IntelliVue Patient Monitor

IntelliVue Patient Monitor

Instructions for Use

IntelliVue Patient Monitor

MX800

Release H.0 with Software Revision H.0x.xx

Patient Monitoring

Part Number 453564208131

Printed in Germany 07/10

*453564208131*

1 Introduction

Introducing the Monitor

Devices for Acquiring Measurements

Operating and Navigating

Operating Modes

Understanding Screens

Connecting Additional Displays to the Monitor

Using the XDS Remote Display

Using the Visitor Screen

Understanding Profiles

Understanding Settings

Changing Wave Speeds

Freezing Waves

Entering Measurements Manually

Changing Monitor Settings

Checking Your Monitor Revision

Getting Started

Disconnecting from Power

Networked Monitoring

Using the Integrated PC

Using the X2 or MP5 with a Host Monitor

2 Alarms

Visual Alarm Indicators

Audible Alarm Indicators

Acknowledging Alarms

Pausing or Switching Off Alarms

Alarm Limits

Reviewing Alarms

Latching Alarms

Testing Alarms

Alarm Behavior at Power On

Alarm Recordings

3 Patient Alarms and INOPs

Patient Alarm Messages

Technical Alarm Messages (INOPs)

4 Managing Patients

Admitting a Patient

1

Table of Contents

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40

41

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14

22

29

47

54

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63

68

97

97

3

4

Quick Admitting a Patient

Editing Patient Information

Discharging a Patient

Transferring Patients

Data Upload from an MMS

Care Groups

5 ECG, Arrhythmia, ST and QT Monitoring

Skin Preparation for Electrode Placement

Connecting ECG Cables

Selecting the Primary and Secondary ECG Leads

Checking Paced Status

Understanding the ECG Display

Monitoring Paced Patients

Changing the Size of the ECG Wave

Changing the Volume of the QRS Tone

Changing the ECG Filter Settings

Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)

Choosing EASI or Standard Lead Placement

About ECG Leads

ECG Lead Fallback

ECG Lead Placements

Capture 12-Lead

EASI ECG Lead Placement

ECG and Arrhythmia Alarm Overview

Using ECG Alarms

ECG Safety Information

About Arrhythmia Monitoring

Switching Arrhythmia Analysis On and Off

Choosing an ECG Lead for Arrhythmia Monitoring

Understanding the Arrhythmia Display

Arrhythmia Relearning

Arrhythmia Alarms

About ST Monitoring

Switching ST On and Off

Understanding the ST Display

Updating ST Baseline Snippets

Recording ST Segments

About the ST Measurement Points

ST Alarms

Viewing ST Maps

About QT/QTc Interval Monitoring

QT Alarms

Switching QT Monitoring On and Off

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6 Monitoring Pulse Rate

Entering the Setup Pulse Menu

System Pulse Source

Switching Pulse On and Off

Using Pulse Alarms

7 Monitoring Respiration Rate (Resp)

Lead Placement for Monitoring Resp

Understanding the Resp Display

Changing Resp Detection Modes

Changing the Size of the Respiration Wave

Changing the Speed of the Respiration Wave

Using Resp Alarms

Changing the Apnea Alarm Delay

Resp Safety Information

8 Monitoring SpO2

SpO2 Sensors

Applying the Sensor 2

Connecting SpO2 Cables

Measuring SpO2

SpO2 Signal Quality Indicator (Fast SpO2 only)

Assessing a Suspicious SpO2 Reading

Changing the Averaging Time

Understanding SpO2 Alarms

Pleth Wave

Perfusion Numeric

Perfusion Change Indicator

Setting SpO2/Pleth as Pulse Source

Setting Up Tone Modulation

Setting the QRS Volume

Calculating SpO2 Difference

9 Monitoring NBP

Introducing the Oscillometric NBP Measurement

Preparing to Measure NBP

Starting and Stopping Measurements

Enabling Automatic Mode and Setting Repetition Time

Enabling Sequence Mode and Setting Up The Sequence

Choosing the NBP Alarm Source

Switching Pulse from NBP On/Off

Assisting Venous Puncture

Calibrating NBP

10 Monitoring Temperature

Making a Temp Measurement

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6

Calculating Temp Difference

11 Monitoring Invasive Pressure

Setting up the Pressure Measurement

Zeroing the Pressure Transducer

Adjusting the Calibration Factor

Displaying a Mean Pressure Value Only

Changing the Pressure Wave Scale

Optimizing the Waveform

Using the Wave Cursor

Non-Physiological Artifact Suppression

Choosing the Pressure Alarm Source

Calibrating Reusable Transducer CPJ840J6

Calculating Cerebral Perfusion

Calculating Pulse Pressure Variation

Measuring Pulmonary Artery Wedge Pressure

Editing the Wedge

Identifying the Pressure Analog Output Connector

12 Monitoring Cardiac Output

Hemodynamic Parameters

Using the C.O.Procedure Window

Accessing the Setup C.O. and Setup CCO Menus

Entering the HemoCalc Window

Measuring C. O. Using the PiCCO Method

Measuring C.O. Using the Right Heart Thermodilution Method

Documenting C.O. Measurements

C.O. Injectate Guidelines

C.O./CCO Curve Alert Messages

C.O./CCO Prompt Messages

C.O./CCO Warning Messages

C.O./CCO Safety Information

13 Monitoring Carbon Dioxide

Measurement Principles

Measuring CO2 using M3014A or X2

Measuring Mainstream CO2 using M3016A

Measuring Microstream CO2 using M3015A/B

Setting up all CO2 Measurements

14 Monitoring Airway Flow, Volume and Pressure

Attaching the Flow Sensor

Zero Calibration

Automatic Purging

Manual Purging

Gas Compensation

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197

Setting up Spirometry

15 Monitoring tcGas

Identifying tcGas Module Components

Setting the tcGas Sensor Temperature

Using the tcGas Site Timer

Setting the tcGas Barometric Pressure

Remembraning the tcGas Transducer

Calibrating the tcGas Transducer

Applying the tcGas Transducer

Finishing tcGas Monitoring

TcGas Corrections

16 Monitoring Intravascular Oxygen Saturation

Selecting a Measurement Label

Preparing to Monitor with the M1021A Wide Module

Preparing to Monitor with the M1011A Narrow Module

Further Information for Both Modules

17 Monitoring EEG

EEG Monitoring Setup

Using the EEG Impedance/Montage Window

About Compressed Spectral Arrays (CSA)

Changing EEG Settings

EEG Reports

EEG Safety Information

EEG and Electrical Interference

18 Monitoring BIS

BIS Monitoring Setup

BIS Continuous Impedance Check

BIS Cyclic Impedance Check

BIS Window

Changing the BIS Smoothing Rate

Switching BIS and Individual Numerics On and Off

Changing the Scale of the EEG Wave

Switching BIS Filters On or Off

BIS Safety Information

19 Assigning a Telemetry Device and a Monitor to One Patient

How Can You Combine Devices?

Functions Available When the Telemetry Data Window is Displayed

General Telemetry-related Functions

Use Models With Telemetry

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8

20 Trends

Viewing Trends

Setting Up Trends

Documenting Trends

Trends Databases

Screen Trends

21 Calculations

Viewing Calculations

Reviewing Calculations

Performing Calculations

Entering Values for Calculations

Documenting Calculations

22 High Resolution Trend Waves

Changing the Hi-Res Trend Waves Displayed

Hi-Res Trend Wave Scales

Hi-Res Trend Waves and OxyCRG

Printing Hi-Res Trend Wave Reports

Hi-Res Trend Wave Recordings

23 Event Surveillance

Levels of Event Surveillance

Event Groups

Event Episodes

Events Pop-Up Keys

Event Triggers

The Events Database

Viewing Events

Annotating Events

Documenting Events

24 ProtocolWatch

SSC Sepsis Protocol

25 Recording

Central Recording

Starting and Stopping Recordings

Overview of Recording Types

All ECG Waves Recordings

Creating and Changing Recordings Templates

Changing ECG Wave Gain

Recording Priorities

Recording Strip

Reloading Paper

Recorder Status Messages

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280

26 Printing Patient Reports

Starting Report Printouts

Stopping Reports Printouts

Setting Up Reports

Setting Up Individual Print Jobs

Checking Printer Settings

Printing a Test Report

Switching Printers On Or Off for Reports

Dashed Lines on Reports

Unavailable Printer: Re-routing Reports

Checking Report Status and Printing Manually

Printer Status Messages

Sample Report Printouts

27 Using the Drug Calculator

Accessing the Drug Calculator

Performing Drug Calculations

Charting Infusion Progress

Using the Titration Table

Documenting Drug Calculations

28 IntelliBridge EC10 Module

Connecting an External Device

Changing Waves and Numerics Displayed

Viewing the IntelliBridge Device Data Window

Using Screens with External Device Data

Alarms/INOPs from External Devices

Language Conflict with External Device Drivers

29 VueLink Modules

Connecting an External Device

Changing VueLink Waves and Numerics Displayed

Viewing the VueLink Device Data Window

Using VueLink Screens

Switching VueLink On and Off

Alarms/INOPs From External Devices

Language Conflict with External Device Drivers

30 Using Timers

Viewing Timers

Timer Setup Pop-up Keys

Setting Up Timers

Displaying a Timer On The Main Screen

Displaying A Clock On The Main Screen

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31 Respiratory Loops

Viewing Loops

Capturing and Deleting Loops

Showing/Hiding Loops

Changing Loops Display Size

Using the Loops Cursor

Changing Loops Type

Setting Up Source Device

Documenting Loops

32 Laboratory Data

Viewing Received Data

33 Care and Cleaning

General Points

Cleaning the Monitor

Disinfecting the Monitor

Sterilizing the Monitor

Cleaning, Sterilizing and Disinfecting Monitoring Accessories

Cleaning the SO2 Optical Module

Cleaning the Recorder Printhead (M1116B only)

34 Maintenance and Troubleshooting

Inspecting the Equipment and Accessories

Inspecting the Cables and Cords

Maintenance Task and Test Schedule

Troubleshooting

Disposing of the Monitor

Disposing of Empty Calibration Gas Cylinders

35 Accessories

ECG/Resp Accessories

NBP Accessories

Invasive Pressure Accessories

SpO2 Accessories

Temperature Accessories

Cardiac Output (C.O.) Accessories

Mainstream CO2 Accessories

Sidestream CO2 Accessories

Mainstream CO2 Accessories (for M3016A)

Microstream CO2 Accessories

Spirometry Accessories

tcGas Accessories

EEG Accessories

BIS Accessories

SO2 Accessories for M1021A

10

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380

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361

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363

363

SO2 Accessories for M1011A

Recorder Accessories

Battery Accessories

36 Specifications

Intended Use

Manufacturer's Information

Symbols

Installation Safety Information

Monitor Mounting Precautions

Altitude Setting

Monitor Safety Specifications

EMC And Radio Regulatory Compliance

Physical Specifications

Environmental Specifications

Performance Specifications

Interface Specifications

Measurement Specifications

Safety and Performance Tests

37 Default Settings Appendix

Country-Specific Default Settings

Alarm and Measurement Default Settings

Alarm Default Settings

ECG, Arrhythmia, ST and QT Default Settings

Pulse Default Settings

Respiration Default Settings

SpO2 Default Settings

NBP Default Settings

Temperature Default Settings

Invasive Pressure Default Settings

Cardiac Output Default Settings

CO2 Default Settings

Spirometry Default Settings tcGas Default Settings

SO2 Default Settings

SvO2 Default Settings

ScvO2 Default Settings

EEG Default Settings

BIS Default Settings

VueLink Default Settings

Index

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431

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457

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1

1

Introduction

These Instructions for Use are for clinical professionals using the IntelliVue MX800 patient monitor.

This basic operation section gives you an overview of the monitor and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment.

Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients. Read and keep the Instructions for Use that come with any accessories, as these contain important information about care and cleaning that is not repeated here.

This guide describes all features and options. Your monitor may not have all of them; they are not all available in all geographies. Your monitor is highly configurable. What you see on the screen, how the menus appear and so forth, depends on the way it has been tailored for your hospital and may not be exactly as shown here.

In this guide:

• A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient.

• A caution alerts you to where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.

Introducing the Monitor

The IntelliVue MX800 patient monitor offers a monitoring solution optimized for the high-end surgical, cardiac, medical and neonatal care environments. Combining patient surveillance and data management, it allows multi-measurement monitoring by linking separate modules. The MX800 uses the touch screen as primary input device and has a remote control for convenient access to the five main keys and numeric data input.

The monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital signs) and document them on a printer. You can view measurement trend graphs, with up to three measurements combined in each graph, to help you identify changes in the patient's physiological condition. You can view fast-changing measurement trends with beat to beat resolution and see up to four high resolution trend segments. Event surveillance enhances documentation and review of physiologically significant events by automatically detecting and storing up to 50 user-defined clinical events over a 24 hour period.

13

1 Introduction

With the optional Integrated PC, you have computer functionality directly in the monitor. You can use standard applications (e.g. Web browsers), connect to the hospital network or intranet, and run a second independent display with content from the patient monitor.

An IntelliVue X2 or MP5 can be connected to your monitor, where it acts as a multi-measurement module, acquiring measurements for the host monitor. When the X2 or MP5 is disconnected from the the original host monitor, it continues to monitor the patient as a fully independent, battery powered patient monitor, eliminating the need for a separate transport monitor. On connection to a new host monitor, the X2 or MP5 resumes its role as multi-measurement module, ensuring fully continuous monitoring.

Major Parts and Keys

1

Color coded alarm lamps

2

Alarms Off lamp

3

Power on/Standby switch with integrated LED: Green - On/

Standby, Red - Error

4

AC power LED

5

Mounting quick-release lever

(when this is pressed the monitor is not fixed on the mounting)

6

Part number and serial number

Devices for Acquiring Measurements

The patient monitor acquires patient measurements using the devices described in this section. You can also extend the measurement capabilities of your monitor with such devices. Of these measurement devices, only the X2 has its own power on/standby switch, and can be powered from an external power supply or a rechargeable battery when not directly connected to the monitor (refer to the IntelliVue X2 Instructions for Use for details). All the rest take their power exclusively from the monitor, and switch on automatically when you turn on the monitor. A green power-on LED indicates when they are drawing power from the monitor. A permanently illuminated, or flashing, red LED indicates a problem with the unit that requires the attention of qualified service personnel.

All symbols used on the front panels are explained in the “Specifications” on page 393 chapter, in

“Symbols” on page 395.

WARNING

When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation.

14

1 Introduction

Flexible Module Rack (M8048A)

The flexible module rack (FMS) lets you use up to eight plug-in physiological measurement modules.

The maximum number of specific module types that can be used simultaneously in an FMS is: five pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any combination).

Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side to connect an additional MMS. Use the connector on the right to connect to the monitor.

1

X1 Multi-Measurement Module

2

Multi-Measurement Module mount

3

Flexible Module Rack

4

Power on LED

5

Interruption indicator

Measurement Modules

You can use up to eight measurement modules with the Flexible Module Rack (M8048A). Available modules are:

• Invasive blood pressure (M1006B)

• Temperature (M1029A)

• Oxygen saturation of arterial blood (SpO

2

) (M1020B)

• Cardiac output (M1012A), and Continuous cardiac output with M1012A Option #C10

• Transcutaneous gas (M1018A)

• Mixed venous oxygen saturation - SvO

2

(M1021A)

• Intravascular Oxygen Saturation - ScvO

2

or SvO

2

(M1011A)

• Recorder (M1116B)

• VueLink device interface (M1032A)

• IntelliBridge EC10

• EEG (M1027A)

• Bispectral Index - BIS (M1034A)

• Spirometry (M1014A)

You can plug in and unplug modules during monitoring. Insert the module until the lever on the module clicks into place. Remove a module by pressing the lever upwards and pulling the module out.

A measurement automatically switches on when you plug the module in, and switches off when you unplug it. Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label.

15

1 Introduction

The connector socket on the front of each module is the same color as the corresponding connector plug on the transducer or patient cable.

Press the Setup key on the module's front to display the measurement's setup menu on the monitor screen. When the setup menu is open, a light appears above the key. Some modules have a second key.

On the pressure module, for example, it initiates a zeroing procedure.

Example Module (SpO2)

1

2

3

4

Module name

Setup key LED

Setup key to enter setup menu of measurement modules or external device data window. Some modules have a second module-specific key next to this one, for example Zero.

Connector socket for patient cable/transducer

X1 Multi-Measurement Module (M3001A)

The X1 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG

(including arrhythmia and ST monitoring), respiration, SpO

2

, NBP and either invasive pressure or temperature.

You can connect it to the monitor via a cable or mount it on the left side of the FMS.

16

1 Introduction

X1 Connectors and Symbols

3

4

1

2

5

6

7

White ECG/Resp connector

Blue SpO

2

connector

Red NBP connector

Combined pressure (red) and temperature

(brown) connector - connect either invasive pressure transducer or temperature probe.

You might have a version of the MMS that does not have this connector.

NBP STAT key - starts NBP STAT series of measurements

OR

Zero key - initiates a zero procedure for the connected pressure transducer when pressed and held for a second

NBP Start/Stop key - starts or stops NBP measurements

Silence: acknowledges all active alarms by switching off audible alarm indicators and lamps

X2 Multi-Measurement Module (M3002A)

The X2 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG

(including arrhythmia and ST monitoring), respiration, SpO

2

, NBP and either invasive pressure and temperature, or CO

2

. It has a color touchscreen display.

The X2 has the added capability to operate as a stand-alone monitor, and can be powered by a rechargeable battery. This makes it particularly suited to transport situations. When the X2 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor running on battery power, eliminating the need for a separate transport monitor. When the

X2 is connected to a new host monitor, it resumes its role as MMS, ensuring fully continuous monitoring. For details of using the X2 as a stand-alone monitor, refer to the IntelliVue X2 Instructions

for Use.

When connected to a host monitor ( Companion Mode is indicated), the X2 takes power from the host, including that required for battery charging. The X2 can also be powered by AC mains when not connected to a host monitor using the optionally available external power supply (M8023A). See the

IntelliVue X2 Instructions for Use for details.

17

1 Introduction

X2 Overview

X2 Controls and Indicators

1

2

3

4

5

6

7

8

On/Standby switch

Power and battery indicators (see “X2

Controls and Indicators” on page 18)

3.5-inch TFT LCD touchscreen QVGA display

Alarm lamps (see “X2 Controls and

Indicators” on page 18)

Battery eject button

Hard keys (see “X2 Controls and

Indicators” on page 18)

Measurement connectors (see “X2 Patient

Connectors, Right Side” on page 19)

Battery compartment

18

1

2

3

4

External power LED. Green when monitor is powered from an external power source.

Battery status LED. Yellow when charging. Flashing red when battery is empty.

On/Standby LED. Green when monitor is on. Red indicates an error.

On/Standby switch. Disabled when X2 is connected to a host monitor

1 Introduction

5

6

7

8

9

10

11

Main Screen key: closes all open menus/windows and returns to the main screen.

SmartKeys key: brings up SmartKeys on the screen.

Alarms key: turns alarms On/Off, or pauses them.

Silence key

Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is acknowledged.

Active INOP alarm lamp in light blue. Blinks until active INOP is acknowledged.

Alarms off indicator. When alarms are suspended, the lamp is red, and the alarms off symbol is shown.

X2 Patient Connectors, Right Side

Showing symbols version (international) - English version has text labels

5

6

7

3

4

1

2

Pressure (option)

Temperature (option)

Noninvasive blood pressure

SpO

2

ECG sync pulse output

ECG/Respiration

CO

2

(option in place of Pressure and Temperature)

X2 Left Side

1

2

Loudspeaker

MSL Connector. Connects to the external power supply or a host monitor via the MSL cable for AC mains operation, battery charging, and communication with a network.

19

1 Introduction

MMS Extensions

The MMS extensions connect to the X1 and X2 MMS and use the MMS settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the MMS.

WARNING

• The MMS extensions can only function when they are connected to an MMS. If the MMS is removed during monitoring, the measurements from both the MMS and the extension are lost.

• Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered from AC mains, when connected to a host monitor or the external power supply (M8023A), or from the Battery

Extension.

To separate an extension from the MMS, press the release lever down, and push the MMS forward.

M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions

The optional M3014A Capnography extension adds mainstream capnography or sidestream capnography, and optionally one pressure plus either a pressure or a temperature, Cardiac Output and

Continuous Cardiac Output to the MMS.

M3014A

1

2

3

4

Pressure connectors (red)

Temperature connector (brown)

Mainstream/sidestream connector CO

2

Cardiac Output connector

20

1 Introduction

The optional M3015A Microstream CO

2

extension adds microstream capnography and optionally either pressure or temperature to the MMS. The optional M3015B Microstream CO

2

extension adds microstream capnography, two pressures and a temperature to the MMS.

M3015A M3015B

1

2

3

4

5

Pressure connectors (red) - M3015A optional

Temperature connector (brown) - M3015A optional

Inlet

Microstream connector CO

2

Gas sample outlet

The optional M3016A Mainstream CO

2

extension adds mainstream capnography and optionally either pressure or temperature to the MMS.

M3016A

1

2

3

Pressure connectors (red)

Temperature connector (brown)

Mainstream/sidestream connector CO

2

(optional)

When a capnography extension is connected to an X2 MMS with CO

2

, the CO

2

from the extension will be automatically deactivated in favor of the one in the X2. If you prefer to use the CO

2

measurement on the extension, you can activate it via the measurement selection key (see “Resolving

Label Conflicts” on page 38)

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1 Introduction

The cardiac output measurement in the M3014A is deactivated when the extension is used with an X2

MMS, even if the X2 is connected to an external power supply. The cardiac output measurement is only available when the X2 is connected to a host monitor.

M3012A Hemodynamic MMS Extension

1

2

3

4

Cardiac Output (orange; optional)

Connection to MMS

Pressure connectors (red)

Temperature connectors (brown)

The M3012A Hemodynamic extension can be connected to the M3001A Multi-Measurement Module to provide the following additional measurements: Temperature, Pressure, an additional Pressure or

Temperature, and C.O. and CCO measurements.

The cardiac output measurement is deactivated when the extension is used with an X2 MMS unless the

X2 is connected to a host monitor.

Operating and Navigating

Everything you need to operate the monitor is contained on its screen. Almost every element on the screen is interactive. Screen elements include measurement numerics, waveforms, screen keys, information fields, alarms fields and menus.

The configurability of the monitor means that often you can access the same element in different ways.

For example, you might be able to access an item through its on-screen setup menu, via a hard key, or via a SmartKey.

22

1 Introduction

Monitor information line

1 network connection indicator

(documented in Information

Center Instructions for Use)

2 bed label

3 patient identification

4 patient category

5 paced status

6 date and time

7 access the

Profiles menu

8 current screen name/enter

Change Screen menu

9 adjust alarm volume/level indicator

Other screen elements

10 alarm status area - shows active alarm messages

11 status line - shows information messages and prompting you for action

12 close all open menus and windows and return to main screen

13 enter

Main Setup menu

14 scroll right to display more SmartKeys

15 SmartKeys - these change according to your monitor's configuration

16 scroll left to display more SmartKeys

17

Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled

Alarms Off. Select again to immediately re-enable alarm indicators.

18

Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (

ReAlarm) is configured on.

Selecting Screen Elements

Select a screen element to tell the monitor to carry out the actions linked to the element. For example, select the Patient Identification element to call up the Patient Demographics window, or select the

HR numeric to call up the

Setup ECG

menu. Select the ECG wave segment to call up the

ECG Lead menu.

Note that the space between each line of a menu may be configured to wide or narrow to facilitate your most common method of operation, either touch, remote control or a pointing device such as a mouse.

23

1 Introduction

Using the Touchscreen

Select screen elements by pressing them directly on the monitor's screen.

Disabling Touchscreen Operation

To temporarily disable touchscreen operation of the monitor, press and hold the

Main Screen permanent key. A padlock will appear on the

Main Screen

permanent key.

Press and hold the

Main Screen

permanent key again to re-enable the touchscreen operation.

Using a Mouse or Trackball

If you are using a mouse or trackball, select screen elements by clicking on them (press and release the left mouse button). While you are moving the mouse, a cursor appears and a highlight shows your current position.

Moving Windows

You can move windows and menus using the Touchscreen or a mouse. To move a window,

1

Select the title of the window and keep your finger on the title, or the mouse button pressed.

2

Move your finger on the Touchscreen, or move the mouse, to move the window.

3

Take your finger off the screen, or release the mouse button, to place the window in the final position.

The new position is only active until the window or menu is closed. Not all locations on the screen can be a target position, a window cannot overlap the monitor info line, the alarms and INOPs or the status line.

Using Keys

The monitor has four different types of keys:

Permanent Keys

A permanent key is a graphical key that remains on the screen all the time to give you fast access to functions.

Pause Alarms

- pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off .

Select again to immediately re-enable alarm indicators.

Silence

- acknowledges all active alarms by switching off audible alarm indicators and lamps.

Main Screen

- close all open menus and windows and return to the main screen.

Main Setup - enter main setup menu.

24

1 Introduction

SmartKeys

A SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased. If you have an integrated PC (iPC) you may also see

Smartkeys generated by applications on the iPC.

enter profile menu, or revert to default profile show BIS Sensor change Screen, or revert to default screen previous Screen freeze waves set alarm limits change alarm volume change QRS volume enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained.

review beat labels (annotate arrhythmia wave) change amplitude (size) of ECG wave

- start/stop manual NBP measurement

- start auto series

- stop current automatic measurement within series start NBP measurement and measurement series start veni puncture (inflate cuff to subdiastolic pressure) quick admit a patient enter patient identification menu to admit/discharge/transfer end case to discharge a patient view information for patients in other beds change screen brightness (not for independent displays) re-learn arrhythmia enter cardiac output procedure start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series stop current NBP measurement set the NBP repeat time

25

1 Introduction

access patient reports start a delayed recording access Vital Signs recording function set wide automatic alarm limits access wedge procedure window review vital signs trend access event surveillance access the calculator gas analyzer - exit standby mode unpair equipment and continue central monitoring with the monitor access the spirometry data window start 12-Lead Capture (only available if Information Center is connected) access EEG CSA zero invasive pressure transducer access pop-up recording keys access Select Waves recording function set narrow automatic alarm limits access the Loops window review graph trend access calculations access the Drug Calculator suppress zero for all gas measurements unpair equipment and continue central monitoring with the telemetry device access ST Map application access remote applications (if

Application Server is connected) access the EEG montage

26

display external device information access ProtocolWatch switch CO

2

pump off enter data manually open the Histogram window

1 Introduction

access timers set standard or EASI lead placement new lead setup start/stop car seat assessment record open Unit Conversion window

Hardkeys

A hardkey is a physical key on a monitoring device, such as the zero pressure key on the MMS or a setup key on a module.

Pop-Up Keys

Pop-up keys are task-related graphical 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.

27

1 Introduction

Using the Remote Control

The remote control provides you with direct access to five hard keys, a navigation knob and a numeric keypad:

Hardkeys

1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps.

Behavior follows the Silence permanent key configuration.

2 Alarms Off/Pause Alarms- pauses alarm indicators. Behavior follows the Pause Alarms permanent key configuration.

3 Main Screen - close all open menus and windows and return to the main screen.

4 SmartKeys - display a block of SmartKeys specially configured for remote tasks (see below)

5 Back - go back one step to the previous menu.

Keypad

6 Type numeric data on the keypad and press the Enter key to enter the data on the monitor.

Navigation knob

7 Rotate the knob to highlight screen elements, then press to select the highlighted element.

The remote control is connected via USB cable to the monitor.

Using the SmartKeys Key

The SmartKeys hard key on the remote control displays a block of SmartKeys on the monitor screen.

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1 Introduction

Nine SmartKeys appear in a 3 by 3 matrix which corresponds to the layout of the numeric pad on the remote control.

Pressing the 1 key on the remote control selects the top left SmartKey, pressing the 8 key selects the bottom center SmartKey. The . and the down in the available SmartKeys.

key can be used to select the arrow keys to page up and

The SmartKeys which appear can be configured so that you have the functions available which you most often need when using the remote control. If no list of SmartKeys has been configured, the standard SmartKeys will be displayed and you can page through to the key you want.

Using the On-Screen Keyboard

Use this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete single characters, or use the

Clr

key to delete entire entries. Select

Enter

to confirm what you have entered and close the on-screen keyboard.

If a conventional keyboard is connected to the monitor, you can use this instead of or in combination with the on-screen keyboard.

Using the On-Screen Calculator

You can use the on-screen calculator to perform any of the standard operations for which you would normally use a handheld calculator.

• To access the on-screen calculator, select the

Calculator

SmartKey, or select

Main

Setup Î Calculations Î Calculator .

Operating Modes

When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:

1

2

Select the Main Setup menu.

Select

Operating Modes

and choose the mode you require.

Your monitor has four operating modes. Some are passcode protected.

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1 Introduction

Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them.

These are for your information and can be changed only in Configuration Mode.

Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend information is deleted from the monitor’s memory.

Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks. These tasks are described in the Configuration Guide. During installation the monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on, the number of waves you see and so forth.

Service Mode: Passcode protected, this is for trained service personnel.

When the monitor is in Demonstration Mode, Configuration Mode, or Service Mode, this is indicated by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand corner. Select the mode box in the center of the screen to change to a different mode.

When an X2 or MP5 is connected to a host monitor ( Companion Mode is indicated):

• The monitor in companion mode will adopt the operating mode of the host monitor.

• You cannot change the operating mode at the monitor in companion mode.

Standby Mode

Standby mode can be used when you want to temporarily interrupt monitoring.

To enter Standby mode,

• select the Monitor Standby SmartKey or

• select Main Setup , followed by Monitor Standby .

The monitor enters Standby mode automatically after the End Case function is used to discharge a patient.

Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed. This can be configured to a moving image or a blank screen. If a patient location is entered at the Information

Center, this will also be displayed on the Standby screen (availability depends on Information Center revision).

To resume monitoring,

• Select anything on the screen or press any key.

If you connect an X2 or MP5 that is powered on (and not in Standby) to a host monitor in Standby mode, the host will leave Standby mode. When connected to a host monitor, with both the host and the monitor in companion mode in Standby mode, leaving Standby on the monitor in companion mode will also make the host leave Standby.

30

1 Introduction

Understanding Screens

Your monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and other elements on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.

When you switch from a complex to a less complex Screen layout, some measurements may not be visible but are still monitored in the background. If you switch to a more complex Screen with, for example, four invasive pressure waves but you have only two pressures connected to the monitor, the

"missing" two pressures are either left blank or the available space is filled by another measurement.

Switching to a Different Screen

1

To switch to a different Screen, select the current Screen name in the monitor info line, or select the

Change Screen

SmartKey.

2

Choose the new Screen from the pop-up list.

Changing a Screen's Content

If you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, high-res waves, or trends. Be aware that these changes cannot be stored permanently in Monitoring Mode.

To change the selection of elements on a Screen,

1

Select the element you want to change.

2

From the menu that appears, select Change Wave , Change Numeric , or ChangeHiResTrend , and then select the wave or numeric you want, or select the high-resolution trend wave you want from the list of available waves.

If you do not see Change Numeric in the menu, this Screen may be configured to always display the numeric beside its wave. Changing the wave will automatically change the numeric.

The changed Screen is shown with an asterisk in the monitor info line.

In the

Change Screen

menu, the changed Screen is shown linked to the original Screen and marked with an asterisk.

Up to three modified Screens can be accessed via the

Change Screen

menu.

To recall Screens, either

• select the name of the Screen in the Change Screen menu or

• use the previous/next arrows at the top of the

Change Screen

menu to move back and forth in the Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed.

After a patient discharge, the monitor's default Screen is shown. Modified Screens are still available in the Change Screen menu.

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1 Introduction

If the monitor is switched off and then on again, modified Screens are erased from the monitor's memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained (unless

Automat. Default

is configured to

Yes

).

Connecting Additional Displays to the Monitor

You can connect a second display, showing the same Screen as the main display, to your monitor, for

viewing only.

If you have the optional independent display interface, you can connect a second display which can be configured and operated individually using standard input devices.

For monitors with multiple displays and multiple input devices, the usage and behavior can be configured according to specific requirements at installation (for example, use for two independent operators or tracking of mouse input across two displays). For details refer to the Service Guide.

When two operators are using two displays, the scope of an action depends on the type of operation:

• Patient monitoring operations such as Silence or Pause alarms take effect for the monitor as a whole, the results will be seen on both displays.

• Display operations such as the Main Screen key and Back hardkey will take effect only on the display being operated.

If you are operating two displays with one remote control, to navigate from one display to another:

1

2

Move the highlight to the

Main Screen

key and then turn one click further.

The highlighting moves to a special "jump" field at the edge of the Screen.

Press the navigation knob on the remote control to confirm; the highlighting will automatically move to the other display.

The content of each Screen can be changed individually as described in the previous section. If you are operating two displays, you can choose Screens for both displays from one location:

1

2

Select

Profiles

in the monitor info line of the first display,

Select

Display 1

, or

Display 2

, then select the Screen you want to appear on that display from the list of available Screens.

When two displays are mounted next to each other or one above the other, a special Screen can be assigned which spans across both displays. The Screen content for these Tall and Wide Screens can then use the increased area available with two displays. These Screens appear in the Screen list with a special Tall Screen or Wide Screen symbol.

Certain windows (for example: cardiac output procedure) can only be shown on one display at a time.

If you try to open one of these windows when it is already shown on another display, you will see a blank gray window with a cross through it.

Using the XDS Remote Display

Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local

Area Network (LAN) as the monitor.

It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software.

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1 Introduction

For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS

Application.

Using the Visitor Screen

If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and

Information Center. You can change the name of the visitor Screen in Configuration Mode.

• To activate this Screen, select the Screen name in the monitor info line to open the Change Screen menu, then select the name of the visitor Screen configured for your monitor from the list of available Screens.

To select a Screen with waves and numerics again,

• Touch the gray box in the center of the screen, showing the visitor Screen's name, to open the

Change Screen menu and select a different Screen to show waves and numerics again.

Understanding Profiles

Profiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings.

The settings that are defined by Profiles are grouped into three categories. Each category offers a choice of 'settings blocks' customized for specific monitoring situations. These categories are:

Display (screens)

Each profile can have a choice of many different predefined screens.

If you are using a second display, each display can have its own individual screen selection.

When you change the profile, the screen selection configured for the new profile becomes active.

Measurement Settings

Each profile can have a choice of different predefined measurement settings. These relate directly to individual measurements, for example, measurement on/off, measurement color, alarms limits,

NBP alarm source, NBP repeat time, temperature unit (°F or °C), pressure unit (mmHg or kPa).

Monitor Settings

Each profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.

You can change from one complete profile to another or swap individual settings blocks (display/ monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode.

Depending on your monitor configuration, when you switch on or discharge a patient the monitor either continues with the previous profile, or resets to the default profile configured for that monitor.

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1 Introduction

WARNING

If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be set up to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles.

When you leave Demonstration Mode, the monitor uses the default profile.

Swapping a Complete Profile

1

Select Profiles in the monitor info line, or select the Profiles SmartKey.

2

3

4

In the

Profiles

menu, select

Profile

.

Chose a profile from the pop-up list.

Confirm your selection.

Swapping a Settings Block

1

Select

Profiles

in the monitor info line, or select the

Profiles

SmartKey.

2

3

4

In the

Profiles

menu, select

Display

or

Measmnt.Settings

or

Monitor Settings

to call up a list of the settings blocks in each category.

Choose a settings block from the pop-up list.

Confirm your selection.

Default Profile

Your monitor has a default profile that it uses when you leave Demonstration, or Service modes, or when you discharge a patient. This profile is indicated by a diamond shaped symbol.

Locked Profiles

Some profiles are locked, so that you cannot change them, even in Configuration Mode.

These are indicated by this lock symbol.

Understanding Settings

Each aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including,

34

1 Introduction

Screen Settings, to define the selection and appearance of elements on each individual Screen

Measurement settings, to define settings unique to each measurement, for example, high and low alarm limits

Monitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness.

You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitor's Configuration Mode. All settings are reset to the stored defaults:

• when you discharge a patient

• when you load a Profile

• when the monitor is switched off for more than one minute (if Automat. Default is set to Yes ).

Changing Measurement Settings

Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:

• via the measurement numeric - select the measurement numeric to enter its setup menu. For example, to enter the

Setup ECG

menu, select the HR (heart rate) numeric.

• via the Setup hardkey (on plug-in modules) - press the Setup hardkey on the module front.

• via the Main Setup permanent key - if you want to setup a measurement when the measurement is switched off, use the Main Setup permanent key and select Measurements . Then select the measurement name from the pop-up list. With this permanent key you can access any setup menu in the monitor.

• via the Measurement Selection key.

This guide always describes the entry method using the setup menu. But you can use any method you prefer.

Switching a Measurement On and Off

When a measurement is off, its waves and numerics are removed from the monitor's screen. The monitor stops data acquisition and alarming for this measurement. A measurement automatically switches off if you disconnect its module or MMS. If you disconnect a transducer, the monitor replaces the measurement numeric with question marks. If in this situation alarms are paused or switched off, the measurement in question may be switched off completely, depending on monitor configuration.

1

2

Enter the measurement's setup menu and select the measurement.

Select the measurement name to switch between on and off. The screen display indicates the active setting.

Switching Numerics On and Off

For some measurements, such as EEG, you can choose which numerics to view on the screen.

In the measurement's setup menu, select the numeric name to toggle between on and off.

For example in the

Setup EEG

menu, select the EEG numeric name to toggle between on and off.

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1 Introduction

Adjusting a Measurement Wave

To quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement wave menu, which has only wave-related measurement settings.

Changing Wave Speeds

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.

The monitor distinguishes three groups of wave speed settings,

RespiratorySpeed

, for all respiratory waves: CO

2

, anesthetic agents and O

2

EEG Speed

, for all EEG and BIS waves

• Global Speed , for all waves not included in the other two groups.

Changing the Wave Group Speed

The wave speed group setting defines the speed of all the waves in the group.

To change the wave speed of a wave speed group,

1

2

3

Select Main Setup Î User Interface

Select

Global Speed

,

RespiratorySpeed

, or

EEG Speed

as required

Select a value from the list of available speeds.

Changing Wave Speed for a Channel

To change the wave speed of an individual wave channel,

1

Enter the Wave menu for a measurement by selecting its wave.

2

3

Select Change Speed .

To set the speed to the wave group speed, select RespiratorySpeed , EEG Speed , or Global Speed .

To set an individual channel speed, select a numeric value from the list of available speeds. This overrides the wave group speed setting and set the speed for the individual wave channel on the monitor Screen. The wave channel speed is independent of the wave (label) depicted in the channel, if you change the wave, the new wave will retain the set channel speed.

Freezing Waves

You can freeze waves on the screen and measure parts of the wave using cursors. The waves are frozen with a history of 20 seconds so that you can go back and measure what you have seen.

Freezing An Individual Wave

To freeze a wave,

1

Enter the Wave menu for the measurement by selecting the wave on the screen.

2

Select Freeze Wave .

The realtime wave is replaced with the frozen wave.

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1 Introduction

Freezing All Waves

To freeze all waves on the screen,

1

Select the

Freeze Waves

SmartKey.

All realtime waves are replaced with frozen waves.

Measuring Frozen Waves

To measure a frozen wave,

1

Select the frozen wave.

If you are using touch, this automatically positions the vertical cursor. The cursor can be repositioned by touching the required point on the wave, or

2

3

Using the SpeedPoint or another pointing device or touch: use the right/left arrow keys to move the vertical cursor.

The vertical cursor moves through the time axis and the current value is displayed next to the cursor.

Use the up/down arrow keys to activate and move the horizontal cursor.

The horizontal cursor measures the wave value, which is displayed above the cursor line. If the wave is a pressure wave, the cursor value can be stored as a systolic, diastolic or mean pressure value; if the pressure wave is a PAP wave it can also be stored as a PAWP value; for pressure waves

P, P1 to P8 it can also be stored as an IAP value. The stored value appears in the trend database as a manually entered value.

Changing The Wave Speed

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.

To change the wave speed:

1

Select the frozen wave.

2

3

Select Change Speed .

Select a speed from the list.

Using Labels

You may have more than one instance of some measurements, for example pressure, being used simultaneously.The monitor uses labels to distinguish between them. The default settings defined in the profile (such as measurement color, wave scale, and alarm settings) are stored within each label.

When you assign a label to a measurement, the monitor automatically applies these default settings to the measurement. The labels assigned are used throughout the monitor, in reports, recordings, and in trends.

Changing Measurement Labels (e.g. Pressure)

To change a measurement label of a measurement with multiple labels (e.g. invasive pressure or temperature),

1

Enter the wave menu of the measurement.

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1 Introduction

2

3

Select Label .

Choose a label from the list.

The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you select. You can change scale settings in Monitoring Mode, but color can only be changed in the monitor's Configuration Mode.

Any labels already being used in the monitor are shown "grayed-out" in the list and cannot be selected.

About Label Sets

Your monitor may be configured to use a

Restricted

or

Full

label set. The

Full

label set provides extra labels for Pressure and Temp. See the sections in this Instructions for Use on Pressure and Temp for more information.

If you connect an MMS from a monitor using a Full label set to an IntelliVue monitor using a

Restricted label set or an M3/M4 monitor, any additional labels switch to labels available in the target monitor. This may cause a label conflict with other monitored measurements.

Be aware that connecting a monitor using the Full label set to an Information Center with certain software revisions may affect the availability of measurement information from the additional labels on the Information Center. See the Information Center documentation and your monitor's Configuration

Guide for information on label set compatibility.

Resolving Label Conflicts

Each label must be unique, that is, it can only be assigned once. You cannot monitor two pressures labeled "ICP" at the same time. If you need to use two identical pressures, you must assign different labels to them, for example, P and ICP.

Measurement labels are stored in the measurement device (module or MMS). If you try to use two measurement devices that have identical labels, this causes a label conflict in the monitor.

Measurement selection key with question marks indicating a label conflict.

Depending on your configuration, the monitor will either

• resolve the conflict automatically, by assigning a new, generic label to the most recently connected conflicting label (e.g. a second FAP label could be changed to ABP)

• display the

Measurement Selection

window automatically for you to resolve the conflict

• take no action, you must enter the Measurement Selection window and resolve the conflict

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1 Introduction

All the currently available measurement devices, for example MMSs, MMS extensions, measurement modules, Gas analyzers, devices connected to a host monitor and manually entered measurements

(marked ), are depicted in the Measurement Selection window.

De-activated devices are grayed-out (here the Temp measurement on the left)

Any measurement labels causing a label conflict are shown in red. If a measurement device is connected but currently unavailable, for example, because it was deactivated due to a label conflict, the device is shown "grayed-out".

When an X2 or MP5 is connected to a host monitor, the measurement selection window looks like this:

X2 connected to host monitor MP5 connected to host monitor

WARNING

When an X2 or MP5 with an active measurement, say SpO

2

, is connected to a host monitor with the same measurement already active, the SpO

2

measurement on the X2 or MP5 is deactivated and the

Meas. DEACTIVATED

INOP is displayed. The measurement can only be reactivated if the X2 or MP5 is disconnected from the host monitor. The label conflict can be resolved on the host monitor like any other label conflict.

To resolve a label conflict:

1

2

3

Select the measurement selection key or select

Main Setup Î Meas. Selection

to display the

Measurement Selection window.

Select the device whose label you want to correct.

Use the measurement selection pop-up keys to resolve the conflict. Select either:

Change Label

: to assign a different label to the conflicting label

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1 Introduction

– De- Activate : to disable the conflicting device. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged. When the device has been deactivated the question marks under the measurement selection key will be replaced by XXX.

– Setup <Measurement Label> : to enter the Setup menu for the measurement and change the conflicting device's label to a different label.

Modify Driver

(VueLink/IntelliBridge only): - to modify the device driver setup to disable the conflicting device's label.

Label Compatibility

When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center.

When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used.

If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision.

Updating The Frozen Wave

To update the wave, that is freeze the current wave:

1

2

Select the frozen wave.

Select Freeze Again .

Releasing Frozen Waves

To release frozen waves,

1

Select a frozen wave.

2

Select

Unfreeze Waves

.

All frozen waves are released.

Entering Measurements Manually

You can enter values into the monitor that have been measured with other equipment or manually (for example, manual temperatures, lab values). These values are then stored in the database, included in trends and reports, and passed on to the Information Center and central charting systems. There is no alarm functionality for manually entered measurements.

To enter values,

1

2

Select the

Enter Values

SmartKey or select

Main Setup Î Enter MeasValues

Select the measurement you want to enter values for. The Edit window will open.

3

4

5

If the measurement is switched off, switch it on by selecting the label.

Select Value and enter the value.

Select

Date/Time

to enter the date and time for the value. The default is always the current date and time.

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1 Introduction

6

For compound labels, for example ABPs , ABPd and ABPm , select the Format field to select whether all values are required or a single value.

7

Select Save .

When a manually entered value has been configured to display as a numeric on the screen, you can also enter a new value for this measurement by selecting the numeric, then selecting Enter MeasValues .

Manually entered measurement values are marked with a * on the display, in trends, and so forth. Each measurement has a defined measurement interval after which a value becomes invalid (no value is then displayed). Values can be entered up to two hours after they have been measured or up to the measurement interval, if this is shorter.

The list of measurement labels which appears in the

Enter Measurement Values

window is set in

Configuration Mode.

No values can be entered manually on a monitor in companion mode when it is connected to a host monitor.

Switching Manually Entered Measurements On and Off

To switch a manually entered measurement on or off,

1

2

3

Select the

Enter Values

SmartKey or select

Main Setup Î Enter MeasValues

.

Select the measurement you want to switch on or off.

Select the measurement label field to switch between On and Off .

Changing Monitor Settings

To change monitor settings such as brightness, or QRS tone volume, select the

Main Setup

permanent key and then select

User Interface

to enter a submenu where you can change these settings.

Adjusting the Screen Brightness

1

Select the

Brightness

SmartKey.

2

Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright.

Optimum

is suitable for most monitoring locations and optimizes power usage for battery powered monitors.

Your monitor may be configured with a lower brightness for Standby mode and also (for battery powered monitors) for transport to conserve battery power. These settings can only be changed in the monitor's Configuration Mode.

If you are using a monitor with an external display, the

Brightness

SmartKey does not adjust the brightness of this display. See the instructions supplied with the external display for instructions.

Setting the Date and Time

1

2

Select the Date, Time screen element from the monitor's info line to enter the Date, Time menu.

Select, in turn, the

Year

,

Month

,

Day

,

Hour

(in 24 hour format, only) and

Minute

as necessary.

Select the correct values from the pop-up list.

41

1 Introduction

3

Select Store Date, Time to change the date and time.

If your monitor is connected to an Information Center, the date and time are automatically taken from this. Once it is set, the internal clock retains the setting even when you switch off the monitor.

WARNING

Changing the date or time will affect the storage of trends and events.

Checking Your Monitor Revision

1

2

3

Select Main Setup Î Revisions to open the Monitor Revision menu.

Select the correct device from the device pop-up keys.

From the

Monitor Revision

menu, select the monitor component for which you need revision information.

Getting Started

Once you understand the basic operation principles, you can get ready for monitoring. We also recommend working through the CBT for self-training before using the monitor (not available in all languages).

Inspecting the Monitor

WARNING

If the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel.

1

2

3

Before you start to make measurements, carry out the following checks on the monitor including all connected MMSs, modules, or MMS extensions.

– Check for any mechanical damage.

– Check all the external cables, plug-ins and accessories.

Plug the power cord into the AC power source.

Check all the functions of the instrument that you need to monitor the patient, and ensure that the instrument is in good working order.

Switching On

Press the on/off switch on the monitor for one second. The monitor performs a self test and is then ready to use. If you see a message such as

CO₂ SENS.WARMUP

wait until it disappears before starting to monitor that measurement. Connected devices usually take their power from the monitor. External devices such as gas monitors and those connected via VueLink/IntelliBridge have their own power switches.

42

1 Introduction

Power On/Power Off Behavior

The general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows:

• A monitor that was switched on prior to a temporary power loss switches on again when power is restored.

• A monitor that was switched off prior to a temporary power loss remains off when power is restored.

• An X2 or MP5 switches on automatically when connected to a running host monitor.

• When an X2 or MP5 is disconnected from a running host monitor, the X2 or MP5 continues to run without interruption on battery power.

Setting up the Modules

1

Decide which measurements you want to make.

2

3

Connect the required modules, MMSs, or MMS extensions.

Check that you have the correct patient cables and transducers plugged in. The connectors are color-coded to the patient cables and transducers for easy identification.

Starting Monitoring

After you switch on the monitor,

1

2

3

Admit your patient to the monitor.

Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and so forth are appropriate for your patient. Change them if necessary.

Refer to the appropriate measurement chapter for further details of how to perform the measurements you require.

WARNING

During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns.

Disconnecting from Power

The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect, unplug the power cable.

Monitoring After a Power Failure

If the monitor is without power for less than one minute, monitoring will resume with all active settings unchanged. If the monitor is without power for more than one minute, the behavior depends on your configuration. If Automat. Default is set to Yes , the default profile will be loaded when power is restored. If

Automat. Default

is set to

No

, all active settings are retained, if power is restored within

48 hours. The

Automat. Default

setting is made in Configuration Mode.

43

1 Introduction

Networked Monitoring

You can connect your monitor to an Information Center on a network, using one of the optional interfaces:

• Standard wired LAN

• Wireless LAN

• IntelliVue Instrument Telemetry System (IIT)

WARNING

Do not connect patient monitors to the standard hospital network.

Additionally, when an IntelliVue X2 or MP5 is equipped with IIT and declared at the Information

Center as a telemetry device, it allows data continuity when paired to a host monitor. After disconnection from the host monitor, it continues to monitor the patient during transport and

provides continuous data to the same sector on the Information Center. (See “Assigning a Telemetry

Device and a Monitor to One Patient” on page 267.)

If your monitor is connected to a network, a network symbol is displayed in the upper left corner next to the bed label. To see details about the Care Group, the monitoring equipment, and technical information about the network,

• in the monitor info line, select the bed label.

Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks.

Printout functionality and data export are not guaranteed when using a standard hospital network.

Using the Integrated PC

If your monitor has the optional integrated PC (iPC), you can run applications on the iPC. The applications display data on the monitor's display (or on a second independent display) that is generated on and retrieved from the iPC or externally.

For details about applications, refer to the XDS/iPC Instructions for Use.

The monitor runs independently of the iPC, and vice versa.

WARNING

• Some clinical applications may show data from another patient. Be aware that some of the data on your patient monitor display may not always be from your patient.

• Applications running on the iPC cannot act as a primary alarming device and cannot be relied upon for alarm notification. There may be no audible or visible indications apart from what is shown on the screen and any data shown may be delayed.

Starting the iPC

Your monitor may be configured to have the iPC start up automatically when the monitor is switched on. If not:

44

1 Introduction

1

2

Select Main Setup then Internal PC .

In the Internal PC menu, select Switch PC On to start the iPC.

Viewing the iPC Desktop on the Monitor Display

If the Desktop is not displayed on the monitor display:

1

Select the iPC icon, or

2

Select

Main Setup Î Internal PC Î Show PC Window

.

To hide the Desktop again, select

Main Screen

.

Adjusting the iPC Audio Volume

The Audio from the iPC is normally configured to be off. However, your monitor may have the iPC audio configured on for use with specific PC applications.

WARNING

Always minimize the iPC audio volume or mute it completely when it is not needed for an iPC application. This will avoid iPC tones distracting from or masking tones from the monitor.

Using Input Devices with the iPC and Monitor

You can connect input devices such as a mouse, trackball and keyboard to the rear of the patient monitor (using the left hand row of USB connectors) and use them for input to the monitor.

Correspondingly you can connect input devices to the rear of the patient monitor (using the right hand row of USB connectors) or to the front USB connector and use them for the iPC. Sharing input devices and touchscreen input requires a specific software application; refer to the XDS/iPC

Instructions for Use for details.

If the iPC is switched off when input devices are shared, any input devices connected to it will not be available for use with the monitor.

Shutting the iPC Down

The iPC will be shut down automatically when the monitor is switched off.

If you want to shut down the iPC when the monitor is on,

1

2

Select

Main Setup

then

Internal PC

.

In the

Internal PC

menu, select

Switch PC Off

.

If there is a problem with the shutdown, and you need to switch off the iPC manually,

1

2

Select Main Setup then Internal PC .

In the Internal PC menu, select Force PC Off to force the iPC to power down.

Special Situations at Shutdown

• If you switch the monitor off and then on again immediately, the iPC will continue running and will not be shut down.

45

1 Introduction

• In some situations, shutting down the iPC can take a little time. The monitor will go into Standby mode until the shutdown is complete. By touching the touchscreen, you can bring the monitor back into operating mode. If you do this, the iPC will restart when the shutdown is complete.

• If the shutdown cannot be completed within a certain time, a window will open giving the reason: for example, that a file has not been saved, or that updates are being installed. You can then decide whether to wait (for example, in the case of the updates) or to take action (for example by saving the unsaved file). You will also have the option to force shutdown, if necessary.

Using the X2 or MP5 with a Host Monitor

When you connect an X2 or MP5 in companion mode to a host monitor, an integrated system is formed for monitoring a single patient. The following general observations and considerations apply to such a system:

• The host monitor is the "master" of the system, and you have full control over all the system's operation only via the host monitor.

• Functions you can operate on a monitor in companion mode are restricted to measurements originating in that device. If you try to operate controls that are disabled, you are prompted by the message Not available in Companion Mode .

• Depending on how it is configured, your host monitor can determine whether the user interface of a connected monitor in companion mode is completely disabled or not, and what is displayed on the screen (a standard main screen, or a blank screen indicating

Companion Mode

).

This is controlled by two monitor settings that are applied to the monitor in companion mode on connection. You can change the settings in Configuration Mode.

• Global settings such as line frequency, QRS sound and ECG lead colors from the host monitor, are applied to the monitor in companion mode on connection. When disconnected from the host, the monitor in companion mode re-applies its own global settings.

• No audible alarms are available on a monitor in companion mode when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps which are controlled by the host monitor. Alarms become active again as soon as the monitor in companion mode is disconnected from the host monitor.

• The host monitor is the master of all ADT information. ADT operations on the monitor in companion mode are disabled, and any pending actions on the monitor in companion mode (for example, admit or end case) are cancelled.

• The date and time of the monitor in companion mode is synchronized with that of the host monitor.

• Event surveillance in the monitor in companion mode is disabled. Main Setup menu operations and SmartKeys are disabled. While connected to a host monitor, no new events are detected in the monitor in companion mode, and no events are deleted. There is no transfer of stored events from the monitor in companion mode to the host monitor. After disconnection from the host monitor, event surveillance is enabled again in the monitor in companion mode, and new events are detected.

46

2

2

Alarms

The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements.

The monitor has two different types of alarm: patient alarms and INOPs.

Patient Alarms

Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy).

INOPs

INOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, LEADS OFF ), the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded. INOPs without this audible indicator indicate that there may be a problem with the reliability of the data, but that monitoring is not interrupted.

Most INOPs are light blue, however there are a small number of INOPs which are always yellow or red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be configured as red or yellow INOPs to provide a severity indication:

ECG LEADS OFF

NBP CUFF OVERPRESS

• CUFF NOT DEFLATED

• OCCLUSION

TELE DISCONNECTED

Replace TeleBatt

All monitors in a unit should have the same severity configured for these INOPs.

Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the trigger delay time for the individual measurement. See the specifications section for details.

If more than one alarm is active, the alarm messages are shown in the alarm status area in succession.

An arrow symbol next to the alarm message informs you that more than one message is active.

47

2 Alarms

The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged.

Visual Alarm Indicators

WARNING

• No alarms are available on an X2 or MP5 when connected to a host monitor (

Companion Mode is indicated). Alarms become active again as soon as the X2 or MP5 is disconnected from the host monitor.

• Alarm fields and other visual alarm indicators are disabled on an X2 or MP5 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps, which are controlled by the host monitor.

Alarm Message

An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow ( ) at the side. The background color of the alarm message matches the alarm priority: red for red alarms, yellow for yellow alarms, light blue for standard INOPs, red for red

INOPs and yellow for yellow INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms, ** for yellow alarms, * for short yellow alarms. Standard INOPs do not have a symbol, red and yellow INOPs have exclamation marks beside the alarm message: !!! for red

INOPs and !! for yellow INOPs.

Depending on how your monitor is configured, it may display alarm limit violation messages

• in text form, for example

** SpO₂ LOW

or

• in numeric form, for example

**Pulse xxx>yyy

where the first number shows the maximum deviation from the alarm limit, and the second number shows the currently set limit.

Flashing Numeric

The numeric of the measurement in alarm flashes.

Bright Alarm Limits

If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if

Show ALarmLimits

is enabled and there is sufficient room on the screen.

Alarm Lamp

A lamp on the monitor's front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds. The color is yellow or red corresponding to the highest priority patient alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow or red INOPs as follows:

48

2 Alarms

INOP Lamp Color

Yellow

Red

On

1.0 seconds

0.25 seconds

Off

1.0 seconds

0.25 seconds

If only patient alarms are present, and no INOPs, the patient alarms will use both left and right sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and right sections to flash but light blue INOPs will always light continuously in the left section only.

Nurse Call Systems

If configured to do so, red, yellow and light blue alarms are indicated on any device connected to the nurse call relay.

Audible Alarm Indicators

The audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to non-latching).

WARNING

• Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.

• No audible alarm indicators are available on an X2 or MP5 when connected to a host monitor

(

Companion Mode

is indicated). Alarms become active again as soon as the X2 or MP5 is disconnected from the host monitor.

Alarm Tone Configuration

The audible alarm indicators of your monitor are configurable. In the monitor's Configuration Mode, you can:

• increase the alarm volume of unacknowledged alarms at regular intervals

• change the interval between alarm sounds (ISO/IEC Standard alarms only)

• change the base volume of the red and yellow alarm tones and the INOP tones

• change the alarm sound to suit the different alarm standards valid in different countries.

Traditional Audible Alarms (HP/Agilent/Philips/Carenet)

• Red alarms and red INOPs: A high pitched sound is repeated once a second.

• Two-star yellow alarms and yellow INOPs: A lower pitched sound is repeated every two seconds.

• One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration.

49

2 Alarms

• Standard INOPs: an INOP tone is repeated every two seconds.

ISO/IEC Standard Audible Alarms

• Red alarms and red INOPs: A high pitched tone is repeated five times, followed by a configurable pause.

• Two-star yellow alarms and yellow INOPs: A lower pitched tone is repeated three times, followed by a configurable pause.

• One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration.

• Standard INOPs: a lower pitched tone is repeated twice, followed by a pause.

Changing the Alarm Tone Volume

• The alarm volume symbol at the top right of the monitor screen gives you an indication of the current volume.

To change the volume, select the volume symbol and then select the required volume from the pop-up selection.

• If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, or change the setting, select the Alarm Volume SmartKey.

The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale. Any settings that are inactive ("grayed out") have been disabled in the monitor's Configuration Mode.

• When the alarm volume is set to zero (off), the alarm volume symbol reflects this.

If you switch the alarm volume off, you will not get any audible indication of alarm conditions.

There is no alarm volume indication on the screen of an X2 or MP5 when connected to a host monitor

(

Companion Mode

is indicated).

Minimum Volume for No Central Monitoring INOP

If your monitor is connected to an Information Center, and the connection is interrupted, the INOP message No Central Monit.

will appear within 30 seconds, accompanied by an INOP tone. To help ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the monitor alarm volume is set to zero.

Minimum Volume for Severe Yellow or Red INOPs

Severe yellow or red INOPs require action to ensure the well-being of the patient. Therefore the minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.

50

2 Alarms

The severe INOPs for which this applies are:

CUFF NOT DEFLATED (configurable to yellow or red)

NBP CUFF OVERPRESS

(configurable to yellow or red)

!!INSERT BATTERY

- X2 (yellow)

Power Loss Tone

When power is lost - no power is available via the power cable - a buzzer will sound, if so configured.

The tone can be silenced by pressing the On/Off power switch.

Acknowledging Alarms

To acknowledge all active alarms and INOPs, select the

Silence

permanent key. This switches off the audible alarm indicators and alarm lamps.

Alternatively, you can acknowledge alarms by pressing the

Silence

hardkey on the MMS or on the

SpeedPoint. The hardkeys follow the behavior configured for the permanent key.

monitor is configured to re-alarm, a dashed check mark will be shown .

If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message stays on the screen with a check mark symbol beside it, except for NBP alarms and alarms from other intermittent measurements. When such an alarm is acknowledged the alarm message disappears.

If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.

Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also stops alarm indication.

Acknowledging Disconnect INOPs

Acknowledging an INOP that results from a disconnected transducer switches off the associated measurement, unless the monitor is configured to not allow this. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the Information Center switches off the audible

INOP indicator but does not switch off the measurement.

Unplugging an MMS or a plug-in module automatically switches off its measurements.

51

2 Alarms

Alarm Reminder

If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). Alarm Reminder is not available for standard, light blue INOPs but for yellow and red INOPs.

In Configuration Mode, you can set the interval between silencing the alarm and sounding the reminder tone to one, two, or three minutes.

The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the

Information Center Instructions for Use for further information.

Pausing or Switching Off Alarms

If you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely.

To view the alarm pause setting chosen for your unit,

1

Select

Main Setup Î Alarms Î Alarm Settings

2

Check the Alarms Off setting.

This setting can only be changed in Configuration Mode.

To Pause All Alarms

• Select the

Pause Alarms

permanent key. If your monitor is configured to infinite pause time, the permanent key is labelled

Alarms Off

, and selecting it switches alarms off.

• Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key.

Depending on the configuration, you may need to select

Confirm

to complete the change.

To Switch All Alarms Off

You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause and the permanent key is labeled

Alarms Off

.

• Select the

Alarms Off

permanent key.

• Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key.

Depending on the configuration, you may need to select

Confirm

to complete the change.

Pausing alarms infinitely is the same as switching them off.

52

2 Alarms

To Switch Individual Measurement Alarms On or Off

1

Select the measurement numeric to enter its setup menu.

2

Select

Alarms

to switch between on and off.

The alarms off symbol is shown beside the measurement numeric.

While Alarms are Paused or Off

• The red Alarms Paused lamp on the monitor front panel is lit.

In the alarm field, the monitor displays the message ALARMS PAUSED 1:28 or ALARMS OFF , together with the alarms paused symbol or the alarms off symbol.

Alarms Off

Alarms Paused

• No alarms are sounded and no alarm messages are shown.

• INOP messages are shown but no INOP tones are sounded.

The only exceptions are the INOPs CUFF NOT DEFLATED , NBP CUFF OVERPRESS and INOPs relating to empty, missing and malfunctioning batteries.

These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or off. You need to remove the INOP condition first before you can switch the alarm tones off again.

• The nurse call relay is not active.

If a disconnect INOP is present and alarms are paused or switched off, the measurement in question may be switched off, depending on monitor configuration.

Restarting Paused Alarms

To manually switch on alarm indication again after a pause, select the permanent key Pause Alarms (or

Alarms Off ) again.

Alarm indication starts again automatically after the pause period expires. If the monitor is configured to stay paused infinitely, you must select Alarms Off again to restart alarm indication.

Resetting Arrhythmia Alarm Timeouts

To reset the arrhythmia alarm timeout period, select the

Alarms Off

or

Pause Alarms

permanent key and then reselect it.

53

2 Alarms

Extending the Alarm Pause Time

If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patient's condition closely.

To extend the alarm pause time to five or 10 minutes,

1

Select one of the alarm fields. This calls up the

Alarm Messages

window.

2

Select either the pop-up key PauseAl. 5 Min or the pop-up key PauseAl. 10 Min . Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes.

Alarm Limits

The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, BIS and SpO

2

), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off, or setting the low alarm limit to 0 switches it off. In these cases, the alarms off symbol is not displayed.

WARNING

Be aware that the monitors in your care area may each have different alarm settings, to suit different patients. Always check that the alarm settings are appropriate for your patient before you start monitoring.

Viewing Individual Alarm Limits

You can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen.

If your monitor is not configured to show the alarm limits next to the numeric, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits.

Viewing All Alarm Limits

The

Alarm Limits

overview window lists the currently set alarm limits for all measurements. If an

Apnea alarm delay time is set, this is also shown. The alarms off symbol is shown beside the measurement label of any measurement whose alarm switched off.

To open the

Alarm Limits

window, either select any alarm field to open the

Alarm Messages

window, then select the

Alarm Limits

pop-up key, or select the

Alarm Limits

SmartKey, if configured

.

54

2 Alarms

1

Measurement labels, with alarms off symbol where appropriate

2

Current alarm limits

3

Graphic view of current yellow and red alarm limits and currently monitored measurement value.

Off

indicates the measurement is switched off

• Select

Show ST Limits

to expand the list of ST leads and view the currently set alarm limits.

Selecting

Hide ST Limits

hides the list again.

You can use the pop-up keys that open with the

Alarm Limits

window to perform common tasks:

– All Al. On / All Al. Off ,

All Lim. Narrow

/

All Lim. Wide

to set narrow or wide alarm AutoLimits for all measurements.

Print Limits

/

Record Limits

to print a list of all current alarm limit settings on a connected printer or recorder.

These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the

Alarm Limits

window.

Changing Alarm Limits

To change individual measurement alarm limits using the measurement's Setup Menu,

1

In the measurement's setup menu, select the alarm limit you want to change. This calls up a list of available values for the alarm limit.

2

Select a value from the list to adjust the alarm limit.

Alternatively, you can use the keys in the measurement alarm limits window, which you access by selecting the measurement label in the

Alarm Limits

window.

55

2 Alarms

56

T

7

8

9

10

11

3

4

1

2

5

6

Parameter label

High red alarm (view only)

High yellow alarm field. Select to open a pop-up list of high alarm limits

Alarms On/Off key - select to switch between alarms on or off

Preview Alarm AutoLimits for a measurement before applying

Select to apply wide AutoLimits

Select to apply narrow AutoLimits

Low yellow alarm field. Select to open a pop-up list of low alarm limits

Low red alarm (view only)

Graphic view of alarm limits with currently measured value

15-min trend, showing alarm limits and monitored measurement values

To change alarm limits,

1

Enter the

Alarm Limits

window.

2

Using touch: to set the high alarm limit, select the high yellow alarm field to open a pop-up list of high alarm limits. Select a limit from the list. Repeat to set the low yellow alarm field.

Using a SpeedPoint or Navigation Point: position the cursor in the high yellow alarm field, then press the knob inwards. Rotate the knob to the left or right to adjust the limit. Press the knob again to set the displayed limit. Repeat to set the low yellow alarm limit.

If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically adapt the red alarm limit.

When an ST measurement is in the alarm limits window there are also two pop-up keys available labeled All ST Narrow / All ST Wide . With these keys you can set Auto Limits for all ST Leads.

2 Alarms

About Automatic Alarm Limits

The monitor can automatically set alarm limits suited to your individual patient, using the Automatic

Alarm Limits function (AutoLimits). This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe

AutoLimits for each patient based on the measured values from the last 12 seconds.

The wide and narrow limits have a fixed relationship to the measured value within the nonpathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinician's judgment about the specific patient.

1

2

3

4

Wide alarm limits

Narrow alarm limits

Alarm Limits

Measurement value

Limits Narrow

sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patient's vital signs.

Limits Wide

sets limits further away from the currently measured values for situations where small changes are not so critical.

Use the keys in the measurement alarm limits window to apply AutoLimits for individual measurements. These keys are not available if AutoLimits have been disabled for the measurement in the monitor's Configuration Mode.

AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitor's Configuration mode.

Use the measurement alarm limits window to check AutoLimits before you apply them to ensure that they are appropriate for your individual patient and their clinical condition. Once applied, AutoLimits are shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not appropriate for your patient, you must set alarm limits manually. The limits remain unchanged until you set them again or change them manually.

About Smart Alarm Delays

The monitor can be configured to apply a delay before announcing limit alarms. The delay is calculated using an intelligent algorithm. This capability can be used to suppress alarms which occur because a limit is exceeded for a short time or by a small amount. Currently, Smart Alarm Delays are available only for SpO

2

limit alarms and are not available in the U.S.A. or in clinical environments under FDA control. See the Monitoring SpO

2

chapter for details.

57

2 Alarms

WARNING

Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are.

Documenting Alarm Limits

The alarm limits pop-up keys appear with the

Alarm Limits

and measurement alarm limits windows.

• Select the Print Limits pop-up key to print an overview of all alarm limits on a connected printer.

• Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder.

Reviewing Alarms

You can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen.

To see the currently active alarms and INOPs listed in one place, select any of the alarm status areas on the monitor screen. The

Alarm Messages

window pops up.

All alarms and INOPs are erased from the Alarm Messages window when you discharge a patient, or if you change to Demonstration Mode.

Alarm Messages Window

The

Alarm Messages

window shows all the currently active alarms and INOPs sorted by priority, beginning at the top with the most recent. INOPs are shown on the left hand side and patient alarms are shown on the right hand side. Any active red alarms are shown first, followed by yellow alarms.

Acknowledged alarms or INOPs are shown with the check mark symbol.

The Alarm Messages window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive ("grayed-out"). Selecting the

Review Alarms pop-up key opens the

Review Alarms

window.

If you do not immediately understand an INOP or alarm message, refer to its help text.

• In the

Alarm Messages

window, select the INOP message. This calls up a help window with an explanation of the INOP message and, where appropriate, a suggested solution for the problem.

• If the alarm or INOP was generated in a device other than the monitor (for instance, in an MMS or FMS), this source is specified at the end of the help text.

Review Alarms Window

The

Review Alarms

window contains a list of the most recent alarms and INOPs with date and time information.

58

2 Alarms

If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit. The

Review Alarms

window also shows when the monitor was switched on (after being switched off for longer than 1 minute) and any actions related to switching alarms on and off, entering or leaving Standby mode, silencing alarms or changing the ECG source.

When you select an item from the list, you can get additional information about that item. If you select a high or low limit alarm in the list, the Graphical Trends window will open to provide further data. If you select an alarm resulting from an event alarm notification, the

Event Episode

window for that event will open. If you select an alert other than a high or low alarm, a help text window opens with more information. This is the same as the help text window that opens in the Alarm Messages window. Some items in the list are simply log items not related to a patient alert as such (for example,

Alarms On

or

Alarms Off

). You cannot see any further information if you select one of these items.

When you close these windows you will return to the

Review Alarms

window.

The information in the

Review Alarms

window is deleted when a patient is discharged, and when you leave Demonstration Mode.

The

Review Alarms

window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive. Selecting the

Active Alarms

pop-up key opens the Alarm Messages window.

Latching Alarms

The alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed or announced by the monitor after the alarm condition ends. The indication lasts until you acknowledge the alarm.

Viewing the Alarm Latching Settings

To see the alarm latching setting for your monitor

1

2

In the monitor's Main Setup menu, select Alarms .

Select Alarm Settings , and see the Visual Latching and Audible Latching settings.

This setting can only be changed in Configuration Mode. You should be aware of the settings chosen for your unit. There are three possible choices each for visual and audible latching, red, red and yellow, and off. These choices can be combined to give the following settings:

Visual Latching

Audible Latching

R = red alarms, Y = yellow alarms

R&Y

R&Y

R&Y

R

R&Y

Off

R

R

R

Off

Off

Off

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2 Alarms

Alarm Latching Behavior

Red & Yellow Measurement

Alarms

Non-latching alarms Visual and audible latching

Visual latching, audible non-latching

Alarm has not been acknowledged.

Alarm has been acknowledged.

Alarm condition still present.

Alarm condition no longer present.

Alarm condition still present.

Alarm condition no longer present.

Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.

All audible and visual alarm indicators automatically stop.

Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.

Alarm tone on.

Alarm lamp on.

Alarm message.

Flashing numerics.

Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).

Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).

Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.

Alarm message.

Flashing numerics.

Audible alarm indicators automatically stop.

Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).

Audible and visual alarm indicators automatically stop.

Audible and visual alarm indicators automatically stop.

Audible and visual alarm indicators automatically stop.

All INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 138 for information on one-

star yellow alarms latching behavior.

Testing Alarms

When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO

2

or CO

2

) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.

Alarm Behavior at Power On

If the monitor is switched off for longer than one minute and then switched on again (or after a loss of power lasting longer than one minute, or when a patient is discharged), the monitor can be configured to:

• restore the alarm settings from the monitor's configured default Profile,

• restore the most recently used alarm settings, or

• switch the alarms off.

After any of these situations, you should check that the alarm settings are appropriate for your patient and monitoring situation, and if necessary, select the correct Profile and patient category.

If power is lost for less than one minute, the alarm on/off condition prior to the power loss is restored.

60

2 Alarms

Alarm Recordings

You can set up your monitor so that it automatically triggers alarm recordings at the Information

Center, or if configured, to a printer as a realtime report.

1

2

Press the

Main Setup

SmartKey.

Select

Alarms

from the

Main Setup

menu.

3

4

Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.

Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list.

5

For the desired measurement(s), choose the alarm condition to trigger an alarm recording:

Red Only : an alarm recording will automatically be triggered when the measurement enters a red alarm condition.

Red&Yellow

: both yellow and red alarms will trigger an alarm recording.

Off:

disables automatic alarm recording.

Refer to the Recording chapter for details of how to set up a recording.

61

2 Alarms

62

3

3

Patient Alarms and INOPs

This chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options.

For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for Use.

Patient Alarm Messages

The measurement labels and abbreviations for pressure, temperature, SpO

2

, and anesthetic agent alarms are explained in the individual chapters.

Some alarms may be shown at the Information Center in shortened form, when transferred through

IntelliVue Instrument Telemetry. These shortened alarm texts are included in the list and identified with the note "at Information Center".

Note that yellow arrhythmia alarms may be shown with one or with two stars, depending on your monitor configuration and the Information Center revision you are using.

Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices.

Refer to your Gas Module Instructions for Use for patient alarms and INOPs from the gas modules.

Alarm Message

* AFIB

** AFIB

*** APNEA

*** APNEA x:yy

*** APNEA >10min

*** ASYSTOLE

** awRR HIGH

From

ECG/

Arrhythmia

CO

2

, Resp,

Spirometry

ECG

CO2, Resp,

AGM

Condition Indication

Atrial fibrillation waveform detected yellow alarm lamp, short yellow audible alarm

Respiration has stopped for longer than the preset apnea time. "x:yy" denotes the Apnea duration in minutes and seconds numeric flashes, red alarm lamp, alarm tone

No QRS detected for a period greater than the asystole threshold (in the absence of Vfib or chaotic ECG)

The airway respiration rate has exceeded the high alarm limit.

numeric flashes, red alarm lamp, alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone

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3 Patient Alarms and INOPs

Alarm Message

** awRR LOW

** BIS HIGH

** BIS LOW

***BRADY/P xxx<yyy

***BRADY xxx < yyy

** CCO HIGH

** CCI HIGH

** CCO LOW

** CCI LOW

** CPP HIGH

** CPP LOW

*** DESAT

*** DESAT xx < yy

** EC10 ALARM

*** EC10 ALARM at Information Center

** etCO₂ HIGH

** etCO₂ LOW

** etO₂ HIGH

** etO₂ LOW

* EVENT:<Event

Group>

** EVENT:<Event

Group>

*** EVENT:<Event

Group>

From

CO2, Resp,

AGM

BIS

BIS

Press, SpO

CCO

CCO

CPP

CPP

SpO

2

CO2, Resp,

AGM

CO2, Resp,

AGM

Event surveillance

2

EC10

Intellibridge

O

O

2

2

, AGM

, AGM

Condition Indication

The airway respiration rate has dropped below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone

The Bispectral Index value has exceeded the high alarm limit.

The Bispectral Index value has dropped below the low alarm limit.

The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit.

Continuous Cardiac Output or CC

Index is above the high alarm limit.

Continuous Cardiac Output or CC

Index is below the low alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone

The CPP value has exceeded the high alarm limit.

The CPP value has fallen below the low alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone

The SpO

2

value has fallen below the desaturation alarm limit. xx denotes the lowest measured value, and yy is the desaturation limit.

numeric flashes, red alarm lamp, alarm tone

A yellow (**) or red (***) patient alarm is present on the IntelliBridge module.

Check the monitor display for more detailed alarm information.

(on monitor) yellow or red alarm lamp; the alarm text is defined by the Intellibridge device driver

The end tidal CO

2 been exceeded.

high alarm limit has numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone

The end tidal CO

2

value has fallen below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone

The end tidal O been exceeded.

2

high alarm limit has

The end tidal O

2

value has fallen below the low alarm limit.

An event has occurred and the event notification is configured to alarm.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone event group name flashes, yellow or red alarm lamp and alarm tone

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3 Patient Alarms and INOPs

Alarm Message

* EVENT

** EVENT

*** EVENT at Information center

*** EXTREME BRADY

***TACHY xxx > yy

** HR LOW

* IRREGULAR HR

** IRREGULAR HR

* MISSED BEAT

** MISSED BEAT

* MULTIFORM PVCs

** MULTIFORM PVCs

** NBP HIGH

** NBP LOW

* NON-SUSTAIN VT

** NON-SUSTAIN VT

* PACER NOT CAPT

** PACER NOT CAPT

* PACER NT PACING

** PACER NT PACING

From Condition Indication

Event surveillance

ECG

ECG

ECG

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

NBP

An event has occurred and the event notification is configured to alarm.

Check on the monitor for more details on event group.

The bradycardia limit has been exceeded.

The tachycardia limit has been exceeded

The heart rate has fallen below the low alarm limit.

Consistently irregular heart rhythm.

No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only).

Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats.

The measured NBP value is above the high alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if

Arrhythmia is switched on.

numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone

NBP

ECG/

Arrhythmia

ECG/

Arrhythmia

(paced patients only)

ECG/

Arrhythmia

(paced patients only)

The measured NBP value is below the low alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

A run of Vs having a ventricular

HR>V-Tach HR limit, but lasting for less than the V-Tach Run limit has been detected.

A missed beat with a pace pulse was detected.

A missed beat without a pace pulse was detected.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm

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3 Patient Alarms and INOPs

Alarm Message

* PAIR PVCs

** PAIR PVCs

* PAUSE

** PAUSE

***<Pressure>

DISCONNECT

** QTc HIGH

** ΔQTc HIGH

From

ECG/

Arrhythmia

ECG/

Arrhythmia

PRESS

*** <Press Label> HIGH PRESS

** <Press Label> HIGH PRESS

*** <Press Label> LOW PRESS

** <Press Label> LOW PRESS

** Pulse HIGH

** Pulse LOW

* PVCs/min HIGH

** PVCs/min HIGH

PRESS

SpO

2

PRESS

SpO

2

ECG/

Arrhythmia

ECG/QT

ECG/QT

Condition Indication

A non-ventricular contraction, followed by two ventricular contractions, followed by a nonventricular contraction has been detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm

No beat detected for a period greater than the pause threshold.

The pressure is non-pulsatile and the mean pressure is continuously less than

10mmHg (1.3kPa). This alarm occurs only with arterial pressures (P, ABP,

ART, Ao, BAP, FAP, PAP, UAP, P1, P2,

P3, P4).

The measured pressure value is above the extreme high alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, red alarm lamp, alarm tone numeric flashes, high limit is highlighted, red alarm lamp, alarm tone numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone

The measured pressure value is above the high alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

The measured pressure value is below the extreme low alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

The measured pressure value is below the low alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

The pulse rate has exceeded the high alarm limit.

numeric flashes and low limit is highlighted, red alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone

The pulse rate has dropped below the low alarm limit.

More premature ventricular contractions have been detected in a minute than the limit.

QTc value has exceeded the QTc high limit for more than 5 minutes

ΔQTc value has exceeded the ΔQTc high limit for more than 5 minutes numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone

66

3 Patient Alarms and INOPs

Alarm Message

* R-ON-T PVCs

** R-ON-T PVCs

** RR HIGH

** RR LOW

* RUN PVCs HIGH

** RUN PVCs HIGH

ECG/

Arrhythmia

** <SO₂ Label> HIGH

SvO

2

/SO

2

** <SO₂ Label> LOW

** <SpO₂ Label> LOW

** ST-<n> HIGH

** ST-<n> LOW

**ST MULTI <n>,<n>

**ST MULTI at Information Center

* SVT

** SVT

***TACHY/P xxx>yy or

***TACHY xxx > yy

** Tblood HIGH

From

ECG/

Arrhythmia

RESP

RESP

SvO

** <SpO₂ Label> HIGH SpO

SpO

2

/SO

2

2

ECG/ST

ECG/ST

ECG/ST

ECG/ST

2

ECG/

Arrhythmia

Press,

SpO

2

,ECG

C.O.

Condition Indication

For HR <100, a PVC with R-R interval

< 1/3 the average interval followed by a compensatory pause of 1.25 x average

R-R interval or two such Vs without compensatory pause occurring within 5 minutes of each other. (When HR

>100, 1/3 R-R interval is too short for detection.).

The respiration rate has exceeded the high alarm limit.

numeric flashes, yellow alarm lamp, short yellow audible alarm

The respiration rate has dropped below the low alarm limit.

A run of PVCs greater than 2 was detected.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm

The the measured intravascular oxygen saturation has exceeded the high limit.

The measured intravascular oxygen saturation has fallen below the low limit.

The arterial oxygen saturation has exceeded the high alarm limit.

The arterial oxygen saturation has fallen below the low alarm limit.

numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone

The ST elevation in lead <n> is higher than the limit.

The ST depression in lead <n> is lower than the limit.

The ST depression or elevation is outside of the limit in two or more leads <n> and <n>

The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone

(on monitor) numeric flashes, yellow alarm lamp, alarm tone

A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the

SVT HR limit.

The tachycardia limit has been exceeded. xxx denotes the highest measured value; yy is the tachycardia limit.

The blood temperature value has exceeded the high alarm limit.

numeric flashes, yellow alarm lamp, alarm tone numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone

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3 Patient Alarms and INOPs

Alarm Message

** Tblood LOW

** tcpO₂ HIGH

** tcpCO₂ HIGH

** tcpO₂ LOW

** tcpCO₂ LOW

* TELE ALARM

** TELE ALARM

*** TELE ALARM

Telemetry

** <Temp Label> HIGH TEMP

* VENT BIGEMINY

** VENT BIGEMINY

*** VENT FIB/TACH

* VENT RHYTHM

** VENT RHYTHM

* VENT TRIGEMINY

** VENT TRIGEMINY

*** VTACH

** VueLink ALARM

*** VueLink ALARM at Information Center

From

C.O.

tcGas tcGas

** <Temp Label> LOW TEMP

ECG/

Arrhythmia

ECG

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG,

Arrhythmia

VueLink

Condition Indication

The blood temperature value has fallen below the low alarm limit.

numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone

The tcpO

2

or tcpCO

2

value has exceeded the high alarm limit.

The tcpO

2

or tcpCO

2 value has fallen below the low alarm limit.

numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone

This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window.

The temperature has exceeded the high alarm limit.

The temperature has fallen below the low alarm limit.

yellow or red alarm lamp and alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone

A dominant rhythm of N, V, N, V (N = supraventricular beat, V = ventricular beat) was detected.

A fibrillatory waveform for 4 consecutive seconds was detected.

A dominant rhythm of adjacent Vs > vent rhythm limit and ventricular HR <

VTach HR limit was detected.

A dominant rhythm of N, N, V, N, N,

V (N = supraventricular beat, V = ventricular beat) was detected.

Ventricular tachycardia has been detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach

HR limit).

A yellow (**) or red (***) patient alarm is present on the VueLink module.

Check the monitor display for more detailed alarm information.

numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, red alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, red alarm lamp, alarm tone

(on monitor) yellow or red alarm lamp; the alarm text is defined by the VueLink device driver

Technical Alarm Messages (INOPs)

If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by

-?-

. If an INOP may lead to unreliable measurement values, a

?

appears next to the numeric.

The measurement labels and abbreviations for pressure, temperature, SpO

2

, and VueLink INOP messages are explained in the individual measurement chapters.

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3 Patient Alarms and INOPs

Monitor INOPs

INOP Message,

Indication

Bad Server Link

INOP tone

CENTRAL: TELE ONLY

INOP tone

Check Alarm Lamps

INOP tone

Check DrugSettings

INOP tone

!!CHECK ECG SOURCE

INOP tone

Check Flex Texts

INOP tone

Check Keyboard

INOP tone

Check Main Board 2

INOP tone

Check Monitor Func

INOP tone

Check Monitor Temp

INOP tone

Check Mouse Device

INOP tone

Check MSL Voltage

INOP tone

Check Network Conf

INOP tone

!! CHECK PAIRING

INOP tone

Check Screen Res.

INOP tone

Check Settings

INOP tone

Check SpeedPoint

INOP tone

Check Touch Input

INOP tone

What to do

1) An MMS with an incompatible software revision is connected to the monitor. This combination does not allow monitoring, OR

2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact your service personnel.

System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station.

Perform a visual check of the alarm lamp to establish whether there is a problem.

Contact your service personnel to check the internal connections to the alarm lamps.

There was a problem loading the drug settings. Check that the settings are complete and correct.

The telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and the monitor if they are no longer used for the same patient.

Check the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel.

Perform a visual and functional check of the keyboard. Contact your service personnel.

There is a problem with the second main board in the monitor. Contact your service personnel.

Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel.

The temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed. If the situation continues, contact your service personnel.

Perform a visual and functional check of the mouse input device. Contact your service personnel.

There is a problem with the voltage of the Measurement Link (MSL). Contact your service personnel.

The monitor is receiving network topology information from more than one source, e.g. the Database Server and an Application Server. Contact your service personnel.

There is a problem with device pairing. Check that the monitor and telemetry device are correctly paired.

The Screen you have selected uses a resolution which is not supported by the display.

The monitor will show a generic Screen instead until you select a different Screen.

Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.

If this INOP appears, check the monitor and patient settings before you resume monitoring. If the settings are unexpected, there may be a problem with the monitor software. Contact your service personnel.

Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel.

Perform a visual and functional check of the touch input device. Contact your service personnel.

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3 Patient Alarms and INOPs

INOP Message,

Indication

What to do

Check Waves

INOP tone

The options purchased with this monitor may not support the number of waves required to show the selected Screen, so some waves or high resolution trends are missing from the Screen. Select a different Screen with fewer waves.

Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.

CHK ECG Sync Cable

INOP tone

Chk MSL Connection

INOP tone

The ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected.

Chk IndepDsp Cable

The monitor cannot communicate with the D80 Intelligent Display. Check the MSL coupling cable. The end with the gray connector must be connected to the Intelligent

Display.

Check that the MSL cable is properly connected. If this is the case, try using another

MSL cable, to check if your cable is defective. If this does not help, the device connected via the MSL cable may be defective, contact your service personnel.

ECG EQUIP MALF T

Numeric is displayed with a

-?-

INOP tone

Internal.Comm.Malf

INOP tone

MCC Reversed

INOP tone

Contact your service personnel.

The ECG in the Telemetry device is faulty.

There is a problem with I2C Bus communication in the monitor. Contact your service personnel.

MCC Unsupported

INOP tone

An MSL coupling cable has been connected to a device which does not support MSL coupling.

Meas. DEACTIVATED

An X2 or MP5 has been connected to a host monitor (companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor.

!!MORE BED ALARMS

!!!MORE BED ALARMS at Information Center

MSL Power High

The MSL coupling cable is reversed. Connect the end with the grey connector to the

Intelligent Display.

The monitor is associated with a telemetry device and is sending data to the Information

Center via the telemetry device. There are currently more alarms at the bedside than can be transmitted to the Information Center.

The power consumption of the devices connected to the Measurement Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel.

MSL Power Off

INOP tone

The power consumption of the devices connected to the Measurement Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel.

MSL Power Overload

INOP tone

The power consumption of the devices connected to the Measurement Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off.

Contact your service personnel.

No Central Monit.

INOP tone

There is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. In case the connection is via a telemetry device, the current telemetry use model does not support central monitoring Contact your service personnel.

NO ECG AT CENTRAL

The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device.

Rem.AlarmDev.Malf.

INOP tone

There is a problem with the connection to the remote alert device. Contact your service personnel to check the remote alert device and its connections.

Settings Malfunc.

INOP tone

The monitor cannot use the predefined settings for monitoring. Contact your service personnel.

70

3 Patient Alarms and INOPs

INOP Message,

Indication

Speaker Malfunct.

SRR INTERFERENCE

INOP tone

SRR INVALID CHAN

INOP tone

SRR MALFUNCTION

What to do

Contact your service personnel to check the speaker and the connection to the speaker.

The short range radio connection has interference from another device. Try using another channel.

The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration.

Malfunction in the short range radio device. If the INOP persists contact your service personnel.

The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor.

Telemetry device not supported (companion mode)

TAAP DISABLED

INOP tone

TELE CONFIG UNSUPP

INOP tone

TELE EQUIP MALF

INOP tone

TELE INCOMPATIBLE

TELE UNSUPPORTED

INOP tone

TimeExpired:<Timer

Label>

INOP tone

Unsupported LAN

INOP tone

User I/F Malfunct.

INOP tone

The telemetry device has a malfunction. Disconnect and reconnect the telemetry device.

If the INOP reappears, replace the telemetry device.

SRR-enabled telemetry device is not supported by this central software revision. Please check configuration.

This telemetry device is not supported for direct connection to the monitor.

The time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP.

There is a problem with the communication to the network and central monitoring is currently not possible. Check the connection. If the INOP persists, switch off the monitor and contact your service personnel.

Perform a visual and functional check of all the monitor input devices. Contact your service personnel.

71

3 Patient Alarms and INOPs

Battery INOPs

INOP Message,

Indication

Batt EMPTY

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off.

Batt INCOMPAT.

INOP tone

Batt LOW

INOP tone

Batt MALFUNCTION

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.

BATTERIES EMPTY

Batt 1 EMPTY

Batt 2 EMPTY

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off.

BATTERIES INCOMPAT

Batt 1 INCOMPAT.

Batt 2 INCOMPAT.

INOP tone

BATTERIES LOW

Batt 1 LOW

Batt 2 LOW

INOP tone

BATTERIES MALFUNC.

Batt 1 MALFUNCTION

Batt 2 MALFUNCTION

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.

Batt 1 MISSING

Batt 2 MISSING

INOP tone

During this INOP, alarms cannot be paused or switched off.

What to do

The estimated remaining battery-powered operating time is less than 10 minutes.

Replace the battery immediately.

If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.

The battery cannot be used with this monitor. Replace with the correct battery

(M4607A).

The estimated battery-powered operating time remaining is less than 20 minutes.

The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.

Place the battery in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.

The estimated remaining battery-powered operating time of the indicated battery or batteries is less than 10 minutes. Replace the batteries immediately.

If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.

The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book.

The estimated battery-powered operating time remaining is less than 20 minutes.

The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.

Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.

The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately.

72

3 Patient Alarms and INOPs

INOP Message,

Indication

What to do

BATT EXTENSN MALF

INOP tone

Charge Batt 1 Now

Charge Batt 2 Now

INOP tone

There is a hardware error in the Battery Extension. Contact your service personnel.

Battery must be charged. Connect the monitor to mains power or exchange the battery.

CHARGER MALFUNC.

INOP tone, battery LED may flash

CHECK BATT TEMP

INOP tone

There is a problem with the battery charger in the monitor. Connect the monitor to mains power and contact your service personnel.

The temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat.

Chk MSL Connection

Check the MSL connection between X2/MP2 and the battery extension for damage or loose connections. Check also if a second X1 or X2 has been connected accidentally (e.g. in companion mode).

ExtBat EMPTY

The estimated battery-powered operating remaining time is less than 10 minutes.

Replace the battery in the battery extension immediately.

ExtBat INCOMPAT.

ExtBat LOW

The battery in the battery extension cannot be used.

The estimated battery-powered operating time remaining is less than 20 minutes.

ExtBat MALFUNCTION The monitor cannot determine the status of the battery in the battery extension. If this

INOP persists, replace the faulty battery in the battery extension. If the condition persists and the monitor is not connected to mains power or a host monitor, this INOP is re-issued two minutes after you acknowledge it.

ExtBat MISSING

!!INSERT BATTERY

Severe yellow INOP tone

During this INOP, alarms cannot be paused or switched off.

MSL Power High

There is no battery in the Battery Extension

X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on AC mains while the battery compartment is open (not sealed with a battery).

Load a battery immediately.

The power consumption of the devices connected to the Battery Extension is too high.

If this situation continues, the Battery Extension will be switched off. Contact your service personnel.

MSL Power Off

The power consumption of the devices connected to the Battery Extension was too high for too long.The Battery Extension has been switched off. Contact your service personnel

MMS, MMS Extensions and FMS INOPs

INOP Message,

Indication

MMS

MEASSRV

UNSUPPORTD

INOP tone

MMS UNPLUGGED

INOP tone

MMS UNSUPPORTED

INOP tone

What to do

The Multi-Measurement module is not supported by the monitor. Contact your service personnel.

Make sure that the Multi-Measurement Module is connected to the monitor. All MMS measurements are off while the MMS is unplugged.

The Multi-measurement Module is not supported by your monitor. Contact your service personnel.

73

3 Patient Alarms and INOPs

INOP Message,

Indication

NO PPV FROM MMS

What to do

The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.

MMS Extension

MMS Ext.EQUIP MALF

INOP tone

MMS Ext. UNPLUGGED

INOP tone

MMS Ext. Unpowered

INOP tone

MMSExt.Unsupported

INOP tone

FMS

FMS UNPLUGGED

INOP tone

FMS UNSUPPORTED

INOP tone

NO PPV FROM FMS

Loss of communication between the Multi-Measurement Module and the MMS extension. Contact your service personnel.

The MMS extension has been disconnected from the Multi-Measurement Module.

The MMS extension cannot operate while the Multi-Measurement Module is running on battery power.

The MMS extensions not supported by your monitor. Contact your service personnel.

Make sure that the Flexible Module Rack is connected to the monitor. All FMS measurements are off while the FMS is unplugged.

The Flexible Module Rack is not supported by your monitor. Contact your service personnel.

The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.

Display INOPs

INOP Message,

Indication

Indep.Dsp Malfunc.

Indep.Dsp NotSupp.

Intell.Dsp Malf.

Intell.Dsp Missing

Intell.Dsp Unsupp.

What to do

There is a problem with the Independent Display. Check the MSL coupling cable then contact your service personnel.

The monitor does not support a second main display. The monitor software is incompatible. Contact your service personnel.

There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your service personnel.

The monitor has lost contact with the connected Intelligent Display. Contact your service personnel.

The monitor does not support the connected Intelligent Display. The monitor software is incompatible.

74

3 Patient Alarms and INOPs

ECG, Arrhythmia, QT and ST INOPs

INOP Message,

Indication

What to do

Arrhythmia

CANNOT ANALYZE

ECG

The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.

If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off.

!!ECG/AR ALARM OFF All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume

ECG alarm generation, switch ECG alarms on or select ECG as the alarm source.

SOME ECG ALRMS OFF This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile.

ECG

CANNOT ANALYZE

ECG

C LEAD OFF

HR Numeric is replaced by

-?- for 10 seconds.

INOP tone

ECG/ARRH ALARM

OFF

!!ECG/AR ALARM OFF

ECG EQUIP MALF

Numeric is displayed with a

-?-

INOP tone

<ECG Lead> LEAD

OFF

!! <ECG Lead> LEAD

OFF

!!! <ECG Lead> LEAD

OFF

Numeric is displayed with a

-?-

INOP tone

ECG EL. NOISY <ECG

Lead>

ECG LEADS OFF

!! ECG LEADS OFF

!!!ECG LEADS OFF

The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.

If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off.

The C electrode (AAMI: V electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select

ECG menu to confirm the new lead set.

New Lead Setup in the Setup

All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume

ECG alarm generation, switch ECG alarms on or select ECG as the alarm source.

Contact your service personnel.

The ECG hardware is faulty.

Not all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by <ECG lead> [RA, LA, LL,

RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected.

The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy.

Check the ECG connections and make sure that the electrode indicated is attached.

Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced.

75

3 Patient Alarms and INOPs

INOP Message,

Indication

ECG NOISY SIGNAL

INOP tone

EcgOut EQUIP MALF

INOP tone

LA LEAD OFF

Numeric is replaced by -?for 10 seconds.

INOP tone

LL LEAD OFF

Numeric is replaced by -?for 10 seconds.

INOP tone

RA LEAD OFF

Numeric is replaced by -?-

INOP tone

RL LEAD OFF

Numeric is replaced by -?for 10 seconds.

INOP tone

V LEAD OFF

Numeric is replaced by -?for 10 seconds.

INOP tone

What to do

The ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient.

The ECG signal may be saturated or overloaded.

There is a problem with the device connected to the ECGOut connector. Contact your service personnel.

The LA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New Lead Setup in the Setup ECG menu to confirm the new lead set.

The LL electrode has become detached from the patient or the lead set has been changed.

Reattach the electrode or select the new lead set.

New Lead Setup in the Setup ECG menu to confirm

The RA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select to confirm the new lead set.

The RL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New Lead Setup in the Setup ECG menu to confirm the new lead set.

New Lead Setup in the Setup ECG menu

The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select

ECG menu to confirm the new lead set.

New Lead Setup in the Setup

ST

CANNOT ANALYZE ST The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the

ECG signal quality and the ST measurement points.

If the patient has a ventricular pacemaker, ST analysis is not possible.

QT

CANNOT ANALYZE QT The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase.

Pulse INOPs

INOP Message,

Indication

PULSE NO ALARMING

Numeric is replaced by -?-

INOP tone

What to do

Pulse has no alarming because the system pulse is measured by an external device. Select another pulse source to enable pulse alarming.

76

3 Patient Alarms and INOPs

Resp INOPs

INOP Message,

Indication

Resp EQUIP MALF

Numeric is replaced by -?-

INOP tone

Resp ERRATIC

Numeric is replaced by -?-

Resp LEADS OFF

Numeric is replaced by -?-

INOP tone

What to do

Contact your service personnel. The RESP hardware is faulty.

The monitor has detected too many artifacts in the measured Resp signal. Check that the

RA and LL electrodes are correctly attached and have not dried out.

Not all the required leads for Resp monitoring are attached. Make sure that the RA and

LL leads are attached.

NBP INOPs

INOP Message,

Indication

!! CUFF NOT DEFLAT

!!!CUFF NOT DEFLAT

Numeric is displayed with a

-?-

Severe yellow/red INOP tone

During this INOP, alarms cannot be paused or switched off.

!! CUFF OVERPRESS

!!!CUFF OVERPRESS

Numeric displayed with -?-

Severe yellow/red INOP tone

During this INOP, alarms cannot be paused or switched off.

What to do

Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try repeating the measurement.

You can silence the INOP, but the INOP message remains visible until the next NBP measurement is started or the

Stop All SmartKey is selected.

[Adult or pediatric patients: The NBP cuff pressure has exceeded 15 mmHg (2kPa) for more than 3 minutes.

Neonatal patients: The NBP cuff pressure has exceeded 5mmHg (0.7kPa) for more than

90 seconds.]

The NBP cuff pressure exceeds the overpressure safety limits. Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try restarting the measurement.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the

Stop All SmartKey is selected.

77

3 Patient Alarms and INOPs

INOP Message,

Indication

NBP DEACTIVATED

INOP tone

NBP EQUIP MALF

Numeric is replaced by -?-

INOP tone

NBP INTERRUPTED

Numeric is replaced by -?-

INOP tone

NBP MEASURE FAILED

Numeric may be displayed with a -?-

INOP tone

What to do

The NBP measurement label in the measurement device has been deactivated by deactivating the label in the

Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the

Measurement Selection window.

Remove the cuff from the patient. The NBP hardware is faulty. Contact your service personnel.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the

Stop All SmartKey is selected.

Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement.

If the INOP occurs repeatedly, contact your service personnel.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the

Stop All SmartKey is selected.

This INOP arises when the measurement needed longer than the maximum time for inflation, deflation or the total measurement.

Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the

Stop All SmartKey is selected.

Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue measuring.

Temperature INOPs

INOP Message,

Indication

T1, T2, T3, T4 INOPs

Tamb INOPs

Tart INOPs

Tcereb INOPs

Tcore INOPs

<Temp Label>

DEACTIVATED

INOP tone

What to do

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

A Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either reconnect a Temp transducer or reactivate the measurement label in the

Measurement Selection window.

Contact your service personnel.

The temperature hardware is faulty.

<Temp Label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone

<Temp Label> NO

TRANSDUC

Numeric is replaced by -?-

INOP tone

Make sure the TEMP probe is connected to the MMS or module.

If you silence this INOP, the measurement will be switched off.

78

3 Patient Alarms and INOPs

INOP Message,

Indication

<Temp Label>

UNPLUGGED

INOP tone

What to do

A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in the

Measurement Selection window.

Try changing the application site of the transducer.

[The temperature is less than -1°C, or greater than 45°C.]

<Temp Label>

OVERRANGE

Numeric is replaced by -?-

INOP tone

Tesoph INOPs

Tnaso INOPs

Trect INOPs

Tskin INOPs

Ttymp INOPs

Tven INOPs

Tvesic INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

See

<Temp Label> INOPs

SpO2 INOPs

INOP Message,

Indication

<SpO₂ Label>

DEACTIVATED

INOP tone

<SpO₂ Label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone

<SpO₂ Label>

ERRATIC

Numeric is replaced by -?-

INOP tone

<SpO₂ Label>

EXTD.UPDATE

Label is displayed with a -?-

(questionable numeric)

<SpO₂ Label>

INTERFERNCE

Numeric is replaced by -?-

INOP tone

<SpO₂ Label> LOW

PERF

Label is displayed with a -?-

(questionable numeric)

What to do

The SpO

2

measurement label in the measurement device has been deactivated by deactivating the label in the

Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the

Measurement Selection window.

The MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel.

Check the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.

The update period of displayed values is extended due to an NBP measurement on the same limb or an excessively noisy signal.

There is too much interference, caused by a high level of ambient light and/or electrical interference. Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is not damaged or positioned too close to power cables.

Accuracy may be compromised due to very low perfusion. Stimulate circulation at sensor site. If INOP persists, change the measurement site.

79

3 Patient Alarms and INOPs

INOP Message,

Indication

What to do

<SpO₂ Label> NOISY

SIGN.

Numeric is replaced by -?-

INOP tone

<SpO₂ Label> NON-

PULSAT.

Numeric is replaced by -?-

INOP tone

<SpO₂ Label> NO

SENSOR

Numeric is replaced by -?-

INOP tone

<SpO₂ Label> POOR

SIGNAL

Label is displayed with a -?-

(questionable numeric)

<SpO₂ Label> PULSE?

Numeric is replaced by -?-

INOP tone

<SpO₂ Label>

SEARCHING

Numeric unavailable

<SpO₂ Label> SENSOR

MALF

Numeric is replaced by -?-

INOP tone

<SpO₂ Label> SENSOR

OFF

Numeric is replaced by -?-

INOP tone

<SpO₂ Label>

UNKN.SENSOR

Numeric is replaced by a -?-

<SpO₂ Label>

UNPLUGGED

Numeric is replaced by -?-

INOP tone

<SpO₂ Label>

UPGRADE

Label is displayed with a -?-

Numeric is unavailable

Excessive patient movement or electrical interference is causing irregular pulse patterns.

Try to reduce patient movement or to relieve the cable strain on the sensor.

Check the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is finished.

Make sure the SpO

2

sensor is connected. If the INOP persists, try another adapter cable and sensor. If you silence this INOP, the measurement will be switched off.

The signal condition of the SpO

2 be compromised.

measurement is poor and measurement accuracy may

The detectable pulsations of the SpO

2

signal are outside the specified pulse rate range.

SpO

2

is analyzing the patient signal to derive Pulse, SpO

2

and Perf values. Please wait until the search analysis is complete.

The SpO

2

sensor or adapter cable is faulty. Try another adapter cable and sensor. If the

INOP persists, contact your service personnel.

The SpO

2

sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer.

The connected sensor or adapter cable is not supported by the SpO only specified sensors and cables.

2

measurement. Use

An SpO

2

measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in the

Measurement Selection window.

The SpO

2 mode.

measurement is currently in upgrade mode. Monitoring is not possible in this

80

3 Patient Alarms and INOPs

Pressure INOPs

INOP Message,

Indication

ABP INOPs

Ao INOPs

ART INOPs

BAP INOPs

CVP INOPs

CPP CHK SOURCES

Numeric is replaced by a -?-

INOP tone

CPP CHK UNITS

Numeric is replaced by a -?-

FAP INOPs

IC1 / IC2 INOPs

ICP INOPs

LAP INOPs

P / P1 / P2 / P3 / P4

INOPs

PAP INOPs

PPV BAD <Press

Label> SIGNAL

PPV BAD SIGNAL at Information Center

PPV CHK SOURCES

What to do

See

See

<Press Label> INOPs

See

<Press Label> INOPs

See

See

<Press Label> INOPs

<Press Label> INOPs

<Press Label> INOPs

Not all measurements or values required to perform the calculation are available. Check the measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

See

<Press Label> INOPs

See

<Press Label> INOPs

See

<Press Label> INOPs

See

<Press Label> INOPs

See

<Press Label> INOPs

See

<Press Label> INOPs

The arterial pressure source selected for PPV is not providing a pulsatile signal.

The arterial pressure source selected for PPV is not providing a pulsatile signal.

<Press Label>

ARTIFACT

Numeric questionable

<Press Label>

DEACTIVATED

INOP tone

The arterial pressure source selected for PPV is unplugged or switched off. When this

INOP has displayed for 1 minute PPV will be switched off.

A non-physiological event (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile INOP will be suppressed.

A Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

<Press Label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone

<Press Label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone

<Press Label> NOISY

SIGNAL

Pulse numeric is replaced by

-?-

INOP tone

To switch the measurement on again, either reconnect a Pressure transducer or reactivate the measurement label in the

Measurement Selection window.

Contact your service personnel.

The pressure hardware is faulty.

Make sure that the pressure transducer is connected to the measurement device or module.

If you silence this INOP, the measurement will be switched off.

This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse detector finds a pulse rate above 350bpm. This is usually caused by movement artifact or electrical interference.

81

3 Patient Alarms and INOPs

INOP Message,

Indication

What to do

<Press Label> NON-

PULSATILE

Pulse numeric is replaced by

-?-

INOP tone

<Press Label>

OVERRANGE

Numeric is replaced by -?-

INOP tone

<Press Label>

REDUCE SIZE

<Press Label>

UNPLUGGED

INOP tone

This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate being measured is less than 25 beats per minute or the amplitude is less than three mmHg.

Check the catheter and connections to the patient.

Make sure that the measurement has been properly prepared and zeroed, and that the transducer is level with the heart. If this INOP persists, try another transducer.

Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the transducer.

Increase the scale for the pressure wave.

A Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in the

Measurement Selection window.

Perform a zero and check the calibration of the transducer.

<Press Label>

ZERO+CHECK CAL

Numeric is replaced by -?-

RAP INOPs

UAP INOPs

UVP INOPs

See

See

See

<Press Label> INOPs

<Press Label> INOPs

<Press Label> INOPs

CO2 INOPs

INOP Message,

Indication

CO₂ AUTO ZERO

Numeric is replaced by a -?if the Autozero lasts >15 sec, INOP tone sounds.

CO₂ CAL MODE

CO

2

numeric displays current CO

2

value for accuracy check

CO2 CAL RUNNING

Numeric is replaced by a -?-

CO₂CHANGE SCALE

What to do

The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO

2

values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring.

Currently no calibration is running. Accuracy can be checked by placing the transducer on the two cells of the calstick and starting calibration. To start monitoring, leave

Cal. Mode.

Wait until calibration is finished.

CO₂ CHK ADAPTER

Numeric is replaced by a -?-

INOP tone

CO₂ CHECK CAL

Numeric is replaced by a -?-

INOP tone

The CO

2 wave.

wave is clipped. Select a more appropriate wave scale to display the whole

Check that the sensor is connected to the airway adapter, clean the airway adapter, if necessary. Perform a zero calibration. If the INOP persists, contact your service personnel.

The CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer.

82

3 Patient Alarms and INOPs

INOP Message,

Indication

What to do

CO₂ DEACTIVATED

INOP tone

CO₂ EQUIP MALF

Numeric is replaced by -?-

INOP tone

The CO2 measurement label in the measurement device has been deactivated by deactivating the label in the

Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the

Measurement Selection window.

The Measurement Extension is faulty. Unplug and replug the Multi-Measurement

Module with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel.

CO₂ FAILED CAL

Numeric is replaced by -?-

INOP tone

CO₂ NO SENSOR

Numeric is replaced by -?-

INOP tone

CO₂ NO TRANSDUC

Numeric is replaced by -?-

INOP tone

CO₂ NO TUBING

Numeric is replaced by -?-

INOP tone

!! CO₂ OCCLUSION

!!! CO₂ OCCLUSION

Numeric is replaced by a -?-

INOP tone

CO₂ OVERRANGE

Numeric is replaced by -?-

INOP tone

CO₂ PUMP OFF

Numeric is replaced by a -?-.

CO₂ PURGING

Numeric is replaced by a -?-

INOP tone

CO₂ SENS.WARMUP

Numeric is displayed with a

-?-

Microstream CO2: INOP tone

Mainstream CO2: no INOP tone

CO₂ UPDATE FW

Numeric is replaced by a -?-

INOP tone

Make sure that the Cal cell was changed between CAL1 and CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel.

There is no CO

2 be switched off.

There is no CO

2

sensor connected. If you silence this INOP the CO

2

measurement will

transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 measurement will be switched off.

Either the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories).

If you silence this INOP, the measurement will be switched off.

The sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line.

The CO

2

value is higher than the measurement range. If you suspect a false high value, contact your service personnel.

The pump has been switched off for fifteen minutes. To switch it on again, select

Pump

On in the Setup CO₂ menu.

The Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is removed, the INOP will disappear. If not, the INOP

CO₂ OCCLUSION is displayed.

Wait until the sensor reaches operating temperature and the INOP disappears.

The software in the Measurement Extension does not match the software in the MMS.

Contact your service personnel.

83

3 Patient Alarms and INOPs

INOP Message,

Indication

CO₂ WAIT CAL2

Numeric is replaced by a -?-

CO₂ ZERO FAILED

Numeric is replaced by a -?-

INOP tone

CO₂ ZERO REQU'D

Numeric is replaced by a -?-

INOP tone

CO₂ZERO RUNNING

What to do

Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle.

An error occurred during the last zero calibration. Check the airway adapter and clean, if necessary. Perform another zero calibration. If the INOP persists, contact your service personnel.

Perform zero calibration for the CO2 sensor. If the INOP persists, contact your service personnel.

Wait until zero calibration is finished.

SO2 INOPs

INOP Message,

Indication

What to do

<SO₂ Label> CAL

FAILED

Numeric is replaced by -?-

INOP tone

<SO₂ Label> CAL

MODE

Numeric is replaced by -?-

INOP tone

<SO₂ Label>CAL

REQUIRED

Numeric is replaced by -?-

INOP tone

<SO₂ Label> CANNOT

MEAS

Numeric is replaced by -?-

INOP tone

<SO₂ Label>CONFIG

ERROR

Numeric is replaced by -?-

INOP tone

<SO₂ Label> CONN

OPTMOD

Numeric is replaced by -?-

INOP tone

<SO₂ Label> EQUIP

MALF

Numeric displays -?-

INOP tone

<SO₂ Label>

INCOMPAT.

INOP tone

The calibration failed. Check the catheter-to-Optical-Module connection. Manually restart the calibration. Try another catheter and Optical Module. If the catheter is already inserted, perform an in-vivo calibration.

Pre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The catheter is now ready for insertion.

There is no valid calibration data in the Optical Module. Perform either a pre-insertion or an in-vivo calibration.

The signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter.

The Optical Module has been configured to SaO

2

Mode. Use

Change to Venous in the setup menu to reconfigure to venous saturation mode.

The Optical Module was disconnected during data storage. Reconnect the Optical

Module for at least 20 seconds.

The SO

2

/SvO

2

Module or Optical Module is faulty. Unplug and replug the Optical

Module and SO

2

/SvO your service personnel.

2

module. Exchange the modules. If the INOP persists, contact

The SO

2

Module or Optical Module is not supported. Contact your service personnel.

84

3 Patient Alarms and INOPs

INOP Message,

Indication

What to do

<SO₂ Label> IN-VIVO

CAL

<SO₂ Label>LIGHT

INTENS

Numeric is replaced by -?-

INOP tone

<SO₂ Label> LOW

LIGHT

Numeric is replaced by -?-

INOP tone

<SO₂ Label> NO

OPTMOD

Numeric is replaced by -?-

INOP tone

<SO₂ Label> OPTMOD

MALF

The in-vivo calibration is not yet complete. Lab values must be stored to the Optical

Module to complete the calibration. Either continue with the next steps of the current calibration or recall the previous calibration.

The intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the catheter (and perform a Light Intensity Calibration).

The optical signal levels are too low. Check that the catheter is either in the optical reference or inserted into the patient. Check the catheter-to-Optical Module connection.

If INOP persists, try another catheter and Optical Module.

Connect the Optical Module. If the INOP persists, try another Optical Module.

Silencing this INOP switches the measurement off.

The Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this capability is needed, use another Optical

Module.

<SO₂ Label> PRE-INS

CAL

Numeric displays -?-

INOP tone

<SO₂ Label>

UNPLUGGED

Numeric displays -?-

INOP tone

<SO₂ Label> UPGRADE

INOP tone

The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete.

Measurement switched on and SO

2

/SvO

2

module unplugged from the rack.

The SO

2

module is currently in upgrade mode.

Monitoring is not possible in this mode.

<SO₂ Label> WARMUP

Numeric is displayed with ?

The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished.

C.O. INOPs

INOP Message,

Indication

CCI NO BSA

CCI numeric unavailable

INOP tone

CCO BAD PRESS SIGN numeric is replaced by -?-

INOP tone

CCO NO <Press

Label> numeric is replaced by -?-

INOP tone may sound

CCO NO CALIBRATION numeric is replaced by -?-

What to do

CCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight and height to provide the BSA for CCI calculation.

The arterial pressure wave can currently not be used for pulse contour calculation for

CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia.

CCO/CCI cannot be calculated. Make sure that the pressure chosen in the

Setup CCO menu under

CCO From matches the pressure measured with the arterial catheter for

CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP.

The CCO measurement is currently not calibrated.

85

3 Patient Alarms and INOPs

INOP Message,

Indication

CCO NO PRESS at Information Center

What to do

CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for

CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP.

CCO NOT SUPPORTED numeric is replaced by -?-

INOP tone

CCO OVERRANGE

CCI OVERRANGE numeric is replaced by -?-

INOP tone

CCO <Press Label>

INVALID numeric is replaced by -?-

INOP tone may sound

CCO PRESS INVALID at Information Center

A catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right Heart C.O. catheter, or the measurement mode has been changed manually.

Silencing this INOP switches the measurement off.

The measured CCO or CCI value is not within the specified range for CCO/CCI measurement.

The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.

CCO PRESS OVERRANG numeric is replaced by -?-

INOP tone

CCO PULSE OVERRANG numeric is replaced by -?-

INOP tone

CCO/Tbl NO TRANSD.

Numeric is replaced by -?-

INOP tone

CCO RECALIBRATE numeric is replaced by -?-

C.O. DEACTIVATED

INOP tone

The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.

The mean value of the arterial pressure values used for pulse contour calculation for

CCO is below 0 mmHg or above 300 mmHg.

The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm.

No transducer attached to the module or catheter disconnected.

The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. You should recalibrate CCO or CCI with transpulmonary

C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed. The pressure measurement must be zeroed before a CCO calibration.

The Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the

Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the

Measurement Selection window.

There is a problem with the C.O. hardware. Contact your service personnel.

C.O. EQUIP MALF

Numeric is replaced by a -?-

INOP tone

C.O. UNPLUGGED numeric is replaced by -?-

INOP tone

Tblood NO TRANSDUC

Numeric is replaced by -?-

INOP tone

Tblood OVERRANGE

Numeric is replaced by -?-

Plug in the C.O. module. Silencing this INOP switches off the measurement.

No transducer attached to the module or catheter disconnected.

Tblood out of range 17°C - 43°C.

86

3 Patient Alarms and INOPs

tcGas INOPs

INOP Message,

Indication

What to do

<tcGas Label> CAL

FAILED

Numeric is replaced by -?-

INOP tone

<tcGas Label> CAL

REQUIRD

Numeric is replaced by -?-

INOP tone

A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration has failed more than once, remembrane the transducer and restart the calibration. If this INOP persists, contact your service personnel.

Calibration is required before applying the transducer to the patient.

Insert a membraned transducer into the calibration chamber on the module, connect the calibration unit to the calibration chamber, open the gas valve and start the calibration. If this INOP occurs during a calibration, there may be a module or transducer malfunction: contact your service personnel.

Wait until the tcpO

2

/tcpCO

2

calibration is finished.

<tcGas Label> CAL

RUNNING

Numeric displays first -?-, then numeric is displayed with a ?

<tcGas Label> CHECK

TIME

<tcGas Label>

CHANGE SITE

If

Heat Switch Off is configured to

Yes, numeric is replaced by -?-

INOP tone

<tcGas Label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone

<tcGas Label> NO

TRANSDUC

Numeric is replaced by -?-

INOP tone

<tcGas Label>

STABILIZING

Numeric is displayed with a

?

<tcGas Label>

UNPLUGGED

Numeric is replaced by -?-

INOP tone

Site Timer due to time out in 15 minutes or less.

Site Timer has timed out. Change the application site to avoid skin burns. To reset the

Site Timer, either calibrate and change the measurement site, or change the measurement site and reset the Site Timer manually by selecting the appropriate site time from the

Setup tcGas menu.

There is a malfunction in the transducer or module. Connect another transducer. If this

INOP persists, contact your service personnel.

No transducer is connected to the tcpO

2 off the measurement.

/tcpCO

2

module. Silencing the alarm switches

The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes.

The measurement is switched on but the module is unplugged.

The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.

87

3 Patient Alarms and INOPs

EEG INOPs

INOP Message,

Indication

EEG EQUIP MALF

INOP tone

EEG IMPEDANCE HIGH

EEG1 IMPED. HIGH

EEG2 IMPED. HIGH

What to do

The EEG hardware is faulty. Contact your service personnel.

The signal electrode in one or both channels exceeds the user-selected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines. If the INOP persists, contact your service personnel.

Reconnect specified electrode.

EEG1 LEAD OFF <n>

EEG2 LEAD OFF <n>

[n = electrode]

EEG1 LEAD OFF

EEG2 LEAD OFF at Information Center

EEG1 LEADS OFF

EEG2 LEADS OFF

EEG LINE NOISE

EEG1 LINE NOISE

EEG2 LINE NOISE

EEG MUSCLE NOISE

EEG1MUSCLE NOISE

EEG2MUSCLE NOISE

EEG NO TRANSDUC

INOP tone

EEG UNPLUGGED

INOP tone

EEG1 OVERRANGE

EEG2 OVERRANGE

One or more electrodes are not connected. Check in the

EEG Impedance /

Montage window on the monitor which electrode(s) are affected and reconnect the electrodes.

Two or more electrodes are not connected. Check in the

EEG Impedance /

Montage window which electrodes are affected and reconnect the electrodes.

Excessive line noise has been detected in either channel EEG1 or EEG2, or in both

EEG channels.

Keep all cables together and away from metallic bodies, other cables & radiated fields.

Too much power above 30 Hz has been detected in channel EEG1 or EEG2, or both.

Check the Electrode-to-Skin Impedance and reposition the electrode away from possible muscle activity, if necessary.

The trunk cable is disconnected from the EEG plug-in module. Reconnect the trunk cable. Silencing this INOP switches the measurement off.

Plug in module. Silencing this INOP switches off the measurement.

Input signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electrosurgery. X denotes the EEG channel.

BIS INOPs

INOP Message,

Indication

BIS CABLE INCOMPAT

INOP tone

BIS CABLE USAGE

INOP tone

BIS DSC DISCONN

INOP tone

BIS DSC INCOMPT

INOP tone

What to do

The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philips-supported sensor cable.

The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.

DSC is not properly connected OR either DSC or BIS engine may be faulty.

Make sure that the DSC is properly connected to the BIS Engine. If INOP persists, replace DSC with a known good one of the same type.

If INOP persists replace BIS engine.

Silencing this INOP switches the measurement off.

DSC is not supported by the BIS engine or new DSC connected to an old BIS engine. A software upgrade may be required. Contact your service personnel.

88

3 Patient Alarms and INOPs

INOP Message,

Indication

BIS DSC MALFUNC

What to do

BIS DSC UPDATE

INOP tone

BIS ELECTR. DISC.

INOP tone

BIS ENGINE DISCONN

INOP tone

BIS ENGINE INCOMPT

INOP tone

BIS ENGINE MALFUNC

INOP tone

BIS EQUIP MALF

INOP tone

BIS HIGH IMPEDANCE

INOP tone may sound

BIS IMPEDANCE CHCK

INOP tone may sound

BIS ISOELECTRC EEG

BIS LEAD OFF

INOP tone may sound

BIS OVERCURRENT

INOP tone

BIS SENSOR DISCONN

INOP tone

BIS SENSOR INCOMPT

INOP tone

BIS SENSOR MALFUNC

INOP tone

Electrocautery used during self-test OR malfunction in the DSC hardware.

Make sure not to use electrocautery during the self-test procedure. Disconnect and reconnect the DSC to the BIS engine. If the INOP persists, replace the DSC or contact your service personnel.

DSC update currently being carried out. This INOP will disappear when the DSC update is finished. Do not disconnect the DSC during the update. No action is needed.

One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections.

BIS engine not connected OR Module Cable defective.

Make sure that the Module Cable is properly connected. If INOP persists, replace the

Module Cable.

Silencing this INOP switches the measurement off.

BIS engine software is not supported. A software upgrade may be required. Contact your service personnel.

MP20/30 - BIS engine not supported.

Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine.

There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the

INOP persists, contact your service personnel.

Impedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question using correct skin preparation.

If INOP persists, contact your service personnel.

The Cyclic Impedance check is running. It will stop automatically if all impedances are within the valid range. If any electrodes do not pass the impedance test, check the sensor montage and press the electrode pads firmly.

To manually stop the Cyclic Impedance Check, select

Cyclic Check off in the Setup

BIS menu.

No discernible EEG activity is detected for longer than one minute.

Check the patient. Check that the electrodes are properly connected.

One or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly.

If this INOP persists, replace the sensor(s) in question, using correct skin preparation.

Unplug and replug the BIS module or, f or the MP20/MP30, disconnect and reconnect the BISx from the Interface board. If the INOP persists, contact your service personnel.

The sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty.

Check all the connections.

Disconnect and reconnect the sensor, PIC, DSC, BISx.

If the INOP persists, replace the sensor.

If the INOP persists, replace PIC. If INOP persists, contact your service personnel.

Silencing this INOP switches the measurement off.

Unsupported sensor connected or sensor type unknown or not supported by your software revision. Replace the sensor, using only Philips supported sensors.

Malfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR patient interface cable (PIC) or DSC or BISx may be faulty.

Replace the sensor. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure that the both sides of the PIC connector (between PIC and sensor) are dry. If you are not sure that the connector is dry, replace the PIC until it has dried. If this INOP persists, contact your service personnel.

89

3 Patient Alarms and INOPs

INOP Message,

Indication

BIS SENSOR USAGE

INOP tone

BIS SQI < 15% (INOP tone)

OR

BIS SQI < 50%(no INOP tone)

What to do

Excessive sensor usage. Replace sensor.

A Cyclic Impedance Check will start automatically.

If the signal quality is below 50%, BIS numerics cannot be reliably derived.

If the signal quality is below 15%, no BIS numerics can be derived.

This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices. Make sure the sensor is properly attached to the patient. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure the patient is completely relaxed (even small motions of the facial muscles affect the signal quality).

Plug in the BIS module. Silencing this INOP switches off the measurement.

BIS UNPLUGGED

INOP tone

BISx DISCONNECTED

INOP tone

BISx INCOMPATIBLE

INOP tone

BISx MALFUNCTION

INOP tone

The BISx is not connected to the BIS module or the BIS interface board. Silencing this

INOP switches the measurement off.

The BISx software is not compatible with the BIS module or with the MP20/MP30 monitor software. A software upgrade may be required. Contact your service personnel.

The BISx is faulty. Disconnect and reconnect it to the module or BIS interface board. If the INOP persists, replace the BISx.

MP20/MP30 - Malfunction on interface board. If the INOP persists, contact your service personnel.

Spirometry INOPs

INOP Message, Indication

AWFCHANGE SCALE

AWPCHANGE SCALE

AWVCHANGE SCALE

SPIRO MALFUNCTION

SPIRO INCOMPATIBLE

SPIRO UPGRADE

SPIRO CANNOT MEAS

SPIRO PURGE FAILED

SPIRO UNKN. SENSOR

SPIRO ALARMS SUPPR

SPIRO PURGING

Source

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

Spirometry

What to do

Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave.

Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave

Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave.

Module failure detected. Contact your service personnel.

Module revision not compatible with the host monitor software revision. Contact your service personnel.

The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring.

Measurement is at its limit, e.g. ambient pressure out of range.

The purge operation could not be completed successfully.

Check for kinked sensor tubings, hard occlusions and make sure that the pump is running and all valves are switching.

An unknown sensor ID code was detected. Use only the

sensors listed in the “Accessories” on page 373 chapter.

Alarming is suppressed for the spirometry module.

A purge operation is in progress - no data update on the screen. Wait until purge is complete.

90

INOP Message, Indication

SPIRO NO SENSOR

SPIRO NO BREATH

SPIRO GAS COMPENS?

SPIRO PATIENT CAT.

3 Patient Alarms and INOPs

Source

Spirometry

Spirometry

Spirometry

Spirometry

What to do

No sensor detected. Make sure the correct sensor is attached to the breathing circuit.

No breath was detected for more than 25 seconds. Breath derived numerics are not available.

Gas compensation is set to

Gas Analyzer but not all gases necessary for compensation are measured by a gas monitor.

Some of the fall-back values provided by the user are used.

Measurement accuracy might be reduced.

Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions

on selecting the correct sensor in the “Spirometry” on page 426 chapter.

VueLink INOPs

INOP Message,

Indication

What to do

VueLink ALARM at Information Center

<VueLink Option>

CHK CABLE

INOP tone

<VueLink Option>

CHK CONF.

INOP tone

A technical alarm is present on the VueLink module. The INOP text on the monitor is defined by the VueLink device driver.

No cable or the wrong cable connected to the VueLink module, or incorrect device selected. Silencing this INOP switches the measurement off.

VueLink INOP abbreviations may differ slightly depending on the device category.

The wrong external device has been selected on the VueLink module, or the external device has not been correctly setup, or the wrong cable has been used to connect the device to the VueLink module.

VueLink INOP abbreviations may differ slightly depending on the device category.

<VueLink Option>

CHECK SETUP

INOP tone

<VueLink Option>

EQUIP MALF

INOP tone

<VueLink Option> NO

CONFIG

INOP tone

No information was received from the external device. The device may be switched off or disconnected.

VueLink INOP abbreviations may differ slightly depending on the device category.

Malfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.

VueLink INOP abbreviations may differ slightly depending on the device category.

The VueLink module has not been configured during installation. The installation process should be completed by either your biomedical engineering department or the

Philips service engineer.

VueLink INOP abbreviations may differ slightly depending on the device category.

<VueLink Option>

UNPLUGGED

INOP tone

The VueLink module has been unplugged from the rack, or the whole rack has been disconnected. The measurement automatically disappears from the display. Silencing this

INOP switches off the measurement.

VueLink INOP abbreviations may differ slightly depending on the device category.

91

3 Patient Alarms and INOPs

IntelliBridge INOPs

INOP Message,

Indication

DEVICE CHECK SETUP

INOP tone

What to do

Device identification completed, but communication could not be established due to timeout.

DEVICE CHECK CONF.

INOP tone

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

Device identification completed, but communication could not be established due to error.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

DEVICE DEMO DATA

INOP tone

DEVICE REAL DATA

INOP tone

<External Device>

UNPLUGGED

INOP tone

DEVICE UNSUPPORTED

INOP tone

<EC10 / EC40> EQUIP

MALF

INOP tone

EC10 INOP

!! EC10 INOP

!!! EC10 INOP at Information Center

NO DEVICE DATA

TEXT UPLOAD FAILED

INOP tone

The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode.

The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data.

The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

Device identification completed, but no appropriate device driver installed.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

Malfunction in the IntelliBridge module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.

A technical alarm is present on the IntelliBridge EC10 module.

On the monitor the indication is a red (!!!), yellow (!!) or cyan alarm lamp (as appropriate) and an INOP text that is defined by the IntelliBridge EC10 device driver.

Communication with connected device has been lost.

Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary.

Telemetry INOPs

0

INOP Message,

Indication

What to do

BATTERY LOW T

Check ECG Settings

INOP tone

The battery in the Telemetry device is low and must be replaced soon.

Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate.

!!CHECK ECG SOURCE Both the telemetry device and the monitor have valid ECG signals

Chk SpO₂T Settings

INOP tone

Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate.

INVALID LEADSET

LEADSET UNPLUGGED The leadset has been unplugged from the telemetry device.

NO ECG SOURCE

A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them.

92

3 Patient Alarms and INOPs

INOP Message,

Indication

!! REPLACE BATT. T

!!!REPLACE BATT. T

Severe yellow/red INOP tone

During this INOP, alarms cannot be paused or switched off.

!!TELE DISCONNECT

!!!TELE DISCONNECT

INOP tone

!! TELE INOP

!!! TELE INOP

Severe yellow/red INOP tone

Tele Sync Unsupp.

INOP tone

What to do

The battery in the telemetry device is almost empty and must be replaced.

Telemetry transceiver was disconnected or short range radio link was lost.

For cable connections; check Telemetry interface, cable connection and setup.

For short range radio connections: if the telemetry transceiver has not moved out-ofrange, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.) If this INOP persists, ask your service personnel to survey the interference sources.

Check for further details at the Information Center or in the Telemetry Data window on the monitor.

The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above.

ProtocolWatch INOPs

INOP Message,

Indication

PW:Action Required

PW: Check Settings

PW In Conflict

What to do

The protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response.

Contact your service personnel. Settings could not be loaded or interpreted correctly

There is a patient information mismatch which has not yet been resolved (>15 minutes).

Calculated Values INOPs

INOP Message,

Indication

ΔSpO₂ CHK SOURCES

Numeric is replaced by -?-

ΔSpO₂ CHK UNITS

Numeric is replaced by -?-

Sp-vO₂ CHK SOURCES

Numeric is replaced by -?-

Sp-vO₂ CHK UNITS

Numeric is replaced by -?-

What to do

Not all measurements or values required to perform the calculation are available. Check measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

Not all measurements or values required to perform the calculation are available. Check measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

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3 Patient Alarms and INOPs

INOP Message,

Indication

SVR CHK SOURCES

SVRI CHK SOURCES

Numeric is replaced by -?-

SVR CHK UNITS

SVRI CHK UNITS

Numeric is replaced by -?-

SVR SET CVP USED

SVRISET CVP USED

ΔTemp CHK SOURCES

Numeric is replaced by -?-

ΔTemp CHK UNITS

Numeric is replaced by -?-

What to do

Not all measurements or values required to perform the calculation are available. Check measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

A CVP value is required for this calculation, but is not currently being measured. The monitor is using the CVP value preset in the

Setup SVR menu.

Not all measurements or values required to perform the calculation are available. Check measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

Cableless Measurement Device INOPs

INOP Message,

Indication

cl NBP Batt Empty cl NBP Batt Incomp cl NBP Batt Low cl NBP Batt Malf cl NBP Batt Temp cl NBP Check Batt cl NBP Disconnect cl NBP No Cradle cl NBP Remove cl NBP Serv Batt cl SpO₂ Batt Empty cl SpO₂ Batt Incmp cl SpO₂ Batt Low cl SpO₂ Batt Malf cl SpO₂ Batt Temp cl SpO₂ Check Batt

What to do

The remaining battery time of the NBP Pod is below 30 minutes. Change the battery.

The battery in use with the NBP Pod is incompatible. Replace it with one approved for use with the NBP Pod.

The remaining battery time of the NBP Pod is below 2 hours.

There is a malfunction in the NBP Pod's battery system. Contact your service personnel.

The temperature of the battery in the NBP Pod is critically high. Check that the Pod is not covered or exposed to a heat source. If the INOP persists, remove the Pod from the patient and contact your service personnel.

The battery in the NBP Pod is nearing the end of its useful life. Only 50 charge/ discharge cycles remain. Contact your service personnel to replace the battery.

The NBP Pod has lost the connection to the monitor.

The NBP Pod is not in its cradle.

The temperature of the battery in the NBP Pod is too high. Remove the Cableless

Measurement Device from the patient and contact service personnel.

The battery in the NBP Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the battery

The remaining battery time of the SpO

2

Pod is below 30 minutes. Change the battery.

The battery in use with the SpO

2 use with the SpO

2

Pod.

Pod is incompatible. Replace it with one approved for

The remaining battery time of the SpO

2

Pod is below 2 hours.

There is a malfunction in the SpO

2 personnel.

Pod's battery system. Contact your service

The temperature of the battery in the SpO

2

Pod is critically high. Check that the Pod is not covered or exposed to a heat source. If the INOP persists, remove the Pod from the patient and contact your service personnel.

The battery in the SpO

2

Pod is nearing the end of its useful life. Only 50 charge/ discharge cycles remain. Contact your service personnel to replace the battery.

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3 Patient Alarms and INOPs

INOP Message,

Indication

cl SpO₂ Disconnect cl SpO₂ No Cradle cl SpO₂ Remove cl SpO₂ Serv Batt

What to do

The SpO

2

Pod has lost the connection to the monitor.

The SpO

2

Pod is not in its cradle.

The temperature of the battery in the SpO

2 the patient and contact service personnel.

Pod is too high. Remove the SpO

2

Pod from

The battery in the SpO

2

Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the battery

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3 Patient Alarms and INOPs

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4

4

Managing Patients

Use the

Patient Demographics

window and its associated pop-up keys to admit, discharge, and transfer (ADT) patients.

All patient demographic and ADT information is shared between the patient monitor and the

Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center.

Note that when an X2 or MP5 monitor is connected to a host monitor, its ability to admit or discharge a patient is disabled, and the host monitor controls patient demographic and ADT information.

Admitting a Patient

The monitor displays physiological data and stores it in the trends as soon as a patient is connected.

This lets you monitor a patient who is not yet admitted. It is however important to admit patients properly so that you can identify your patient on recordings, reports, and networked devices.

During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

NOTE

It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center.

To admit a patient,

1

2

3

4

Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient

Demographics

window.

Clear any previous patient data by selecting the Dischrge Patient or End Case pop-up key and then

Confirm

.

If you do not discharge the previous patient, you will not be able to distinguish data from the previous and current patients, for example, in the trend database.

Select

Admit Patient

.

Enter the patient information: select each field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information.

If a conventional keyboard or a barcode scanner is connected to the monitor you can use this to enter patient information.

Last Name

: Enter the patient's last name (family name), for example

Doe

.

First Name

: Enter the patient's first name, for example

Doe, John

.

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4 Managing Patients

– Middle Name (if configured to appear): Enter the patient's middle name.

Lifetime Id

,

Encounter Id

: Whether these fields appear and how they are labeled can be configured for your hospital. One or both fields may be displayed and the labels may read:

MRN , Case Id , Visit Id , etc. Enter the appropriate data for the fields displayed.

– Patient Cat.

: Choose the patient category, either Adult , Pedi , or Neo .

Paced

: Choose

Yes

or

No

(You must use

Yes

if your patient has a pacemaker).

Height

: Enter the patient's height.

Weight

: Enter the patient's weight.

– BSA : The monitor calculates the body surface area automatically.

Date Of Birth

: Enter the patient's date of birth. Enter this in the form dd/mm/yyyy.

Age

: The monitor calculates the patient age automatically.

– Gender : Choose Male or Female .

– Notes (1) / Notes (2) : Enter any extra information about the patient or treatment.

Select

Confirm

. The patient's name appears on the monitor info line at the top of the screen.

Patient Category and Paced Status

The patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is set to

No

, pace pulses are filtered and therefore do not show in the ECG wave.

WARNING

Patient Cat.

and

Paced

status 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 monitor uses the default settings from the current profile, which might not be correct for your patient.

Patient category

Changing the patient category may change the arrhythmia and NBP alarm limits. Always check alarm limits to make sure that they are appropriate for your patient.

Paced status

For paced patients, you must set Paced to Yes . If it is incorrectly set to No , the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole.

Admitting a Centrally-Monitored Patient

You can admit a patient at either the bedside or the Information Center. When you admit a patient, the patient's name appears on the bedside monitor and the Information Center.

If you do not fill in all patient information required by the Information Center, the Information Center may reject the admission. Complete all the required fields and try again to admit the patient.

Quick Admitting a Patient

Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later.

1

Select the

Quick Admit

SmartKey.

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4 Managing Patients

3

4

2

Enter the required data (ID fields or last name depending on configuration) with the keyboard or a barcode scanner.

Select Enter .

In the confirmation window, select Confirm to discharge the previous patient (if confirmation is configured).

Check that patient category and paced status are correct for the new patient.

5

If the monitor is connected to an Information Center and only the ID field is entered, the patient name is set to - - - at the Information Center. Complete the rest of the demographic details as soon as possible to fully identify the patient on the network, on the monitor and on printed reports. To complete the details, select

Admit Patient

again and complete all required fields.

Editing Patient Information

To edit the patient information after a patient has been admitted, select the patient name field on the

Main Screen to open the Patient Demographics window, and make the required changes.

Discharging a Patient

WARNING

Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient.

A discharge:

– clears the information in the Patient Demographics window

– erases all patient data (such as trend, event, and calculation data) from the monitor, measurement modules and Information Center. This ensures that data from a previous patient are not mixed with data from the new patient.

– resets patient category and paced settings to the settings defined in the default Profile

– resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile

– discharges the patient from the Information Center.

When a patient is discharged from the monitor or from an Information Center, all patient data is deleted. Make sure that you have printed out any required reports before discharging. Check that a functioning local or central printer is available before you use End Case .

To Discharge a Patient

1

Select the patient name field or select the

Admit/Dischrg

SmartKey to open the

Patient

Demographics

window and associated pop-up keys.

2

Select the pop-up key for either:

End Case

- to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an

End Case

SmartKey is configured for your monitor, you can also select this instead and then confirm.

To see which end case reports are set up for your monitor, select

Main

Setup Î Reports Î Auto Reports . For each auto report, if End Case Report is set to On ,

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4 Managing Patients

this report will be printed when you select End Case . See the section on AutoReports for information on setting up end case reports.

Dischrge Patient

- to discharge the patient without printing any reports.

New Patient Check

The monitor can be configured to ask you in certain situations:

• after a specified power-off period

• after a specified standby period

• when no basic vitals (HR, RR, Pulse, SpO

2

, NBP) have been measured for a specified period whether a new patient is now being monitored. The pop-up window is entitled Is This A New

Patient?

. The monitor offers a Yes key to discharge the previous patient and begin monitoring a new patient and a

No

key to continue monitoring with the current patient data and settings.

The time periods for the three conditions can be configured independently.

Transferring Patients

To save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, information can be shared between Multi-Measurement Modules (MMS), patient monitors, and Information Centers.

– patient demographic information is shared between connected MMSs, patient monitors, and

Information Centers

– measurement settings and calibration data can be uploaded from an MMS to a patient monitor, if configured

– trend information can be uploaded from an MMS to a patient monitor, if configured.

Different sets of patient and measurement-related data are stored in the monitor and the Multi-

Measurement Module. Understanding this will help you to understand what happens to patient data when you transfer patients.

Patient Information Stored in Monitor

Patient demographics (name,

DOB, patient IDs)

yes

Monitor settings (alarm pause time, alarm volume)

yes

Stored in MMS and extensions

yes no

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4 Managing Patients

Patient Information Stored in Monitor

Measurement settings for all measurements (alarm limits, measurement on/off, etc.)

yes

Trend data

Calculation data (HemoCalc data)

Stored in MMS and extensions

yes, for all MMS and extensions measurements yes, for all MMS and extensions measurements (up to a maximum of 16 or 32, depending on your database configuration) yes most recent 8 hours of information, for all MMS and extensions measurements no

Events data

yes no

WARNING

If the monitor is not battery-powered, you cannot monitor during transport.

Transferring a Centrally-Monitored Patient

Scenario: A centrally-monitored patient is moved to another monitoring location on the same

Information Center database server without interrupting the collection of patient trend information.

1

2

Before you disconnect the MMS from the monitor, select the patient name field or select the

Admit/ Dischrge

SmartKey to open the

Patient Demographics

window, then select the

Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the

Transfer

key is inactive ("grayed-out").

This step preserves the patient's demographic data during the transfer.

Remove the MMS and any connected extensions from the monitor.

3

4

5

6

Connect the MMS to the transfer monitor and monitor your patient during the move.

At the new location, connect the MMS to the monitor. If the monitor detects a patient mismatch, a window will open showing your patient's data and asking whether to

Complete Transfer Of

This Patient?

.

Select

Yes

to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MMS to the receiving monitor.

Verify that the settings for patient category and paced mode are correct.

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4 Managing Patients

Transferring a Centrally-Monitored Patient with X2 or MP5

WARNING

Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).

Scenario: A centrally-monitored patient is moved to another monitoring location on the same

Information Center database server without interrupting the collection of patient trend information.

1

2

Before you disconnect the X2/MP5 from the host monitor, select the patient name field or select the

Admit/ Dischrge

SmartKey to open the

Patient Demographics

window, then select the

Transfer

pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive ("grayed-out").

This step preserves the patient's demographic data during the transfer.

Remove the X2/MP5 and any connected extensions from the monitor.

3

4

5

Move the patient using the X2/MP5 as the transport monitor.

At the new location, connect the X2/MP5 to the new host monitor. If the monitor detects a patient mismatch, a window will open showing your patient's data and asking

Complete Transfer

Of This Patient?

.

Select

Yes

to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor.

6

Verify that the settings for patient category and paced mode are correct.

Transferring a Centrally-Monitored Patient with X2 or MP5 using IIT

WARNING

Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).

Scenario: A centrally-monitored patient is moved with an X2 or MP5 to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. The X2/MP5 has an IntelliVue Instrument Telemetry interface (IIT), is connected to a host monitor, and is declared as a telemetry device at the Information Center.

2

3

NOTE

The Transfer key is not available while the X2/MP5 is connected to a host monitor ( Companion

Mode

is indicated).

1

Remove the X2/MP5 and any connected extensions from the host monitor.

Move the patient using the X2/MP5 as the transport monitor.

At the new location, just before connecting the X2/MP5 to the new host monitor:

– open the

Patient Demographics

window.

– select the Transfer pop-up key.

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4 Managing Patients

4

5

wait until the transfer has completed.

Connect the X2/MP5 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patient's data and asking Complete Transfer Of This Patient?

.

Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor.

6

Verify that the settings for patient category and paced mode are correct.

If you accidentally transfer a patient, use Re-Admit to restore this patient's data to the Information

Center. If you are not connected to the network, select Clear Transfer to leave transfer mode. The patient data remains in the monitor.

Transferring a Patient with an X1 (no Information Center)

Scenario: A patient is moved to another monitoring location using a transport monitor and re-admitted at the new monitor.

1

2

Disconnect the X1 from the original monitor and silence the resulting

UNPLUGGED

INOP.

If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient's data.

Connect the X1 to the transport monitor and move the patient.

3

4

At the new monitoring location, remove the X1 from the transport monitor and connect it to the new monitor.

If prompted, re-admit the patient to the new monitor: in the

Select Patient

window, select the patient in the X1 to retain the data in the X1. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X1 to the monitor. Verify that the settings for patient category and paced mode are correct.

Transferring a Patient with an X2 or MP5 (no Information Center)

WARNING

Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A).

Scenario: A patient is moved to another monitoring location using the X2 or MP5 and re-admitted at the new monitor.

1

Disconnect the X2/MP5 from the original host monitor and silence the resulting

UNPLUGGED

INOP.

If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient's data.

2

3

4

Move the patient using the X2/MP5 as the transport monitor.

At the new monitoring location, connect the X2/MP5 to the new host monitor.

If prompted, re-admit the patient to the new monitor: in the Select Patient window of the new monitor, select the patient in the X2/MP5 to retain the data in the X2/MP5. This will upload the

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4 Managing Patients

patient demographics, and, if configured, the measurement settings and trend data stored in the

X2/MP5 to the monitor. Verify that the settings for patient category and paced mode are correct.

Data Upload from an MMS

The Multi-Measurement Module stores eight hours of patient trend data at one-minute resolution. It also stores patient demographic information and the measurement settings (including the ST baseline) and calibration data for the measurements carried out by the MMS and any connected extensions. This data can be uploaded to an IntelliVue patient monitor, if your monitor is configured to do so and if at least five minutes of trend information is stored in the MMS.

Your monitor's data upload settings are defined in Configuration Mode to suit your patient transfer use model.

How data is uploaded to the host monitor depends on the configuration mode settings

MMS Trend

Upload

and

MMS Sett. Upload

.

If there is a patient mismatch and you select

Continue Monitor

, no data will be uploaded from the

MMS.

Data Exchange Between Information Centers

You can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors.

Resolving Patient Information Mismatch

When you connect together devices which store patient demographic data, for example:

• an MMS and a monitor,

• an X2 or MP5 and a host monitor,

• a monitor and an Information Center, the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical.

Depending on your monitor's configuration, this mismatch may be automatically resolved or you may have to resolve it manually. If your monitor is configured to resolve mismatches automatically, depending on the configuration, either the monitor or the Multi-Measurement Module data is automatically retained.

WARNING

1

2

When a monitor is connected to an Information Center by the wireless IntelliVue Instrument

Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary.

It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example

Paced and Patient Category, may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to

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4 Managing Patients

alarm in the case of asystole. It is important that the Patient Category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set.

In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a

"telemetry device" at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center.

Manually Resolving Patient Mismatch

The patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor

Info Line and in the

Select Patient

window. The monitor displays a message such as

Different patients in Central and Monitor

.

The

Select Patient

window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, but the indicators remain until you do.

For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the

Transfer

key has been selected, the monitor will show this patient's data and ask Complete Transfer Of This

Patient?

Patient

. You can then select

Yes

to complete the transfer. If you select

No

you will go to the

Select

window.

There can be up to three sets of demographic data in the

Select Patient

window if the patient is different in the Information Center, monitor, and MMS.

After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.

Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the MMS. Always check the Patient

Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.

WARNING

After resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient.

Patient Mismatch - If One Set of Patient Data is Correct

If there is a mismatch between an Information Center and a monitor, or a monitor and an MMS, choose the data set you want to continue using for this patient by selecting one of the sectors in the

Select Patient

window.

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4 Managing Patients

1

2

Patient demographics

Patient category and paced status

3

Same Patient

- see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 106 below.

4

New Patient

- see “Patient Mismatch - If Both Patient Data Sets Are Correct” on page 106 below.

After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.

Patient Mismatch - If Neither Patient Data Set is Correct

A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring.

Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient.

Patient Mismatch - If Both Patient Data Sets Are Correct

A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the

MMS that was used during the patient transport to the monitor.

Select

Same Patient

if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor.

Patient Information

Patient name

Patient IDs

Screen Notes

This information is taken from...

the monitor, if the patient was admitted there. For centrally-admitted patients, this information is taken from the Information Center.

106

This information is taken from...

the Multi-Measurement Module. if connected, otherwise the data is taken from the monitor.

4 Managing Patients

Patient Information

Patient Category

Date of Birth

Height

Weight

Gender

Paced Status

Trend data

Paced status is always set to

Yes

where there is a mismatch in patient information.

if there is newer trend data stored in the MMS, it is uploaded to the monitor.

Automatically Resolving Patient Mismatch

Your monitor can be configured to automatically resolve mismatches in one of two ways.

• continue using the patient in the MMS, and delete the old data in the monitor. This is suitable for transport monitors.

• continue with the patient in the monitor, and delete the data in the MMS.

Care Groups

If your monitor is connected to an Information Center, you can group bedside monitors into Care

Groups. This lets you:

• view information on the monitor screen from another bed in the same or in a different Care

Group.

• be notified of yellow or red alarm conditions at the other beds in the Care Group.

• see the alarm status of all the beds in the Care Group on each monitor screen.

There are two main types of Care Groups:

• standard care group (Bed-based Care Group) - up to 12 patients monitored by up to 4

Information Centers

• unit group (Unit-based Care Group) - for a complete unit with up to 64 patients monitored by up to 4 Information Centers

Monitors must be assigned to these Care Groups at the Information Center. There is a third care group which can be assigned locally at the bedside. This is the

My Central

care group which includes all beds (up to 16) from the Information Center your bed is connected to. This care group setting is typically used in facilities with only one Information center. The selection of beds is automatic and cannot be changed.

The functions available with Care Groups depend on the Information Center revision your monitors are connected to. See your Information Center Instructions for Use for further details.

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4 Managing Patients

Understanding the Care Group Overview Bar

The Care Group monitors' status is shown in symbol form in the Care Group overview bar. Flashing symbols indicate active alarms, symbols that are not flashing indicate alarms that have been acknowledged. Selecting a bed symbol calls up the window for that bed or a setup window to select this.

The Care Group overview bar must be configured to display on the monitor Screen. If it is not visible on your monitor, select a Screen which has been configured to show the bar.

Care Group Symbols (four alternative display possibilities depending on space available)

No data from this bed

The alarms are on but there are no currently active alarms at this monitor

The highest priority alarm at this monitor is a standard INOP

The highest priority alarm at this monitor is a short yellow alarm

The highest priority alarm at this monitor is a yellow alarm

The highest priority alarm at this monitor is a red alarm

The highest priority alarm at this bed is a yellow INOP

The highest priority alarm at this bed is a red INOP

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4 Managing Patients

Care Group Symbols (four alternative display possibilities depending on space available)

The alarms at this monitor are suspended

The monitor is in standby mode the monitor is in Demonstration mode

The current monitor

Care Group Symbols (used in the Care Group overview bar and the

My Care Group

window)

This is a telemetry bed

This bed is on a wireless network

This bed is on a wired network

This is a "paired" bed, with a bedside monitor and a telemetry transmitter assigned.

Viewing the My Care Group Window

This window shows the alarm status, bed name, and patient name for every bed in the Care Group.

The window for the Unit group shows first the beds of the Information Center this bed is connected to. By selecting the Information Center name at the top of the list, you can display a list of all

Information Centers associated with the Unit group, and select another Information Center to view.

To enter the My Care Group window,

• select the

Other Patients

SmartKey, if configured, or

• in the

Main Setup

menu, select

My Care Group

.

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4 Managing Patients

Use the My Care Group pop-up keys to navigate through the Care Groups:

My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information

Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed.

Other Units

lets you view a list of all the Care Units in your Care Domain. Select any Care Unit to view a list of the Information Centers connected to it. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Bed window for that bed.

Alarming Beds

lets you view a list of all beds in your care group with an unacknowledged alarm.

The beds are listed in order of alarm severity.

Viewing the Other Bed Window

The Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network. Waves and numeric information from another bed are delayed. If configured, Other Bed information is displayed in color, using the colors defined by the Information

Center.

The Other Bed window can be configured to pop-up automatically when an alarm occurs at another bed. To avoid too many windows appearing (for example, in large care groups) and covering the monitor's own bed data on the screen, you can temporarily disable this automatic pop-up:

1

2

Select

Main Setup Î Network Î Auto Window

Select

Disabled

When automatic pop-up is disabled in this way, an icon will appear as a reminder in the Care Group

Overview Bar next to the monitor's own bed label . Depending on the configuration, the automatic pop-up is disabled for five minutes or until you set it to Enabled again.

• To open the Other Bed window, select the required bed label or patient name in the Care Group

Overview Bar. If you are in a Unit Group with many beds, the My Care Group window may open for you to select the bed.

110

The Other Bed window may be configured to display embedded in a specially designed Screen.

• To display the embedded Other Bed screen element, in the

Change Screen

menu, select a Screen designed to show the Other Bed information permanently.

4 Managing Patients

Note that a Screen with an embedded Other Bed screen element cannot be displayed on the D80

Intelligent Display.

Changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check that the correct other bed is displayed.

Other Bed Pop-Up Keys

Select the

Other Patients

SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys:

Next Wave

lets you view waveforms not currently shown in the other bed window.

More Vitals

lets you view more numerics not currently shown in the other bed window.

Next Bed lets you view waveforms and numerics from the next available bed in the Care Group.

My Care Group lets you call up the Care Group window to select another bed.

Alarming Beds

lets you view a list of all beds in your care group with an unacknowledged alarm.

The beds are listed in order of alarm severity.

Silence Bed lets you silence active alarms at the other bed. (Whether you see this key depends on the revision and configuration of the Information Center your monitors are connected to.)

WARNING

The Silence Bed pop-up key in the Other Bed window silences alarms at a remote bed. Be aware that accidental use of this key could silence alarms for the wrong patient.

To silence own bed alarms use the Silence permanent key on screen.

Visual Alarm Status Information in the Other Bed Window

• If individual alarms are switched off at the other bed, this is indicated by the crossed alarm symbol beside the measurement numeric.

• If alarms are switched off at the other bed, the message

Alarms Off

is shown in the other bed window.

• In the embedded Other Bed window, the crossed speaker symbol in the upper right hand indicates that the volume of the audible alarm status change notification for the other beds in the care group is set to zero at the overview monitor.

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4 Managing Patients

Care Group Alarms

Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group. The visual and audible indicators used depend on the monitor and

Information Center configuration.

When an alarm is detected at another bed in the Care Group,

• the alarm status is shown in the Care Group overview bar as an icon.

• a message informing you about the care group alarm is shown in the monitor status line.

• if configured, the Other Bed window, the

Alarming Beds

window or the

My Care Group

window may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at the Information Center). The automatic alarm notification is suppressed when a window, menu or pop-up keys are active.

• if configured, an audible status change notification is issued. The tone type and volume can be configured.

Automatic alarm notification can be switched off permanently in the monitor's Configuration Mode or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode:

1

2

Select the network symbol on the monitor screen to call up the

Network

menu.

Select Auto Window to toggle between the settings Enabled and Disabled .

This setting resets to the default at discharge and when the monitor is switched on. Always re-enable the Auto Window as soon as possible.

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5

5

ECG, Arrhythmia, ST and QT

Monitoring

The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see

“About Arrhythmia Monitoring” on page 131), ST monitoring (see “About ST Monitoring” on

page 141) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 151).

Skin Preparation for Electrode Placement

2

3

4

5

Good electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor conductor of electricity.

1

Select sites with intact skin, without impairment of any kind.

Clip or shave hair from sites as necessary.

Wash sites thoroughly with soap and water, leaving no soap residue.

We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.

Dry skin thoroughly.

Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site.

Connecting ECG Cables

1

2

3

4

Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.

Place the electrodes on the patient according to the lead placement you have chosen.

Attach the electrode cable to the patient cable.

Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on the monitor display.

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5 ECG, Arrhythmia, ST and QT Monitoring

CAUTION

To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips.

Selecting the Primary and Secondary ECG Leads

The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.

The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis.

You should choose a lead as primary or secondary lead that has the following characteristics:

• the QRS complex should be either completely above or below the baseline and it should not be biphasic

• the QRS complex should be tall and narrow

• the P-waves and T-waves should be less than 0.2 mV

To select a lead as primary or secondary lead:

• In the Setup ECG menu, select Primary or Secondary , then select the appropriate lead. You can assign any available lead whether it is currently displayed or not.

Checking Paced Status

It is important to set the paced status correctly when you start monitoring ECG.

♦ To change the paced status in the Setup ECG menu, select Paced to toggle between Yes or No .

WARNING

Pace pulse rejection must be switched on for paced patients by setting "Paced" to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient.

Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias.

Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display.

Keep pacemaker patients under close observation.

Understanding the ECG Display

Your display may be configured to look slightly different.

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5 ECG, Arrhythmia, ST and QT Monitoring

1

2

3

4

5

Lead label of the displayed wave

1 mV calibration bar

Pacer spikes

Pace pulse markers

Current heart rate

6

7

Current heart rate alarm limits

EASI lead placement label

8

ECG Filter label

ECG HR numeric: This is the heart rate derived from the monitored ECG.

Pace pulse markers: These are shown if the

Paced

status has been set to

Yes

, the pacer spikes are not configured to have a fixed size, and the patient has a paced signal.

Pacer Spikes: The pacer spikes are shown in white, unless the ECG wave is white, then they will be green. If the pacer spikes have been configured to have a fixed size, they will be displayed in the background as a dotted line.

1

Pacer spikes configured to have a fixed size

Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, or the 2nd

Sync Out channel is configured to

ECG SyncPuls

and a sync cable is plugged in, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave. The synchronization marks will be shown in yellow, unless the ECG wave is yellow, then they will be green.

ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the left side.

Monitoring Paced Patients

An ECG optimized for monitoring a paced patient should look like this:

1

2

Normal Beats

Pace Pulses/Beats

You should choose a lead as primary or secondary lead that has these characteristics:

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5 ECG, Arrhythmia, ST and QT Monitoring

• the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.

• the QRS complex should be tall and narrow

• the P-waves and the T-waves should be less than 0.2 mV.

For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They are then shown in the background as a dotted lines. The length of the dotted line is fixed to the wave channel height and is independent of the actual pacer amplitude.

Setting the Paced Status (Pace Pulse Rejection)

In the Setup ECG menu, select Paced to toggle between Yes and No .

You can also change the paced status in the Patient Demographics window.

When

Paced

is set to

Yes

:

– Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes.

– pace pulse marks are shown on the ECG wave as a small dash (only when the pacer spikes are not configured to have a fixed size).

– The paced symbol is displayed on the main screen.

When Paced is set to No , pacer spikes are not shown in the ECG wave. Be aware that switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected.

Paced

Non-Paced

Avoiding Pace Pulse Repolarization Tails

Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as

QRSs in the event of cardiac arrest or other arrhythmias.

If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.

1

Repolarization tail (note width)

Changing the Size of the ECG Wave

If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the

ECG waves on the screen.

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5 ECG, Arrhythmia, ST and QT Monitoring

Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor.

Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose

Auto Size

, or an individual size using the

Size Up

/

Size Down

keys, the calibration bar may be a different size for each wave.

To Change the Size of an Individual ECG Wave

1

Select the wave segment you want to change. This calls up the lead menu for this segment.

2

In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.

Selecting Auto Size lets the monitor choose the optimal adjustment factor for all available ECG waves.

To Change the Size of all the ECG Waves

To change the size of all the ECG waves on the screen by a fixed adjustment factor,

1

In the

Setup ECG

menu, select

Adjust Size

.

2

Select the required adjustment factor from the line of pop-up keys.

Size X0.5

to halve the wave size

Size X1

to display the wave without zoom

Size X2

to double the wave size

– Size X4 to multiply the wave size by four

Previous Size

: to return one step to the previous size

Auto Size

: to let the monitor choose the optimal adjustment factor for all the ECG waves.

Changing the Volume of the QRS Tone

The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off).

To change the QRS volume, in the

Setup ECG

menu select

QRS Volume

and then select the appropriate volume from the pop-up list.

Changing the ECG Filter Settings

The ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.

To change the filter setting, in the

Setup ECG

menu, select

Filter

and then select the appropriate setting.

Monitor

: Use under normal measurement conditions.

– Ext. Monitor : Use when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the

Monitor

setting.

Filter

: The filter reduces interference to the signal. It should be used if 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

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5 ECG, Arrhythmia, ST and QT Monitoring

usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electrosurgical units. Under normal measurement conditions, selecting

Filter

may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor.

If

AutoFilter

is set to

On

in Configuration Mode, the filter setting will automatically be set to

Filter if electromagnetic interference is detected.

Diag

: 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 segments are visible.

The setting

Diag

selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the

Adult, Pedi and Neo patient category. The term "diagnostic" relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/

AAMI standard EC11-1991.

Selecting Positions of Va and Vb Chest Leads (for

6-lead placement)

The two chest leads for the 6-lead placement can be positioned at any two of the V1 to V6 positions.

Select the positions you have used in the

Setup ECG

menu, so that the chest leads will be correctly labeled.

1

2

3

In the

Setup ECG

menu, select

Va Lead

.

Select the position used from the list.

Select

Vb Lead

and select the position used from the list

Choosing EASI or Standard Lead Placement

You must enable either standard lead placement or EASI lead placement.

• In the

Setup ECG

menu, select

Lead Placement

and then

Standard

or

EASI

.

EASI is shown beside the 1 mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts.

See the section on “EASI ECG Lead Placement” on page 127 for electrode placement diagrams.

About ECG Leads

To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called "leads". To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor.

When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis.

Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location.

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5 ECG, Arrhythmia, ST and QT Monitoring

ECG Leads Monitored

If you are using

a 3-electrode set a 5-electrode set a 6-electrode set a 10-electrode set

these leads are available:

I, II, III

I, II, III, aVR, aVL, aVF, V and MCL

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

Resp is measured between electrodes:

RA and LL

RA and LL

RA and LL

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A

Changing Lead Sets

To change the ECG lead set,

When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement.

When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a

LEAD OFF

INOP message; select

New Lead

Setup in the Setup ECG menu and the INOP message will disappear.

ECG Lead Fallback

If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback. When the

Leads Off condition is corrected, the leads are automatically switched back.

This setting can only be changed in Configuration Mode.

ECG Lead Placements

The labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.

AAMI

RA

LA

LL

RL

V

V1

Electrode labels

EASI

A

N

I

S

E

IEC

F

N

R

L

C

C1

Electrode colors

AAMI

White

Black

Red

Green

Brown

Brown/Red

IEC

Red

Yellow

Green

Black

White

White/Red

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5 ECG, Arrhythmia, ST and QT Monitoring

Electrode labels

AAMI

V2

V3

V4

V5

V6

EASI IEC

C2

C3

C4

C5

C6

Standard 3-Lead Placement

Electrode colors

AAMI

Brown/Yellow

Brown/Green

Brown/Blue

Brown/Orange

Brown/Violet

IEC

White/Yellow

White/Green

White/Brown

White/Black

White/Violet

1

2

3

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

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Standard 5-Lead Placement

5 ECG, Arrhythmia, ST and QT Monitoring

3

4

5

1

2

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, the position depends on your required lead selection

6-Lead Placement

For a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and Vb, can be positioned at any two of the V1 to V6 positions shown in the chest electrode diagram below. The Va and Vb lead positions chosen must be selected in the Setup ECG

Menu to ensure correct labeling.

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5 ECG, Arrhythmia, ST and QT Monitoring

Chest Electrode Placement

A - Angle of Lewis

V1 on the fourth intercostal space at the right sternal border

V2 on the fourth intercostal space at the left sternal border

V3 midway between the V2 and V4 electrode positions

V4 on the fifth intercostal space at the left midclavicular line

V5 on the left anterior axillary line, horizontal with the V4 electrode position

V6 on the left midaxillary line, horizontal with the

V4 electrode position

V3R -V6R on the right side of the chest in positions corresponding to those on the left

VE over the xiphoid process

V7 on posterior chest at the left posterior axillary line in the fifth intercostal space

V7R on posterior chest at the right posterior axillary line in the fifth intercostal space

For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space.

1

2

Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.

Palpate and count down the chest until you locate the fourth intercostal space.

10-Lead Placement

When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement.

122

Conventional 12-Lead ECG

5 ECG, Arrhythmia, ST and QT Monitoring

3

4

1

2

5

V1 - V6

LA

RA

RL

LL

In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.

Limb electrodes:

– Place arm electrodes on the inside of each arm, between the wrist and the elbow.

– Place leg electrodes inside of each calf, between the knee and the ankle.

Chest electrodes:

V1 - on the 4th intercostal space at the right sternal border

V2 - on the 4th intercostal space at the left sternal border

V3 - midway between the V2 and V4 electrode positions

V4 - on the 5th intercostal space at the left midclavicular line

V5 - on the left anterior axillary line, horizontal with the V4 electrode position

V6 - on the left midaxillary line, horizontal with the V4 electrode position

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Modified 12-Lead ECG

3

4

1

2

5

6

LA

V1-V6

LL

RL

RA

Angle of Lewis

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen.

The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.

Choosing Standard or Modified Electrode Placement

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch

Mod.LeadPlacment

to

On

in the monitor. To do this,

• in the

Setup ECG

menu, select

Mod.LeadPlacment

to toggle between

On

and

Off

.

– When

Mod.LeadPlacment

is set to

On

, 12 Lead ECG Reports will be labeled

12 Lead ECG

Report (Mason-Likar) , and captured 12-lead ECGs will be labeled Mason-Likar to the right of the bandwidth annotation at the Information Center.

– When

Mod.LeadPlacment

is set to

Off

, 12 Lead ECG Reports will be labeled

12 Lead ECG

Report (Standard)

, and captured 12-lead ECGs will not be annotated at the Information

Center.

WARNING

Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead

ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and

ST slope.

Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.

Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label.

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5 ECG, Arrhythmia, ST and QT Monitoring

Capture 12-Lead

You can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured

ECG data and then store it and send it to a connected Information Center for analysis. You can also print a 12-Lead report.

The monitor can store one 12-Lead ECG episode at any time.

Viewing the Realtime 12-Lead ECG

To open the 12-Lead ECG window and view the realtime ECG waves,

• Select the

Capture 12 Lead

SmartKey, or

• Select

Main Screen Î Capture 12 Lead

If a previously viewed 12-Lead ECG was not stored, a window will pop up asking whether you want to keep it or not. The title bar of the window shows the date and time when this 12-Lead ECG was captured. If you do not need the ECG, select

No

to discard it, otherwise, select

Yes

and then select

Store & Send to store that 12-Lead ECG and send it to an Information Center (if one is connected).

If your patient is not admitted, you will be prompted to enter at least the age and gender of the patient.

This information is needed for analysis of the 12-Lead ECG at the Information Center but is not essential if you only want to capture the 12-Lead ECG without sending it for analysis. To enter this information:

1

2

3

Select the

Admit Patient

pop-up key, then

Enter the information in the Patient Demographics window.

Open the 12-Lead ECG window again as described above.

The age and gender will now be displayed in the title bar of the pop-up keys.

To change the way the realtime waves are displayed, select the Change View pop-up key or select the wave area. You can switch between a one or two column display. The two column display lets you see a larger representation of the waves.

While the realtime 12-Lead waves are being viewed in the window, the ECG filter mode (see

“Changing the ECG Filter Settings” on page 117) is changed to the 12-Lead filter setting (see “Setting

Up the 12-Lead ECG” on page 126).

Capturing the 12-Lead ECG

To capture the last 10 seconds of ECG data, select the Capture Waves pop-up key. The pop-up key is active as soon as enough wave data is available; until then a progress bar is displayed in the title bar of the pop-up keys. A preview of the captured data appears on the screen (unless your monitor is connected to an Information Center with software release earlier than Revision M — then the captured data is automatically stored and sent to the Information Center).

The title bar of the pop-up keys will now show the current filter setting and, if you are using EASI lead

placement, an EASI indicator (see “EASI ECG Lead Placement” on page 127).

You can at any time return to the realtime 12-Lead ECG view by selecting the

Show Waves

pop-up key. From there, you return to the preview window by selecting the

Show Preview

pop-up key.

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Setting Up the 12-Lead ECG

In the Preview window, select the Setup 12 Lead pop-up key to choose settings for filter, gain, etc., if changes are needed. All changes apply to both the display and the printed 12-Lead report.

Filter

Applies a filter to the waveforms.

Choices are

0.05-150Hz D, 0.5-150Hz eM, 0.5-40Hz M (or0.5-55Hz M for pediatric and neonatal patient categories),

0.5-20Hz F. The selected filter will be displayed in the title bar of the pop-up keys.

Gain

Chest Gain

Paper Speed

Format

Defines the gain used for the waveforms.

Choices are

2.5 mm/mV, 5 mm/mV, 10 mm/mV and 20 mm/mV.

Defines the gain for the chest leads relative to the standard gain setting.

Choices are

Full and Half.

Defines the waveform speed.

Choices are

25 mm/sec and 50 mm/sec.

Defines the page layout.

Choices are

12X1, 6X2, 3X4, 3X4 1R and 3X4 3R. 1R and 3R refer to 1 or 3 rhythm leads.

Time

Defines whether all leads show simultaneous or sequential intervals of time, when displaying or printing 2 or more columns.

Choices are

Sequential and Simultaneous.

Rhythm Lead 1

Defines which lead will be used as rhythm lead 1, 2 or 3.

Rhythm Lead 2

Rhythm Lead 3

Choices are

MCL.

Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V,

This setting is only relevant when

3X4 1R or 3X4 3R is selected as Format.

Lead Sequence

Defines the sequence in which the leads are presented.

Choices are

Cabrera and Internat.

Storing and Sending the 12-Lead ECG

You can enter an order number that will then be associated with the 12-Lead ECG. To enter an order number, select the

Enter OrderNo.

pop-up key. The order number will be displayed in the title bar of the pop-up keys.

To store the previewed data on the monitor and send it to a connected Information Center for storage and analysis, select the Store & Send pop-up key. If the monitor is connected to an Information

Center, use the

Store & Send

function before patient transport to store the 12-Lead ECG centrally, as the 12-Lead ECG data will not be uploaded from the MMS to another monitor after transport.

If the connection to the Information Center is not active while storing, the 12-Lead ECG will be automatically sent as soon as the connection is established or restored. If a previously stored 12-Lead

ECG is waiting to be sent to the Information Center, it will be overwritten when a new 12-Lead ECG is stored and can then not be sent to the Information Center.

Printing the 12-Lead ECG

Print a dedicated 12-Lead ECG report by selecting the

Print Report

pop-up key.

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Capture 12-Lead Pop-up Keys

Here is a summary of all the pop-up keys available during 12-Lead ECG procedure:

Pop-up Keys

Admit Patient

Change View

Capture Waves

Show Waves

Show Preview

Setup 12 Lead

Enter OrderNo.

Print Report

Store & Send

Show Stored

Selecting this pop-up key lets you

enter the age and gender for the patient in the Patient Demographics window, to allow analysis of the 12-Lead ECG.

switch between the single column and two-column display of the realtime wave data. capture the current ECG waves and open the preview window.

return to the realtime 12-Lead ECG view.

show the preview of the captured 12-Lead wave data.

choose settings for filter, gain, display layout, etc.

enter an order number that is stored with the capture and displayed in the title bar of the pop-up keys. print a 12-Lead report. store the captured 12-Lead ECG in the monitor and send it to the

Information Center. view a previously stored 12-Lead ECG, allowing a visual comparison between the current and the stored data.

EASI ECG Lead Placement

Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia.

WARNING

EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead

ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional

ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.

Respiratory monitoring is also possible with the EASI placement; respiration is measured between the

I and A electrodes.

Place the electrodes as accurately as possible to obtain the best quality EASI measurements.

When EASI lead placement is selected,

EASI

is shown beside the 1mV calibration bar on the ECG wave on the display, and

EASI

is marked on any recorder strips and printouts.

EASI Monitoring During INOP Conditions

If one of the derived EASI leads has an INOP condition (for example, LEAD OFF ), a flat line is displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn.

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EASI Electrode Placement

3

4

1

2

5

E (V) - on the lower sternum at the level of the fifth intercostal space

A (LL) - on the left midaxillary line at the same level as the E electrode

S (LA) - on the upper sternum

I (RA) - on the right midaxillary line at the same level as the E electrode

N - reference electrode - can be anywhere, usually below the sixth rib on the right hip

ECG and Arrhythmia Alarm Overview

The ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.

• Cardiotach alarms are available when HR is on and the active alarm source is ECG, but arrhythmia is switched off

• Basic arrhythmia alarms are available when Arrhythmia is switched on

• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced

Arrhythmia option has been enabled for your monitor

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Cardiotach Alarms

***Asystole

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**High heart rate

**Low heart rate

Additional Alarms with Basic

Arrhythmia Option

Additional Alarms with

Enhanced Arrhythmia Option

***Ventricular Tachycardia **Afib

**Pacer Not Capture

**Pacer Not Pacing

**PVCs/min HIGH (PVC > limit/min)

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs

Using ECG Alarms

ECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms chapter. Special alarm features which apply only to

ECG are described here.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value (the Δ value) to the high and low alarm limits.

3

4

1

2

5

6

Extreme Brady Limit

Low Limit

High Limit

Extreme Tachy Limit

Δ Extreme Brady

Δ Extreme Tachy

You need to know which value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the extreme rate alarms set for your monitor, in the

Setup ECG

menu, see the menu items

Δ

ExtrTachy

and

Δ ExtrBrady

.

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ECG Alarms Off Disabled

Be aware that your hospital department may have decided to disable the Alarms Off setting for ECG in the monitor's Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring

Mode. If you try to switch off the HR alarms, you will see the message

To activate enter Config and enable Alarms Off .

HR Alarms When Arrhythmia Analysis is Switched Off

When arrhythmia analysis is switched off, only these HR-related alarms will be detected:

• the asystole alarm

• the ventricular fibrillation/tachycardia alarm

• the extreme tachycardia and extreme bradycardia alarms

• the high heart rate and low heart rate alarms.

Enhanced Asystole Detection

In order to improve alarming on asystole under certain conditions, you can set

Asystole Detect.

in

Configuration Mode to

Enhanced

. In enhanced mode an asystole alarm will be suppressed for up to five seconds if a valid beat-to-beat Pulse is detected from a Pressure.

ECG Safety Information

CAUTION

Interference from instruments near the patient and ESU interference can cause problems with the

ECG wave. See the monitor specifications for more information.

WARNING

Defibrillation and Electrosurgery:

Do not touch the patient, or table, or instruments, during defibrillation.

After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions.

ECG cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again.

According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your

ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.

When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal.

General:

When you are connecting the electrodes or the patient cable, 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.

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During surgery:

Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.

Pacemaker failure:

During complete heart block or pacemaker failure to pace/capture, tall P-waves (greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest.

Patients exhibiting intrinsic rhythm:

When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest.

The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patient's heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined.

Filtered ECG signal from external instruments:

Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance.

External pacing electrodes:

When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This may result in the arrhythmia algorithm's failure to detect pacemaker noncapture or asystole.

Fusion beat pacemakers:

Pacemakers that create fusion beats (pace pulse on top of the QRS complex) cannot be detected by the monitor's QRS detector.

Rate adaptive pacemakers:

Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the

Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.

About Arrhythmia Monitoring

Arrhythmia analysis provides information on your patient's condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously

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5 ECG, Arrhythmia, ST and QT Monitoring

• optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.

• detects beats, for example, QRS complexes, identifying them for further analysis.

• measures signal features such as R-wave height, width, and timing.

• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.

• examines the ECG signal for ventricular fibrillation, asystole, and noise.

Arrhythmia Options

Your monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labeling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different

options are listed in the section “ECG and Arrhythmia Alarm Overview” on page 128, the rhythm and

ectopic messages detected are listed in “Arrhythmia Status Messages” on page 134.

Where Can I Find More Information?

See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed information on the arrhythmia algorithm and its clinical application.

Switching Arrhythmia Analysis On and Off

1

2

In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off .

Select the

Confirm

pop-up key which appears at the bottom of the screen.

Be aware that when arrhythmia analysis is switched off,

– the message Arrhythmia Off appears beside the ECG wave, if configured to do so

– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/ tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate and low heart rate alarms)

– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.

Choosing an ECG Lead for Arrhythmia Monitoring

It is important to select a suitable lead for arrhythmia monitoring.

Guidelines for non-paced patients are:

– QRS complex should be tall and narrow (recommended amplitude > 0.5 mV)

– R-Wave should be above or below the baseline (but not bi-phasic)

– T-wave should be smaller than 1/3 R-wave height

– the P-wave should be smaller than 1/5 R-wave height.

For paced patients, in addition to the above, the pace pulse should be:

– not wider than the normal QRS

– the QRS complexes should be at least twice the height of pace pulses

– large enough to be detected, with no re-polarization.

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To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.

Aberrantly-Conducted Beats

As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.

Atrial Fibrillation Alarm

The monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability.

In order to generate an Afib alarm the following criteria must be detected for 1 minute:

• normal beat RR intervals must be irregular

• PR interval deviation must be large

• P-wave region must not match well

Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats.

Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm.

An Afib alarm can be falsely detected in the presence of:

• sinus arrhythmia,

• muscle noise, or

• electrode motion artifact.

If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations.

See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis.

Intermittent Bundle Branch Block

Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the

QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.

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Understanding the Arrhythmia Display

Your monitor screen may look slightly different from the illustration.

1

4

5

2

3

6

7

Beat label

Pace pulse marks

Rhythm status message

PVC Numeric

HR Numeric

Ectopic status message

Delayed arrhythmia wave

Viewing Arrhythmia Waves

To review arrhythmia beat labels, in the

Setup Arrhythmia

menu, select

Annotate Arrhy

.

The wave showing the primary ECG lead will be delayed by six seconds and shown on a gray background. Beat labels will be annotated above the ECG wave and

Delayed

will be written beside it.

To return to the normal ECG primary lead display, select Annotate Arrhy again.

Arrhythmia Beat Labels

Arrhythmia beat labels tell you how the monitor is classifying beats.

N = Normal

V = Ventricular Ectopic

S

= Supra-ventricular Premature

P

= Paced

' = Pacer spike

" = Biventricular Pacer Spike

L

= Learning patient's ECG

A

= Artifact (noisy episode)

?

= Insufficient information to classify beats

I

= Inoperative condition (e.g., LEADS OFF)

M

= Pause or missed beat

Arrhythmia Status Messages

The monitor displays two types of status messages:

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• Rhythm Status Messages -- to indicate the patient's rhythm.

• Ectopic Status Messages -- to indicate the presence of ectopic beats.

These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.

The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats.

If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level.

Rhythm Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Rhythm Status Message Description

Asystole

Vent Fib/Tach

Vtach

Sustained VT

Vent Rhythm

Vent Bigeminy

Vent Trigeminy

Paced Rhythm

Irregular HR

Sinus Brady

Sinus Rhythm

Sinus Tach

SV Brady

SV Rhythm

SV Tach

Unknown ECG Rhythm

Learning ECG

Learning Rhythm

CANNOT ANALYZE ECG

No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal

A fibrillatory wave for 4 consecutive seconds

A dominant rhythm of adjacent Vs and a HR > the V-Tach

Heart Rate Limit

Rhythm cannot be determined

Algorithm is learning the ECG beat morphology

Algorithm is learning the rhythm of the classified beats

ECG signal is predominantly invalid and therefore cannot be analyzed

B or E

B, E

B, E

B, E

Ventricular tachycardia rhythm for more than 15 seconds

A dominant rhythm of adjacent PVCs and a HR ≤ the V-Tach

HR Limit

A dominant rhythm of N, V, N, V

E

E

A dominant rhythm of N, N, V, N, N, V

A dominant rhythm of paced beats

Consistently irregular rhythm

A dominant rhythm of SV beats preceded by P-waves

E

E

B, E

E

B, E

A dominant rhythm of SV beats not preceded by P-waves B, E

B, E

B, E

B, E

B, E

Ectopic Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

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Ectopic Status Message Explanation B or E

(No message displayed) No ectopic activity within the last minute

Run PVCs

Pair PVCs

Pacer Not Capt

More than 2 consecutive PVCs within the last minute

Pair PVCs within the last minute

Pause with pace pulse (paced patient only) within the last minute

Pacer Nt Pacing

Pause

Pause without pace pulse (paced patient only) within the last minute

No beat detected for 1.75 x average R-R interval for HR <120, or

No beat for 1 second with HR >120 (non-paced patient only), or

No beat detected for more than the set pause threshold.

R-On-T PVCs

Multiform PVCs

Frequent SVPBs

SVPBs

SV Beats

Paced Beats

R-ON-T detected within the last minute

Multiform PVCs detected within the last minute

SVPB count within last minute is greater than 5

SV count within last minute and rhythm status is PACED

Paced beat count within last minute and rhythm status is NOT

PACED

E

E

B, E

B, E

E

E

E

E

1-5 SVPBs in the last minute with a sinus rhythm and no Vs E

B, E

B, E

Arrhythmia Relearning

During a learning phase:

• Alarm timeout periods are cleared

• Stored arrhythmia templates are cleared

• Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.

Initiating Arrhythmia Relearning Manually

To initiate relearning manually, in the

Setup Arrhythmia

menu, select

Relearn Arrhy

.

– While the monitor is learning, the delayed arrhythmia wave displays the beat label

L

and the rhythm status message

Learning ECG

.

– Next, the monitor determines the dominant rhythm. The beats are labeled N , and the rhythm status message changes to Learning Rhythm .

After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly.

If beats are still not classified correctly, check that the ECG is optimized for arrhythmia monitoring.

You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves.

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Automatic Arrhythmia Relearn

Arrhythmia relearning is initiated automatically whenever:

• ECG monitoring is switched on

• The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs

• A Leads Off INOP condition (that has been active for > 60 seconds) ends.

If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled

L

and there is no

Learning ECG rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active.

Arrhythmia Relearn and Lead Fallback

Lead fallback triggers an automatic arrhythmia relearn.

WARNING

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.

For this reason you should:

• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free

• be aware that arrhythmia relearning can happen automatically

• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)

• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads

• always ensure that the arrhythmia algorithm is labeling beats correctly.

Arrhythmia Alarms

Arrhythmia alarms can be switched on and off and the alarm settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here.

The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter.

The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).

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Yellow Arrhythmia Alarms

Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions.

Depending on your monitor and Information Center configuration, they may be shown with one or two stars. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply.

WARNING

When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (onestar). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms behave as usual.

Arrhythmia Alarms and Latching

When using arrhythmia analysis, Visual Latching and Audible Latching should be on for red alarms, or at least Visual Latching should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in

Configuration Mode.

Switching Individual Arrhythmia Alarms On and Off

Some arrhythmia alarms can be individually switched on or off. They are:

Non-Sustain

Multif.PVCs

,

Vent Rhythm

,

Run PVCs

,

Pair PVCs

,

R-On-T PVCs

,

V.Bigeminy

,

V.Trigeminy

,

, Pause , SVT , IrregularHR , Missed Beat , PVCs/min and Afib .

To switch individual alarms on or off, in the

Setup Arrhythmia

menu, select the alarm from the list to toggle between On and Off . The monitor displays the INOP message SOME ECG ALRMS OFF, if configured, when more alarms are switched off than configured in your active profile.

Switching All Yellow Arrhythmia Alarms On or Off

All yellow arrhythmia alarms can be switched on and off together. To do this,

• In the Setup Arrhythmia menu, select All Yellow Off or All Yellow On .

Adjusting the Arrhythmia Alarm Limits

Some arrhythmia alarms have limits which can be individually adjusted. They are:

VTach HR

Threshold

, VTach Run , PVCs/min , Vent Rhythm , SVT HR , SVT Run , Asystole Thresh.

, Pause

1

2

To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted.

Select the appropriate setting from the pop-up list.

Arrhythmia Alarm Timeout Periods

Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:

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• if a more serious alarm condition is active in the same chain

• if a timeout period is in effect for a particular alarm

• if a timeout period is in effect for a higher alarm in that chain.

See “Arrhythmia Alarm Chaining” on page 140 for more details on alarm chains.

What is a Timeout Period?

Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm. Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see

“Arrhythmia Alarm Chaining” on page 140.

To view the timeout period configured for your monitor, in the

Setup Arrhythmia

menu, see the menu items TimeOut 1st and TimeOut 2nd .

This setting can only be changed in Configuration Mode.

Resetting the Timeout Period

To reset the timeout period, select the

Alarms Off

or

Pause Alarms

permanent key and then reselect it.

How are Yellow Arrhythmia Alarms Indicated?

When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators. Yellow arrhythmia alarms are always set to latch visually for three minutes except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:

Alarm Condition Example

Single alarm instance

Continuous alarm condition

Same intermittent alarm condition

Non-sustained Vtach

Pair of PVCs

Short yellow alarm tone sounds Alarm message displayed

when alarm condition is initially detected

PVCs/min HIGH when alarm condition is initially detected and - as an alarm reminder - every time the configured timeout period has expired each time the alarm condition is detected, provided that the configured timeout period has expired for 3 minutes (latching time) until the alarm condition stops, plus a maximum of three minutes latching time

If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will get an alarm reminder every time the configured timeout period has expired.

If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared. Silencing an alarm does not reset its timeout period, so you will not get a realarm for the same condition or lower on the chain until the timeout expires.

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Arrhythmia Alarm Chaining

When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm "chains": PVC Alarms; Beat Detection Alarms, and Rate Alarms.

Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are occurring.

See “ECG and Arrhythmia Alarm Overview” on page 128 for information on which alarms are

included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 138

for an explanation of how alarm timeouts work.

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– If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain.

– Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated.

Understanding PVC-Related Alarms

PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs).

Example:

This diagram illustrates the conditions under which PVC alarms would be generated if the Vent

Rhythm Run limit is set to 12, the V-Tach Run Limit is set to 8, and the V-Tach HR Limit is set to 100.

You will see that

• if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated

• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated.

About ST Monitoring

The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor.

All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the monitor for ST Segment analysis.

ST analysis is always performed using a dedicated filter which ensures diagnostic quality. If you are monitoring ECG using an ECG filter mode other than Diagnostic, the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave. For diagnostic evaluation of the ST segment, always switch to Diagnostic filter mode or use the ST snippet.

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WARNING

Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example:

• if you are unable to get a lead that is not noisy

• if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline

• if the patient is continuously ventricularly paced

• if the patient has left bundle branch block.

You should consider switching ST monitoring off if these conditions are present.

This monitor provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.

ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for

ST monitoring in neonatal and pediatric modes is ST Analysis : Off .

Switching ST On and Off

To switch all ST monitoring on or off, in the

Setup ST Analysis

menu, select

ST Analysis

to toggle between

On

and

Off

.

Selecting Leads for ST Analysis

You select which leads to use for ST analysis in the Setup ST Analysis menu.

To see the current list of leads selected for ST analysis:

1

2

2

Enter the

Setup ST Analysis

menu.

Select

Setup ST Leads

. This opens the

Setup ST Leads

pop-up window. Leads chosen for ST monitoring are listed here. There are two pop-up keys at the bottom of the screen,

Add

and

Delete . If all leads are already selected, the Add pop-up key is disabled.

To choose a lead for ST monitoring:

1

Select the

Add

key at the bottom of the

Setup ST Leads

window. This opens the

Choices

pop-up window.

Choose a lead from the list for ST monitoring. This closes the

Choices

window and adds the selected lead to the list of chosen leads.

To disable ST monitoring for a lead:

1

2

Choose a lead from the list in the Setup ST Leads window.

Select the

Delete

key. This removes this lead from the list.

NOTE

The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen.

To change the order in which ST leads are displayed,

1

2

In the

Setup ST Leads

menu, choose a lead from the list.

Select the

Sort Up

or

Sort Down

key to move the lead up or down in the list.

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Understanding the ST Display

Your monitor screen may be configured to look slightly different from the illustrations.

1

2

3

ST numerics

Current HR alarm limits

Current heart rate

ST Numerics

Up to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet.

A positive ST value indicates ST segment elevation; a negative value indicates depression.

ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the Setup ST Analysis Î Setup ST Leads list. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric.

ST Index

The ST index numeric ( STindx ) is the sum of the absolute values for the ST leads V2, V5, aVF.

Because it is based on absolute values, it is always a positive number. If you haven't selected one of the leads V2, V5, and aVF for ST analysis, the STindx numeric will display a question mark "?".

To switch the ST index numeric on or off for display, in the

Setup ST Analysis

menu, select

ST-Index to toggle between

On

and

Off

.

ST Snippets

ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient.

The information is updated once per minute.

If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select a Screen configured to show snippets from the pop-up list of available Screens.

ST Baseline Window

The ST Baseline Window shows an ST snippet drawn on a grid. The current ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between these two numerics.

A "?" in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored.

The Baseline Window opens with the ST pop-up keys Update Baseline , Record ST , Change ST Lead ,

Adjust ST Points

,

ST Map

and arrow keys for scrolling through the available leads.

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5 ECG, Arrhythmia, ST and QT Monitoring

To view the ST Baseline window, select any snippet on the Screen.

6

7

4

5

1

2

3

ST label and numeric

Baseline ST numeric and difference since baseline was stored

Difference between current values and baseline values

1 mV calibration bar

Current snippet

ST baseline

Timestamp of most recently stored baseline snippet

Updating ST Baseline Snippets

ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear.

The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines,

1

2

Select an ST snippet to open the ST Baseline window.

In the

ST Baseline

window, select

Update Baseline

to store all current snippets as baselines. This deletes all previously-stored baselines.

An ST baseline copy is also stored in the MMS, for transport purposes.

Recording ST Segments

To record all currently available ST snippets and baselines, in the ST Baseline window, select the popup key

Record ST

.

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About the ST Measurement Points

The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.

1

R-wave peak at 0 msec

2

J point, for example, 48 msec

3

Difference = ST value

4

ST measurement point, for example, J + 60 msec

5

Isoelectric point set to -80 msec

6

P

7

Q

8

S

9

T

CAUTION

The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus the placement of the ST point. Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set.

Always ensure that ST measurement points are appropriate for your patient.

Adjusting ST Measurement Points

Depending on your monitor's configuration, the ST point can be positioned either

• relative to the J-point.

In the Adjust ST Points window, the pop-up keys ISO Point , J Point and ST Point are visible and can be adjusted.

or

• directly by selecting a numeric value for the ST point.

In the

Adjust ST Points

window, you can adjust the ISO and ST point.

The

ST Uses

setting can only be changed in Configuration Mode.

To adjust the ST measurement points,

1

2

In the

Setup ST Analysis

menu, select

Adjust ST Points

to open the

Adjust ST Points

window.

Alternatively, you can use the Adjust ST Points pop-up key in the ST Baseline window.

Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads.

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5 ECG, Arrhythmia, ST and QT Monitoring

3

Use the Select Point pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active.

146

1 ST label and the ST numeric that would apply using the current points

2 1mV calibration bar

3 Cursors for adjusting ST points

4 Timestamp of most recent ST point adjustment

5 Highlighted ST point

The ISO-point cursor (1) positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds. 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 cursor (2) positions the J-point relative to the R-wave peak. It helps you to correctly position the ST-point. Position the J-point at the end of the QRS complex and the beginning of the ST segment.

The J-point cursor is not available if your monitor is configured to let you set the ST point directly.

5 ECG, Arrhythmia, ST and QT Monitoring

4

5

To position the ST-point (3) relative to the J-point: select either

J+60

or

J+80

. Select

J Point

and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment.

To position the ST-point directly: select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the

ST segment.

Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all ST values.

The most recent ST Points adjustment time is displayed in the

Adjust ST Points

window. This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor.

To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key.

ST Alarms

ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads.

If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits.

Single- or Multi-lead ST Alarming

Be aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead will be announced.

To choose individual or multi-lead ST alarming,

• In the

Setup ST Analysis

menu, select

ST Alarm Mode

and select either

Single ST

or

Multi ST

.

Changing ST Alarm Limits

The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.

1

2

3

In the

Setup ST Analysis

menu, select

ST Alarm Mode

and select

Single ST

or

Multi ST

.

Select the alarm to be adjusted.

Select the appropriate setting.

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5 ECG, Arrhythmia, ST and QT Monitoring

Viewing ST Maps

The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in

ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the

ECG parameter.

Current View

In current view, the monitor displays an ST map that corresponds to the current ST values. Three or more leads per plane are necessary to display a map.

The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads.

148

1

Alarm status indicator

2

EASI Limb Leads

3

EASI Chest Leads

4

ST index (for EASI)

5

6

ST label, value and polarity of corresponding lead

ST map

If an ST lead is switched off, its axis is not shown in the map.

5 ECG, Arrhythmia, ST and QT Monitoring

If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is off), the area formed by the remaining ST leads is left open.

If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.

Trend View

In trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old.

The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values on the diagrams show the current ST values.

If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off

20 seconds ago. The current ST values and the first trended value reflect this change in the lead setup.

All other maps are displayed the way in which they were recorded.

1

Limb Leads

2

Chest Leads

3

current ST values

4

trending interval

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5 ECG, Arrhythmia, ST and QT Monitoring

In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed.

Viewing an ST Map

To display an ST map,

• In the

Main Setup

menu, select

ST Map

.

Working in the ST Map Task Window

You may need to activate the ST map task window to see all the data, and to access the pop-up keys.

Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here.

Switching Between ST Map Views

To switch between views,

• Select

Current View

or

Trend View

to toggle between views.

If your trend view is empty, you need to adjust the priority of this measurement in the trending priority

list. See “Trend Priority” on page 278.

Displaying an ST Reference Baseline

You can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request.

Select Show Baseline / Hide Baseline to toggle between baseline display on and off.

Updating an ST Map Reference Baseline

To update the baseline,

• In the

Setup ST Analysis

menu, select

ST Baseline Î Update Baseline.

Changing the Scale of the ST Map

To change scale,

• Select Size Up or Size Down to alter the size at which monitor displays the map.

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5 ECG, Arrhythmia, ST and QT Monitoring

Changing the Trending Interval

To determine how frequently the monitor displays a trended sample,

1

In Trend view, select

Select Interval

.

2

Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.

Printing an ST Map Report

To print the most recently viewed (current or trend) window,

1

2

3

Select

Main Setup Î Reports

.

Select

ST Map

.

Press Print .

About QT/QTc Interval Monitoring

The QT interval is defined as the time between the beginning of the Q-wave and the end of the Twave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome.

The QT interval (1) has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in

Configuration Mode.

For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned on.

QT Measurement Algorithm

The QT values are updated every five minutes except in the initial phase (first five minutes) where they are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing. Normal beats followed by a premature QRS will be excluded from the measurements to prevent the premature beat from obscuring the end of the T-wave. If the algorithm cannot form a representative waveform, for example because the morphology of the beats is too varied, a CANNOT ANALYZE QT INOP will be generated after 10 minutes. This is also the case if normal beats have been falsely labeled so that the algorithm does not have enough valid beats to make QT measurements. No QT value is calculated if the QT-HR is >150 bpm (Adult) or >180 bpm (Pedi/Neo).

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5 ECG, Arrhythmia, ST and QT Monitoring

Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor.

Where Can I Find More Information?

See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick

Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance.

Indications For Use Of QT Interval Monitoring

Of special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category.

Limitations For Use Of QT Interval Monitoring

Some conditions may make it difficult to achieve reliable QT monitoring, for example:

• the T-wave is very flat

• T-waves are not well defined due to atrial flutter or atrial fibrillation

• the end of the T-wave is difficult to define because of the presence of U-waves

• a high heart rate causes the P-wave to encroach on the end of the previous T-wave

• noise or high QRS morphology variation

For these cases you should select a lead with a good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave.

Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.

Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm.

If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured.

When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable

QTc calculation it is important to avoid a region where the heart rate is changing.

WARNING

QT/QTc measurements should always be verified by a qualified clinician.

Selecting The QT Leads

For QT Monitoring you can select one of the following three modes:

• All Leads mode - all available leads (I, II, III, V, MCL, V1 - V6) are used to produce a global QT measurement. For EASI lead placement, directly acquired AI, AS and ES leads are used.

• Primary-Lead mode - the primary lead will be used for QT measurement. If the original primary lead becomes unavailable or is changed, QT measurement will continue with the new primary lead.

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5 ECG, Arrhythmia, ST and QT Monitoring

• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable.

To select the mode,

1

2

Select the QT numeric to enter the Setup QT Analysis window.

Select QT Lead and select

All

,

Primary Lead

or one of the available single leads.

When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads.

Changing the lead(s) used for QT measurements will not cause the baseline to be reset.

QT View

In the

QT View

window you can verify that the QT algorithm detects correct Q and T points.

The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray.

The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads.

Changing The View To A Single Wave Set

To view one set of waves in a larger scale, you can cycle through the different views,

1

2

3

Select Current view to see the set of current waves.

Select

Baseline

view to see the set of baseline waves.

Select

Split

view to return to the combined view with current and baseline waves.

Setting The QT Baseline

In order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the effect of medication on the QT interval you can set the current value as the baseline before you begin medication. This baseline will then be used to calculate the ΔQTc value.

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5 ECG, Arrhythmia, ST and QT Monitoring

To set the baseline,

• Select Set Baseline and set the value.

If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the ΔQTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a ΔQTc alarm from being generated. Discharging a patient clears the baseline.

Printing The QT Waves

To start a printout,

• Select Print QT .

Recording The QT Waves

To start a recording,

• Select

Record QT

.

QT Alarms

There are two QT alarms, QTc high limit alarm and ΔQTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The ΔQTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes.

The

CANNOT ANALYZE QT

INOP and the -?- will be displayed when no QT measurement could be calculated for 10 minutes. Up to this time the previous valid value will be displayed. The following additional messages on the cause of the invalid measurements may also be displayed.

Additional Message

QT Startup

Asystole or Leads Off

Insufficient Valid Leads

Invalid Rhythm for QTc

High QT-HR

Small R Wave

Small T Wave

Cause of Invalid QT Measurement

QT monitoring was just turned on or has been reset

1

Not all specified leads needed to perform QT analysis are available, or

2

Asystole condition is detected

Not enough valid QRS complexes to generate a QT measurement

Not enough valid RR intervals to generate QT-HR, the averaged HR used for QTc calculation

QT-HR exceeds the specified upper limit of 150 bpm (for adults) or

180 bpm (for neonates and pediatrics)

R-wave of the signal is too small

T-wave of the signal is too small

154

Additional Message

End of T not Detected

QT out of Range

QTc out of Range

QTc Erratic

5 ECG, Arrhythmia, ST and QT Monitoring

Cause of Invalid QT Measurement

End of the T-Wave cannot be accurately detected

QT measurement is outside the specified range of valid QT values

(200-800 msec)

QTc measurement is outside the specified range of valid QTc values

(200-800 msec)

QTc measurements are not stable

Switching Individual QTc Alarms On and Off

Each QTc alarm can be switched off individually.

To switch an alarm on or off, in the Setup QT Analysis menu, select QTc High Alarm or ΔQTc High

Alarm

to toggle between

On

and

Off

.

Changing QTc Alarm Limits

Set the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits.

1

2

In the

Setup QT Analysis

menu, select

QTc High Limit

.

Select the appropriate setting.

3

4

Select ΔQTc High Limit .

Select the appropriate setting.

Switching QT Monitoring On and Off

To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analysis to switch between

On

and

Off

.

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5 ECG, Arrhythmia, ST and QT Monitoring

156

6

6

Monitoring Pulse Rate

The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO

2

signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the

Setup Pulse

menu to check whether it is switched on.

Entering the Setup Pulse Menu

If a pulse numeric is displayed on the screen, select it to enter the setup menu for that pulse source. If no pulse numeric is visible, in the

Setup SpO₂

menu or the setup menu from an arterial pressure, select pulse with the correct source, e.g.

Pulse (HR)

.

System Pulse Source

The currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:

• is monitored as system pulse and generates alarms when you select pulse as the active alarm source

• is sent via the network to the Information Center, if available

• is trended in the HighRes Trends and stored in the monitor's databases.

To define which pulse rate is used as system pulse,

1

2

In the Setup Pulse menu, select System Pulse .

Select one of the SpO

2

or arterial pressure labels from the pop-up list, or select

Auto

.

If you select Auto , the monitor automatically chooses a pulse rate to be used as system pulse. It looks through the list from top to bottom and activates the first pulse rate that is switched on and available.

If your selected pulse source measurement becomes unavailable or is switched off, the monitor will use the next measurement from the list as system pulse until the selected pulse source measurement becomes available again.

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6 Monitoring Pulse Rate

Switching Pulse On and Off

To switch a particular pulse numeric on or off, enter the

Setup Pulse

menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO

2

pulse numeric on or off,

1

2

Enter the

Setup Pulse

menu by selecting the Pulse numeric or by selecting

Pulse

in the

Setup

SpO₂ menu.

In the

Setup Pulse

menu, select the correct pulse label, e.g.

Pulse (SpO₂)

, to toggle between

On and Off .

Using Pulse Alarms

You can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the

Setup Pulse

menu or the

Setup ECG

menu by selecting

Alarm Source

. Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms.

Pulse alarms are only generated when the active alarm source is set to Pulse, a pulse source is set as system pulse and pulse alarms are switched on.

Selecting the Active Alarm Source: ECG or Pulse?

In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the monitor uses either ECG or Pulse as its active alarm source. To change the alarm source, select

Alarm Source

in the

ECG/Pulse Alarms

menu, then select

• ECG : if you want the HR to be the alarm source for HR/Pulse.

• Pulse : If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off.

• Auto : If the alarm 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 at least one

ECG lead can be measured without an INOP condition.

The monitor will automatically switch to Pulse as the alarm source if:

– a valid ECG lead can no longer be measured and

– a Pulse source is switched on and available,

The monitor then uses the pulse rate from the measurement currently active as system pulse.

While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source.

Note:

If ECG is switched off, the monitor will always change to Pulse as alarm source, if a Pulse is available.

One exception to this rule can arise when you have a telemetry device paired with your monitor. The monitor ECG is then deactivated but the monitor may be configured to allow only ECG as the active alarm source. In this case the monitor will not switch to Pulse as alarm source and Pulse will not be available as a selection in the ECG/Pulse Alarms menu.

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6 Monitoring Pulse Rate

WARNING

Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the

section “ECG and Arrhythmia Alarm Overview” on page 128, including Asystole, Vfib and Vtach

alarms, and the heart rate alarms. This is indicated by the message

ECG/ARRH ALARM OFF

(unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow

(medium severity) INOP after a fixed number of hours.

High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.

Alarm Source Selection Disabled

If you cannot change the alarm source, selection of the alarm source may be disabled. If you try to change the source, the monitor displays the message

To activate enter Config and enable Alarm

Source Selection

. This setting can only be changed in Configuration Mode.

Changing HR/Pulse Alarm Limits

As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the

Setup

Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO

2

is 30 bpm; from HR 15 bpm, and from Pressure 25 bpm.

Extreme Alarm Limits

The extreme rate alarms, *** EXTREME TACHY and *** EXTREME BRADY , generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm limits. You need to know what value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

• To see the values added to the high and low limit alarms to create the extreme rate alarms for your monitor, in the

Setup ECG

menu, see the menu items

Δ ExtrTachy

and

Δ ExtrBrady

.

QRS Tone

The active alarm source is also used as a source for the QRS tone. You can change the tone volume in the Setup SpO₂ and Setup ECG menus and the QRS tone modulation in the Setup SpO₂ menu.

WARNING

The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis.

If arrhythmia detection is needed, do not rely on the audible QRS tone.

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6 Monitoring Pulse Rate

160

7

7

Monitoring Respiration Rate

(Resp)

For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two

ECG electrodes on the patient's chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).

Lead Placement for Monitoring Resp

Correct patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG.

The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI™ placement - to measure Resp, as long as you use ICU ECG cables.

The Resp signal is always measured between two of the ECG electrodes. If you are using standard

ECG electrode placement, Resp is measured between the RA and LL electrodes. If you are using

EASI™ ECG electrode placement, Resp is measured between the I and A electrodes.

Optimizing Lead Placement for Resp

If you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients.

Repositioning ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation.

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 electrode 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.

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7 Monitoring Respiration Rate (Resp)

Lateral Chest Expansion

Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum point of breathing movement to optimize the respiratory wave.

Abdominal Breathing

Some patients with restricted chest 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.

Understanding the Resp Display

The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text

HR = RR

next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration.

1

2

3

4

Resp wave label

One Ohm calibration bar

Manually-set Resp detection level

Resp numeric and label

Changing Resp Detection Modes

The Resp detection level can be set either automatically or manually.

• To change the resp detection mode, in the

Setup Resp

menu, select

Detection

to toggle between the settings.

Auto Detection Mode

In Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode,

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7 Monitoring Respiration Rate (Resp)

• the detection level (a dotted line) is not displayed on the waveform,

• the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient.

If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.

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).

Manual Detection Mode

In Manual Detection Mode you must set the Resp detection level.

• In the

Setup Resp

menu, select

Manual Up

or

Manual Down

. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached.

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.

Resp Detection Modes and Cardiac Overlay

In Auto Detection Mode:

If you are monitoring Resp and the 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 a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac 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” on page 162.

Changing the Size of the Respiration Wave

WARNING

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.

• In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to decrease it.

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7 Monitoring Respiration Rate (Resp)

Changing the Speed of the Respiration Wave

Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.

• Select the Resp wave to enter the

Resp Wave

menu, then select

Change Speed

. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).

Using Resp Alarms

Resp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter.

Changing the Apnea Alarm Delay

The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm.

1

2

In the

Setup Resp

menu, select

Apnea Time

.

Select the appropriate setting.

Resp Safety Information

WARNING

Respiration detection level

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.

Apnea

The respiration measurement does not recognize obstructive and mixed apneas — it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.

The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

Interference

If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated Immunity 3V/ m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit.

Resp Accessories

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7 Monitoring Respiration Rate (Resp)

To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set.

This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery is being performed.

Rate adaptive pacemakers

Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the

Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.

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7 Monitoring Respiration Rate (Resp)

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8

8

Monitoring SpO2

Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements:

• Oxygen saturation of arterial blood (SpO

2

) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).

• Pleth waveform - visual indication of patient's pulse.

• Pulse rate (derived from pleth wave) - detected pulsations per minute.

• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation.

The monitors are also compatible with SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information.

SpO2 Sensors

Depending on the purchased SpO

2

option, different sensors and adapter cables can be used. The sensors for the different options are color-coded to match the connectors. See the section on

Accessories for a compatibility table.

Familiarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site.

CAUTION

Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors when there is a known allergic reaction to the adhesive.

Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor.

Applying the Sensor 2

1

2

Follow the SpO

2

sensor's instructions for use, adhering to all warnings and cautions.

Remove colored nail polish from the application site.

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8 Monitoring SpO2

3

4

Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure.

When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7 and 8 mm (0.27" and 0.31"). When applying a M1193A neonatal sensor do not overtighten the strap.

Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient's tissue.

WARNING

Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site at least every four hours.

Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.

Ambient Temperature: At elevated ambient temperatures be careful with measurement sites that are not well perfused, because this can cause severe burns after prolonged application. All listed sensors operate without risk of exceeding 41°C on the skin if the initial skin temperature does not exceed

35°C.

Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, an NBP cuff or an intravascular venous infusion line.

Connecting SpO2 Cables

Connect the sensor cable to the color-coded socket on the measurement device (MMS or module).

You can connect some Philips sensors directly to the measurement device. For other sensors, use the corresponding adapter cable.

CAUTION

Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "long" cable version).

Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.

Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.

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8 Monitoring SpO2

Measuring SpO2

1

2

Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO

2

and pulse numerics.

During measurement, ensure that the application site:

– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.

– has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.

WARNING

• Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours.

• Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.

• Inaccurate measurements may result when the application site for the sensor is deeply pigmented or deeply colored, for example, with nail polish, artificial nails, dye or pigmented cream.

• Interference can be caused by:

– High levels of ambient light (including IR warmers) or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.)

– Another SpO

2

sensor in close proximity (e.g. when more than one SpO

2

measurement is performed on the same patient). Always cover both sensors with opaque material to reduce cross-interference.

– Electromagnetic interference, especially at perfusion indicator values below 1.0 and signal quality indicator below medium.

– Excessive patient movement and vibration.

SpO2 Signal Quality Indicator (Fast SpO2 only)

The SpO

2

numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the displayed values.

The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled.

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8 Monitoring SpO2

Assessing a Suspicious SpO2 Reading

Traditionally, pulse rate from SpO

2

was compared with heart rate from ECG to confirm the validity of the SpO

2

reading. With newer algorithms, such as FAST-SpO

2

, this is no longer a valid criteria because the correct calculation of SpO

2

is not directly linked to the correct detection of each pulse.

When pulse rate is very low, or strong arrhythmia is present, the SpO

2

pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO

2

value.

If you doubt the measured SpO

2

, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality.

WARNING

With pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or electromagnetic interference can give unexpected intermittent readings when the sensor is not attached. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling.

Changing the Averaging Time

Depending on the monitor configuration, you may be able to change the averaging time for the SpO

2 values.

The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO

2

technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO

2

value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high.

1

2

In the Setup SpO₂ menu, select Average .

Select the required averaging time from the list.

Understanding SpO2 Alarms

This refers to SpO

2

specific alarms. See the “Alarms” on page 47 chapter for general alarm

information. SpO

2

offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit.

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8 Monitoring SpO2

CAUTION

If you measure SpO

2

on a limb that has an inflated noninvasive blood pressure cuff, a non-pulsatile

SpO

2

INOP can occur. If the fetal monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating a critical status, such as sudden pulse loss or hypoxia.

Alarm Delays

There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components:

• The general system delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and the configured averaging time. The longer the averaging time configured, the longer the time needed until the numerical values reflect the physiological event.

• The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the combination of the configured alarm delay time plus the general system alarm signal delay time.

The alarm delay time can be configured to a fixed value (between 0 and 30 seconds) or the monitor can

be configured to apply a delay based on an intelligent algorithm. See “About Smart Alarm Delays” on page 171 for details on how this works.

See “Performance Specifications” on page 405 for delay specifications.

About Smart Alarm Delays

The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.

The monitor can be configured to apply a delay before announcing SpO

2

limit alarms. The delay is calculated using an intelligent algorithm. This capability can be used to suppress alarms which occur because a limit is exceeded for a short time or by a small amount.

WARNING

Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are.

The following factors are considered when calculating the delay:

• the amount by which a limit is exceeded

• the time it is exceeded for, and hence

• the speed with which the values change when a limit is exceeded

If the measured value rises, or falls, very quickly, an alarm will be announced with only a short delay. If the value changes slowly, the delay will be longer before an alarm is announced. And if the value changes slowly and only for a short time, an alarm may not be announced at all. Here are some specific examples to illustrate this.

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8 Monitoring SpO2

Examples

In the examples, the SpO

The measured SpO

2

2

low alarm limit is set to 90%, and the Smart Alarm Delay is configured on. signal is represented by the dotted curve. The vertical axis (V) shows the change in the SpO

2

value and the horizontal axis (T) shows the time.

In example 1, the SpO

2

value is dropping quickly and goes below the low alarm limit at the point marked a. At the point marked b it also crosses into the shaded area which represents the Smart Alarm

Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between a and b, is short.

In example 2, the SpO

2

value is dropping more slowly and goes below the low alarm limit at the point marked c.At the point marked d it also crosses into the shaded area which represents the Smart Alarm

Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between c and d, is this time longer.

In example 3, the SpO

2

value drops slowly below the low alarm limit and after a short time increases again above the limit. As the value never crosses into the shaded area which represents the Smart

Alarm Delay criteria, no alarm is announced.

However, if a limit is exceeded by a small amount for a very long time, an alarm will be announced. For this case there is a maximum delay time after which an alarm will always be announced.

Configuration

To accommodate different levels of patient stability, there are three different Smart Alarm Delay settings: Short , Medium and Long , which correspond to three different sets of criteria (three different shaded areas). The appropriate setting for the treatment area where the monitor is to be used is decided during monitor configuration. The

Short

setting ensures a quick response to changing conditions for less stable patients. The

Medium

and

Long

settings extend the delay to avoid unnecessary alarms for more stable patients. For detailed numeric information about the different settings, see the SpO

2

section in the Specifications chapter. For background information as a basis for the decision for a specific setting, see the Configuration Guide.

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8 Monitoring SpO2

Adjusting the Alarm Limits

In the Setup SpO₂ menu:

• Select

High Limit

then choose the high alarm limit.

• Select

Low Limit

then choose the low alarm limit.

WARNING

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.

Adjusting the Desat Limit Alarm

The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation.

1

2

In the

Setup SpO₂

menu, select

Desat Limit

.

Adjust the limit.

Pleth Wave

The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.

1 Minimum size for reliable SpO

2

value

Perfusion Numeric

The perfusion numeric ( Perf ) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow.

As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO

2

measurement. Above 1 is optimal, between 0.3-1 is acceptable.

Below 0.3 is marginal; reposition the sensor or find a better site.

Perfusion Change Indicator

The perfusion change indicator is a graphic symbol which shows the change in the perfusion value, relative to a reference value which you can set.

To set the current perfusion value as the reference value:

• In the

Setup SpO₂

menu, select

Set Perf Ref.

.

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8 Monitoring SpO2

When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric.

1 Perfusion change indicator

Setting SpO2/Pleth as Pulse Source

1

2

In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu.

In the Setup Pulse menu, select System Pulse and select the correct SpO

2

label from the pop-up list.

Setting Up Tone Modulation

If tone modulation is on, the QRS tone pitch lowers when the SpO

2

level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.

In the

Setup SpO₂

menu, select

Tone Modulation

to switch between

Yes

(for on) and

No

(for off).

Tone modulation is licensed under US patent US 4.653.498 from Nellcor Puritan Bennett

Incorporated.

Setting the QRS Volume

In the Setup SpO₂ menu, select QRS Volume and set the appropriate QRS tone volume.

Calculating SpO2 Difference

When a second SpO

2

measurement is present (either through the SpO device), the monitor displays both SpO

2

values, and calculates the difference between them. The second value is subtracted from the first.

2

module or through an external

1

2

3

4

5

From the

Main Setup

menu, select

Measurements

.

From the

Setup ΔSpO₂ menu, select

First SpO₂

.

Choose the first measurement source.

Select Second SpO₂ .

Choose the second measurement source.

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9

9

Monitoring NBP

This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National

Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements

(depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure.

In neonatal mode, the blood pressure measurements determined with this device comply with the

American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-

1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.

The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.

A physician must determine the clinical significance of the NBP information.

Introducing the Oscillometric NBP Measurement

Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish.

Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques.

WARNING

Patient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients.

Intravenous infusion: Do not use the NBP 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.

Skin Damage: Do not measure NBP in cases of sickle-cell disease or any condition where skin damage has occurred or is expected.

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9 Monitoring NBP

Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements in cases of severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff.

CAUTION

If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.

Measurement Limitations

Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine.

The measurement may be inaccurate or impossible:

• with excessive and continuous patient movement such as shivering or convulsions

• if a regular arterial pressure pulse is hard to detect

• with cardiac arrhythmias

• with rapid blood pressure changes

• with severe shock or hypothermia that reduces blood flow to the peripheries

• with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery

• on an edematous extremity.

The effectiveness of this sphygmomanometer has not been established in pregnant, including preeclamptic patients.

Measurement Modes

There are four modes for measuring NBP:

• Manual - measurement on demand.

• Auto - continually repeated measurements (between one minute and 24 hours adjustable interval).

Sequence

- up to four measurement cycles which will run consecutively, with number of measurements and interval between them configurable for each cycle.

STAT

- rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients.

Reference Method

The measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-arterial). For further information, see the Application Note supplied on the monitor documentation DVD.

In Neonatal mode, to comply with safety standards, invasive is always used as the reference method.

This setting cannot be changed and is not visible in any operating mode.

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9 Monitoring NBP

In Adult and Pediatric mode, to check the current setting, select Main

Setup Î

Invasive

Measurements Î NBP

, and check whether the

Reference

. This setting can only be changed in Configuration Mode.

setting is set to

Auscultatory

or

Preparing to Measure NBP

1

2

3

4

Connect the cuff to the air tubing.

Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing.

Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted.

A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb.

Apply the cuff to a limb at the same level as the heart. If it is not, you must use the measurement correction formula to correct the measurement.

The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements.

Correcting the Measurement if Limb is not at Heart Level

To correct the measurement if the limb is not at 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 or add 1.9 mmHg (0.25 kPa) for each inch higher.

deduct 1.9 mmHg (0.25 kPa) for each inch lower.

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9 Monitoring NBP

Understanding the NBP Numerics

1

4

5

2

3

6

7

Alarm source

Measurement Mode

Timestamp/Timer

Mean pressure

Diastolic

Systolic

Alarm limits

Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values.

The measured NBP value, together with the corresponding pulse rate if this is switched on, will be displayed for one hour. After that the values are regarded as invalid and are no longer displayed. In

Auto mode the measurement values may disappear more quickly (to be replaced by new measurement values), if the repeat time is set to less than one hour.

Alarm Sources

If you have parallel alarm sources, the sources are displayed instead of the alarm limits.

NBP Timestamp

Depending on your configuration, the time shown beside the NBP numeric can be:

– the time of the most recent NBP measurement, also known as the "timestamp", or

– the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here.

The NBP timestamp will normally show the completion time of the NBP measurement. Only under the following conditions the timestamp shows the beginning of the measurement:

• when in Auto or Sequence mode, and

• the monitor is configured to synchronize the measurements in a measurement series to an "easyto-document time. For example, if you start the first measurement at 08:23, and the Repeat Time is set to 10 minutes, the monitor automatically performs the next measurement at 8:30, then 8:40 and so on.

During Measurements

The cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement.

Starting and Stopping Measurements

Use the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements.

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9 Monitoring NBP

Action to be performed

Start manual measurement

Start Auto series

Start STAT measurement

NBP Setup menu SmartKeys

Start/Stop

Start/ Stop

MMS hardkey

Start/Stop

---

Start NBP

NBP STAT

STAT (for MMS without Pressure/

Temp measurement)

NBP STAT

Stop Manual measurements

Start/Stop

Start STAT

Start/Stop

Start/ Stop

Stop current Auto measurement

Start/Stop

Stop NBP

Start/Stop

Start/ Stop

Stop current STAT measurement and end series

Stop Auto, Manual or STAT measurement AND series

Start/Stop

NBP STAT

Stop All

Stop NBP

Start/Stop

Start/ Stop

STAT (for MMS without Pressure/

Temp measurement)

NBP STAT

Stop NBP

Stop All

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9 Monitoring NBP

CAUTION

Use clinical judgment to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff.

Enabling Automatic Mode and Setting Repetition

Time

1

2

In the

Setup NBP

menu, select

Mode

and select

Auto

from the pop-up menu.

For an automatic measurement, select

Repeat Time

and set the time interval between two measurements.

Enabling Sequence Mode and Setting Up The

Sequence

1

2

3

4

In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.

Select

Setup Sequence

to open the

Setup Sequence

window.

Up to four measurement cycles can be setup which will run consecutively. For each cycle you can set the number of measurements and the interval between them. If you want to run less than four cycles in a sequence, you can set the number of measurements for one or more cycles to

Off

.

Select each sequence in turn and select the number of measurements and the time interval between the measurements.

To have measurements continue after the sequence, set the number of measurements for your last cycle to

Continuous

and this cycle will run indefinitely.

CAUTION

Be aware that, if none of the cycles are set to Continuous , NBP monitoring will end after the last measurement of the cycle.

When the NBP measurement mode is set to

Sequence

, the repetition time for

Auto

mode cannot be changed.

Choosing the NBP Alarm Source

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic.

In the Setup NBP menu, select Alarms from and choose from:

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9 Monitoring NBP

Menu option

Sys.

Dia.

Mean

Sys & Dia

Dia & Mean

Sys & Mean

Sys&Dia&Mean

Pressure value monitored

systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel

If

Mean

is not selected as alarm source (

Sys.

,

Dia.

, or

Sys & Dia

selected), but the monitor can only derive a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits. Check that the mean alarm limits are appropriate for the patient, even when not using mean as the alarm source. When no value can be derived an

NBP MEASURE FAILED

INOP will be displayed.

Switching Pulse from NBP On/Off

In the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse value is displayed together with the time the measurement was made. After one hour the value becomes invalid. There are no alarms associated with pulse from NBP.

To switch the display of the pulse value on or off:

• In the

Setup NBP

menu select

Pulse (NBP)

.

Assisting Venous Puncture

You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.

1

2

In the Setup NBP menu select VeniPuncture .

Puncture vein and draw blood sample.

3

Reselect

VeniPuncture

to deflate the cuff.

During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode.

NOTE

Performing a venous puncture while automatic or sequence NBP measurements in are being made suspends the measurement series for the duration of the venous puncture inflation and for three minutes afterwards.

Calibrating NBP

NBP is not user-calibrated. Cuff-pressure transducers must be verified at least once every two years by a qualified service professional, and calibrated, if necessary,. See the Service Guide for details.

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9 Monitoring NBP

182

10

10

Monitoring Temperature

WARNING

Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension

(865297).

You can measure temperature using an X1 or X2 Multi-Measurement Module (MMS), one of the

MMS extensions, or the temperature plug-in module.

Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.

Making a Temp Measurement

5

6

3

4

1

2

Select the correct type and size of probe for your patient.

If you are using a disposable probe, connect the probe to the temperature cable.

Plug the probe or temperature cable into the temperature connector socket.

Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.

Select an appropriate temperature label.

Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement.

WARNING

Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.

Selecting a Temperature for Monitoring

Tell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that label's stored color and alarm settings.

1

In the Setup <Temp Label> menu, select Label.

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10 Monitoring Temperature

2

Select the appropriate label from the list.

Temp

Tart

Tcore

Tesoph non-specific temperature label arterial temperature core temperature esophageal temperature

Trect

Tskin

Tven

Tnaso rectal temperature skin temperature venous temperature nasopharyngeal temperature

Extended Temperature Label Set

The following additional labels are available if Label Set is set to Full . This setting can only be changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.

T1

,

T2

,

T3

,

T4

Tamb

Tcereb

Ttymp

Tvesic

Non-specific temperature labels ambient temperature cerebral temperature tympanic temperature vesical temperature

Calculating Temp Difference

The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled

ΔTEMP

.

1

In the

Main Setup

menu, select

Measurements

.

2

3

In the Setup ΔTemp menu, select First Temp .

Label the measurement source as appropriate.

4

5

Select

Second Temp

.

Label the measurement source as appropriate.

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11

11

Monitoring Invasive Pressure

WARNING

Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension

(865297).

CAUTION

Do not use the X2 in combination with monitors using an M1006A pressure module and the

HP1290A pressure transducer. This may cause interference on the respiration or invasive pressure signals.

You can measure pressure using an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions or the pressure plug-in module. With the plug-in module you may see a wave channel before the pressure cable is plugged in - with the MMS this will not be the case.

Setting up the Pressure Measurement

1

2

3

Plug in the pressure cable.

Prepare the flush solution.

Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.

WARNING

If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading.

1

2

Connect the pressure line to the patient catheter.

If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.

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11 Monitoring Invasive Pressure

3

Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.

WARNING

If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient's ear. Incorrect leveling may give incorrect values.

Selecting a Pressure for Monitoring

Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that label's stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values.

1

2

In the Setup <Press Label> menu, select Label .

Select the appropriate label from the list.

Label

ABP

ART

Ao

CVP

ICP

LAP

Description Label

Arterial blood pressure

P

Arterial blood pressure (alternative) PAP

Aortic pressure

RAP

Central venous pressure

Intracranial pressure

UAP

UVP

Left atrial pressure

Description

Non-specific pressure label

Pulmonary artery pressure

Right atrial pressure

Umbilical arterial pressure

Umbilical venous pressure

Extended Pressure Label Set

The following additional labels are available if

Label Set

is set to

Full

. This setting can only be changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.

Label

BAP

FAP

IC1

,

IC2

P1

,

P2

,

P3

,

P4

Description

Brachial arterial pressure

Femoral arterial pressure

Alternative intracranial pressures

Alternative non-specific pressure labels

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11 Monitoring Invasive Pressure

Zeroing the Pressure Transducer

To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy. You must perform a zero:

• when you use a new transducer or tubing

• every time you reconnect the transducer cable to the monitor

• if you think the monitor's pressure readings are not correct.

When using a pressure module, the zero information is stored in the module. When a pressure module, with the transducer connected, is plugged into the monitor, the monitor will use the Zero stored in the module.

Zeroing ICP (or IC1/IC2)

Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values are automatically stored and you will not be prompted to repeat the zero procedure.

If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the

Multi-Measurement module or pressure module while zeroing. Reconnecting the transducer recalls the stored values.

WARNING

If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero.

Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturer's instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient.

Determining a Pressure's Most Recent Zero

The monitor displays the most recent zero on the status line. If this has "timed-out" after you have performed a zero, redisplay the information in the status line by entering the pressure's setup menu.

Zeroing a Pressure Measurement

WARNING

Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing.

1

2

3

Turn off the stopcock to the patient.

Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer.

In the setup menu for the pressure, select

Zero <Press Label>

.

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11 Monitoring Invasive Pressure

4

When you see the message <Press Label> zero done at <date and time> on the status line, close the stopcock to atmospheric pressure, and open the stopcock to the patient.

CAUTION

When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure.

Using the Zero Hardkey

Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module.

Pressing the Zero hardkey for two seconds on the M3001A Multi-Measurement module zeros the pressure being measured by the Multi-Measurement module and the pressures from any connected

MMS extensions.

Zeroing All Pressures Simultaneously

WARNING

Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.

If you are measuring pressures with more than one measuring device, using the

Zero Press

SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select

All Press to zero all pressures simultaneously.

Troubleshooting the Zero

The status line lists the probable cause of an unsuccessful zero:

Message

unable to zero - equipment malfunction unable to zero - excessive offset unable to zero - unstable signal

Corrective Action

The hardware is faulty. Contact your service personnel.

Make sure the transducer is vented to air and try again. If this fails, the hardware may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel.

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11 Monitoring Invasive Pressure

Message Corrective Action

unable to zero - no transducer unable to zero - pulsatile pressure unable to zero - timed out

Switch on first

Make sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer.

Make sure that the transducer is vented to air, not to the patient, and try again.

Try pressing the Zero hardkey or

Zero <Press Label>

key again. If this fails, replace the transducer and adapter cable and contact your service personnel.

Pressure measurement is switched off. To switch it on, in the

Setup <Press

Label>

menu, select the pressure's label.

Adjusting the Calibration Factor

Each time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same.

1

2

In the

Setup <Press Label>

menu, select

Cal. Factor

.

If the value here does not match that on the transducer, select the corresponding value from the list now in accordance with your hospital's procedure.

To confirm you want to use the new calibration factor, select the Confirm pop-up key.

Displaying a Mean Pressure Value Only

Use this when you want to see only the mean pressure.

In the pressure's setup menu, select Mean only . Toggle between On to display mean pressure value only, and Off to display all pressure values (systolic, diastolic and mean).

Changing the Pressure Wave Scale

1

2

3

Select the label of the pressure wave whose scale you want to set to enter the

Setup <Press

Label>

menu.

In the

Setup <Press Label>

menu, (for example

ABP

) select

Scale

.

Select a value from the pop-up list:

– a positive value sets the top gridline. The bottom gridline is set at zero.

– a negative value sets the bottom gridline. The middle gridline is set at zero.

Optimizing the Waveform

In the

Setup <Press Label>

menu, select

Optimum Scale

to let the monitor select the best minimum and maximum scales for the current wave.

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11 Monitoring Invasive Pressure

Using the Wave Cursor

When the pressure wave is selected, you can display a cursor in the wave. It appears as a white horizontal line in the wave. Using the pop-up keys you can move the cursor up or down to the required position and store the corresponding value. The cursor value can be stored

• as a systolic, diastolic or mean pressure value,

• as an IAP (intra-abdominal pressure) value - for the waves P, P1 to P8, if IAP is configured as a measurement which can be manually entered

• as a PAWP value - if the pressure wave is a PAP wave

The stored value appears in the trend database as a manually entered value.

To display and position the cursor

1

Select the pressure wave.

2

3

Select

Activate Cursor

.

Use the pop-up arrow keys to position the cursor.

Using the pop-up keys you can also change the scale or the speed for the wave, freeze the wave or start a printout or recording.

Non-Physiological Artifact Suppression

Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample.

Your monitor may be configured to suppress these non-physiological artifacts for a specified duration

( Artifact Suppr.

is configured to 30 sec , 60 sec , or 90 sec ). During artifact suppression, the monitor shows the INOP message

<Press Label> ARTIFACT

, and a question mark is shown beside the pressure numerics. Pressure alarms and the

<Press Label> NON-PULSATILE

INOP are suppressed during the configured period. The CPP alarms are not suppressed.

Choosing the Pressure Alarm Source

WARNING

Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.

In the

Setup <Press Label>

menu, select

Alarms from

and choose the source.

Menu option

Sys.

Dia.

Mean

Pressure value monitored

systolic diastolic mean

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11 Monitoring Invasive Pressure

Menu option

Sys & Dia

Dia & Mean

Sys & Mean

Sys&Dia&Mean

Pressure value monitored

systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel

Select and set the

High Limit

and

Low Limit

for the pressure(s) you have selected.

Extreme Alarm Limits

The extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the Δ value) to the high and low alarm limits. This value can be set for each pressure label individually.

5

6

3

4

1

2

Extreme Low Limit

Low Limit

High Limit

Extreme High Limit

Δ Extreme Low

Δ Extreme High

You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

• To see the extreme pressure alarms set for your monitor, in the

Setup <Press Label>

menu, see the menu items Δ Extreme High and Δ Extreme Low .

The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message.

Calibrating Reusable Transducer CPJ840J6

Depending on your monitor's configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:

• standard sphygmomanometer.

• sterile 10cc syringe with heparinised solution.

• 3-way stopcock.

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11 Monitoring Invasive Pressure

• approximately 25cm of tubing.

Making the Pressure Calibration

WARNING

Never perform the invasive pressure calibration while a patient is being monitored.

1

2

Zero the transducer.

Connect the syringe and manometer.

a. Attach the tubing to the manometer.

b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient.

c. Attach the syringe to one port and the manometer tubing to the other port.

d. Open the port to the manometer.

192

4

5

6

7

3

8

1 Tubing to manometer

2 Syringe with heparinised solution

3 To pressure connector on monitor

4 Patient connection stoppered

5 Off

Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the recommended calibration pressure.

In the

Setup <Press Label>

menu, select

Cal. Press

.

Select the calibration pressure from the list, for example 200 mmHg.

Select Confirm to recalculate the calibration factor using the applied pressure.

When the monitor displays

<Press Label> mercury calibr. done at <date and time>

, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones.

Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure's setup menu.

11 Monitoring Invasive Pressure

9

Reconnect the patient and start measuring again.

Troubleshooting the Pressure Calibration

The status line lists the probable cause of an unsuccessful calibration.

Message Corrective Action

unable to calibrate - equipment malfunction unable to calibrate - out of range

Contact your service department. The pressure hardware is faulty.

Make sure that you have selected the value for

Cal. Press

that you are applying to the transducer, and repeat the calibration.

Make sure that the transducer is connected and try again.

unable to calibrate - no transducer unable to calibrate - unstable signal unable to calibrate - perform zero first

Make sure there are no disturbances to the transducer, and repeat the calibration.

No valid zero. Zero the transducer.

Calculating Cerebral Perfusion

The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.

The difference is labeled CPP.

1

2

In the Main Setup menu, select Measurements .

In the

Setup CPP

menu, select one of the listed pressures as the arterial pressure source.

Calculating Pulse Pressure Variation

Note: Pulse Pressure Variation can be calculated in two different ways on this monitor - directly from the pressure measurement or in conjunction with the CCO measurement. Refer to the Cardiac Output chapter for information on PPV from CCO. Only one PPV can be active at a time.

Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures. The average variation in pulse pressure is calculated over periods of 32 seconds.

WARNING

• This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician.

• The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.

• PPV calculation may lead to inaccurate values in the following situations:

– at respiration rates below 8 rpm

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11 Monitoring Invasive Pressure

– during ventilation with tidal volumes lower than 8 ml/kg

– for patients with acute right ventricular dysfunction ("cor pulmonale").

• The PPV measurement has been validated only for adult patients

To select an arterial pressure as PPV source:

1

2

In the

Main Setup

menu, select

Measurements

.

In the

Setup PPV

menu, select

ABP

,

ART

,

Ao

,

BAP

,

P

or

FAP

as the arterial pressure source.

CAUTION

Older Multi-Measurement modules cannot supply a beat-to-beat arterial pressure value. In this case the monitor shows a NO PPV FROM<Server> INOP.

Measuring Pulmonary Artery Wedge Pressure

Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:

• Fluid status

• Myocardial contractility

• 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 (preload).

The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoracic pressure is fairly constant. You can use the respiration waveform as a reference when assessing the

PAWP waveform, to ensure constant measurement timing relative to the respiratory cycle. The monitor displays the PAWP value for up to 24 hours or until you admit a new patient.

WARNING

The pressure receptor in the catheter records pressure changes that occur only in front of the occlusion. Even though the catheter tip is in the pulmonary artery, the receptor records pressure changes transmitted back through the pulmonary circulation from the left side of the heart.

While performing the wedge procedure, the monitor switches off the pressure alarms for pulmonary artery pressure (PAP).

Due to a slight measurement delay, you should not use sidestream CO

2

as a direct reference for determining the end expiratory point in the pressure curve.

To start the Wedge procedure,

1

2

In the Main Setup menu, select Wedge to display the wedge procedure window.

Prepare and check the pressure line according to your hospital policy.

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11 Monitoring Invasive Pressure

3

4

5

6

7

8

Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory wave as reference waves.

Select Change Speed if you want to change the speed of the displayed wave. The speed can also be changed in the screen for editing the wedge.

Select Change Scale to change the wave scale of the PAP. The same scale will be used in the screen for editing the wedge. If the setting

Optimum Scale

is used, the wave scale will be optimized when a wedging waveform is recognized and will revert to the previous scale when the wedge procedure window is closed.

Inflate the balloon when the monitor prompts you:

Ready for balloon inflation

. The waveform changes from the PAP to the PAWP wave. The measurement takes approximately 12 seconds. On completion, the monitor stores the PAWP waveform display and prompts you to deflate the balloon. If the monitor cannot detect a wedging waveform you must use

Store Trace

to store the wedge and two reference waves manually.

Deflate the balloon when the monitor prompts you:

Ready for balloon deflation

and verify that the waveform returns to pulmonary artery shape.

If you need to start a new measurement, select

Restart Wedge

.

Editing the Wedge

1

2

5

6

3

4

Select the

Edit Wedge

pop-up key to see the stored waveforms.

The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any previously stored value and the time it was stored.

Select

Change Speed

if you want to change the speed (resolution) of the displayed wave.

Move the cursors up, down, right and left to set them on the correct wedge position.

Select Store Wedge to store the PAWP value.

Select

Print Wedge

to print the PAWP waveform and any reference waves or

Record Wedge

to record them. While recording or printing, you cannot perform any more Wedge tasks.

WARNING

Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the minimum time necessary to get an accurate measurement.

If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon, the pulmonary artery pressure waveform assumes a wedged appearance. Take appropriate action, in accordance with standard procedures, to correct the situation.

If the PAWP (mean) is greater than the PAP (systolic), deflate the balloon and report the incident in accordance with hospital policy, because the pulmonary artery could be accidentally ruptured, and the wedge value derived will not reflect the patient's hemodynamic state, but will merely reflect the pressure in the catheter or balloon.

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11 Monitoring Invasive Pressure

Identifying the Pressure Analog Output Connector

1

Analog output (module M1006B, option C01 only)

196

12

12

Monitoring Cardiac Output

The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window, 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 measurements can be carried out using the right heart thermodilution method or the PiCCO method (transpulmonary thermodilution).

• The right heart method is available with

– C.O. module M1012A, standard and option #C10

– M3012A Hemodynamic Measurement Extension Module, options #C05 and #C10

– M3014A Capnography Measurement Extension Module, option #C05 and #C10

• The PiCCO method is available with

– C.O. module M1012A, option #C10

– M3012A Hemodynamic Measurement Extension Module, option #C10

– M3014A Capnography Measurement Extension Module, option #C10

The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing pulse contour analysis on the blood pressure waveform.

Hemodynamic Parameters

This table illustrates the hemodynamic parameters available with each method, whether they are measured continuously, and whether they can be shown on the monitor's main screen or in the

Hemodynamic Calculations window.

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12 Monitoring Cardiac Output

Measured and Calculated Hemodynamic

Parameters and Indexes

Blood Temperature (Tblood)

C.O./C.I.: Cardiac Output

CCO/CCI: Continuous Cardiac Output

Y

N

Y

PiCCO Method

(Transpulmonary

Thermodilution)

Continuous?

Y

Y

Y

Main

Screen

SVR/SVRI: Systemic Vascular Resistance

SV/SI: Stroke Volume/SV Index

SVV: Stroke Volume Variation

*dPmax: Left Ventricular Contractility Index Y

CFI: Cardiac Function Index N

PPV: Pulse Pressure Variation

ITBV/ITBVI: Intrathoracic Blood Volume

Y

N

N and Y

N and Y

Y

EVLW/EVLWI: Extravascular Lung Water N

GEDV/GEDVI: Global End-Diastolic Volume N

*PVPI: Pulmonary Vascular Permeability Index N

*GEF: Global Ejection Fraction N

*RLShnt: Right-Left-Shunt Fraction

PVR/PVRI: Pulmonary Vascular Resistance

LCW/LCWI: Left Cardiac Work

RCW/RCWI: Right Cardiac Work

N

Not available

N

Not available

RVSW/RVSWI: Right Ventricular Stroke Work Not available

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

N

Right Heart Thermodilution

HemoCalc

Window

Continuous?

Main

Screen

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

N

Y

Y (in the

C.O. field)

Y

Y

Y

N

Not available

N

N

Not available

Not available

Not available

Not available

Not available

Not available

Not available

Not available

Not available

N

N

Not available

N

N

Y

Y

N

N

N

N

N

N

Y

Y

Y

Y

Y

Y

HemoCalc

Window

N

Y

* currently not available in the U.S.A. or in clinical environments under FDA control.

Using the C.O.Procedure Window

The procedure window displays up to six trials (measurement curves) with the trial number and the

C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys automatically appears to let you carry out C.O.-related tasks. This example shows the procedure window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly different on your monitor.

To open the procedure window,

• Select Cardiac Output in the Setup C.O.

or Setup CCO menu, or

• Select the

Cardiac Output

SmartKey on the Screen, if configured, or

• Press the START hardkey on the front of the C.O. plug-in module, if available, or

• Press a remote start switch, if you are using one.

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12 Monitoring Cardiac Output

1

Average

- column of averaged values

2

Unit

column

3

Continuously measured numeric

4

5

6

Prompt message field

Thermodilution curve of current trial

Curve alert message field

Current trial number

7

8

11

Setup information

9

Trial

numbers for the trial curves

10

Trial curves

Results table of current trial

12

Trial curve scale

• To change the measurement parameters shown in the results table of the procedure window, select the

Table Contents

pop-up key and choose from the list of available parameters.

• To view the currently-used temperature unit, see the "grayed-out" setting

Temperature Unit

in the

Setup C.O.

menu. This setting can only be changed in Configuration Mode.

• The Cardiac Output screen element may be configured to display permanently on a specially designed Screen. Selecting the screen element opens the cardiac output pop-up keys.

Accessing the Setup C.O. and Setup CCO Menus

C.O. settings can be changed in the Setup C.O.

menu. To access this menu,

• press the C.O. hard key on the C.O. module, or

• select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen.

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12 Monitoring Cardiac Output

CCO/CCI settings can be changed in the Setup CCO menu. To access this menu,

• select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen.

Entering the HemoCalc Window

From the procedure window, select the pop-up key Hemo Calc to open the Hemo Calculations window.

Measuring C. O. Using the PiCCO Method

The PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the blood pressure waveform. A fluid with a known volume and temperature is injected into the right atrium through a CVP catheter. The injectate bolus mixes with the blood in the heart and the change in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery.

The PiCCO Method requires a pressure measurement made using either the M1006B Pressure module, or a M3001A/M3002A MMS, or a measurement extension module M3015A, M3014A, or

M3012A. (A pressure from an external device may not be used.) You will also need a conventional central venous (CVP) line and an arterial catheter from PULSION Medical Systems. You must use the approved catheters and puncture locations.

Measuring Continuous Cardiac Output

Every time C.O. is measured with the PiCCO method, the monitor uses this C.O. value and the result of the pulse contour analysis to calculate a patient-specific calibration factor. The monitor uses this value to compute CCO and the other continuous hemodynamic parameters. CCO values are calculated on a beat-to-beat basis and then averaged over a 12-second time frame. The calculated values are displayed as numerics on the monitor screen.

Measuring Systemic Vascular Resistance

The monitor uses CCO, an arterial pressure, and CVP to calculate a continuous SVR value. If a continuously measured CVP value is not available, the monitor uses a preset, static CVP value to calculate the SVR (you will see the INOP message

SVR SET CVP USED

). If the BSA is available, the monitor uses the CCI to calculate the SVRI. A CCO or CCI from an external device can also be used for the SVR/SVRI calculation.

SVR/SVRI settings can be changed in the corresponding setup menu. To enter the menu, select

Î Main Setup Î Measurements Î SVR

or

SVRI

.

To display a

SVR/SVRI

numeric on the Screen, select any numeric, then select

Change Numeric

and select

SVR

or

SVRI

from the list of available numerics.

Measuring Pulse Pressure Variation

Note: Pulse Pressure Variation can be calculated in two different ways on this monitor - in conjunction with CCO or directly from the pressure measurement. Refer to the Invasive Pressure chapter for information on PPV from pressure. Only one PPV can be active at a time.

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12 Monitoring Cardiac Output

Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures.

WARNING

• The monitor calculates PPV from beat-to-beat values of the arterial pressure selected for CCO.

The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician.

• The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.

• PPV calculation may lead to inaccurate values in the following situations:

– at respiration rates below 8 rpm

– during ventilation with tidal volumes lower than 8 ml/kg

– for patients with acute right ventricular dysfunction ("cor pulmonale").

• The PPV measurement has been validated only for adult patients

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12 Monitoring Cardiac Output

Setting Up the PiCCO C.O. Measurement

1 C.O. Module

2 C.O. Interface Cable

3 PULSION Pressure Transducer

4 Press Module

5 Pressure Adapter Cable

6 Thermistor Connection Cable

7 Thermistor Connection

8 PULSION Arterial Catheter

9 CVP Line

10 Injectate Temperature Probe

Housing

11 Injectate Syringe

12 Injectate Temperature Probe

13 Remote Switch

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1

2

3

4

Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit from PULSION Medical Systems. It must be placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery. You must use the approved catheters and puncture locations.

Set up the central venous line.

Connect the injectate temperature probe housing to the venous line.

Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices to the C.O. interface cable:

– Injectate temperature probe

– Thermistor connector

– Remote start switch (if used).

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin.

12 Monitoring Cardiac Output

5

6

7

8

9

10

11

If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories.

Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the Setup C.O.

menu, select Method and then select

Transpulmnry .

Check that you are using the correct probe - the M1646. This is the only probe supported for use; it can be used with room temperature injectate or with cold injectate.

Check that the correct arterial catheter constant is selected.

If the catheter is recognized by the monitor, the catheter constant is automatically displayed and cannot be changed manually. If it is not recognized, in the procedure window, select

CathCt

and use the pop-up keypad to enter the correct value. The catheter constant is usually written either on the catheter or on the catheter packaging.

Make sure that the injectate volume setting matches the injectate volume you will use. To change the volume, in the procedure window, select

InjVol

and select the correct injectate volume from the pop-up list.

If there is a problem with the volume or temperature you have chosen, the monitor will issue a curve alert message to inform you of this.

If you are measuring CCO or CCI, check that the correct pressure source is selected in the

Setup

CCO

menu. The pressure label under

CCO From

must match the pressure measured with the arterial catheter. To change the pressure source, select CCO From to call up a list of available pressure labels and select the correct label.

If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item

Alarms From . To change the alarm source, select Alarms From and choose either CCO or CCI .

Performing PiCCO C.O. Measurements

Always wait for the monitor to indicate readiness for the next step before proceeding.

If you are measuring CCO, all measurements should be conducted within 15 minutes. Older measurements "expire" for CCO calibration.

1

Enter the procedure window.

2

3

4

When you see the message Ready for new measurement , start the measurement by selecting the pop-up key Start C.O.

or pressing the Start hardkey on the C.O. module, or pressing the remote start switch. If the measuring mode is set to

Auto

the

Start C.O.

key will also enable the automatic start of consecutive measurements.

When you hear the ready tone and see the message

Stable baseline, inject now!

, inject the solution into the CVP catheter.

At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and

EVLW values and any curve alerts are displayed and a message will appear Wait before starting new measurement

or in

Auto

mode

Prepare for next injection or press Stop

.

When you see the Stable baseline, inject now!

message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of 6 measurements before editing. If you perform more than 6 measurements without rejecting any, the oldest will automatically be deleted when a 7th curve is stored.

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12 Monitoring Cardiac Output

Editing PiCCO C.O. Measurements

It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output.

1

2

Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.

Reject unsatisfactory trials: use the

Select Trial

pop-up key to move between trials, then select the

Accept Reject

pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials.

If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.

Saving and Calibrating PiCCO C.O. Measurements

When you have finished editing the trials, you must save the results. This closes the measurement series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases.

Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate

CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the same direction over 15 minutes, or if there are large or sudden changes in the patient's condition.

The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO.

To save and calibrate,

• In the procedure window, select the pop-up key SaveC.O. &Cal CCO to use the averaged C.O. value to calibrate Continuous Cardiac Output (CCO).

Your monitor may be configured to have two separate pop-up keys, Save C.O.

and Cal CCO , instead of the combined

SaveC.O. &Cal CCO

.

WARNING

CCO calibration is patient-specific. When the C.O. module or measurement extension module is plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in doubt perform a new CCO calibration first.

CCO Calibration Status Indicators

Each measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial's validity to be used in a CCO calibration.

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12 Monitoring Cardiac Output

For a trial to be eligible for calibration, the pressure signal must be continuously available and undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the pressure measurement, change the pressure label, or disturb the pressure signal in any other way during this time.

Cal

?Cal

N/A

Exp

A pressure signal for CCO was available during the measurement (valid for calibration)

A disturbed pressure signal for CCO was available during the measurement (valid for calibration)

No adequate pressure signal for CCO was available during the measurement (no valid calibration data)

This trial is more than 15 minutes older than the most recent trial and has expired for

CCO calibration (no valid calibration data)

Measuring C.O. Using the Right Heart

Thermodilution Method

In the right heart thermodilution method, a fluid of known volume and temperature is injected into the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter. The injectate bolus 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.

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12 Monitoring Cardiac Output

Setting up RH C.O. Measurements

1 C.O. Module

2 C.O. Interface Cable

3 Remote Start Switch

4 Thermistor Connector

5 Thermistor Connection Cable

6 PA Catheter

7 Injectate Temperature Probe

Housing

8 Injectate Syringe

9 Injectate Temperature Probe

206

4

5

6

1

2

3

Set up the PA line using a PA catheter.

Attach the injectate temperature probe housing to the PA line.

Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices into the C.O. interface cable:

– injectate temperature probe

– remote start switch (if used).

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin.

Plug the thermistor connection cable of the PA catheter into the thermistor connector.

Connect the injectate temperature probe to the injectate temperature probe housing.

Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the

Setup C.O.

menu, select

Method

and then select

Right

Heart .

12 Monitoring Cardiac Output

Ice-Bath Setup for RH Thermodilution C.O. Measurements

If you are using the flow-through method illustrated above, the injectate temperature is measured at the time of injection by the temperature probe in the injectate temperature probe housing.

If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in an ice-bath and the probe measures the temperature of the contents of the ice bucket.

Setting the Computation Constant

Check that the correct Computation Constant is entered in the procedure window. This can be found in the documentation supplied with the catheter and is based on the injectate volume, injectate temperature and catheter type. To change the value, in the procedure window, select

Computation

Constant and use the pop-up keypad to enter the correct value.

Performing RH C.O. Measurements

1

Enter the procedure window.

2

3

4

When you see the message Ready for new measurement , select the pop-up key Start C.O.

. If the measuring mode is set to Auto the Start C.O.

key will also enable the automatic start of consecutive measurements.

When you hear a ready tone and see the message Inject now!

, inject the solution into the right atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second.

At the end of the measurement the thermodilution curve, cardiac output, index values and curve alerts (if necessary) are displayed and a message will appear

Wait before starting new measurement or in Auto mode Prepare for next injection or press Stop .

When you see the

Inject now!

message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of six measurements before editing. If you perform more than six measurements without rejecting any, the oldest will automatically be deleted when a seventh curve is stored.

Editing and Saving RH C.O. Measurements

It is important to identify and reject erroneous measurements (called "trials"), as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output.

1

2

3

Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.

Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the

Accept Reject

pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials.

If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.

Save average C.O. values. To close a measurement series, you must save the average values by selecting the pop-up key

Save C.O.

. This sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases.

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12 Monitoring Cardiac Output

Documenting C.O. Measurements

You can document C.O. measurements on the default printer or recorder.

1

In the procedure window, select the pop-up key

Print/ Record.

2

From the pop-up list, choose:

Print Results

to print the contents of the procedure window

Record Results

to record the contents of the procedure window

Record Trial

to send an individual trial curve to the recorder.

C.O. Injectate Guidelines

The greater the injectate volume and the colder the temperature, the more accurate the measurement.

Reduced injectate volume or higher injectate temperature may reduce the specified accuracy.

For adult patients, to ensure the greatest measurement accuracy, use a cold injectate (< 8°C) of 10 ml volume, if not contra-indicated by the patient's condition. Your choice of injectate volume should be based on the injectate temperature and the patient's cardiac output.

Guidelines for Right Heart Thermodilution C.O. Injectate

If you are using the right heart thermodilution method, the use of injectate with a temperature less than

8°C lower than the blood temperature may cause incorrect values for the thermodilution.

Guidelines for PiCCO C.O. Injectate

If you are using the PiCCO method, the use of injectate with a temperature that is not at least 12°C lower than the blood temperature may cause incorrect values for the thermodilution and CCO calibration.

Injectate Volume, Patient Weight and ETVI Values (PiCCO Only)

When deciding on an injectate volume and temperature, you must consider your patient's weight and extra-vascular thermal volume index (ETVI).

High ETVI

The dilution of injectate is influenced by extravascular tissue and fluid. The accuracy of the PiCCO method may be reduced in patients with high extra-vascular thermal volume index (ETVI) values. Use the table below as a guide in selecting the correct injectate temperature. As shown in the table, if your patient has an ETVI > 10, you must use cold injectate.

Weight

Use the table below as a guide in choosing an injectate volume appropriate for the patient weight.

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12 Monitoring Cardiac Output

Patient

Weight

< 3 kg

< 10 kg

< 25 kg

< 50 kg

< 100 kg

≥ 100 kg

Cold Injectate

ETVI < 10

2 ml

2 ml

3 ml

5 ml

10 ml

15 ml

ETVI ≥ 10

2 ml

3 ml

5 ml

10 ml

15 ml

20 ml

Room Temperature Injectate

ETVI < 10 ETVI ≥ 10

3 ml

3 ml

5 ml

10 ml

15 ml

20 ml

Use cold injectate

C.O./CCO Curve Alert Messages

After each measurement trial, the monitor analyzes the thermodilution curve. If the curve appears abnormal, a curve alert message appears in the procedure window. A question mark symbol ("

?

") may appear next to the cardiac output numeric if any of these messages appear. The curve alert messages are not error messages and do not necessarily mean that the measured values are invalid.

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12 Monitoring Cardiac Output

C.O./CCO Curve Alert

Messages

Tinj off scale

Noisy baseline

Temperature baseline drift

Small signal, more indicator required

Injectate temperature too high

High ETVI, use cold injectate or greater inj. volume

Disturbed injection

Possible Causes

The Tinjectate is out of the range -1°C and 30°C. Cool down or heat up the injectate or change the injectate solution and repeat the measurement.

A blood temperature baseline drift that could not be compensated was detected during the C.O. measurement. Possible causes are:

- Interference may be caused by a ventilator.

- Interference may be caused by an infusion pump: infusions of significant volume through the central line should be paused at least 30 seconds before the first thermodilution measurement in a series and should not recommence until the measurement series is completed.

- Do not administer injections through the central line during a measurement series.

- Electrical devices in the vicinity can cause interference: check for infusion pumps connected to the central catheter, cables parallel to the thermodilution cable, electrocautery. Make sure all devices are properly grounded.

- Wait until measurement results are displayed before moving the patient or catheter.

- Close the stopcock to the injectate syringe after the injection.

- Do not rinse the catheter during measurement, to avoid temperature fluctuations.

May occur if patient is recovering from open heart surgery, or if patient was cooled down for surgery and is in the process of regaining normal body temperature when the measurement is made.

The peak of the transpulmonary thermodilution curve was below

0.1ºC. Increase injectate volume and/or lower injectate temperature.

The difference between the blood and injectate temperatures is too small. The calculated value for C.O. may not be accurate.

The ETVI value is too high. The accuracy of the transpulmonary thermodilution measurement may be reduced. Increase injectate volume and/or lower injectate temperature following the

guidelines given in the section “Guidelines for PiCCO C.O.

Injectate” on page 208.

The injection should be performed quickly and with a steady pressure. Shaking, unsteady pressure, or injections that take longer than six seconds may cause this message to appear; you should bear this in mind if you are using a large injectate volume (> 10 ml).

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12 Monitoring Cardiac Output

C.O./CCO Curve Alert

Messages

Check Injectate Temperature

Probe Type

Unsteady baseline

Multiple peaks

Abnormal decay time

Very long curve

Very short curve

Irregular curve

Delayed injection

Possible Causes

The recorded Tinj signal is uncharacteristic for the M1646 injectate temperature probe. An incorrect probe type may have been used.

There is a noisy baseline, and thermal baseline drift.

Caused by faulty injection technique.

May be caused by low cardiac output. Calculated value for

C.O. may not be accurate.

The decay time of the curve is longer than 15 seconds.

Decay time of the curve is less than 0.5 seconds. If there is a noisy baseline, part of the baseline may have been mistaken for a thermodilution curve. Calculated value for C.O. may not be accurate.

Any combination of curve alert messages.

Injection is given more than 15 seconds after Start C.O.

is selected. Calculated value for C.O. may not be accurate.

If you have followed all of these guidelines, your measurement values should be valid, even if you still see a curve alert message. Ensure that at least three subsequent measurements within the current series do no differ by more than 15%. If the difference exceeds 15%, use your clinical judgement to determine the appropriate intervention.

C.O./CCO Prompt Messages

Prompt messages appear in the procedure window if a C.O. measurement trial must be terminated.

C.O./CCO Prompt Messages

Curve below baseline, measurement terminated

Excessive curve height, measurement terminated

Unstable baseline, injection not recommended!

Excessive baseline drift, don't inject now!

Possible Causes

May be caused by thermal baseline drift. No C.O. value calculated.

The curve exceeds the upper limit. This may be caused by an injectate that was too cold. No C.O. value calculated.

The baseline is unstable. Wait until the baseline is stable before injecting. If this does not occur within a reasonable time, injection is possible but the accuracy of the measured values may be reduced.

No measurement is possible. Measured values are incorrect.

C.O./CCO Warning Messages

Warning messages contain important information about the C.O. measurement.

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12 Monitoring Cardiac Output

C.O./CCO Warning Messages Possible Causes

Next measurement erases older curve

Previous C.O. setup data replaced

Verify C.O. setup data

Check arterial pressure, CCO cal currently not possible

Verify the Computation Constant

Previous Comp. Constant replaced

Six curves are stored, this is the maximum possible. If another measurement is stored, the oldest thermodilution curve will be erased.

A C.O. module or measurement extension module has been plugged in with different C.O. setup data from the previous data. The new C.O. setup data is read from the new C.O. device, and replaces the current data. The message disappears when the Start C.O. pop-up key is pressed.

A new transpulmonary thermodilution catheter has been connected to the C.O. Interface Cable.

Poor or invalid pressure signal, for example if pressure was not zeroed.

A new catheter has been plugged in, or the computation constant has been changed and

Start C.O.

has not been selected.

A new C.O. module or measurement extension module with a different computation constant from the current one has been connected. The new computation constant is read from the new C.O. device, and replaces the current one. The message disappears when

Start C.O.

is selected.

C.O./CCO Safety Information

WARNING

Catheter constant - Make sure that the arterial catheter constant for the measurement is appropriate to the catheter used.

Computation Constant - Make sure that the computation constant for the measurement is appropriate to the injectate volume, injectate temperature and catheter type used.

IABP - Do not perform transpulmonary thermodilution measurements on patients undergoing IABP treatment.

CCO accuracy - Accuracy of the CCO measurement and all the derived values may be influenced by patients with valve diseases or artificial valves.

C.O. and MRI - Do not use the Cardiac Output Interface Cable in Magnetic Resonance Imaging

(MRI) Applications.

Aortic graft patients - Do not use an arterial catheter in the arteria femoralis when it is contra indicated, for example, with patients who have an aortic graft.

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12 Monitoring Cardiac Output

CAUTION

During the cardiac output measurement procedure the blood temperature alarms are inactive. This is indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive during this procedure prevents false alarms. The alarms are automatically reactivated when you have completed the measurement procedure.

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214

13

13

Monitoring Carbon Dioxide

WARNING

Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension

(865297).

Only one CO

2

measurement at a time is supported.

Use the CO

2 measurement to monitor the patient's respiratory status and to control patient ventilation.

There are two methods for measuring carbon dioxide in the patient's airway:

• Mainstream measurement uses a CO

2 sensor attached to an airway adapter directly inserted into the patient's breathing system. This method is available using the M3014A Capnography

Extension and the M3016A Mainstream CO

2

Extension, or the X2 with the optional CO

2 measurement.

• Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient's airway and analyzes it with a remote CO

2 sensor built into the measurement system.

Philips offers the sidestream CO

2

measurement in the M3014A Capnography Extension or the X2 with the optional CO2 measurement, and the Microstream method of sidestream CO

2 measurement in the M3015A/B Microstream CO

2

Extension.

Refer to your Gas Module Instructions for Use, if you are using a Gas Module to monitor CO

2

.

WARNING

Correlation: The etCO

2

readings do not always correlate closely with paCO

2

, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.

Pharmaceuticals in aerosols: Do not measure CO

2

in the presence of pharmaceuticals in aerosols.

Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.

Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel.

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13 Monitoring Carbon Dioxide

Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO

2

values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO

2

readings. Even with combined nasal oral cannulas, the etCO

2 readings may be slightly lower than actual in patients breathing through the mouth only.

Measurement Principles

For both mainstream and sidestream measurements, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO

2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO

2

.

When using a wet ventilator circuit, monitor mainstream CO

2

if available, in preference to sidestream

CO

2

.

The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure.

The measurement provides:

• a CO

2

waveform.

• an end tidal CO

2

(etCO

2

) value: the CO

2

value measured at the end of the expiration phase.

• an inspired minimum CO

2

(imCO

2

): the smallest value measured during inspiration.

• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO

2 waveform.

Depending on the Max Hold setting configured for your monitor, the etCO

2 highest CO

2 the etCO

2

numeric shows breath-to-breath value (

Max Hold

set to

Off

).

numeric shows either the

value measured within the configured time period (

Max Hold

set to

10 sec

or

20 sec

) or

Measuring CO2 using M3014A or X2

The M3014A Capnography Extension or the X2 with the CO

2

option measures partial pressure of carbon dioxide in a patient's expired gas using the mainstream method or the sidestream method.

The mainstream CO

2

measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO

2

measurement can be used, with appropriate accessories, with intubated and non-intubated adult, pediatric, infant and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patient's breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.

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13 Monitoring Carbon Dioxide

WARNING

Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation.

Before the CO

2

measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO

2

readings. The CO

2

readings will typically deviate

5% for every 1000m difference.

CAUTION

Use the CO

2

measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory.

Preparing to Measure Mainstream CO2

You must perform a zero as described in this procedure each time you use a new airway adapter.

1

2

Attach the sensor connector to the CO

2

connector on the MMS extension, or on the X2 (when the optional CO2 measurement is integrated).

Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition.

3

Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly. To zero the sensor:

– expose the sensor to room air and keep it away from all sources of CO

2 including the ventilator, the patient's breath and your own.

– in the setup menu for the CO

2

, select Start Zero Cal .

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13 Monitoring Carbon Dioxide

– When you see the message CO₂ calibration done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring.

4

Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection.

WARNING

To prevent stress on the endotracheal tube, support the sensor and airway adapter.

Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable.

Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the

CO

2

waveform changes unexpectedly without a change in patient status.

To avoid infection, use only sterilized, disinfected or disposable airway adapters.

Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population.

Preparing to Measure Sidestream CO2

1

Plug the sensor cable into the monitor's CO

2

input connector. Allow the sensor two minutes warm up time

2

Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly.

3

To zero the sensor:

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13 Monitoring Carbon Dioxide

4

– expose the sensor to room air and keep it away from all sources of CO

2 including the ventilator, the patient's breath and your own.

– in the setup menu for the CO

2

, select

Start Zero Cal

.

– when you see the message zero done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring.

For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section.

For intubated patients with an integrated airway adapter in the breathing circuit.: Connect the male luer connector on the straight sample line to the female port on the airway adapter.

For non-intubated patients: Place the nasal cannula onto the patient.

For patients prone to mouth breathing use an oral-nasal cannula.

For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow.

WARNING

Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor.

Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity.

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13 Monitoring Carbon Dioxide

CAUTION

Always disconnect the cannula, airway adapter or sample line from the sensor when not in use.

Using the Sidestream Sensor Holder

The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.

1

Push the sensor into the holder until it clicks into position.

2

Clamp the holder onto an IV pole, a shelf or another appropriate location.

To remove the sensor from the holder, release the clip and pull the sensor out of the holder.

Removing Exhaust Gases from the System

WARNING

Anesthetics: When using the sidestream CO

2

measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.

Measuring Mainstream CO2 using M3016A

The M3016A Mainstream CO

2

Extension measures partial pressure of carbon dioxide in a patient's expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO

2

measurement with ventilated adults, pediatric and neonatal patients.

WARNING

Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation during use. This may cause incorrect readings.

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13 Monitoring Carbon Dioxide

Preparing to Measure Mainstream CO2

1

Attach the transducer connector to the CO

2

connector on the M3016A extension.

2

3

Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition.

Perform an accuracy check and then, if necessary, calibrate the transducer.

Checking Transducer Accuracy

WARNING

Check transducer accuracy at least once a week or if you doubt the CO

2

readings.

1

2

3

4

5

In Setup CO₂ menu, select Cal. Mode to switch on calibration mode.

Look at the calibration value displayed in the

Setup CO₂

menu next to

Start CAL1

. Is it the same as the value on the calstick? If not, calibrate the transducer now.

Place the transducer on the low cell of the calstick (labeled 0.0 mmHg or "ZERO"). The reading on the screen should be zero within ±1 mmHg within one minute.

Place the transducer on the high cell of the calstick. The reading on the screen should be within ±1 mmHg of the value on the calstick within one minute.

If both readings are in range, you can leave calibration mode and begin monitoring. If either of the readings is out of range, calibrate the transducer.

Calibrating the Transducer

1

Check that the windows on the calstick are clean and clear.

2

3

4

5

6

Place the transducer on one of the calstick cells and select

Start CAL1

.

Enter the calibration value printed on the calstick then press

Confirm

to start calibration.

When the message

CO₂ CAL1 calibration done -- Start CAL2 calibration

appears, put the transducer on the other cell and select

Start CAL2

then press

Confirm

.

When you see the message

CO₂ calibration completed - leave Cal. Mode

, calibration is complete.

Select

Cal. Mode

to switch calibration mode off. You cannot monitor in calibration mode.

Attaching and Removing the CO2 Transducer

1

Open the latch and place the transducer (B) onto the airway adapter (A). Place the airway adapter in the patient's breathing circuit between the endotracheal tube and the Y-piece. You may see the

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13 Monitoring Carbon Dioxide

CO₂ SENS.WARMUP

message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement.

2

To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.

WARNING

To prevent stress on the endotracheal tube, support the transducer and airway adapter.

To avoid infection, use only sterilized airway adapters.

Measuring Microstream CO2 using M3015A/B

The M3015A/B Microstream CO

2

Extension measures the partial pressure of carbon dioxide in a patient's expired gas using Microstream technology.

The measurement is equipped with an automatic barometric pressure compensation.

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13 Monitoring Carbon Dioxide

Preparing to Measure Microstream CO2

Use appropriate accessories for:

• the patient type (adult, pediatric or neonatal),

• the ventilation situation (including humidification)

• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).

All accessories are for single patient use only.

Using Microstream Accessories

The Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory.

For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set.

For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine

(which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO

2

, oxygen (O

2

) may be delivered to the patient to support gas exchange. This is done by using an O

2

/CO

2

FilterLine, or a Smart CapnoLine O

2

(a combined oral-nasal O

2

/CO

2

FilterLine).

Using the FilterLine and Airway Adapter

WARNING

Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity.

2

3

1

Attach the female Luer connector to the CO

2

inlet connector by pushing the socket cover aside and screwing the connector into place.

Check that the FilterLine is not kinked.

Change the FilterLine if a

CO₂ OCCLUSION

INOP appears on the monitor or if the readings become extremely erratic.

Disconnect the FilterLine during suctioning and nebulizing therapies or suppress sampling by turning

off the pump as described in “Suppressing Sampling (not Mainstream CO2)” on page 225.

Check the table in the Microstream CO

2

Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories.

CO

2

values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blocked

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13 Monitoring Carbon Dioxide

Removing Exhaust Gases from the System

WARNING

Anesthetics: When using the 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.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector.

Suppressing Zero Calibration

To prevent an automatic zero calibration from being started in the next five minutes,

• in the

Setup CO₂

menu, select

No Zero For 5Min

, or select the

Suppress CO₂ Zero

SmartKey, if configured.

Selecting

No Zero For 5Min

or selecting the

Suppress CO₂ Zero

SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.

Setting up all CO2 Measurements

These tasks are common to all CO

2

measurements except where otherwise noted.

Adjusting the CO2 Wave Scale

1

In the

CO₂ Wave

menu or the

Setup CO₂

menu, select

Scale

.

2

Choose a suitable scale range from the pop-up list.

Setting up CO2 Corrections

Temperature, water vapor in the patient's breath, barometric pressure, and the proportions of O

2,

N

2

O and Helium in the mixture all influence CO

2

absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections.

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13 Monitoring Carbon Dioxide

Correction

Altitude

(M3014A only)

O

2

(M3014A only)

Humidity

N

2

O

(M3016A mainstream and M3015A/B microstream only)

Gas

(M3014A only)

Agent

(M3014A only)

Altitude is set during installation. The monitor automatically applies an appropriate correction.

In the

Setup CO₂

menu, select

Oxy. Corr

and select a value between 20% and

100%, the default value is 20%. If you are not measuring the expired O estimate it by subtracting 5% from the inspired O value from the list.

2

2

,

then select the nearest

At installation, the monitor is configured to automatically apply either Body

Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure

Dry (ATPD). To see which, go to the Setup CO₂ menu, and scroll down to look at Hum. Corr or Humidity Corr.

.

In the

Setup CO₂

menu, select

N₂O Corr.

and turn on or off. If N

2 present in the ventilation gas mixture, you must turn this on.

O is

If the N

2

O correction is not available in the

Setup CO₂

menu, the CO

2 measurement in your MMS Extension does not require N

2 is setup with Gas Corr.

. (see below).

O correction or it

In the Setup CO₂ menu, select Gas Corr.

and select Helium , N₂O or turn off.

If Helium or N

2

O is present in the ventilation gas mixture, you must make the appropriate selection.

If the Gas correction is not available in the

Setup CO₂

menu, the CO

2 measurement in your MMS Extension does not require N

2 correction or the N

2

O or Helium

O correction is setup with N₂O Corr.

(see above).

In the Setup CO₂ menu, select Agt. Corr and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration.

Suppressing Sampling (not Mainstream CO2)

To temporarily stop sampling, in the

Setup CO₂

menu, select

Pump 15Min Off

or use the

CO₂ Pump

Off

SmartKey if available.

Selecting

Pump 15Min Off

again before fifteen minutes have passed resets the timer to fifteen minutes.

To re-start the pump, in the

Setup CO₂

menu, select

Pump On

.

Changing CO2 Alarms

This refers to CO

2

specific alarms. See the Alarms section for general alarm information.

1

2

In the

Setup CO₂

menu, select etCO₂ High

or imCO₂ High

and choose the high alarm limit.

Select etCO₂ Low

and choose the low alarm limit.

Changing the Apnea Alarm Delay

This determines the time limit after which the monitor alarms if the patient stops breathing.

1

In the Setup CO₂ menu, select awRR .

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13 Monitoring Carbon Dioxide

2

3

In Setup awRR menu, select Apnea Time .

Choose the apnea alarm delay time.

WARNING

Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A/B) measurement only.

Deriving Alarms From awRR

1

2

3

In the Setup CO₂ menu, select awRR .

In the Setup awRR menu, select Alarms .

Choose

On

to derive alarms from the airway respiration signal or

Off

to disable them.

Changing awRR Alarm Limits

1

2

3

In the

Setup CO₂

menu, select awRR

.

Select

High Limit

to set the upper alarm limit.

Select

Low Limit

to set the lower alarm limit.

Select the appropriate setting.

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14

14

Monitoring Airway Flow,

Volume and Pressure

The M1014A Spirometry Module is designed to be used in combination with Philips-branded airway flow sensors and combined CO

2

/airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics.

The measurement provides:

• Airway flow, airway volume and airway pressure waveform.

• Numerics for:

– respiratory rate

– tidal volume

– minute volume

– PEEP (positive end-expiratory pressure)

– PIP (peak inspiration pressure)

– dynamic compliance

– airway resistance

• Numerics for: (only visible in SpirometryValues Window, no alarming, no trending)

– peak inspiratory flow

– peak expiratory flow

– negative inspiratory pressure

– mean airway pressure

– plateau pressure numeric

– I:E ratio

The measurement also provides pressure-volume loops, flow-volume loops and pressure-flow loops.

Please see the “Respiratory Loops” on page 359 chapter for details on loops.

When using combined CO

2

/Flow sensors you can also perform mainstream capnography with intubated adult, pediatric and neonatal patients. See the Measuring CO

2 chapter for details on the CO

2 measurement and the Accessories chapter for a list of compatible accessories.

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14 Monitoring Airway Flow, Volume and Pressure

WARNING

Electrical Shock Hazard: Do not open the module. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the module. Refer servicing to qualified service personnel.

Attaching the Flow Sensor

CAUTION

Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory.

1

Select the appropriate flow sensor. Make sure that you are using the correct sensor for the respective patient category. Otherwise accuracy may be reduced.

Pediatric/Adult Flow Sensor (M2785A). Color: clear

For intubated patients with endotracheal tube diameters >4 mm. Adds approximately 6.5 cc of deadspace.

Infant/Neonatal Flow Sensor (M2786A) Color: violet

For intubated patients with endotracheal tube diameters ≤ 4 mm. Adds less than 1 cc of deadspace.

You can also use combined CO

2

/flow sensors. Note that the M3014A Capnography Extension is required to measure CO

2

.

Pediatric/Adult Combined CO

2

/Flow Sensor (M2781A). Color: clear

For intubated patients with endotracheal tube diameters >5.5 mm. Adds

8 cc of deadspace.

Pediatric Combined CO

2

/Flow Sensor (M2783A): Color: green

For intubated patients with endotracheal tube diameters of 3.5 - 6 mm.

Adds less than 4 cc of deadspace.

Infant/Neonatal Combined CO

2

Color: violet

/Flow Sensor (M2782A).

For intubated patients with endotracheal tube diameters of 2.5 -4 mm. Adds less than 1 cc of deadspace.

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14 Monitoring Airway Flow, Volume and Pressure

1

2

3

If you are using a combined CO

2

/Flow sensor, connect it to the CO

2

sensor head first. The airway adapter clicks into place when seated correctly.

Click the connector into place in the flow sensor receptacle on the monitor before connecting to the breathing circuit.

Install the flow sensor or the combined CO

2

/Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y-piece. Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards. The correct position is also indicated by an arrow on some of the sensors. (Graphic shows combined CO

2

/Flow Sensors).

1 Pediatric/adult sensor

2 Pediatric sensor

3 Infant/Neonatal sensor

WARNING

To prevent stress on the endotracheal tube, support the sensor and airway adapter.

Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable or tubing.

Replace the sensor, if excessive moisture or secretions are observed in the tubing and cannot be removed by a purge cycle.

Reuse poses a patient hazard. Do not disassemble, clean, disinfect or sterilize the sensor.

A system leak may significantly affect readings of flow, volume, pressure and other respiratory mechanics parameters.

Do not leave the sensor in the patient circuit when not connected to the monitor.

NOTE

• Do NOT place the airway adapter between the endotracheal tube and the elbow (pediatric/adult circuit), as this may allow patient secretions to block adapter windows.

• The striped tubing of the flow sensor should always be proximal to the patient.

• Position the airway adapter with the spirometry tubing pointing upwards.

• To prevent "rain-out" and moisture from draining into the airway adapter, do NOT place the airway adapter in a gravity dependent position.

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14 Monitoring Airway Flow, Volume and Pressure

• Periodically check the flow sensor and tubing for excessive moisture or secretion build up.

Perform a purge cycle if droplets are visible within the sensor or tubing. Repeat if necessary. If purging does not remove the droplets, replace the sensor.

• For routine performance of airway care, separate the system between the endotracheal tube and the airway adapter (neonatal circuit), or between the endotracheal tube and elbow (pediatric/adult circuit). Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows.

• Measurement values provided by a ventilator may differ significantly from the values provided by the spirometry module, due to different locations of the flow sensor.

• Incorrect entry of gas compensation parameters (i.e. temperature, gas composition) may reduce the accuracy of the measured values.

• An abnormal volume waveform as displayed below may be an indicator of an air leak:

In general, if MVexp or TVexp are significantly smaller than MVin or TVin , the tubing should be checked for leaks.

Zero Calibration

The zero calibration maintains the accuracy of the spirometry waves and numerics by regularly compensating for drifts within the measurement section. It is performed automatically without user interaction and takes about 2 seconds to complete. The automatic zero calibration is normally carried out every ten minutes. During warm-up or when the ambient pressure changes, this interval may be reduced to two minutes.

During the zero calibration the waveform is flat but the numerics remain on the screen. Typically, a zero calibration is started at the beginning of a respiration cycle, therefore a waveform may begin normally and then immediately become flat for the time of the zero calibration.

1 Zero Calibration

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14 Monitoring Airway Flow, Volume and Pressure

Automatic Purging

A double lumen connecting line (tubing) connects the flow sensors to the patient monitor. The

M1014A Spirometry Module includes an automatic and manual purge feature which provides a flush of room air to keep the sensor tubing free from water condensation and patient secretions. This feature is available for the adult, pediatric, and neonatal modes. The purge will begin with the exhalation portion of the ventilator cycle.

NOTE

• During the purge cycle the pump will be heard

• If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced

• With each purge cycle, a zero calibration is automatically performed

Adult Mode

The system automatically purges the sensor tubing every ten minutes or less, depending on system conditions. In adult mode, the system will purge both sides of the line, one at a time, during each purge cycle. The higher the pressure, the more frequent the purging. This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure.

Neonatal and Pediatric Modes

The automatic purge cycles used in the neonatal or pediatric mode is fixed at every three minutes regardless of circuit pressure. Only one side of the sensor tubing will be purged during each purge cycle.

Unlike the adult purge mode, the neonatal or pediatric purge mode does not use the full force of the internal pump, but rather pressurizes an internal reservoir which is used for the purge. This minimizes the pressure delivered to the ventilator circuit, but does deliver a sufficient pressure to purge the sensor tubing.

Manual Purging

Occasionally, purging may be required in between the automatic purge cycles. The manual purge may be used as often as needed. Check the orientation of the flow sensor if repeated manual purge cycles become necessary.

To manually purge, press the Purge button on the module (marked by on international versions of the module) or select Purge in the Setup Spirometry window to initiate a combined purge and zero cycle.

Gas Compensation

Temperature and the proportions of individual gases influence the flow measurement. If values seem inaccurately high or low, check that the monitor is using the appropriate gas compensation. Gas compensation can be done using either manually entered gas concentrations or gas concentrations from the gas analyzer.

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14 Monitoring Airway Flow, Volume and Pressure

NOTE

If you unintentionally switch the gas compensation to the incorrect setting, the accuracy of the measured flow and volume values may be significantly reduced. The tables below show examples of incorrect gas compensation settings and the resulting inaccuracies:

N

2

O

2

N

2

O Agent Difference between measured and actual values

Actual Gas Composition

Gas Compensation Setting

60 40

40

Incorrect Balance Gas Setting (N

2

O instead of N

2

)

60 15%

N

2

O

2

N

2

O Agent Difference between measured and actual values

Actual Gas Composition

55

Gas Compensation Setting

60

Incorrect Agent Percentage Setting

40

40

5

0 15%

Setting up Spirometry

The following settings can be accessed through the

Setup Spirometry

menu.

Optimizing Scale Settings

In the

Setup Spirometry

menu, select

Optimize Scales

. The scale settings for all three spirometry waves (AWF, AWP, AWV) will be optimized.

Spirometry Values Window

You can view all spirometry measurement data in the spirometry data window. In the Setup

Spirometry

menu, select

Show All Values.

Alarms and Alarm Limits

Alarms can be derived from PEEP, PIP, MV and RRspir. In the

Setup Spirometry

menu you can set the alarm limits. Please refer to the Alarms chapter of this manual for details on alarm settings.

Changing the Apnea Alarm Delay

This determines the time limit after which the monitor alarms if the patient stops breathing.

1

2

3

In the

Setup Spirometry

menu, select

RRspir

.

In

Setup RRspir

menu, select

Apnea Time

.

Choose the apnea alarm delay time.

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14 Monitoring Airway Flow, Volume and Pressure

WARNING

Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

WARNING

If an apnea occurs during a zero calibration or purge, the time delay between the start of apnea and the activation of the apnea alarm could be up to 10 seconds plus the configured apnea delay time.

Automatic Alarm Suppression

If the automatic alarm suppression is switched on, all spirometry alarms are suppressed until breathing activity has been detected. This setting must be made in configuration mode.

Choosing Measured AWV Components

1

2

In the

Setup Spirometry

menu, select

AWV

.

Select

MV

to choose the measured components for Minute Volume (inspiratory and/or expiratory or off).

Select

TV

to choose the measured components for Tidal Volume (inspiratory and/or expiratory or off).

NOTE

If MV and TV are set to off, there will be no alarming for these parameters.

Setting the Gas Compensation Mode

1

2

In the

Setup Spirometry

menu, select

Gas Compensation

.

Select

Mode

to choose the Gas Compensation mode:

– select

Manual

for manually entered gas concentrations or

– select Gas Analyzer for gas concentrations from the gas analyzer.

NOTE

• Gas concentrations from the gas analyzer are only available for Philips gas analyzers, not for devices connected via a Vuelink/IntelliBridge module.

• If gas concentrations from the gas analyzer are selected but not all data is available, the missing data is taken from manually entered values. In case of invalid data or no data at all, the INOP message

SPIRO GAS COMPENS?

is displayed.

Changing the Type of Balance Gas

1

2

3

In the

Setup Spirometry

menu, select

Gas Compensation

.

Select

Balance Gas

to change the type of balance gas.

Select the appropriate setting (N

2

or N

2

O).

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14 Monitoring Airway Flow, Volume and Pressure

Changing the Concentration of Inspired O2 and the Inspired Agents

1

2

3

In the Setup Spirometry menu, select Gas Compensation .

Select

Inspired O₂

to change the concentration of inspired O

2

.

Select

Inspired Agent

to change the concentration of the inspired agent(s).

Select the appropriate setting.

Changing the Temperature of the Inspired Gas

Depending on the type of ventilator environment (e.g. if you are using a Heat Moisture Exchanger) you may want to change the temperature setting of the inspired gas:

1

2

3

In the Setup Spirometry menu, select Gas Compensation .

Select Inspired Temp to change the temperature of the inspired gas.

Select the appropriate temperature setting.

NOTE

Changing the temperature setting unintentionally will result in approximately 3% reduced accuracy per

10°C (18°F) temperature setting change.

234

15

15

Monitoring tcGas

The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood.

The monitor's settings for altitude and barometric pressure influence the measurement. The tcpO

2

/ tcpCO

2

measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as halothane, can cause incorrect or drifting readings.

Transcutaneous measurements cannot replace arterial blood gas monitoring. However, you can use transcutaneous monitoring to reduce the frequency of arterial sampling. The values at tissue level will not be the same as those measured arterially because the measurement is transcutaneous. They correlate with (track closely) the arterial values. For example, a drop in transcutaneous values usually indicates a corresponding drop in arterial values.

Transcutaneous values will not always correlate with blood samples taken from the capillary blood of the heel (heelsticks or astrups).

Identifying tcGas Module Components

3

4

1

2

Press to enter Setup tcGas menu

Press to start calibration

Calibration chamber

Transducer connector

Setting the tcGas Sensor Temperature

1

In the Setup tcGas menu, select Transducer Temp.

.

235

15 Monitoring tcGas

2

Choose a temperature value appropriate for your patient's age, weight and physical condition in accordance with your hospital policy.

Usually, a higher transducer temperature gives a better correlation and a quicker response time.

However, higher temperatures also increase the risk of skin burns. Most physicians prefer a temperature between 42°C (107°F) and 44°C (111°F), and a site time of four hours or less. Usually, the higher the transducer temperature, the less the site time should be. Whenever you change the temperature setting, the monitor forces you to make a new calibration.

Using the tcGas Site Timer

Availability and behavior of the site timer depend on your monitor's configuration.

WARNING

Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics, such as irritation, reddening, blistering or burns. If the site timer is disabled, the transducer will heat indefinitely while on a patient. Change the site regularly, in accordance with medical procedures in your hospital.

Setting the tcGas Site Timer

The site timer helps reduce the risk of skin burn by ensuring that the transducer is used at one site for no longer than a predefined period. It reminds you when this period expires.

1

In the

Setup tcGas

menu, select

Site Time

.

2

Choose the time you want the transducer to remain on the measurement site. The optimum time depends on the transducer temperature and your patient's skin sensitivity.

The site timer starts automatically when you remove the calibrated transducer from the calibration chamber. If you return the transducer to the chamber and then remove it again, the site time continues to count down the remaining time; it does not start a new time period. The time remaining before the site timer expires appears in the status line which is visible as long as the Setup tcGas menu is open.

When the time expires, the monitor sounds a tone and a displays a change site INOP. The monitor either switches off the transducer heating or continues monitoring, depending on its configuration.

Although you can reuse the transducer for up to two hours after the heating is switched off, without making a new calibration, you are recommended to recalibrate before applying it to a patient. After two hours without heat, you must recalibrate.

During the initial few minutes of use, the monitor eliminates false alarms by temporarily suppressing tcGas alarms. It displays the <tcGas Label> STABILIZING INOP. After you apply the transducer to the skin, the instrument reading slowly assumes a steady value. The reading stabilizes when the measurement site is warm and local hyperemization is complete. This takes 10 to 20 minutes for the tcpO2 reading and three to seven minutes for tcpCO2.

Restarting the tcGas SiteTimer

To restart the site timer without recalibration (for example, after the site time has elapsed):

1

2

In the

Setup tcGas

menu, select

Site Time

.

Enter and confirm your desired time.

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15 Monitoring tcGas

Disabling the tcGas Site Timer

Depending on your monitor's configuration, you might be able to disable the site timer. Remember, this means that the transducer heats indefinitely while on a patient.

1

2

In Setup tcGas menu, select Site Timer and switch this to Disabled .

Select the

Confirm

pop-up key.

Setting the tcGas Barometric Pressure

Altitude and barometric pressure affect tcGas values. The monitor derives barometric pressure from its altitude setting. If you want to set the true barometric pressure you must do this before starting a calibration - changes after calibration do not influence tcGas values. The monitor remembers this pressure setting until you enter a new one.

1

2

In the

Setup tcGas

menu, select

Ambient Pressure

.

Enter the current barometric pressure reading indicated by your barometer.

3

Select the Confirm pop-up key.

Remembraning the tcGas Transducer

Follow the instructions supplied with the transducer.

New/Dried Out Transducers

Remembrane all new or dried out transducers twice before using. After the first remembraning, unplug the transducer from the module and leave it for 24 hours with the cap on. Remembrane again before calibrating.

Storing tcGas Transducers

If you need to store a sensor for more than 24 hours, protect it for up to 28 days by putting two drops of electrolyte solution into the cap. Screw the cap on the sensor. Remembrane if it dries out or after 28 days.

Calibrating the tcGas Transducer

You can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the 'out-of-gas' zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not prompt you to do so. You MUST calibrate when:

• you remembrane the transducer

• you change the transducer heat setting

• you doubt the measurement accuracy

• you start a new monitoring period or use a new site

• the monitor displays the

Calibration required

INOP message.

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15 Monitoring tcGas

1

Connect the calibration unit to the inlet on the side of the module's calibration chamber using the recommended gas tubing. Different tubing will cause inaccurate measurements.

2

Plug the transducer cable into the module. Swing the calibration chamber cover open and insert the transducer into the chamber. Close the cover to secure the transducer. Set the transducer temperature at the monitor now.

3

On the 15210B calibration unit, turn the timer control clockwise as far as you can. On the

Radiometer calibration unit, press the button with the green arrow once.

4

Press CAL on the module until the light above the key comes on and wait (three - 20 minutes) for the completion message to appear on the monitor. Alternatively, in the

Setup tcGas

menu, select

StartCalibration

. To save gas on 15210B, if the timer control dial is not in the start position when the monitor displays the completion message, turn the dial counter-clockwise to the start position.

For TCC3, if the green light is still flashing when INOP <tcGas Label> CAL RUNNING disappears, press the green arrow button again.

Calibration Failure

If calibration fails, the monitor displays

<tcGas Label> transducer or cal. unit malfunction

and the

<tcGas Label> CAL FAILED INOP for the measurement.

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15 Monitoring tcGas

Troubleshooting tcGas Calibration

Perform each of the following steps, in order, until calibration is successful.

1

2

3

4

5

Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the calibration unit. If the pressure indicator reading is in the out of gas zone, there is insufficient gas in the cylinder. Connect the gas tubing firmly to the calibration unit and to the module's calibration chamber.

If Step 1 fails, check whether you need to activate the transducer (necessary if the electrolyte has dried out or if you have a new transducer). Remembrane the transducer, removing the old membranes, and cleaning the transducer head thoroughly.

Calibrate a second time.

If Step 2 is unsuccessful, calibrate again. This calibration may be required to stabilize the electrochemical system in the transducer.

Only if the above steps are unsuccessful (you have activated and remembraned the transducer and calibration has still failed twice), replace the transducer.

Applying the tcGas Transducer

1

Peel protection film from fixation ring. Using a finger, press the sticky side of the ring on to clean, dry skin. Press around the outside to ensure a good seal. Apply three to five drops of contact fluid in the ring's center. Remove transducer from chamber.

2

Align the arrow on the transducer with the tab on the ring and fasten by turning a quarter-turn clockwise. Wait 10-20 minutes for readings to stabilize.

3

Apply the transducer as soon as possible after you see the message indicating that calibration is complete. If you wait longer than 30 minutes, the heat supply to the transducer switches off to prevent the electrolyte from drying out and a new calibration is necessary.

Optimize the measurement by selecting a site with high capillary density and blood flow, thin epidermis and no cardiovascular disorders. Most physicians use the abdomen, chest and back.

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15 Monitoring tcGas

WARNING

You must either remove the transducer before defibrillating, or remembrane and calibrate the transducer after defibrillating.

CAUTION

To avoid transducer damage, remove it from the patient during high frequency surgical procedures.

Selecting the tcGas HeatPowerDisplay Mode

The heat power display gives an indication of the skin's perfusion below the transducer and of the transducer's contact with the skin. If the transducer loses contact, the heat power value drops significantly. When perfusion is poor you need less heat power to maintain the transducer temperature.

• In the

Setup tcGas

menu, select

HeatPowerDisplay

and then

Relative

or

Absolute

. Choose

Relative

when the skin temperature is stable (the

<tcGas Label> STABILIZING

INOP disappears).

This indicates subsequent changes in the relative heat power (and therefore changes in perfusion or transducer contact) since the last zeroing.

Zeroing the tcGas Relative Heat Power

When you start a calibration, the

HeatPowerDisplay

is set to

Absolute

. When you switch to

Relative

, it automatically zeros. Zero again if you change application site.

Finishing tcGas Monitoring

Replace the transducer in the calibration chamber.

When changing the application site after a measuring period, some users leave the fixation rings in position to allow them to quickly move the transducer from site to site. Always unscrew the transducer from the fixation ring before removing the fixation ring from the skin.

TcGas Corrections

Transcutaneous pCO

2

values tend to be higher than arterial values due to the metabolic processes of the skin and the effect of heating on the blood under the transducer. Depending on your monitor's configuration, one or both of these corrections may automatically apply.

Temperature Correction for tcpCO2

The transducer temperature causes an increase in partial CO

2

pressure. Your monitor may be configured to correct this.

• In the

Setup tcGas

menu, look at the menu item

CO₂ Correction

. If correction is enabled, it is set to

On

.

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15 Monitoring tcGas

Metabolism Correction for tcpCO2

CO

2

production in the epidermis increases the CO

2

value. Your monitor may be configured to automatically deduct a metabolism factor (only applies when

CO₂ Correction

is on).

In the

Setup tcGas

menu, look at the value shown for the menu item

MetabolismFactor

. This is deducted from the CO

2

value.

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15 Monitoring tcGas

242

16

16

Monitoring Intravascular

Oxygen Saturation

Depending on the probe or catheter used and the measurement location, the two modules, M1011A and M1021A, measure the central venous oxygen saturation or mixed venous oxygen saturation continuously and invasively.

The two modules can be differentiated by their size and their labeling. The M1011A is a single-width module (narrow) and is labeled SO

2

. The M1021A is a double-width module (wide) and is labeled

SvO

2

.

1 M1011A

2 M1021A

WARNING

Injected dyes, such as methylene blue, or intravascular dyshemoglobin may lead to inaccurate measurements.

Do not monitor oxygen saturation during infusion of I.V. fat emulsion or other turbid substances through the distal lumen of the OptiCath catheter. These liquids might temporarily modify the blood scattering and absorption characteristics at the catheter tip. This interferes with the optical measurement of oxygen saturation. After infusion is complete, you can again monitor oxygen saturation accurately.

During injection of the bolus for thermodilution cardiac output measurements, the SvO

2 measurement might be disturbed.

Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.

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16 Monitoring Intravascular Oxygen Saturation

Do not use probes/catheters when they, or the packaging, are damaged.

Always select the correct label for the measurement location and the catheter/probe in use. This is especially important when Protocol Watch is in use, to ensure that the correct limits are used for the criteria applied.

CAUTION

Use the modules with Philips approved accessories only. Refer to the instructions for use provided with the accessory.

Selecting a Measurement Label

Always select a measurement label before inserting a catheter/probe.

Use the SvO2 label when the catheter/probe will be located in the pulmonary artery (measuring mixed venous oxygen saturation). This is the only label which allows the measurement value to be used to

calculate oxygen extraction (see “Calculating Oxygen Extraction” on page 249) and in the standard

oxygen calculations.

Use the ScvO2 label when the catheter/probe will be located in a central vein (measuring central venous oxygen saturation.

Use the SO2 label in all other cases.

To select a measurement label:

1

2

3

Select Main Setup Î Measurements Î <SO₂ Label>

Select

Label

.

Select the appropriate label for the catheter/probe location.

Preparing to Monitor with the M1021A Wide

Module

In addition to the measurement module, you need a Hospira OptiCath catheter, and 50131 Optical

Module. Use only the Hospira accessories listed in the Accessories section.

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16 Monitoring Intravascular Oxygen Saturation

1

2

3

4

5

Optical module

Balloon inflation stopcock

Hospira fiber optic catheter

Optical reference

Enter setup/calibration

Connect the optical module (Hospira 50131) to the measurement module. Allow the optical module to warm up before you perform a calibration. Although the warm up message disappears from the screen after one minute, Hospira recommends letting the optical module warm up for 15 minutes for best accuracy. Please refer to the instructions for the optical module.

To avoid false alarms during the pre-insertion calibration and insertion of the catheter into the patient, the monitor automatically suspends alarms during the pre-insertion calibration, for up to three minutes after you remove the catheter tip from the optical reference. After light intensity calibration, or after three minutes (whichever comes first), the monitor returns to the alarm state it was in prior to preinsertion calibration.

Carrying out a Pre-insertion Calibration

WARNING

It is strongly recommended to carry out a pre-insertion calibration prior to all insertions. If this is not possible, you must perform an in-vivo calibration after insertion.

Refer to the instructions for use that accompany the catheter. Do not use the catheter if the packaging is damaged. If you have to disconnect the monitor from the patient (for example, when transferring the patient from one location to another), you must disconnect at the SvO

2

module. The catheter should remain in the optical module, otherwise you need to recalibrate.

1

2

Remove outer wrapping from catheter tray to uncover optical connector.

Place the optical module on the catheter tray in the space provided and open the lid.

3

4

5

Place the optical connector into the optical module (with the label "TOP" facing upwards) and close the lid.

In the Setup <SO₂ Label> menu, select Start Pre-InsCal . Ensure that the tip of the catheter is still in the optical reference.

Insert the catheter when you see the message <SO₂ Label> calibration completed - catheter ready for insertion

. If the calibration fails, repeat the calibration before inserting the catheter. If it fails a second time, replace the optical module.

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16 Monitoring Intravascular Oxygen Saturation

Inserting the Catheter

1

Remove the inner cover of the catheter tray.

2

Remove the catheter tip from the optical reference. Check the catheter's proper operation (for example: the balloon tip).

3

Prepare and insert the catheter in accordance with standard hospital practice.

The SvO

2

catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and sudden decrease in intensity readings. Refer to the documentation provided with the fiber-optic catheter, paying special attention to any precautions, warnings or contraindications.

Secure the optical module directly or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient. Position the optical module to avoid contact with liquids, because fluid entering the catheter-optical module connection may impair light transmission.

If you place the catheter in the patient without performing the pre-insertion calibration, you must perform an in-vivo calibration once the catheter is in place.

Performing a Light Intensity Calibration

Perform a light intensity calibration after the catheter is in its proper position. When the catheter is positioned properly, the light intensity indicator must cover at least two small divisions above the midpoint.

• In the

Setup <SO₂ Label>

menu, select

Start Light Cal

.

Calibration is complete after a few seconds. If you doubt existing light intensity readings, recalibrate.

Performing In-Vivo Calibration

Perform an in-vivo calibration:

• if you place the catheter in a patient without performing a pre-insertion calibration.

• if the catheter was disconnected from the optical module.

• when the catheter has been in the patient for 24 hours.

• if any significant change in light intensity occurs that the monitor cannot correct automatically.

Setting Up the In-Vivo Calibration

Check for:

• proper positioning of the catheter in the patient.

• relatively stable oxygen saturation in patient.

• that the SvO

2

light intensity indicator covers at least two divisions above the midpoint.

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16 Monitoring Intravascular Oxygen Saturation

Making the In-Vivo Calibration

1

2

3

Be prepared to draw a blood sample from the patient.

In the

Setup <SO₂ Label>

menu, select

Start In-VivoCal

.

To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.

4

Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice.

Obtain laboratory analysis of the sample using direct measurements.

5

6

7

Select

CalibrationValue

and select from the list the value received from the lab.

Complete the calibration by selecting

Store In-VivoCal

(even if the stored calibration value did not change) and select

Confirm

. This updates the data stored in the optical module.

Selecting Recall Last Cal recalls the previously stored calibration value.

If the calibration fails, check that the light intensity indicator is indicating a stable medium to high level.

Repeat the calibration.

Setting Up the In-Vivo Calibration

Check for:

• proper positioning of the probe/catheter in the patient.

• relatively stable oxygen saturation in patient.

• that the light intensity indicator is indicating a stable medium to high level.

Depending on the probe/catheter in use you may need to enter a catheter correction factor. This will be indicated in the table in the Accessories chapter or in the catheter documentation.

1

2

In the

Setup <SO₂ Label>

menu, select

Catheter Factor

.

Enter the correction factor.

Making the In-Vivo Calibration

1

Be prepared to draw a blood sample from the patient.

2

3

In the

Setup <SO₂ Label>

menu, select

Start In-VivoCal

.

To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.

4

Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice.

Obtain laboratory analysis of the sample using direct measurements.

5

6

7

Select CalibrationValue and select from the list the value received from the lab.

Select

Hct [%]

(or

Hb [mmol/l]

or

Hb [g/dl]

depending on the set up) and enter the corresponding value from the laboratory analysis.

To change the setup for entering the Hb/Hct, see “Changing the Lab Value Required for Entry” on page 248 below.

8

Complete the calibration by selecting

Store In-VivoCal

(even if the stored calibration value did not change) and select

Confirm

. This updates the data stored in the optical module.

Selecting

Recall Last Cal

recalls the previously stored calibration value.

If the calibration fails, check that the light intensity indicator is indicating a stable medium to high level.

Repeat the calibration.

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16 Monitoring Intravascular Oxygen Saturation

Changing the Lab Value Required for Entry

You can change the lab value required to be entered:

Hb [g/dl]

,

Hb [mmol/l]

or

Hct [%].

1

In the

Setup <SO₂ Label>

menu, select

Hb/Hct Entry

.

2

Select your preferred lab value and unit.

Preparing to Monitor with the M1011A Narrow

Module

In addition to the module, you need a Philips SO

2

Optical Module and a compatible fiber optic probe or catheter. Use only the accessories listed as applicable for the intended measurement location in the

Accessories section.

Connecting the Optical Module

1

Connect the optical module to the SO

2

module. Allow the optical module to warm up before you insert the probe/catheter and perform a calibration.

Although the warmup message disappears from the screen after one minute, it is preferable to let the optical module warm up for 10 minutes for best accuracy.

2

3

Position the optical module to avoid contact with liquids. Fluid entering the catheter-optical module connection will impair measurement performance.

Place the optical module on the catheter tray in the space provided and open the lid.

4

For instructions on the placement of fiber optic catheters/probes, refer to the documentation provided with the accessory.

After Insertion

The SO

2

probe/catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the probe/catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and a sudden decrease in intensity readings. Refer to the documentation provided with the fibre-optic probe/catheter, paying special attention to any precautions, warnings or contraindications.

Secure the optical module directly attached or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient.

You must perform an in-vivo calibration once the probe/catheter is in place.

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16 Monitoring Intravascular Oxygen Saturation

The probe/catheter should be replaced after it has been in place for 72 hours.

CAUTION

Do not apply excessive tension to any sensor cable or part of the catheter.

Performing In-Vivo Calibration

Perform an in-vivo calibration:

• when you place the catheter in a patient.

• if the catheter was disconnected from the optical module.

• when the catheter has been in the patient for 24 hours.

• if any significant change in light intensity occurs that the monitor cannot correct automatically.

Further Information for Both Modules

Checking Suspicious Values

If you have any doubts about the correctness of the measurement value, take a blood sample and have it analyzed using standard laboratory procedures.

Calculating Oxygen Extraction

Oxygen extraction is the difference between the measured SpO monitoring SpO

2

and SvO

2

and SvO

2

values. If you are

2

, the monitor can calculate this value and display it as a numeric.

• To switch oxygen extraction calculation on or off, in the

Setup Sp-vO₂

menu, select

Sp-vO₂

and toggle between On and Off .

• If more than one SpO

2

value is available, you must choose which value is used in the calculation.

In the Setup Sp-vO₂ menu, select SpO₂ Source and select the required source.

If one of the calculation sources becomes unavailable, the monitor displays the INOP Sp-vO₂ CHK

SOURCES for one minute. After this time, the calculation automatically switches off. If the missing source becomes available again, the calculation automatically switches on again.

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16 Monitoring Intravascular Oxygen Saturation

250

17

17

Monitoring EEG

The Electroencephalograph (EEG) module monitors the patient's cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics:

Spectral Edge Frequency - The SEF is the frequency below which a defined percentage of the Total

Power lies. The percentage is set in Configuration Mode.

Mean Dominant Frequency (MDF) - The MDF is the mean value of the frequency which dominates the measured EEG.

Peak Power Frequency (PPF) - The PPF is the frequency with the highest measured amplitude.

Total Power (TP) - The TP numeric indicates the power in the measured frequency band.

Percentage of total power in each frequency band:

Alpha

waves (8 to 13 Hz)

Beta

waves (13 to 30 Hz)

Theta

waves (4 to 8 Hz)

– Delta waves (0.5 to 4 Hz).

EEG Monitoring Setup

4

5

1

2

3

6

Plug the trunk cable into the EEG module.

Prepare the patient's skin prior to placing the electrodes. Good electrode-to-skin contact is important for a good EEG signal, as the skin is a poor conductor of electricity.

– Shave hair from sites, if necessary.

– Wash sites thoroughly with soap and water. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.

– Use a skin preparation paste to remove skin cells and oil before placing the electrodes.

Select the desired electrode montage in the Setup EEG menu or in the EEG Impedance / Montage window.

Attach the reference electrode first.

Place the electrodes on the patient's head according to the selected montage. Use electrode gel if you are not using pre-gelled electrodes. Remember to select a site where the signal will not be interfered with by muscle artifacts.

Connect the electrode connector end to the trunk cable.

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17 Monitoring EEG

7

8

Check the electrode-to-skin impedance in the EEG Impedance / Montage window.

For good signal quality, keep all lead wires together and away from other electric devices and metallic bodies.

Using the EEG Impedance/Montage Window

To open the window, in the

Setup EEG

menu, select

Show Montage

, or select the

EEG Montage

SmartKey.

The window may be configured to look slightly different on your monitor.

1

2

Electrode locations on the patient's head. The symbols represent the electrode-to-skin impedance.

Wiring and impedance values for the selected montage

Choosing an EEG Electrode Montage

1

2

To activate one of the five pre-configured electrode montages, select the arrow beside the label in the

EEG Impedance / Montage

window and choose a montage from the list.

Attach the electrodes as illustrated in the EEG Impedance / Montage window.

The five default electrode montage configurations can be modified and renamed in Configuration

Mode.

Montage Name

Montage A

Montage B

Montage C

Montage D

Montage E

EEG1+ EEG1Label1

Fp1

O1

F3

C3

Fp1

T3

T3

C3

P3

T5

Fp1-T3

O1-T3

F3-C3

EEG2+

Fp2

O2

F4

C3-P3 C4

Fp1-T5 Fp2

EEG2-

T4

T4

C4

P4

T6

Label2

Fp2-T4

O2-T4

F4-C4

C4-P4

Fp2-T6

The electrode locations are labeled according to the international 10-20 electrode placement system.

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17 Monitoring EEG

Changing the Impedance Limit

The impedance limit can be set for all electrodes simultaneously in the Setup EEG menu, or in the EEG

Impedance / Montage

window using the pop-up keys. If the limit is exceeded during monitoring, an

INOP will appear and the graphic impedance indicator will change.

To change the impedance limit, either

• use the pop-up keys that appear with the EEG Impedance / Montage window, or

• in the

Setup EEG

menu, select

Impedance Limit

to call up a list of selections between 1 and

30 kOhm, then select the required limit from this list.

About Electrode-to-Skin Impedance

Electrode-to-skin impedance is the main quality indicator for the measured EEG signal. During normal EEG monitoring, electrode-to-skin impedance is measured continuously and disconnected electrodes are detected. The impedance value for each single, independent signal electrode is displayed in the EEG Impedance / Montage window. If the measured electrode-to skin impedance of one or more electrodes is above the limit, an INOP will be issued.

For impedance measurement at least two electrodes, plus the reference electrode, must be connected.

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17 Monitoring EEG

Impedance Indicators

Electrode/Skin

Impedance

Electrode not connected

Symbol Color

red

Noisy signal

Electrode connected, impedance above limit

Electrode connected, impedance at or below limit gray yellow green

Displayed

Impedance

Value

no value

Action

connect electrode

60 kΩ (fixed) check electrode-to-skin connections measured value

(e.g. 15 kΩ) check limit, check electrode-to-skin contact measured value

(e.g. 3 kΩ) no action necessary

About Compressed Spectral Arrays (CSA)

The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA).

The CSA window provides an overview of the patient's EEG values over time. It may be configured to look slightly different on your monitor.

• To view the CSA window permanently embedded on a Screen, select a Screen configured to display the CSA window.

• To view the CSA window over the current Screen, select the

EEG CSA

SmartKey, if configured, or select Setup EEG or Main Setup then Show CSA .

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17 Monitoring EEG

The CSA contains the following information

Lead label

CSA label for example, Fp1-T3, Fp2-T4

CSA1 or CSA2 according to EEG channel

Status line

Spectral lines

Montage label

Filter settings

Buffer label and time

Current SEF Threshold for example, Montage A for example, 1-30 Hz the buffer and interval between spectral lines on the CSA can only be changed in Configuration Mode

The energy at each frequency is computed and displayed as a spectral line

Trendlines

EEG values are sampled at configured time intervals and displayed as color-coded trendlines.

Trendlines are available for the three frequency numerics (SEF, PPF, MDF)

INOP marker

Annotations:

Filter change marker

Montage change marker

Changing CSA Settings

When CSAs are shown embedded on the Main Screen, select the CSA to show the pop-up keys. When the CSA is shown in a window over the current screen, the pop-up keys are always displayed.

Setup CSA Window

Buffer

On/Off SEF

On/Off MDF

On/Off PPF

This menu entry lets you

choose one of the three pre-configured buffers. A buffer defines the interval between the spectral lines displayed in the CSA. switch the trendline of the specific numeric on or off

Changing EEG Settings

Be aware that any changes made to EEG settings apply to both EEG channels.

Switching EEG Numerics On and Off

Each EEG numeric can be individually switched on or off in the

Setup EEG

menu.

1

In the

Setup EEG

menu, select the numeric label.

2

Select On or Off to switch between the settings.

Changing the Scale of the EEG Waves for Display

This only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings.

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17 Monitoring EEG

1

2

In the Setup EEG menu, select Wave Scale to call up a list of wave scales.

Select the required scale from this list.

Scaling information is displayed with each EEG wave.

• If

Show Gridlines

is set to

On

in Configuration Mode, gridlines and the current wave scale values are shown with the EEG wave.

• If

Show Gridlines

is set to

Off

in Configuration Mode, the current wave scale is indicated by a size bar beside the EEG wave.

Changing Filter Frequencies

The low and high pass filters screen out undesirable interference from the raw EEG wave display. The current EEG filter frequency settings are shown in the header of the CSA. Changing filter settings affects the EEG wave and all the EEG numerics. Whenever the filter setting is changed, a filter change marker appears next to the spectral lines.

To change the filter settings:

1

2

In the Setup EEG menu, select Low Filter or High Filter to call up a list of available frequencies.

Select the required frequency from this list.

Changing the Speed of the EEG Wave

The EEG measurement has its own speed control and is not affected by the wave speed settings of the other measurements.

In the Setup EEG menu, select EEG Speed . Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).

EEG Reports

The content of EEG Reports is always the same and does not need to be configured.

To print an EEG Report, in the

Setup EEG

menu, select

Print Report

.

Alternatively, you can select the CSA and use the Print Report pop-up key to start the report.

To modify the buffer and trendline settings on the CSA Report, in the

Reports

menu, select

CSA On

EEG Rep.

. If you do not change these settings, the monitor will use the default settings with the trendlines for the SEF numeric on and the buffer time from Buffer C.

CSA on Report

Buffer

Trend SEF

Trend MDF

Trend PPF

This menu entry lets you

choose one of the three pre-configured buffer times switch the trendline of the specific numeric on or off

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17 Monitoring EEG

EEG Safety Information

WARNING

Do not touch the patient, or table, or instruments during defibrillation.

When connecting electrodes and/or patient cables, ensure that the EEG leads and connectors do not come into contact with other conductive parts or earth.

High-frequency Surgery - To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the EEG electrodes should not be located between the surgical site and the electrosurgical unit return electrode.

EEG and Electrical Interference

CAUTION

Interference from a non-grounded instrument near the patient and electrosurgery interference can cause problems with the waveform and the CSA.

Radiated field strengths above 1 V/m and patient signals ≤ 50 µV may cause noise on the EEG waves at various frequencies. Therefore, it is recommended to avoid the use of electrical radiating equipment in close proximity to the patient monitor. The noise does not influence the measurement accuracy.

Interference from ECG can be eliminated by adjusting the low filter settings.

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17 Monitoring EEG

258

18

18

Monitoring BIS

Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient's forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS intended use statement.

The BIS Module provides the monitor with an EEG wave and the following numerics:

Bispectral Index (BIS). The BIS numeric reflects the patient’s level of consciousness. It ranges from

100 (fully awake) to 0 (suppression; no electrical brain activity).

Signal Quality Index (SQI). The SQI numeric reflects signal quality and provides information about the reliability of the BIS, SEF, TP, SR, and Bursts numerics during the last minute.

It ranges from 0 to 100%:

SQI < 15%: the numerics cannot be derived

SQI 15% to 50%: the numerics cannot be reliably derived

SQI 50% to 100%: the numerics are reliable.

Electromyographic Activity (EMG). The EMG numeric reflects the electrical power of muscle activity and high frequency artifacts.

EMG < 55 dB: this is an acceptable EMG

EMG ≤ 30 dB: this is an optimal EMG

(note that the minimum possible EMG is approximately 25 dB).

Suppression Ratio (SR). The SR is the percentage of time over the last 63-second period during which the EEG is considered to be in a suppressed state.

Spectral Edge Frequency (SEF).The SEF is the frequency below which 95% of the Total Power is measured.

Total Power (TP). The TP numeric indicates the power in the frequency band 0.5 to 30 Hz. The useful range is 30 - 100 dB.

Bursts (BISx module used with the Extend sensor only). The Bursts numeric helps you quantify suppression by measuring the number of EEG bursts per minute, where an EEG burst is defined as a period of activity followed and preceded by inactivity (at least 0.5 second).

BIS Monitoring Setup

There are two BIS solutions available for use with the M1034A BIS module: using the DSC and BIS engine or using the BISx.

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18 Monitoring BIS

Monitoring BIS Using the DSC and BIS Engine

1

2

3

4

5

6

BIS Engine Cable

BIS Module

Aspect BIS Engine 185-0111

Aspect Digital Signal Converter

185-0124

Aspect Patient Interface Cable

186-0131

Aspect BIS Sensor

1

2

3

If you are monitoring BIS with the DSC and BIS engine, a. Connect the BIS engine to the BIS module using the BIS Engine Cable.

b. Connect the digital signal converter (DSC) to the digital signal converter port on the front of the BIS Engine. Use the attachment clip to secure the digital signal converter near, but not above the patient's head.

c. Attach the patient interface cable (PIC) to the digital signal converter (DSC).

Attach the BIS sensor to the patient following the instructions supplied with the sensor.

Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.

A variety of sensors are available for use in the OR and ICU environments: see the chapter on accessories for information.

Connect the BIS sensor to the patient interface cable.

As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window.

260

Monitoring BIS using the BISx

18 Monitoring BIS

1

2

3

4

BIS Module

Aspect BISx 185-0145-PH

Aspect Patient Interface Cable 186-

0131

Aspect BIS Sensor

1

2

If you are monitoring BIS using the BISx, a. Connect the BISx device to the BIS module b. Use the clip on the rear of the BISx device to affix it in a position convenient for your patient, not above the patient's head.

Attach the BIS sensor/BIS electrodes to the patient following the instructions supplied with the sensor.

Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.

A variety of sensors are available for use in the OR and ICU environments: see the chapter on accessories for information.

CAUTION

Ensure that the BISx does not come into prolonged contact with your patient's skin, as it may generate heat and cause discomfort.

The BISx may remain connected to a patient during defibrillation as long as the sensor is not located between the defibrillator pads.

3

With sensors for single-patient use: a. Attach the patient interface cable (PIC) to the BISx device.

b. Connect the BIS sensor to the PIC.

With Semi Re-usable Sensors: c. Attach the sensor cable to the BISx device.

d. Snap the sensor cable onto the electrodes.

As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window. The number of uses remaining for the semi re-usable sensor is shown in the status line when the BIS window is open.

Manufacturer's Information

BISx, the Patient Interface Cable and the BIS Sensors are manufactured by Aspect Medical Systems.

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18 Monitoring BIS

BIS Continuous Impedance Check

This checks:

• the combined impedance of the signal electrodes plus the reference electrode.

This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results.

• the impedance of the ground electrode.

This is done every ten minutes and takes approximately 4 seconds. It causes an artifact in the EEG wave, and the message Ground Check is shown on the monitor screen during the check. If the ground electrode does not pass this check, another check is started. This continues until the ground electrode passes the check.

If the Continuous Impedance Check interferes with other measurements, it can be switched off. To do this:

1

2

In the

Setup BIS

menu, select

Cont. Imp. Check

.

Select On or Off as required.

CAUTION

Switching the continuous impedance check off will disable automatic notification to the user of impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done if the check interferes with or disturbs other measurements.

When a Semi-reusable Sensor is in use the continuous impedance check cannot be switched off. If it is switched off when the sensor is connected, it will automatically be switched on again.

BIS Cyclic Impedance Check

This measures the exact impedance of each individual electrode. It causes a disturbed EEG wave, and the INOP BIS IMPEDANCE CHCK is shown on the monitor screen during the check.

Starting a Cyclic Impedance Check

The Cyclic Impedance Check is automatically started when a sensor is connected. To manually start a

Cyclic Impedance Check:

• select

Cyclic Check

in the

Setup BIS

menu to toggle between

On

and

Off

, or

• select StartCyclicCheck in the BIS window.

Stopping a Cyclic Impedance Check

The Cyclic Impedance Check stops automatically if the impedances of all electrodes are within the valid range. To manually stop a Cyclic Impedance Check:

• select

Cyclic Check

in the

Setup BIS

menu to toggle between

On

and

Off

, or

• select Stop CyclicCheck in the window.

If you stop a Cyclic Impedance Check before the ground electrode has passed, a ground electrode impedance check will be started automatically. This cannot be switched off.

262

18 Monitoring BIS

BIS Window

To open the BIS window, in the

Setup BIS

menu, select

Show Sensor

.

The window may look slightly different on your monitor. The graphic in the BIS Window automatically adapts to show the type of sensor you are using, showing three or four electrodes as required. Each symbol in the graphic represents an electrode and illustrates the most recentlymeasured impedance status of the electrodes. Although BIS may still be measured when the electrode status is red or yellow, for best performance, all electrodes should be green.

In addition, if the measured electrode-to skin impedance of any electrode or electrode combination is above the limit, or if disconnected electrodes are detected, an INOP will be issued, either

BIS HIGH

IMPEDANCE

or

BIS LEAD OFF.

1

2

3

4

Reference Electrode

Ground Electrode

Signal Electrode(s)

Time of the most recent cyclic check

BIS Impedance Indicators

Electrode-to-Skin

Impedance

Electrode has no skin contact

Symbol Color

red

Too much signal noise, impedance cannot be measured

Impedance above limit

Impedance within valid range gray yellow green

Action

Reconnect electrode, or check the sensorto-skin contact. If necessary, clean and dry skin.

Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.

Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.

No action necessary

263

18 Monitoring BIS

In addition to the symbols, the impedance value in kOhm is also displayed.

Changing the BIS Smoothing Rate

The smoothing rate defines how the monitor averages the BIS value.

To change the smoothing rate, in the Setup BIS menu, select Smoothing Rate then choose either:

– 15 sec : this provides increased responsiveness to changes in the patient's state.

– 30 sec : this provides a smoother BIS trend with decreased variability and sensitivity to artifacts.

Switching BIS and Individual Numerics On and Off

To switch the BIS measurement on or off:

• In the

Setup BIS

menu, select

BIS

and then

On

or

Off

as required.

To switch individual numerics provided by the BIS Module on or off:

• In the Setup BIS menu, select SQI , TP , SEF , SR , EMG , or Bursts and then On or Off as required.

Changing the Scale of the EEG Wave

Changing the scale only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings.

The scale information shown depends on whether gridlines are switched on or off for display. This setting can only be changed in Configuration Mode.

1

2

In the Setup BIS menu, select Scale to call up a list of wave scales.

Select the required scale from this list.

– When gridlines are switched off, you can choose from the available scale values: 50 mV,

100 mV, 200 mV, and 500 mV. Scaling information is displayed as a vertical bar on the EEG wave together with its height equivalent in mV.

– When gridlines are switched on, scales are defined as a range, either ± 25 mV, ± 50 mV, ±

100 mV, or ± 250 mV. Scaling information is shown in the form of gridlines.

Switching BIS Filters On or Off

The low and high pass filters screen out undesirable interference from the raw EEG wave display. The notch filter removes line frequency interference. Filter settings affect the EEG wave and the SEF and

TP values, but they do not affect the BIS, EMG, SR, and SQI values.

The filter settings are set in Configuration Mode. You can switch all the filters on or off together in

Monitoring Mode.

1

2

In the

Setup BIS

menu, select

Filters

.

Select

On

or

Off

as required.

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18 Monitoring BIS

BIS Safety Information

For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and

Etomidate, please contact Aspect Medical Systems to request a copy of their publication "A Clinician's

Guide to the Bispectral Index®".

Considerations for Use

Due to limited clinical experience in the following applications, BIS values should be interpreted cautiously in patients with known neurological disorders, those taking psychoactive medications, and in children below the age of 1.

WARNING

Conductive Parts: The conductive parts of sensors and connectors should not contact other conductive parts, including earth.

High-frequency Surgery: To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the BIS sensor should not be located between the surgical site and the electrosurgical unit return electrode.

Defibrillation: The BIS sensor must not be located between defibrillator pads when a defibrillator is used on a patient connected to the patient monitor.

Securing Cables: To minimize the risk of patient strangulation, the patient interface cable (PIC) must be carefully placed and secured.

CAUTION

Revisions: The system will only function if all component revisions are compatible. Otherwise, an incompatibility INOP is displayed.

If the DSC has an older software revision than the BIS Engine, the DSC will automatically be upgraded by the BIS Engine. Do not disconnect the DSC from the BIS Engine, or disconnect the BIS module from the monitor, or switch the monitor power off within the first ten seconds after connection, as this will disrupt a possible software upgrade and cause damage to the DSC.

Impedance Checks: Impedance checks may influence data acquisition of other electroencephalographic devices.

265

18 Monitoring BIS

266

19

19

Assigning a Telemetry

Device and a Monitor to One

Patient

It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called

"pairing" and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen.

A telemetry device can be:

• any Philips telemetry device (only for indirect connections, see below).

• a TRx/TRx+ Intellivue Telemetry system transceiver.

• an MP5 monitor or X2 Multi measurement module with a telemetry interface, declared as a telemetry device and with a telemetry equipment label.

For complete user information, including accessory listings and specifications, for the M4841A/

M4851A TRx/TRx+ IntelliVue Telemetry Transceiver, refer to the Instructions for Use provided with the device.

How Can You Combine Devices?

• With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor.

• With a direct connection to the monitor

– an MP5 or X2 is connected via MSL cable to the monitor, or

– a telemetry transceiver with a short range radio adapter is assigned to an MP5 or X2 which is connected (Companion Mode) to a an MX800 host monitor the data arrive with a minimal delay on the monitor screen.

Indirect Connection - Manual Pairing

The telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the

Information Center Instructions for Use.

To pair the monitor with a telemetry device at the monitor:

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19 Assigning a Telemetry Device and a Monitor to One Patient

1

2

3

Select Main Setup then Measurements

Select Telemetry

The Setup Telemetry menu will appear with only one entry Paired Equipment .

Enter here the equipment label of the telemetry device to be paired.

Pairing at the monitor is only possible when the monitor already has a connection to the Information

Center and the Information Center software version allows pairing at the monitor.

Telemetry Data Window

The measurements from the telemetry device are shown in the telemetry data window on the monitor.

1

A current alarm generated by the telemetry device.

2

Delayed

- indication that data in the window is delayed

3

Telemetry data window

WARNING

All data presented in the telemetry data window are delayed for several seconds.

If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG analog output.

Direct Connection - Automatic Pairing

The following direct connections are possible:

• an MP5 or X2, declared as a telemetry device, and connected with an MSL cable to a monitor.

WARNING

• When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A

No ECG Out

message will appear in the ECG wave channel.

268

19 Assigning a Telemetry Device and a Monitor to One Patient

• When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected.

• Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device.

Pairing an X2 or MP5 With a Telemetry Interface to a Host Monitor

An X2 Multi-measurement module or an MP5 using an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a "telemetry device" at the Information Center.

When the X2 or MP5 is disconnected from the host monitor it will remain paired and the measurement data will appear at the host monitor in the Telemetry Data window. After the X2 or MP5 is disconnected from the monitor it may take over 15 seconds until their data is displayed at the

Information Center.

Pairing of a host monitor and a telemetry device, with all the related functionality, is only possible when the host monitor is using a wired LAN connection or a wireless LAN interface (but not using the IntelliVue Instrument Telemetry interface).

The X2 or MP5 can also be manually paired to a host monitor without a direct connection, as

described in “Indirect Connection - Manual Pairing” on page 267.

Refer also to for further related use modes.

Functions Available When the Telemetry Data

Window is Displayed

Controlling the Telemetry Device from the Bedside

You can change settings for a paired telemetry device at the monitor:

1

Select the telemetry data screen element

2

Select the Setup Tele pop-up key

The

Setup Telemetry

menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here.

Viewing and Silencing Telemetry Alarms at the Bedside

When a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center.

If configured, a generic

* TELE ALARM

message will appear in the alarm status area with standard alarm tones. The * TELE ALARM message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example

** HR LOW

) will appear in the telemetry data window.

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19 Assigning a Telemetry Device and a Monitor to One Patient

If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor

Silence

key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the

Silence Bed

pop-up key will be available:

1

Select the telemetry screen element.

2

Select the Silence Bed pop-up key.

Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms.

WARNING

Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured.

Suspending Telemetry Alarms

When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected.

Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device.

Using Standby

When you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring.

Refer to the Information Center Instructions for Use for details on the Standby behavior of the

Information Center and telemetry device.

General Telemetry-related Functions

The following functions are valid for directly and indirectly connected telemetry devices.

ECG Source Tracking at the Information Center

The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated — the ECG Setup menu will no longer be accessible.

When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitor's own measurements, the SpO

2

T measurement (if present) will no longer be displayed.

In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa.

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19 Assigning a Telemetry Device and a Monitor to One Patient

In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active.

Synchronized Settings

If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:

Heart Rate

ECG

Arrhythmia

HR/Pulse Alarm On/Off, Heart Rate High/Low Limit,

Primary Lead, Secondary Lead, Va Lead

1

, Vb Lead

1

, Lead Placement

Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach

Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/min On/Off,

Pacer not capture On/Off, Pacer not pace On/Off, Non-Sustain On/Off,

Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed

Beat On/Off, Pause On/Off, R-on-T PVCs On/Off, Vent. Bigeminy On/

Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR

On/Off, SVT On/Off, Afib On/Off

ST

QT

ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST

Priority List, Single ST Alarm Limit, Multi ST Alarm Limit

QT analysis On/Off, QT Lead, QTc High Alarm On/Off, ΔQTc Alarm

On/Off, QTc High Limit, ΔQTc High Limit, QTc Formula

2

, QT Baseline

SpO

2

T SpO

2

Alarms on/off, SpO

2

Alarm limits

NBP Alarm Suppression On/Off, Pulse(SpO

2

) On/Off

1

Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6.

2

This setting will only be synchronized when the Information Center supports QT Analysis for Telemetry

WARNING

• Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate.

• Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6

If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes.

Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a

Check ECG Settings

or

!! CHECK PAIRING

INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient.

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19 Assigning a Telemetry Device and a Monitor to One Patient

Use Models With Telemetry

The standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the

Information Center in the same patient sector as the monitor data. The following variations are possible:

1

The monitor is paired with a telemetry transceiver - indirect connection

– telemetry data appear on the monitor

2

An MP5 or X2 is declared as a telemetry device and paired with an MX800 monitor - direct or indirect connection

– MP5/X2 measurement data appear on the monitor it is paired with

– a telemetry transceiver cannot be used with the MP5/X2

3

A telemetry transceiver directly connected (SRR or for MP5 cable) to an MP5 or X2, that is connected (Companion Mode) to an MX800 monitor - direct connection.

– telemetry data appear on the host monitor

– telemetry transceiver is paired with the host monitor but is assigned to the MP5 or X2

the MP5 or X2 must have no equipment label

The different variations require different configuration settings; refer to the Configuration Guide for details.

272

20

20

Trends

Trends are patient data collected over time and displayed in graphic, tabular or histogram form to give you a picture of how your patient's condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodicallymeasured parameters, such as Cardiac Output.

Viewing Trends

Trend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.

• To view trends embedded as a screen element, enter the

Change Screen

window, then select a

Screen designed to show an embedded trend window.

• To open the tabular trends window over the current Screen, select

Main

Setup Î Trends Î Vitals Trend

, or select the

Vitals Trend

SmartKey .

• To open the graphic trends window over the current Screen, select the Graph Trend SmartKey

.

• To open the histogram trend window over the current screen, select

Main

Setup Î Trends Î Histogram

, or select the

Histo- gram

SmartKey.

The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom or the top of the screen shows you where you are in the trends database.

The preview column on the right-hand side shows the latest available measurement value. The preview column is updated every five minutes or whenever an NBP or other aperiodic measurement is completed.

A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement.

Your monitor screen may look slightly different to the examples shown in this chapter.

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20 Trends

Trends Pop-Up Keys

When you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks.

Pop-Up Keys

Select Group

Select Interval

Print/ Record

Print

Vital Signs

Graph Trend

Selecting this pop-up key lets you....

see a pop-up list of trend groups and select a group for viewing.

see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.

print a tabular trends report or make a tabular trend recording of the data in the current window. The report will use the current trend interval settings.

print a graphic trends report of the data in the current window. The report will use the current trend interval settings.

move the cursor one step to the left or right to navigate through the trends database timeline.

move the cursor one page to the left or right to navigate through the trends database timeline.

jump to the beginning or the end of the trends database to see the most recent or oldest trend information stored.

scroll up and down the screen to see measurement trends that do not fit in the current view.

open the current trend view in tabular form. The displayed time period and resolution stay the same.

open the current trend view in graphic form. The displayed time period and resolution stay the same.

Viewing Graphic Trends

274

A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column.

In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.

20 Trends

To use the trend cursor to navigate in time through the trends database,

1

Select the graphical trend or the arrow pop-up keys to activate the cursor.

2

3

Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or

Place the cursor at a specific time by touching the graph.

Viewing Vital Signs Trends

1

Aperiodic values are shown with a timestamp

The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.

Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets.

If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow.

To view the Vital Signs trend with one column for each NBP measurement (see ):

1

2

With the Vital Signs trend open, select

Interval

.

Select

NBP

from the pop-up list.

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20 Trends

Viewing Histogram Trends

The title line of the window shows the label of the trended measurement and the resolution of the data; in the RR histogram above, 1 minute trend samples.

The horizontal axis shows the range and unit of the displayed measurement. The vertical axis shows the percentage of time.

The columns in the foreground show how much of the time the measured values fell into this range on the scale. For example, in the histogram above, the RR value was between 15 and 20 rpm during 70% of the last four hours. The arrow mark over that column shows that the currently measured value is also in this range. These columns are displayed in the same color as the measurement data.

The columns in the background show the cumulative percentage value: each of the foreground columns is added to the sum of those columns to the left of it.

A question mark is displayed if less than two-thirds of the data are valid samples.

The pop-up keys in the window can be used to change the measurement, the time period and the range. You can also print out a histogram report.

The SpO

2

histograms can be trend histograms or realtime histograms with 1 second samples. For

SpO

2

realtime histograms, the range cannot be changed.

Setting Up Trends

Trends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under

Main Setup Î Trends

.

Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu.

Making Segment Settings

The Graphical Trends window is divided into measurement segments, each of which has its own settings.

To enter the segment menu,

• select the left hand column of the segment, where the measurement label is displayed.

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20 Trends

Expanded View

To expand the segment to fill the

Graphical Trends

window,

• in the

Segment

menu, select

Expand

to have that segment enlarged to fill the window.

In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement,

• in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement.

To return the segment to its original size,

• in the Segment menu, select Expand again.

Trend Scales for Segment Measurements

To change the trend scales for a measurement in the current segment:

1

In the

Segment

menu, select the measurement label

2

Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale.

Optimum Scale

To have the monitor automatically select an optimum scale for viewing, based on current values,

• in the

Segment

menu, select

Optimum Scale

.

This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in

Parameter Scales

.

To switch off automatic optimum scaling,

• in the Segment menu, select Optimum Scale again.

Trend Group

To add or remove measurements for this trend group or change the order of the existing measurements:

1

2

In the

Segment

menu, select

Change Group

.

Use the

Add

,

Change

,

Sort Up

and

Sort Down

pop-up keys to change or re-order the group as required.

No. of Segments

In an embedded graphical trend window, you can select the number of segments to be displayed in the

Segment

menu:

• In the

Segment

menu, select

No. Of Segments

Trend Groups

The measurements grouped in trend groups define the trends displayed together in the Vital Signs or

Graphical Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group

All

contains all available measurements, you cannot change the order or selection of this group.

277

20 Trends

To change the selection of measurements in a trend group, either use the Change Group setting in the

Segment

menu or:

1

2

Select Main Setup Î Trends Î Trend Groups .

Select the Trend Group you want to change and use the pop-up keys to Add , Change , or Delete the selection of measurements trended.

To temporarily change the order in which the measurements are displayed in a group,

1

2

Select

Main Setup Î Trends Î Trend Groups

.

Select the Trend Group and then the measurement you want to move and use the

Sort Up

/

Sort

Down

pop-up keys.

Trend Interval

The trend interval defines the resolution of trend data shown on the Screen. High-resolution data is especially suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative.

To set the trend resolution, in the

Vital Signs

or

Graphical Trends

window,

• Select the Select Interval pop-up key and then select the required interval from the list.

Trend Priority

The monitor stores trend information for all monitored measurements, if configured to do so. (Data from VueLink or IntelliBridge modules cannot be included in trends when the label is a free-text label.)

If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements.

To see the measurement priority list for trending,

1

2

In the

Main Setup

menu, select

Trends

.

Select

Trend Priority

.

To add measurements to the priority list,

1

2

Select the pop-up key

Add

and choose from the pop-up list of available measurements.

Use the

Sort Up

and

Sort Down

pop-up keys to change the priority order.

Trend Parameter Scales

Parameter scales define how the trend waveform will appear on the screen and in trend reports.

Separate scales can be set for adult, pediatric, and neonatal patient trends.

To change the trend parameter scales settings, either use the

Scale

setting in the

Segment

menu or:

1

In the

Main Setup

menu, select

Trends

.

2

Select

Parameter Scales

.

3

Select the measurement or parameter you want to change from the list.

4

5

Select the pop-up key Change to call up the Scale menu.

In the

Scale

menu, select the parameter label you want to define settings for. Select

Adult

,

Pedi

, and Neo and use the pop-up keypad to enter new upper and lower scale definitions.

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20 Trends

Graphical Trend Presentation

Graphical trends and screen trends for measurements with compound values (for example ABP or

CO

2

) can be viewed in line or band form.

To change the presentation style,

1

2

Select Main Setup Î Trends

Select

Global Style

and choose

Line

to display the trends as a continuous line

• Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.

This sample ABP trend shows the continuously-measured values for the systolic, diastolic and mean pressures displayed in band form.

Setting Measurement and Period for Histograms

To set the default for the measurement data to be used in the histogram,

1

Select

Main Setup Î Trends

.

2

3

4

Select Setup Histogram .

Select

Data Source

.

Select either a realtime SpO

2

or

Trended Data

. From the trended data list select the required measurement.

To set the default period for the histogram,

1

Select

Main Setup Î Trends

.

2

3

Select Histogram .

Select Select Period and select the required time period from the list.

When viewing a histogram, the data source, the period and the range can be changed using the pop-up keys.

Documenting Trends

To print a Vital Signs or Graphical Trends report,

• in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen.

Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor's configuration. Trends reports can be printed on central or local printers.

To make a Vital Signs recording,

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20 Trends

• in the Vital Signs window, select the Print/ Record pop-up key, then select the Record Vitals popup key.

Vital Signs recordings print the trend data for the current group and trend period shown in the Vital

Signs

window.

Trends Databases

Depending on the purchased options and the monitor's configuration, the trends databases store information for up to 32 measurements for up to 72 hours.

The values in the trends database are stored as measured by the monitor, they are not averaged values.

The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown.

Example database configuration

In this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution.

"4 hours @ 12 second resolution" means that the monitor stores trend data every 12 seconds, for the most recent four hours.

Aperiodic Trends Database

Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time.

Trending Multiple-Value Measurements

Some measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements.

Screen Trends

Trends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, histogram or horizon format.

If you do not see screen trends on the monitor Screen, select a different Screen, one that is configured to show screen trends. Screen trends are only available on specially designed Screens.

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20 Trends

Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended.

Setting the Screen Trend Time

To set the ScreenTrend Time for all graphical, histogram and horizon screen trends ("global" trend time),

1

2

Select a screen trend then select Setup Trend , or select Main Setup Î Trends .

Select

ScreenTrend Time

and select the required time: 30 minutes, one, two, four, eight, or twelve hours.

This is now the Global screen trend time and defines the period of trend information shown for all screen trends.

To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends,

1

Select a screen trend.

2

3

Select

Change TrendTime

Select the required trend time.

Selecting

Global

leaves the trend time set to the global screen trend time.

Changing the Selection of Screen Trends Displayed

1

Select the screen trend.

2

2

Select

Change Trend

and select the required trend from the list of available trends.

Select

Blank

to remove the selected trend from the Screen.

If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend.

To display two or more screen trends overlapping,

1

Select the screen trend to open the screen trend menu,

Select

Change Trend Î Add Trend

and select a screen trend from the pop-up list.

Activating the Cursor for Screen Trends

To activate the cursor for Screen Trends:

1

2

Select the screen trend.

Select

Activate Cursor

.

You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor.

To de-activate the cursor,

• Select

Main Screen

.

Changing the Screen Trend View

To switch between tabular, graphic, histogram and horizon views, select the screen trend then select

Change View

and select the required view.

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20 Trends

Tabular View

Aperiodic measurements such as NBP, C.O., C.I., and Wedge can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label.

The trend time for tabular screen trends depends on the space available on the Screen. Up to 30 measurements or 12 hours information can be shown.

Histogram View

The histogram view presents a combination of graphical trend and histogram. The histogram is on the right hand side in a horizontal presentation with vertical gridlines representing 25%, 50%, 75% and

100%. Each column shows the percentage of time that the measurement values were in a specific range. This range is represented by the column's position in the graphical trend gridlines. The arrow mark next to a column shows that the currently measured value is in the range covered by that column.

If less than two-thirds of the samples are valid, a question mark will be displayed with the histogram, except when the histogram consists of intermittently measured data.

Horizon View

The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient's condition since the baseline was set.

The horizon view is made up of:

• a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition. The horizon can be set to represent your patient's current condition, or a target condition and can be a single value or a range.

• a graphical trend, displaying patient data for the set TrendTime (1).

• a trend indicator arrow, indicating how the patient trend has developed in the set time period

(10 minutes, 5 minutes or 2 minutes) (2).

• a deviation bar, showing how the currently measured value deviates from the set horizon (3). The height of the deviation bar is an indication of the extent of the change in your patient's condition relative to the (horizon) baseline.

Your monitor may not be configured to show all elements of the screen trend horizon view.

Setting the Horizon

The horizon is the reference value to which deviations in the measurements are compared.

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20 Trends

1

2

To set the horizon, select the horizon trend

Select

– Set High Horizon to select the upper horizon value. If the high and low horizon values are the same, the horizon is a baseline - if the values are different the horizon is a range.

Set Low Horizon

to select the lower horizon value.

Auto Horizon

to set the horizon for the selected horizon trend to the currently-measured value

Auto All

to reset the horizon for all horizon screen trends to the currently-measured values

Set Horizon

to set the horizon to a specific value from a pop-up list.

Setting the Horizon Trend Scale

The horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.

To set the horizon trend scale delta,

1

Select the horizon trend.

2

Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits.

Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient's condition having changed.

If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.

Setting the Time Period for the Trend Indicator Arrow

The time period for which the trend indicator arrow is displayed can be set in the Trends window.

1

Select

Main Setup Î Trends

.

2

Select

HorizonArrowTime

.

3

Select 10, 5 or 2 minutes.

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20 Trends

284

21

21

Calculations

Calculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information.

Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations.

Hemodynamic

Cardiac Index (C.I.)

Stroke Volume (SV)

Stroke Index (SI)

Systemic Vascular Resistance (SVR)

Systemic Vascular Resistance Index (SVRI)

Pulmonary Vascular Resistance (PVR)

Pulmonary Vascular Resistance Index (PVRI)

Left Cardiac Work (LCW)

Left Cardiac Work Index (LCWI)

Left Ventricular Stroke Work (LVSW)

Left Ventricular Stroke Work Index (LVSWI)

Right Cardiac Work (RCW)

Right Cardiac Work Index (RCWI)

Right Ventricular Stroke Work (RVSW)

Right Ventricular Stroke Work Index (RVSWI)

Extra Vascular Lung Water Index (EVLWI)

Intrathoracic Blood Volume Index (ITBVI)

Global End Diastolic Volume Index (GEDVI)

Oxygenation

Arterial Oxygen Content (CaO

2

)

Venous Oxygen Content (CvO

2

)

Arteriovenous Oxygen Content

(CavO

2

)

Oxygen Availability Index (DO2I)

Oxygen Consumption (VO

2

)

Oxygen Consumption Index

(VO

2

I)

Oxygen Extraction Ratio (O

2

ER)

Alveolar-Arterial Oxygen

Difference (AaDO

2

)

Percent Arteriovenous Shunt

(Qs/Qt)

Ventilation

Minute Volume (MINVOL)

Compliance (COMP)

Dead Space (Vd)

Dead Space/Tidal Volume

Ratio (Vd/Vt)

Alveolar Ventilation

(ALVENT)

The hemodynamic calculations available depend on the Cardiac Output measurement method being used and the regulatory standards that apply for your hospital: see the C.O. chapter for availability details.

285

21 Calculations

Viewing Calculations

• Select the

Calcs

SmartKey to open the

Calculations

window.

• Select the Calc Type field and select the required calculation type for display.

Calculations Windows

This example calculations window shows the

Hemodynamic Calculations

window. The ventilation and oxygenation windows are similar.

1

Height used for the calculations

2

Weight

used for the calculations

3

Calculation Time

4

Calculations input values

5

Output values

6

Indexed calculation values

Calculations Pop-Up Keys

Depending on the calculations group you choose, a selection of pop-up keys will appear to let you navigate through the stored events and carry out calculations-related tasks.

286

21 Calculations

Pop-Up Keys

Resample Vitals

Perform Calc

Print/Record

On/Off DateTime

On/Off Ranges

Cardiac Output

Hemo Review

Vent Review

Oxygen Review

Selecting this pop-up key lets you....

use the most recent monitored values. Resampling sets the calculation time to the current time, and displays the corresponding values for the previous second.

perform the displayed calculation using the currently-input values and store the calculation in the calculations database print or record the displayed calculation.

toggle between showing the date and time or the units for the calculation input values.

toggle between showing the normal ranges or the units for the calculation output values.

access the C.O. procedure window.

open the hemodynamic calculations review window.

open the ventilation calculations review window.

open the oxygenation calculations review window.

Reviewing Calculations

To enter the calculations review window, select the

Oxygen Review

,

Vent Review

, or

Hemo Review pop-up key as required.

The review window lists all the input and output values for each measurement in the calculations group. The timeline in the review window lists the times the calculations were performed.

To review individual calculations, select the calculation in the review window and then select the

Original Calc

pop-up key.

The storage time for calculations is the same as the trend database storage time configured for the monitor. So if trends are stored for 48 hours, the calculations will also be stored for 48 hours.

Performing Calculations

You must check that all input values are appropriate for your patient before performing calculations.

1

2

Select the

Calcs

SmartKey to open the

Calculations

window.

Check the calculation time in the

Calc Time

field.

When you enter the calculation window, this field will show either the current time or the time of the most recent available C.O. measurement, depending on your monitor configuration.

– To choose a different calculation time, select the

Calc Time

field. This calls up a list showing the timestamps of calculations performed earlier. Select a time from this list, or select

Select

Time

to enter a time of your choice. The values from the Vital Signs database from the 30 minute period before the selected time will be used.

– To enter the current time, select the

Resample Vitals

pop-up key. If you choose the current time, the monitor will resample all the required values that are monitored.

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21 Calculations

3

Enter any values that must be entered or edited manually. Select the value field and then use the pop-up keypad to enter the required values. Select

Enter

to confirm each entered value. Manuallyentered values are marked with an asterisk (*).

Entering Values for Calculations

The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available. If the calculation time is the last C.O. time, values will be used from up to and including 30 minutes before the C.O. time, except for height and weight where the last available value will be used.

• To enter calculations values manually or edit automatically-entered values, select the value field to open the on-screen keyboard and use this to enter the correct value. Values edited manually are marked with an asterisk symbol (*).

If you enter a value that has more decimal places than allowed for a particular input, the value you enter will be rounded off after you select Enter . If you enter a value which cannot be stored, the message

Value out of range

will appear. Enter a new value.

In hemodynamic calculations, if the systolic and diastolic pressures are manually entered, the mean pressure is calculated and marked with an asterisk (*). The formula used to estimate the mean pressure is [systolic + (diastolic x 2)] / 3.

Automatic Value Substitution

If the monitor cannot find a value required for calculation, it automatically tries to find an equivalent source for this value. For example, if C.O. is required but unavailable, the monitor automatically looks for CCO as a alternative source of C.O. values, or an alternative Pressure label may be used instead of

ABP. The label of the value in the

Calculations

window does not change. Substituted values are marked with an asterisk (*).

Automatic Unit Conversion

The monitor needs consistent units for performing calculations. It automatically converts units where necessary before it performs the calculation, for example, pressures sourced in kPa, cmH

2

O, or mbar are automatically converted to mmHg, or to cmH

2

O for ventilation calculations.

Manual Unit Conversion

If you need to convert units for other purposes you can use the Unit Conversion window:

1

Select

Main Setup Î Calculations

.

2

Select

Unit Conversion

.

3

Select the field under the unit you know and use the on-screen keypad to enter the known value.

The converted value automatically appears in the adjacent field.

BSA Formula

Your monitor provides both the Boyd and Dubois formulas for the calculation of body surface area

(BSA). For calculations, the monitor uses the setting defined in the Patient Demographics menu. All calculation results that use BSA are indexed to the selected formula.

288

21 Calculations

• To check the current setting, select the patient name to enter the Patient Demographics menu.

BSA(B)

indicates that the Boyd formula is used;

BSA(D)

indicates that the Dubois formula is used.

Comparing Dynamic Compliance Values

If you compare the dynamic compliance value (COMP) from the ventilation calculations with the value from the Spirometry measurement you may see a difference. This comes from the different sampling methods:

• The algorithm in the ventilation calculations takes into account only two sets of paired AWP/

AWV data: those from complete expiration and complete inspiration, when AWF is zero.

• The algorithm in the Spirometry application takes into account all sets of paired AWP/AWV data

(125Hz sampling rate), over one complete breath cycle, and calculates an "averaged" compliance using a least square method.

Documenting Calculations

To send a Calculations recording to a connected recorder, in the

Calculations

window, select the

Print/ Record pop-up key, then select the Record Calc pop-up key.

Calculations recordings print the patient demographic information and the content of the current

Calculations window on the recorder strip.

To print a report for the calculation group currently on the monitor screen, select the pop-up key

Print

Calc . To print the review window, select the pop-up key Print in the review window. All the calculations in the current group will be printed in the report.

Calculation reports can be printed on central or local printers.

This example report shows the oxygen calculation group. Ventilation and hemodynamic calculation reports are similar.

1

2

3

Patient information

Calculation group

Three columns of calculations input and output values, with times, units and ranges, where appropriate

289

21 Calculations

290

22

22

High Resolution Trend Waves

High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance.

They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient's condition across different hi-res trend waves.This can aid in the early detection of cardiorespiratory and hemodynamic problems.

The amount of data you can show on a screen depends on the display size and resolution: for example, on an eight inch (20 cm) wave trace on your monitor screen, you can view approximately six minutes of hi-res trend wave trace. The hi-res waves are drawn at a speed of 3 cm/minute.

The availability of hi-res trend waves depends on your monitor configuration and on the options purchased for your monitor.

Changing the Hi-Res Trend Waves Displayed

To change the selection of hi-res trend waves on the Screen:

1

2

Select a displayed hi-res trend wave.

Select the required hi-res trend wave from the pop-up list.

If there are no hi-res trend waves on the Screen, you must change to a Screen with hi-res trend waves.

Hi-Res Trend Wave Scales

Hi-res trend waves are either compressed realtime waves or fast numeric trends.

• Hi-res trend waves from compressed realtime waves include: Resp, CO

2

, ABP, PAP, CVP, ICP,

AWP, anesthetic agents.

• Hi-res trend waves from fast numeric trends include: btbHR, SpO

2

, tcpO

2

, tcpCO

2

, Pulse, Perf,

CPP, BIS, CCO, inO

2

, Delta SpO

2

.

Hi-res trend waves from realtime waves use the wave scale as their display scale. Changing the wave scale changes the hi-res trend wave scale.

Hi-res trend waves from numerics use a pre-defined display scale dependent on the patient category.

Hi-Res Trend Waves and OxyCRG

OxyCRG is a combination of three hi-res trend waves, btbHR, SpO

2

, and Resp, mainly used in neonatal monitoring.

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22 High Resolution Trend Waves

Printing Hi-Res Trend Wave Reports

To print hi-res trend waves on reports, you can choose to print either

• all VisibleWaves - prints all waves and hi-res trend waves currently displayed

• All Waves - prints realtime waves and hi-res trend waves for all currently-monitored measurements

HiRes Waves

- prints hi-res trend waves for the currently-monitored measurements

OxyCRG Waves

- prints hi-res trend waves for btbHR, SpO

2

, and Resp.

For each hi-res trend wave, a maximum of six minutes of measurement data will be printed.

See the section on Reports for more information on setting up reports.

Hi-Res Trend Wave Recordings

The selection of waves in hi-res trend wave recordings and the recording speed are defined by the preconfigured HiResTrd recording template. See the section on Recordings for more information.

To start a hi-res trend waves recording,

1

2

select the Recor- dings SmartKey, if configured, or select Main Setup Î Recordings select the

HiRes Recordng

pop-up key.

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23

23

Event Surveillance

Events are electronic records of episodes in your patient's condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations.

Depending on the level of event surveillance available on your monitor, the information stored for each event episode can include:

waveforms for up to four measurements of your choice (depending on episode type, see “Events

Pop-Up Keys” on page 296 for more details)

• numeric vital signs for all the measurements monitored

• any alarm conditions active when the event episode was triggered

• any annotations connected with the event.

You can navigate through the event database to view events retrospectively, and you can document events on a recording or report marked with the patient name, bed label, and the data and time.

When an MP5 is connected to a host monitor, event surveillance will be disabled. No new events will be detected and no existing events will be deleted. There is no data exchange between the host monitor and the MP5 for event surveillance. When the MP5 is disconnected from the host monitor event surveillance will resume and new events will be detected.

Levels of Event Surveillance

The appearance of the Events windows and menus and the settings you can select for events depends on the event surveillance option purchased for your monitor: basic event surveillance, advanced event surveillance, or neonatal event review (NER). This table lists the differences between the options.

To determine which level of event surveillance your monitor has, select Main Setup Î Event

Surveill.

Î Setup Events

and select the trigger group to see the available event groups.

• if the only event group listed is NER , your monitor has the Neonatal Event Review option

• if there is one event group and it is not

NER

, your monitor has the Basic Event Surveillance option

• if you see six event groups, your monitor has the Advanced Event Surveillance option.

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23 Event Surveillance

Event Functionality

Annotation

Basic Event

Surveillance

Option C06

Advanced Event Surveillance

Option C07

Neonatal Event Review

(NER)

Option C04

Event groups

Measurements per group

1

3

6 (one group can be configured to NER)

4

NER

3 (plus 1 for episode recording)

2 1

Triggers per measurement 1

Trigger types

Simple ("at least one") Combined ("at least two") Simple ("at least one") no yes yes

Types of event episode

Event views

Database capability

Event Notification

Average trend

Snapshot events

Graphic Event Review window, Graphic Event

Episode window

Average trend

High resolution trend

Snapshot events

Summary view, graphic and tabular Event Review window, graphic and tabular Event

Episode window

25 events for 24 hours 25 events for 24 hours

25 events for 8 hours

50 events for 8 hours

50 events for 24 hours no yes

High Resolution Trend

Graphic and tabular Event

Review window, graphic and tabular Event Episode window

25 events for 24 hours

25 events for 8 hours

50 events for 8 hours

50 events for 24 hours no

Event Groups

The event group

• monitors the patient's signals to detect event triggers

• defines which waveforms are recorded in the event data.

In basic event surveillance only one event group can be active at a time, with Advanced Event

Surveillance all six groups can be active simultaneously. Active event groups monitor for event triggers.

Event groups are defined in Configuration Mode. In monitoring mode the groups can be adapted to current conditions, for example episode types and threshold levels can be changed.

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23 Event Surveillance

Event Episodes

When an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event).

Manually-triggered event episodes document patient information from the time leading up to the event trigger; they do not have a post-time.

The episode type defines the level of detail captured in an event episode. The higher the data resolution, the shorter the period that the monitor can store in its memory. High-resolution data is suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative.

Event Episode Types

Average trend

20 minutes, five samples per minute

HiResTrend

Four minutes, four samples per second.

Neonatal Event Review (NER) is a type of

HiResTrend

Realtime Wave Snapshot

15 seconds

Pre-time

2 minutes

4 minutes

6 minutes

8 minutes

10 minutes

12 minutes

14 minutes

16 minutes

18 minutes

1 minute

2 minutes

3 minutes

5 seconds

10 seconds

Post-time

18 minutes

16 minutes

14 minutes

12 minutes

10 minutes

8 minutes

6 minutes

4 minutes

2 minutes

3 minutes

2 minutes

1 minute

10 seconds

5 seconds

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23 Event Surveillance

Events Pop-Up Keys

Depending on the events view you choose, a selection of the events pop-up keys let you navigate through the stored events and carry out events-related tasks.

Pop-Up Keys

Event Setup

Show Episode

Show Review

Review Group

Show Summary

Manual Event

Start CAR Stop CAR

CAR Histogrm

Vitals View Graphic

View

Table

Review

Delete Event

Graphic

Review

Select Annotatn

Print/ Record

CAR

Review

Selecting this pop-up key lets you....

open the

Event Setup

menu.

open the

Event Episode

window to review the selected event in detail.

open the

Event Review

window.

choose a different event group for reviewing in the Event Review window

(Advanced Event Surveillance only).

open the

Event Summary

window.

start a manually-triggered event capture.

open the Start CAR window to start a Car seat Assessment Record (CAR) period or stop a currently running CAR.

open the window showing the CAR SpO

2 histogram move the cursor left or right to the next event to navigate through the events database. Placing the cursor over an event highlights it and shows the event values for the selected event.

jump to the first or last event in the event database.

toggle between a tabular and graphic version of the

Event Episode

window currently viewed.

toggle between a tabular and graphic version of the Event Review window currently viewed.

delete the currently-selected event from the database. The monitor asks you to confirm this deletion. You cannot retrieve deleted events.

access the list of available annotations to add a nursing note for the current event episode (Advanced Event Surveillance only).

access the printing and recording pop-up keys to document events.

Event Triggers

You can trigger event capture manually, for example, if you want to record a patient's condition before a procedure. You can also set events to trigger automatically, when the patient's values cross a predefined threshold value, or when a particular measurement or procedure is carried out.

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23 Event Surveillance

If more than one trigger is available for the measurements in the active event group, the trigger condition may be

At Least One Param.

,

At Least Two Param.

,

At Least Three Par.

, or

All Four

Parameter

. If the trigger is

At Least One Param.

(this is short for 'at least one measurement parameter'), the monitor starts an event capture if a trigger occurs in any of this event group's measurements. If the trigger is At Least Three Par.

, the monitor captures events when three or more trigger thresholds from this event group's measurements are violated. With

Enhanced Condition

you can not only select a minimum number of triggers to trigger an event but define which specific measurement triggers these must be. For example, At Least Two Param.

will cause an event to be captured if a trigger occurs in any two of this event group's measurements - with Enhanced Condition you can select that only when triggers are in HR and SpO

2 an event will be captured.

The trigger condition for event groups is set in the monitor's Configuration Mode.

If You Use Alarm Limits As Event Triggers

The event capture is triggered automatically when your patient's values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions.

The asterisk symbols beside the trigger tell you about the alarm triggers:

*** indicates a high priority (red) alarm

** indicates a lower priority (yellow) alarm. This category includes short yellow arrhythmia alarms, which may be configured to be shown as one star alarms (*) on your monitor.

Triggers without asterisk symbols are user-defined triggers.

If You Set User-defined Threshold Triggers

You can define event triggers that are independent of alarm limits. You must set a threshold value and a threshold time for the trigger. If you set the trigger threshold time to 12 seconds, the monitor triggers an event if the threshold is violated for more than 12 seconds.

If You Set "On Measurement" Triggers

You can set aperiodic measurements (such as NBP) or procedures (such as Cardiac Output) to trigger an event whenever they start.

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If You Set Use-defined Deviation Triggers

You can define event triggers that are independent of specific limits and based instead on deviations from the current values. You must set a deviation and a period of time in which the deviation occurs.

There are three types of deviation available:

ANY Deviation

,

UP Deviation

where only changes in a positive direction are detected and DOWN Deviation where only changes in a negative direction are detected. The deviation can be defined either in relative terms as a percentage, for example 10%, or as an absolute value, such as 10 bpm.

Event Retriggering

If a condition that triggered an event persists and the values remain beyond the trigger threshold, a new event will not be triggered.

For a new event to be triggered by the same condition, the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold.

Event Notification

(Advanced Event Surveillance Only). You can be notified when an event is detected. For each event group you can define a type of notification depending on the severity of the event conditions. The notification can be a status message with a prompt tone or a standard *, **, or *** alarm notification.

These event alarms are handled exactly like measurement alarms; they can be silenced and are also suspended when all alarms are suspended. You should only use alarm notification for events which are comparable in severity to standard measurement alarms to avoid potential confusion due to too many alarms. Notification in the form of an alarm is not available when the trigger condition is

At Least One

Param.

. Selecting None switches event notification off.

Setting the type of notification, or switching notification off, is done in Configuration Mode.

Setting Triggers for NER and Basic Event Surveillance

298

1

Group Name

2

Episode Type

3

Measurements used as event triggers

1

2

3

Select Main Setup Î Event Surveill.

Î Setup Events to enter the Event Setup window.

Select the name of the current episode type to set the episode pre/post time.

Set the event trigger for each measurement. Select each trigger name and select, if available, either an alarm trigger, or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time.

23 Event Surveillance

4

5

Set the trigger status to Activated to start event triggering. If the status is Deactivated event surveillance is effectively switched off.

Select Confirm to confirm your changes.

Setting Triggers and Notification for Advanced Event Surveillance

1

Group Name

2

Group Type

3

Notification Type

4

Episode Type

5

Trigger Condition

6

Measurements used as event triggers

1

2

3

4

5

Select the group name to enter the setup window for that group.

Set the trigger status to

Activated

, to have this event group trigger events, or

Deactivated

.

Set the episode type.

Select the name of the current episode type and select an episode type from the pop-up list. The pre/post episode time for the selected episode type is displayed.

Set the trigger for each measurement. Select each trigger name and select either an alarm trigger or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. If a deviation trigger is configured, set the deviation and duration.

Select

Confirm

to confirm your changes.

Triggering Events Manually

To manually trigger an event, select the SmartKey Manual Event and (for Advanced Event

Surveillance) select the group in which the event will be triggered.

For manually-triggered events, patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group.

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Running a Car Seat Assessment Record

In the NER group you can run a Car Seat Assessment Record (CAR). This is a special period of event surveillance using the current setup of the NER group.

To start a CAR period:

1

2

Select the

Start CAR

pop-up key or SmartKey.

Select the required time period for the assessment.

3

Select

Confirm

to start the CAR.

If the NER group was not active it will be activated automatically.

During the CAR period an SpO

2

histogram is also generated with 1 second samples. For general

information about the presentation of data in a histogram, see “Viewing Histogram Trends” on page 276. The CAR SpO

2

histogram is unique: it can only be accessed from the events function. It is generated from the beginning of the CAR period (contrary to the non-SpO

2

histograms which are generated from trended data retrospectively at the end of a time period). Settings are fixed for this histogram and cannot be changed when viewing it.

The Events Database

The maximum number of events that can be stored in the event database depends on the database configuration and the level of event surveillance used. The event database is set up in the monitor's

Configuration Mode. Events are stored in the monitor's event database for the configured lifetime, either 8 hours or 24 hours. Deleted events cannot be retrieved. Events are automatically deleted when:

• their configured lifetime is over

• the storage capacity of the database is exceeded (storing a further event deletes the oldest event in the memory)

• a patient is discharged.

As the event database is cleared when you discharge a patient, you should ensure that you have documented any events you require for the patient records before you confirm the discharge.

Viewing Events

• To see a summary of all the events in every group in the event database, use the Event Summary window.

• To review all the events in a particular event group, use the Event Review window.

• To review individual event episodes in detail, use the Event Episode window.

To start viewing events, either:

• in the

Main Setup

menu, select

Event Surveill.

and then select the event view you require from the list, or

• select the

Event Surveill

SmartKey and then select the event view you require from the list.

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Event Summary and Event Counter

Vertical bars mark events in the

Event Summary

window. The timeline shows the position of the stored events in the event database. Selecting this view activates a cursor that lets you navigate across the timeline. Use the Show Episode pop-up key to select individual events for review in the Event

Episode

window. It also calls up the events pop-up keys.

The event counter counts the total number of events in the database. If more than one event group was set to trigger events within the event history, the event counter also counts the event group totals.

Counting Combi-Events

If one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a brady event, the brady event is not counted as a single event but as part of the apnea event.

Counting Neonatal Event Review (NER) Events

For neonatal events (NER, formerly "OxyCRG"), apnea events (A), bradycardia events (B), and combinations of these events are counted and classified by the event counter in the Event Summary . If they are associated with a Desaturation (D), this is also marked. Manual events (M) are counted separately. For example, A(D):2(1) indicates that two apnea events occurred and one of them was associated with a desaturation.

Event Summary Window

(Advanced Event Surveillance only). The Event Summary window shows the number of stored events in each event group and the total number of events in the database. Vertical bars mark events on a timeline showing the position of the stored events in the event database. The symbol next to the group name indicates the activation and notification status: symbol meaning group activated, notification set to ***alarm group activated, notification set to **alarm

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23 Event Surveillance

symbol meaning group activated, notification set to *alarm group activated, notification set to screen prompt group is activated, notification is switched off no symbol group not activated

Selecting the Event Summary window calls up the events pop-up keys.

Parts of the

Event Summary

window can also be embedded in Screens so that they are always visible, for example the Total row showing the total number of events with the bars on the timeline or the column showing all the groups with the activation and notification status.

Event Review Window

To enter the

Event Review

window, select the graphic event summary, if available, or select the events pop-up key

Show Review

.

When you open the

Event Review

window, it automatically shows the event group with the most recent event.

• To view other event groups, select the pop-up key

Review Group

and select the group from the list.

Event Episode Window

To enter the Event Episode window, select the pop-up key Show Episode .

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Depending on the event group settings, the Event Episode window shows either 20 minutes of average trend event information, four minutes of high-resolution event information, or 15 seconds of realtime wave information.

1

2

3

4

Follow-on event values

Trigger event values, highlighted

Timeline, showing episode Pre/Post-time

Active event group

The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded. In this example, Desat 76<85 tells you that 76 was the lowest SpO

2

value measured during the event time and that the Desat trigger threshold was set to 85 when the event was triggered. If the event was manually triggered, the event value boxes display

"manual".

Annotating Events

1

2

To annotate an event, in the

Event Episode

window, select the pop-up key

Select Annotatn

.

Select the required annotation from the pop-up list of available annotations for the currently active event group.

Up to 20 annotations can be configured to let you add commonly-used clinical notes to event episodes for documentation purposes. To see the complete list of available annotations, in the

Event Setup menu, select

Event Annotation

.

Documenting Events

You can print a report or make a recording of the events history stored in the database or of individual event episodes or a Car Seat Assessment Record.

Documenting Event Review

1

In the

Event Review

window, select the pop-up key

Print/ Record

. This calls up the event documentation pop-up keys.

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23 Event Surveillance

2

For a graphic Event Review recording, select the Record Graphic pop-up key.

For a tabular Event Review recording, select the

Record Tabular

pop-up key.

For a CAR review report, select the

Print CAR

pop-up key

To print an Event Report, select the

Print Review

pop-up key.

Documenting an Event Episode

1

In the Event Episode window, select the pop-up key Print/ Record . This calls up the event documentation pop-up keys.

2

To make an Event Episode recording, select the Record pop-up key.

To print an Event Episode, select the

Print Episode

pop-up key.

Event Recordings

Event recordings can be sent to a locally-connected M1116B recorder module.

Event Review Recordings

Each event review recording strip begins with a summary of the events stored in the event database.

Recording strip annotation is explained in the Recording chapter.

304

1

2

3

4

5

Event total per event group

Event types

Total events in database

Event groups

Recording strip code

6

Patient information and medical record no.

In graphic event review recordings, events are represented by bars, and each event group is printed on a separate channel.

The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections).

23 Event Surveillance

In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp.

The measurements in the event group are shown in the next columns, marked "Parameter 1, Parameter

2...", along with the event values measured at the time of the event. For each event, the trigger values are shown.

This section of the recording is A4 or letter size, so that it fits in a patient file.

Event Episode Recordings

Event episode recordings are divided into four sections.

The first section shows the patient information and the event group of the episode with the event values for the group measurements. The trigger symbol marks the event trigger.

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23 Event Surveillance

The second section (2 below) shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording.

If there are four measurements in the event group being recorded, two waveforms will be recorded in two separate waveforms segments.

The third section (3 above) shows the most important vital signs information, including numerics, active alarms, and any annotations made on the event episode.

The fourth section (4 above) shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered.

Event Reports

Event reports can be printed on A4 and letter size paper on a printer connected locally or centrally to your monitor.

Event Review Reports

The event review report documents all the events stored in the event database for a selected group.

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Event Episode Reports

The event episode report documents the patient information from the currently-selected event. See the section on event recordings for an explanation of the report elements.

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Event Summary Reports

(Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups.

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24

24

ProtocolWatch

ProtocolWatch (PW) is a clinical decision support tool. It allows you to run a clinical protocol which can monitor developments in the patient's condition, taking into account:

• measured values from the monitor

• values manually entered by you (for example manual temperature measurements, lab values)

• your assessment of patient status

ProtocolWatch notifies you when certain conditions or combinations of conditions occur and it documents developments in a log which can be printed.

SSC Sepsis Protocol

The SSC (Surviving Sepsis Campaign) Sepsis Protocol is a protocol implemented for the

ProtocolWatch application. The SSC Sepsis Protocol is for use in screening for severe sepsis and monitoring of its treatment. It is a computerized implementation of the January 2008 Surviving Sepsis

Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Philips does not make any claims about their effectiveness to reduce the morbidity or mortality associated with severe sepsis.

The SSC Sepsis Protocol assists you in recognizing the early signs and symptoms of sepsis by comparing the state of your patient to the defined criteria and then guides you through the recommended treatment protocol. Use of the SSC Sepsis Protocol requires thorough knowledge of the complete SSC Guidelines for Management of Severe Sepsis and Septic Shock. Due to space limitations on the screen, the recommendations cannot always be reproduced in the full detail available in the printed and on-line guidelines. The SSC Sepsis Protocol is not a diagnostic or therapeutic tool and is not intended to replace the competent judgment of a clinician.

The SSC Sepsis Protocol consists of three separate consecutive phases:

Severe Sepsis Screening - measurement values and patient status are compared to the Severe Sepsis

Screening criteria. When these criteria have been met, the clinician confirms the presence of infection and sepsis-related organ dysfunction and can authorize entering the Sepsis Resuscitation Bundle.

Sepsis Resuscitation Bundle - the recommendations for sepsis resuscitation are listed and can be checked off as they are implemented. After achievement of all the sepsis resuscitation goals, or at the latest after 6 hours, the Sepsis Resuscitation Bundle is completed and the Sepsis Management Bundle begins.

Sepsis Management Bundle - the recommendations to maintain patient status are listed and can be checked off as they are implemented. The Sepsis Management Bundle ends when 24 hours have passed since the Sepsis Resuscitation Bundle began.

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Depending on the option your monitor has, it may be that only the Severe Sepsis Screening phase is implemented. If, at the end of this phase sepsis has been confirmed, and the patient is transferred for treatment in the resuscitation and management phases, you can transfer the current state, the settings and the log from the SSC Sepsis Protocol in the MMS to another monitor with the full version of the

SSC Sepsis Protocol. The transfer of data and settings must be enabled in Configuration mode.

WARNING

Always consider the specific clinical context for your patient, before following SSC Sepsis Protocol treatment recommendations.

The SSC Sepsis Protocol and this description are based on the SSC Guidelines for Management of

Severe Sepsis and Septic Shock from January 2008 and the SSC Bundle definitions from January 2005.

To check the version of the Guidelines and Bundle definitions on the monitor,

• Select

Main Setup Î Revision Î ProtocolWatch Î SSC Sepsis

Orientation On The Screen

At the top of each window there is an orientation line showing the phases available on your monitor, with the currently active phase highlighted.

You can also place the ProtocolWatch symbol, together with the currently active phase, on the main screen, in one of the numeric positions. This allows you to see at a glance which phase is currently active, even when no SSC Sepsis Protocol window is currently displayed.

If you need to enter data or perform an action in an SSC Sepsis Protocol window, the symbol will turn into a SmartKey.

Transferring Patients And Moving Manually Between Phases

If a patient has already been diagnosed as having severe sepsis before connecting them to the monitor, you can select

Main Setup Î ProtocolWatch Î Manual Transition

to go directly to the Sepsis

Resuscitation Bundle to monitor treatment. Direct entry to the Sepsis Management Bundle is also possible using the Manual Transition function and the time into the selected bundle can be set.

If a patient has been screened on arrival, for example in the emergency department, then transferred to

Intensive Care when Sepsis is confirmed, the current state, the settings and the log from the SSC Sepsis

Protocol will be transferred with the MMS to the new monitor. Should it be necessary, you can select the phase at the new monitor manually with

Main Setup Î ProtocolWatch Î Manual Transition

.

The transfer of data and settings must be enabled in Configuration mode.

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CAUTION

It is not possible to transfer SSC Sepsis Protocol data from a monitor with release F.0 software to another monitor with release G.0 software or above, and vice versa.

Suspending the Protocol for 24 Hours

To suspend the protocol for 24 hours:

1

2

Select Main Setup Î ProtocolWatch Î Suspend for 24 hours .

Select

Confirm

.

The protocol will resume activity after 24 hours with Severe Sepsis Screening.

Severe Sepsis Screening

As soon as an adult patient is connected to the monitor, and heart rate or pulse is being measured, the protocol begins to observe heart rate, temperature and respiration rate values in the background. If temperature or respiration rate is not being measured continuously, a pop-up window appears at 4hour intervals to ask for manually measured values. These values are all compared to the screening criteria: HR above 90, Temp above 38.3°C (100.9°F) or below 36.0°C (96.8°F), RR above 20.

If any one of the values fulfills the screening criteria, the first

Severe Sepsis Screening

window appears:

The measured value which has fulfilled the criteria is shown highlighted (in the example shown above it is respiration). There is a check box for the infection signs and symptoms listed,

• if the monitor has measured values which meet the screening criteria, and

• for all signs and symptoms which cannot be measured by the monitor.

Check the box if you can confirm that this sign or symptom is present and new. If the patient is mechanically ventilated, the

Mechanically ventilated

box must be checked. If you have manually measured temperature or respiration rate, you can enter the values using the Enter RR and Enter Temp keys.

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Select Confirm when the check boxes reflect the current patient status.

Select Remind 15 min if you want to delay filling out this screen. (When you enter the screen manually this key will be a Cancel key, as no action is required in this case.)

Changing Conditions

The window reappears if:

• a previously fulfilled criteria is again fulfilled

• a new HR or RR criteria is fulfilled,

• the HR or RR value which previously fulfilled the criteria now triggers a ** RR HIGH , ** HR

HIGH alarm or a

***TACHY xxx > yy

alarm,

• after 8 hours (configurable to 12 hours) if at least one infection sign is still present.

Two Or More Infection Signs Or Symptoms Confirmed

If you have confirmed two or more infection signs in the first Severe Sepsis Screening window, a new pop-up window appears asking Is the patient history suggestive of a new infection?

.

If you select Yes , the next screen appears requesting a lactate measurement.

If you select

No

, the screening phase continues and the first Severe Sepsis Screening window reappears in the situations described in Changing Conditions above.

Lactate Measurement

To enter the Lactate value, select the

Enter Lact

key. If the value entered is > 4 mmol/l the check box is automatically checked.

Select

Confirm

when a value has been entered. What follows depends on the Lactate value:

• If Lactate is > 4 mmol/l: the value meets the criteria for severe sepsis and a window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle.

• If Lactate is ≤ 4 mmol/l: a further window appears requiring your input to determine on the basis of blood pressure values whether the patient meets the criteria for severe sepsis.

Hypotension Evaluation

If the Lactate value was not above 4 mmol/l, the next window asks whether the patient has persistent hypotension.

The protocol defines Hypotension as:

• SBP < 90mmHg (12.0kPa), or

• MAP < 65mmHg (9.0kPa), or

• SBP decrease > 40mmHg (5.0kPa) below baseline.

You can see this definition in the window by selecting

Show Details

.

If the patient has persistent hypotension as defined, select Yes . This acknowledges that the patient meets the criteria for severe sepsis and a final window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle.

If the patient does not have persistent hypotension, select

No

. After an hour a screen appears asking

Is the previously acknowledged infection still present?

.

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24 ProtocolWatch

If you select Yes , the window for the Lactate measurement will reappear. If you select No , screening continues — comparing heart rate, temperature and respiration rate values against the screening criteria.

Authorized Clinician Review

To review the protocol, select

Protocol Log

. You can also print out the log to document the screening phase.

Select

Confirm

to complete the screening phase and, if you have the appropriate monitor option, continue to the Sepsis Resuscitation Bundle phase.

Sepsis Resuscitation Bundle

The treatment recommendations from the Sepsis Resuscitation Bundle are presented and the implementation of the recommendations is monitored.

When the Sepsis Resuscitation Bundle phase begins, the ProtocolWatch Screen automatically appears on the monitor (if configured and available on the monitor).

The lower area of the screen contains:

• a reminder list of the treatment recommendations - recommendations which have been fulfilled are shown in gray, overdue recommendations are shown in orange

• a timer showing the time already passed in this phase

• three horizon trends for MAP, CVP and ScvO

2

or SvO

2

, if these measured values are available

• a list of the latest manually entered values - if you select this list you will open the Manual Entry

Log

window where the last 24 manually entered values are shown for reference

If ScvO

2

or SvO

2

and CVP are not being continuously measured, a pop-up window appears at hourly intervals to ask for a manually measured value.

Monitoring the Sepsis Resuscitation Bundle Recommendations

When you select the lower area of the

ProtocolWatch

Screen, the

Sepsis Resuscitation Bundle window appears. If you do not have the

ProtocolWatch

Screen displayed, the

Sepsis Resuscitation

Bundle window appears automatically once an hour.

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24 ProtocolWatch

Select the

Enter Lact

key to enter a lactate value. When you have entered a value, or if a lactate value had previously been entered, the box is checked.

Check the

Take Blood Cultures

box when you have taken blood cultures.

Check the Administer Intravenous Antibiotics box when you have started broad-spectrum antibiotic therapy.

The remaining three recommendations are automatically compared to the Sepsis Resuscitation Bundle criteria, if the measurements are available on the monitor. A box is checked when the corresponding recommendation has been fulfilled.

Depending on your configuration, continuously measured CVP values may be disregarded if they exceed a set limit. Whether this is so, and which limit is applied, is set in the monitor's Configuration mode.

If you have manually measured ScvO

2 or CVP, you can enter the values using the

Enter ScvO2

and

Enter CVP keys. The box is checked automatically if the value fulfils the recommendation.

The boxes for MAP, ScvO2/SvO2 and CVP can also be checked manually (for cases where the monitor does not measure them) but only when the timer has reached 4 hours to ensure that these values are achieved and maintained mid-term. Check these boxes if the recommendation has been fulfilled.

To see more details about the recommendations, select the Show Details key.

Select Confirm when the check boxes reflect the current treatment status.

Checking The Sepsis Resuscitation Bundle Window

During the Sepsis Resuscitation Bundle you can open the

Sepsis Resuscitation Bundle

window at any time to check the status or to make entries. The recommendations are shown as follows:

• Recommendations which are not yet fulfilled are shown in black. They also appear in the list on the lower area of the ProtocolWatch Screen.

• Recommendations which are overdue are shown in orange.

• Recommendations which have been fulfilled and confirmed are shown in gray. They no longer appear in the list on the lower area of the

ProtocolWatch

Screen.

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Previewing the Sepsis Management Bundle

At any time during the Sepsis Resuscitation Bundle you can preview the Management Bundle in order to see which recommendations will follow there.

• Select the

Preview Managmnt

key.

Ending The Sepsis Resuscitation Bundle

When all recommendations have been fulfilled and confirmed, or when 6 hours have passed since the bundle started, the Sepsis Resuscitation Bundle is ended.

You are asked to confirm with the

Yes

key that the Sepsis Management Bundle should now be started.

If you select

No

, the Sepsis Resuscitation Bundle is extended for 1 hour.

Sepsis Management Bundle

The stabilization recommendations from the Sepsis Management Bundle are presented and the implementation of the recommendations is monitored.

When the Sepsis Management Bundle phase begins, the ProtocolWatch Screen is automatically updated (if configured and available on the monitor). In the lower area of the Screen, the list of recommendations for the Sepsis Management Bundle replaces the list for the Sepsis Resuscitation

Bundle. The timer shows the combined time for both phases.

Monitoring the Sepsis Management Bundle Recommendations

When you select the lower area of the

ProtocolWatch

Screen, the

Sepsis Management Bundle window appears. If you do not have the

ProtocolWatch

Screen displayed, the

Sepsis Management

Bundle window appears automatically once every six hours.

The

Low Dose Steroids for septic shock per policy

recommendation and/or the

Drotrecogin Alfa per policy

recommendation may not appear if they have been configured not to do so for your hospital.

Check the

Low Dose Steroids administered

box when you have started steroid therapy or the

Low

Dose Steroids contra-indicated box if this treatment is contra-indicated for your patient.

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24 ProtocolWatch

Check the Drotrecogin Alfa administered box when you have started recombinant human activated protein C therapy or the

Drotrecogin Alfa contra-indicated

box if this treatment is contra-indicated for your patient.

The boxes for

Maintain Glucose <8.3mmol/l (150 mg/dl)

and

Maintain Insp. Plateau Pressure

<30cmH₂O

can only be checked when the timer has reached 20 hours to ensure that the stabilization of these values is achieved long-term. Check these boxes if the recommendation has been fulfilled.

Recommendations which have been fulfilled are shown in gray with the time fulfillment was entered.

To see more details about the recommendations, select the

Show Details

key.

Select Confirm when the check boxes reflect the current treatment status.

Ending The Sepsis Management Bundle

The Sepsis Management Bundle normally ends 24 hours after the Sepsis Resuscitation Bundle started, as documented by the bundle timer on the ProtocolWatch screen. You are asked to confirm with the

Yes

key that routine monitoring should now resume. By selecting

No

you can extend the Sepsis

Management Bundle phase by an additional 6 hours.

After completion of the Sepsis Management Bundle a sepsis standby phase begins which allows time for further patient stabilization and recovery. During this phase Severe Sepsis Screening is suspended.

The standby phase is by default 7 days but the length can be adjusted in Configuration Mode.

Viewing And Printing The Protocol Log

The Protocol Log stores all user interactions, alarms and phase transitions while the SSC Sepsis

Protocol is running.

To view the Log select Main Setup Î ProtocolWatch Î Protocol Log

You can choose between three different views of the Protocol Log:

Summary View

- a short form which does not include when the windows were triggered

Full View

- a complete log of all user interactions, alarms and phase transitions

• Phase View - you can view log entries for one phase by selecting that phase on the orientation line

When the Log consists of several pages, you can move through the pages with the Previous Page and

Next Page keys.

To start a Protocol Log printout, select Print .

The log is cleared whenever a patient is discharged.

Always Discharge Patients

It is essential that patients are discharged when monitoring ends. As a reminder, the monitor can be configured to display a pop-up window when the monitor has been switched off, in Standby mode, or not monitoring basic vitals for a certain time. The window asks whether a new patient is being monitored and offers a pop-up key to discharge the previous patient if this is the case. The window must be configured in Configuration Mode.

When the previous patient is discharged, this clears the protocol log, resets the timers and deletes manually entered measurement values.

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Recording

The M1116B plug-in recorder records numerics for all active measurements and up to three waveforms. You can use it for local recording mounted in the monitor's FMS.

1

2

3

4

M1116B Plug-in Recorder

Continue LED - flashes if a continuous recording is ongoing

RUN/CONT key - starts a delayed recording or makes the current recording continuous

STOP key - stops the current recording

Central Recording

For central recording from the bedside, your monitor must be connected via a network to an

Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A

4-Channel Recorder. Recordings made on the M3160A may look slightly different to those described here. See the documentation supplied with the Information Center for information on the 4-Channel

Recorder.

Starting and Stopping Recordings

The recordings pop-up keys let you start and stop recordings. Select the

Recor- dings

SmartKey to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.

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25 Recording

The selection of pop-up keys available depends on the monitor you are using.

Delayed Recordng

RT A Recordng

RT B Recordng

RT C Recordng

Select Waves

HiRes Recordng

All ECG Waves

Vital Signs

Alarm Limits

ST Segments

ECG QT

Setup Recordng

Stop All Recordng

Quickstarting Recordings

To quickstart any type of recording using a pre-configured recordings template,

• Select the

Recor- dings

SmartKey and then select the pop-up key of the recording type you want to start.

Alternatively, you can

• Select the

Main Setup

SmartKey, select

Recordings

, then select the recording type.

To quickstart a delayed recording,

• Select the SmartKey Delayed Record to immediately start a delayed recording.

M1116B only

• You can also start a delayed recording by pressing the Run/Cont key on the recorder module.

Extending Recordings

Timed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue until stopped manually or by an INOP condition.

• To extend an ongoing recording by its runtime, reselect its

Start

pop-up key once.

• To make an ongoing recording continuous, reselect its

Start

pop-up key twice within 5 seconds.

M1116B only

• You can also make an ongoing recording continuous by pressing the Run/Cont key on the recorder module.

Stopping Recordings

Recordings stop automatically when the preset runtime is over, when the recorder runs out of paper, when you open the recorder door or when the recorder has an INOP condition.

• To manually stop a recording, select the

Recor- dings

SmartKey and then select the pop-up key

Stop All Recordng .

M1116B only

• You can also stop a recording by pressing the Stop key on the recorder module.

Recording Without a Template

To record without a pre-configured template, selecting the waves you require,

320

25 Recording

1

2

Either: Select the Recor- dings SmartKey then select the pop-up key Select Waves .

Or: Select the SmartKey

Record Waves

.

Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the

Continue

pop-up key.

Select one of the recording speed pop-up keys to set the required recording speed.

3

4

Select the Start pop-up key to start the recording.

Select Waves

recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping.

Overview of Recording Types

This table details settings for local recordings. For details on recordings made on the central recorder, see your Information Center Instructions for Use.

Delayed Alarm Realtime (RT)

All ECG

Waves

HiRes Trend

Procedure or

Context

Type of recording

Recording

Destination

Information recorded

Number of waves

Speed

Runtime

Stops

Overlap

manual local recorder and central from the start trigger minus the delay time up to 3

50, 25, 12.5, 6.25,

2.5 mm/sec

15, 20, 25, or 30 seconds automatically

Delay Time 10, 15 seconds up to 3 waves automatic, triggered by defined alarm conditions local recorder and central from the start trigger minus the delay time up to 3

50, 25, 12.5, 6.25,

2.5 mm/sec

15, 20, 25, or 30 seconds automatically

10, 15 seconds up to 3 waves

N/A

N/A

N/A

N/A

N/A manual printer local recorder and central

N/A

N/A from the start trigger up to 3

50, 25, 12.5, 6.25,

2.5 mm/sec

6, 8, 10, 15 seconds or continuously automatically if limited, manually if continuous none up to 3 waves manual local recorder only from the start trigger, in realtime all ECG waves currently monitored and available

25 mm/sec

4 seconds per wave none none manual local recorder only manual, use the context window's popup keys to start local recorder only from the start trigger minus delay time up to 3 highresolution trends

(beat-to-beat) waves defined by the context up to 3 waves, or specific to the context, e.g. a wedge procedure

1, 2, 2.5, 3, 6 cm/ min

10 minutes, or continuously automatically automatically if limited, manually if continuous

6, 5, 4, 3, 2, 1 minutes up to 3 waves defined by the context defined by the context defined by the context defined by the context defined by the context

N/A = not applicable

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25 Recording

All ECG Waves Recordings

An

All ECG Waves

recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead. All available leads are recorded sequentially in the standardized lead order. The recording is realtime, that is, the information recorded is not simultaneous.

Creating and Changing Recordings Templates

To save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the

Setup Recording

menu. You can create templates for one delayed recording, one alarm recording, three realtime recordings (two for MP20/30), and one high resolution recording. All ECG Waves recordings do not need to be configured, they always use the same format.

Changing recordings templates changes the settings that will be used each time a recording of this name is triggered.

1

2

3

Select the Main Setup permanent key to call up the Main Setup menu.

Select

Recordings

to enter the

Setup Recording

menu.

Select the name of the template you want to create or change. Each recording name is linked to a recording type, delayed, alarm, realtime, and hi-res trends. Recording names can be changed in the monitor's Configuration Mode.

4

Design the template by selecting each menu item and entering the information for the template.

Recorder

: choose which recorder the recording will print to (

Local

,

Central 2-Ch

, or

Central 4-

Ch recorder, or

Printer

(for realtime reports in alarm recording only)).

Channel 1

,

Channel 2

, etc.: choose which waveform to record in each channel. If the wave assigned to a recording channel in a particular template is not available when a recording is triggered, the channel is left blank on the recording strip. The pop-up list of available (currently monitored) waves differs according to the recording type:

– Realtime, delayed and alarm recordings: the list shows all the currently available waves.

– High-resolution recordings: the list shows all the available high-resolution waves.

In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:

Alarm Par

will always record the measurement in alarm in the chosen recorder channel

– Primary Lead will always record the current primary lead in the chosen recorder channel

– SecondryLead will always record the current secondary lead in the chosen recorder channel

Any Agent

will always record the currently selected anesthetic agent.

For high-resolution recordings only the

Any Agent

setting is available.

Overlap

: define whether the recorded waveforms will be printed overlapping or beside each other.

• Speed : choose the recording print speed.

• Delay Time : Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the "Delay Time" and can be set as specified

in “Overview of Recording Types” on page 321. This setting can only be changed in Configuration

Mode.

Run Time

: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely.

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25 Recording

Central Config - if available in the General menu, select this setting to use the recording settings made for the centrally-connected recorder.

Changing ECG Wave Gain

The

ECG Gain

setting in the

General Recording Setup

window defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings,

1

2

3

In the Setup Recording menu select General .

Select

ECG Gain

.

Select the required setting:

Auto

: the wave recording will use the same scale as the ECG wave on the monitor screen

– 5 mm/mV , 10 mm/mV , 20 mm/mV : the wave recording will use a scale of 5, 10, or 20 millimeters per millivolt.

Recording Priorities

Manually-started recordings have priority over automatically-started recordings. If an automatically-triggered alarm recording is running, and a realtime or delayed recording is manually started, the alarm recording is stopped and the manually-requested recording is started.

More recent manually-started recordings have priority over older manually-started recordings.

If a manually-started recording is running, and another manually-started recording is triggered, then the older recording is stopped and the more recent manually-started recording is started.

Alarm recordings are prioritized according to alarm priority. If an alarm recording triggered by a yellow alarm is running and a new alarm recording is triggered by a red alarm, the yellow alarm recording is stopped and the red alarm recording is started.

Recording Strip

The information printed on the recording strip includes the patient name and MRN, bed number, date and time of recording, recording speed, and recording code. Active alarm and INOP messages as well as numerics for all currently monitored measurements are also printed.

Recording strip annotations are printed at the beginning of the recording strip and updated at regular intervals, every 15 minutes for recordings made at speeds lower than 6.25 mm/s, and every 60 seconds for recordings made at speeds greater or equal to 6.25 mm/s.

Recording Strip Code

The recording strip code printed in the first line of the initial annotation has up to seven characters, specifying recording type, operating mode, application area, patient category, and delay time, if applicable.

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25 Recording

Recording type

Operating mode

Application area

Patient category

Code

A

P

N

C

N

I

O

C

S

M

D

90

8A

0B

91

Meaning

Realtime

Delayed

Alarm

Context (Procedures)

Monitoring

Demo

Configuration

Service

ICU

OR

CCU

NICU

Adult

Pediatric

Neonatal

Recorded Waveforms

A selection of up to three waveforms is recorded, marked with wave labels and wave scale information.

Wave scale information can be in the form of a calibration bar, like the 1 mV calibration bar for ECG, or calibration steps before the waveform starts.

Maintaining Recording Strips

Recording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation.

Reloading Paper

M1116B

1

2

3

4

5

Use the latch on the right side of the recorder door to pull the door open.

Remove the empty core.

Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top.

Recommended paper: 40477A and 40477B.

Pull out some paper and fold along the front edge at a 45° angle. This makes it easier to feed the paper under the roller as shown.

Feed the paper through and pull some paper out from the top of the roller.

1

Close the recorder door.

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25 Recording

2

To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper.

Recorder Status Messages

Recorder Status Messages

For example:

Local alarm recording running

No Central alarm recording available

No local alarm recording available

No alarm recording available

Central Recorder out of paper

Local Recorder out of paper

Central Recorder door open

Local Recorder door open

<Recorder name> not supported

Explanation

The named recording is currently running.

No alarm recording can be made on the selected recorder. Try selecting another recorder. If a local recorder was selected, the monitor will try to reroute the recording to a central recorder. Recordings configured to a central recorder cannot be rerouted to a local recorder. Alarm recordings may be lost. Try configuring

Printer

as the alarm recording destination.

No recorder available. Alarm recordings will be lost.

Try configuring Printer as the alarm recording destination.

The named recorder is out of paper.

The door of the specified recorder is open.

The M1116A recorder is not supported. Connect a

M1116B plug-in recorder.

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25 Recording

326

26

26

Printing Patient Reports

Starting Report Printouts

Most patient reports can be printed by selecting Main Setup Î Reports (or the Print Reports

SmartKey) and then selecting the report name in the top half of the

Reports

menu. Report names are shown only for reports that have been correctly set up.

Data from the time of the print request is printed, even if the print job is delayed in the printer queue.

Your monitor can also be set up to automatically print all reports when a matching printer is available.

To set this up

1

2

Select Main Setup Î Reports

Select Auto Print Dbs .

– Always will print all reports when a matching printer is available.

Host Only

will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in gray on the

Reports Job List

)

must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 333.

Never

will print no reports automatically; all reports stored in the host or companion database

must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 333.

Printout Location

Depending on availability, reports can be printed on locally connected printers, printers connected to the Information Center or the Application server, an external PC-based print server with Philips server software or into the print database.

Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available.

Print jobs in the print database are not deleted after a patient discharge. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient.

When an X2 or MP5 is connected to a host monitor, reports requested or stored on the X2 or MP5 can be printed via the host monitor. Reports requested on the X2 or MP5 when connected to a host monitor will not show any patient alarms or INOPs. In order to see alarms, reports should be requested on the host monitor.

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26 Printing Patient Reports

Starting the Different Types of Report

Report types Report contents How to start printing reports

Vital Signs Report

Graphic Trends Report

Events Reports depends on selected trend group, data resolution, and period.

Event Episode

Graphic or tabular Event Review

In the

Vital Signs window, select Print/ Record, then select

Print.

In the

Graphical Trends window, select Print.

In the

Event Episode or Event Review window, select the popup key

Print/ Record, then select Print Review or Print

Episode.

In the

Setup EEG menu, select Print Report.

EEG Report

ECG Reports

ST Map Report

Wedge Report

Calculations Report

Drug Calculator

Report

EEG Waves, numerics, CSAs, montage information and impedance values

Depends on format selected

ST data in a transversal and/or horizontal multiaxis diagram,

Cardiac Output Report Trial curves and numerics

Wedge numerics and reference wave

Hemodynamic, Oxygenation, or

Ventilation Review

Titration Table

Select the

ECG Report A or ECG Report B Smartkeys, if configured, or the

Print Reports SmartKey followed by ECG

Report A or ECG Report B.

In the

ST Map (Current) or ST Map (Trend) window, select

Print.

In the

Cardiac Output (Right Heart) or Cardiac Output

(Transpulmonary) window, select the pop-up key Print/

Record.

In the

Wedge window, select the Print Wedge pop-up key.

In the

Calculations windows, select the Print/ Record pop-up key.

In the

Titration Table window, select the Print Titr.Tbl pop-up key.

In the

Drip Table window, select the Print Drip Tbl pop-up key.

In the

Alarm Limits window, select Print Limits.

Drip Table

Alarm Limits Report Graphic and numeric report of all current alarm limits

Realtime Reports, including oxyCRG

Reports

Loops Report patient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT waves Or all measured HiRes waves, OR oxyCRG waves (RT waves: ECG Primary lead,

Pleth, Resp; HiRes waves: btbHR, HiRes

SpO

2

, HiRes Resp)

Individual Loops diagram with timestamp, currently measured numerics

Select the

In the

Realtime Report SmartKey, if configured.

Loops window, select Print Loop.

Battery Report Battery serial numbers, information on the currently-measured and potential charge status of the battery or batteries

Central Report A/B/C These are reports configured at the

Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available.

In the

Battery Status window, select Print Status.

In the

Main Setup select Reports then Central Report A,

Central Report B or Central Report C.

Stopping Reports Printouts

• To stop Reports printing, in the

Reports

menu, select

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26 Printing Patient Reports

– Delete Report to stop the current print job

Delete All Repts

to cancel all queued report printouts

Scheduled Rep.

to select

Off

and switch off scheduled reports.

Setting Up Reports

As the content of context-linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the procedure window these reports do not need to be set up, however a target printer can be configured in the

Setup Reports

menu.

The content you define in the individual Setup Reports menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the

ECG Reports

menu, every ECG report will be printed at this speed, irrespective of format.

ECG report layout and Auto Reports settings must be defined in Configuration Mode.

Setting Up ECG Reports

The settings you choose in the

ECG Reports

menu apply for all ECG reports printed. To set up ECG

Reports,

1

2

3

4

Select

Main Setup Î Reports Î ECG Reports

. Note the report layout configured for your monitor, either Internat or Cabrera . This setting is inactive ("grayed-out") in Monitoring Mode and can only be changed in Configuration Mode.

Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG report printouts.

Select Speed and select the report print speed.

Select

Annotation

and switch to

On

if the printed ECG wave should be annotated with beat labels.

See the chapter on ECG for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.

Setting Up Vital Signs and Graphic Trend Reports

The settings you choose in the

Vital Signs Report

and

Graphical Trend Report

menus apply for all

Vital Signs and Graphic Trend reports printed.

To set up Vital Signs and Graphic Trend reports,

Select Main Setup Î Reports Î Vital Signs Rep.

or Graph Trend Rep.

.

1

Select

Trend Group

and select the group you want to print on the report. The groups available depend on your monitor's trend configuration.

2

3

Select

Period

and select the period of time for which trend data should be printed on the report. If

Automatic Period is configured to On , all trend data for the current patient will be printed, irrespective which trend period is selected.

Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report,

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26 Printing Patient Reports

Setting Up Auto Reports

Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports:

Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report.

To set up Auto Reports,

1

2

Select

Main Setup Î Reports Î Auto Reports

and select the Auto Report you want to set up

(A, B, C, or D).

Select

Report

and assign a report type to the Auto Report.

3

4

Select End Case Report and switch to On if you want the selected report to print automatically when you select

End Case

to discharge a patient.

Switch

End Case Report

to

Off

if the report is a Scheduled Report only.

Select

Scheduled Rep.

and toggle to

On

if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day.

For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on.

– To set the time of day at which you want the report to print every day: select

Start Hour

and

Start Minute

and select the required time from the pop-up list

– To set the time interval in minutes between two scheduled reports: select Rep. Freq. (hrs) and

Rep. Freq. (min) and select the time interval from the pop-up list.

If you are setting up an end case report, these settings will be inactive ("grayed-out").

Switch

Scheduled Rep.

to

Off

if the report is an End Case Report only.

5

Repeat the procedure for all Auto Reports you want to set up.

All Auto Reports or Scheduled Reports set to

On

print automatically at the predefined trigger.

Be aware that the monitor's memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost.

Setting Up Individual Print Jobs

To adjust the appearance of individual print jobs, in the

Reports

menu,

Select

Main Setup Î Reports Î Setup Reports

to enter the

Setup Reports

menu.

1

Select

Report

and then select the report you want to set up.

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26 Printing Patient Reports

2

3

Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected.

Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:

VisibleWaves : all waves currently visible, in the order they appear on the screen.

All Waves

: all measured waves.

RT Waves

: all currently measured realtime waves, according to the monitor's priority list.

HiRes Waves

: all measured HiRes waves.

OxyCRG Waves : the OxyCRG/Neonatal Event Review waves.

Vital Signs

: trend information in tabular form.

Graph Trend

: trend information in graphic form.

ECG reports: ECG3X4 , ECG6X2 , ECG12X1 , ECG4X2 , ECG8X1 , ECG12X1 (2P)

EEG reports: EEG Report .

Episode

: a single patient event episode.

Review

: an overview of patient events

Alarm Limits : a list of all currently set alarm limits.

Select

Report Size

to set the paper size to be used for the report:

Unspecified

to use the default size for the template chosen, Universal , A4 , Letter , LrgUniversal , A3 , or Ledger . The list of available sizes depends on the report type selected.

4

5

Select Orientation to set the orientation of the report printout: Unspecified to use the default size for the template chosen, Landscape or Portrait .

Select Target Device and choose which printer the print job will be sent to: Unspecified to use the default printer, or choose from the list of printer names defined at the Information Center or in the monitor's Configuration Mode (for example,

Remote 1

or

Database

).

Some settings may be inactive ("grayed-out") in this menu for reports that can only be started in a special window.

Checking Printer Settings

The printer settings for your monitor are defined in Configuration Mode. The printer settings

Paper

Size , Resolution , Color Support , and Duplex Option for the active printer are visible but inactive

("grayed-out") in the Setup Printers menu. When Print Database is selected as active printer only the

Paper Size

setting will be shown.

To enter the Setup Printers menu, in the Reports menu, select Setup Printers .

Printer names for locally-connected printers can be defined in Configuration Mode. You can see whether a specified printer is centrally or locally connected in the Setup Printers menu under Port . If

"Local" is included in the port name, e.g.

Local 2

, that indicates locally-connected printers, and

"Remote", e.g.

Remote 1

, indicates centrally-connected printers.

Printing a Test Report

A test report can be printed in Configuration mode, refer to the Service Guide for details.

331

26 Printing Patient Reports

Switching Printers On Or Off for Reports

You can enable or disable printer status to switch individual printers on or off for report printouts.

1

In the

Setup Printers

menu, select

Printer

and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.

2

Select

Printer Status

to toggle between the settings

Enabled

and

Disabled

. If you set this to

Disabled

, no reports will be printed to the named printer.

If the monitor detects that no printer of a particular type is available, the Printer Status setting will automatically be set to Disabled and "grayed out".

Dashed Lines on Reports

If a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing.

For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place.

Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/ mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.

To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.

Unavailable Printer: Re-routing Reports

If you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitor's memory.

If the target device of this print job was set to

Unspecified

, the monitor will periodically try to resend the print job to the first printer listed in the

Setup Printers

menu under

Printer

that is set to

Enabled and that has paper of the correct size.

To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-route a print job,

• Enable the new target printer by selecting it in the

Setup Printers

menu and toggling to

Enabled

.

As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.

If the target device of the print job was set to a specific printer, re-routing is not possible.

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26 Printing Patient Reports

Checking Report Status and Printing Manually

A list of all print requests which are waiting, printing or stored can be viewed in the

Reports Job List

.

To view the list, in the

Reports

menu, select

Reports Job List

.

The following information is displayed for each print request:

• Report title

• Patient name (except for system reports such as the battery status report)

• Request date and time

• Report paper format

• Job status:

Preparing

,

Printing

,

Waiting

,

In Database

,

In Companion

,

Retry

,

Cancelling

,

Error

.

Individual reports can be deleted from the list with the Delete Report key, and all reports with the

Delete All Repts

key.

CAUTION

The Reports Job List includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality.

If an MP5 or an X2 is connected to a host monitor, all print requests which are stored in the print database are shown "grayed out" on the Reports Job List and will not be deleted with the Delete All

Repts

key.

Printing Manually

Those jobs shown in black will be printed automatically when a matching printer is available. If the

Auto Print Dbs setting is Host Only or Never , some or all reports will not be printed automatically and will be shown in gray. Any jobs shown in gray must be printed manually; to do this,

1

2

In the Reports Job List , select the required report

Select

Print Report

.

Selecting

Print All Reps.

will send all reports to the printer.

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26 Printing Patient Reports

Printer Status Messages

Printer Status Message Possible causes and suggested action

Print job queued for

<Printer Name>

Print job could not be queued (insufficient resources)

Print job could not be queued (queue is full)

Print job could not be queued (no matching printer found)

Cancelling all print jobs

Cancelling the active print job

Cancelling print jobs due to patient discharge

Cancelling # print jobs due to hotstart

The report has been placed in the queue for the named printer.

The printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again, OR

A report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request.

Delete All Reps

has been selected in the

Reports

menu, OR

The Operating Mode has been changed from Monitoring Mode to

Demonstration or Service Mode.

The current report is being canceled as the result of a user request.

When a patient is discharged, all queued reports are canceled except those stored in the print database. "N" is the number of reports canceled.

The monitor has restarted and all report requests have been canceled except those stored in the print database. "N" is the number of reports canceled.

Printing failed: No report configured!

Printing on <Printer

Name>...

A report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report.

A report is in progress, or the monitor is waiting for the central printer to accept the print job.

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26 Printing Patient Reports

Printer Status Message Possible causes and suggested action

Printer <Printer Name> unavailable suspended

Î job

Print database full suspended

Î job

Job on <Printer Name> failed (data unavailable)

Job on <Printer Name> failed (printer unavailable)

Job on <Printer Name> failed (data requisition error)

The chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available.

The requested report does not fit into the print database. You can

select another printer to print the report (see “Unavailable Printer: Rerouting Reports” on page 332). Alternatively you can delete another

report from the

Reports Job List

(using the

Delete Report

key) to create space for your report.

A report cannot be started on the requested printer.

One of three reasons is shown in the status message:

• data unavailable - the connected X2 or MP5 has been removed before the data for the report was transferred.

• printer unavailable - make sure the printer is plugged in, switched on, and has paper loaded.

• data requisition error - an internal error has caused data required for the report to be unavailable, try starting the report again.

Print job on <Printer

Name> done

The report has been printed.

Sample Report Printouts

Each report header contains the patient's bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end.

The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the

Addressograph

and it can only be changed in the monitor's Configuration Mode.

335

26 Printing Patient Reports

Alarm Limits Report

336

1

2

Measurement labels, with alarms off symbol where alarms are switched off

Graphic view of current alarm limits in relation to currently monitored measurement value

Realtime Report

26 Printing Patient Reports

1

2

3

Patient demographic information, time stamp

Active Alarms and INOPs, followed by vital signs

Measurement waves section

337

26 Printing Patient Reports

Cardiac Output Report

ECG Reports

338

1

2

Patient information

Numeric block

3

Wave area

Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values.

The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patient's paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.

ECG Report type

12-Lead ECG

Multi-lead ECG

Available Formats

3X4 landscape

6X2 landscape

12X1 portrait

12X1 landscape

12X1 (2P) landscape

2X4 landscape

8X1 portrait

8X1 landscape

Available Paper Sizes

A4, letter, A3, ledger

A4, letter, A3, ledger

A4 and letter only

A4, letter, A3, ledger

A4, letter (2 pages)

A4, letter, A3, ledger

A4 and letter only

A4, letter, A3, ledger

26 Printing Patient Reports

Other Reports

See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports.

339

26 Printing Patient Reports

340

27

27

Using the Drug Calculator

Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time.

Term Definition Units

Dose

Rate

Amount

total quantity of drug to be delivered to the patient over time amount units per time or per kg/ time, if the drug is weightdependent volume of the mixture to be delivered to the patient over time amount of drug to be added to diluent to make up a mixture ml/hour ng, mcg*, mg, g, mUnit, Unit, where g stands for gram quantity of mixture of diluent and drug ml

Volume

Concentration

ratio of the amount of drug to the solution volume amount units per ml

Standardized Rate 1ml volume of the mixture to be delivered to the patient per hour ml/hr

*Be aware that your hospital may use either 'µg' or 'mcg' as an abbreviation for microgram. These abbreviations are equivalent.

WARNING

Before you administer any drug, always check that the correct calculation units and patient category are selected. Consult your pharmacy if you have questions.

Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge. The Drug Calculator performs calculations based on the values input during use, it does not check the plausibility of the calculations performed.

341

27 Using the Drug Calculator

Accessing the Drug Calculator

• To access the Drug Calculator, select Main Setup Î Calculations Î select the

Drug Calc

SmartKey, if configured.

Performing Drug Calculations

Drug Calculator , or

Using the service Support Tool, a list of drugs can be configured for the monitor containing predefined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the

Drug Calculator window opens a list of configured drugs. Contact your pharmacist if you have any questions about the drugs in the list.

If ANY DRUG is the only entry in the list of drugs, no drugs have been pre-configured for your monitor. Drug calculations can be performed for non-specific drugs.

You must have a Support Tool to add additional drugs to the Drug Calculator.

About the Rule of Six

If the Rule of Six has been enabled for use with individual drugs in your Drug Calculator, you can use the formula in crisis situations to quickly calculate the amount of a drug needed to yield a target dose for continuous infusion for neonatal or pediatric patients (the drug amount is given in "mg", the patient weight in "kg"). The Rule of Six can only be used with the dose unit mcg/kg/min.

CAUTION

JCAHO recommends disabling the Rule of Six. The configuration is not JCAHO-compliant if Rule of

Six is enabled.

The Drug Calculator uses the following formula for Rule of Six calculations, based on the patient's weight:

• For a target dose of 0.1 mcg/kg/min, the Drug Calculator multiplies 0.6 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.

• For a target dose of 1.0 mcg/kg/min, the Drug Calculator multiplies 6.0 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.

342

27 Using the Drug Calculator

Performing Calculations for a Non-Specific Drug

If a list of drugs has not been configured for your monitor, you can use the Drug Calculator to calculate drug doses for a single, generic drug called

ANY DRUG

. Selecting the arrow beside the drug name in the

Drug Calculator

window shows that are no other drugs configured.

1

Enter three of these four values: dose, amount, volume, and rate of the infusion solution.

To enter values, select the correct unit, then select each value field and use the pop-up keypad to enter the correct value.

2

If you have chosen a weight-dependent dose unit, you must enter the patient weight now or choose a different unit.

If available, the patient weight from the

Patient Demographics

window is entered automatically in the

Drug Calculator

window when the Drug Calculator is accessed. To change the patient weight, select the

Weight

key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information.

3

When you have entered three values, the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field. Standardized rate and concentration are also calculated.

Performing Calculations for a Specific Drug

1

Select the arrow beside

ANY DRUG

, then select the required drug from the list of drugs.

This opens the window for the selected drug.

343

27 Using the Drug Calculator

2

3

Select the correct patient category for your patient.

If you have a neonatal or pediatric patient, the

Rule Of 6

choice may be available. Select if required.

Enter the patient weight, if necessary.

If available, the patient weight from the

Patient Demographics

window is entered automatically in the

Drug Calculator

window. To change the patient weight, select the

Weight

key then use the onscreen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. Select the weight unit shown to change between lb and kg.

4

When a specific drug is selected, the initial values for Dose , Amount and Volume are the configured Start values for this drug. The Rate is then calculated. If other values are required you

can calculate any value by entering the remaining three values as described in “Performing

Calculations for a Non-Specific Drug” on page 343.

The column on the right of the window shows either drug dose or dosage rate, whichever is the calculated value. The current calculated value is shown on a scale with the recommended range in green. If the current calculated value lies outside the recommended range it is shown in red.

If you have changed values in the Drug Calculator and you want to revert to the configured values, select

Reset Values

key at any time.

Charting Infusion Progress

The

Drip Table

shows you at a glance how much of the infusion has been administered to your patient and how much time is left.

• To see the

Drip Table

, in the

Drug Calculator

window, select the

Drip Table

pop-up key.

If the Drip Time exceeds 24 hours, the Drip Time timestamp shows - - :- - : - - .

344

Using the Titration Table

27 Using the Drug Calculator

Use the

Titration Table

to see at a glance what dose your patient would receive of a drug at different infusion rates. By clicking on the title row of the table you can switch between the Dose increments and

Rate increments

view.

Values outside of the recommended range are shown in red.

To see the

Titration Table

,

• in the

Drug Calculator

window, select the pop-up key

Titr. Table.

The

Titration Table

is configured with the service Support Tool.

Documenting Drug Calculations

• In the

Drug Calculator

window, select the pop-up key

Record DrugCalc

to immediately start a recording of the current drug calculation.

• In the

Titration Table

window, select the pop-up key

Print Titr.Tbl

to print a report of the current

Titration Table.

• In the

Drip Table

window, select the pop-up key

Print Drip Tbl

to print a report of the current

Drip Table.

345

27 Using the Drug Calculator

346

28

28

IntelliBridge EC10 Module

An IntelliBridge EC10 module transmits information from a connected external device to your monitor. The IntelliBridge EC5 ID module is used to provide identification information from the external device. Data imported from the external device, for example waveforms, measurement numerics, settings and alarms, can be displayed on the monitor, passed on to an Information Center and included in trends as appropriate. The external device may show more information than is available on the monitor. Data from IntelliBridge EC10 modules cannot be included in monitor trends when the label is a free-text label.

3

4

1

2

5

module name setup indicator LED setup/data viewing key connection status LED external device cable connector

See the documentation supplied with the IntelliBridge module for a list of supported devices and accessories, and for configuration information.

Connecting an External Device

3

4

5

6

1

2

Insert the module into the FMS or integrated module slot.

Check that you have the correct EC5 ID module for the external device - indicated on the EC5 label.

Connect the EC5 ID module to the external device.

Connect the EC5 to the EC10 module using the supplied cable.

Switch the external device on.

The connection status LED (4) will flash green until it has correctly identified the external device and started communication. Check that the connection status LED then lights green continuously indicating that communication has been established.

347

28 IntelliBridge EC10 Module

Changing Waves and Numerics Displayed

To change the waves and numerics from the IntelliBridge module displayed on the Screen,

1

2

Select

Main Setup Î Measurements Î <External Device>

to enter the setup menu for the connected device.

Select

Setup Driver

.

3

4

Select Setup Waves or Setup Numerics and make the changes required.

Close the setup menu. The monitor takes a few seconds to activate the change.

Viewing the IntelliBridge Device Data Window

To view the IntelliBridge device data window, either

• select the setup key on the IntelliBridge module, or

• select the

External Devices

SmartKey and then select the pop-up key with the device name on it, or

• in the

Setup <External Device>

menu, select

Show Device Data

.

Check that the correct external device ID is shown in the window title.

Select the device data window then

Setup Device

to open the setup menu for the connected device.

With the More Data key you can page through additional data which does not fit on the first screen.

When an infusion system is connected the data is presented differently. The data from each pump is displayed in a horizontal frame in the window. Data from several infusion pumps can be displayed.

To see a detailed information window for one of the pumps, you can select data for that pump on the

Screen or select the More Data pop-up key.

Using Screens with External Device Data

Your monitor may be configured to show external device data permanently on the Screens.

Select the device data window to display the pop-up keys that let you access the setup menu and make changes.

348

28 IntelliBridge EC10 Module

Alarms/INOPs from External Devices

The IntelliBridge module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the External Device Data window tells you either Device Alarms Ignored or Device Alarms Accepted or No Alarms Available .

External device alarms status symbols precede some, but not all, measurement labels.

the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.

Alarms from external devices are transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device.

Refer to the documentation supplied with the IntelliBridge module for details of how alarms are announced on the monitor and the Information Center.

INOPs from the IntelliBridge Module

INOP Text

!!NO DEVICE DATA

!!!NO DEVICE DATA

NO DEVICE DATA

DEVICE UNSUPPORTED

DEVICE CHECK CONF.

DEVICE CHECK SETUP

INOP Condition

Communication has been lost to a connected device when

– !! a medium priority INOP or patient alarm was present

– !!! a high priority INOP or patient alarm was present

Communication has been lost to a connected device with no (or only low priority) INOPs/physical alarms.

Device identification completed but no appropriate device driver installed

Device identification completed but communication could not be established due to errors

Device identification completed but communication could not be established due to timeout

Language Conflict with External Device Drivers

You should avoid language conflicts between the IntelliBridge module device driver and the monitor.

Be aware that if you connect an IntelliBridge module with a different operating language to the monitor, the monitor will show:

• measurement labels in the monitor language

• alarm and INOP texts in the IntelliBridge module device driver language.

349

28 IntelliBridge EC10 Module

350

29

29

VueLink Modules

A VueLink module transmits information from a connected external device to your monitor. Each module can be connected to one of up to three preselected external devices, and supports alarms from the external device. Data from VueLink modules cannot be included in monitor trends when the label is a free-text label.

The external device may show more information than is available on the monitor. The number of waves and numerics you can view simultaneously on your monitor's main screen depends on the module type. Type A modules support one wave and two numerics, type B modules support two waves and six numerics.

Module

Auxiliary

Ventilator

Gas Analyzer

Anesthesia

Machine

Auxiliary Plus

Type

B

B

A

B

B

2

2

1

2

Max. Wave Max.

Numeric

2

2

6

6

6

6

External Devices

standalone measurement module ventilators gas analyzers anesthesia machines external multi-measurement devices

1

4

5

2

3

6

7

module name device label selection LED setup key external device cable connector setup indicator LED module type (A or B)

351

29 VueLink Modules

The device labels (2) on the module indicate for which external devices the module is configured. The selection LED (3) shows which device is currently active. The device label text may differ slightly from the labels on the external devices.

See the documentation supplied with the VueLink module for a list of supported devices and accessories, and for configuration information.

Connecting an External Device

1

Insert the module into the FMS or integrated module slot.

2

Check that the device selection LED (3) lights to show that it has correctly identified the external device. If not, select Main Setup Î Measurements Î and then the name of the external device to enter the setup menu for the connected device.

3

In the device setup menu, select Device , select the correct device from the list, and confirm the selection.

Connect the external device to the module and switch it on.

4

Once the VueLink device has been correctly connected, you can select the

External Devices

SmartKey and then select the Setup Device pop-up key to access the setup menu for the connected device.

CAUTION

Selecting the wrong device can cause unpredictable system behavior. Rectify this by switching off the external device when it is safe to do so, and selecting the correct device.

Changing VueLink Waves and Numerics Displayed

To change the waves and numerics from the VueLink module displayed on the Screen,

1

Select

Main Setup Î Measurements

and then the name of the connected device to enter its setup menu.

2

3

Select the item you want to change, then select the new item from the pop-up list, or

Select

Show Device Data

to view the device data window.

Close the setup menu. The monitor takes a few seconds to activate the change.

352

29 VueLink Modules

Viewing the VueLink Device Data Window

To view the VueLink device data window, either

• select the setup hardkey on the VueLink module or the

External Devices

SmartKey, and then select the pop-up key for the device, or

• in the

Setup <External Device>

menu, select

Show Device Data

.

Select the device data window then the

Setup Device

key to open the setup menu for the connected device.

Using VueLink Screens

Your monitor may be configured to show VueLink device data permanently on the Screens.

Select the device data window to display the external device pop-up keys that let you access the setup menu and carry out external device tasks.

Switching VueLink On and Off

• To switch VueLink measurements on and off, in the setup menu for the external device, select

Device Interface

to toggle between the settings

On

and

Off

.

Alarms/INOPs From External Devices

The VueLink module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the VueLink info window tells you either Device Alarms Ignored or Device Alarms Accepted or No Alarms Available . External device alarms status symbols precede some, but not all, measurement labels.

!

the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.

alarms status of this external measurement is unknown

353

29 VueLink Modules

Alarms from external devices are:

• transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device.

• always non-latching on the monitor.

• announced as a flashing numeric while the alarm condition persists.

• announced audibly and visibly at the Information Center.

Language Conflict with External Device Drivers

You should avoid language conflicts between the VueLink module device driver and the monitor. Be aware that if you connect a VueLink module with a different operating language to the monitor, the monitor will show:

• measurement labels in the monitor language

• alarm and INOP texts in the VueLink module device driver language.

354

30

30

Using Timers

With the Timers function you can set timers to notify you when a specific time period has expired.

CAUTION

Do not use the timers to schedule critical patient-related tasks.

Viewing Timers

You can view currently active timers in the Timers window or directly on the Main Screen (if a timer has been substituted for a numeric).

To open the Timers window:

• Select the Timer SmartKey or

• Select

Main Setup Î Timer

The maximum number of timers which can be active depends on your monitor model.

For a timer with a defined run time a progress bar is shown with the run time for that timer. Next to the progress bar the elapsed time or the remaining time is shown, depending on whether the timer is counting up or down. On the left, the label of the timer and a symbol indicating the type of expiry notification is shown.

Timer Types

There are four types of timer: Basic , Enhanced , Cyclic and No Limit . A Basic timer has a single, defined run time and progress is shown in the progress bar. An

Enhanced

timer is like a

Basic

timer but the progress bar shows progress beyond the end of the run time. A

Cyclic

timer is like a

Basic timer but restarts automatically when the run time is expired. A

No Limit

timer has no run time or progress bar and shows the time elapsed since the timer was started.

The type of timer is set in the monitor's Configuration Mode and is associated with the timer label.

355

30 Using Timers

Timer Setup Pop-up Keys

When you open the

Timers

window and select a timer, then select the setup key, the setup window opens and a selection of pop-up keys appear to let you activate and control the timers.

Pop-Up Keys

Start

Stop

Clear

Timers

Selecting this pop-up key lets you....

start the timer.

stop the timer, allowing either restarting after a pause (

Start

key) or clearing

(

Clear

key).

clear the timer, ending this timer episode.

return to the timer window showing all active timers

Setting Up Timers

The timer type, display color of the timer and whether a window automatically pops up on expiry are settings made in Configuration Mode for each timer label.

The remaining timer settings can be made in Monitoring Mode. If you change settings when a timer is running it will not be stopped. The timer will continue to count but the new settings will be applied.

To display the setup window for a timer,

• in the

Timers

window, select the required timer, then select the setup key or

• select a timer on the Screen then select

Setup Timers

.

Timer Label

You can select from a variety of specific labels, for example

Tourniquet

,

Infus

,

Docu

or from four non-specific labels TimerA , TimerB , TimerC , and TimerD . When you assign a label to a timer, the monitor automatically applies the associated configuration settings to this timer, but the timer continues counting and is not reset.

To select a label, in the Timers window:

1

Select the required timer and display the

Setup

window.

2

Select

Label

.

3

Select a specific or non-specific label from the list.

Run Time

The run time can be set between 1 minute and 96 hours.

No Limit

timers have no run time.

To set the run time, in the

Timers

window:

1

2

3

Select the required timer and display the Setup window.

Select

Run Time

.

Select a run time from the list.

356

30 Using Timers

Timer Counting Direction

Timers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up.

To change the direction, in the Timers window:

1

Select the required timer and display the

Setup

window.

2

Select

Direction

to switch between

Up

and

Down

.

Notification

When a timer expires (except a No Limit timer), the color changes to red and a message appears in the status line on the Main Screen. Be aware that if a timer has been configured to display in light red, the color will not visibly change when the timer expires.

Additional notification is also available and can be set to:

Alarm : An INOP alarm indicates the expiry of the timer

Sound

: A single tone indicates the expiry of the timer

No Sound

: No additional notification

To set the additional notification, in the Timers window:

1

Select the required timer and display the Setup window.

2

Select

Notification

and select the notification level required from the list.

If an MP5 is connected to a host monitor, and notification is set on the MP5 to

Alarm

, the INOP alarm will appear on the host monitor

TimeExpired:MMS

.

Timer Volume

For all Timers with the notification setting

Sound

, you can set the volume of the tone.

To set the volume, in the

Timers

window:

1

Select the required timer and display the

Setup

window.

2

Select Timer Volume and select a volume setting from the list.

Displaying a Timer On The Main Screen

If you want to have a timer displayed on the Main Screen, you can substitute it for a numeric which is not directly associated with a wave. If limited space is available, some of the timer display elements may not be displayed. The minimum information displayed is the label and the elapsed or remaining time.

357

30 Using Timers

To display a timer on the Main Screen:

1

Select the numeric you want to substitute.

2

3

Select

Change Numeric

.

Select

Any Timer

.

Main Screen Timer Pop-up Keys

When you select a timer displayed on the Main Screen, additional pop-up keys become available:

Pop-Up Keys

Setup <Timer Label>

Change Timer

Timers

Selecting this pop-up key lets you....

enter the setup screen for the currently selected timer.

select a different timer for display.

enter the

Timers

window.

Displaying A Clock On The Main Screen

In the same way that you can substitute a timer for a numeric, you can also substitute a larger clock display for a numeric.

To display a clock on the Main Screen:

1

Select the numeric you want to substitute.

2

3

Select

Change Numeric

.

Select

Clock

.

When you select the clock on the Main Screen you can select Date, Time in the menu to set the date and time.

358

31

31

Respiratory Loops

Using a VueLink module or IntelliBridge module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient's lung function, and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close).

You can measure:

• Pressure-volume loops

• Pressure-flow loops

• Volume-flow loops.

Note that you cannot store loops from different patients and different source devices in the same list as they are patient and device specific. This prevents you from inadvertently comparing information from different patients.

Viewing Loops

In the loops display, the current loop is drawn in white, and up to six stored loops are color-coded to match their timestamps. The currently-used source device is shown in the window title.

To view respiratory loops permanently on your Screen,

• select the current Screen name to open the

Change Screen

menu, then select a Screen configured to display the loops screen element.

Select the loops screen element to access the loops pop-up keys.

359

31 Respiratory Loops

To open the Loops window, and its associated pop-up keys,

• select Main Setup Î Loops , or select the Loops SmartKey, if configured.

In the

Loops

window, in addition to the stored loops, two realtime airway waves and up to nine available numerics from the source device can be shown.

Capturing and Deleting Loops

Up to six loops of each kind can be stored for reference.

To capture the current Loop and display it in the Loops window,

• select the

Capture Loop

pop-up key.

The monitor will prompt you to save the loop for reference, either in addition to or in place of previously stored loops.

Status messages at the bottom of the window provide information on the loop capture process.

To delete Loops from the reference list,

• Select the

Select Loop

pop-up key to view the list of stored loops and delete the loops from the list.

Showing/Hiding Loops

Colored rectangles beside the loops timestamps and color-coded with the loops tell you whether each loop is currently displayed or not:

– A filled-in rectangle marks loops currently shown in the

Loops

window

– A rectangle outline marks loops not currently shown.

Selecting the timestamp of the currently-displayed loop hides it and shows the next in the list; selecting the timestamp of a currently hidden loop displays it.

Changing Loops Display Size

To change the loops display size, in the

Loops

window, select the pop-up key

Select Size

then select

Size X0.5

to display loops at half the usual size

Size X1

to display loops at the usual size

• Size X2 to display loops at twice the usual size

This does not affect the size of loops printed in reports.

Using the Loops Cursor

To view the coordinates for any point on a stored loop,

1

2

Select the pop-up key Select Loop .

Select the required loop from the list of available loops.

3

Use the arrow pop-up keys to move the cursor around the loop. The values for both loop axes are shown for every point on the loop.

Select the X at the top of the loop list to exit the cursor.

360

31 Respiratory Loops

Changing Loops Type

To change the loop type, in the

Loops

window, select the

Loop Type

pop-up key (only available if the source device delivers three waves), then select

Press/Volume

to display Pressure/Volume loops

Flow/Volume

to display Volume/Flow loops

• Press/Flow to display Pressure/Flow loops.

or, if the source device only delivers two waves,

1

2

In the

Loops

window, select the

Setup Device

pop-up key to enter the setup window for the external device.

Select

Wave 1

and select pressure, flow, or volume waves as required. Repeat for

Wave 2

.

Setting Up Source Device

The source device for the loops is indicated in the Loops window title.

• Select the

Setup Device

pop-up key to view the settings of the current source device.

If the source device is changed, all reference loops from a previous device are cleared from the reference list when the first loop from the new source device is captured. Reconnecting the previous device recalls its reference list.

Documenting Loops

1

2

In the Loops window, select the pop-up key Print Loop

From the list of available loops, select an individual loop, or select

Print All

to print a report of all

For each loop, the report prints

• the currently-displayed loop, with the loop capture timestamp

• up to six realtime numerics provided by the loop source device

• SpO

2

, etCO

2

, PO

2

, and PCO

2

numerics from the patient monitor, if available.

361

31 Respiratory Loops

362

32

32

Laboratory Data

Laboratory data can be entered manually at the Information Center or at the monitor. For details on

manual entry at the monitor, see “Entering Measurements Manually” on page 40. Selected laboratory

data can be integrated on the monitor - values are then stored in the database and included in trends and reports and can be displayed as a numeric on the main screen. Which data can be stored and used on the monitor in this way is selected in Configuration Mode.

Viewing Received Data

When new data has been received from the Information Center a New Lab Data received. Check Lab

Results Window.

Setup Î

message will appear with the arrival time. To view the data, select

Lab Results

or the

Lab Results

SmartKey.

Main

The Lab Results window shows the most recent set of data received. The data is grouped into categories:

• Blood Gases

• Electrolytes

Hematology

Metabolites

• Chemistry

Enzymes/Markers

Coagulation

Urine Diagnostics

If no results are available for a particular category, that category will not be shown. Values which were entered manually at the Information Center will be marked with an asterisk (*).

363

32 Laboratory Data

364

33

33

Care and Cleaning

Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods.

Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital's Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to "Guidelines for Prevention of

Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-

Safety Workers" issued by the U.S. Department of Health and Human Services, Public Health Service,

Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country.

General Points

Keep your monitor, modules, Multi-Measurement Module, MMS extensions, Flexible Module Rack, cables and accessories free of dust and dirt.

After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first.

Observe the following general precautions:

• Always dilute according to the manufacturer's instructions or use lowest possible concentration.

• Do not allow liquid to enter the case.

• Do not immerse any part of the equipment or any accessories in liquid.

• Do not pour liquid onto the system.

• Never use abrasive material (such as steel wool or silver polish).

• Never use bleach.

WARNING

If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.

The general care and cleaning information given here meets the requirements of Aspect Medical

Systems for their BIS measurement devices.

365

33 Care and Cleaning

Cleaning the Monitor

Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene.

Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement connectors. Wipe around, not over, connector sockets.

CAUTION

To clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by selecting and holding the

Main Screen

key until the padlock symbol appears on it, indicating that touch operation is disabled. Select and hold again to re-enable touch operation. Unplug a mouse, keyboard or other connected device before cleaning it.

Disinfecting the Monitor

CAUTION

Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.

Hospital policy: Disinfect the product as determined by your hospital's policy, to avoid long term damage to the product.

Clean equipment before disinfecting. Recommended types of disinfecting agents are:

Product Name

Isopropanol

Bacillol® AF

Bacillol®25

Meliseptol®

Accel TB RTU

Oxivir® Tb Cleaner Disinfectant

Oxivir® Tb Wipes

Product Type Ingredients

liquid liquid, spray liquid spray liquid spray wipes

Isopropanol 80%

100 g concentrate contains:

Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 g

Ethanol 100 mg/g

Propan-2-ol (= 2-Propanol) 90 mg/g; Propan-1-ol (= 1-

Propanol) 60 mg/g

50% 1-Propanol

0.5% accelerated hydrogen peroxide

0.5% accelerated hydrogen peroxide

0.5% accelerated hydrogen peroxide

366

33 Care and Cleaning

Product Name

Carpe Diem

TM/MC

Tb

Ready-to-Use General Virucide,

Bactericide, Tuberculocide,

Fungicide, Sanitizer

Carpe Diem

TM/MC

Tb Wipes

Super Sani-Cloth

Germicidal Disposable Wipes

SANI-CLOTH® PLUS

Germicidal Disposable Wipes

SANI-CLOTH® HB Germicidal

Germicidal Disposable Wipes

Product Type

spray wipes wipes wipes wipes

Ingredients

0.5% accelerated hydrogen peroxide

0.5% accelerated hydrogen peroxide isopropanol 55% quaternary ammonium chlorides 0.5% isopropanol 15% quaternary ammonium chlorides 0.25% isopropanol < 0.15% quaternary ammonium chlorides 0.14%

Sterilizing the Monitor

Sterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies.

Cleaning, Sterilizing and Disinfecting Monitoring

Accessories

To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory.

Cleaning the SO2 Optical Module

The outside of the optical module can be cleaned as described under “Cleaning the Monitor” on page 366. The compartment with the fiber-optic connection can only be cleaned with a dry cloth. Do

not introduce any moisture into this compartment.

Cleaning the Recorder Printhead (M1116B only)

If you run recordings at low speed (1 or 2cm/min) for extended periods, deposits of paper debris may collect on the print head making recordings unevenly fainter in horizontal stripes.

1

2

3

Remove the recorder.

Open the recorder door and un-thread the paper from behind the rubber roller.

Tear off or roll up the excess paper into the roll chamber to get it out of your way.

367

33 Care and Cleaning

4

Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two inches of the strip come out from the top of the roller.

5

6

7

Close the recorder door, aligning both ends of the strip over the top of the door.

Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip through and out of the recorder.

Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the recorder.

368

34

34

Maintenance and

Troubleshooting

WARNING

Schedule: 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.

Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.

Inspecting the Equipment and Accessories

You should perform a visual inspection before every use, and in accordance with your hospital's policy.

With the monitor switched off:

1

Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse.

2

3

Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use.

Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier.

4

If the MMS and MMS Extensions are mounted on the monitor, make sure that they are locked into place and do not slide out without releasing the locking mechanism.

WARNING

Electrical Shock Hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor, monitor or measurement device. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel.

369

34 Maintenance and Troubleshooting

Inspecting the Cables and Cords

1

2

3

4

5

Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.

Inspect the Measurement Link cable and ensure that it makes good connection with the MMS and the FMS. Make sure that there are no breaks in the insulation.

Inspect the cable connecting the MMS to the monitor. Make sure the connectors are properly engaged.

Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.

Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.

Maintenance Task and Test Schedule

The following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation DVD.

Ensure that these tasks are carried out as indicated by the monitor's maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.

Maintenance and Test Schedule Frequency

Monitor Tests

Safety checks. Selected tests on the basis of IEC 60601-1

At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped.

Monitor Maintenance

Check ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation)

At least once every two years, or as needed.

Replace backlight

(integrated displays only)

25,000 - 30,000 hours (about three years) of continuous usage, or as needed.

Multi-measurement Module and Module Tests

Performance assurance for all measurements not listed below.

Multi-measurement Module and Module Maintenance

NBP calibration At least once every two years, or as specified by local laws.

Microstream CO2 calibration and performance test

Mainstream and sidestream CO2 calibration check (M3014A)

At least once every two years, or if you suspect the measurement values are incorrect.

At least once a year or after 4000 operating hours.

At least once a year, or if you suspect the measurement values are incorrect.

370

34 Maintenance and Troubleshooting

Troubleshooting

If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly.

If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log,

1

In the

Main Setup

menu, select

Revisions

.

2

Select the pop-up key corresponding to the status log you want to consult, for example, for the

MMS or the monitor.

3

View the status log by selecting Status Log from the Monitor Revision window.

Disposing of the Monitor

WARNING

To avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your country's laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste.

You can disassemble the monitor, MMS, FMS and modules as described in the Service Guide.

You will find detailed disposal information on the following web page: http://www.healthcare.philips.com/main/about/Sustainability/Recycling/pm.wpd

The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium).

Do not dispose of waste electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered.

Disposing of Empty Calibration Gas Cylinders

1

2

3

Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.

When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.

Write "Empty" on the cylinder and dispose of it appropriately for scrap metal.

371

34 Maintenance and Troubleshooting

WARNING

Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.

372

35

35

Accessories

You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details.

WARNING

Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard.

Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved accessories may compromise device functionality and system performance and cause a potential hazard.

Packaging: Do not use a sterilized accessory if its packaging is damaged.

ECG/Resp Accessories

This symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.

The following cables may not all be available in all countries. Please check availability with your local

Philips supplier.

Recommended Cables

Trunk Cables

Part No.

Length

3-Electrode Cable

Set

5-Electrode Cable

Set

6-Electrode Cable

Set

10-Electrode

Cable set

(5+5)

M1669A

2.7 m

M1668A

2.7 m

M1667A

2.7 m

M1663A

2.0 m

10-Electrode

Cable set

(6+4)

M1665A

2.7 m

373

35 Accessories

3-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU snap shielded

ICU Clip non-shielded

ICU Clip non-shielded

5-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU Snap shielded

ICU Miniclip non-shielded

Length

1.0 m

1.0 m

1.0 m

0.45 m

0.7 m

AAMI Part No.

M1675A

M1671A

M1673A

M1622A

M1624A

Length

1.0 m/1.6 m

1.0 m/1.6 m

1.0 m/1.6 m

0.7 m/1.3 m

AAMI Part No.

M1973A

M1968A

M1644A

M1647A

6-Electrode Cable Sets

Description

OR Grabber

ICU Grabber

ICU Snap

Length

1.0 m/1.6 m

1.0 m/1.6 m

1.0 m/1.6 m

AAMI Part No.

M1684A

M1680A

M1682A

10-Electrode (5+5)Cable Sets

Description Length

ICU Grabber, chest, shielded

ICU Snap, chest, shielded

OR Grabber, chest, shielded

1.0 m

1.0 m

1.0 m

For Limb Leads see 5-electrode cable sets

AAMI Part No.

M1976A

M1602A

M1979A

IEC Part No.

M1678A

M1672A

M1674A

--

M1626A

IEC Part No.

M1974A

M1971A

M1645A

M1648A

IEC Part No.

M1685A

M1681A

M1683A

IEC Part No.

M1978A

M1604A

M1984A

374

35 Accessories

10-Electrode (6+4)Cable Sets

Description Length

ICU Grabber, chest, shielded

ICU Snap, chest, shielded

1.0 m

1.0 m

OR Grabber, chest, shielded 1.0 m

For Limb Leads see 6-electrode cable sets

AAMI Part No.

M1532A

M1537A

M1557A

One-piece Cables

Description

3-lead Grabber, ICU

5-lead Grabber, ICU

Length

1.0 m

1.0 m

AAMI Part No.

989803143181

989803143201

Radio-translucent Cables

Pack of five single wires, radio-translucent, 0.9 m, M1649A

Set Combiners and Organizers

Set combiners and organizers

Set combiner

Set organizer for shielded leadsets - grabber and snap

Set organizer for non-shielded lead sets - miniclip

Bedsheet clip

Replacement red cover for trunk cable (for 5-electrode cable sets)

3-electrode

5-electrode

3-electrode

4-electrode

5-electrode

6-electrode

3-electrode

5-electrode

IEC Part No.

M1533A

M1538A

M1558A

IEC Part No.

989803143171

989803143191

Part No.

M1501A

M1502A

M1503A

M1664A

M1504A

M1679A

M1636A

M1638A

M1509A

989808148861

375

35 Accessories

Supported Cables

Trunk Cables

Length

0.9 m

2.7 m

3-Electrode Cable Set

AAMI Part No.

M1540C

M1500A

IEC Part No.

M1550C

M1510A

5-Electrode Cable Set

AAMI Part No.

M1560C

M1520A

IEC Part No.

M1570C

M1530A

3-Electrode Cable Sets

Description

OR

ICU Grabber shielded

ICU snap shielded

ICU Clip non-shielded

ICU Clip non-shielded

Length

1.0 m

1.0 m

1.0 m

0.45 m

0.7 m

AAMI Part No.

M1601A

M1603A

M1605A

M1608A

M1609A

IEC Part No.

M1611A

M1613A

M1615A

M1618A

M1619A

5-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU Snap shielded

ICU Clip non-shielded

Length

1.0 m/1.6 m

1.0 m/1.6 m

1.0 m/1.6 m

0.7 m/1.3 m

AAMI Part No.

M1621A

M1623A

M1625A

M1629A

IEC Part No.

M1631A

M1633A

M1635A

M1639A

3-Electrode One Piece Cables

AAMI 3-Electrode One

Piece Cables

OR Grabber

ICU Snap

Length

1.9 m

1.9 m

AAMI Part No.

IEC 3-electrode One

Piece Cables

M1970A

M1972A

OR Grabber

ICU Grabber

IEC Part No.

M1980A

M1981A

376

35 Accessories

5-Electrode One Piece Cables

AAMI 5-electrode One

Piece Cables

OR Grabber

ICU Snap

Length

2.5 m

2.5 m

AAMI Part No.

IEC 5-electrode One

Piece Cables

M1975A

M1977A

OR Grabber

ICU Grabber

IEC Part No.

M1985A

M1986A

Set Combiners and Organizers

Set combiners and organizers

Set combiner

Set organizer

Bedsheet clip

Part No.

3-electrode

5-electrode

M1501A

M1502A

Shielded 3-electrode M1503A

Shielded 5-electrode M1504A

M1509A

NBP Accessories

These cuffs and tubings are designed to have special protection against electric shocks

(particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery.

Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs

Patient Category

Adult (Thigh)

Large Adult

Adult

Small Adult

Pediatric

Infant

Limb

Circumference

42 to 54 cm

34 to 43 cm

27 to 35 cm

20.5 to 28 cm

14 to 21.5 cm

10 to 15 cm

Bladder

Width

20 cm

16 cm

13 cm

10.5 cm

8 cm

5.5 cm

Disposable cuff

Part No.

M1879A

M1878A

M1877A

M1876A

M1875A

M1874A

Reusable cuff

Part No.

M1576A

M1575A

M1574A

M1573A

M1572A

M1571A

Tubing

M1598B

(1.5 m) or

M1599B

(3 m)

377

35 Accessories

Reusable Cuff Kits

Cuff Kits

Infant, pediatric, small adult, adult

Small adult, adult, large adult, thigh

Infant, pediatric, small adult, adult, large adult, thigh

Adult/Pediatric Antimicrobial Coated Reusable cuffs

Patient Category (color)

Adult Thigh (gray)

Large Adult X-Long (burgundy)

Large Adult (burgundy)

Adult X-Long (navy blue)

Adult (navy blue)

Small Adult (royal blue)

Pediatric (green)

Infant (orange)

Limb

Circumference

45 - 56.5 cm

35.5 - 46.0 cm

35.5 - 46.0 cm

27.5 - 36.5 cm

27.5 - 36.5 cm

20.5 - 28.5 cm

13.8 - 21.5 cm

9 - 14.8 cm

Bladder

Width

21.0 cm

17.0 cm

17.0 cm

13.5 cm

13.5 cm

10.6 cm

8.0 cm

5.4 cm

Part No.

M4559A

M4558A

M4557A

M4556A

M4555A

M4554A

M4553A

M4552A

Part No.

M1577A

M1578A

M1579A

Tubing

M1598B

(1.5 m) or

M1599B

(3 m)

Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs

Patient Category

Adult (Thigh)

Large Adult X-Long

Large Adult

Adult X-Long

Adult

Small Adult

Pediatric

Infant

Limb

Circumference

45 - 56.5 cm

35.5 - 46 cm

35.5 - 46 cm

27.5 - 36.5 cm

27.5 - 36.5 cm

20.5 - 28.5 cm

15.0 - 21.5 cm

9 - 15 cm

Bladder

Width

20.4 cm

16.4 cm

16.4 cm

13.1 cm

13.1 cm

10.4 cm

8.0 cm

5.6 cm

Part No.

M4579A

M4578A

M4577A

M4576A

M4575A

M4574A

M4573A

M4572A

Tubing

M1598B

(1.5 m) or

M1599B

(3 m)

378

35 Accessories

Neonatal/Infant Cuffs (Disposable, non-sterile)

Cuffs

Size 1

Size 2

Size 3

Size 4

Limb

Circumference

3.1 to 5.7 cm

4.3 to 8.0 cm

5.8 to 10.9 cm

7.1 to 13.1 cm

Bladder

Width

2.2 cm

2.8 cm

3.9 cm

4.7 cm

Part No.

M1866A

M1868A

M1870A

M1872A

Tubing

M1596B

(1.5 m) or

M1597B

(3 m)

Invasive Pressure Accessories

These transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.

If you are using the M3012A Hemodynamic MMS Extension, and you want to measure temperature and invasive pressure at the same time, we recommend that you use the pressure transducer CPJ840J6, with a round module connector piece, and not a transducer with a square connector. Pressure transducers with square connectors may make it difficult to connect the adjacent Temperature connector at the same time.

Transducer, accessories, sensor kits

Reusable pressure transducer 5 µV/V/mmHg sensitivity

Sterile disposable pressure domes for CPJ840J6 (pack of 50)

Transducer holder for CPJ840J6 (pack of 4)

IV pole mount for CPJ840J6

Monitoring Line Set for CPJ840J6

Single channel disposable sensor kit (20) - (EU/EFTA only)

Dual channel disposable sensor kit (20) (EU/EFTA only)

Transducer holder for M1567/8A (EU/EFTA only)

IV pole mount for M1567/8A (EU/EFTA only)

Adapter cable for disposable sensor kit 3,0m for M1567/8A

Pressure transducer kits

PiCCO monitoring kit, 30cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A

PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A

PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A and central venous pressure line

PULSION Pressure Interface Cable for disposable pressure transducer

Part No

CPJ840J6

CPJ84022

CPJ84046

CPJ84447

CPJ84026

M1567A

M1568A

M2271A

M2272C

M1634A

PV8103

PV8115

PV8115CVP

PMK 206

379

35 Accessories

SpO2 Accessories

This section lists accessories for use with Philips SpO

2

technology. For accessory lists for other SpO

2 technologies, refer to the instructions for use provided with these devices.

Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the

Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and

M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare.

Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with:

• Masimo adapter cables,

• Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "Long" version) or with a cable longer than 2 m.

All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.

Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result.

Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor.

Option A01 is the Philips FAST-SpO

2

version; Option A02 is the Nellcor OxiMax-compatible version.

The SpO

2

Option A02 may not be available in all countries. Some sensors may not be available in all countries.

Product

Number

Description Compatible with

Opt. A01 Opt. A02

Philips reusable sensors.

M1191A/B Adult sensor (2 m cable), for patients over 50 kg. Any finger, except thumb.

M1191AL/BL M1191A/B with longer cable (3 m)

M1192A Small adult, pediatric sensor (1.5 m cable) for patients between 15 kg and 50 kg. Any finger except thumb.

M1193A

M1194A

Neonatal sensor (1.5 m cable) for patients between 1kg and 4 kg. Hand or foot.

Ear sensor (1.5 m cable) for patients more than

40 kg.

M1195A

M1196A

Infant sensor (1.5 m cable) for patients between 4kg and 15 kg. Any finger except thumb.

Adult clip sensor (3 m cable) for patients over

40 kg. Any finger except thumb.

yes yes yes yes yes yes yes no no no no no no no

Comments

No adapter cable required.

380

35 Accessories

Product

Number

Description

M1191T

M1192T

M1193T

Adult sensor (0.45 m cable), for patients over

50 kg. Any finger, except thumb.

Small adult, pediatric sensor (0.45 m cable) for patients between 15 kg and 50 kg. Any finger except thumb.

Neonatal sensor (0.9 m cable) for patients between 1 kg and 4 kg. Hand or foot.

M1196T Adult clip sensor (0.9 m cable) for patients over

40 kg. Any finger except thumb.

Philips disposable sensors. Not available in the USA.

M1904B

M1903B

M1902B

M1901B

Identical to OxiMax MAX-A

Identical to OxiMax MAX-P

Identical to OxiMax MAX-I

Identical to OxiMax MAX-N yes yes yes yes

Compatible with

Opt. A01 Opt. A02 yes no yes yes yes no no no yes yes yes yes

Comments

Requires M1943 (1 m) or M1943AL (3 m) adapter cable

Option A01: Use adapter cable M1943A or M1943AL.

Option A02: Must use adapter cable

M1943NL.

Philips disposable sensors. Available worldwide.

M1131A

M1132A

Adult/Pediatric finger sensor, 0.45 m cable

(patient size > 20 kg)

Infant finger or toe sensor, 0.9 m cable (patient size 3 - 10 kg) yes yes

M1133A

M1134A Adhesive-free, Adult/Infant/Neonatal, 0.9 m cable

Foot or hand for neonates < 3 kg

Big toe or thumb for patients between 10 kg and 20 kg

Any finger except thumb for patients > 40 kg

NELLCOR disposable sensors (must be ordered from Nellcor)

OxiMax MAX-

A

OxiMax

MAX-AL

Adult/Infant/Neonatal, 0.9 m cable

Foot or hand for neonates < 3 kg

Big toe or thumb for patients between 10 kg and 20 kg

Any finger except thumb for patients > 40 kg

Adult finger sensor (patient size > 30 kg)

OxiMax MAX-A with long cable yes yes yes yes

OxiMax MAX-

P

Pediatric foot/hand sensor (patient size 10-50 kg) yes

OxiMax MAX-I Infant foot/hand sensor (patient size 3-20 kg) yes

OxiMax MAX-

N

Adult finger or neonatal foot/hand sensor

(patient size > 40 kg or < 3 kg) yes no no no no yes yes yes yes yes

Use adapter cable

M1943A or M1943AL.

Use adapter cable

M1943A or M1943AL.

Use adapter cable

M1943A or M1943AL.

Use adapter cable

M1943A or M1943AL.

Option A01: Use adapter cable M1943A or M1943AL.

Option A02: Must use adapter cable

M1943NL.

381

35 Accessories

Product

Number

Description

MAX-FAST

OxiMax MAX-

R

Forehead sensor

Adult nasal sensor

OxiMax SC-A Adult SoftCare sensor

OxiMax SC-

NEO

Neonatal SoftCare sensor

OxiMax SC-PR Pre-term infant SoftCare sensor

Oxisensor II D-

25

Oxisensor II D-

20

Adult sensor (patient size > 30 kg)

Pediatric sensor (patient size 10-50 kg)

Oxisensor II I-

20

Oxisensor II N-

25

Infant sensor (patient size 3-20 kg)

Neonatal sensor (patient size < 3 kg or > 40 kg)

See OxiMax MAX-A OxiCliq A

OxiCliq P

OxiCliq I

OxiCliq N

See OxiMax MAX-P

See OxiMax MAX-I

See OxiMax MAX-N no no no yes yes yes yes yes yes yes yes

Compatible with

Opt. A01 Opt. A02 no no yes yes yes yes yes no no no no yes yes yes yes no yes

Comments

Must use M1943NL adapter cable.

Must use M1943A or

M1943 AL adapter cable

Option A01: Use adapter cable M1943A or M1943AL together with OC-3 adapter cable.

Option A02: Must use adapter cables

M1943NL and OC-3 adapter cable.

Must use M1943NL adapter cable

Oxiband OXI-

A/N

Oxiband OXI-

P/I

Adult / neonatal sensor

Pediatric / infant sensor

Durasensor

DS100A

Adult finger clip sensor

Dura-Y D-YS Y-sensor

Extension / Adapter Cables for Philips and Nellcor Sensors

M1941A Extension cable (2 m) no no no yes yes yes yes yes For use with Philips reusable sensors and

M1943A adapter cable.

382

Product

Number

M1943A

M1943AL

M1943NL

OC-3

Description

Adapter cable (1.1 m cable)

Adapter cable (3 m cable)

OxiMax adapter cable (3 m cable)

Adapter Cable for OxiCliq sensors

35 Accessories

Compatible with

Opt. A01 Opt. A02 yes yes no no no yes yes yes

Comments

Adapter cable for

Philips/Nellcor disposable sensors.

Adapter cable for

Philips disposable/

Nellcor disposable and reusable sensors.

Available from Nellcor only.

Product

Number

Description Compatible with

Opt. A01 Opt. A02

MASIMO LNOP® reusable sensors.

LNOP DCI Adult Finger Sensor (> 30 kg)

LNOP DCIP Pediatric Finger Sensor (10 - 50 kg)

LNOP YI Multi-Site Sensor (> 1kg)

LNOP TC-I Ear Sensor (> 30 kg)

MASIMO LNCS® reusable sensors.

LNCS DCI Adult Finger Sensor (> 30 kg)

LNCS DCIP Pediatric Finger Sensor (10 - 50 kg)

LNCS YI

LNCS TC-I

Multi-Site Sensor (> 1kg)

Ear Sensor (> 30 kg)

MASIMO LNOP® disposable adhesive sensors.

LNOP Adt Adult Sensor (> 30 kg)

LNOP Adtx Adult Sensor (> 30 kg)

LNOP Pdt Pediatric Sensor (10 - 50 kg)

LNOP Pdtx Pediatric Sensor (10 - 50 kg)

LNOP Inf-L Infant Toe Sensor (3 - 20 kg)

LNOP Neo-L Neonatal Sensor (< 3 kg) or Adult adhesive Sensor (> 40 kg)

LNOP NeoPt-

L

Neonatal Pre-Term Sensitive Skin Sensors (< 1 kg)

MASIMO LNCS® disposable adhesive sensors.

LNCS Adtx Adult Finger Sensor, 18 inch (> 30 kg)

LNCS Adtx-3 Adult Finger Sensor, 3 feet (> 30 kg)

LNCS Pdtx Pediatric Finger Sensor, 18 inch (10 - 50 kg)

LNCS Pdtx-3 Pediatric Finger Sensor, 3 feet (10 - 50 kg)

LNCS Inf Infant Toe Sensor, 18 inch (3 - 20 kg)

LNCS Inf-3 Infant Toe Sensor, 3 feet (3 - 20 kg) yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes no no no no no no no no no no no no no no no no no no no no no

Philips Part Number n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

383

35 Accessories

Product

Number

Description

LNCS Neo Neonatal Foot Sensor, 18 inch (< 3 kg) or Adult Finger Sensor 18 inch(> 40 kg)

LNCS Neo-3 Neonatal Foot Sensor, 3 feet (< 3 kg) or Adult Finger Sensor, 3 feet(> 40 kg)

LNCS NeoPt Neonatal pre-term sensitive skin Sensor 18 inch

(< 1 kg)

LNCS NeoPt-3 Neonatal pre-term sensitive skin Sensor 3 feet

(< 1 kg)

Compatible with

Opt. A01 Opt. A02 yes no yes yes yes no no no

Philips Part Number n/a n/a n/a n/a

Adapter Cable for MASIMO sensors.

LNOP MP12 LNOP MP Series Patient Cable (3.6 m)

Adapter Cable for Masimo LNOP Sensors

LNC MP10 LNCS MP Series Patient Cable (3.0 m) Adapter

Cable for Masimo LNCS Sensors yes yes no no

451261000761

989803148221

The Philips M3001A/M3002A option A01 and the M1020B option A01 SpO2 Module use Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo.

Temperature Accessories

Temperature Probes

Reusable

General purpose probe

Small flexible vinyl probe (Infant/Pediatric)

Attachable surface probe

Disposable

General purpose probe

Skin probe

Esophageal/Stethoscope Probe (French 12)

Esophageal/Stethoscope Probe (French 18)

Esophageal/Stethoscope Probe (French 24)

Esophageal/Rectal Probe (French 12)

384

Part No.

21075A

21076A

21078A

M1837A

21091A

21093A

21094A

21095A

21090A

Minimum measurement time for accurate readings

90 sec

60 sec

60 sec

90 sec

60 sec

180 sec

210 sec

310 sec

90 sec

Temperature Probes

Foley Catheter Probe (12 French)

Foley Catheter Probe (16 French)

Foley Catheter Probe (18 French)

Adapter cable 1.5m

Adapter cable 3.0m

Part No.

M2255A

21096A

21097A

21082B

21082A

35 Accessories

Minimum measurement time for accurate readings

180 sec

180 sec

180 sec

Cardiac Output (C.O.) Accessories

See Pressure accessories for PULSION continuous cardiac output accessories.

Description

Accessories common to both methods

Accessories Set of ice buckets

Remote handswitch

Latex free PiCCO inline temperature probe

Right Heart Thermodilution

C.O. Interface Cables

Right heart catheter for thermodilution

Edwards CO-Set+ (only with 23001A/B)

Injectate Probes

2.7 meter cable

2.4 m + 2.4 m cable

(from Edwards Lifesciences) contact Edwards Lifesciences for information

2.4m injectate temp. probe (reusable)

0.5m injectate temp. probe (reusable)

Ice bath temp. probe

Transpulmonary Thermodilution

C.O. Interface Cables

PULSION Pressure Transducer Kits (pressure line available in various lengths)

Pressure Interface Cable for disposable pressure transducer

2.4 m + 2.4 m cable

Contact PULSION for information

PULSION PMK 206

Part No

14455A

15244A

M1646A

M1642A

M1643A

831HF75

23001A

23001B

23002A

M1643A

385

35 Accessories

Mainstream CO2 Accessories

Description

CO

2

Sensor

Adult/Pediatric Airway Adapter (reusable)

Infant Airway Adapter (reusable)

Adult Airway Adapter (single-patient use)

Infant Airway Adapter (single-patient use)

Sidestream CO2 Accessories

Description

CO

2

Sensor

Nasal and Oral-Nasal Cannulas

CO

2

Nasal Cannula, Adult

CO

2

Nasal Cannula, Pediatric

CO

2

Nasal Cannula, Infant

CO

2

/ O

2

Nasal Cannula, Adult

CO

2

/ O

2

Nasal Cannula, Pediatric

CO

2

/ O

2

Nasal Cannula, Infant

CO

2

Oral-Nasal Cannula, Adult

CO

2

Oral-Nasal Cannula, Pediatric

CO

2

/ O

2

Oral-Nasal Cannula, Adult

CO

2

/ O

2

Oral-Nasal Cannula, Pediatric

Airway Adapters

Airway Adapter Set, ET > 4.0 mm

Airway Adapter Set, ET =< 4.0 mm

Airway Adapter Set H, ET > 4.0 mm

Airway Adapter Set H, ET =< 4.0 mm

Straight Sample Lines

Straight Sample Line

Straight Sample Line H

386

Part No.

M2501A

M2513A

M2516A

M2533A

M2536A

Part No.

M2741A

M2744A

M2745A

M2746A

M2750A

M2751A

989803144471

M2756A

M2757A

M2760A

M2761A

M2768A

989803144531

M2772A

M2773A

M2776A

M2777A

35 Accessories

Mainstream CO2 Accessories (for M3016A)

Description

CO

2

Sensor

Standard Airway Adapter (reusable)

Small Airway Adapter (reusable)

Part No.

M1460A

M1465A

14363A

Microstream CO2 Accessories

• "FilterLine Set" is a combination of a FilterLine with an Airway Adapter.

• "H" in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.

• "Smart CapnoLine" is a combined oral-nasal FilterLine.

• "Smart CapnoLine O

2

" is a combined oral-nasal-O

2

-CO

2

FilterLine.

• "NIV Line" is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).

• The accessories are supplied in packs of 25.

• Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A).

Microstream accessory selection flowchart

Is the patient intubated?

Yes

Short-term

(up to 6 hours)

No

Does the patient need oxygen?

Yes

Long-term

(up to 72 hours)

Short-term

(up to 8 hours)

Oral/Nasal

Key Applications

Long-term

(up to 24 hours)

Nasal

No

Long-term

(up to 24 hours)

Nasal

Short-term

(up to 8 hours)

Oral/Nasal

Short-term

(up to 8 hours)

Nasal

387

35 Accessories

Microstream accessory selection flowchart

Critical Care OR, EMS, ED Procedural

Sedation, Critical

Care, EMS, ED

Critical Care, Sleep

Lab, Long-term

Pain Management

Critical Care, Sleep

Lab

Procedural

Sedation, Critical

Care, EMS, ED

Philips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate)

FilterLine Set:

A/P: M1920A

FilterLine Set

Long:

A/

P:989803160241*

FilterLine:

M1925A*

FilterLine H Set:

A/P: M1921A

I/N: M1923A

FilterLine H Set

Long

A/

P:989803160251*

I/

N:989803160261*

VitaLine H Set:

A/

P:989803159571*

I/N:

989803159581*

FilterLine H:

M1926A*

*Not available in all geographies.

Smart CapnoLine

O

2

:

A: M2522A

P: M2520A

Smart CapnoLine

O

2

Long

A:989803160281*

P:989803160271*

CapnoLine HO

2

:

A: M4680A

P: M4681A

CapnoLine H:

A: M4689A

P: M4690A

I/N: M4691A

EMS, ED

Smart CapnoLine:

A: M2526A

P: M2524A

Smart CapnoLine

Plus Long

A:989803160301*

NIV Line:

A: 4686A

P: M4687A

Spirometry Accessories

Description

Adult/Pediatric Flow Sensor

Neonatal Flow Sensor

Adult/Pediatric CO

2

/Flow Sensor

Neonatal CO

2

/Flow Sensor

Pediatric CO

2

/Flow Sensor

Part No.

M2785A

M2786A

M2781A

M2782A

M2783A

Measurement of CO2 and Spirometry with Neonates

For measurement of CO

2

and Spirometry with neonates, the use of the M3014A Mainstream CO

2

Extension, the M1014A Spirometry Module and the M2782A Combined CO

2

/Flow Sensor is

recommended.

The M1923A Filterline H Set Infant/Neonatal used for Microstream CO

2

measurement with the

M3015A Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A).

388

35 Accessories

tcGas Accessories

This symbol indicates that the specified transducer (but not its membranes) is designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and is defibrillator proof.

Description tcpO2/CO2 transducer

Accessory Kit for M1918A (O-ring remover, absorbent paper, electrolyte solution, 12 replacement membranes)

Application Kit for M1918A (4x25 disposable fixation rings, contact fluid)

tcpO2/CO2 transducer

Accessory Kit for M1918B (10 replacement membranes, electrolyte solution)

Application Kit for M1918B (4x25 disposable fixation rings, contact fluid)

Calibration gas - 6 gas bottles

Calibration gas - 6 gas bottles (Europe and Japan only)

Replacement tubing (5 tubes)

Calibration unit

Radiometer TCC3 calibration unit (available from Radiometer)

1

May not be available in all countries due to pending regulatory clearance

EEG Accessories

Part No.

M1918A

15209-60010

15209-60020

M1918B

1

989803151951

1

989803151961

1

15210-60010

15210-64010

M2205A

15210B n/a

Description

Trunk Cable 2.7 m

Trunk Cable, 1.0 m

Reusable 80-cm-long 5-lead cables with 10 mm silver/silverchloride leadwired cup electrodes (Adult)

Reusable 80 cm 5-lead cables with 6 mm silver/silverchloride leadwired cup electrodes

(Pediatric/Neonatal)

Reusable 80 cm 5-lead cables with clip

Disposable EEG electrodes

EC2™ Electrode Cream (conductive paste)

Part No.

M2268A

M2269A

M1931A

M1932A

M1934A

M1935A

M1937A

389

35 Accessories

BIS Accessories

Use only Aspect BIS sensors with the BIS module. The sensor is a silver/silver chloride electrode array that uses Aspect's patented ZipPrep technology and a proprietary connector. The sensor/electrodes are for single patient use only. Check shelf-life before use.

The patient interface cable (Philips Ordering No. M1034-61630, Aspect Part No. 186-0131) has an estimated lifetime of one year. Do not scrap it when disposing of the BIS sensor.

The sensor cable from the Semi-Reusable Sensor is re-usable but has a maximum number of uses, the electrodes are single patient use only. The monitor displays how many uses remain for the sensor cable.

BIS Sensors

To re-order sensors, contact Aspect Medical Systems.

Description

BIS and BISx - compatible

BIS Sensor Quatro (formerly Sensor XP)

BIS Sensor Plus

BIS Sensor Pediatric (4 electrode)

BIS Sensor Extend

Pieces per pack

Philips Ordering No Aspect Part

No

50

50

25

50

M1997A

M4546A

989803143581 n/a

186-0106

186-0076

186-0200

186-0160

Other BIS Accessories

Order the following parts from your nearest Philips sales office and quote the Philips ordering number

Description

PIC PLUS Cable

Philips Ordering Number

M1034-61630

SO2 Accessories for M1021A

Contact your local Hospira representative for information on accessories. They are not available from

Philips.

Description

Optical Module

Hospira Opticath

®

Catheter family (SvO

2

, ScvO

2

)

Hospira Part No.

50131

Contact Hospira for part numbers of compatible catheters

390

35 Accessories

SO2 Accessories for M1011A

Contact your local PULSION or Edwards representative for information on accessories. They are not available from Philips.

Description

Philips SO

2

Optical Module

Pulsion: CeVOX Fiberoptic Probe family (ScvO

2

)

Edwards: Philips-compatible versions of the PreSep

Catheter (ScvO

2

(SvO

2

) families

) or Swan-Ganz Oximetry Catheter

Product Number

(Order Number)

989803151591

Contact PULSION for part numbers of compatible probes

Contact Edwards for part numbers of compatible catheters

Recorder Accessories

Description

For M1116B recorder:

10 rolls of paper

80 rolls of paper

Battery Accessories

Part No.

40477A

40477B

Description

Lithium Ion Smart Battery 1Ah (internal battery for X2)

Battery Charger and Conditioner (requires size adapter 4512 610 17451 to charge

M4607A battery)

Size adapter for M4607A battery

Part No.

M4607A

865432

4512 610 17451

391

35 Accessories

392

36 Specifications

36

Specifications

The specifications in this section apply to the MX800 patient monitor.

The monitor is not user installable. It must be installed by qualified service personnel.

Intended Use

The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in health care facilities. The monitor is to be used by trained health care professionals.

The monitor is only for use on one patient at a time. It is not intended for home use. Rx only:

U.S. Federal Law restricts this device to sale by or on the order of a physician. Not a therapeutic device.

The transcutaneous gas measurement (tcGas) is restricted to neonatal patients only.

ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients.

The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11).

BIS is intended for use under the direct supervision of a licensed health care practitioner or by personnel trained in its proper use. It is intended for use on adult and pediatric patients within a hospital or medical facility providing patient care to monitor the state of the brain by data acquisition of EEG signals. The BIS may be used as an aid in monitoring the effects of certain anesthetic agents.

Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation.

The SSC Sepsis Protocol, in the ProtocolWatch clinical decision support tool, is intended for use with adult patients only.

The derived measurement Pulse Pressure Variation (PPV) is intended for use with sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. The PPV measurement has been validated only for adult patients.

The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.

WARNING

The monitor is not intended for use in an MRI environment or in an oxygen-enriched environment

(for example, hyperbaric chambers).

Manufacturer's Information

You can write to Philips at this address

393

36 Specifications

Philips Medizin Systeme Boeblingen GmbH

Hewlett-Packard-Str. 2

71034 Boeblingen

Germany

Visit our website at: www.healthcare.philips.com/us/.

© Copyright 2010. Koninklijke Philips Electronics N.V. All Rights Reserved.

BIS Manufacturer's Information

BISx, the BIS engine, the DSC, the Patient Interface Cable and the BIS Sensor are manufactured by

Aspect Medical Systems:

Aspect Medical Systems, Inc

141 Needham St

Newton,

MA 02464

USA

1-617-559-7000

Free call:

1-888-BIS_INDEX

1-888-247-4633

Email: [email protected]

Web: www.aspectmedical.com

Address of the EU Authorized Representative:

Aspect Medical Systems International B.V.

Rijnzathe 7d2

3454 PV De Meern

The Netherlands

Phone: +31.30.662.9140

Email: [email protected]

Trademark Acknowledgement

PiCCO

TM

is a trademark of PULSION Medical Systems AG.

Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc, and are registered in the USA,

EU and other countries.

Microstream

®

, FilterLine

Oridion Systems Ltd.

®

, and Smart CapnoLine

®

are trademarks or registered trademarks of

Citrix

®

and ICA

®

(Independent Computing Architecture) are registered trademarks of Citrix Systems,

Inc.

The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor

®

, Durasensor

®

, Dura-

Y

®

, Oxiband

®

, Oxicliq

®

, OxiMax

®

. MAX-FAST

®

is a trademark of Mallinckrodt Inc.

Masimo

®

, Masimo SET

®

, and LNOP are federally registered trademarks of the Masimo Corporation.

Other product and company names mentioned in this book may be trademarks of their respective owners.

394

36 Specifications

Symbols

These symbols can appear on the monitor and its associated equipment.

Symbols

Refer to accompanying documents

Protective earth Equipotential grounding

Standby

Alternating current

Electrical input indicator

(In some cases gas input indicator)

Gas input indicator built-in wireless network

Non-ionizing radiation symbol

Pressure connector

Temperature connector

FMS power-on indicator

Connection direction indicator

Electrical output indicator

(In some cases gas output indicator)

Gas output indicator

USB interface

Identifies year and month of manufacture

NBP connector

Monitor supports 12-lead

ECG

Error LED

Connection direction indicator

Connector has special protection against electric shocks and is defibrillator proof

Quick mount release

Data input/output symbol

Always use separate collection for waste electrical and electronic equipment (WEEE)

Cardiac Output connector

SpO

2

connector

395

36 Specifications

Symbols

Masimo SET technology

Silence Alarms

Main Screen

ECG Sync Output/

Analog ECG Output

Nellcor OxiMax compatible

Alarms On/Off

SmartKeys

Uses FAST SpO

2 algorithm

Alarms Switched Off

Back key

Installation Safety Information

WARNING

If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1, IEC60601-1-1, UL60601-1. Consult your service personnel.

Grounding The monitor must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter.

Equipotential

Grounding

If the monitor is used in internal examinations on the heart or brain, ensure that the room incorporates an equipotential grounding system to which the monitor has a separate connections.

Combining equipment 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.

Fusing

Network Cables

The monitor uses double fusing (line and neutral).

All network cables must be unshielded.

Connectors

The actual placement of boards and configuration of connections for your monitor depends on how

your hardware has been configured. See the symbols table (“Symbols” on page 395) to see which

symbols are used to mark the connections.

WARNING

Connect only medical devices to the ECG output connector socket.

396

36 Specifications

Rear of the Monitor

4

5

6

7

1

2

3

Serial/MIB (RS232) connectors, type RJ45

AC power input

Protective earth screw hole

Equipotential ground connector

Main measurement links (MSL)

USB rear connectors (for remote control, keyboard, pointing devices, printer)

Serial RS232 connector

11

12

13

14

8

9

Nurse Call

Wired network connector

10 Video out connector (digital/analog)

The following connectors are only present with the iPC

USB rear connectors (for keyboard, pointing devices, printer)

Audio in/out

Local Area Network

Video out connector (digital/analog)

The following connectors are only present with the Independent Display Interface

15 Serial RS232 connector for touch

16 Video out connector (digital/analog)

397

36 Specifications

Left side of the Monitor

1

ECG Sync Output/Analog ECG output connector

Right side of the Monitor

1

USB side connector (only present with the iPC)

398

36 Specifications

Monitor Mounting Precautions

Mount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved mounting solution. Select the mounting equipment and the mounting position so that no patient, operator or other person can be harmed by a monitor removed intentionally or released accidentally from the mount. When using the Quick Mount, be aware of the danger of accidental activation of the

Quick Mount release button when lifting or moving items located under the monitor, such as pole mounts, etc. If in doubt, use the Philips Fix Mount solution to avoid such situations. Please refer to the respective IntelliVue Monitor Service Manual, Installation Instructions chapter, for more details.

Altitude Setting

Altitude affects tcGas and CO

2

measurements. The monitor must be configured at installation to the correct altitude.

Monitor Safety Specifications

The monitors, together with the Multi-Measurement Modules (M3001A/M3002A), and the Flexible

Module Rack (M8048A), all modules and MMS extensions, comply with the Medical Device Directive

93/42/EEC.

185-0145-PH Aspect BISx, 185-0111 Aspect BIS Engine and 185-0124 Aspect DSC comply with the requirements of the Council Directive 93/42/EEC of 14 June 1993 (Medical Device Directive).

In addition, the product complies with:

IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 60601-1:2003;

CAN/CSA C22.2#601.1-M90 +Suppl. No. 1-94 + Am. 2; IEC 60601-1-1:2000; EN 60601-1-1:2001;

IEC 60601-1-2:2001 + A1:2004; EN 60601-1-2:2001 + A1:2006.

The possibility of hazards arising from software errors was minimized in compliance with ISO

14971:2007, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999.

Classification (according to IEC 60601-1): Class 1, Type CF, Continuous Operation. The BIS measurement uses a Type BF applied part.

EMC And Radio Regulatory Compliance

This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-

001 du Canada.

399

36 Specifications

IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network

Adapter)

FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and

RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.

The maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210.

The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210.

The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems.

The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly

Available Interfaces (PAI) and used throughout the EEA.

CAUTION

High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and

5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices.

IntelliVue 802.11 Bedside Adapter CE compliances:

This device is compliant to Council Directive 73/23/EEC (Low voltage directive) & 89/336/

EEC (EMC directive) & 1999/5/EC (Radio Equipment and Telecommunications Terminal

Equipment Directive)

The radio component contained in this device is compliant to Council Directive 1999/5/

EC (Radio Equipment and Telecommunications Terminal Equipment Directive)

IntelliVue Instrument Telemetry ISM (2.4GHz)

FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and

RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.

The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications

Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.

400

36 Specifications

IntelliVue Instrument Telemetry WMTS (US only)

The radio device used in this product complies with part 15 of the FCC Rules. Operation is subject to the condition that these devices do not cause harmful interference. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless

Medical Telemetry Service.

Short Range Radio Interface

FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and

RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.

The radio component contained in this device is in compliance with the essential requirements and other relevant provisions of Council Directive 1999/5/EC (Radio Equipment and

Telecommunications Terminal Equipment Directive)

In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66.

Class 1 radio equipment.

Physical Specifications

Product

MX800 Monitor

M3001A

Multi-Measurement Module (MMS)

M3002A

Multi-Measurement Module (MMS)

M3012A

Hemodynamic MMS Extension

M3014A

Capnography MMS Extension

M3015A

Microstream CO

2

MMS Extension-

M3016A

Mainstream CO

2

MMS Extension

M8048A

Flexible Module Rack (FMS)

M8025A

Remote Alarm Device

M1006B

Invasive Press Module

Max

Weight

W x H x D

<500 g

<0.99 lb

<550 g

<1.21 lb

<450 g

<0.99 lb

<3500 g

<7.7 lb

<12 kg

<26.4 lb

<650 g

<1.4 lb

<1.25 kg

<2.8 lb

<550 g

1.2 lb

<300 g

<0.7 lb

190 g (6.7 oz)

Option #C01:

225 g (7.9 oz)

<478 x 364 x 152 mm

18.82 x 14.33 x 5.98 in

188 x 96.5 x 51.5 mm

7.4 x 3.8 x 2 in

188 x 99 x 86 mm

7.4 x 3.9 x 3.4 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<320 x 135 x 120 mm

12.6 x 5.3 x 4.7 in

62 x 125 x 63 mm

2.4 x 5 x 2.5 in

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

Comments

without cable management including battery, without handle or options without plug-in modules

401

36 Specifications

Product

M1029A

Temperature Module

M1012A

Cardiac Output Module

M1014A

Spirometry Module

M1018A

Transcutaneous Gas Module

M1020B

SpO

2

Module

M1021A

Mixed Venous Oxygen Saturation

Module

M1011A

SO

2

Module

- Optical Module

M1027A

Electroencephalograph Module

M1034A

BIS Interface Module

BISx

- DSC Digital Signal Converter

- BIS Engine

M1032A

Vuelink Module

865115

IntelliBridge EC10 Module

865114

IntelliBridge EC5 Module

M1116B

Thermal Array Recorder Module

865244

Remote Control

Max

Weight

W x H x D

215 g (7.6 oz) 36 x 99.6 x 97.5 mm,

1.4 x 3.9 x 3.8 in

225 g (7.9 oz.) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

250 g (8.8 oz.) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

350 g (11.3 oz) 72.5 x 99.6 x 97.5 mm,

2.9 x 3.9 x 3.8 in

<250 g

0.55 lb

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

460 g

(13.04 oz)

72.5 x 99.6 x 97.5 mm

2.9 x 3.9 x 3.8 in)

Comments

170 g

(6.0 oz)

240 g

(8.4 oz)

200 g

(7.0 oz)

35 g

(1.1 oz)

<200g

(7.1 oz)

<200g

(7.1 oz)

130 g (4.6 oz)

(without cabling)

36 x 99.6 x 102.5 mm

1.4 x 3.9 x 4.0 in

50 x 30 x 120 mm

2.0 x 1.2 x 4.7 in

210 g (7.4 oz) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

215 g

7.6 oz

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

499 g

1.1 lb

95.3 x 63.5 mm

(diameter x height)

3.8 x 2.5 in

66 x 25 x 107 mm

2.6 x 1.0 x 4.25 in

25 g

(0.8 oz

507.5 g

17.9 oz.

<250 g

43 x 93 x 95 mm

1.7 x 3.7 x 3.7 in

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

36 x 99.6 x 102.5 mm

1.4 x 3.9 x 4.0 in

35 x 17 x 57 mm

1.4 x 0.7 x 2.1 in

21.5 x 17 x 65 mm

0.9 x 0.7 x 2.6 in

73 x 99.6 x 97 mm

2.9 x 3.6 x 3.9 in.

53 x 165 x 23 mm

2.1 x 6.5 x 0.9 in including 2.9m cable without cables with PIC Plus Cable (1.22 m,

4 ft) and cable to BIS module with PIC Plus Cable (1.22 m,

4 ft) with D-Sub 9-pin male or female connector without cable and strain relief without navigator knob

402

36 Specifications

Environmental Specifications

The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges.

When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.

MX800 Monitor

Item

Temperature Range

Humidity Range

Altitude Range

Ingress Protection

Condition

Operating

Storage

Operating

Storage

Operating

Storage

Range

0 to 40°C (32 to 100°F)

0 to 35°C (32 to 95°F) when equipped with the iPC

-20 to 60°C (-4 to 140°F)

15% to 95% Relative Humidity (RH) (non condensing)

5% to 95% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft)

IPX1

X2 (M3002A) and External Power Supply (M8023A)

Item

Temperature Range

Condition

Operating

Storage including transportation

Operating

Range

0 to 40°C (32 to 104°F)

-20 to 60°C (-4 to 140°F)

0 to 35°C (32 to 95°F)

Temperature Range when charging the battery

Humidity Range

15% to 95% Relative Humidity (RH)

5% to 95% Relative Humidity (RH)

Altitude Range

Operating

Storage including transportation

Operating

Storage including transportation

X2

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft)

IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°)

403

36 Specifications

Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A,

Measurement Modules, and Flexible Module Rack M8048A

Item

Temperature Range

Humidity Range

Altitude Range

Condition

Operating

Non-operating

Operating

Non-operating

Operating

Non-operating

Range

0 to 45°C (32 to 113°F)

-40 to 70°C (-40 to 158°F)

95% Relative Humidity (RH) max. @ 40°C (104°F). M3015A only non-condensing.

90% Relative Humidity (RH) max. @ 65°C (150°F)

-500 m to 4600 m (-1600 to 15000 ft)

-500 m to 15300 m (-1600 to 50000 ft)

Thermal Array Recorder Module M1116B

Item

Temperature Range

Humidity Range

Condition

Operating

Non-operating

Operating

Altitude Range

Non-operating

Operating

Non-operating

Range

+5 to 45

°

C (41 to 113

°

F)

-10 to 70°C (14 to 158°F)

95% Relative Humidity (RH) max @ 40°C (104°F) (non condensing)

95% Relative Humidity (RH) max @ 65°C (150°F) (non condensing) up to 3048 m (10000 ft) up to 3048 m (10000 ft)

Remote Control 865244

Item

Temperature Range

Humidity Range

Altitude Range

Condition

Operating

Storage

Operating

Storage

Operating

Storage

Range

0 to 40°C (32 to 100°F)

-20 to 60°C (-4 to 140°F)

15% to 95% Relative Humidity (RH) (non condensing)

5% to 95% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft)

404

36 Specifications

Performance Specifications

MX800 Performance Specifications

Power Specifications

Power Consumption

Line Voltage

Current

Indicators

Sounds

Trends

Frequency

Alarms Off

Alarms

On/Standby/Error

<200 W average

100 to 240 V

1.9 to 0.9 A

50/60 Hz red (crossed out alarms symbol) LED red/yellow/light blue (cyan) LED green/red LED integrated in power switch

External Power green LED

Audible feedback for user input

Prompt tone

QRS tone, or SpO

2

modulation tone

4 different alarm sounds

Remote tone for alarms on other beds in network

Tone for Timer expired

Resolution

Information

12, 16, 24 or 32 numerics @ 12 sec, 1 minute, 5 minute resolution

Multiple choices of number of numerics, resolution and duration depending on trend option and application area.

For example: neonatal extended 12 numerics, 24 hours @ 12 secs or

32 numerics 32 hours @ 1 minute intensive care extended: 16 numerics 120 hours @ 5 minutes anesthesia extended 32 numerics 9 hours @ 12 seconds

High Res Trend Waves Measurements available HR, SpO

2

, Resp, tcpO

2

, Pulse, Perf, tcpO

2

, CO

2

, ABP, PAP,

CVP, ICP, CPP, BIS, CCO, AWP, Anesthetic Agents, Delta

SpO

2

, inO

2

Resolution Measurement samples are taken at a resolution of four samples per second

Update speed waves are drawn at a speed of 3 cm/minute

Events

Information

Alarm Signal

Episode data

Capacity (max)

System delay

Pause duration trigger condition and time, event classification and associated detailed view of episode data configurable, either:

4 minutes of high resolution trend or

20 minutes of numerics trend @ 12 sec. resolution or

15 seconds of 4 waves @ 125 samples/sec. (Snapshot) including all current numerics, alarms and inops

25 or 50 events for either 8 or 24 hours less than 3 seconds

1,2,3 minutes or infinite, depending on configuration

Review Alarms

Extended alarm pause 5 or 10 minutes

Information all alarms / inops, main alarms on/off, alarm silence and time of occurrence

Capacity 300 items

405

36 Specifications

MX800 Performance Specifications

Real Time Clock

Range

Accuracy

Hold Time

Buffered Memory

Hold Time

Contents from: January 1, 1997, 00:00 to: December 31, 2080, 23:59 better than 4 seconds per day infinite if powered by AC; otherwise at least 48 hours (typical:

>72 hours) if powered by AC: infinite without power: at least 8 hours

Active settings, trends, patient data, realtime reports, events, review alarms

X2 (M3002A) Performance Specifications

Power Specifications

Power consumption <12 W average

Operating Voltage

<30 W while battery is loading

36 to 60 V DC floating

Battery Specifications

Operating Time

(with new, fully charged battery at

25°C)

Basic monitoring configuration: 2.5 hours

(Brightness set to optimum, ECG/Resp, SpO

2 in use, NBP measurement every 15 minutes)

measurements

Indicators

Sounds

Trends

Alarm signal

Review Alarms

Charge Time When X2 is off: 2 hours

When X2 is in use, and connected to a monitor, without extensions: 12 hours approx.

When X2 is in use, and connected to the external power supply (M8023A), without extensions: 12 hours approx.

red (crossed-out alarm symbol) LED Alarms Off

Alarms red/yellow/light blue (cyan) LED

On/Standby / Error green / red LED

AC Power

Battery

External Power

Resolution

Information green LED yellow (charging)/red blinking (empty) LED green LED

Audible feedback for user input

Prompt tone

QRS tone, or SpO

2

modulation tone

4 different alarm sounds

12 or 16 numerics @ 12 sec, 1 minute, 5 minute resolution.

Multiple choices of number of numerics, resolution and duration depending on trend option and application area.

For example:

For neonatal, you can choose between 12 and 16 numerics.

System delay

Pause duration less than 3 seconds

1,2,3 minutes or infinite, depending on configuration

Extended alarm pause 5 or 10 minutes

Information all alarms / inops, main alarms on/off, alarm silence and time of occurrence

Capacity 300 items

406

36 Specifications

X2 (M3002A) Performance Specifications

Real Time Clock

Range

Accuracy

Hold Time

Buffered Memory

Hold Time

Contents from: January 1, 1997, 00:00 to: December 31, 2080, 23:59

<4 seconds per day (typically) infinite if powered by host monitor or external power supply; otherwise at least 48 hours if powered by host monitor or external power supply: infinite without power: at least 48 hours (typical: >72 hours)

Active settings, trends, patient data, realtime reports, review alarms

M8023A External Power Supply (for M3002A) Performance Specifications

Power Specifications

Power consumption <12 W average

<30 W peak

Line Voltage

Current

100 to 240 V ~

1.3 to 0.7 A

Indicators

Frequency

Power

50/60 Hz ~ green LED

M3001A MMS Performance Specifications

Trends Trend Data Buffered

Memory

Contents if powered by monitor mains connection via MSL: infinite without power applied: at least 6 hours trend data, patient identification and all active settings

Integrated PC (iPC) Performance Specifications

PC Components

Processor

Hard disk

RAM

Intel Core 2 Duo SP9300/SP9400

160 GB

4 GB

865244 Remote Control Performance Specifications

Power (when not connected to the USB interface of the monitor)

Two AA primary cells

407

36 Specifications

Interface Specifications

MX800 Interface Specifications

Network

MIB/RS232

Standard

Connector

Isolation

Standard

Connectors

Mode

USB Interface

(4 ports)

Power

Isolation

Standard

Connector

Power

RS232 (Standard)

RS232 (Independent display interface option)

Isolation

Connector

Power

Isolation

Connector

Power

Isolation

Basic Nurse Call

Relay

Connector

Contact

Isolation

Delay

IntelliVue Instrument

Telemetry Wireless

Network (USA only)

Type

Technology

IntelliVue Instrument

Telemetry Wireless

Network (except USA)

Frequency Band

Type

Technology

IntelliVue 802.11

Bedside Adapter

(Wireless Network

Adapter)

Frequency Band

Type

Technology

Frequency Band

100-Base-TX (IEEE 802.3 Clause 25)

RJ45 (8 pin) basic insulation (reference voltage: 250 V; test voltage: 1500 V)

IEEE 1073-3.2-2000

RJ45 (8 pin)

Software-controllable

BCC (RxD/TxD cross over) or

DCC (RxD/TxD straight through)

5 V ±5 %, 100 mA (max.) basic insulation (reference voltage: 250 V; test voltage: 1500 V)

USB 2.0 full-speed (embedded host)

USB series "Standard A" receptacle

Low power port 4.4V min; max. load for all ports together

500 mA none

RJ45 (8-pin) none basic insulation (reference voltage: 250 V; test voltage: 1500 V)

RJ45 (8-pin) none none modular Jack 6P6C, active open and closed contact

<=100 mA, <=24 V DC basic insulation (reference voltage: 250 V; test voltage: 1500 V)

<[Configured Latency +0.5] sec

Internal WMTS Adapter compatible with Philips Cellular Telemetry System (CTS), cellular infrastructure

WMTS, 1395-1400 MHz and 1427-1432 MHz

Internal ISM Adapter compatible with Philips Cellular Telemetry System (CTS), cellular infrastructure

2.4 GHz ISM

Internal Wireless Adapter

IEEE 802.11a/b/g

2.4 GHz and 5 GHz ISM Band

408

MX800 Interface Specifications

Short Range Radio

Interface

Measurement Link

(MSL)

Video Interface

(standard)

Type

Technology

Frequency band

Modulation technique

Effective radiated power

Internal SRR interface

IEEE 802.15.4

2.4 GHz ISM (2.400 - 2.483 GHz)

DSSS (O -QPSK) max. 0 dBm (1 mW)

Connectors

Voltage

Power

Power Sync.

ODU out (Proprietary)

56 V ±10 %

45 W

5 V CMOS Level; 78.125 kHz (typ.)

LAN signals

Serial signals

IEEE 802.3 10-Base-T compliant

RS-422 compliant

Connector DVI (digital and analog, single link)

Digital video signals single link TMDS

Analog video signals 0.7 [email protected] Ohm

HSYNC/VSYNC signals

TTL

DDC signals none

Video Interface

(Independent display interface option)

DDC power

Connector

5 V +/-5% @0-55 mA

DVI (digital and analog, single link)

Pixel clock frequency 31,5 MHz - 119 MHz

Digital video signals single link TMDS

Analog video signals 0.7 [email protected] Ohm

HSYNC/VSYNC signals

TTL

DDC signals none

DDC power 5 V +/-5% @0-55 mA

ECG Sync Output/Analog ECG Output (1/4" stereo phone jack with tip, ring, sleeve)

General

Connector

Isolation

1/4" phone with tip, ring, sleeve functional isolation

36 Specifications

409

36 Specifications

MX800 Interface Specifications

Analog ECG Output

(ring, tip)

Digital Pulse Output

(ring)

Full scale on display signal gain x measured ECG voltage

Gain error

Baseline offset

<15 %

<100 mV

Bandwidth 1 to 100 Hz

Output voltage swing ±4 V (min)

Signal delay

Signal delay with older versions of the

M3001A MMS

<22 ms

<30 ms

[identifiable with the serial number prefix

DE227 or DE441 and option string

#A01]

Pacemaker Pulse

Output low voltage level

Output high voltage level

Pulse Width

Pulse Rise Time

Signal delay

Signal delay with older versions of the

M3001A MMS

[identifiable with the serial number prefix

DE227 or DE441 and option string

#A01] filtered and included in ECG output signal

<0.4 V @ I=-1 mA

>2.4 V @ I=1 mA

100 ms±10 ms (active high)

<1 ms (from 0.4 V to 2.4 V)

< 25ms per AAMI EC13

< 35ms per AAMI EC13

X2 (M3002A) Interface Specifications

Measurement Link

(MSL)

Connectors

Power

Power Sync.

LAN signals

Serial signals

Local signals

Female ODU (Proprietary)

30 V to 60 V input

RS-422 compliant input 78.125 kHz (typical)

IEEE 802.3 10-Base-T compliant

RS-422 compliant

Provided for connecting MMS extensions

410

36 Specifications

X2 (M3002A) Interface Specifications

ECG Sync Pulse

Output (rectangular pulse)

Wireless Network

Device Interface

Short Range Radio

Interface

1

Cable detection

Marker In

Wave Output

Connector

Output levels

Yes

No

No

Binder Series 709/719

Output low <0.8 V @ I = -4 mA

Output high >2.4 V @ I = 4 mA

None Isolation

Pulse Width

Delay from R-wave peak to start of pulse

Minimum required Rwave amplitude

Signals

100 +/- 10 ms (high)

20 ms maximum per AAMI EC13

0.5 V

RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND

12.5 V ±20%, 3.5 W continuous

Internal SRR interface Type

Technology

Frequency Band

IEEE 802.15.4

2.4 GHz ISM (2.400 - 2.483 GHz)

Modulation Technique DSSS (O -QPSK)

Effective radiated power max. 0 dBm (1 mW)

1

The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A Intellivue

Telemetry System Transceiver

M8023A External Power Supply (for M3002A) Interface Specifications

Measurement Link

(MSL)

Connectors

Power

Power Sync.

LAN signals

Serial signals

Local signals

Male ODU (Proprietary)

48 V output

RS-422 compliant output 78.125 kHz (typical)

IEEE 802.3 10-Base-T compliant

RS-422 compliant output 78.125 kHz (typical)

Not connected

Integrated PC (iPC) Interface Specifications

Ethernet LAN (external)

Connector

LAN Signals

Reinforced insulation

USB

Audio

6 external ports (5 rear, 1 right side)

Type A connectors microphone input stereo headphone output stereo

DVI Video with DVI-I connector

DVI

VGA

RJ-45

IEE 802.3 1000-Base-T compliant

IEC60601-1 A-k compliant

USB 2.0 supporting high speed mode

3.5 mm audio jack

3.5 mm audio jack supports resolutions up to

1920x1200 supports resolutions up to

2048x1536

411

36 Specifications

Display Specifications

19" WSXGA

Type

Resolution

Refresh frequency

Useful screen

Pixel size

482 mm active matrix color LCD

(TFT)

1680 x 1050 (WSXGA+)

58 Hz

409,5 mm x 255.9 mm

0.244 mm x 0.244 mm

Measurement Specifications

See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.

ECG/Arrhythmia/ST/QT

Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-

27:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/

EC13:1991/2002.

ECG/Arrhythmia/ST Performance Specifications

Cardiotach

PVC Rate

ST Numeric

QT Numeric

QTc Numeric

ΔQTc Numeric

QT-HR Numeric

Range

Accuracy

Resolution

Sensitivity

Range

Resolution

Range

Accuracy

Resolution

Range

Accuracy

Resolution

Range

Resolution

Range

Resolution

Range - adult

Range - pediatric and neonatal

Adult/pedi: 15 to 300 bpm

Neo range: 15 to 350 bpm

±1% of range

1 bpm

≥200 µV peak

0 to 300 bpm

1 bpm

-20 to +20 mm

±0.5 mm or 15%, whichever is greater

0.1 mm

200 to 800 ms

±30 ms

8 ms

200 to 800 ms

1 ms

-600 to +600 ms

1 ms

15 to 300 bpm

15 to 350 bpm

412

36 Specifications

ECG/Arrhythmia/ST Performance Specifications

Sinus and SV Rhythm Ranges

Brady

Bandwidth

Normal

Tachy

Diagnostic Mode

Extended Monitoring

Mode

Monitoring Mode

Adult: 15 to 59 bpm

Pedi: 15 to 79 bpm

Neo: 15 to 89 bpm

Adult: 60 to 100 bpm

Pedi: 80 to 160 bpm

Neo: 90 to 180 bpm

Adult: >100 bpm

Pedi: >160 bpm

Neo: >180 bpm

Adult/neo/pedi: 0.05 to 150 Hz

Adult/neo/pedi: 0.5 to 150 Hz

Filter Mode

Bandwidth

when the ECG is transmitted from a telemetry device via short range radio

Diagnostic Mode

Extended Monitoring

Mode

Monitoring Mode

Adult: 0.5 to 40 Hz

Neo/pedi: 0.5 to 55 Hz

Adult/neo/pedi: 0.5 to 20 Hz

Adult/neo/pedi: 0.05 to 40 Hz

Adult/neo/pedi: 0.5 to 40 Hz

Differential Input Impedance

Common Mode Rejection Ratio

Filter Mode

Electrode Offset Potential Tolerance

Auxiliary Current

(Leads off Detection)

Input Signal Range

Adult: 0.5 to 40 Hz

Neo/pedi: 0.5 to 40 Hz

Adult/neo/pedi: 0.5 to 20 Hz

>2 MΩ RA-LL leads (Resp)

>5 MΩ at all other leads (at 10 Hz including patient cable)

Diagnostic mode: >86 dB (with a 51 kΩ/47 nF imbalance).

Filter mode: >106 dB (with a 51 kΩ/47 nF imbalance).

±500 mV

Active electrode: <100 nA

Reference electrode: <900 nA

±5 mV

ECG/Arrhythmia/ST/QT

Alarm Specifications

HR

Extreme Tachy

Extreme Brady

Run PVCs

PVCs Rate

Vent Tach HR

Vent Tach Run

Range Adjustment

15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard

Adult:1 bpm steps (15 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:1 bpm steps (15 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm

Difference to low limit 0 to 50 bpm

Clamping at 15 to 100 bpm

2 PVCs

5 bpm steps

5 bpm steps

5 bpm steps

Not adjustable by user

1 to 99 PVCs/minute

20 to 300 bpm

3 to 99 PVCs/minute

1 PVC

5 bpm

1 PVC

413

36 Specifications

ECG/Arrhythmia/ST/QT

Alarm Specifications

Vent Rhythm Run

SVT HR

SVT Run

ST High

ST Low

QTc High

ΔQTc High

Range

3 to 99 PVCs/minute

120 to 300 bpm

3 to 99 SV beats

-19.8 to +20 mm

-20 to +19.8 mm

200 ms to 800 ms

30 ms to 200 ms

Adjustment

1 PVC

5 bpm

1 SV beat

0.2 mm

0.2 mm

10 ms steps

10 ms steps

ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27

Respiration Excitation Waveform

Noise Suppression

Time to Alarm for

Tachycardia

Vent Tachycardia

1 mV pp

,206 bpm

Vent Tachycardia

2 mV pp

,195 bpm

Sinusoidal signal, 260 μA, 40.5 kHz

RL drive gain 44 dB max., max. voltage 1.8 Vrms

Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds

Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds

Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds

Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds

Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds

Tall T-Wave Rejection Capability

Heart Rate Averaging Method

Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds

Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitude

Three different methods are used:

Normally, heart rate is computed by averaging the 12 most recent RR intervals.

For runs of PVCs, up to 8 RR intervals are averaged to compute the HR.

If each of 3 consecutive RR intervals is greater than 1200 ms

(that is, rate less than 50 bpm), then the 4 most recent RR intervals are aver\-aged to compute the HR.

Response Time of Heart Rate Meter to Change in Heart Rate

HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds

Heart Rate Meter Accuracy and Response to

Irregular Rhythm

Accuracy of Input Signal Reproduction

Pacemaker Pulse Rejection Performance

HR change from 80 to 40 bpm:

Range: [5.6 to 6.4 sec] Average: 6.0 seconds

Ventricular bigeminy: 80 bpm

Slow alternating ventricular bigeminy: 60 bpm

Rapid alternating ventricular bigeminy: 120 bpm

Bidirectional systoles: 90 bpm

Methods A and D were used to establish overall system error and frequency response.

Rejection of pacemaker pulses with amplitudes from ±2 mV to

±700 mV and widths from 0.1 ms to 2.0 ms (Method A)

414

Respiration

Respiration Performance Specifications

Respiration Rate

Bandwidth

Noise

Range

Accuracy

Resolution

Adult/pedi: 0 to 120 rpm

Neo: 0 to 170 rpm at 0 to 120 rpm ±1 rpm at 120 to 170 rpm ±2 rpm

1 rpm

0.3 to 2.5 Hz (–6 dB)

Less than 25 mΩ (rms) referred to the input

36 Specifications

Respiration Alarm

Specifications

Range

High

Low

Adult/pedi: 10 to 100 rpm

Neo: 30 to 150 rpm

Adult/pedi: 0 to 95 rpm

Neo: 0 to 145 rpm

Apnea Alarm

10 to 40 seconds

Adjustment

under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps

5 second steps

Delay

max. 14 seconds for limits from 0 to 20 rpm: max. 4 seconds for limits above 20 rpm: max.

14 seconds

SpO2

Unless otherwise specified, this information is valid for SpO

2

measured using the M3001A and

M3002A Multi-measurement modules and the M1020B measurement module. The SpO

2

Performance

Specifications in this section apply to devices with Philips SpO

2

technology. For SpO

2

Performance

Specifications valid for other SpO

2

technologies, refer to the instructions for use provided with these devices.

Complies with ISO 9919:2005 / EN ISO 9919:2009 (except alarm system; alarm system complies with

IEC 60601-2-49:2001).

Measurement Validation: The SpO

2

accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements.

Display Update Period: Typical: 2 seconds, Maximum: 30 seconds. Maximum with NBP INOP suppression on: 60 seconds.

415

36 Specifications

SpO

2

Performance Specifications

SpO2

The specified accuracy is the rootmean-square (RMS) difference between the measured values and the reference values

Range

Option #A01

Accuracy

Option #A02

Accuracy

Resolution

0 to 100%

Philips Reusable Sensors:

M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2 % (70 % to

100 %)

M1193A, M1194A, M1195A, M1196A = 3 % (70 % to 100 %)

M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%)

M1193T (Neonate) = 4 % (70 % to 100 %)

Philips Disposable Sensors with M1943A(L):

M1132A, M1133A (adult/infant), M1134A (adult/infant) = 2 %

M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate),

M1134A (neonate) = 3 % (70 % to 100 %)

NellcorPB® Sensors with M1943A(L):

MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-25,

OxiCliq A, P, I, N = 3 % (70 % to 100 %)

Masimo Reusable Sensors® with LNOP MP12 or LNC MP10:

LNOP DC-I, LNOP DC-IP, LNOP YI (adult/pedi/infant), LNCS DC-

1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2% (70% to 100%)

LNOP YI (neonate), LNCS YI (neonate) = 3% (70% to 100%)

LNOP TC-I, LNCS TC-I: 3.5 % (70 % to 100 %)

Masimo Disposable Sensors® with LNOP MP12 or LNC MP10:

LNOP DC-I, LNOP DC-IP, LNOP YI (adult/pedi/infant, LNCS DC-

1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2 % (70 % to 100 %)

LNOP Neo-L, LNOP NeoPt-L, LNCS Neo-L, LNCS NeoPt-L: 3 %

(70 % to 100 %)

Philips Reusable Sensors

M1193AN = 3 % (70 % to 100 %)

Philips Disposable Sensors with M1943NL:

M1901B (Adult), M1902B, M1903B, M1904B = 2 % (70 % to 100 %)

M1901B (Neonate) = 3 %

NellcorPB® Sensors with M1943NL:

MAX-FAST, MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N (Adult) =

2 % (70 % to 100 %)

SC-A, OxiCliq A, P, I, N (Adult) = 2.5 % (70 % to 100 %)

MAX-N (Neonate), Dura-Y D-YS (Infant to Adult), DS-100A,Oxiband

OXI-A/N (Adult), OXI-P/I = 3 % (70 % to 100 %)

MAX-R, OxiCliq N (Neonate), SC-NEO (Neonate), SC-PR

(Neonate), Dura-Y D-YS with D-YSE or D-YSPD clip = 3.5 % (70 % to 100 %)

Dura-Y D-YS (Neonate), Oxiband OXI-A/N (Neonate) = 4 % (70 % to 100 %)

1%

416

36 Specifications

SpO

2

Performance Specifications

Pulse

Range

Accuracy

Resolution

Sensors

Pulse Oximeter

Calibration Range

30 to 300 bpm

±2% or 1 bpm, whichever is greater

1 bpm

Wavelength range: 500 to 1000 nm

Emitted Light Energy: ≤15 mW

Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)

70% to 100%

SpO

2

Alarm

Specifications

SpO

2

Desat

Pulse

Tachycardia

Bradycardia

Range Adjustment Delay

Adult: 50 to 100%

Pedi/Neo: 30 to 100%

1% steps

Adult: 50 to Low alarm limit

Pedi/Neo: 30 to Low alarm limit

30 to 300 bpm

1% steps

Adult:

1 bpm steps (30 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:

1 bpm steps (30 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm 5 bpm steps

Difference to low limit 0 to 50 bpm 5 bpm steps

Clamping at 30 to 100 bpm 5 bpm steps

(0, 1, 2, 3,... 30)

+4 seconds or Smart Alarm

Delay (see table below)

(0, 1, 2, 3,... 30)

+4 seconds max. 14 seconds max. 14 seconds max. 14 seconds

SpO

2

Smart Alarm Delay Specifications

The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.

2%

3%

4%

5%

6%

Deviation from violated alarm limit

Resulting alarm delay

1%

Short

25 sec

(maximum delay)

12 sec

10 sec

10 sec

10 sec

10 sec

Medium

50 sec

(maximum delay)

25 sec

16 sec

12 sec

10 sec

10 sec

Long

100 sec

(maximum delay)

50 sec

33 sec

25 sec

20 sec

16 sec

417

36 Specifications

SpO

2

Smart Alarm Delay Specifications

The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.

Deviation from violated alarm limit

Resulting alarm delay

7%

8%

9%

>9%

Short

10 sec

10 sec

10 sec

10 sec

Medium

10 sec

10 sec

10 sec

10 sec

Long

14 sec

12 sec

11 sec

10 sec

NBP

Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.

NBP Performance Specifications

Measurement

Ranges

Systolic

Accuracy

Pulse Rate Measurement Accuracy

Pulse Rate Range

Measurement Time

Cuff Inflation Time

Diastolic

Mean

Pulse Rate

Initial Cuff Inflation Pressure

Adult: 30 to 270 mmHg (4 to 36 kPa)

Pedi: 30 to 180 mmHg (4 to 24 kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Adult: 10 to 245 mmHg (1.5 to 32 kPa)

Pedi: 10 to 150 mmHg (1.5 to 20 kPa)

Neo: 10 to 100 mmHg (1.5 to 13 kPa)

Adult: 20 to 255 mmHg (2.5 to 34 kPa)

Pedi: 20 to 160 mmHg (2.5 to 21 kPa)

Neo: 20 to 120 mmHg (2.5 to 16 kPa)

Adult: 40 to 300

Pedi: 40 to 300

Neo: 40 to 300

Max. Std. Deviation: 8 mmHg (1.1 kPa)

Max. Mean Error: ±5 mmHg (±0.7 kPa)

40 to 100 bpm: ±5 bpm

101 to 200 bpm: ±5% of reading

201 to 300 bpm: ±10% of reading

(average over NBP measurement cycle)

40 to 300 bpm

Typical at HR >60 bpm

Auto/manual/sequence: 30 seconds (adult)

25 seconds (neonatal)

Stat: 20 seconds

Maximum time: 180 seconds (adult/pediatric)

90 seconds (neonates)

Typical for normal adult cuff: Less than 10 seconds

Typical for neonatal cuff: Less than 2 seconds

Adult: 165 ±15 mmHg

Pedi: 130 ±15 mmHg

Neo: 100 ±15 mmHg

418

36 Specifications

NBP Performance Specifications

Auto Mode Repetition Times

STAT Mode Cycle Time

Venipuncture Mode Inflation

1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutes

5 minutes

Inflation Pressure Adult

Pediatric

Automatic deflation after

20 to 120 mmHg (3 to 16 kPa)

20 to 80 mmHg (3 to 11 kPa)

Neonatal

20 to 50 mmHg (3 to 7 kPa)

Adult/pediatric

170 seconds

Neonatal

85 seconds

Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated

Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure.

In neonatal mode, the blood pressure measurements determined with this device comply with the

American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 -

1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.

NBP Alarm

Specifications

Systolic

Adjustment

10 to 30 mmHg: 2 mmHg (0.5 kPa)

>30 mmHg: 5 mmHg (1 kPa)

Diastolic

Mean

Range

Adult: 30 to 270 mmHg (4 to 36 kPa)

Pedi: 30 to 180 mmHg (4 to 24 kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Adult: 10 to 245 mmHg (1.5 to 32 kPa)

Pedi: 10 to 150 mmHg (1.5 to 20 kPa)

Neo: 10 to 100 mmHg (1.5 to 13 kPa)

Adult: 20 to 255 mmHg (2.5 to 34 kPa)

Pedi: 20 to 160 mmHg (2.5 to 21 kPa)

Neo: 20 to 120 mmHg (2.5 to 16 kPa)

NBP Overpressure Settings

Adult >300 mmHg (40 kPa) >2 sec

Pedi

Neo

>300 mmHg (40 kPa) >2 sec

>150 mmHg (20 kPa) >2 sec not user adjustable

Invasive Pressure and Pulse

Complies with IEC 60601-2-34:2000/EN60601-2-34:2000.

419

36 Specifications

Invasive Pressure Performance Specifications

Measurement Range

Pulse Rate

Input Sensitivity

Transducer

Range

Accuracy

Resolution

Frequency Response

Zero Adjustment

Range

Accuracy

Drift

Gain Accuracy

Accuracy

Drift

Overall Accuracy

Non linearity and

Hysteresis

(including transducer)

Volume displacement of CPJ840J6

–40 to 360 mmHg

25 to 350 bpm

±1% Full Range

1 bpm

Sensitivity: 5 µV/V/mmHg (37.5 µV/V/kPa)

Adjustment range: ±10%

Load Impedance: 200 to 2000 Ω (resistive)

Output Impedance: ≤3000 Ω (resistive) dc to 12.5 Hz or 40 Hz

±200 mmHg (±26 kPa)

±1 mmHg (±0.1 kPa)

Less than 0.1 mmHg/°C (0.013 kPa/°C)

±1%

Less than 0.05%/°C

Error of ≤0.4 %FS (@CAL 200 mmHg)

±4% of reading or ±4 mmHg (±0.5 kPa), whichever is greater

0.1 mm

3

/100 mmHg

Analog output Specifications

Analog Output

Range available only with

M1006B #C01 (@ CAL

200 mmHg)

Level

Accuracy

Offset

Resolution

Signal delay

-0.4 V to 3.6 V

1 V / 100 mmHg

±3% full scale

±30 mV

8 Bit (@ 5 V range)

20 ms

420

36 Specifications

Invasive Pressure Alarm Specifications

Invasive Pressure Alarm

Specifications

Pressure

Extreme High

Extreme Low

Pulse

Tachycardia

Bradycardia

Range Adjustment Delay

–40 to 360 mmHg

(–5.0 to 48 kPa)

Difference to high limit 0 to

25 mmHg

Clamping at -40 to 360 mmHg

Difference to low limit 0 to

25 mmHg

Clamping at -40 to 360 mmHg

-40 to 50 mmHg

2 mmHg (0.5 kPa)

>50 mmHg

5 mmHg (1 kPa)

5 mmHg steps (0.5 kPa)

5 mmHg steps (1.0 kPa)

5 mmHg steps (0.5 kPa)

5 mmHg steps (1.0 kPa)

25 to 300 bpm Adult:

1 bpm steps (25 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:

1 bpm steps (25 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm 5 bpm steps

Difference to low limit 0 to 50 bpm 5 bpm steps

Clamping at 25 to 100 bpm 5 bpm steps max.

12 seconds max.

14 seconds max.

14 seconds

Temp

Complies with EN 12470-4:2000. Specified without transducer.

Temp Performance Specifications

Temp

Range

Resolution

Accuracy

Average Time Constant

–1 to 45°C (30 to 113°F)

0.1°C (0.2°F)

±0.1°C (±0.2°F)

Less than 10 seconds

Temp Alarm Specifications Range

Temp High/Low Alarms

–1 to 45°C (30 to 113°F)

Adjustment

-1 to 35°C (30 to 95°F), 0.5°C (1.0°F) steps

35 to 45°C (95 to 113°F), 0.1°C (0.2°F) steps

CO2

The CO

2

measurement in M3014A and M3015A complies with EN ISO 21647:2004 + Cor.1:2005

(except alarm system; alarm system complies with IEC 60601-2-49:2001).

421

36 Specifications

M3015A Microstream CO

2

Performance Specifications

CO2 awRR

Warm-up Time

Rise Time

Range

Accuracy

Resolution

Stability

Range

Accuracy

Sample Flow Rate

Gas Sampling Delay Time

Sound Pressure

Total System Response Time

0 to 150 mmHg (0 to 20 kPa), or 20% CO

2

, whichever is lower

Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greater

After 5 minutes warmup:

0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)

Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of reading

These specifications are valid for 21% O

2

and N2 balance, up to 35°C ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode. Outside of these conditions the accuracy reaches at a minimum

±4 mmHg or ±12% of the reading, whichever is greater.

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

Included in Accuracy specifications

0 to 150 rpm

0 to 40 rpm: ±1 rpm

41 to 70 rpm: ±2 rpm

71 to 100 rpm: ±3 rpm

>100 rpm: ±5% of reading

5 minutes for full accuracy specification

190 ms for neonatal mode

(measured with FilterLine H for neonatal)

240 ms for adult mode

(measured with FilterLine H for adult)

50 + 15/-7.5 ml/minute

Maximum:

3 seconds (2m sample lines)

6 seconds (4m sample lines)

Acoustic noise: <45 dBA

The total system response time is the sum of the delay time and the rise time.

Microstream CO

2

Humidity Correction Factor

Either BTPS or ATPD can be selected as the humidity correction factor for the Microstream CO

2 readings. The formula for the correction calculation is: where:

P

BTPS

= partial pressure at body temperature and pressure, saturated

P

ATPD

= partial pressure at ambient temperature and pressure, dry

422

36 Specifications

M3014A Mainstream CO

2

Performance Specifications

CO2 awRR

Warm-up Time

Response Time

Range

Accuracy

Resolution

0 to 150 mmHg (0 to 20.0 kPa) after 2 minutes warmup:

For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)

For values from 41 to 70 mmHg: ±5% of reading

For values from 71 to 100 mmHg: ±8% of reading

The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, P abs

= 760 mmHg, flow rate = 2 l/min.

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

Stability:

Short term drift ±0.8 mmHg over four hours

Long term drift Accuracy specification will be maintained over a 120 hour period

Range

Accuracy

2 to 150 rpm

±1 rpm

2 minutes with CO

2

transducer attached for full accuracy specification

Less than 60 ms (with adult or infant reusable or disposable adapter)

M3014A Sidestream CO

2

Performance Specifications

CO2

Range

Accuracy

Resolution

0 to 150 mmHg (0 to 20.0 kPa) after 2 minutes warmup:

For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)

For values from 41 to 70 mmHg: ±5% of reading

For values from 71 to 100 mmHg: ±8% of reading

For values from 101 to 150 mmHg: ±10% of reading

At respiration rates above 80 rpm, all ranges are ±12% of actual. The specifications are valid for gas mixtures of CO

2

, balance N

2

, dry gas at

760 mmHg within specified operating temperature range.

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

Stability:

awRR

Short term drift ±0.8 mmHg over four hours

Long term drift Accuracy specification will be maintained over a 120 hour period

Range

Accuracy

2 to 150 rpm

±1 rpm

Warm-up Time

Sample Flow Rate

Total System Response Time

Operating Temperature

2 minutes with CO

50 ±10 ml/minute

3 seconds

2

sensor attached for full accuracy specification

0 to 40°C (32 to 100°F)

M3014A Mainstream and Sidestream CO

2

Humidity Correction Factor

423

36 Specifications

Either BTPS or ATPD can be selected as the humidity correction factor for the CO

2

readings. The formula for the correction calculation is: where:

P

BTPS

= partial pressure at body temperature and pressure, saturated

P

ATPD

= partial pressure at ambient temperature and pressure, dry

Pabs = absolute pressure

P

H2O

= 42 mmHg @35°C and 100% RH

M3016A Mainstream CO

2

Performance Specifications

CO2

Range –4 to 150 mmHg (-0.5 to 20.0 kPa)

Accuracy

awRR

Warm-up Time

Response Time

Resolution

Stability

Range

Accuracy after 20 minutes warmup and calibration:

For values between 0 and 40 mmHg: ±2.2 mmHg (±0.29 kPa)

For values between 40 and 76 mmHg: ±5.5% of reading

The specifications are valid for 45% O

2

and N

2

or N

2

O balance. Outside these conditions the accuracy reaches at a minimum the requirements of

EN864/ISO9918.

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

±1.0 mmHg over a 7 day period

0 to 150 rpm

±2 rpm

20 minutes with CO

2

transducer attached for full accuracy specification

Less than 125 ms (for step from 10% to 90%)

Mainstream CO

2

Humidity Correction Factor

Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO

2 readings. The formula for the correction calculation is: where:

P

BTPS

= partial pressure at body temperature and pressure, saturated

P

ATPD

= partial pressure at ambient temperature and pressure, dry

Pabs = absolute pressure

P

H2O

= 42 mmHg @35°C and 100% RH

424

36 Specifications

CO

2

Alarm

Specifications etCO

2

High

etCO

2

Low

imCO

2

High

awRR High awRR Low

Apnea delay

Range Adjustment Delay

20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa)

10 to 90 mmHg (1 to 12 kPa)

2 to 20 mmHg

(0.3 to 3.0 kPa)

Adult/pedi: 10 to 100 rpm

Neo: 30 to 150 rpm

Adult/pedi: 0 to 95 rpm

Neo: 0 to 145 rpm

10 to 40 seconds steps of 1 mmHg

(0.1 kPa) under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps

5 second steps

M3002A/M3014A/M3016A: less than

14 seconds

M3015A: less than 21 seconds.

M3002A/M3014A/M3016A: less than

14 seconds

M3015A: less than 21 seconds.

M3002A/M3014A/M3016A: less than

14 seconds

M3015A: less than 21 seconds.

M3015A: settings <20 rpm: less than 8 seconds

>20 rpm: less than 21 seconds

M3002A/M3014A/M3016A settings <20 rpm: less than 4 seconds

>20 rpm: less than 14 seconds set apnea delay time + 4 seconds

(M3002A/M3014A/M3016A) or

8 seconds (M3015A with 2 m sample lines) or 11 seconds (M3015A with 4 m sample lines).

Interfering Gas and Vapor Effects On CO2 Measurement Values

The specified deviations for M3002A/M3014A are valid when the appropriate corrections are switched on and set correctly.

Gas or Vapor

Nitrous Oxide

Halothane

Enflurane

Isoflurane

Sevoflurane

Xenon

Helium

Metered dose inhaler propellants

Desflurane

Ethanol

Isopropanol

Acetone

Methane

Gas Level

(% volume fraction)

15

0.1

0.1

0.1

1.0

5

80

-

50

5

5

60

4

M3002A/M3014A M3015A

Additional deviation due to gas interference, measured at 0 - 40 mmHg CO

2

±1 mmHg

±2 mmHg

±5%

±5%

±2 mmHg

±2 mmHg

±2 mmHg

-5 mmHg

±1 mmHg not specified for use

±5%

±5%

±5%

±5%

±5%

+5 mmHg

±1 mmHg

±1 mmHg

±1 mmHg

±1 mmHg

±5%

±5%

±5%

±5%

±5%

425

36 Specifications

Spirometry

The following specifications apply for 760 mmHg ambient pressure and patient gas: room air at 35°C, unless otherwise noted

Spirometry Performance Specifications

Flow Wave (AWF)

Range

Pressure Wave

(AWP)

Respiration Rate numeric (RRspir)

Inspired Minute

Volume numeric

(MVin)

Expired Minute

Volume numeric

(MVexp)

Accuracy

Scales

Scale Default

Volume Wave (AWV) Range

Accuracy

Scales

Scale Default

Range

Accuracy

Scales

Scale Default

Range

Resolution

Range

Resolution

Range

Resolution

±25 l/min (neonatal)

±100 l/min (pediatric)

±180 l/min (adult)

±3% or

0.125 l/min (neonatal)

0.25 l/min (pediatric)

0.5 l/min (adult)

±10, ±20, ±40, ±60, ±80, ±100, ±120, ±150 l/min

±20 l/min (neonatal)

±100 l/min (pediatric)

±150 l/min (adult)

0 to 100 ml (neonatal)

0 to 400 ml (pediatric)

0 to 3000 ml (adult)

±5% or

±3 ml (neonatal)

±12 ml (pediatric)

±90 ml (adult), whichever is greater

50, 100, 200, 600, 800, 1000, 2000, 3000 ml

50 ml (neonatal)

200 ml (pediatric)

800 ml (adult)

-20 to 120 cmH

2

O

±2% or ±0.5 cmH

2

O whichever is greater

10, 20, 40, 60, 80, 100, 120 cmH

2

O

20 cmH

2

40 cmH

2

40 cmH

2

O (neonatal)

O (pediatric)

O (adult)

2 to 120 breaths/min

1 breath/min

0.01 to 5 l/min (neonatal)

0.06 to 30 l/min (pediatric)

0.4 to 60 l/min (adult)

0.01 l/min (neonatal/pediatric)

0.1 l/min (adult)

0.01 to 5 l/min (neonatal)

0.06 to 30 l/min (pediatric)

0.4 to 60 l/min (adult)

0.01 l/min (neonatal/pediatric)

0.1 l/min (adult)

426

Spirometry Performance Specifications

Inspired Volume numeric (TVin)

Expired Volume numeric (TVexp)

Lung Compliance numeric

Airway Resistance numeric

Range

Resolution

Range

Resolution

Range

Resolution

Range

5 to 100 ml (neonatal)

30 to 400 ml (pediatric)

200 to 3000 ml (adult)

1 ml (neonatal/pediatric)

10 ml (adult)

5 to 100 ml (neonatal)

30 to 400 ml (pediatric)

200 to 3000 ml (adult)

1 ml (neonatal/pediatric)

10 ml (adult)

0 to 500 ml/cmH

2

O

1 ml/cmH

2

O

0 to 500 cmH

0 to 250 cmH

0 to 100 cmH

2

O/l/s (neonatal)

2

O/l/s (pediatric)

2

O/l/s (adult)

1 cmH

2

O/l/s

0 to 120 cmH

2

O

1 cmH

2

O

Peak Inspiratory

Pressure numeric

(PIP)

Mean Airway

Pressure

Plateau Pressure numeric

Resolution

Range

Resolution

Negative Inspiratory

Pressure numeric

Range

Resolution

Range

Resolution

Range

Resolution

Positive End-

Expiratory Pressure numeric (PEEP)

Range

Resolution

Barometric Pressure numeric (PB)

Range

Peak Inspiratory

Flow numeric (PIF)

Resolution

Range

-20 to 0 cmH

2

O

1 cmH

2

O

0 to 120 cmH

2

O

1 cmH

2

O

0 to 120 cmH

2

O

1 cmH

2

O

0 to 99 cmH

2

O

1 cmH2O

Peak Expiratory

Flow numeric (PEF)

Range

Inspiration to

Expiration ratio numeric (I:E)

Resolution

Resolution

Range

Resolution

400 to 800 mmHg

1 mmHg

0.3 to 25 l/min (neonatal)

1 to 100 l/min (pediatric)

2 to 180 l/min (adult)

0.1 l/min (neonatal)

1 l/min (pediatric/adult)

0.3 to 25 l/min (neonatal)

1 to 100 l/min (pediatric)

2 to 180 l/min (adult)

0.1 l/min (neonatal)

1 l/min (pediatric/adult)

1: 0.2 ... 9.9

0.1

36 Specifications

427

36 Specifications

Cardiac Output / Continuous Cardiac Output

C.O./CCO Performance Specifications

C.O. (right heart)

C.O. (transpulmonary

)

EVLW

ITBV

CCO

Range

Accuracy

Repeatability

0.1 to 20.0 l/min

Instrument Specification (electrical): ±3% or 0.1 l/min

System Specification: ±5%.or 0.2 l/min

Instrument Specification (electrical): ±2% or 0.1 l/min

System Specification: ±3%.or 0.1 l/min

Range

Accuracy

Repeatability

0.1 to 25.0 l/min

Instrument Specification (electrical): ±4% or 0.15 l/min

System Specification: ±5% or 0.2 l/min

Instrument Specification (electrical): ±2% or 0.1 l/min

System Specification: ±3% or 0.1 l/min

10 to 5000 ml Range

Standard Deviation 10% or 1 ml/kg

Range 50 to 6000 ml

Accuracy

Repeatability

±10% or 30 ml

±5% or 20 ml

Range 0.1 to 25.0 l/min

Standard Deviation 10% or 0.3 l/min

Display Update

Blood Temperature

Range

Injectate Temperature Range

2 seconds nominal

17.0 to 43°C (62.6 to 109,5°F)

-1 to 30°C (30.2 to 86.0°F)

C.O./CCO Alarm

Specifications

TBlood

CCO

Range

17 to 43°C

0.1 to 25.0 l/min

Adjustment

Steps of 0.5°C (17 to 35°C)

Steps of 0.1°C (35 to 43°C)

Steps of 1°F (63 to 95°F)

Steps of 0.2°F (95 to 109°F)

0.1 l/min (0.1 to 10.0 l/min)

0.5 l/min (10.0 to 25.0 l/min)

Delay

10 seconds after the value exceeds the set limit range

10 seconds after the value exceeds the set limit range

tcGas

Complies with IEC 60601-2-23:1999/EN60601-2-23:2000.

tcGas Performance Specifications tcpO2

Range

Resolution

Overall Accuracy

(incl. transducer)

tcpO2 Test Signal

0 to 750 mmHg (0 to 100 kPa)

1 mmHg (0.1 kPa)

0 to 20.9% O

2

better than +5 mmHg (+0.7 kPa)

Above 20.9% O

2

better than +10% of reading

60 mmHg (8.0 kPa)

428

36 Specifications tcGas Performance Specifications

tcpO2 Drift, including transducer

tcpO2 response time, including transducer

tcpCO2

Range

Transducer Heating

Typically 1.25%/h

Typically 30 s

5 to 200 mmHg (0.7 to 26.7 kPa)

Resolution

Overall Accuracy

(incl. transducer)

1 mmHg (0.1 kPa)

5 to 76 mmHg (0.7 to 10.1 kPa) better than +5 mmHg(+0.7 kPa)

Above 76 mmHg (10.1 kPa) better than +10% of reading

40 mmHg (5.3 kPa) tcpCO2 Test Signal

tcpCO2 Drift, including transducer Typically 2.5%/h

tcpCO2 response time, including transducer Typically 60 s

Warm-up Time

Site Timer

<3 minutes

0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hours. Change Site alarm when site time is expired and configurable automatic heating switch-off

Available Temperatures -

37.0°C, 41.0 to 45°C in steps of 0.5°C

Alarm Delay

10 seconds after the value exceeds the set limit range.

tcGas Alarm Specifications Range tcpO2

10 to 745 mmHg

1.0 to 99.5 kPa

tcpCO2

10 to 195 mmHg

1.0 to 26 kPa

Adjustment

10 to 30 mmHg: 1 mmHg

1.0 to 4.0 kPa: 0.1 kPa

32 to 100 mmHg: 2 mmHg

4.2 to 13 kPa: 0.2 kPa

105 to 745 mmHg: 5 mmHg

13.5 to 99.5 kPa: 0.5 kPa

10 to 30 mmHg: 1 mmHg

1.0 to 4.0 kPa: 0.1 kPa

32 to 100 mmHg: 2 mmHg

4.2 to 13 kPa: 0.2 kPa

105 to 195 mmHg: 5 mmHg

13.5 to 26 kPa: 0.5 kPa

Intravascular Oxygen Saturation

Performance Specifications

SO2, SvO2, ScvO2

Range

Accuracy

Resolution

Stability (system)

Response Time (10 % to 90 %)

10% to 100%

±2% (i.e. ±2 units), 1 standard deviation over 40% to 100%

1 range.

1%

Drift <2% over 24 hours

5 seconds

1

The accuracy specification for Edwards Lifesciences’ Philips-compatible catheters has been verified in the saturation range 40%-95%.

429

36 Specifications

EEG

Complies with IEC 60601-2-26:1994/EN60601-2-26:1994.

EEG Performance Specifications

Leakage Current

Input Signal Range

Differential Input Impedance

Max. DC Input Offset Voltage

Input Protection

Common Mode Rejection

Noise

Electromagnetic Susceptibility

Electrode

Impedance

Measurement

Bandwidth

Range

Accuracy

Low Filter Cut-Off Frequencies

High Filter Cut-Off Frequencies

<=10 mA @ 110 Vac

1 mVp-p

>15 MΩ @ 10 Hz

±320 mV

Against defibrillation (5 kV) and electrosurgery

>105 dB @ 5 kΩ imbalance and 60 Hz

<0.4 mVRMS (1 to 30 Hz)

<10 mVp-p @ 3 V/m, 26-1000 MHz

0 to 30 kΩ

±1 kΩ

0.5 Hz to 50 Hz (–3 dB)

0.5, 1.0, 2.0, and 5.0 Hz

(12 dB/octave)

15 Hz (65 dB/octave)

30 Hz (75 dB/octave)

50 Hz (85 dB/octave)

BIS

Alarm Specifications

SO2, SvO2, ScvO2

Range

10% to 100%

Adjustment Delay

1% max. 15 +4 seconds after value exceeds the set limit range

BIS Performance Specifications BIS, BISx M1034A

Bispectral Index (BIS) Range

Signal Quality Index (SQI) Range

EMG Range

Suppression Ratio (SR)

Spectral Edge Frequency (SEF)

Total Power (TP)

Bursts

Noise

Wave Scale

Update Frequency (BIS Numeric)

0 - 100

0 - 100%

0 - 100 dB

0 - 100%

0.5 - 30.0 Hz

0 - 100 dB

(BISx only) 0 - 30 /minute

<0.3 µV RMS (2.0 µV peak-to-peak)

With gridlines on: ±25 µV, ±50 µV, ±100 µV, ±250 µV

With gridlines off: 50 µV, 100 µV, 200 µV, 500 µV

2048 ms

430

36 Specifications

BIS Performance Specifications BIS, BISx M1034A

Bandwidth

High Pass Filters

Low Pass Filters

Notch Filters (for line frequency)

Impedance Measurement Range

0.25 - 100 Hz (-3 dB)

0.25 Hz, 1 Hz, 2 Hz (-3 dB)

30 Hz, 50 Hz, 70 Hz, 100 Hz (-3 dB)

50 Hz, 60 Hz

0 to 999 kΩ

BIS Alarm Specifications Range

BIS High/Low Alarm 0 - 100

Adjustment

1

Alarm Delay

Max. 2 seconds

Safety and Performance Tests

You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications, are described in the Service Guide.

Electromagnetic Compatibility (EMC) Specifications

Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radio frequency (RF) communications equipment can affect medical electrical equipment.

Accessories Compliant with EMC Standards

All accessories listed in the accessories section comply, in combination with the patient monitor, with the requirements of IEC 60601-1-2:2001 + A1:2004.

WARNING

Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment.

Electromagnetic Emissions

The monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environment.

431

36 Specifications

Emissions test

Radio Frequency (RF) emissions

RF emissions CISPR 11

Harmonic emissions IEC 61000-3-2

Voltage fluctuations IEC 61000-3-3

Compliance Avoiding Electromagnetic Interference

Group 1

Class A n/a n/a

The monitor 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

The monitor 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

WARNING

The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients.

Avoiding Electromagnetic Interference (Resp and BIS)

The respiration (Resp) and BIS measurements are very sensitive measurements that measure very small signals. Technological limitations do not allow higher immunity levels than 1 V/m for radiated RF electromagnetic fields and 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of these measurements.

Electromagnetic Immunity

The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below.

Immunity test

Electrostatic discharge (ESD)

IEC 61000-4-2

Electrical fast transient/burst

IEC 61000-4-4

Surge

IEC 61000-4-5

IEC 60601-1-2 test level

±6 kV contact

±8 kV air

±2 kV for power supply lines

±1 kV for input/output lines

±1 kV differential mode

±2 kV common mode

Compliance level

±6 kV contact

±8 kV air

±2 kV for power supply lines

±1 kV for input/output lines

±1 kV differential mode

±2 kV common mode

Electromagnetic environment guidance

Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.

Mains power quality should be that of a typical commercial and/or hospital environment

Mains power quality should be that of a typical commercial and/or hospital environment

432

36 Specifications

Immunity test

IEC 60601-1-2 test level

Voltage dips, short interruptions and voltage variations on power supply input lines

IEC 61000-4-11

<5% UT

(>95% dip in UT) for

0.5 cycles

40% UT

(60% dip in UT) for 5 cycles

70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec

Compliance level

<5% UT

(>95% dip in UT) for

0.5 cycles

40% UT

(60% dip in UT) for 5 cycles

70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec

Electromagnetic environment guidance

Mains power quality should be that of a typical commercial and/or hospital environment. If the user of the monitor requires continued operation during power mains interruptions, it is recommended that the monitor is equipped with an internal battery or is powered from an uninterruptible power supply.

Power frequency (50/

60 Hz) magnetic field

IEC 61000-4-8

3 A/m 3 A/m Power frequency magnetic fields should be a t levels characteristic of a typical location in a typical commercial and/or hospital environment

In this table, UT is the a.c. mains voltage prior to application of the test level.

Recommended Separation Distance

WARNING

The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that other equipment complies with CISPR emission requirements.

In the following table, 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). The values given in brackets are for respiration and BIS.

Portable and mobile RF communications equipment should be used no closer to any part of the monitor, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter.

Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range.

Interference may occur in the vicinity of equipment marked with this symbol:

433

36 Specifications

Immunity test

Conducted RF

IEC 61000-4-6

Radiated RF

IEC 61000-4-3

IEC 60601-1-2 test level

Compliance level Electromagnetic environment guidance

3 VRMS

150 kHz to 80 MHz

3 V/m

80 MHz to 2.5 GHz

3 VRMS

(1 VRMS for respiration and BIS)

Recommended separation distance: d = 1.2√P

3 V/m

(1 V/m for respiration and BIS) for respiration and BIS: d = 3.5√P

Recommended separation distance:

80 MHz to 800 MHz d = 1.2√P

80 MHz to 800 MHz for respiration and BIS d = 3.5√P

800 MHz to 2,5 GHz d = 2.3√P

800 MHz to 2,5 GHz for respiration and BIS d = 7.0√P

2.0 to 2,3 GHz for short range radio d = 7.0√P

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 monitor is used exceeds the applicable RF compliance level above, the monitor should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the monitor.

These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.

Recommended separation distances from portable and mobile RF communication equipment

The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment.

In the following table, 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). The values given in brackets are for respiration and BIS.

434

36 Specifications

Frequency of transmitter

150 kHz to 80 MHz

Equation

d = 1.2√P for respiration and BIS: d = 3.5√P

Rated max. output power of transmitter

0.01 W

0.1 W

1 W

10 W

100 W

Separation distance

0.1 (0.4) m

0.4 (1.1) m

1.3 (3.5) m

3.8 (11.1) m

12.0 (35.0) m

80 MHz to 800 MHz

d = 1.2√P for respiration and BIS: d = 3.5√P

Separation distance

0.1 (0.4) m

0.4 (1.1) m

1.3 (3.5) m

3.8 (11.1) m

12.0 (35.0) m

800 MHz to 2,5 GHz

d = 2.3√P for respiration and BIS: d = 7.0√P

Separation distance

0.2 (0.7) m

0.7 (2.2) m

2.3 (7.0) m

7.3 (22.1) m

23.0 (70.0) m

Electrosurgery Interference/Defibrillation/Electrostatic Discharge

The equipment returns to the previous operating mode within 10 seconds without loss of any stored data. Measurement accuracy may be temporarily decreased while performing electrosurgery or defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magnetic fields (MRI).

Fast Transients/Bursts

The equipment will return to the previous operating mode within 10 seconds without loss of any stored data (M1032 within 30 seconds). If any user interaction is required, the monitor indicates this with a technical alarm (INOP).

Restart time

After power interruption, an ECG wave will be shown on the display after 30 seconds maximum.

435

36 Specifications

436

37

37

Default Settings Appendix

This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor's default settings can be permanently changed in

Configuration Mode.

Note: If your monitor has been ordered pre-configured to your requirements, the settings at delivery will be different from those listed here.

Country-Specific Default Settings

Certain default settings are specific to a particular country. These are listed here for all countries alphabetically.

Country-Description

Afghanistan

Åland Islands

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antarctica

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

Line

Frequency

50

50

50

50

50

50

60

60

50

60

60

50/60 [Hz]

50

50

50

50

60

Units

Weight

kg kg kg kg kg kg kg lb lb lb kg kg, lb kg kg kg kg lb

Units

Height

cm cm cm cm cm cm cm in in in cm in, cm cm cm cm cm in

ECG Cable

Color

AAMI

AAMI

IEC

AAMI

AAMI

IEC

IEC

IEC, AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

IEC

AAMI

AAMI

437

37 Default Settings Appendix

Country-Description

Bahamas, The

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Bouvet Island

Brazil

British Indian Ocean Territory

Brunei

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Islands

Cocos Keeling Islands

Colombia

Comoros

Congo

Congo, Democratic Republic of the

Line

Frequency

50

60

60

60

50

50

50

50

50

60

50

50

60

60

60

60

50

50

60

60

50

50

50

50

50

60

60

60

60

60

60

50

60

50

50

50

Units

Weight

kg kg lb kg kg kg kg kg kg lb kg kg lb lb kg lb kg kg kg lb kg kg kg kg kg lb lb lb kg lb kg kg lb kg kg kg

438

ECG Cable

Color

IEC

IEC

IEC

IEC

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

IEC

IEC

AAMI

IEC

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

Units

Height

cm cm in cm cm cm cm cm cm in cm cm in in cm in cm cm cm in cm cm cm cm cm in in in cm in cm cm in cm cm cm

Country-Description

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands, Malvinas

Faroe Islands

Fiji

Finland

France

French Guiana

French Polynesia

French Southern Territories

Gabon

Gambia, The

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Units

Weight

kg kg lb lb kg lb lb lb kg lb kg lb kg kg lb kg kg kg lb kg kg kg kg kg kg kg kg kg lb kg kg lb kg kg kg kg kg

Line

Frequency

50

50

60

60

50

60

60

60

50

60

50

60

50

50

60

50

50

50

60

50

50

50

50

60

60

50

60

50

60

50

50

60

60

50

50

60

50

37 Default Settings Appendix

Units

Height

cm cm in in cm in in in cm in cm in cm cm in cm cm cm in cm cm cm cm cm cm cm cm cm in cm cm in cm cm cm cm cm

ECG Cable

Color

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

IEC

IEC

AAMI

IEC

IEC

AAMI

IEC

AAMI

AAMI

IEC

AAMI

IEC

IEC

IEC

IEC

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

IEC

IEC

IEC

IEC

IEC

AAMI

IEC

AAMI

439

37 Default Settings Appendix

Country-Description

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Heard Island and McDonald

Islands

Holy See, Vatican City State

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran, Islamic Republic of

Iraq

Ireland

Isle of Man

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

Korea, Democratic People's

Republic of

Korea, Republic of

Kuwait

Kyrgyzstan

Lao People's Democratic

Republics

Latvia

Lebanon

Lesotho kg kg kg kg kg kg kg kg kg kg kg kg lb lb kg kg kg kg lb kg kg kg kg lb kg kg kg kg

Units

Weight

lb lb kg kg kg kg lb

50

50

50

60

50

50

50

50

50

50

50

50

60

60

50

50

50

50

60

60

50

60

50

60

50

50

50

50

Line

Frequency

60

50

60

60

60

60

60

440

AAMI

AAMI

IEC

IEC

IEC

IEC

AAMI

IEC

IEC

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

IEC

IEC

AAMI

AAMI

AAMI

IEC

ECG Cable

Color

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

IEC cm cm cm cm cm cm cm cm cm cm cm cm in in cm cm cm cm in cm cm cm cm in cm cm cm cm

Units

Height

in in cm cm cm cm in

Country-Description

Liberia

Libyan Arab Jamahiriya

Liechtenstein

Lithuania

Luxembourg

Macao

Macedonia, The former

Yugoslavian Republic of

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia, Federal States of

Moldova, Republic of

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Units

Weight

kg lb lb kg kg lb kg lb lb lb kg lb lb lb kg kg lb kg kg lb kg kg kg lb lb kg kg kg kg kg kg lb kg lb kg kg

60

60

60

60

60

60

50

60

60

60

50

50

60

50

50

50

60

60

50

50

50

50

50

50

60

50

60

50

60

Line

Frequency

50

60

60

50

50

60

50

37 Default Settings Appendix

Units

Height

cm in in cm cm in cm in in in cm in in in cm cm in cm cm in cm cm cm in in cm cm cm cm cm cm in cm in cm in

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

IEC

IEC

AAMI

IEC

AAMI

IEC

IEC

AAMI

IEC

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

ECG Cable

Color

IEC

AAMI

AAMI

IEC

IEC

AAMI

IEC

441

37 Default Settings Appendix

Country-Description Line

Frequency

Niger

Nigeria

Niue

Norfolk Islands

Northern Mariana Islands

Norway

Oman

Pakistan

Palau

Palestinian Territory

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn

Poland

Portugal

Puerto Rico

Qatar

Reunion

Romania

Russian Federation

Rwanda

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Pierre and Miquelon 60

Saint Vincent and the Grenadines 50

Samoa

San Marino

60

60

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Serbia & Montenegro

Seychelles

50

60

60

50

50

50

50

50

60

60

50

60

50

60

50

60

60

50

50

60

60

50

60

50

50

60

50

50

50

60

60

60

50

Units

Weight

kg kg lb kg kg lb kg lb kg lb kg kg kg lb lb lb kg kg lb kg lb kg kg lb lb kg kg kg kg lb kg lb lb kg kg lb kg

442

ECG Cable

Color

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

IEC

AAMI

AAMI

AAMI

IEC

AAMI

IEC

AAMI

AAMI

Units

Height

cm cm in cm cm in cm in cm in cm cm cm in in in cm cm in cm in cm cm in in cm cm cm cm in cm in in cm cm in cm

Country-Description

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Georgia and the South

Sandwich Islands

Spain

Sri Lanka

Sudan

Suriname

Svalbard and Jan Mayen

Swaziland

Sweden

Switzerland

Syrian Arab Rep

Taiwan, Province of China

Tajikistan

Tanzania, United Republic of

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

UK

Ukraine

United Arab Emirates

United Kingdom

Units

Weight

lb lb kg kg kg kg lb kg kg lb lb kg lb lb lb kg kg lb lb kg kg kg kg kg kg lb lb kg lb kg kg lb lb kg lb lb

Line

Frequency

50

50

50

50

60

50

60

60

60

60

60

50

60

60

60

50

50

60

60

50

50

50

50

50

60

50

60

50

60

60

60

60

60

50

60

60

37 Default Settings Appendix

Units

Height

in in cm cm cm cm in cm cm in in cm in in in cm cm in in cm cm cm cm cm cm in in cm in cm cm in in cm in in

AAMI

AAMI

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

IEC

IEC

AAMI

IEC

AAMI

AAMI

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

ECG Cable

Color

IEC

IEC

IEC

IEC

AAMI

IEC

AAMI

AAMI

443

37 Default Settings Appendix

Country-Description

United States

United States Minor Outlying

Islands

Uruguay

Uzbekistan

Vanuatu

Venezuela

Viet Nam

Virgin Islands (British)

Virgin Islands (US)

Wallis and Futuna Islands

Western Sahara

Yemen

Zambia

Zimbabwe

50

50

60

60

50

60

60

60

50

50

60

60

Line

Frequency

60

60 lb lb kg kg lb lb kg lb lb lb kg kg

Units

Weight

lb lb in in cm cm in in cm in in in cm cm

Units

Height

in in

ECG Cable

Color

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

Alarm and Measurement Default Settings

The default wave speed for all measurements except Respiration is 25 mm/sec. For Respiration the default wave speed is 6.25 mm/sec

In the following tables, settings may be entered only once per table row if they are the same for all patient categories.

Alarm Default Settings

Alarm Settings

Alarm Volume

Alarms Off

Pause Al. 5Min

Pause Al. 10Min

Auto Alarms Off

AlarmOffReminder

Visual Latching

Audible Latching

Alarm Reminder

Reminder Time

Factory Default H10/H20/H40

H30 (deviations from H10/

H20/H40)

5

2 min

Enabled

Enabled

Off

Off

Red&Yellow

Red&Yellow

On

3 min

Red Only

Off

444

Alarm Settings

Alarm Sounds

RedAlarmInterval

Yel.Al. Interval

Alarm Low

Red Alarm Volume

Yell.AlarmVolume

Inop Volume

AutoIncrease Vol

IncreaseVolDelay

Keep Blinking

Relay1 Sensitiv.

Relay2 Sensitiv.

Relay3 Sensitiv.

CyanRelayLatency

Yel.RelayLatency

Alarm Text

NoCentrMonMinVol

37 Default Settings Appendix

Factory Default H10/H20/H40

H30 (deviations from H10/

H20/H40)

Traditional

10 sec

20 sec

4

AlarmVol. +2

AlarmVol. +0

AlarmVol. +0

2 Steps

20 sec

No

R&Y&C

Red&Yellow

Red

5 sec

2 sec

Standard

On4

2

ECG, Arrhythmia, ST and QT Default Settings

Factory defaults H10/H20/H40

ECG Settings

Adult Pedi Neo

High Limit

Low Limit

ECG/Arrhy Alarms On

Alarm Source Auto

ECG

QRS Volume

120 bpm

50 bpm

On

1

Primary Lead

Secondary Lead

Analysis Mode

Lead Placement

II

V

160 bpm

75 bpm

On

Auto

On

1

II

V

200 bpm

100 bpm

On

Auto

On

1

II

V

Multi Lead Multi Lead Multi Lead

Standard Standard Standard

Mod.LeadPlacment Off

Filter

AutoFilter

Default ECG Size

Color

Asystole Thresh.

Monitor

Off

Size X1

Green

4.0 sec

Off

Monitor

Off

Size X1

Green

4.0 sec

Off

Monitor

Off

Size X1

Green

3.0 sec

H30 (deviations from H10/H20/H40)

Adult

Auto

Filter

Pedi Neo

445

37 Default Settings Appendix

ECG Settings

Δ ExtrTachy

Tachy Clamp

Δ ExtrBrady

Brady Clamp

ECG AL. OFF Inop

Fallback

Alarms Off

AlarmSource Sel.

Va Lead

Vb Lead

SyncPulse Sensit

SyncPulse Marker

PulseAlarms Tele

Factory defaults H10/H20/H40

Adult

20 bpm

200 bpm

20 bpm

40 bpm

Cyan

On

Enabled

Enabled

V2

V5

Medium

On

Enabled

Pedi

20 bpm

220 bpm

20 bpm

40 bpm

Cyan

On

Enabled

Enabled

V2

V5

Medium

On

Enabled

Neo

20 bpm

240 bpm

20 bpm

50 bpm

Cyan

On

Enabled

Enabled

V2

V5

Medium

On

Enabled

H30 (deviations from H10/H20/H40)

Adult Pedi Neo

40 bpm 60 bpm 80 bpm

Pulse Default Settings

Pulse Settings

Alarm Source

Pulse (source label)

System Pulse

Alarms Off

AlarmSource Sel.

Factory defaults H10/H20/H40

Adult

Auto

On

SpO₂

Enabled

Enabled

Pedi

Auto

On

SpO₂

Enabled

Enabled

Neo

Auto

On

SpO₂

Enabled

Enabled

H30 (deviations from H10/H20/H40)

Adult

Auto

Pedi

Auto

Neo

Auto

Auto Auto Auto

Pulse Alarm Settings

Pulse Alarms1

High Limit

Low Limit

Δ ExtrBrady

Brady Clamp

Δ ExtrTachy

Tachy Clamp

Factory defaults H10/H20/H40

Adult

On

120 bpm

50 bpm

20 bpm

40 bpm

20 bpm

200 bpm

Pedi

On

160 bpm

75 bpm

20 bpm

40 bpm

20 bpm

220 bpm

Neo

On

200 bpm

100 bpm

20 bpm

50 bpm

20 bpm

240 bpm

H30 (deviations from H10/H20/H40)

Adult Pedi Neo

40 bpm

1

When Pulse is not the alarm source, the alarms will be

Off.

Pulse alarms use the settings of the currently selected Pulse alarm source.

60 bpm 80 bpm

446

37 Default Settings Appendix

Respiration Default Settings

Respiration Settings

High Limit

Low Limit

Apnea Time

Alarms

Resp

Detection

Color

Factory defaults H10/H20/H40

Adult

30 rpm

8 rpm

20 sec

On

On

Auto

(Trigger

Mode)

Yellow

Pedi

30 rpm

8 rpm

20 sec

On

On

Auto

(Trigger

Mode)

Yellow

Neo

100 rpm

30 rpm

20 sec

On

On

Auto

(Trigger

Mode)

Yellow

H30 (deviations from H10/H20/H40)

Adult Pedi Neo

Off

White

Off

White

Off

White

SpO2 Default Settings

SpO

2

Settings

Mode

Repeat Time

Alarms

QRS Volume

Tone Modulation

Tone Mod. Type

Perfusion

Average

NBP Alarm Suppr.

Extd. Auto OnOff

Color

Average In Mon.

Signal Quality

SpO

2

Alarm Default Settings

Setting

Desat Limit

Low Limit

High Limit

Desat Delay

Factory Defaults

Adult

Continuous

15 min

On

1

Yes

Enhanced

On

10 sec

On

Disabled

Cyan (light blue)

No

On

Pedi

Continuous

15 min

On

1

Yes

Enhanced

On

10 sec

On

Disabled

Cyan (light blue)

No

On

Neo

Continuous

15 min

On

1

Yes

Enhanced

On

10 sec

On

Disabled

Cyan (light blue)

No

On

Adult

80

90

100

20 sec

Pedi

80

90

100

20 sec

Neo

80

85

95

20 sec

447

37 Default Settings Appendix

SpO

2

Alarm Default Settings

Setting

High Alarm Delay

Low Alarm Delay

SmartAlarmDelay (SAD)

High Alarm Delay (SAD)

Low Alarm Delay (SAD)

Label

Pulse settings

Adult

10 sec

10 sec

Off

Short

Short

SpO₂

Pulse (SpO₂) On On

For all other Pulse default settings, refer to the Pulse Default Settings table.

Pedi

10 sec

10 sec

Off

Short

Short

SpO₂

Neo

10 sec

10 sec

Off

Short

Short

SpO₂

On

NBP Default Settings

NBP Settings

Mode

Alarms from

High Limit

Low Limit

Alarms

NBP

Repeat Time

Pulse (NBP)

Unit

Done Tone

Start Time

VP Pressure

Reference

Color

Factory defaults H10/H20/H30

Adult Pedi Neo

H30 (deviations from H10/H20/H40)

Adult

Auto

Sys.

Auto

Sys.

Manual

Sys.

160/90 (110) 120/70 (90) 90/60 (70) 180/90 (110)

90/50 (60)

On

On

10 min

On mmHg

Off

Synchroniz ed

60 mmHg

Auscultato ry

Red

70/40 (50)

On

On

10 min

On mmHg

Off

Synchroniz ed

40 mmHg

Auscultato ry

Red

40/20 (24) 70/50 (65)

On

On

10 min

On mmHg

Off

Synchroniz ed

3 min

On

NotSynchr on.

30 mmHg

Invasive

Red Magenta

Pedi

3 min

On

NotSynchr on.

Magenta

Neo

3 min

NotSynchr on.

Magenta

448

37 Default Settings Appendix

Temperature Default Settings

Temp Settings

Low Limit

High Limit

Alarms

Unit

Range

Color

Factory defaults H10/H20/H40

Adult

36

39

On

°C

35...43

Green

Pedi

36

39

On

°C

35...43

Green

Neo

36

39

On

°C

35...43

Green

H30 (deviations from H10/H20/H40)

Adult

35

Pedi

35

Neo

35

Light

Green

Light

Green

Light

Green

Invasive Pressure Default Settings

ABP, ART, Ao, BAP,

FAP, P, P P1, P2, P3,

P4, UAP Settings

Alarms from

High Limit

Low Limit

Alarms

Extreme Alarms

Δ Extreme High

Δ Extreme Low

Sys. High Clamp

Factory defaults H10/H20/H40

Adult

Sys.

160/90 (110) 120/70 (90)

90/50 (70)

On

15

15

Pedi

Sys.

70/40 (50)

On

10

10

Neo

Sys.

90/60 (70)

55/20 (36)

On

Disabled Disabled Disabled

5

5

H30 (deviations from H10/H20/H40)

Adult

180/90 (110)

70/50 (70)

190/100

(125)

140/80 (100) 105/75 (75)

Sys. Low Clamp

Scale

Mean only

Filter

Mercury Cal

Artifact Suppr.

Unit

Color

80/45 (65)

150

No

12 Hz

Yes

60 sec mmHg

Red

60/35 (45)

100

No

12 Hz

Yes

60 sec mmHg

Red

45/15 (30)

100

No

12 Hz

Yes

60 sec mmHg

Red

65/45 (65)

Pulse settings (for

ABP, ART, Ao, BAP, FAP, UAP,P)

Pulse (Press label)

On On On

For all other Pulse default settings, refer to the Pulse Default Settings table.

Pedi Neo

449

37 Default Settings Appendix

PAP Settings

Alarms from

High Limit

Low Limit

Alarms

Extreme Alarms

Δ Extreme High

Δ Extreme Low

Dia. High Clamp

Dia. Low Clamp

Scale

Mean only

Filter

Mercury Cal

Artifact Suppr.

Unit

Color

CVP, RAP, LAP, UVP

Settings

Factory defaults H10/H20/H40

Adult

Alarms from

High Limit

Low Limit

Alarms

Mean

14/6 (10)

6/-4 (0)

Extreme Alarms

Δ Extreme High

On

Enabled

5

Δ Extreme Low

5

Mean High Clamp

20/10 (15)

Mean Low Clamp

Scale

Mean only

Filter

0/-5 (-5)

30

Yes

12 Hz

Yes Mercury Cal

Artifact Suppr.

Unit

Color

60 sec mmHg

Cyan (light blue)

Pedi

Mean

10/2 (4)

2/-4 (0)

On

Enabled

5

5

15/5 (10)

0/-5 (-5)

30

Yes

12 Hz

Yes

60 sec mmHg

Cyan (light blue)

Neo

Mean

10/2 (4)

2/-4 (0)

On

Enabled

5

5

15/5 (10)

0/-5 (-5)

30

Yes

12 Hz

Yes

60 sec mmHg

Cyan (light blue)

H30 (deviations from H10/H20/H40)

Adult

Blue

Pedi

Blue

Neo

Factory Defaults

Adult

Dia.

34/16 (20)

10/0 (0)

On

Enabled

5

5

45/20 (25)

5/-5 (-5)

30

No

12 Hz

Yes

60 sec mmHg

Yellow

65/5 (35)

15/-5 (5)

30

No

12 Hz

Yes

60 sec mmHg

Yellow

Pedi

Dia.

60/4 (26)

24/-4 (12)

On

Enabled

5

5

65/5 (35)

15/-5 (5)

30

No

12 Hz

Yes

60 sec mmHg

Yellow

Neo

Dia.

60/4 (26)

24/-4 (12)

On

Enabled

5

5

450

37 Default Settings Appendix

ICP, IC1, IC2 Settings

Alarms from

High Limit

Low Limit

Alarms

Extreme Alarms

Δ Extreme High

Δ Extreme Low

Mean Low Clamp

Mean High Clamp

Scale

Mean only

Filter

Mercury Cal

Artifact Suppr.

Unit

Color

Factory Defaults

Adult

Mean

14/6 (10)

6/-4 (0)

On

Enabled

10

10

20/10 (-5)

0/-5 (0)

30

Yes

12 Hz

Yes

60 sec mmHg

Magenta

Pedi

Mean

10/2 (4)

2/-4 (0)

On

Enabled

10

10

15/5 (-5)

0/-5 (0)

30

Yes

12 Hz

Yes

60 sec mmHg

Magenta

Neo

Mean

10/2 (4)

2/-4 (0)

On

Enabled

10

10

15/5 (-5)

0/-5 (0)

30

Yes

12 Hz

Yes

60 sec mmHg

Magenta

Cardiac Output Default Settings

C.O. Settings

Auto-Calibration

Tblood HighLimit

Tblood Low Limit

Tblood Alarms

Temperature Unit

Color

Factory defaults H10/H20/H40

Adult

On

39.0°C

36.0°C

On

°C

Green

Pedi

On

39.0°C

36.0°C

On

°C

Green

Neo

On

39.0°C

36.0°C

On

°C

Green

CCO/CCI Settings

Settings common to CCO and CCI

Alarms From

CCO From

Color

CCO

Alarms

Factory

Adult

CCO

ABP

Green

On

H30 (deviations from H10/H20/H40)

Adult

Yellow

Factory

Pedi

CCO

ABP

Green

On

Pedi

Yellow

Factory

CCO

ABP

Green

On

Neo

Yellow

Neo

451

37 Default Settings Appendix

CCO High Limit

CCO Low Limit

CCI

Alarms

CCI High Limit

CCI Low Limit

CO2 Default Settings

8.5 l/min

4.0 l/min

On

4.3 l/min/m2

2.0 l/min/m2

3.7 l/min

2.6 l/min

On

4.3 l/min/m2

2.6 l/min/m2

1.3 l/min

0.3 l/min

On

5.2 l/min/m2

1.2 l/min/m2

CO

2

Settings

etCO₂ Low etCO₂ High imCO₂ High

CO₂ Alarms

Unit

Scale imCO₂

N₂O Corr. (only

M3015A/M3016A)

Oxygen Corr. (only

M3014A)

Gas Corr. (only

M3014A)

Humidity Corr.

Max Hold awRR awRR Alarms

High Limit (awRR)

Low Limit (awRR)

Apnea Time

Color

16%

Off

BTPS

Off

On

On

30

8

20 sec

Yellow

Factory defaults H10/H20/H40

Adult

30

50

4

On mmHg

40 mmHg

On

Off

Pedi

30

50

4

On mmHg

40 mmHg

On

Off

Neo

30

50

4

On mmHg

40 mmHg

On

Off

16%

Off

BTPS

Off

On

On

30

8

20 sec

Yellow

16%

Off

BTPS

Off

On

On

60

30

20 sec

Yellow

H30 (deviations from H10/H20/H40)

Adult

25

60

Pedi

25

60

Neo

25

60

50

Off

White

50

Off

White

50

Off

White

452

37 Default Settings Appendix

Spirometry Default Settings

Spirometry Settings

Apnea Time

MVexp Low

MVexp High

PIP High

PEEP Low

PEEP High

High Limit (RRspir)

Low Limit (RRspir)

Scale (AWF)

Scale (AWV)

Scale (AWP)

Factory

Adult

20

4.0 l/min

8.0 l/min

40

0

25

8

30

±150 l/min

±800 ml

±40 cmH

2

O

Factory

Pedi

20

2.5 l/min

4.0 l/min

25

0

25

8

30

±100 l/min

±200 ml

±40 cmH

2

O

Factory

Neo

20

0.4 l/min

0.8 l/min

20

0

25

30

60

±20 l/min

±50 ml

±20 cmH

2

O

tcGas Default Settings

tcGas Settings

tcpO₂ High Limit tcpO₂ Low Limit tcpO₂ Alarms tcpCO₂ HighLimit tcpCO₂ Low Limit tcpCO₂ Alarms

Site Timer

Disable Timer

Heat Switch Off (i.e., after Site Timer elapsed)

Transducer Temp.

CO₂ Correction (Severinghaus)

MetabolismFactor tcGas Unit

Temperature Unit tcpO₂ Color tcpCO₂ Color

Factory

Adult

80 mmHg

50 mmHg

On

50 mmHg

30 mmHg

On

4.0 hours

Not Allowed

No

43.0°C

On

8 mmHg mmHg

°C

Blue

Green

Factory

Pedi

80 mmHg

50 mmHg

On

50 mmHg

30 mmHg

On

4.0 hours

Not Allowed

No

43.0°C

On

8 mmHg mmHg

°C

Blue

Green

Factory

Neo

80 mmHg

50 mmHg

On

50 mmHg

30 mmHg

On

4.0 hours

Not Allowed

No

43.0°C

On

8 mmHg mmHg

°C

Blue

Green

453

37 Default Settings Appendix

SO2 Default Settings

SO

2

Settings

Low Limit

HR High Limit

Alarms

Light Intensity

Color

Hb/Hct Entry

Factor Entry

Factory

Adult

70%

80%

On

On

Yellow

Hct [%]

Disabled

Factory

Neo

70%

80%

On

On

Yellow

SvO2 Default Settings

SO

2

Settings

Low Limit

High Limit

Alarms

Light Intensity

Color

Hb/Hct Entry

Factor Entry

Factory

Adult

60%

80%

On

On

Yellow

Hct [%]

Disabled

Factory

Pedi

60%

80%

On

On

Yellow

ScvO2 Default Settings

SO

2

Settings

Low Limit

High Limit

Alarms

Light Intensity

Color

Factory

Adult

70%

80%

On

On

Yellow

Factory

Pedi

70%

80%

On

On

Yellow

Factory

Pedi

70%

80%

On

On

Yellow

Factory

Neo

60%

80%

On

On

Yellow

Factory

Neo

70%

80%

On

On

Yellow

454

37 Default Settings Appendix

EEG Default Settings

EEG Settings Factory

Adult

Factory

Pedi

Factory

Neo

TP, SEF On

MDF, PPF, Delta, Theta, Alpha, Beta Off

SEF Threshold

Numeric Average

90%

8 sec

Wave Scale

Show Gridlines

Low Filter

High Filter

0.5 Hz

30 Hz

On

Off

90%

8 sec

On

Off

90%

8 sec

100µV (or +/- 50µV if

Show Gridlines is configured to Yes)

No No No

0.5 Hz

30 Hz

0.5 Hz

30 Hz

Impedance Limit

Smoothing CSA

Color

5 kOhm

On

Yellow

5 kOhm

On

Yellow

5 kOhm

On

Yellow

BIS Default Settings

BIS Settings

SQI

EMG

SR

SEF

TP

Bursts

Scale

Show Gridlines

Filters

Low Filter

High Filter

Notch Filter

High Limit

Low Limit

Alarms

Smoothing Rate

Color

Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40)

Adult Pedi Neo

On

On

On

On

On

On

On

On

On

Off

Off

Off

Off

Off

Off

On On On

100µV (or +/- 50µV if

Show Gridlines is configured to

Yes)

No No No

On On On

2 Hz 2 Hz 2 Hz

Adult

Off

70 Hz

On

70

20

On

30 sec

Yellow

70 Hz

On

70

20

On

30 sec

Yellow

70 Hz

On

70

20

On

30 sec

Yellow

15 sec

Magenta

Pedi

Off

15 sec

Magenta

Neo

Off

15 sec

Magenta

455

37 Default Settings Appendix

VueLink Default Settings

Device Alarms

Color

Ignored

Green

456

1

Index

#

10-Electrode (5+5)Cable Sets

374

10-Electrode (6+4)Cable Sets

375

10-Lead Placement

122

3-Electrode Cable Sets

374

,

376

3-Electrode One Piece Cables

376

5-Electrode Cable Sets

374

,

376

5-Electrode One Piece Cables

377

6-Electrode Cable Sets

374

6-Lead Placement

121

A

Abdominal Breathing

162

Aberrantly-Conducted Beats

133

About Arrhythmia Monitoring

131

About Automatic Alarm Limits

57

About Compressed Spectral Arrays

(CSA)

254

About ECG Leads

118

About Electrode-to-Skin Impedance

253

About Label Sets

38

About QT/QTc Interval Monitoring

151

About Smart Alarm Delays

57

,

171

About ST Monitoring

141

About the Rule of Six

342

About the ST Measurement Points

145

Accessing the Drug Calculator

342

Accessing the Setup C.O. and Setup CCO

Menus

199

Accessories

373

Accessories Compliant with EMC

Standards

431

Acknowledging Alarms

51

Acknowledging Disconnect INOPs

51

Activating the Cursor for Screen

Trends

281

Adjusting a Measurement Wave

36

Adjusting ST Measurement Points

145

Adjusting the Alarm Limits

173

Adjusting the Arrhythmia Alarm

Limits

138

Adjusting the Calibration Factor

189

Adjusting the CO2 Wave Scale

224

Adjusting the Desat Limit Alarm

173

Adjusting the iPC Audio Volume

45

Adjusting the Screen Brightness

41

Admitting a Centrally-Monitored

Patient

98

Admitting a Patient

97

Adult Mode

231

Adult/Pediatric Antimicrobial Coated

Reusable cuffs

378

Adult/Pediatric Multi-Patient Comfort

Cuffs and Disposable Cuffs

377

Adult/Pediatric Soft Single Patient Single-

Hose Disposable Cuffs

378

After Insertion

248

Alarm and Measurement Default

Settings

444

Alarm Behavior at Power On

60

Alarm Default Settings

444

Alarm Delays

171

Alarm Lamp

48

Alarm Latching Behavior

60

Alarm Limits

54

Alarm Limits Report

336

Alarm Message

48

Alarm Messages Window

58

Alarm Recordings

61

Alarm Reminder

52

Alarm Source Selection Disabled

159

Alarm Sources

178

Alarm Tone Configuration

49

Alarms

47

Alarms and Alarm Limits

232

Alarms/INOPs From External Devices

353

Alarms/INOPs from External Devices

349

All ECG Waves Recordings

322

Altitude Setting

399

Always Discharge Patients

318

Annotating Events

303

Aperiodic Trends Database

280

Applying the Sensor 2

167

Applying the tcGas Transducer

239

Arrhythmia Alarm Chaining

140

Arrhythmia Alarm Timeout Periods

138

Arrhythmia Alarms

137

Arrhythmia Alarms and Latching

138

Arrhythmia Beat Labels

134

Arrhythmia Options

132

Arrhythmia Relearn and Lead Fallback

137

Arrhythmia Relearning

136

Arrhythmia Status Messages

134

Assessing a Suspicious SpO2 Reading

170

Assigning a Telemetry Device and a

Monitor to One Patient

267

Assisting Venous Puncture

181

Atrial Fibrillation Alarm

133

Attaching and Removing the CO2

Transducer

221

Attaching the Flow Sensor

228

Audible Alarm Indicators

49

Authorized Clinician Review

315

Auto Detection Mode

162

Automatic Alarm Suppression

233

Automatic Arrhythmia Relearn

137

Automatic Purging

231

Automatic Unit Conversion

288

Automatic Value Substitution

288

Automatically Resolving Patient

Mismatch

107

Avoiding Electromagnetic Interference

(Resp and BIS)

432

Avoiding Pace Pulse Repolarization

Tails

116

B

Battery Accessories

391

Battery INOPs

72

BIS

430

BIS Accessories

390

BIS Continuous Impedance Check

262

BIS Cyclic Impedance Check

262

BIS Default Settings

455

BIS Impedance Indicators

263

BIS INOPs

88

BIS Manufacturer's Information

394

BIS Monitoring Setup

259

BIS Safety Information

265

BIS Sensors

390

BIS Window

263

Bright Alarm Limits

48

BSA Formula

288

C

C.O. Injectate Guidelines

208

C.O. INOPs

85

457

C.O./CCO Curve Alert Messages

209

C.O./CCO Prompt Messages

211

C.O./CCO Safety Information

212

C.O./CCO Warning Messages

211

Cableless Measurement Device INOPs

94

Calculated Values INOPs

93

Calculating Cerebral Perfusion

193

Calculating Oxygen Extraction

249

Calculating Pulse Pressure Variation

193

Calculating SpO2 Difference

174

Calculating Temp Difference

184

Calculations

285

Calculations Pop-Up Keys

286

Calculations Windows

286

Calibrating NBP

181

Calibrating Reusable Transducer

CPJ840J6

191

Calibrating the tcGas Transducer

237

Calibrating the Transducer

221

Calibration Failure

238

Capture 12-Lead

125

Capture 12-Lead Pop-up Keys

127

Capturing and Deleting Loops

360

Capturing the 12-Lead ECG

125

Cardiac Output (C.O.) Accessories

385

Cardiac Output / Continuous Cardiac

Output

428

Cardiac Output Default Settings

451

Cardiac Output Report

338

Cardiac Overlay

161

Care and Cleaning

365

Care Group Alarms

112

Care Groups

107

Carrying out a Pre-insertion

Calibration

245

CCO Calibration Status Indicators

204

Central Recording

319

Changing a Screen's Content

31

Changing Alarm Limits

55

Changing awRR Alarm Limits

226

Changing CO2 Alarms

225

Changing Conditions

314

Changing CSA Settings

255

Changing ECG Wave Gain

323

Changing EEG Settings

255

Changing Filter Frequencies

256

Changing HR/Pulse Alarm Limits

159

Changing Lead Sets

119

Changing Loops Display Size

360

Changing Loops Type

361

Changing Measurement Labels (e.g.

458

Pressure)

37

Changing Measurement Settings

35

Changing Monitor Settings

41

Changing QTc Alarm Limits

155

Changing Resp Detection Modes

162

Changing ST Alarm Limits

147

Changing the Alarm Tone Volume

50

Changing the Apnea Alarm Delay

164

,

225

,

232

Changing the Averaging Time

170

Changing the BIS Smoothing Rate

264

Changing the Concentration of Inspired

O2 and the Inspired Agents

234

Changing the ECG Filter Settings

117

Changing the Hi-Res Trend Waves

Displayed

291

Changing the Impedance Limit

253

Changing the Lab Value Required for

Entry

248

Changing the Pressure Wave Scale

189

Changing the Scale of the EEG Wave

264

Changing the Scale of the EEG Waves for

Display

255

Changing the Scale of the ST Map

150

Changing the Screen Trend View

281

Changing the Selection of Screen Trends

Displayed

281

Changing the Size of the ECG Wave

116

Changing the Size of the Respiration

Wave

163

Changing the Speed of the EEG Wave

256

Changing the Speed of the Respiration

Wave

164

Changing the Temperature of the Inspired

Gas

234

Changing the Trending Interval

151

Changing the Type of Balance Gas

233

Changing The View To A Single Wave

Set

153

Changing the Volume of the QRS

Tone

117

Changing the Wave Group Speed

36

Changing The Wave Speed

37

Changing VueLink Waves and Numerics

Displayed

352

Changing Wave Speed for a Channel

36

Changing Wave Speeds

36

Changing Waves and Numerics

Displayed

348

Charting Infusion Progress

344

Checking Paced Status

114

Checking Printer Settings

331

Checking Report Status and Printing

Manually

333

Checking Suspicious Values

249

Checking The Sepsis Resuscitation Bundle

Window

316

Checking Transducer Accuracy

221

Checking Your Monitor Revision

42

Chest Electrode Placement

122

Choosing an ECG Lead for Arrhythmia

Monitoring

132

Choosing an EEG Electrode Montage

252

Choosing EASI or Standard Lead

Placement

118

Choosing Measured AWV

Components

233

Choosing Standard or Modified Electrode

Placement

124

Choosing the NBP Alarm Source

180

Choosing the Pressure Alarm Source

190

Cleaning the Monitor

366

Cleaning the Recorder Printhead (M1116B only)

367

Cleaning the SO2 Optical Module

367

Cleaning, Sterilizing and Disinfecting

Monitoring Accessories

367

CO2

421

CO2 Default Settings

452

CO2 INOPs

82

Comparing Dynamic Compliance

Values

289

Configuration

172

Connecting Additional Displays to the

Monitor

32

Connecting an External Device

347

,

352

Connecting ECG Cables

113

Connecting SpO2 Cables

168

Connecting the Optical Module

248

Connectors

396

Controlling the Telemetry Device from the

Bedside

269

Conventional 12-Lead ECG

123

Correcting the Measurement if Limb is not at Heart Level

177

Counting Combi-Events

301

Counting Neonatal Event Review (NER)

Events

301

Country-Specific Default Settings

437

Creating and Changing Recordings

Templates

322

Current View

148

D

Dashed Lines on Reports

332

Data Exchange Between Information

Centers

104

Data Upload from an MMS

104

Default Profile

34

Default Settings Appendix

437

Deriving Alarms From awRR

226

Determining a Pressure's Most Recent

Zero

187

Devices for Acquiring Measurements

14

Direct Connection - Automatic

Pairing

268

Disabling the tcGas Site Timer

237

Disabling Touchscreen Operation

24

Discharging a Patient

99

Disconnecting from Power

43

Disinfecting the Monitor

366

Display INOPs

74

Displaying A Clock On The Main

Screen

358

Displaying a Mean Pressure Value

Only

189

Displaying a Timer On The Main

Screen

357

Displaying an ST Reference Baseline

150

Disposing of Empty Calibration Gas

Cylinders

371

Disposing of the Monitor

371

Documenting Alarm Limits

58

Documenting an Event Episode

304

Documenting C.O. Measurements

208

Documenting Calculations

289

Documenting Drug Calculations

345

Documenting Event Review

303

Documenting Events

303

Documenting Loops

361

Documenting Trends

279

During Measurements

178

E

EASI ECG Lead Placement

127

EASI Electrode Placement

128

ECG Alarms Off Disabled

130

ECG and Arrhythmia Alarm Overview

128

ECG Lead Fallback

119

ECG Lead Placements

119

ECG Leads Monitored

119

ECG Reports

338

ECG Safety Information

130

ECG Source Tracking at the Information

Center

270

ECG, Arrhythmia, QT and ST INOPs

75

ECG, Arrhythmia, ST and QT Default

Settings

445

ECG, Arrhythmia, ST and QT

Monitoring

113

ECG/Arrhythmia/ST/QT

412

ECG/Resp Accessories

373

Ectopic Status Messages

135

Editing and Saving RH C.O.

Measurements

207

Editing Patient Information

99

Editing PiCCO C.O. Measurements

204

Editing the Wedge

195

EEG

430

EEG Accessories

389

EEG and Electrical Interference

257

EEG Default Settings

455

EEG INOPs

88

EEG Monitoring Setup

251

EEG Reports

256

EEG Safety Information

257

Electromagnetic Compatibility (EMC)

Specifications

431

Electromagnetic Emissions

431

Electromagnetic Immunity

432

Electrosurgery Interference/Defibrillation/

Electrostatic Discharge

435

EMC And Radio Regulatory

Compliance

399

Enabling Automatic Mode and Setting

Repetition Time

180

Enabling Sequence Mode and Setting Up

The Sequence

180

Ending The Sepsis Management

Bundle

318

Ending The Sepsis Resuscitation

Bundle

317

Enhanced Asystole Detection

130

Entering Measurements Manually

40

Entering the HemoCalc Window

200

Entering the Setup Pulse Menu

157

Entering Values for Calculations

288

Environmental Specifications

403

Event Episode Recordings

305

Event Episode Reports

307

Event Episode Window

302

Event Episodes

295

Event Groups

294

Event Notification

298

Event Recordings

304

Event Reports

306

Event Retriggering

298

Event Review Recordings

304

Event Review Reports

306

Event Review Window

302

Event Summary and Event Counter

301

Event Summary Reports

308

Event Summary Window

301

Event Surveillance

293

Event Triggers

296

Events Pop-Up Keys

296

Example Module (SpO2)

16

Examples

172

Expanded View

277

Extended Pressure Label Set

186

Extended Temperature Label Set

184

Extending Recordings

320

Extending the Alarm Pause Time

54

Extreme Alarm Limits

129

,

159

,

191

F

Fast Transients/Bursts

435

Finishing tcGas Monitoring

240

Flashing Numeric

48

Flexible Module Rack (M8048A)

15

Freezing All Waves

37

Freezing An Individual Wave

36

Freezing Waves

36

Functions Available When the Telemetry

Data Window is Displayed

269

Further Information for Both Modules

249

G

Gas Compensation

231

General Points

365

General Telemetry-related Functions

270

Getting Started

42

Graphical Trend Presentation

279

Guidelines for PiCCO C.O. Injectate

208

Guidelines for Right Heart Thermodilution

C.O. Injectate

208

H

Hardkeys

27

Hemodynamic Parameters

197

High ETVI

208

High Resolution Trend Waves

291

Hi-Res Trend Wave Recordings

292

Hi-Res Trend Wave Scales

291

Hi-Res Trend Waves and OxyCRG

291

Histogram View

282

Horizon View

282

How are Yellow Arrhythmia Alarms

Indicated?

139

How Can You Combine Devices?

267

HR Alarms When Arrhythmia Analysis is

459

Switched Off

130

Hypotension Evaluation

314

I

Ice-Bath Setup for RH Thermodilution

C.O. Measurements

207

Identifying tcGas Module

Components

235

Identifying the Pressure Analog Output

Connector

196

If You Set "On Measurement" Triggers

297

If You Set Use-defined Deviation

Triggers

298

If You Set User-defined Threshold

Triggers

297

If You Use Alarm Limits As Event

Triggers

297

Impedance Indicators

254

Indications For Use Of QT Interval

Monitoring

152

Indirect Connection - Manual Pairing

267

Initiating Arrhythmia Relearning

Manually

136

Injectate Volume, Patient Weight and

ETVI Values (PiCCO Only)

208

INOPs from the IntelliBridge Module

349

Inserting the Catheter

246

Inspecting the Cables and Cords

370

Inspecting the Equipment and

Accessories

369

Inspecting the Monitor

42

Installation Safety Information

396

IntelliBridge EC10 Module

347

IntelliBridge INOPs

92

IntelliVue 802.11 Bedside Adapter (Option

J35 Wireless Network Adapter)

400

IntelliVue Instrument Telemetry ISM

(2.4GHz)

400

IntelliVue Instrument Telemetry WMTS

(US only)

401

Intended Use

393

Interface Specifications

408

Interfering Gas and Vapor Effects On CO2

Measurement Values

425

Intermittent Bundle Branch Block

133

Intravascular Oxygen Saturation

429

Introducing the Monitor

13

Introducing the Oscillometric NBP

Measurement

175

Introduction

13

Invasive Pressure Accessories

379

Invasive Pressure Alarm Specifications

421

Invasive Pressure and Pulse

419

Invasive Pressure Default Settings

449

ISO/IEC Standard Audible Alarms

50

L

Label Compatibility

40

Laboratory Data

363

Lactate Measurement

314

Language Conflict with External Device

Drivers

349

,

354

Latching Alarms

59

Lateral Chest Expansion

162

Lead Placement for Monitoring Resp

161

Left side of the Monitor

398

Levels of Event Surveillance

293

Limitations For Use Of QT Interval

Monitoring

152

Locked Profiles

34

M

M3012A Hemodynamic MMS

Extension

22

M3014A, M3015A, M3015B and M3016A

Capnography MMS Extensions

20

Main Screen Timer Pop-up Keys

358

Mainstream CO2 Accessories

386

Mainstream CO2 Accessories (for

M3016A)

387

Maintaining Recording Strips

324

Maintenance and Troubleshooting

369

Maintenance Task and Test Schedule

370

Major Parts and Keys

14

Making a Temp Measurement

183

Making Segment Settings

276

Making the In-Vivo Calibration

247

Making the Pressure Calibration

192

Managing Patients

97

Manual Detection Mode

163

Manual Purging

231

Manual Unit Conversion

288

Manually Resolving Patient Mismatch

105

Manufacturer's Information

261

,

393

Measurement Limitations

176

Measurement Modes

176

Measurement Modules

15

Measurement of CO2 and Spirometry with

Neonates

388

Measurement Principles

216

Measurement Specifications

412

Measuring C. O. Using the PiCCO

Method

200

Measuring C.O. Using the Right Heart

Thermodilution Method

205

Measuring CO2 using M3014A or X2

216

Measuring Continuous Cardiac

Output

200

Measuring Frozen Waves

37

Measuring Mainstream CO2 using

M3016A

220

Measuring Microstream CO2 using

M3015A/B

222

Measuring Pulmonary Artery Wedge

Pressure

194

Measuring Pulse Pressure Variation

200

Measuring SpO2

169

Measuring Systemic Vascular

Resistance

200

Metabolism Correction for tcpCO2

241

Microstream CO2 Accessories

387

Minimum Volume for No Central

Monitoring INOP

50

Minimum Volume for Severe Yellow or Red

INOPs

50

MMS Extensions

20

MMS, MMS Extensions and FMS

INOPs

73

Modified 12-Lead ECG

124

Monitor INOPs

69

Monitor Mounting Precautions

399

Monitor Safety Specifications

399

Monitoring After a Power Failure

43

Monitoring Airway Flow, Volume and

Pressure

227

Monitoring BIS

259

Monitoring BIS using the BISx

261

Monitoring BIS Using the DSC and BIS

Engine

260

Monitoring Carbon Dioxide

215

Monitoring Cardiac Output

197

Monitoring EEG

251

Monitoring Intravascular Oxygen

Saturation

243

Monitoring Invasive Pressure

185

Monitoring NBP

175

Monitoring Paced Patients

115

Monitoring Pulse Rate

157

Monitoring Respiration Rate (Resp)

161

Monitoring SpO2

167

Monitoring tcGas

235

Monitoring Temperature

183

Monitoring the Sepsis Management Bundle

Recommendations

317

Monitoring the Sepsis Resuscitation Bundle

Recommendations

315

Moving Windows

24

460

N

NBP

418

NBP Accessories

377

NBP Default Settings

448

NBP INOPs

77

NBP Timestamp

178

Neonatal and Pediatric Modes

231

Neonatal/Infant Cuffs (Disposable, nonsterile)

379

Networked Monitoring

44

New Patient Check

100

New/Dried Out Transducers

237

No. of Segments

277

Non-Physiological Artifact

Suppression

190

Notification

357

Nurse Call Systems

49

O

One-piece Cables

375

Operating and Navigating

22

Operating Modes

29

Optimizing Lead Placement for Resp

161

Optimizing Scale Settings

232

Optimizing the Waveform

189

Optimum Scale

277

Orientation On The Screen

312

Other Bed Pop-Up Keys

111

Other BIS Accessories

390

Other Reports

339

Overview of Recording Types

321

P

Pairing an X2 or MP5 With a Telemetry

Interface to a Host Monitor

269

Patient Alarm Messages

63

Patient Alarms and INOPs

63

Patient Category and Paced Status

98

Patient Mismatch - If Both Patient Data

Sets Are Correct

106

Patient Mismatch - If Neither Patient Data

Set is Correct

106

Patient Mismatch - If One Set of Patient

Data is Correct

105

Pausing or Switching Off Alarms

52

Performance Specifications

405

Performing a Light Intensity

Calibration

246

Performing Calculations

287

Performing Calculations for a Non-Specific

Drug

343

Performing Calculations for a Specific

Drug

343

Performing Drug Calculations

342

Performing In-Vivo Calibration

246

,

249

Performing PiCCO C.O.

Measurements

203

Performing RH C.O. Measurements

207

Perfusion Change Indicator

173

Perfusion Numeric

173

Permanent Keys

24

Physical Specifications

401

Pleth Wave

173

Pop-Up Keys

27

Power Loss Tone

51

Power On/Power Off Behavior

43

Preparing to Measure Mainstream

CO2

217

,

221

Preparing to Measure Microstream

CO2

223

Preparing to Measure NBP

177

Preparing to Measure Sidestream CO2

218

Preparing to Monitor with the M1011A

Narrow Module

248

Preparing to Monitor with the M1021A

Wide Module

244

Pressure INOPs

81

Previewing the Sepsis Management

Bundle

317

Printer Status Messages

334

Printing a Test Report

331

Printing an ST Map Report

151

Printing Hi-Res Trend Wave Reports

292

Printing Manually

333

Printing Patient Reports

327

Printing the 12-Lead ECG

126

Printing The QT Waves

154

Printout Location

327

ProtocolWatch

311

ProtocolWatch INOPs

93

Pulse Default Settings

446

Pulse INOPs

76

Q

QRS Tone

159

QT Alarms

154

QT Measurement Algorithm

151

QT View

153

Quick Admitting a Patient

98

Quickstarting Recordings

320

R

Radio-translucent Cables

375

Realtime Report

337

Rear of the Monitor

397

Recommended Cables

373

Recommended Separation Distance

433

Recommended separation distances from portable and mobile RF communication equipment

434

Recorded Waveforms

324

Recorder Accessories

391

Recorder Status Messages

325

Recording

319

Recording Priorities

323

Recording ST Segments

144

Recording Strip

323

Recording Strip Code

323

Recording The QT Waves

154

Recording Without a Template

320

Reference Method

176

Releasing Frozen Waves

40

Reloading Paper

324

Remembraning the tcGas Transducer

237

Removing Exhaust Gases from the

System

220

,

224

Resetting Arrhythmia Alarm Timeouts

53

Resetting the Timeout Period

139

Resolving Label Conflicts

38

Resolving Patient Information

Mismatch

104

Resp Detection Modes and Cardiac

Overlay

163

Resp INOPs

77

Resp Safety Information

164

Respiration

415

Respiration Default Settings

447

Respiratory Loops

359

Restart time

435

Restarting Paused Alarms

53

Restarting the tcGas SiteTimer

236

Reusable Cuff Kits

378

Review Alarms Window

58

Reviewing Alarms

58

Reviewing Calculations

287

Rhythm Status Messages

135

Right side of the Monitor

398

Run Time

356

Running a Car Seat Assessment Record

300

S

Safety and Performance Tests

431

Sample Report Printouts

335

Saving and Calibrating PiCCO C.O.

461

Measurements

204

Screen Trends

280

ScvO2 Default Settings

454

Selecting a Measurement Label

244

Selecting a Pressure for Monitoring

186

Selecting a Temperature for

Monitoring

183

Selecting Leads for ST Analysis

142

Selecting Positions of Va and Vb Chest

Leads (for 6-lead placement)

118

Selecting Screen Elements

23

Selecting the Active Alarm Source

ECG or Pulse?

158

Selecting the Primary and Secondary ECG

Leads

114

Selecting The QT Leads

152

Selecting the tcGas HeatPowerDisplay

Mode

240

Sepsis Management Bundle

317

Sepsis Resuscitation Bundle

315

Set Combiners and Organizers

375

,

377

Setting Measurement and Period for

Histograms

279

Setting SpO2/Pleth as Pulse Source

174

Setting the Computation Constant

207

Setting the Date and Time

41

Setting the Gas Compensation Mode

233

Setting the Horizon

282

Setting the Horizon Trend Scale

283

Setting the Paced Status (Pace Pulse

Rejection)

116

Setting the QRS Volume

174

Setting The QT Baseline

153

Setting the Screen Trend Time

281

Setting the tcGas Barometric Pressure

237

Setting the tcGas Sensor Temperature

235

Setting the tcGas Site Timer

236

Setting the Time Period for the Trend

Indicator Arrow

283

Setting Triggers and Notification for

Advanced Event Surveillance

299

Setting Triggers for NER and Basic Event

Surveillance

298

Setting up all CO2 Measurements

224

Setting Up Auto Reports

330

Setting up CO2 Corrections

224

Setting Up ECG Reports

329

Setting Up Individual Print Jobs

330

Setting Up Reports

329

Setting up RH C.O. Measurements

206

Setting Up Source Device

361

Setting up Spirometry

232

Setting Up the 12-Lead ECG

126

Setting Up the In-Vivo Calibration

246

,

247

Setting up the Modules

43

Setting Up the PiCCO C.O.

Measurement

202

Setting up the Pressure Measurement

185

Setting Up Timers

356

Setting Up Tone Modulation

174

Setting Up Trends

276

Setting Up Vital Signs and Graphic Trend

Reports

329

Severe Sepsis Screening

313

Short Range Radio Interface

401

Showing/Hiding Loops

360

Shutting the iPC Down

45

Sidestream CO2 Accessories

386

Single- or Multi-lead ST Alarming

147

Skin Preparation for Electrode

Placement

113

SmartKeys

25

SO2 Accessories for M1011A

391

SO2 Accessories for M1021A

390

SO2 Default Settings

454

SO2 INOPs

84

Special Situations at Shutdown

45

Specifications

393

Spirometry

426

Spirometry Accessories

388

Spirometry Default Settings

453

Spirometry INOPs

90

Spirometry Values Window

232

SpO2

415

SpO2 Accessories

380

SpO2 Default Settings

447

SpO2 INOPs

79

SpO2 Sensors

167

SpO2 Signal Quality Indicator (Fast SpO2 only)

169

SSC Sepsis Protocol

311

ST Alarms

147

Standard 3-Lead Placement

120

Standard 5-Lead Placement

121

Standby Mode

30

Starting a Cyclic Impedance Check

262

Starting and Stopping Measurements

178

Starting and Stopping Recordings

319

Starting Monitoring

43

Starting Report Printouts

327

Starting the Different Types of Report

328

Starting the iPC

44

Sterilizing the Monitor

367

Stopping a Cyclic Impedance Check

262

Stopping Recordings

320

Stopping Reports Printouts

328

Storing and Sending the 12-Lead ECG

126

Storing tcGas Transducers

237

Supported Cables

376

Suppressing Sampling (not Mainstream

CO2)

225

Suppressing Zero Calibration

224

Suspending Telemetry Alarms

270

Suspending the Protocol for 24 Hours

313

SvO2 Default Settings

454

Swapping a Complete Profile

34

Swapping a Settings Block

34

Switching a Measurement On and Off

35

Switching All Yellow Arrhythmia Alarms

On or Off

138

Switching Arrhythmia Analysis On and

Off

132

Switching Between ST Map Views

150

Switching BIS and Individual Numerics On and Off

264

Switching BIS Filters On or Off

264

Switching EEG Numerics On and Off

255

Switching Individual Arrhythmia Alarms

On and Off

138

Switching Individual QTc Alarms On and

Off

155

Switching Manually Entered Measurements

On and Off

41

Switching Numerics On and Off

35

Switching On

42

Switching Printers On Or Off for

Reports

332

Switching Pulse from NBP On/Off

181

Switching Pulse On and Off

158

Switching QT Monitoring On and Off

155

Switching ST On and Off

142

Switching to a Different Screen

31

Switching VueLink On and Off

353

Symbols

395

Synchronized Settings

271

System Pulse Source

157

T

Tabular View

282

tcGas

428

tcGas Accessories

389

TcGas Corrections

240

tcGas Default Settings

453

tcGas INOPs

87

462

Technical Alarm Messages (INOPs)

68

Telemetry Data Window

268

Telemetry INOPs

92

Temp

421

Temperature Accessories

384

Temperature Correction for tcpCO2

240

Temperature Default Settings

449

Temperature INOPs

78

Testing Alarms

60

The Events Database

300

Timer Counting Direction

357

Timer Label

356

Timer Setup Pop-up Keys

356

Timer Types

355

Timer Volume

357

To Change the Size of all the ECG

Waves

117

To Change the Size of an Individual ECG

Wave

117

To Discharge a Patient

99

To Pause All Alarms

52

To Switch All Alarms Off

52

To Switch Individual Measurement Alarms

On or Off

53

Trademark Acknowledgement

394

Traditional Audible Alarms (HP/Agilent/

Philips/Carenet)

49

Transferring a Centrally-Monitored

Patient

101

Transferring a Centrally-Monitored Patient with X2 or MP5

102

Transferring a Centrally-Monitored Patient with X2 or MP5 using IIT

102

Transferring a Patient with an X1 (no

Information Center)

103

Transferring a Patient with an X2 or MP5

(no Information Center)

103

Transferring Patients

100

Transferring Patients And Moving

Manually Between Phases

312

Trend Group

277

Trend Groups

277

Trend Interval

278

Trend Parameter Scales

278

Trend Priority

278

Trend Scales for Segment

Measurements

277

Trend View

149

Trending Multiple-Value

Measurements

280

Trends

273

Trends Databases

280

Trends Pop-Up Keys

274

Triggering Events Manually

299

Troubleshooting

371

Troubleshooting tcGas Calibration

239

Troubleshooting the Pressure

Calibration

193

Troubleshooting the Zero

188

Trunk Cables

373

,

376

Two Or More Infection Signs Or

Symptoms Confirmed

314

U

Unavailable Printer

Re-routing Reports

332

Understanding Profiles

33

Understanding PVC-Related Alarms

141

Understanding Screens

31

Understanding Settings

34

Understanding SpO2 Alarms

170

Understanding the Arrhythmia

Display

134

Understanding the Care Group Overview

Bar

108

Understanding the ECG Display

114

Understanding the NBP Numerics

178

Understanding the Resp Display

162

Understanding the ST Display

143

Updating an ST Map Reference

Baseline

150

Updating ST Baseline Snippets

144

Updating The Frozen Wave

40

Use Models With Telemetry

272

Using a Mouse or Trackball

24

Using ECG Alarms

129

Using Input Devices with the iPC and

Monitor

45

Using Keys

24

Using Labels

37

Using Microstream Accessories

223

Using Pulse Alarms

158

Using Resp Alarms

164

Using Screens with External Device

Data

348

Using Standby

270

Using the C.O.Procedure Window

198

Using the Drug Calculator

341

Using the EEG Impedance/Montage

Window

252

Using the FilterLine and Airway

Adapter

223

Using the Integrated PC

44

Using the Loops Cursor

360

Using the On-Screen Calculator

29

Using the On-Screen Keyboard

29

Using the Remote Control

28

Using the Sidestream Sensor Holder

220

Using the SmartKeys Key

28

Using the tcGas Site Timer

236

Using the Titration Table

345

Using the Touchscreen

24

Using the Visitor Screen

33

Using the Wave Cursor

190

Using the X2 or MP5 with a Host

Monitor

46

Using the XDS Remote Display

32

Using the Zero Hardkey

188

Using Timers

355

Using VueLink Screens

353

V

Viewing All Alarm Limits

54

Viewing an ST Map

150

Viewing And Printing The Protocol

Log

318

Viewing and Silencing Telemetry Alarms at the Bedside

269

Viewing Arrhythmia Waves

134

Viewing Calculations

286

Viewing Events

300

Viewing Graphic Trends

274

Viewing Histogram Trends

276

Viewing Individual Alarm Limits

54

Viewing Loops

359

Viewing Received Data

363

Viewing ST Maps

148

Viewing the Alarm Latching Settings

59

Viewing the IntelliBridge Device Data

Window

348

Viewing the iPC Desktop on the Monitor

Display

45

Viewing the My Care Group Window

109

Viewing the Other Bed Window

110

Viewing the Realtime 12-Lead ECG

125

Viewing the VueLink Device Data

Window

353

Viewing Timers

355

Viewing Trends

273

Viewing Vital Signs Trends

275

Visual Alarm Indicators

48

Visual Alarm Status Information in the

Other Bed Window

111

VueLink Default Settings

456

VueLink INOPs

91

VueLink Modules

351

463

W

Weight

208

What is a Timeout Period?

139

Where Can I Find More Information?

132

,

152

While Alarms are Paused or Off

53

Working in the ST Map Task Window

150

X

X1 Connectors and Symbols

17

X1 Multi-Measurement Module

(M3001A)

16

X2 Controls and Indicators

18

X2 Left Side

19

X2 Multi-Measurement Module

(M3002A)

17

X2 Overview

18

X2 Patient Connectors, Right Side

19

Y

Yellow Arrhythmia Alarms

138

Z

Zero Calibration

230

Zeroing a Pressure Measurement

187

Zeroing All Pressures Simultaneously

188

Zeroing ICP (or IC1/IC2)

187

Zeroing the Pressure Transducer

187

Zeroing the tcGas Relative Heat Power

240

464

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