rpm:
±2 rpm
121 to 150 rpm:
±3 rpm
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range
EtCO2 High
(low limit + 2) to 99 mmHg
EtCO2 Low
0 to (high limit - 2)mmHg
FiCO2 High
0 to 99 mmHg
awRR High
(low limit + 2) to 100 rpm
awRR Low
6 to (high limit - 2) rpm
Step
A-22
1 mmHg
1 rpm
Mainstream CO2 Module
CO2 Measurement range
0 to 150 mmHg
Accuracy
Accuracy drift
0 to 40 mmHg:
±2 mmHg
41 to 70 mmHg:
±5% of the reading
71 to 100 mmHg:
±8% of the reading
101 to 150 mmHg:
±10% of the reading
Meet the requirement for measurement accuracy within 6 hours
Resolution
0 to 69 mmHg:
1 mmHg
70 to 150 mmHg:
0.25 mmHg
Rise time
<60 ms
awRR measurement range
0 to 150 rpm
awRR measurement accuracy
±1 rpm
Alarm limit
Range
EtCO2 High
(low limit + 2) to 150 mmHg
EtCO2 Low
0 to (high limit - 2)mmHg
FiCO2 High
0 to 150 mmHg
awRR High
(low limit + 2) to 100 rpm
awRR Low
6 to (high limit - 2) rpm
Step
1 mmHg
1 rpm
A.5.10 AG
Standards
Meet standard of ISO 21647 and YY0601
Technique
Infrared absorption
Warm-up time
Sample flow rate
Measurement range
Resolution
Iso accuracy mode:
45 s
Full accuracy mode:
10 min
Adult, pediatric:
120, 150, 200 ml/min
Neonate:
70, 90, 120 ml/min
Accuracy:
±10 ml/min or ±10%, whichever is greater
CO2:
0 to 10%
O2, N2O:
0 to 100%
Des:
0 to 18%
Sev:
0 to 8%
Enf, Iso, Hal:
0 to 5%
awRR:
2 to 100 rpm
CO2:
1 mmHg
awRR:
1 rpm
A-23
Iso accuracy
CO2:
±0.3%ABS
N2O:
±(8%REL+2%ABS)
Other anesthetic gases:
8%REL
Gases
Range (%REL)
Accuracy (%ABS)
0 to 1
±0.1
1 to 5
±0.2
5 to 7
±0.3
7 to 10
±0.5
>10
Not specified
0 to 20
±2
20 to 100
±3
0 to 25
±1
25 to 80
±2
80 to 100
±3
0 to 1
±0.15
1 to 5
±0.2
5 to 10
±0.4
10 to 15
±0.6
15 to 18
±1
>18
Not specified
0 to 1
±0.15
1 to 5
±0.2
5 to 8
±0.4
>8
Not specified
0 to 1
±0.15
1 to 5
±0.2
>5
Not specified
2 to 60 rpm
±1 rpm
>60 rpm
Not specified
CO2
N2O
O2
Full accuracy
Des
Sev
Enf, Iso, Hal
awRR
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Apnea alarm time
20 s, 25 s, 30 s, 35 s, 40 s
Refreshing rate
1s
A-24
gas sample flow rate 120ml/min, using the DRYLINE™ watertrap and
neonatal DRYLINE™ sampling line (2.5m):
CO2
≤250 ms (fall time: 200ms)
N2O
≤250 ms
O2
≤600 ms
Hal, Iso, Sev, Des
≤300 ms
Rise time
Enf
≤350 ms
(10 % to 90%)
gas sample flow rate 200ml/min, using the DRYLINE™ water trap and
adult DRYLINE™ sampling line (2.5m):
Delay time
CO2
≤250 ms (fall time: 200 ms)
N2O
≤250 ms
O2
≤500 ms
Hal, Iso, Sev, Des
≤300 ms
Enf
≤350 ms
<4 s
Primary anesthetic agent
In full accuracy mode: 0.15%,
Anesthetic agent limit
(type AION 03)
In ISO accuracy mode: 0.4%
Second anesthetic agent:
In full accuracy mode: 0.3% or 5% REL (10% in ISO accuracy mode) of
primary agent if primary agent is greater than 10%
In ISO accuracy mode: 0.5%
* Accuracy applies for the following conditions:
1.
Measurements begin after the module warms up;
2.
Ambient pressure is from 750 to 760 mmHg, and ambient temperature from 22 to
28ºC;
3.
The measured gas is a dry gas and the balance gas N2;
4.Gas sample flow rate is 120 ml/min, respiration rate is 20 rpm with a fluctuation between
±3 rpm, and I:E is 1:2.
A-25
Effect of interference gases on AG measurements
Gas
Concentration
(% )
Quantitive effect (%ABS)3)
CO2
N2O
Agent 1)
O2
CO2
/
/
0.1
0
0.2
N2O
/
0.1
/
0.1
0.2
Agent 1) 2)
/
0.15)
0.15)
0.14)
1
Nitrogen
≤78%
0
0
0
0
Xenon
<100%
0.1
0
0
0.5
Helium
<50%
0.1
0
0
0.5
Ethanol
<0.1%
0
0
0
0.5
Acetone
<1%
0.1
0.1
0
0.5
Methane
<1%
0.1
0.1
0
0.5
Saturated Isopropanol
vapour
/
0.1
0
0
0.5
Metered dose inhaler
propellants,
/
Unspecified
Unspecified
Unspecified
0.5
Methoxyflurane
/
Unspecified
Unspecified
Unspecified
Unspecified
1) Agent represents one of Des, Iso, Enf, Sev, and Hal.
2) Multiple agent interference on CO2, N2O and O2 is typically the same as single agent
interference.
3) For CO2, N2O and Agents, maximum interference from each gas at concentrations within
specified accuracy ranges for each gas. The total interference of all gases is never larger than
5%REL.
4) Only applicable for AION 03-type module, meaning the secondary agent interference on the
primary one.
5) For AION 02-type module, it is the interference provided that input of used anesthetic agent has
been done.
A-26
Alarm limit
Range
Step
EtCO2 High
(low limit + 2) to 76 mmHg
EtCO2 Low
0 to (high limit - 2)mmHg
FiCO2 High
(low limit + 2) to 76 mmHg
FiCO2 Low
0 to (high limit - 2)mmHg
awRR High
(low limit + 2) to 100 rpm
awRR Low
0 to (high limit - 2)rpm
EtO2 High
(low limit + 0.3) to 100 %
EtO2 Low
18 to (high limit - 0.3)%
FiO2 High
(low limit + 0.3) to 100 %
FiO2 Low
18 to (high limit - 0.3)%
EtN2O High
(low limit + 2) to 100 %
EtN2O Low
0 to (high limit - 2)%
FiN2O High
(low limit + 2) to 100 %
FiN2O Low
0 to (high limit - 2)%
EtHal/Enf/Iso High
(low limit + 0.2) to 5.0 %
EtHal/Enf/Iso Low
0 to (high limit - 0.2)%
FiHal/Enf/Iso High
(low limit + 0.2) to 5.0 %
FiHal/Enf/Iso Low
0 to (high limit - 0.2)%
EtSev High
(low limit + 0.2) to 8.0 %
EtSev Low
0 to (high limit - 0.2)%
FiSev High
(low limit + 0.2) to 8.0 %
FiSev Low
0 to (high limit - 0.2)%
EtDes High
(low limit + 0.2) to 18.0 %
EtDes Low
0 to (high limit - 0.2)%
FiDes High
(low limit + 0.2) to 18.0 %
FiDes Low
0 to (high limit - 0.2)%
A-27
1 mmHg
1 rpm
0.1%
1%
0.1%
0.1%
0.1%
FOR YOUR NOTES
A-28
B EMC
The equipment meets the requirements of EN 60601-1-2.
NOTE
z
Use of accessories, transducers, and cables other than those specified may result
in increased emission and/or decreased immunity of the equipment.
z
The equipment should not be used adjacent to or stacked with other equipment,
and if adjacent or stacked use is necessary, the equipment should be observed to
verify normal operation in the configuration in which it will be used.
z
The equipment needs special precautions regarding EMC and needs to be
installed and put into service according to the EMC information provided
below.
z
The equipment may be interfered with by other equipment, even if that other
equipment complies with CISPR emission requirements.
z
Operation of the device, in the case that the patient physiological signal is lower
than the minimum amplitude and/or value specified in the product
specifications, may cause inaccurate results.
B-1
TABLE 1
Guidance and declaration — electromagnetic emissions
The equipment is intended for use in the electromagnetic environment specified below.
The customer or the user of the equipment should assure that it is used in such an environment.
Emissions test
Compliance
Electromagnetic environment — guidance
RF emissions
CISPR 11
Group1
The equipment uses RF energy only for its internal
function. Therefore, its RF emissions are very low and
are not likely to cause any interference in nearby
electronic equipment.
RF emissions
CISPR 11
Class A
Harmonic
Emissions
IEC61000-3-2
Class A
The equipment is suitable for use in all establishments
other than domestic and those directly connected to
the public low-voltage power supply network that
supplies buildings used for domestic purposes.
Voltage
Fluctuations/Flicker
Emissions IEC
61000-3-3
Compliance
Pst ,Tdt (ms)
Dmax(%)
Dc (%)
B-2
TABLE 2
Guidance and declaration — electromagnetic immunity
The equipment is intended for use in the electromagnetic environment specified below.
The customer or the user of the equipment should assure that it is used in such an environment.
Immunity test
IEC 60601 Test
level
Compliance
level
Electromagnetic environment
— guidance
Electrostatic
Discharge (ESD)
IEC 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
IEC 61000-4-4
±2 kV for power
supply lines
±1 kV for
input/output lines
(>3m).
±2 kV for power
supply lines
±1 kV for
input/output
lines (>3m)
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 different
mode
±2 kV common
mode
Mains power quality should be
that of a typical commercial or
hospital environment.
Voltage dips,
Short
interruptions and
voltage variation
on power supply
input lines IEC
61000-4-11
<5% UT
(>95% dip in UT)
for 0.5 cycle
40% UT
(60% dip in UT)
for 5 cycle
70% UT
(30% dip in UT)
for 25 cycle
<5% UT
(>95% dip in UT)
for 5 sec
<5% UT
(>95% dip in UT)
for 0.5 cycle
40% UT
(60% dip in UT)
for 5 cycle
70% UT
(30% dip in UT)
for 25 cycle
<5% UT
(>95% dip in UT)
for 5 sec
Mains power quality should be
that of a typical commercial or
hospital environment. If the user
of our product requires continued
operation during power mains
interruptions, it is recommended
that our product be powered from
an uninterruptible power supply or
a battery.
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.
UT is the A.C. mains voltage prior to application of the test level.
B-3
TABLE 3
Guidance and declaration — electromagnetic immunity
The equipment is intended for use in the electromagnetic environment specified below.
The customer or the user of the equipment should assure that it is used in such an environment
Immunity
test
Conduced
RF IEC
61000-4-6
IEC 60601
Test level
3 Vrms
150kHz to
80MHz
Compliance
level
3 Vrms
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
d = 1.2 x P
d = 1.2 x P 80 MHz to 800 MHz
d = 2.3 x P 800 MHz to 2.5GHz
Radiated
RF IEC
61000-4-3
3 V/m
80MHz to
2.5GHz
3V/m
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 survey, a
should be less than the compliance level in each
frequency range b Interference may occur in the
vicinity of equipment marked with the following
symbol:
Note — At 80 MHz and 800 MHz, 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.
a
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless)
telephones and land mobile radios, amateur radio, 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 ranges 150kHz to 80MHz, field strengths should be less than 3V/m.
B-4
TABLE 4
Recommended separation distances between portable and mobile RF communication and
the equipment
The equipment is intended for use in an electromagnetic environment in which radiated RF
disturbance are controlled. The customer or the user of the equipment can help prevent
electromagnetic interference by maintaining a minimum distance between portable and mobile
RF communication equipment (transmitters) and the equipment as recommended below,
according to the maximum output power of the communication equipment.
Rated Maximum
Output power of
Transmitter W
(Watts)
Separation Distance According to Frequency of Transmitter
M (Meters)
150kHz -80MHz
80MHz -800MHz
800MHz -2.5GHz
d = 1 .2 P
d = 1 .2 P
d = 2 .3 P
0.01
0.12
0.12
0.23
0.1
0.37
0.37
0.74
1
1.17
1.17
2.34
10
3.69
3.69
7.38
100
11.67
11.67
23.34
For transmitters at a maximum output power not listed above, the recommended separation
distanced in meters (m) can be determined 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.
B-5
FOR YOUR NOTES
B-6
C Default Configurations
This chapter lists some of the most important factory default settings for each department in
configuration mode. You cannot change the factory default configuration itself. However, you
can make changes to the settings from the factory default configuration and then save the
changed configuration as a user configuration. The last column of the following tables is for
your notes and review.
Note: In this chapter, O.M means the monitor’s operating mode. Column C refers to the
settings that can be changed in configuration Mode. Column M refers to the settings that can
be changed in monitoring mode.
C.1 Global Configuration
Item Name
General
OR
ICU
NICU
CCU
Patient Cat.
Adu
Adu
Adu
Neo
Adu
Load Selected Config at Startup
Selected
C-1
User Defaults
C.2 Parameters Configuration
C.2.1 ECG
ECG Setup
Item Name
O.M General
OR
ICU
NICU
CCU
C M
Lead Set
* *
5-Lead
3-Lead
5-Lead
ECG Waveforms
* *
2
1
3
Alm Source
* *
HR
Alarm
* *
On
Alm Lev
* *
Med
* *
120
140
120
Ped
160
180
160
Neo
200
200
200
50
40
50
Ped
75
60
75
Neo
100
90
100
HR High
HR Low
Adu
Adu
* *
Sweep
* *
25 mm/s
Beat Vol
* *
2
Paced
*
No
* *
Off
Notch Filter
*
On
HR Source
*
II
Cascade
Gain
* *
X1
Filter
* *
Monitor
*
Normal
ECG Display
Smart Lead Off
* *
Off
Defib. Sync
*
Off
Pacemaker Rate
*
60
1
Surgery Monitor
C-2
Diagnostic
User Defaults
ST Analysis
Item Name Algorithm O.M General
OR
ICU
NICU
CCU
C M
ST Unit
/
* *
mV
ST Analysis /
* *
Off
On
Alarm
/
* *
Off
On
Alm Lev
/
* *
Med
ST-X High
/
* *
when ST Unit is mV:
0.20
when ST Unit is mm:
2.0
when ST Unit is mV:
-0.20
when ST Unit is mm:
-2.0
ST-X Low
ISO
/
Basic
* *
* *
ST
ISO
78 ms
109 ms
Mortara
* *
-80 ms
J
48 ms
ST
J + 60 ms
*: X represents I, II, III, aVR, aVL, aVF, V, V1, V2, V3, V4, V5 or V6.
C-3
User Defaults
Arrh. Analysis
Item Name
Algorithm O.M
Genral
OR ICU NICU CCU User Defaults
C M
Arrh. Analysis
/
*
*
Off
On
PVCs Alarm
/
*
*
Off
On
Alm Lev
/
*
*
Med
PVCs High
/
*
*
10
5
10
*
*
5
3
5
Vtac Rate
*
*
130
150
130
Vtac PVCs
*
*
6
Multif. PVC’s Window
*
*
15
Tachy
*
*
Adu:
100
Ped:
160
Neo:
180
Adu:
60
Ped:
80
Neo:
90
Arrhythmia Threshold Settings
Asystole
Mortara
*
Brady
*
Arrhythmia Alarm Settings
X Alarm
*
*
On
Asystole Alm Lev
*
*
High
VFib/VTac Alm Lev
*
*
High
X Alm Lev
*
*
Med
X Alm Rec
*
*
Off
*
*
On
Asystole Alm Lev
*
*
High
VFib Alm Lev
*
*
High
VTac Alm Lev
*
*
High
X Alm Lev
*
*
Med
X Alm Rec
*
*
Off
*
*
Med
X Alarm
All Alm Lev
Basic
Mortara
/
*X represents a certain arrhythmia event. Refer to the Specifications chapter for details. The
X in “X Alm Lev” refers to all arrhythmia events except for those specially marked ones.
C-4
C.2.2 RESP
Item Name
O.M
General
OR
ICU
NICU
CCU
15 s
20 s
User Defaults
C M
Alarm
*
*
On
Alm Lev
*
*
Med
Sweep
*
*
6.25 mm/s
Lead
*
*
II
Gain
*
*
X2
Resp High
*
*
Adu, Ped: 30
Neo:
Resp Low
*
*
Adu, Ped: 8
Neo:
Apnea Time
Detection Mode
*
100
*
20 s
*
Auto
30
C.2.3 PR
Item Name
O.M
General
OR
ICU
C M
Alarm
* *
On
Alm Lev
* *
Med
HR High Adu
* *
120
150
120
Ped
160
180
160
Neo
200
200
200
50
40
50
Ped
75
60
75
Neo
100
90
100
HR Low Adu
PR Source
Beat Vol
* *
*
* *
SpO2
2
1
C-5
NICU
CCU
User Defaults
C.2.4 SpO2
Item Name
O.M
General
OR
ICU NICU CCU User Defaults
C M
Alarm
* *
On
Alm Lev
* *
Med
SpO2 High
* *
Adu, Ped:
100
Neo:
95
SpO2 Low
* *
Adu, Ped, Neo:
90
Desat Limit
* *
Adu, Ped, Neo:
80
Sweep
* *
25 mm/s
NIBP Simul
*
Off
Pitch Tone
*
Mode 1
Sensivity
* *
Med
Sensivity (Masimo)
* *
Normal
Averaging (Masimo, Nellcor)
* *
8s
Sat-Seconds (Nellcor)
* *
0s
C.2.5 Temp
Item Name
O.M
General
OR
ICU
C M
Alarm
*
*
On
Alm Lev
*
*
Med
Temp Unit
*
*
ºC
T1/T2 High (ºC) Adu
*
*
39.0
Ped
39.0
Neo
39.0
T1/T2 Low (ºC) Adu
TD High (ºC)
36.0
35.0 36.0
Ped
36.0
35.0 36.0
Neo
36.0
35.0 36.0
Adu
*
*
*
*
2.0
Ped
2.0
Neo
2.0
C-6
NICU
CCU
User Defaults
C.2.6 NIBP
Item Name
O.M General
OR
ICU
NICU
CCU
C M
Alarm
* * On
Alm Lev
* * Med
Alm Source
* * All
Measure Mode
* * Manual
Auto
Interval
* * 15 min
5 min
Press. Unit
* * mmHg
Display NIBP
* * Single-group Multi-group Single-group
PR Display
*
Cuff Press
(mmHg)
Inflation
Pressure
(mmHg)
Manual Auto
15 min
Off
Adu
* * 80
Ped
60
Neo
40
Adu
* * 160
Ped
140
Neo
90
Alarm Limits Setup
Sys High
(mmHg)
Sys Low
(mmHg)
Mean High
(mmHg)
Mean Low
(mmHg)
Dia High
(mmHg)
Dia Low
(mmHg)
Adu
* * 160
180
160
Ped
120
140
120
Neo
90
Adu
* * 90
70
90
Ped
70
60
70
Neo
40
120
110
Adu
* * 110
Ped
90
Neo
70
Adu
* * 60
Ped
50
Neo
25
Adu
* * 90
Ped
70
Neo
60
Adu
* * 50
Ped
40
Neo
20
C-7
30 min
15 min
User
Defaults
C.2.7 IBP
Item Name
O.M
General OR
ICU
C M
Alarm
* *
On
Alm Lev
* *
Med
P1 Measure
* *
All
P2 Measure
* *
Mean
P3 Measure
* *
All
P4 Measure
* *
Mean
Alarm Source
* *
All
Press. Unit
* *
mmHg
Response
* *
Med
Sweep
* *
25 mm/s
Auto Scaling
* *
Off
Filter
*
12.5 Hz
Wave Overlapping
* *
Off
Art, Ao, UAP, BAP, FAP Setup
Upper Scale
* *
150
Middle Scale
* *
75
Lower Scale
* *
0
* *
160
180
160
Ped
120
140
120
Neo
90
90
70
90
Ped
70
60
70
Neo
55
120
110
60
70
Sys High
(mmHg)
Sys Low
(mmHg)
Mean High
(mmHg)
Mean Low
(mmHg)
Dia High
(mmHg)
Dia Low
(mmHg)
Adu
Adu
Adu
* *
* *
110
Ped
90
Neo
70
Adu
* *
70
Ped
50
Neo
35
Adu
* *
90
Ped
70
Neo
60
Adu
* *
50
Ped
40
Neo
20
C-8
NICU
CCU
User Defaults
PA Setup
Upper Scale
*
*
30
Middle Scale
*
*
15
Lower Scale
*
*
0
*
*
35
Sys High
(mmHg)
Sys Low
(mmHg)
Mean High
(mmHg)
Mean Low
(mmHg)
Dia High
(mmHg)
Dia Low
(mmHg)
Adu
Ped
60
Neo
60
Adu
*
*
10
Ped
24
Neo
24
Adu
*
*
20
Ped
26
Neo
26
Adu
*
*
0
Ped
12
Neo
12
Adu
*
*
16
Ped
4
Neo
4
Adu
*
*
0
Ped
-4
Neo
-4
CVP, LAP, RAP, ICP, UVP Setup
Upper Scale
*
*
30
Middle Scale
*
*
15
Lower Scale
*
*
0
*
*
10
Mean High
(mmHg)
Mean Low
(mmHg)
Adu
Ped
4
Neo
4
Adu
*
*
0
Ped
0
Neo
0
C-9
C.2.8 C.O.
Item Name
O.M
General OR
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
TB High (ºC)
*
*
39.0
TB Low (ºC)
*
*
36.0
Comp. Const
*
*
0.542
Auto Ti (ºC)
*
*
On
Manual Ti (ºC)
*
*
2.0
Temp Unit
*
*
ºC
Interval (s)
*
*
30
ICU
NICU
CCU
User
Defaults
C.2.9 CO2
Item Name
O.M General
OR
ICU
NICU
CCU
C M
Alarm
* * On
Alm Lev
* * Med
Press.Unit
* * mmHg
Operating Mode
* * Sidestream:
Standby
Microstream/Mainstream:
Sweep
* * 6.25 mm/s
Scale (mmHg)
* * 50
Measure
Sidestream CO2 Setup
Flow Rate
* * 100 ml/min
Humidity Compen
* Off
N2O Compen
* 0
O2 Compen
* 0
Des Compen
* 0
70 ml/min 100 ml/min
C-10
User Defaults
Item Name
O.M
General OR ICU NICU
CCU
C M
Microstream CO2 Setup
Humidity Compen
*
Off
Max Hold
* *
20 s
Auto Standby (min)
* *
0
* *
10 s
O2 Compen
*
Off
Balance Gas
*
Room Air
AG Compen
*
0
*
Adu, Ped:
50
Neo:
45
Adu:
15
Ped:
20
Neo:
30
Mainstream CO2 Setup
Max Hold
Alarm Limits Setup
EtCO2 High (mmHg)
EtCO2 Low (mmHg)
*
*
*
FiCO2 High (mmHg)
*
*
Adu, Ped, Neo:
4
awRR High
*
*
Adu, Ped:
30
Neo:
100
Adu, Ped:
8
Neo:
30
awRR Low
Apnea Time
*
*
*
*
20 s
15 s
C-11
20 s
User Defaults
C.2.10 AG
Item Name
O.M
General
OR
ICU
NICU
C M
Alarm
* *
On
Alm Lev
* *
Med
Sweep
* *
6.25 mm/s
O2 Compen
*
Off
Operating Mode
* *
Measure
Flow Rate
* *
Adu, Ped: 120 ml/min
Neo:
70 ml/min
Auto Standby
* *
Off
Apnea Time
* *
20 s
CO2 Unit
* *
mmHg
Wave Type
* *
Draw
Scale
* *
when unit is mmHg:
50
when unit is %
7.0
CO2 Setup
EtCO2 High
EtCO2 Low
* *
* *
Adu, Ped:
50
Neo:
45
Adu:
15
Ped:
20
Neo:
30
or KPa:
FiCO2 High
* *
4
FiCO2 Low
* *
0
awRR High
* *
Adu, Ped:
30
Neo:
100
Adu, Ped:
8
Neo:
30
awRR Low
* *
C-12
CCU User Defaults
Gas Setup
Agent
*
---
O2 Unit
* *
%
N2O Scale
* *
50
O2 Scale
* *
when unit is mmHg:
400
when unit is %
50
AA Scale
* *
9
Hal/Enf/Iso Scale
* *
2.5
Des Scale
* *
9
Sev Scale
* *
4
EtO2 High
* *
90
EtO2 Low
* *
18
FiO2 High
* *
88
FiO2 Low
* *
18
EtN2O High
* *
55
EtN2O Low
* *
0
FiN2O High
* *
53
FiN2O Low
* *
0
EtHal/Enf/Iso High
* *
3
EtHal/Enf/Iso Low
* *
0
FiHal/Enf/Iso High
* *
2
FiHal/Enf/Iso Low
* *
0
EtSev High
* *
6
EtSev Low
* *
0
FiSev High
* *
5
FiSev Low
* *
0
EtDes High
* *
8
EtDes Low
* *
0
FiDes High
* *
6
FiDes Low
* *
0
C-13
or KPa:
C.3 Routine Configuration
C.3.1 Alarm
Item Name
O.M
General
OR
ICU
NICU
C M
Alarm Pause Time
*
2 min
Minimum Alarm Volume
*
2
1
2
Alm Volume
* *
2
1
2
Reminder Tone
*
Off
Reminder Vol
* *
Low
Reminder Interval
*
1 min
Latching Alarms
*
Off
Display Alarm Limits
*
On
Alm Lev of ECG Lead Off
*
Low
Alm Lev of SpO2 Sensor Off
*
Low
Alarm Tone Interval
*
High Level Alarm:
10 s
Med/Low Level Alarm: 20 s
Alarm Delay
* *
6s
ST Alarm Delay
* *
30s
C-14
CCU User Defaults
C.3.2 Screens
Item Name
O.M
General
OR ICU NICU
CCU
User Defaults
C M
Select Screen
* *
All parameters
Select Wave
1
Sequence for All 2
Parameters
3
Screen
4
* *
ECG
Select
Parameters for
Big Numerics
Screen
Pleth
IBP1
IBP2
5
IBP3
6
IBP4
7
CO2
8
AA
Parameter 1 * *
ECG
Parameter 2
SpO2
Parameter 3
Resp
Parameter 4
NIBP
C.3.3 Waveform
Item Name
O.M
General OR ICU NICU
C M
Sweep Mode
* *
Refresh
Wave Line
*
Medium
Draw Wave
*
Colour
CO2 Wave Type
* *
Draw
Waveforms X
* *
On
Parameter/ ECG
Wave
NIBP
Colour
SpO2
*
Green
White
Cyan
TEMP
White
Art/Ao/UAP/FAP
Red
/BAP/P1 to P4
PA
Yellow
CVP/ICP
Blue
C-15
CCU
User Defaults
LAP
Purple
RAP
Orange
UVP
Cyan
CO2
Yellow
RESP
Yellow
AA
Yellow
N2O
Blue
O2
Green
Hal
Red
Enf
Orange
Iso
Purple
Des
Cyan
Sev
Yellow
C.O.
White
* X represents a waveform label, such as ECG, RESP, CO2 and so forth. The ECG waveform
cannot be set off.
C.3.4 Archives
Item Name
O.M
General
OR
ICU
NICU
CCU
C M
Archives Access
*
Tabular
Trends
Interval
*
*
5 min
Trend Group
*
*
Standard
ECG
Graphic
Trends
Interval
*
*
1s
5s
Trend Group
*
*
Standard
Event Wave Length
*
*
16 s
Event Modification Right
*
Minitrend Length
*
Full
Disclosure
Direct
32 s
On
*
2h
Gain
*
X1
Sweep
*
12.5 mm/s
Save Waves *
*
All the waveforms that the monitor has
C-16
User Defaults
C.3.5 Record
Item Name
O.M
C
General OR
*
ECG1
Waveform 2
*
ECG2
Waveform 3
*
Off
Length
*
*
8s
Interval
*
*
Off
Paper Speed
*
*
25 mm/s
Gridlines
*
*
On
*
*
Off
X
NICU
CCU
M
Waveform 1
Alm Rec
ICU
User
Defaults
* X represents a parameter label.
C.3.6 Print
Item Name
O.M General
OR
C M
Printer
* None
Paper Size
* A4
Print On Both Sides
* Off
ECG
Reports
Tabular
Trends
Reports
ICU
NICU CCU User
Defaults
Set as End Case Report * * Unselected
Amplitude
* * 10 mm/mV
Sweep
* * 25 mm/s
Auto Interval
* * Off
Gridlines
* * Off
12-Lead Format
* * 12X1
Set as End Case Report * * Unselected
Back
* * Auto
Interval
* * Auto
Report Layout
* * Time Oriented
Select Parameters
* * Currently Displayed Trended Parameters
Graphic Set as End Case Report * * Unselected
Trends Back
* * Auto
C-17
Reports
Interval
* * Auto
Select Parameters
* * Currently Displayed Trended Parameters
Realtime Set as End Case Report * * Unselected
Report Sweep
* * Auto
Select Wave
* * Current
C.3.7 Others
Item Name
O.M General
OR
C M
Brightness
* * 5
Key Volume
* * 2
ICU NICU CCU User
Defaults
Modules
X
* * On
Analog
Out.
Analog Out.
* Off
Waveform
* The first ECG waveform on the screen
Nurse Call Signal Type
* Continuous
Contact Type
View
Other
Patient
* Normally Closed
Alm Lev
*
High, Med, Low
Alarm Cat.
*
Phys., Tech.
Auto Alarm
* * On
Audio Pause *
On
Select
QuickKey 1
QuickKeys
*
Standby
QuickKey 2
*
Limits
QuickKey 3
*
Screens
QuickKey 4
*
Auto NIBP
Discharge
Patient
* X represents a module label.
C-18
Standby
D Alarm Messages
This chapter lists only the most important physiological and technical alarm messages. Some
messages appearing on your monitor may not be included.
In this chapter:
The “I” field indicates how alarm indications are cleared: “A” means all alarm indications can be
cleared, “B” indicates all alarm indications except the alarm message can be cleared, and “C”
indicates only alarm tones can be cleared.
The “L” field indicates the alarm level: H means high, M means medium and L means low. “*”
means the alarm level is user-adjustable.
XX represents a measurement or parameter label, such as ECG, NIBP, HR, ST-I, PVCs, RR, SpO2,
PR, etc.
In the “Cause and Solution” column, corresponding solutions are given instructing you to
troubleshoot problems. If the problem persists, contact your service personnel.
D-1
D.1 Physiological Alarm Messages
Measurement
Alarm messages
L
Cause and solution
XX
XX Too High
M*
XX Too Low
M*
XX value has risen above the high alarm limit or fallen
below the low alarm limit. Check the patient’s
condition and check if the patient category and alarm
limit settings are correct.
ECG Weak Signal
H
The ECG signal is so weak that the monitor can’t
perform ECG analysis. Check the patient’s condition
and the ECG connections.
Asystole
H
VFib/VTac
H
Arrhythmia has occurred to the patient. Check the
patient’s condition and the ECG connections.
R on T
M*
VT>2
M*
Couplet
M*
PVC
M*
Bigeminy
M*
Trigeminy
M*
Tachy
M*
Brady
M*
Missed Beats
M*
Irr. Rhythm
M*
Vent. Rhythm
M*
Multif. PVC
M*
PNP
M*
PNC
M*
Resp Apnea
H
The respiration signal was so weak that the monitor
cannot perform respiration analysis. Check the
patient’s condition and the Resp connections.
Resp Artifact
H
The patient’s heartbeat has interfered with his
respiration. Check the patient’s condition and the Resp
connections.
SpO2
SpO2 Desat
H
The SpO2 value has fallen below the desaturation
alarm limit. Check the patient’s condition and check if
the alarm limit settings are correct.
PR
No pulse
H
The pulse signal was so weak that the monitor cannot
perform pulse analysis. Check the patient’s condition,
SpO2 sensor and measurement site.
ECG
Resp
The pacer appears abnormal. Check the pacer.
D-2
Measurement
Alarm messages
L
Cause and solution
CO2
CO2 Apnea
H
AG
AG Apnea
H
The patient stops breathing, or the respiration signal
was so weak that the monitor cannot perform
respiration analysis. Check the patient’s condition and
the RM connections.
FiO2 Too Low
H
Check the patient’s condition, the ventilated O2 content
and the AG connections.
Anesthetic
Mixture’s MAC>3
M
The system has detected more than one anesthesia gas
and the mixture’s MAC was too high. Check the
ventilated anesthesia gases’ type and concentration.
D.2 Technical Alarm Messages
Measurement
Alarm message
L
I
Cause and solution
XX
XX SelfTest Err
H
C
XX Init Err
H
C
XX Comm Err
L
C
An error occurred to the XX module, or there is a
problem with the communications between the
module and the monitor. Restart the monitor.
XX Comm Stop
H
C
XX Comm
Abnormal
L
C
XX Limit Err
L
C
XX parameter limit is accidentally changed.
Contact your service personnel.
XX Overrange
L
C
The measured XX value is not within the
specified range for XX measurement. Contact
your service personnel.
ECG Lead Off
M B
*
ECG YY Lead Off
M B
*
ECG
(YY represents a
leadwire.)
ECG Noisy
L
C
The electrode has become detached from the
patient or the lead wire has become disconnected
from the adapter cable. Check the connections of
the electrodes and leadwires.
The ECG signal is noisy. Check for any possible
sources of signal noise around the cable and
electrode, and check the patient for great motion.
D-3
Measurement
Alarm message
L
I
Cause and solution
ECG Artifact
L
C
Artifacts are detected on the ECG analysis lead
and as a result heart rate cannot be calculated and
Asystole, Vfib and Vtac cannot be analyzed.
Check the connections of the electrodes and
leadwires and check for any possible source of
interference around the cable and electrode.
Check the patient’s condition and check the
patient for great motion.
ECG High Freq.
Noise
L
C
High frequency signals are detected on the ECG
analysis lead. Check for any possible source of
interference around the cable and electrode.
ECG Low Freq.
Noise
L
C
Low frequency signals are detected on the ECG
analysis lead. Check for any possible source of
interference around the cable and electrode.
ECG Amplitude Too
Small
L
C
The ECG amplitude didn’t reach the detected
threshold. Check for any possible source of
interference around the cable and electrode.
ECG Config. Err
L
C
ECG configuration is wrongly downloaded.
Check the downloaded configuration and
re-download the correct configuration.
Resp
Resp Disturbed
L
C
The respiration circuit is disturbed. Restart the
monitor.
Temp
Temp Cal. Err
L
C
A calibration failed. Restart the monitor.
T1 Sensor Off
L
A
T2 Sensor Off
L
A
The Temp sensor has become detached from the
patient or the module. Check the sensor
connections.
SpO2 Sensor Off
M B
*
SpO2 Sensor Fault
L
C
SpO2 No Sensor
L
B
SpO2 Unknown
Sensor
L
C
SpO2 Sensor
Incompatible
L
C
SpO2 Too Much
Light
L
C
There is too much light on the SpO2 sensor. Move
the sensor to a place with lower level of ambient
light or cover the sensor to minimize the ambient
light.
SpO2 Low Signal
L
C
The SpO2 signal is too low or too weak. Check
SpO2
The SpO2 sensor has become detached from the
patient or the monitor, or there is a fault with the
SpO2 sensor, or an unspecified SpO2 sensor has
been used. Check the sensor application site and
the sensor type, and make sure if the sensor is
damaged. Reconnect the sensor or use a new
sensor.
D-4
Measurement
NIBP
Alarm message
L
I
Cause and solution
SpO2 Weak Signal
L
C
SpO2 Weak Pulse
L
C
SpO2 Low Perf
L
B
the patient’s condition and change the sensor
application site. If the error persists, replace the
sensor.
SpO2 Interference
L
C
The SpO2 signal has been interfered. Check for
any possible sources of signal noise around the
sensor and check the patient for great motion.
SpO2 Board Fault
L
C
There is a problem with the SpO2 measurement
board. Do not use the module and contact your
service personnel.
SpO2 Non-Pulsatile
L
C
The pulse signal was so weak that the monitor
cannot perform pulse analysis. Check the patient’s
condition.
NIBP Loose Cuff
L
C
NIBP Air Leak
L
C
The NIBP cuff is not properly connected, or there
is a leak in the airway.
NIBP Pneumatic
Leak
L
C
Check the NIBP cuff and pump for leakages.
NIBP Cuff Type
Wrong
L
C
The cuff type applied mismatches the patient
category. Verify the patient category and replace
the cuff.
NIBP Air Pressure
Err
L
C
An error occurred to the air pressure. Verify that
the monitor application site meets the
environmental requirements and check if there is
any source that affects the air pressure.
NIBP Weak Signal
L
C
The patient’s pulse is weak or the cuff is loose.
Check the patient’s condition and change the cuff
application site. If the error persists, replace the
cuff.
NIBP Signal
Saturated
L
C
The NIBP signal is saturated due to excess motion
or other sources.
NIBP Overrange
L
C
The measured NIBP value is not within the
specified range.
NIBP Excessive
Motion
L
C
Check the patient’s condition and reduce the
patient motion.
NIBP Cuff
Overpress.
L
C
The NIBP airway may be occluded. Check the
airway and measure again.
NIBP Equip Err
H
C
NIBP Timeout
L
C
NIBP Measure
Failed
L
C
An error occurred during NIBP measurement and
therefore the monitor cannot perform analysis
correctly. Check the patient’s condition and NIBP
connections, or replace the cuff.
D-5
Measurement
IBP
Alarm message
L
I
Cause and solution
NIBP Illegally Reset
L
C
An illegal reset occurred during NIBP
measurement. Check if the airway is occluded.
YYSensor Off
L
A
Check the sensor connection and reconnect the
sensor.
(YY represents an
IBP label.)
C.O.
TB Sensor Off
L
A
CO2
CO2 Sensor High
Temp
L
C
Check, stop using or replace the sensor.
CO2 Sensor Low
Temp
L
C
Check, stop using or replace the sensor.
CO2 Airway High
Press.
L
C
CO2 Airway Low
Press.
L
C
An error occurred in the airway pressure. Check
the patient connection and patient circuit, and then
restart the monitor.
CO2 High
Barometric
L
C
CO2 Low
Barometric
L
C
CO2 FilterLine
Occluded
L
C
The airway or watertrap was occluded. Check the
airway and remove the occlusion.
CO2 No Watertrap
L
B
Check the watertrap connections.
CO2 Check Adapter
L
C
There is a problem with the airway adapter.
Check, clean or replace the adapter.
CO2 FilterLine Err
L
C
Check if there is a leak in the CO2 sample line or
the CO2 sample line has been occluded.
CO2 Zero Failed
L
C
Check the CO2 connections. After the sensor’s
temperature becomes stabilized, perform a zero
calibration again.
CO2 Check Cal.
L
C
Perform a calibration.
CO2 Check Airway
L
C
An error occurred to the airway.
CO2 No Filterline
L
A
Make sure that the filterline is connected.
CO2 Main Board
Err
H
C
There is a problem with the CO2 module. Restart
the monitor.
CO2 Replace
Scrubber&Pump
L
C
CO2 15V Overrange
H
C
CO2 Hardware Err
H
C
CO2 User Cal Fail
L
C
Check the CO2 connections, make sure that the
monitor application site meets the requirements,
and check for special sources that affect the
ambient pressure. Restart the monitor.
Re-calibrate the AG module.
D-6
Measurement
AG
Alarm message
L
I
Cause and solution
CO2 Check Sensor
L
C
The CO2 sensor appears abnormal. Check or
replace the sensor.
CO2 No Sensor
L
A
Make sure that the CO2 sensor is connected.
CO2 Temp
Overrange
L
C
The module detects that the temperature has
exceeded the specified range. Please move away
the source of heat or wait for the module to
recover.
AG No Watertrap
L
B
Check the connections of the watertrap and
re-connect it.
AG Change
Watertrap
L
C
Wait until the change is completed.
AG Watertrap Type
Wrong
L
C
Make sure that a correct watertrap has been used.
YY Accuracy
Unspecified
L
C
The measured value has exceeded the specified
accuracy range.
AG Hardware
Mulfunction
H
C
Stop using the AG module and contact your
service personnel.
AG Airway
Occluded
L
C
Check the airway and remove the occlusion.
AG Zero Failed
L
C
Restart the monitor, and then perform a zero
calibration again.
AG Cal. Failed
L
C
Re-calibrate the AG module.
Anesthetic Mixture
L
C
The system has detected more than one anesthesia
gas. Check the ventilated anesthesia gas.
O2 Sensor Err
L
C
The O2 sensor appears abnormal. Contact your
service personnel.
AG Limit Error
L
C
AG violated set alarm limits seriously and
measurements cannot be performed. Contact your
service personnel.
12V Too High
H
C
12V Too Low
H
C
There is a problem with the system power supply.
Restart the monitor.
3.3V Too High
H
C
3.3V Too Low
H
C
Low Battery
M C
(YY represents O2,
N2O, CO2, Enf, Iso,
Sev, Hal, Des, or
awRR (AG)
Power
Connect the monitor to an AC power source and
D-7
Measurement
Recorder
System
Alarm message
L
I
Cause and solution
Battery Depleted
H
C
allow the batteries to charge.
Battery Mismatched
M C
The two batteries have different charge capacity,
or the batteries unspecified have been used, or
there is a problem with the batteries. Make sure
that correct batteries are used and the batteries are
not damaged, or replace the batteries.
RT Clock Need
Reset
L
C
Re-set the system time and restart the monitor.
RT Clock Not Exist
H
C
Contact your service personnel.
Power Board
Comm. Stop
H
C
Contact your service personnel.
Recorder SelfTest
Err
L
C
Stop the recording and restart the monitor.
Recorder Comm Err
L
C
Recorder Head Hot
L
C
The recorder has been working for too long time.
Stop the recording and resume the recording till
the recorder’s printhead cools down.
IP Address Conflict
L
C
Check the monitor’s IP address and re-set it.
Loading User
Config. Failed.
L
C
Loading Factory
Config. Failed.
L
C
The system re-loads configuration automatically.
If the re-leading always failed, contact your
service personnel.
CF Storage Card
Err!
M C
An error occurred when the CF storage card reads
and writes. Contact your service personnel.
CF Card Space Low
L
CF card space is lower than 40 M.
B
D-8
E Symbols and Abbreviations
E.1 Symbols
µA
microampere
µV
microvolt
A
ampere
Ah
ampere hour
bpm
beat per minute
bps
bit per second
ºC
centigrade
cc
cubic centimeter
cm
centimeter
dB
decibel
DS
dyne second
ºF
fahrenheit
g
gram
GHz
gigahertz
GTT
gutta
h
hour
Hz
hertz
in
inch
kg
kilogram
kPa
kilopascal
L
litre
lb
pound
m
meter
mAh
milliampere hour
Mb
mega byte
mcg
microgram
mEq
milli-equivalents
mg
milligram
min
minute
ml
milliliter
E-1
mm
millimeter
mmHg
millimeters of mercury
cmH2O
centimeters of water
ms
millisecond
mV
millivolt
mW
milliwatt
MΩ
megaohm
nm
nanometer
rpm
breaths per minute
s
second
V
volt
VA
volt ampere
Ω
ohm
W
watt
–
minus, negative
%
percent
/
per; divide; or
+
plus
=
equal to
<
less than
>
greater than
≤
less than or equal to
≥
greater than or equal to
±
plus or minus
×
multiply
E-2
E.2 Abbreviations
AaDO2
alveolar-arterial oxygen gradient
AAMI
Association for Advancement of Medical Instrumentation
AC
alternating current
Adu
adult
AG
anaesthesia gas
AHA
American Heart Association
ANSI
American National Standard Institute
Ao
aortic pressure
Art
arterial
aVF
left foot augmented lead
aVL
left arm augmented lead
aVR
right arm augmented lead
awRR
airway respiratory rate
BAP
brachial aterial pressure
BP
blood pressure
BPSK
binary phase shift keying
BSA
body surface area
BTPS
body temperature and pressure, saturated
C.I.
cardiac index
C.O.
cardiac output
CaO2
arterial oxygen content
CCO
continuous cardiac output
CCU
cardiac (coronary) care unit
CE
Conformité Européenne
CIS
clinical information system
CISPR
International Special Committee on Radio Interference
CMOS
complementary metal oxide semiconductor
CMS
central monitoring system
C.O.
cardiac output
CO2
carbon dioxide
COHb
carboxyhemoglobin
CP
cardiopulmonary
CVP
central venous pressure
E-3
DC
direct current
Des
desflurane
Dia
diastolic
DPI
dot per inch
ECG
electrocardiograph
EDV
end-diastolic volume
EEC
European Economic Community
EMC
electromagnetic compatibility
EMI
electromagnetic interference
Enf
enflurane
ESU
electrosurgical unit
Et
end-tidal
EtCO2
end-tidal carbon dioxide
EtN2O
end-tidal nitrous oxide
EtO
ethylene oxide
EtO2
end-tidal oxygen
FAP
femoral arterial pressure
FCC
Federal Communication Commission
FDA
Food and Drug Administration
Fi
fraction of inspired
FiCO2
fraction of inspired carbon oxygen
FiN2O
fraction of inspired nitrous oxide
FiO2
fraction of inspired oxygen
FPGA
field programmable gate array
Hal
halothane
Hb
hemoglobin
Hb-CO
carbon mono-xide hemoglobin
HbO2
oxyhemoglobin
HIS
hospital information system
HR
heart rate
IBP
invasive brood pressure
ICP
intracranial pressure
ICT/B
intracranial catheter tip pressure transducer
ICU
intensive care unit
ID
identification
IEC
International Electrotechnical Commission
IEEE
Institute of Electrical and Electronic Engineers
E-4
IP
internet protocol
Iso
isoflurane
LA
left arm
LAP
left atrial pressure
Lat
lateral
LCD
liquid crystal display
LCW
left cardiac work
LCWI
left cardiac work index
LED
light emitting diode
LL
left leg
LVDS
low voltage differential signal
LVSW
left ventricular stroke work
LVSWI
left ventricular stroke work index
MAC
minimum alveolar concentration
MAP
mean arterial pressure
MDD
Medical Device Directive
MetHb
methemoglobin
MRI
magnetic resonance imaging
N/A
not applied
N2
nitrogen
N2O
nitrous oxide
Neo
neonate
NIBP
noninvasive blood pressure
O2
oxygen
O2CI
oxygen consumption index
O2R
oxygen extraction ratio
OR
operating room
oxyCRG
oxygen cardio-respirogram
PA
pulmonary artery
PAWP
pulmonary artery wedge pressure
PD
photodetector
Ped
pediatric
Pleth
plethysmogram
PR
pulse rate
PVC
premature ventricular contraction
PVR
pulmonary vascular resistance
PVRI
pulmonary vascular resistance index
E-5
R
right
RA
right arm
RAM
random access memory
RAP
right atrial pressure
Rec
record, recording
Resp
respiration
RHb
reduced hemoglobin
RL
right leg
RR
respiration rate
SaO2
arterial oxygen saturation
Sev
sevoflurane
SFM
self-maintenance
SI
stroke index
SpO2
arterial oxygen saturation from pulse oximetry
STR
systolic time ratio
SV
stroke volume
SVR
systemic vascular resistance
SVRI
systemic vascular resistance index
Sync
synchronization
Sys
systolic pressure
Taxil
axillary temperature
TB
blood temperature
TD
temperature difference
Temp
temperature
TFT
thin-film technology
TI
injectate temperature
Toral
oral temperature
Trect
rectal temperature
UAP
umbilical arterial pressure
UPS
uninterruptible power supply
USB
universal serial bus
UVP
umbilical venous pressure
VAC
volts alternating current
E-6
PN: 9211-20-87439(7.0)
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