AS/3™Compact Anesthesia Monitor upgraded with U

AS/3™Compact Anesthesia Monitor upgraded with U
AS/3
 Compact Anesthesia Monitor upgraded with U-LIFE2
User’s Guide
Part II: For Daily Use
8003655_1.p65
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3/4/02, 12:50 PM
Datex-Ohmeda
AS/3 Compact Anesthesia Monitor upgraded with U-LIFE2
User’s Guide
Part II: For Daily Use
Related to software licenses L-ANE03 and L-ANE03A
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Conformity according to the Council Directive 93/42/EEC concerning Medical Devices
CAUTION: U.S. Federal law restricts this device to sale by or on the order of a licensed medical practitioner.
Outside the USA, check local laws for any restriction that may apply.
All specifications subject to change without notice.
Document no. 8005784-0
August 2003
Datex-Ohmeda Inc.
P.O Box 7550
Madison, WI 53707-7550, USA
Tel: +1-608-221 1551, Fax:+1-608-222 9147
www.us.datex-ohmeda.com/
Datex-Ohmeda Division, Instrumentarium Corporation
P.O. Box 900, FIN-00031
DATEX-OHMEDA, FINLAND
Tel. +358 10 39411, Fax +358 9 1463310
www.datex-ohmeda.com/
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The AS/3 Compact Anesthesia Monitor upgraded with L-ANE03 or L-ANE03A software
is indicated for monitoring of hemodynamic (including arrhythmia and ST-segment
analysis), respiratory, ventilatory, gastrointestinal/regional perfusion, Bispectral index
(BIS), Entropy (State Entropy and Response Entropy) and neurophysiological status of
all hospital patients.
The AS/3 Compact Anesthesia Monitor with L-ANE03 and L-ANE03A software when
using BIS is for monitoring the state of the brain by data acquisition and processing of
electroencephalograph signals and may be used as an aid in monitoring the effects of
certain anesthetic agents.
The AS/3 Compact Anesthesia Monitor with L-ANE03 or L-ANE03A software is also
indicated for documenting patient care related information.
The AS/3 Compact Anesthesia Monitor with L-ANE03 or L-ANE03A software is
indicated for use by qualified medical personnel only.
About this guide
This User’s Guide describes the most common features and functions offered by the
Datex-Ohmeda AS/3 Compact Anesthesia Monitor. Descriptions refer to S/5 software
licenses L-ANE03 and L-ANE03A.
If you are a new user of the monitor, we suggest you begin with the section “Starting and
ending.” Also read Part I of this User's Guide. The following conventions are used:
− Names of the hard keys on the Command Board, Remote Controller and modules
are written in the following way: ECG.
− Menu items are written in bold italic typeface, for example ECG Setup
− Menu access is described from top to bottom. For example, the selection of the
Screen Setup menu item and the Waveform Fields menu item would be shown as
Screen Setup - Waveform Fields.
− Messages (alarm messages, informative messages) displayed on the screen are
written inside single quotes: ‘Learning’.
− When referring to different sections in this manual, section names are enclosed in
double quotes: “Cleaning and Care.”
− In this manual, the word “select” means choosing and confirming.
Classifications
In accordance with IEC 60601-1:
− Class I and internal powered equipment - the type of protection against electric
shock.
− Type BF or CF equipment. The degree of protection against electric shock is
Related documentation
indicated by a symbol on each parameter module.
− Equipment is not suitable for use in the presence of a flammable anesthetic
Clinical aspects, basic methods of measurement and technical background:
S/5 Compact Anesthesia Monitor, User’s Reference Manual
Monitor setup instructions: AS/3 Compact Anesthesia Monitor upgraded with ULIFE2, User's Guide Part I
Installation, technical solutions and servicing: AS/3 and CS/3 Compact Monitors
upgraded with U-LIFE2 and S/5 Modules, Technical Reference Manuals
Options and selections of the software: Default Configuration Worksheet
Supplies and accessories: CS/3 Compact Critical Care Monitor upgraded with ULIFE2, User's Guide Part I
Other devices closely related to the AS/3 Compact Anesthesia Monitor:
S/5 Central and S/5 Arrhythmia Workstation User’s Reference Manuals
mixture with air or with oxygen or nitrous oxide.
− Continuous operation according to the mode of operation.
In accordance with IEC 60529:
− IPX1 - degree of protection against harmful ingress of water
In accordance with EU Medical Device Directive: IIb
Responsibility of the manufacturer
Datex-Ohmeda Division, Instrumentarium Corp. is responsible for the safety, reliability
and performance of the equipment only if:
− assembly, extensions, readjustments, modifications, service and repairs are
carried out by personnel authorized by Datex-Ohmeda.
− electrical installation complies with appropriate requirements.
− the equipment is used in accordance with this User’s Guide.
Intended purpose (Indications for use)
The Datex-Ohmeda AS/3 Compact Anesthesia Monitor upgraded with L-ANE03 or
L-ANE03A software is intended for multiparameter patient monitoring with optional
patient care documentation.
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Contents
Starting and ending (Start/End)................................ 3
Entering and loading patient data (Start/End) ........... 4
Screen setup (Start/End) ......................................... 5
Alarms..................................................................... 7
Anesthesia record keeping (Report)........................... 9
Laboratory data and calculations (Calcs) ................. 11
Trends and snapshots (Trends)................................ 13
Recording and printing (Print)................................. 15
Troubleshooting (What if?)...................................... 19
Messages (What if?) .............................................. 25
ECG/ST ................................................................. 35
Impedance respiration (Resp./Temp.) ..................... 45
Temperature (Resp./Temp.).................................... 46
Pulse oximetry (SpO2) ............................................. 47
Non-invasive blood pressure (NIBP) ......................... 49
Invasive blood pressure (InvBP/PCWP) .................... 51
Cardiac output (C.O.) ............................................. 55
Mixed venous oxygen saturation (SVO2).................... 57
Airway gases (Gases).............................................. 59
Patient Spirometry (Spirom.)................................... 61
Gas exchange (Gas exch.) ....................................... 63
Tonometry (Tono).................................................... 65
Neuromuscular transmission (NMT) ......................... 67
EEG and evoked potentials (EEG)............................. 69
Bispectral Index (BIS)............................................. 73
Entropy.................................................................. 75
Trademarks
Datex®, Ohmeda®, and other trademarks AS/3, S/5, D-lite, D-lite+, Pedi-lite,
Pedi-lite+, D-fend, D-fend+, Mini D-fend, TruTrak®+, OxyTip+, MemCard,
ComWheel, EarSat, FingerSat, FlexSat, PatientO2, Entropy, Patient Spirometry and
Tonometrics are property of Instrumentarium Corp. or its subsidiaries. All other
product and company names are property of their respective owners.
© Instrumentarium Corp. All rights reserved.
A portion of the entropy software is derived from the RSA Data Security, Inc. MD5
Message-Digest Algorithm.
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Starting and ending
Automatic case reset
Preparations
The monitor resets a case automatically after a predefined time when
vital signs for some parameters (ECG, Art, NIBP, SpO2, CO2, Resp,
tonometry, EEG, BIS, entropy) or events are not available. When a
case is reset, all trend data will be cleared and alarm limits set to
default values. The predefined reset time depends on the software
license and availability of the network and MemCard option as follows:
L-ANExx software license with network and/or MemCard option: after
15 minutes.
L-ANExx software license without network or MemCard option:
after 60 minutes.
NOTE: This does not apply to user mode CPB in software license
L-ANE03(A).
NOTE: Before using the AS/3 Compact Anesthesia Monitor for the first
time, charge the batteries to their full capacity (charging time 10 hours).
1. Plug in the measurement modules.
2. Turn on the monitor from the power switch.
3. If necessary, change the user mode:
Press the Monitor Setup key and select Select Mode.
NOTE: Changing the mode also changes settings such as the alarm
limits. For details, see the "User's Reference Manual."
Starting monitoring
1. Prepare patient connections according to the setup picture in the
measurement section. Use only Datex-Ohmeda approved supplies
and accessories. The alarms and parameter default settings
become active.
2. If necessary, adjust the waveform and digit fields; see section
"Screen setup."
3. Zero invasive pressure lines, see section “Invasive blood
pressure.”
4. Check the alarm limits; press the Alarms Setup key. Change
them, if necessary. See section "Alarms."
5. Start the measurement according to the instructions in the
measurement section.
6. Enter or load patient data by pressing the Patient Data key; see
section "Entering and loading patient data" below.
A case starts automatically when the monitor receives a patient’s vital
signs, or patient data is entered by the user.
Always observe the monitor and the patient carefully during start-up
periods.
Ending monitoring
1. Print necessary data. Press the Record/Print key.
2. Wait until the printing is finished. Then clear the patient data and
return the settings to their defaults: Reset Case - Reset ALL - YES.
3. Turn the monitor to standby by pressing the power switch if the
monitor will not be used.
4. Clean the monitor according to the instructions.
WARNING: Connect only one patient to the monitor at a
time.
WARNING: Always make sure that necessary alarm
limits are active and set according to the patient's
clinical condition when you start monitoring a patient.
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Entering and loading patient data
When loading trends of patient data without patient’s name or ID,
select the data according to time indicated in the message field.
Entering patient data
When you start a new case, you must enter all relevant patient data:
1. Press the Patient Data key.
2. Enter patient data by pushing and turning the ComWheel.
Receiving data from other sites
Once the monitor is connected to the Datex-Ohmeda network, you can
view and receive data from other monitors in the network.
Loading patient data
To load a case that has already been started on the same or another
monitor, press the Patient Data key and select one of the following:
• Load Prev. Case
Select this when neither memory cards nor network are in use. This
loads the most recent case from the monitor memory when less than
15 minutes has elapsed from the turn-off. If the monitor has been on
but reset, the last case from the previous 24 hours can be retrieved.
• Patient from Net.
Select this when the monitor is connected to the network. This loads a
case from the network. Note that the case must have been closed less
than 24 hours ago.
• Other Networks
Select this to load a case from another network.
• Patient from Card
Select this when the memory cards are in use. This loads a case from
the Data Card. Note that the case must have been closed less than 24
hours ago.
NOTE: You can load a case from a Critical Care Monitor to an
Anesthesia Monitor only if the total length of the case is less than 24
hours (the max. case length for the L-ANE03 and L-ANE03A software
licenses).
1. Press the Patient Data key.
2. Select Other Patients.
• To receive alarms from other patient sites, select Receive Alarms
(and the correct network if there are several available).
• To view other patients’ vital signs, select Show Vital Signs (and
the correct network if there are several available).
NOTE: The heart rate is always calculated from ECG, independently
from the selection made at the other site.
Saving data
The AS/3 Compact Anesthesia Monitor continuously saves patient
data, for example trends. Saving is activated once the case is started.
The monitor saves automatically:
in the monitor memory the most recent case if neither memory
module nor network is in use.
in the network cases from 2 to 90 days depending on the
configuration.
on the Data Card up to 48 hours of information (depends on the
data load). The green Data Card stores and transfers information.
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Screen setup
the "User's Reference Manual" and “Default Configuration
Worksheet."
Selecting a user mode
Modes determine, for example, what is displayed on the screen and in
trends and what the alarm limits are. The monitor starts in startup
mode. The startup mode is one of the user modes chosen during
configuration. To select a user mode:
1. Press the Monitor Setup key.
2. Select Select Mode and choose one of the options.
Changing the modes is described briefly in the User's Guide Part I,
section "Setting up the monitor before use." For more information,
please refer to the “User’s Reference Manual.”
Selecting an appropriate page
In addition to Normal Screen, you can define up to five more pages for
looking at the information on the screen. Pages are preconfigured but if
desired, can also be changed.
To move between different pages:
1. Close all menus.
2. Push the ComWheel to open the Select Page menu.
3. Select the page.
For more information, please refer to the User's Guide Part I, section
"Setting up the monitor before use" or the “User’s Reference Manual.”
Modifying the screen temporarily
• Press the Monitor Setup key and select Screen Setup.
Change the waveform and digit field measurements, split screen
option, minitrend length, and sweep speeds.
• To make other setup changes such as scale changes, press a
parameter key and select its Setup menu. For example, press the
ECG key and select ECG Setup.
Changes are valid until the monitor is turned off (+15 minutes) or until
the case is reset. Only time and date settings are stored permanently.
Changing the split screen contents
You can split the Normal Screen page into two parts. The other half of
the split screen shows trend, ST, spirometry, EEG or EP data.
1. Press the Monitor Setup key.
2. Select Screen Setup.
3. Select Split Screen and choose from the options:
ST shows current and reference QRS complexes and ST trends.
Spiro1 is a basic view of spirometry data.
Spiro2 is an enhanced view of spirometry with additional values.
EEG shows EEG compressed spectral array.
EP shows current evoked potential waveforms.
Trend shows minitrends beside waveforms.
Modifying the screen permanently
You can also make permanent changes in the screen setup. This is
described briefly in the User's Guide Part I, section "Setting up the
monitor before use." For information on default configuration, refer to
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− Any digit field having an empty digit field (="OFF") on the right is
automatically enlarged.
Changing waveform and digit fields
Up to eight waveforms and four digit fields can be displayed
simultaneously.
• Press the Monitor Setup key.
• Select Screen Setup - Waveform Fields or Digit Fields.
− When you select 4 invP, four invasive pressure waveforms are
displayed together, using an area of two normal waveforms.
The 4 invP choice removes the waveform under it.
− Selecting Combine Pressures displays invasive pressures in the
same waveform field with the same zero line, but with individual
scales.
− If 5- or 12-lead ECG is measured, up to three different ECG leads
can be displayed simultaneously in different fields.
Note that:
− Waveforms are always evenly spread to fill the entire waveform
area. The height of the waveforms depends on the number of
waveforms configured to be displayed: When 2 or 3 waveforms are
displayed, the waveforms are at least double the normal height,
and when only 1 waveform is displayed, it fills the entire waveform
area.
− When less than four digit fields contain data, the remaining fields
are automatically enlarged.
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Alarms
To enable the alarms, connect the patient cables. When an alarm becomes active, messages appear in the order of priority. See also section "Alarm
basics" in User's Guide Part I.
NOTE: If the monitor is connected to the network, the alarms can be heard and seen on the S/5 Central as well. Please consult the "Datex-Ohmeda S/5
Central User's Reference Manual :Alarms" for details.
WARNING: Always make sure that necessary alarm
limits are active and set according to the patient's
clinical condition when you start monitoring.
WARNING: When the alarms are silenced, observe the
patient frequently.
Changing source
For NIBP, P1, P2, P3, P4, P5, P6, O2 and Temp, you can select which
measured values trigger the alarm. Only the most recently modified
source is active.
1. Press the Alarms Setup key and select Adjust Limits.
2. Select the measurement.
3. If the highlight is in the adjustment window, push the ComWheel
until you get to the menu selections.
4. Select the desired alarm source ON.
Adjusting limits
• Press the Alarms Setup key and select Adjust Limits.
• Highlight the measurement or select Next Page if it is not displayed.
• Push the ComWheel to open an adjustment window.
• Turn the ComWheel to change limits and accept them by pushing it.
Move between selections by turning the ComWheel.
Receiving alarms from other sites
NOTE: If the monitor is connected to the network, the alarm limits can
also be changed using the S/5 Central if this feature is available and
has been enabled in the Central configuration.
NOTE: The monitor needs to be connected to a network.
1. Press the Patient Data key and select Other Patients - Receive
Alarms.
2. Select the correct network and one of the other sites.
Adjusting volume
• Press the Alarms Setup key.
Showing alarm history
Press the Alarms Setup key and select Alarm History. A list of the last
• Select Alarm Volume and adjust.
20 alarms is displayed.
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Silencing audible alarms permanently
1. Press the Alarms Setup key and select Audio ON/OFF.
Silencing audible alarms temporarily
To silence alarms for two minutes, press the Silence Alarms key. To
2. Select Silence Apnea, Silence ECG, Silence Apn&ECG or Silence
ALL.
silence them for five minutes, press the key for more than three seconds.
If the alarms are not active when you press the Silence Alarms key,
they are pre-silenced for two or five minutes.
Exception: FiO2< 18%, EtO2 < 10% and Ppeak High alarms are
silenced for 20 seconds.
During silencing, all new alarms for the same reason and all alarms for
a different reason are indicated visually.
To silence the individual alarm that is currently active, press Silence
Alarms key twice. This does not pre-silence the upcoming alarms.
If an active alarm is silenced, the monitor gives a reminder beep every
two minutes. By default, silencing alarms is set unselectable and can
only be activated through the Installation menu. For more information,
see the "Setting up the monitor before use: Alarm options " in User's
Guide Part I and “User’s Reference Manual.”
Reactivating alarms
• In Alarms Setup, select Audio ON/OFF and select Activate
Alarms.
Reactivating silenced alarms
• Press the Silence Alarms key during the silencing period.
NOTE: If the monitor is connected to the network, the bedside alarms
can also be silenced using the S/5 Central if this feature is available
and has been enabled in the Central configuration.
The alarm sounds of new alarms are activated. Silenced alarms are active
after two minute period. Apnea alarm is activated after five breaths.
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Anesthesia record keeping
Overview
Getting started
You can keep automatic anesthesia records with the optional
anesthesia record keeping solution.
Before starting, check that:
− The memory cards are properly inserted in the memory module.
− The keyboard is connected.
− The monitor is connected to the network.
The following describes the most frequently used functions. For more
detailed information, see the anesthesia record keeping solution user
documentation.
1. Turn on the power. The green LED on the keyboard lights up. The
MemCard symbol and the network symbol are displayed on the
screen.
2. Press the Reset Case key and select Reset Trends to erase any
previously recorded data.
3. Connect the patient to the monitor.
4. If the monitor prompts for user ID and password before allowing
access to the menus, enter them and push the ComWheel to
confirm.
The network is used for storing patient data and for providing the menu
configurations. You can use the Memory Module with memory cards as
a backup device.
The green Data Card stores and transfers patient data. The white Menu
Card is used for storing the record keeping menus and configurations,
and for loading patient data and user modes from the Data Card.
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Entering data
1. Press the Patient key to enter patient data.
2. Press the Personnel key and select the names of the personnel.
Printing data and closing the record
1. Press the Print key.
2. Select Print and Close to print the record, to close and end it, and
to log out.
3. Press the menu keys to access the corresponding menus and enter
the desired information (gases and ventilation data, laboratory
data, fluids, drugs, events, comments and postoperative
instructions.)
The anesthesia record has two pages by default. If you wish to use the
3-page printout with ventilatory data on the third page, press Special
and select the 3-page record.
Modifying data
You can also close the record by pressing the End of Case key and
selecting Close Record.
1. If you have incorrect entries in the anesthesia record, press the
Modify key to open the menu and modify or delete data.
2. Select Select Event and highlight the data by turning the
ComWheel, or using the Events arrow keys on the keyboard.
− To correct data, select Modify Event.
− To delete data, select Delete Event.
NOTE: If you try to correct data through any other menu than Modify,
you will simply add new data. All the previous data remains in the
record as well.
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Laboratory data and calculations
For more information, please refer to the “User’s Reference Manual.”
Temperature correction
Entering laboratory values
1. Press the Patient Data key.
In the laboratory, blood gas values are measured and calibrated at
+37°C. These values may need to be adjusted to the actual patient
temperature since an increase or decrease in temperature changes the
volume of dissolved gas (PO2, PCO2, pH).
2. Select Lab Data - Enter Values.
3. Enter the values by turning and pushing the ComWheel.
The monitor has three options for temperature correction. To choose:
1. Press the Patient Data key and select Lab Data.
2. Select Correct. and one of the following:
• Lab = Temperature correction has been done in the laboratory
and the values have already been adjusted to patient
temperature. The entered blood gas values are stored without
adjustments.
• Yes = The monitor will perform correction calculations. Select
Source to tell the monitor how the actual patient temperature is
entered for the calculations (Manual, Eso, Naso, Tymp, Rect,
Blad, Core, T1-T4, Tblood). The monitor corrects the entered
blood gas values to patient temperature, and displays both
corrected and uncorrected values.
• No = No temperature correction is needed. The entered blood
gas values are stored as such.
NOTE: When entering laboratory values, make sure that the units you
are using are the same as the ones on the screen. If not, convert the
values or change the units on the screen through Monitor Setup Install/Service - Installation - Units.
Loading laboratory values from an external device
1. Press the Patient Data key.
2. Select Lab Data - Load Art. or Load Ven. NOTE: These selections
are available when there are unconfirmed values in the monitor
memory.
3. Confirm the values with the ComWheel. The message ‘Lab Data
available’ remains in the message field until the values are
confirmed.
NOTE: The monitor marks corrected values with the letter ‘c.’
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Hemodynamic, oxygenation or ventilation calculations
1. Press the Others key.
Viewing calculations
To view values of the three most recent calculations:
1. Press the Others key and select Calculations.
2. Select Hemodynamic/ Oxygenation/Ventilation Calcs - Calc.
Trends -.
If the patient demographics have been entered, the monitor displays
indexed values. You can select the non-indexed values with the
ComWheel.
2. Select Calculations - Hemodynamic/Oxygenation/Ventilation
Calcs.
3. Enter or edit the measurement data using the ComWheel.
4. Save data by selecting Save Calcs.
NOTE: The monitor marks the edited values with an asterisk (*).
NOTE: The monitor uses the last measured and confirmed C.O. value as
source data for hemodynamic and oxygenation calculations.
Recording calculations
To record the current calculation page to a strip chart recorder:
1. Press the Others key.
2. Select Calculations - Hemodynamic/ Oxygenation/Ventilation
Calcs.
3. Select Record Calcs.
Estimated values in oxygenation calculations
Only a couple of percent of the total oxygen content is dissolved in the
blood. The monitor measures SvO2 and also SpO2, which is used for
estimating the SaO2. The oxygen content can be estimated by using
monitored saturations only and disregarding the dissolved amount of
oxygen. The monitor marks these estimated values and all the values
derived from them with the letter ‘e.’
Printing calculations
To print hemodynamic or oxygenation or ventilation calculations:
1. Press the Others key.
2. Select Calculations - Hemodynamic/ Oxygenation/Ventilation
Calcs.
3. Select Calc. Trends - Print Page.
To print all calculations:
1. Press the Record/Print key.
2. Select Print Calcs.
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Trends and snapshots
Graphical trend view
Viewing graphical trends
• Press the Trends key and select Graphical.
• To see more parameters, select Scroll Pages.
• To see more data, select Cursor and scroll with the ComWheel.
Graphical trends contain four trend pages each having up to six
preconfigured fields with different parameters. Real-time ECG waveform
is displayed at the top of each page.
The graphical trend time scale varies from 20 minutes to 24 hours and
the resolution from 10 seconds to one minute. With the 20 minute
trend length, the displayed time period is 30 minutes and the
resolution 10 seconds. With trend lengths from one to 24 hours, the
displayed time period is 24 hours and the resolution one minute.
For HR, ST, PVC, PCWP, C.O., SpO2, PgCO2, VO2, VCO2 and temperature
measurements you can select the scale in the Trend Scales menu.
Symbols
Trend bar: the gap shows the mean value.
Trends view
(1)
(2)
(3)
(4)
(5)
(6)
NIBP trend bar
Trends menu
Measurement trend field
Real time ECG
Numeric value of a measurement at the trend cursor point
Time and marker field
Trend page number
Indicator of change -for example, ST relearning or zeroing of
an invasive blood pressure channel
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Viewing numerical trends
• Press the Trends key and select Numerical.
Automatic snapshots
Automatic snapshot creation can be defined separately for each
arrhythmia alarm. For more details, see section "ECG" and Part I,
section "Setting up the monitor before use."
Snapshots are always taken automatically on Brady, Tachy and Art
sys/dia/mean high/low alarms when they reach the red level if
automatic snapshot creation is enabled, see Part I section “Monitor
setup.” Invasive pressure alarms reach the red level only when there is
a simultaneous yellow HR alarm.
• To see more pages, select Scroll Pages and scroll with the
ComWheel.
• To see more data, select Cursor and scroll with the ComWheel.
Numerical trends contain eight pages with the maximum of 24 hours of
trend data. Real-time ECG waveform is displayed at the top of each page.
Creating snapshots manually
Viewing snapshots
• Press the Trends key.
A snapshot is a frozen frame of preconfigured waveforms or trends
saved in the monitor memory. For configuration, see Part I section
"Setting up the monitor before use."
• Select Snapshot - Next Snapshot.
Turn the ComWheel to move to the next snapshot. In the upper righthand corner, you can see the time the snapshot was created. Five fields
can be displayed on the snapshot page, and six fields can be printed.
To create a snapshot:
• Press the Take Snapshot key.
Erasing trends and snapshots
• Press the Reset Case key and select Reset Trends.
The monitor saves an image of preconfigured waveforms or trends. You
can take up to 100 snapshots, depending on the data load. When a
snapshot is taken by pressing the Take Snapshot key , it is
automatically numbered. This number also appears in the column
‘Mark’ in the numerical trends.
If the power switch has been turned to stand-by position but the case
has not been reset, the trend data will be stored in the memory for 15
minutes.
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Recording and printing
You need
− Laser printer for printouts (serial or parallel printer)
− Optional built-in recorder for recording (or M-REC module)
− Thermal paper for the recorder
NOTE: Recordings on thermal paper may be destroyed when exposed to
light, heat, alcohol, etc. Take a photocopy for your archives.
Side panel keys
Record Wave
Stop
Recorder
Records up to three real-time waveforms
Stops recording
Record
Wave
Starting and stopping the recording
Use side panel keys to start and stop recording immediately.
Stop
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Recording graphical trends
1. Press the Record/Print key.
Recording with the recorder
Recording numerical trends
2. Select Record Trends.
3. Select Record Graphical.
4. Stop recording by selecting Stop Trend.
NOTE: Recording is possible with the optional internal recorder only.
You can record the current values of up to 11 preconfigured
parameters.
1. Press the Record/Print key.
2. Select Record Trends - Record Numerical.
3. Stop recording by selecting Stop Trend.
Alternatively, you can start recording with the Record Trends module
key and stop recording with the Stop key.
Trends are recorded for the time period that corresponds to the time
scale of the graphical trends.
Alternatively, you can start recording with the Record Trends module
key and stop recording with the Stop key.
To choose the time scale:
1. Press the Trends key.
2. Select Time Scale - 20’/1h/2h/4h/6h/8h/10h/12h/24h.
Selecting the format for the recorded numerical trends
You can select the format for the recorded numerical trend to be either
Num. (vertical, 11 parameters) or Tab. (horizontal, four parameters):
To select the parameters for the graphical trends:
1. Press the Record/Print key.
2. Select Record Trends.
3. Select Graphic Trend 1 or Graphic Trend 2.
1. Press the Record/Print key.
2. Select Record Trends - Num. Trend Type - Num. or Tab.
Selecting the default trend format
You can select which trend format is recorded when recording is started
with the module key:
1. Press the Record/Print key.
2. Select Record Trends - Default Trend and Num., Graph. or Tab.
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Recording on alarms
1. Press the Record/Print key.
Recording waveforms
You can record three waveforms to a local recorder, and two to four
waveforms to a network recorder:
2. Select Record Waveforms.
3. Select Start on Alarms - YES.
1. Press the Record Wave side panel key or module key, or press the
Record/Print monitor key and select Record Waveforms Record Wave.
2. If the monitor is connected to the network , you can also use the
network recorder by selecting Record to Net. The network recorder
uses the settings of the S/5 Central.
3. Stop recording by pressing the Stop side panel key or module key,
or by selecting Stop Wave.
Recording is activated when the following alarms reach the red level:
Asystole, Tachy/Brady, Art High/Low, V Fib, V Tachy; V Run >3 with
Extended arrhythmia analysis or Arrhythmia Workstation only and Rapid
VT, X Brady and X Tachy with Arrhythmia Workstation only.
Art and ECG1 waveforms are recorded. Selections are preconfigured.
Changing the waveform appearance
Recording calculations
1. Press the Others key.
To see the waveforms more clearly or more generally, change the paper
speed.
2. Select Calculations -Hemodynamic/Oxygenation/Ventilation
Calcs - Record Calcs.
1. Press the Record/Print key.
2. Select Record Waveforms - Paper Speed.
To select other waveforms for recording, press the Record/Print key
and select Record Waveforms - Waveform 1, 2, or 3.
17
18
Printing currently displayed screen contents
Printing with a laser printer
You can print currently displayed trend data, calculation trends, ECG
waveforms, EEG data, spirometry loop, and calculations.
Selecting a printer
1. Press the Record/Print key.
2. Select Printer Connection.
3. Select Serial or Parallel (local printer) or Net (network printer).
To print trend data:
• Press the Trends key and select:
Graphical/Snapshot/Numerical - Print Page
Printing everything
To print calculations trends:
• Press the Others key and select:
• Calculations - Hemodynamic/Oxygenation/Ventilation Calcs
- Calc Trends - Print Page
To print all the graphical trends, all calculations or all the saved loops:
1. Press the Record/Print key.
2. Select Print Graphical, Print QRS/ST, Print Calcs, Print Loops, or
Print EP’s.
To print ECG and ST data:
• Press the ECG key and select:
• ECG View - Print Page
• ST View - ST Trends - Print Page
• ST View - Print QRS/ST
Printing patient record
1. Press the Record/Print key.
2. Select Print Record.
To print Spirometry loops:
• Press the Airway Gas key and select:
• Spirometry Loops - Print Loop
To print EEG data:
• Press the Others key and select:
• EEG & EP - Print Page
18
19
Troubleshooting
NOTE: Always check the patient’s condition first in problematic situations or if an alarm is triggered.
PROBLEM RELATED TO:
SYMPTOM
POSSIBLE CAUSE AND SOLUTION
• Noisy signal.
AEP signal is unstable
• Check headphone connections.
• Check stimulation intensity.
AEP
AEP signal is poor
• Make sure that the headphones/earphones are working and the sound
intensity is high enough.
Airway gases
Airway gas values are too low
•
Extra arrhythmia are detected
Patient’s medical condition.
• Check the patient.
The morphology of the ECG signal has changed.
• Start relearning manually through ECG - Relearn.
Low amplitude signal in some ECG leads.
• Leads I and II: Select the one with the largest amplitude to ECG1.
• Leads C1-C6 (V1-V6): Select the one with the largest amplitude to ECG2.
• After selecting the leads, start relearning manually.
Arrhythmia
Extra Ventricular Fibrillations are
detected
Battery
Battery operation time is markedly
shortened.
Check the sampling line and connectors for leakage.
•
Charge and discharge the batteries entirely once a month (see Part I
section “Cleaning and care” ).
19
20
PROBLEM RELATED TO:
SYMPTOM
Measurement does not start
Bispectral index
BIS signal is poor
Cardiac output
ECG
C.O. measurement fails
ECG signal is noisy or no QRS is
detected
POSSIBLE CAUSE AND SOLUTION
• Check sensor attachment and placement. Check sensor type.
• Check the digital signal converter: Others – BIS – BIS Setup – Test DSC.
• Check all connections and the PIC Plus cable.
Artifacts or too much EMG activity interfere with the measurement. Some
external devices may also disturb the measurement.
• Check the sensor.
• Ensure that the DSC is not close to other electrical radiating equipment.
The amount of injectate is too small or injectate is too warm.
• Inject smoothly and within less than four seconds.
•
•
Ensure that the patient is not shivering.
Select the correct filter by pressing ECG and selecting ECG Setup Filter.
Check the electrode quality and positioning. Do not place them on body
hair, bones close to skin, layers of fat and major muscles. Pre-gelled
electrodes are recommended.
Change the lead.
Remove the ECG cable from the module and reinsert it.
•
•
•
•
EEG
EEG signal is noisy
Check that the electrodes are properly connected, not dried out and their
impedance is not too high.
Calm the patient since frontal muscle activity can cause artifacts.
Remove sources of external electrical noise (for example, some lamps)
from the vicinity of the patient’s head.
ECG may cause artifacts; change electrode positioning.
•
•
•
20
21
PROBLEM RELATED TO:
Entropy
SYMPTOM
Entropy values seem unstable
Entropy EEG signal is noisy
Entropy EEG signal is poor
Impedance
respiration
Invasive
pressures
Respiration measurement fails
InvBP readings seem unstable
Mixed venous oxygen
SvO2 values are too high
saturation
POSSIBLE CAUSE AND SOLUTION
Check that the sensor is not dried out, and that it is properly connected
and correctly positioned.
• Check the patient status.
Electrosurgery and other high frequency noise may cause artifacts.
• Check sensor attachment.
Some external devices may disturb the measurement.
• Remove disturbing equipment from the proximity of entropy module or
sensor.
•
•
•
Check electrode quality and positioning.
Adjust the detection limits. During ventilator-supported breathing, the
respiration calculation may count only ventilator-produced inspirations
and expirations.
• Other electrical devices may interfere with the measurement.
• Make sure there are no air bubbles in the transducer system.
Flush and zero.
• Place the transducer on the patient’s mid-heart level and zero.
The catheter is wedged and measures partially arterial blood.
• Position the catheter properly.
• Calibrate In Vivo.
21
22
PROBLEM RELATED TO:
Monitor,
measurements,
printing
SYMPTOM
The monitor does not start
POSSIBLE CAUSE AND SOLUTION
Check that the power cord is properly connected.
Check the fuses and replace them if necessary (see Part I section
“Cleaning and care” ).
Check that you have selected the parameter to a waveform or digit field;
see section “Screen setup.”
Check that the measurement module is properly installed.
Remove the module and reinstall it.
•
•
The measured values are not
displayed
You cannot perform a measurement or
a function
•
Printing is not possible.
•
•
•
Printer selection is None; change it through Record/Print – Printer
connection.
Printer is not connected to the network. Check the cable.
•
NMT calibration and measurement fail
Neuromuscular
transmission
Measurement is disturbed
Difficulty in getting the response when
locating the nerve for plexus
stimulation
• Check the electrode quality and positioning.
• Replace stimulating electrodes.
• Check the black ground electrode.
You may try using the local muscle response as an indication of current in the
needle. If there is no response, the needle may be broken.
• Change the needle if necessary.
22
23
PROBLEM RELATED TO:
Non-invasive blood
pressure
Patient Spirometry
Pulse oximetry
SYMPTOM
NIBP measurement does not work or
values seem unstable
Patient Spirometry values seem
unreliable
SpO2 signal is poor
SpO2 measurement results do not
appear on the screen
•
•
•
POSSIBLE CAUSE AND SOLUTION
Check that cuff tubings are not bent, stretched, compressed or loose.
Prevent motion artifacts.
Use cuffs of correct size.
•
•
•
Check the sensor type selection.
Remove the D-lite and shake drops away.
Check that the connectors on the D-lite are intact and connections tight.
• Check the sensor and sensor positioning.
• Change the averaging time from slow to normal.
• Note that skin pigment causes differences.
• Make sure that the patient is not shivering.
The M-OSAT or M-NSAT module overrides other modules' SpO2 measurement.
• Check modules and connections.
23
24
PROBLEM RELATED TO:
Temperature
SYMPTOM
Temperature measurement fails
PgCO2 values seem too high
Tonometry
PgCO2 values seem too low
P(g-Et)CO2 /P(g-a)CO2 values seem
too low (below zero)
P(g-Et)CO2 /P(g-a)CO2 values seem
too high
POSSIBLE CAUSE AND SOLUTION
Check that you are using a correct probe.
Try another probe.
Check that intraluminal acid or feeding is not interfering with
measurement.
Check calibration.
Check the catheter and connector for leakages and distortions and check
the catheter position.
Check that active suctioning is not interfering with the measurement.
Check calibration.
Check the catheter and connector for leakages and distortions.
Check the catheter position.
Check that active suctioning is not interfering with the measurement.
Check calibration.
Check that intraluminal acid or feeding is not interfering with the
measurement.
Check calibration.
•
•
•
•
•
•
•
•
•
•
•
•
•
24
25
Messages
Always check the patient first. If any problem or message persists, contact qualified service personnel. Messages are listed here in alphabetical order.
MESSAGE
EXPLANATION
WHAT TO DO
AEP stimulation ON
Wait until the stimulation has been completed.
Air leakage
AEP measurement is being performed and clicks are being
delivered to the headphones.
NIBP: There is an air leak in the cuff or hose.
Alarms acknowledged (from
Central)
Silenced alarms remain silent. New alarms will have an
audible sound. (Can also be done using the Central.)
If required, turn on the alarms through Alarms
Setup – Audio ON/OFF – Activate Alarms.
Alarms setup changed from
Central
Alarm limits or arrhythmia alarm priorities have been
changed using the Central.
Check the alarm limits and the arrhythmia alarm
priorities – see sections "Alarms" and "ECG/ST.”
Alarms silenced from Central
Alarms have been silenced using the Central.
Apnea
No breath detected for 20 seconds (respiration or CO2
measurement).
Apnea alarm is silenced but will activate after five breaths.
If required, turn on the bedside alarms through
Alarms Setup–Audio ON/OFF–Activate Alarms
Check the ventilator and breathing circuit.
Check the patient status.
Apnea deactivated
Check all connections and test tightness using
venous stasis.
If required, turn on the alarm through Alarms
Setup – Audio ON/OFF – Activate Alarms.
Arrhythmia Workstation is on stand-by or the monitor is not
connected to the ARRWS.
Patient movements, eye blinks, shivering, deep breathing,
arrhythmia or irregular beats may cause some
measurements to fail.
No QRS detected in ECG.
Turn off the ARRWS stand-by.
Check the connection to the ARRWS.
Calm the patient and start a new measurement, if
applicable. If gas exchange is measured, check the
sample line.
Check the electrodes. Check the patient status.
Automatic check off
BIS or entropy sensor's automatic impedance check has
been turned off.
Battery empty
The monitor does not work.
If required, activate the check through Others –
BIS - BIS Setup or Others – Entropy.
Connect the monitor to power outlet.
ARRWS arrh analysis off
Artifact(s)
Asystole
25
26
MESSAGE
EXPLANATION
WHAT TO DO
Battery low
About 10 minutes of battery operating time left.
Connect the monitor to power outlet.
Big contact difference
EEG: Differences in electrode impedances may disturb
measurement.
HR equal or below lower alarm limit.
Check individual impedances of the EEG
electrodes and try to make them similar.
Check the patient status.
NMT or regional block cable is not connected.
The digital signal converter is not connected to the BIS
module.
The entropy sensor cable is not connected to the entropy
module.
Gases: Unsuccessful gas calibration.
Connect the cable.
Connect the DSC to the module.
Reposition or flush the catheter.
Check D-fend
SvO2: Low blood flow at catheter tip, or the tip is against
vessel wall.
Gases: D-fend water trap connection is wrong.
Check ground electrode
EEG: The ground electrode impedance is over <5kΩ.
Checking electrodes
EEG: Electrode impedance is being measured and EEG
analysis is stopped for a few seconds.
BIS or entropy sensor check is in progress.
Brady
Cable off
Calibr. error
Check cath. position
Checking sensor
Check NIBP
Check probe
Check sample gas outlet
NIBP: Measurement affected by low blood pressure and
pulsation, or a change in patient’s condition.
SpO2: There is no detectable SpO2 signal, the sensor is
faulty or it is detached from the patient.
Gases: Sample gas outlet is blocked.
26
Connect the entropy cable to the entropy module.
Perform a new calibration.
Check that the water trap is properly attached to
the gas module.
Press the ground electrode to improve connection. If
necessary, change it. Check impedance.
Wait until the check is completed.
Wait until the check is over. Check results are
displayed.
Check patient status, measurement setup and
cuff.
Check the sensor and connections.
Remove blockage.
27
MESSAGE
EXPLANATION
WHAT TO DO
Check stim electrodes
NMT: Broken connection of the stimulating electrode or cable.
Check the white and brown stimulating electrodes.
C.O. out of range
C.O. value is less than 0.1 l/min or more than 20 l/min.
Cuff loose
Cuff occlusion
NIBP: Cuff is not attached to patient, it is too loose or the
hose is not connected to module.
NIBP: Tubes or hose kinked.
Perform a new measurement.
Check the patient status.
Check cuff and hose.
Cuff overpressure
NIBP: Cuff is squeezed during measurement.
Check NIBP cuff hose and tubes. Restart.
Curve over range
Check that right injectate port is used. Use smaller
injectate.
Check that right injectate port is used. Use colder
injectate or larger volume.
EEPROM Error or EPROM Error
C.O.: Too large a temperature difference for C.O.
calculation.
C.O.: Too small a temperature changes for C.O.
calculation.
BIS: The digital signal converter is not communicating or
operating properly.
EEG: Leads have been disconnected for impedance check
or have just been connected (< 15 seconds ago).
Memory checking failed.
Test the DSC: Others–BIS–BIS Setup-Test DSC.
If the problem persists, call service.
Reconnect the leads to continue the
measurement, or wait a few seconds.
Contact authorized service personnel.
Electrodes OK
EEG: Electrode impedance is below 5 kΩ.
Continue the measurement.
EMG electrodes off
EMG recording electrodes are off.
Attach the electrodes to continue/start the
measurement.
Curve under range
DSC error
EEG measurement off
27
Check tubes and hose.
28
MESSAGE
EXPLANATION
WHAT TO DO
Failure in Agent ID
An unknown agent or three or more agents detected.
Faulty cable
SvO2 cable is defected.
Flush the breathing circuit with O2 flush (O2+,
100% O2).
Empty the vaporizer and refill from an unopened
container.
Replace Edwards Lifesciences Corp. optical module.
Headbox off
EEG headbox is not connected.
Connect the EEG headbox.
High EMG
Calm the patient.
HR limit changed
EEG: High frontal muscle activity may disturb the
measurement.
HR alarm limits are changed on the ARRWS.
Identical 'X' modules
There is another similar module in the system.
Incompatible DSC
BIS: The hardware/software is not compatible with the
digital signal converter type used.
BIS: The sensor used is not a BIS sensor.
Remove the other module. See Part I section
"Monitoring Basics" for identical modules.
Check and change the digital signal converter.
Vaporizer may contain a mixture of agents.
Incompatible sensor
Infl. Limits! Check setup
Insufficient signal
Intensity shift
NIBP: Adult or child cuff is used but infant inflation limit is
selected.
SvO2 signal is not sufficient for performing the
measurement.
SvO2 catheter is kinked, there is a blood clot or Hb has
changed.
28
Check the limits.
Check and change the sensor.
Check cuff and inflation limits.
Check SvO2 connections. Replace optical module.
Calibrate In Vivo or replace catheter.
Update Hb. Check and recalibrate catheter or
replace it.
29
MESSAGE
EXPLANATION
WHAT TO DO
InvBPs not zeroed
InvBP: One or more channels have not been zeroed.
Zero all channels.
In Vitro failed
SvO2:In Vitro calibration was not successful.
In Vivo poor signal
SvO2: The signal during In Vivo calibration is not sufficient.
Check SvO2 connections. Perform In Vitro calibration
again. Straighten catheter and perform In Vivo
calibration. Replace optical module.
Reposition SvO2 catheter and recalibrate.
Irregular curve
C.O.: Patient's breathing or arrhythmia may interfere with the
curve.
C.O.: Irregular QRS synchronization for REF measurement.
Inject the injectate smoothly.
ECG trunk cable, all leadwires, or neutral electrode (RL/N)
are disconnected. Offset voltage between two electrodes
is too high. EEG leads are not connected.
SpO2: Pulse signal is weak possibly because of low
perfusion.
Entropy: Measured EEG signal is too low for reliable
entropy calculation.
C.O.: Measured volumes are too small for reliable
calculation.
Reconnect the disconnected electrode or leadwire.
Irregular HR
Leads off
Low perfusion
Low signal
Low volumes
29
Check the patient status. Check the electrodes.
Change measuring site.
Check the sensor positioning. The patient may be
in total suppression; check the patient status.
Check the volumes.
30
MESSAGE
EXPLANATION
WHAT TO DO
MVexp << MVinsp
Exhaled volume is markedly smaller than inhaled.
Check the whole system for leakages.
Module error
M-BIS module is not working properly.
Check the module. Change if necessary.
Network down: xxx
(xxx= network name)
Network cable is not connected.
S/5 Central is shut down.
Check the cable.
Check the Central.
NIBP manual
Check setup and restart autocycling.
No ARRWS arrhythmia
available
NIBP: Air leakage or loose cuff have interrupted the
autocycling mode.
Arrhythmia Workstation is connected but there is no
arrhythmia signal available.
No C.C. Check C.O. Setup
C.O.: No computation constant can be found.
Check the information given in the C.O. Setup.
No cable
SvO2: The cable is not connected.
No catheter
C.O.: The catheter is not connected, or it is defective.
No HR for REF
C.O.: No QRS synchronisation available for REF
measurement.
Connect the Edwards Lifesciences Corp. optical
module.
Check C.O. connections. Run the C.O. self test to
check the cable. If it is OK, the catheter is faulty.
Check the patient status. Check the electrodes.
30
Discharge the previous patient on the Arrhythmia
Workstation and admit the new patient.
31
MESSAGE
EXPLANATION
WHAT TO DO
No sensor
BIS: The sensor is not connected to the digital signal
converter.
Entropy: The sensor is not connected to the cable.
Check the sensor connection to the DSC and PIC.
No SpO2 probe
SpO2: The probe is not properly connected.
Check connection between sensor and cable.
Check connection between sensor and module.
No SpO2 pulse
SpO2: Pulse signal is poor.
Try other measuring sites.
Noise
Check the patient status. Check the electrodes.
Not an entropy sensor
ECG: Unreliable HR calculation or distorted waveform,
possible during defibrillation.
C.O.: Changes in patient's blood temperature affect C.O.
measuring.
Entropy: The sensor used is not an entropy sensor.
Not calibrated
SvO2: The sensor needs to be calibrated.
Poor electrode contact
EEG electrode impedance is over 5 kΩ.
Poor signal
BIS: Too much EMG activity or artifact for BIS
measurement. Some external devices may also disturb the
measurement.
SpO2: Pulse signal is poor possibly because of low
perfusion.
Noisy baseline
31
Check the patient status. Check the blood
temperature connector.
Make sure that you are using a Datex-Ohmeda
entropy sensor.
Calibrate In Vivo or accept old calibration values.
Improve EEG electrode connection by pressing it.
Change the electrode. Check the impedance.
Check the sensor, then the PIC Plus cable. Press
each electrode in the sensor.
Change measuring site.
32
MESSAGE
EXPLANATION
WHAT TO DO
Press sensor electrode n
Entropy: One of the sensor electrodes has poor contact.
Press sensor electrodes
PVC rate limit changed
Entropy: More than one of the sensor electrodes have poor
contact.
PVC rate limit is changed on the Arrhythmia Workstation.
Press sensor electrode 1, 2 or 3 as indicated in the
message (n= electrode number).
Press all sensor electrodes to ensure proper
contact.
Check the limit.
Px no transducer connected
InvBP: Transducer or channel x cable disconnected.
Connect the transducer or the cable.
RAM Error
Memory checking failed.
Contact authorized service personnel.
Re-calibrate
SvO2: Calibration was last performed more than 24 h ago.
Calibrate In Vivo.
Replace D-fend
Gases: D-fend water trap is partially blocked.
Replace the D-fend.
Replace sensor
Entropy: The sensor is defective, too old or it has been
used for more than 24 hours.
NMT measurement cannot be performed because the
response is too weak.
Replace the sensor.
Response too weak
Sample line blocked
Gas: The sampling line is blocked.
Sensor check failed
The BIS or entropy sensor has not passed the impedance
check.
Gases: The gas measuring sensor is inoperative or the
temperature in the module has increased.
Entropy: The sensor is connected to the cable but not
attached to the patient.
Sensor INOP
Sensor off
32
Check NMT electrode placement and connections.
If electrodes are dry, replace them. Check that the
stimulus current is not too weak.
Change sampling line and water trap.
Check sensor placement and attachment.
Contact authorized service personnel.
Apply the sensor to the patient.
33
MESSAGE
EXPLANATION
WHAT TO DO
SpO2 probe off
SpO2: The finger or ear lobe may be too thin or sensor
halves are not aligned.
Sensor may be defective.
Memory checking failed.
Check connection between sensor and patient.
Replace the sensor.
Contact authorized service personnel.
Supramax search
Entropy: The monitor is collecting data to start the
measurement.
NMT supramaximal stimulus current was not found.
70 mA is used as stimulus current.
NMT search in progress.
Wait for about one minute. Entropy values appear
automatically.
Stop measurement, reposition the stimulating or
recording electrodes, and start the measurement.
Wait.
SvO2 out of range
Calculated SvO2 is not within the range 1-98%.
Recalibrate In Vivo.
Tachy
HR equal or above higher alarm limit.
Check the patient.
Tblood under/ over range
C.O.: The blood temperature is too cold or too warm.
Temperature error
Temp: The self-check has found an error in the
temperature measurement.
BIS: The digital signal converter test has been activated.
Wait until message disappears before starting a
new C.O. measurement. Perform a new
measurement.
Contact authorized service personnel
SRAM Error
Starting
Supramax not found
Testing DSC
Tinj high
Tonometry catheter empty
Tonometry catheter leakage
Tonometry module HW error
C.O.: The injectate temperature is too close to blood
temperature or too warm (over 27°C).
There is no gas in the tonometry catheter. It is filled
automatically during the next measurement.
The tonometry catheter is disconnected, or the sampling
line is leaking inside the module.
Memory checking failed.
33
Wait until the check is over.
Use colder injectate.
Wait for the automatic filling during the next
measurement.
Ensure proper catheter connection and have the
internal leak repaired.
Contact authorized service personnel.
34
MESSAGE
EXPLANATION
WHAT TO DO
Unable to fill tonometry
catheter
Occlusion in the catheter or sampling line, or the balloon is
squeezed.
Check the catheter, sampling line and balloon
positioning.
Unable to measure Dia
Check the patient status and the cuff placement.
Perform a new measurement.
Check the patient status and inflation limits.
Perform a new measurement.
Check the patient status. Check the connectors.
Unstable zero pressure
NIBP: Accurate diastolic pressure is difficult to measure
because of artifacts, weak pulsation etc.
NIBP: Systolic pressure probably higher than maximum
inflation pressure, or artifacts interfere in the systolic area.
Blood temperature does not return to baseline after C.O.
measurement.
NIBP: Pressure is unstable at start of the measurement.
Warming up
The module/monitor is warming up.
Weak pulsation
‘X’ measurement removed
NIBP: Difficult to measure NIBP because: cuff position or
attachment is not correct; blood circulation is weak or
abnormal; heart rate is slow and it is associated with
artifacts; patient is moving; there is an air leakage.
Measurement module has been removed.
‘X’ module removed
Measurement module has been removed.
x-lead off
One of the ECG leadwires is off.
Reconnect the module if you want to restart the
measurement.
Reconnect the module if you want to restart the
measurement.
Check the leadwires and their connections.
xxx high/low
Measured value exceeds the alarm limit.
Check the patient’s condition. Adjust alarm limits.
Unable to measure Sys
Unstable blood temperature
Zeroing during gas calibration failed.
Zero error
'X' is the name of the interfaced device, measurement module or measurement parameter.
34
Calm the patient and retry.
Wait until message disappears. After 20 minutes,
replace optical module or M-COPSv module.
Check the patient status.
Check the cuff position and attachment.
Check that the cuff is not damaged.
Repeat the procedure.
35
ECG/ST
Hemodynamic modules M-NE(12)STPR, M-NE(12)TPR, M-NE(12)STR, M-ESTPR, M-ETPR, M-ESTR
You need
NOTE: In 5-lead ECG, place the 5th electrode (C/V) in one of the six
places indicated, and select the corresponding V lead label.
In 12-lead ECG, C/V is the same as C1/V1.
(1) Module with ECG measurement capability
(2) 3, 5 or 10 leadwire ECG trunk cable
(3) 3 or 5 leadwire ECG set, or a combination of 5 and V leadwire ECG
sets.
ECG electrodes (pre-gelled electrodes are recommended).
Check the expiration date.
L=YELLOW (IEC)
LA=BLACK (AAMI)
R=RED (IEC)
RA=WHITE (AAMI)
NOTE: For 5-lead ECG with a 10 leadwire ECG trunk cable, disconnect
the V leadwire ECG set.
R=RED (IEC)
RA=WHITE (AAMI)
LEAD I
R/RA
L=YELLOW (IEC)
LA=BLACK (AAMI)
R/RA
L/LA
L/LA
V1
V2
LE
AD
II
V4
V5
V6
1 2
LEAD III
V3
F/LL
N/RL
F=GREEN (IEC)
LL=RED (AAMI)
1
N=BLACK (IEC)
RL=GREEN (AAMI)
F/LL
F=GREEN (IEC)
LL=RED (AAMI)
C2 / V2
C3 / V3
C4 / V4
C5 / V5
C6 / V6
0537
2
C/V
R / RA
F / LL
ECG
L / LA
3
35
N / RL
3
6
4 5
36
Hemodynamic modules M-PRESTN, M-RESTN, M-PRETN
You need
NOTE: In 5-lead ECG, place the 5th electrode (C/V) in one of the six
places indicated, and select the corresponding V lead label.
In 12-lead ECG, C/V is the same as C1/V1.
(1) Module with ECG measurement capability
(2) Extension cable
(3) 3 or 5/10 leadwire ECG trunk cable and 3, 5 or 10 leadwire ECG
set
ECG electrodes (pre-gelled electrodes are recommended).
Check the expiration date.
NOTE: Do not use multiparameter cable with M-PRESTN, M-PRETN or
M-RESTN.
L=YELLOW (IEC)
LA=BLACK (AAMI)
R=RED (IEC)
RA=WHITE (AAMI)
LEAD I
R/RA
R=RED (IEC)
RA=WHITE (AAMI)
L=YELLOW (IEC)
LA=BLACK (AAMI)
R/RA
L/LA
L/LA
V1
V2
V3
AD
II
V4
V5
1
LEAD III
LE
V6
F/LL
1
F/LL
N/RL
F=GREEN (IEC)
LL=RED (AAMI)
N=BLACK (IEC)
RL=GREEN (AAMI)
F=GREEN (IEC)
LL=RED (AAMI)
2
3
36
2
3
6
4 5
37
Connecting ECG leadwire sets to ECG trunk cables
12-lead placement according to Mason-Likar
Hemodynamic modules M-NE(12)STPR, M-NE(12)TPR,
M-NE(12)STR, M-ESTPR, M-ETPR, M-ESTR
•
•
•
•
The arm leads are located just below the clavicles in the
infraclavicular fossae.
• The lower limb leads are located just above the iliac crests.
• The six precordial leads (chest leads) are positioned as follows:
V1 is placed in the fourth intercostal space to the right of the
sternum.
V2 is placed in the fourth intercostal space to the left of the
sternum.
V3 is placed between V2 and V4.
V4 is placed in the fifth intercostal space in the midclavicular
(1)
line.
V5 is placed between V4 and V6 same horizontal level as V4.
(2)
V6 is placed in the fifth intercostal space in the midaxillary
line, same horizontal level as V4 and V5.
(1)
Midclavicular line = A line that runs vertically downward from the
midpoint of the clavicle.
(2)
Midaxillary line = A line that runs vertically downward from a point
situated midway between the dorsal and ventral boundaries of the
axilla.
For 3-lead ECG, connect the 3 leadwire ECG set to the 3 or 5
leadwire ECG trunk cable (blue color indicator).
For 5-lead ECG, connect the 5 leadwire ECG set to the 5 or 10
leadwire ECG trunk cable (5= blue color indicator, 10= green color
indicator).
For 12-lead ECG, connect the 5 leadwire ECG set and the
additional V leadwire ECG set to the 10 leadwire ECG trunk cable.
NOTE: Connect a 3 or 5 leadwire ECG trunk cable to the blue connector
on the module. Connect a 5 or 10 leadwire ECG trunk cable to the green
connector.
Hemodynamic modules M-PRESTN, M-RESTN, M-PRETN
•
For 3-lead ECG, connect the 3 leadwire ECG set to the
3 or 5/10 leadwire ECG trunk cable.
NOTE: To use the 5/10 leadwire trunk cable for 3-lead ECG,
connect the 3 leadwire set to the following leads:
IEC: R, F, L
AAMI: RA, LL, LA
•
•
WARNING: Make sure that the leadwire set clips or
snaps do not touch any electrically conductive material
including earth.
For 5-lead ECG, connect the 5 leadwire ECG set to the 5/10
leadwire ECG trunk cable.
For 12-lead ECG, connect the 10 leadwire ECG set to the 5/10
leadwire ECG trunk cable.
WARNING: The 800 mV offset voltage range may be
insufficient for handling the offset potentials when
using ECG electrodes of dissimilar metals.
37
38
Selecting the number of electrodes
Preparing the patient and applying the electrodes
1.
Prepare the skin properly to ensure optimal signal quality:
• Shave any hair from the electrode sites.
• Gently rub the skin surface to increase capillary blood flow
and remove dead skin cells and oil.
• Clean the skin using a mild soap and water solution.
• Dry the skin completely before applying the electrodes.
1. Press the ECG key.
2. Select ECG Setup.
3. Select 3 or 5 for 5 leadwire cable.
With the 12-lead module (green ECG connector and cable), electrode
selection is automatic.
2. Apply the electrodes (see figures and instructions above). Avoid
bones close to the skin, obvious layers of fat and major muscles.
Selecting the user leads
Selecting the ECG filter
1. Press the ECG key.
1. Press the ECG key.
2. Select a lead for ECG1-3 Lead.
2. Select ECG Setup - Filter:
With 3-lead ECG, you can select only one user lead (ECG1 Lead).
With 5- and 12-lead ECG, you can select three user leads.
STfilt filters high-frequency artifacts but catches slow ST changes.
Monit. filters high-frequency artifacts and slow ST changes.
NOTE: No ST analysis.
Diagn. catches high-frequency changes and slow ST changes.
Selecting a label for V Lead
With 5-lead ECG, one V lead is measured according to the placement of
the V lead electrode. To select a label for the lead:
1. Press the ECG key.
2. Select ECG Setup - V Lead.
38
39
Changing the HR source
• Press the ECG key and select ECG Setup - HR Source.
Selecting how to view ECG waveforms
• To set the number of ECG waveforms in Normal Screen, press
Monitor Setup and select Screen Setup - Waveform Fields.
With 3-lead ECG, one lead, and with 5- or 12-lead ECG, up to three
leads can be viewed at the same time.
• To cascade a lead, press ECG and select ECG2/ECG3 Lead Casc.
• To increase ECG amplitude, press ECG and select ECG Size.
• To change the waveform sweep speed, Monitor Setup - Sweep
Speeds. Select Hemodynamics and adjust the value.
• To view ECG waveforms from all 5 or 12 leads, press ECG and
select ECG View (available only with 5- and 12-lead ECG).
AUTO selects the first available of ECG, Art, ABP and Pleth.
Beat sound volume
To adjust the beat sound volume of the monitor:
1.
2.
3.
4.
Press the ECG key.
Select ECG Setup.
Select Beat Sound Volume.
Adjust the volume between 0 and 10.
If you select 0, there is no audible sound.
NOTE: The module input circuits are protected against the effects of
electrosurgery and defibrillation. However, the ECG trace on the
monitor screen may be disturbed during electrosurgery.
Selecting what to display with HR
To select what is displayed with heart rate:
1. Press the ECG key.
2. Select ECG Setup.
3. Select Display with HR - PR/PVC/None.
Displaying ECG grid
To view the ECG waveforms over gridlines on the screen:
Printing ECG
• Press the ECG key and select ECG Setup - Grid - ON. To view
without gridlines, select OFF.
To print all ECG waveforms on a laser printer:
1. Press the ECG key.
2. Select ECG View.
3. Select Print Page.
41
40
WARNING: The impedance respiration measurement
may cause rate changes in Minute Ventilation Rate
Responsive Pacemakers. Set the pacemaker rate
responsive mode off or turn off the impedance
respiration measurement on the monitor.
Monitoring pacemaker patients
1. Press the ECG key.
2. Select ECG Setup - Pacemaker and select one of the following:
• Show = Pacemaker spike is displayed on ECG.
• Sensit = Sensitive pacemaker detection; spike displayed on ECG
• ON R = Pacemaker suppression weakened; asystole alarm may
not be reliable with active pacemakers.
• Hide = Pacemaker spike is not displayed on ECG.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the
patient to avoid burns at monitor measurement sites.
NOTE: If the patient has an atrial pacer, ST calculations can be
performed if the pacer does not coincide with the ISO point’s
adjustment range.
WARNING: Do not rely entirely upon rate meter alarms
when monitoring patients with pacemakers. The
monitor may count the pacemaker pulses as
heartbeats. In this case, asystole and ventricular
fibrillation may go undetected. Always keep these
patients under close surveillance and monitor their vital
signs carefully.
NOTE: Pacemaker detector may not operate correctly during the use of
high-frequency (HF) surgical equipment. The disturbance of HF surgical
equipment typically cause false positive pacer detection.
40
41
Arrhythmia monitoring
NOTE: For optimal results, select STfilt as the ECG filter.
Selecting arrhythmia analysis
Starting relearning manually
NOTE: With L-ANE03 software license only severe analysis is available.
1. Press the ECG key.
2. Select ECG Alarms - Arrh. Alarms - Analys.:
SEVERE detects asystole, bradycardia, tachycardia, ventricular
fibrillation and ventricular tachycardia.
EXTENDED detects (in addition to the types mentioned above),
ventricular run, ventricular couplet, R-on-T PVC, ventricular
bigeminy, ventricular trigeminy, multifocal PVCs, frequent PVCs and
missing beats.
When the patient’s ECG pattern changes considerably, the monitor
should start relearning a new ECG pattern.
You can start relearning manually through ECG - Relearn - Start.
Selecting leads for the arrhythmia analysis
When measuring 5- or 12-lead ECG, you can affect the selection of the
two ECG leads used for detecting beats and ventricular fibrillation. The
selection of user leads (ECG1, ECG2, ECG3) on the monitor affects the
leads used for detection. The first lead used for detection is lead I or II.
The algorithm uses the lead appearing first in user leads. The second
lead used for detection is one of the precordial leads (V1 - V6). The
algorithm uses the precordial lead appearing first in the user leads.
To change the user lead:
1. Press the ECG key.
2. Select a lead for ECG1-3 Lead.
3. Start the relearning manually by selecting Relearn - Start.
Setting arrhythmia alarm priority and snapshot creation
1. Press the ECG key.
2. Select ECG Alarms - Arrh. Alarms - Adjust.
3. Select the desired alarm by turning and pushing the ComWheel.
4. Select Red, Yellow, White or OFF with the ComWheel. Asystole and
ventricular fibrillation alarms are always Red and VTachy alarms
cannot be selected OFF.
5. To create a snapshot on the alarm, select Yes.
6. Select Exit to confirm the changes and return to menu.
NOTE: With a 3 leadwire trunk cable, the algorithm uses the only one
available lead ECG1 Lead, which is I, II or III, depending on the selected
user lead.
NOTE: Alarm priorities can also be set using the S/5 Central if the Central
configuration allows that.
NOTE: If the Arrhythmia Workstation is used, priorities cannot be
changed from the monitor.
41
42
Detecting arrhythmia alarms
For details about detection performance and test results of the arrhythmia algorithm testing, please refer to “User’s Reference Manual: ECG.”
Alarm
Asystole
Bradycardia
Frequent PVCs
Missing beat
Multifocal PVCs
R on T PVC
Tachycardia
Ventricular bigeminy
Ventricular couplet
Ventricular fibrillation
Ventricular run
Ventricular tachycardia
Ventricular trigeminy
Criteria
Cardiac arrest, no QRS complexes for five seconds.
HR below the HR alarm limit.
PVCs per minute above the alarm limit.
Actual RR rate interval more than 1.8 times the average RR interval.
Over the last 15 beats two or more premature ventricular beats with different morphologies are detected.
Early PVC, beat detected as a PVC and previous beat as not a PVC; current RR interval is less than half of the
previous RR interval.
HR over the HR alarm limit.
The following pattern is detected: N, V, N, V, N, V where N = normal, V = PVC (every other beat is a PVC).
Two consecutive ventricular beats, preceded and followed by a normal beat.
Fibrillatory waveform caused by ventricular fibrillation.
Three or more consecutive PVCs and rate of successive beats over 120 bpm.
Six or more consecutive PVCs and rate of successive beats over 120 bpm.
The following pattern is detected: N, N, V, N, N, V, N, N, V where N= normal, V= PVC (i.e., every third beat is a PVC).
42
43
Monitoring ST
The monitor analyzes ST for all measured leads and gives ST trends separately for each lead. The ST analysis starts automatically after the leads have
been connected, the QRS detection has started and the ECG filter selection is either STfilt or Diagn. ST can be viewed as digits, average and reference
complexes and trends.
For details about detection performance and test results of ST segment measurement algorithm testing, see the "User's Reference Manual: ECG."
NOTE: ST segment changes may also be affected by such factors as some drugs or metabolic and conduction disturbances.
ST View
ST number field with four ST values: three
from the user leads and one from the lead
with the largest absolute ST value.
The current average complex (indicated
here with black) for each lead with lead ID
and ST value, together with the reference
complex (indicated here with gray) and
markers of the three measurement points
ISO point, J point and ST point.
The first reference complex is saved
automatically and displayed by default. You
can save manually up to six reference
complexes. (See below.)
NOTE: For optimal results, select STfilt as the ECG filter. With Monit filter the ST analysis is not
available.
ISO point is on the isoelectric line.
J point is the point on the ECG trace where the S wave transitions to the ST segment.
ST segment is the component of the ECG trace between the end of the QRS complex and the T wave.
43
Minitrends for the three user leads. You can
select the scale:
-2...+2 mm
-5...+5 mm
-9...+9 mm
44
Viewing ST in split screen
• Press Monitor Setup and select Screen Setup - Split Screen - ST.
Studying ST Trends
• Press ECG and select ST View - ST Trends. QRS complexes and
The split screen shows current QRS complexes, reference QRS
complexes and ST trends.
• In ST View, select Ref. QRS, scroll to the time of the desired reference
complex saved in the memory and push the ComWheel.
trends for the three user leads are displayed by default. HR trend is
also displayed.
• To see complexes and trends for other leads, select Leads and then
User, Lat., Inf. or Ant.
• To check the saved average complex for the displayed leads, select
Cursor and move the trend cursor with the ComWheel to the desired
time point indicated in the time scale. When you stop, the ST value of
the moment indicated by the trend cursor is displayed next to it, and
the saved average complex is drawn behind the current QRS
complex.
Saving the current complex as the new reference complex
Changing the time scale
Viewing current and reference ST complexes in ST View
• Press ECG and select ST View.
• To show only the data area, select Remove Menu.
Selecting a reference complex from memory
• In ST View, select Save New QRS. The current QRS is saved and
displayed as the reference complex. You can save up to six reference
complexes.
NOTE: If the memory is full and you do not erase a complex before
saving a new one, the oldest manually saved complex is deleted.
• To erase a saved reference complex, select Erase QRS, scroll to the
time of the reference complex to be erased and push the ComWheel.
You cannot erase the first automatically saved reference complex.
NOTE: The time scale setting affects the ST Trends window, ST split
screen trends, ST View trends and the length of the printed reports.
• Press ECG, and select ST View - ST Trends - Time Scale.
Displaying ischemic burden in ST Trends
NOTE: Available only if the ischemic burden has been selected ON.
• Press ECG and select ECG Setup - Ischemic Burden - ON. In an
ischemic episode, the ST value falls outside the threshold limits. The
area between the threshold limit and the ST trend is yellow.
• To change the limits, press ECG and select ST View - ST Trends and
adjust Elev. Limit or Depr. Limit.
Adjusting measurement points
• In ST View, select Adjust ST.
• Adjust the points by selecting Set ISO Point, Set J Point or ST Point
(where the value is the delay between J-point and ST-point in
milliseconds).
Printing ST reports
In ST View, select Print QRS/ST. The length of the report is the same as
the time scale selected in ST Trends.
44
45
Impedance respiration
You need
− The same setup as in the ECG measurement, see section
"ECG/ST."
Starting
Correcting the respiration number
1. Select respiration to a waveform or digit field, otherwise the
respiration data is not included in the trends and no alarms are
activated.
2. Turn on the measurement:
• Press the Others key.
• Select Resp&Temp Setup - Resp Setup.
• Select Measurement and ON.
Normally, the AUTO detection limit is recommended. However, if the
respirations are particularly weak or affected by artifacts, they may not
be included in the respiration rate. To ensure the correct respiration
number, adjust detection limits closer to each other.
1. Press the Others key.
2. Select Resp&Temp Setup - Resp Setup - Detection limit.
3. Adjust the limits.
NOTE: Impedance respiration measurement is intended for patients
over three years old.
WARNING: Respiration movements and impedance
variations may continue in obstructive apnea.
WARNING: Make sure that the leadwire set clips or
snaps do not touch any electrically conductive material
including earth.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the
patient to avoid burns at monitor measurement sites.
WARNING: The impedance respiration measurement
may cause rate changes in Minute Ventilation Rate
Responsive Pacemakers. Set the pacemaker rate
responsive mode off or turn off the impedance
respiration measurement on the monitor
Improving waveform readability
1. Press the Others key.
2. Select Resp&Temp Setup - Resp Setup.
3. Select Size and adjust the waveform size.
45
46
Temperature
You need
(1) Module with temperature
measurement capability
(2) Temperature probe
NOTE: Use only Datex-Ohmeda
temperature probes or
defibrillator-proof
YSI 400 series probes.
1
2
NOTE: Do not use
multiparameter cable with
M-PRESTN, M-PRETN or
M-RESTN.
Changing temperature label
1. Press the Others key.
Combining different temperatures
The monitor displays the difference between different temperatures if
they are displayed in the same digit field.
2. Select Resp&Temp Setup - Temp Setup - X Label.
Changing temperature units
For example, to display Tblood - T1:
1. Press the Monitor Setup key.
2. Select Screen Setup.
3. Select Digit Fields.
4. Select T1+ Tbl in one of the lower fields.
You can select the temperature units to be either degrees Celsius or
degrees Fahrenheit:
1. Press the Others key and select Resp&Temp Setup -Temp Setup.
2. Select Units and then °C or °F with the ComWheel.
46
47
Pulse oximetry (SpO2)
You need
(1)
(2)
(3)
(4)
(5)
NOTE: Do not use multiparameter cables with the M-PRESTN,
M-PRETN and M-RESTN modules.
Module with SpO2 measurement capability
OxyTip+ integrated SpO2 sensor
Interconnect cable for OxyTip+ sensors, or
Interconnect cable for OxyTip+ sensors, or
Adapter cable for OxyTip+ sensors
WARNING: Vibrations during transport may disturb
SpO2 measurement.
WARNING: Allow sensor and cable to dry completely
after cleaning. Moisture and dirt on the connector can
affect the measurement accuracy.
NOTE: This is not a comprehensive list of cables and sensors.
NOTE: Pulse oximetry measurement is intended for patients weighing
over 3 kg (6.6 lb).
Reusable Sensors
OXY-F4-N
OXY-F-UN
2
OXY-F-DB
1
OxyTip+ Adhesive Sensors
3
OXY-AP
4
5
OXY-AF
47
48
Applying sensors
Measurement limitations
• Use dry and clean sensors only.
• Clean the application site. Remove nail polish, artificial fingernails,
earrings etc.
• Clip long fingernails.
• Attach the sensor cable to the wrist or bed clothes to prevent the
cable and sensor from moving.
NOTE: Datex-Ohmeda sensors are latex-free.
− The pulse oximeter cannot distinguish between oxyhemoglobin and
dyshemoglobins, for example, met- or carboxyhemoglobins.
− Poor perfusion may affect the accuracy of measurement when
using the ear probe.
− If possible, do not attach the SpO2 sensor to a limb that is used for
non-invasive blood pressure measurement or for administrating
cold infusions.
WARNING: Conditions that may cause inaccurate
readings and impact alarms include interfering
substances, excessive ambient light, electrical
interference, ventricular septal defects (VSD), excessive
motion, low perfusion, low signal strength, incorrect
sensor placement, poor sensor fit, and/or movement of
the sensor on the patient.
WARNING: Change measuring site frequently. Change
sensor site and check skin and circulatory status every
2 to 4 hours with adults and every hour with small
children.
WARNING: To prevent erroneous readings, do not use
physically damaged sensors. Discard a damaged sensor
immediately. Never repair a damaged sensor or cable;
never use a sensor or cable repaired by others. A
damaged sensor or a sensor soaked in liquid may cause
burns during electrosurgery.
WARNING: Inaccurate SpO2 data can result if a sensor
is past its useful life. Therefore, re-evaluate the
measurement periodically by performing additional
assessment of the patient and equipment, including
consideration of use of alternate monitoring methods
such as direct measurement of arterial oxyhemoglobin
saturation (SaO2).
Adjusting SpO2 settings
You can adjust the volume of the beat sound, the waveform scaling,
and response averaging time:
1. Press the Pulse Oximetry key.
2. Select Beat Sound Volume, Pleth Scale or SpO2 Response.
NOTE: The Pleth Scale and SpO2 Response are not selectable if the
M-NSAT or M-OSAT module is used for SpO2 measurement.
Using the M-NSAT or M-OSAT modules
You cannot use the M-NSAT and M-OSAT modules simultaneously in
the monitor.
The SpO2 measurement with the M-NSAT or M-OSAT module overrides
the other installed modules’ SpO2 measurement.
You can use only Nellcor sensors with the M-NSAT module. Use only
approved accessories for the M-OSAT module as defined in the
M-OSAT instruction sheet.
Displaying pulse rate
The heart rate can originate from various sources. Displaying the pulse
rate measured with pulse oximetry:
1. Press the Pulse Oximetry key and select HR Source - Pleth.
48
49
Non-invasive blood pressure (NIBP)
Cuff
Width
You need
(1) Module with NIBP measurement
capability
(2) Cuff hose
(3) Cuff of correct size
Reusable
cuffs
NOTE: These Datex-Ohmeda NIBP cuffs Disposable
are latex-free.
cuffs
WARNING: Non-invasive blood
pressure measurement is
intended for patients weighing
over 5 kg (11 lb).
1
Thigh cuff
Long large adult
Large adult
Long standard adult
Standard adult
Small adult
Child
Infant
Long large adult
Large adult
Long standard adult
Standard adult
Small adult
Child
Infant cuff #3
Infant cuff #4
Infant cuff #5
cm
inch
20.5
16
16
12.5
12.5
9.5
7
5
16
16
12.5
12.5
9.5
7.0
4.0
4.8
5.5
8.1
6.3
6.3
4.9
4.9
3.7
2.8
2
6.3
6.3
4.9
4.9
3.7
2.7
1.5
1.8
2.2
Over brachial
artery
2
Limb circumference
cm
inch
44 - 57
33 - 47
33 - 47
25 - 35
25 - 35
18 - 26
13 - 19
9 - 14
33 - 47
33 - 47
25 - 35
25 - 35
18 - 26
13 - 19
7.2 - 10.7
8.5 - 12.7
9.6 - 14.3
17.3 - 22.4
13 - 18.5
13 - 18.5
9.8 - 13.8
9.8 - 13.8
7 - 10.2
5.1 - 7.5
3.5 - 5.5
13.0 - 18.5
13.0 - 18.5
9.8 - 13.8
9.8 - 13.8
7.1 - 10.2
5.1 - 7.5
2.8 - 4.2
3.3 - 5
3.7 - 5.6
3
E
X LIN
INDE
Use smaller cuff
Correct size
Use larger cuff
49
Hose
Black
Black
Black
Black
Black
Black
Black
White
Black
Black
Black
Black
Black
Black
White
White
White
50
Starting
Stopping
The monitor sets inflation limits automatically for adults and infants
according to the hose used. For children, the inflation limit must be set
manually. To do this:
• Press the NIBP key and select NIBP Setup - Inflation Limits Child.
To release the cuff pressure before the measurement is finished:
• Press the Start/Cancel side panel or module key, or
press the NIBP key and select Stop xx.
Setting cycling intervals
1. Press the NIBP key.
To produce a single measurement:
• Press the Start/Cancel side panel or module key, or
press the NIBP key and select Start Manual.
2. Select Cycle Time.
3. Select the interval time of the list with the ComWheel.
To measure automatically after set intervals:
• Press the Auto On/Off side panel or module key, or
press the NIBP key and select Start Cycling.
Using NIBP cuff for venous stasis
• Press the NIBP key.
• Select Start Ven. Stasis.
To measure continuously for five minutes:
• Press the STAT On/Off module key, or
press the NIBP key and select Start STAT.
Values for M-PRESTN, M-PRETN and M-RESTN given in parenthesis ().
Inflation limit
Venous stasis
Venous
pressure
stasis time
Infant 150 (145 +5) mmHg
40 (30 +5) mmHg
1 min
Child
200 (200 +10) mmHg 60 (40 +5) mmHg
2 min
Adult
280 (280 +10) mmHg 80 (40 +5) mmHg
2 min
During measurement
• Observe the cuffed limb frequently. Measurement may impair
blood circulation.
• Make sure that tubes are not bent, pressed or stretched.
Measurement may be impaired.
• Blood pressure values may be affected by a change in the patient's
position.
NOTE: The presence of some arrhythmias during NIBP measurement
may increase the time required for the measurement. For details about
the test results of the functioning of the NIBP measurement in the
presence of arrhythmias, see "User's Reference Manual: NIBP."
WARNING: The monitor sets the inflation pressure
automatically according to the first measurement.
Reset the case to reset the inflation limit before
measuring a new patient.
50
51
Invasive blood pressure
You need
You can monitor up to six pressure channels.
(1)
(2)
(3)
(4)
(5)
NOTE: Invasive pressures need to be zeroed after reconnecting the
pressure transducer or cable. If all channels have not been zeroed, the
message ‘InvBPs not zeroed’ appears and the invasive pressure alarms
will reach the white level only.
Module with invasive blood pressure measurement capability
Heparinized fluid bag with pressure infusor
Flushing set
Transducer
Adapter cable for using disposable transducers
2
Disposable
3
1
4
Reusable
5
Reusable
51
52
Starting
Labeling channels
• For the setup, prepare the transducer kit according to the
manufacturer’s instructions.
• Ensure that there is no air in the line.
• Zero the transducer by opening it to air, pressing the Zero ALL
side panel key or the Invasive Pressures monitor key and
selecting Zero Pressures - Zero ALL. You can also use the Zero
ALL Pressures Remote Controller key. Zero each channel.
• Open the line to the patient.
The label of the pressure channel sets its display scale, color, filter,
alarm source and alarm limits. Label descriptions are preconfigured.
To change the label:
1. Press the Invasive Pressures key.
2. Select Px Setup - Label.
Factory default descriptions
The channels have the following factory default descriptions:
LABEL
Scale
Color
Alarm source
Digit format
Filter
Response
P1, Art, ABP
200
Red
Sys
S/D
22
Normal
P2, CVP
20
Blue
off
Mean
9
Normal
P3, RAP, LAP
20
White
off
Mean
9
Normal
ICP
20
White
off
CPP
9
Normal
52
P4, PA
60
Yellow
off
S/D
9
Normal
P5
20
White
off
S/D
9
Normal
P6, RVP
60
White
off
S/D
9
Normal
53
Combining pressures
Determining pressure values visually
Four invasive pressure waveforms can be displayed together so that
they use an area of two normal waveforms, or so that all four are
combined in the same field with the same zero line.
By moving the horizontal cursor across the pressure waveform, you can
get accurate pressure values at selected points. This may be useful,
for example, if the patient's breathing pattern is irregular.
1. Press the Monitor Setup key and select Screen X Setup.
2. Select Waveform Fields.
• To combine all pressure waveforms in one field, select Combine
Pressures and Yes.
• To combine four waveforms, select one waveform area to be
4invP. The 4invP choice removes a waveform below it on the
screen.
1. Press the Invasive Pressures key.
2. Select Px Setup - Px Cursor.
3. Move the cursor up or down by turning the ComWheel. Every time
the cursor is moved, the time (hours and minutes) and pressure
value appear on the screen. This way, you can keep track of the
changes made.
You can remove the cursor by selecting Remove cursor.
53
54
Adjusting PCWP
Pulmonary Capillary Wedge Pressure (PCWP)
Starting
To manually adjust the wedge pressure level:
1. In the Wedge menu, turn the ComWheel to move the cursor to a
point that represents the true PCWP level.
2. Push the ComWheel and select Confirm.
1. Prepare the same setup as in the C.O. measurement and use the
distal lumen for the pressure line.
2. Label the wedge pressure channel 'PA'.
3. Check that the monitor has correct information about the patient’s
ventilation: Invasive Pressures - Ventilation Mode – Contrl
(controlled ventilation) or Spont (spontaneous breathing).
4. Press the Start Wedge module key or press the Invasive
Pressures key and select Wedge Pressure - Measurement.
5. When ‘Inflate the balloon’ is displayed, inflate the catheter
balloon. The monitor automatically freezes the waveform for 20
seconds.
6. When ‘Deflate the balloon’ is displayed, deflate the catheter
balloon.
Canceling the PCWP measurement
• In the Wedge menu, select Cancel.
WARNING: All invasive procedures involve risks to the
patient. Use aseptic technique. Follow catheter
manufacturer's instructions.
WARNING: Make sure that no part of the patient
connections touches any electrically conductive
material including earth.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the
patient to avoid burns at monitor measurement sites.
WARNING: Use only defibrillator proof transducers and
cables.
WARNING: Mechanical shock to the invasive blood
pressure transducer may cause severe shifts in zero
balance and calibration, and cause erroneous
readings.
NOTE: During the wedge pressure measurement, PA values are not
trended and PA alarms are disabled.
54
55
Cardiac output (C.O.)
You need
(1)
(2)
(3)
(4)
(5)
(6)
Module with C.O. measurement capability
Catheter connecting cable
Injectate temperature probe
Injectate syringe
Injectate: 5% dextrose or physiological saline at 0 - 27 °C (32 - 77 °F)
Thermodilution catheter (Edwards Lifesciences Corp. compatible)
5
3
4
1
2
Proximal
Distal
CVP line to InvBP
transducer
Optical connector,
(see SvO 2 section)
Catheter's
termistor
6
NOTE: All invasive procedures involve risks to the patient. Use aseptic technique. Follow the catheter manufacturer’s instructions.
55
56
To calculate the average value:
• Select Confirm. The Hemo Calcs menu appears on the screen.
• To measure more curves, select Previous Menu.
Starting
1. Press the Others key and select C. O - C.O. Setup.
2. Check the catheter type and injectate volume. If they are not
correct, change the values with ComWheel.
• If your catheter type is not on the list, select Catheter Type User and enter the computation constant according to the
catheter package.
To edit the values in the Hemo Calcs menu:
1. Select Edit values and change the value(s).
2. Exit the editing mode by selecting Exit.
3. To return to the C.O. menu, select Previous Menu.
Calculating Body Surface Area (BSA)
You can also save the calculations in the Hemo Calcs menu by
selecting Save Calcs, or record them by selecting Record Calcs.
NOTE: For recording, you need the optional internal recorder.
To produce for example a cardiac index, C.I.:
1. Press the Others key and select C.O. - Demographics.
2. Enter patient’s weight and height for body surface area (BSA)
calculation.
Viewing other cardiac parameters
1. Press the Others key.
Measuring C.O.
1.
2.
3.
4.
5.
6.
2. Select Calculations - Hemodynamic or Oxygenation Calcs.
See also section “Laboratory data and calculations.”
Fill syringe with injectate.
Press the Start C.O. module key.
Inject smoothly within less than four seconds.
Observe the curve displayed on the screen.
If necessary, reject the measurement by selecting Cancel Meas.
Repeat measurement at least three times. Wait at least one minute
between measurements to warm up the catheter. You can save up
to six curves for calculating averages.
Measuring REF
You can measure the right ventricular ejection fraction (REF) with some
C.O. catheters:
1. Use a catheter that allows REF measurement (see catheter package).
2. Press the Others key and select C.O. - C.O. Setup.
3. Select REF measurement ON.
Editing and calculating
WARNING: The cardiac output measurement results
may be erroneous during electrosurgery.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the patient
to avoid burns at monitor measurement sites.
After measuring C.O. values:
1. Press the Others key.
2. Select C.O. - Edit Average.
To reject unacceptable curves:
1. Select Exclude Curves.
2. Select the curve to be eliminated.
56
57
Mixed venous oxygen saturation (SVO2)
You need
(1) Module with SvO2 measurement capability
(2) Edwards Lifesciences Corp. Optical module, OM-2E
(3) Edwards Lifesciences Corp. Swan-Ganz oximetry thermodilution catheter
See also the section “Cardiac output (C.O.)” for thermodilution catheter setup.
1
2
Catheter's optical
connector
3
NOTE: All invasive procedures involve risks to the patient. Use aseptic technique. Follow the catheter manufacturer’s instructions.
57
58
Starting
Entering laboratory results
Always perform In Vitro calibration with a new catheter before removing
the catheter from its package:
1.
2.
3.
4.
5.
1. Plug the Edwards Lifesciences Corp. optical module in the SvO2
module and let it warm up for 20 minutes.
2. Aseptically expose the catheter’s optical connector.
3. Connect the catheter to the optical module.
4. Press the Others key.
5. Select SvO2- Calibrate In Vitro.
Calibrating In Vivo
Maintaining the SvO2 measurement
In Vivo calibration is recommended at least every 24 hours.
1.
2.
3.
4.
5.
6.
Press the Others key.
Select SvO2.
Select Give lab SvO2.
Select Give lab Hb.
Enter laboratory results with the ComWheel.
For optimal accuracy, calibrate In Vivo at least every 24 hours.
If Hb values change significantly, enter the new Hb value:
Insert the catheter.
Press the Others key.
Select SvO2 - Start SvO2.
Select Calibrate In Vivo.
Wait until the highlight moves to Draw Blood Sample.
Take blood samples from distal lumen of the catheter and push the
ComWheel.
1. Press the Others key and select SvO2.
2. Select Update Hb.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the patient
to avoid burns at monitor measurement sites.
58
59
Airway gases
You need
You get
(1) Module with airway gases measurement capability: M-CO, M-COV,
M-CAiOV, M-CAiOVX (1b in the drawing), or a single-width module
for measuring CO2, M-miniC (1a in the drawing)
(2) Anesthesia gas sampling line
(3) Airway adapter with sampling line connector
Depending on the module in use, you can monitor measured
inspiratory and expiratory concentrations of O2, N2O, CO2, and
anesthetic agents, and calculated minimum alveolar concentration
(MAC) and balanced gas.
NOTE: Do not connect anything to the reference gas inlet.
Cartridge
Sampling line connector
Cartridge
D-fend release latch
Oxygen reference
gas inlet
Container
Sample gas outlet
Fan with dust filter
1b
2
3
Sampling
line
connector
1a
Sampling
line
connector
59
60
Starting
During monitoring
• Confirm that the D-fend container is empty and properly attached.
• Connect the gas sampling line to the D-fend and to the airway
adapter. Check that the connections are tight.
• Before connecting the patient, wait until the message ‘Calibrating
gas sensor’ disappears.
• Position the adapter upwards to prevent water from entering the
sampling line.
• If M-miniC is used with O2 and/or N2O contents higher than 40%,
make sure that FiO2 level and N2O level are set accordingly in
Airway gas – CO2 Setup to enable O2 and/or N2O compensation.
•
•
Empty the D-fend container whenever it is more than half full.
Disconnect the airway adapter during nebulization of medications.
NOTE: When the measured CO2 value is outside the specified
measurement range, the numeric value is gray.
Points to note
Anesthetic agent monitoring
− Use only Datex-Ohmeda anesthesia gas sampling lines (PVC/PE)
for monitoring. Using other lines may cause inaccurate readings.
− Never connect the loose end of the gas sampling line to the Patient
Spirometry connector because this may break the PVX unit. The
Patient Spirometry connector is meant for the spirometry tube only.
− Calibrate the airway gas module every sixth month, see Part I of this
guide, section “Cleaning and care.”
Modules automatically identify the agent being used. When two agents
are administered one after the other, both concentrations are displayed
until the first one is less than 0.3 vol%.
Minimum alveolar concentration (MAC) and balance gas are displayed
on a common field.
Preventing Operating Room pollution
When N2O and volatile anesthetics are used, prevent operating room
pollution by connecting the sample gas outlet of the monitor to the
scavenging system or by returning the sample gas to the patient circuit.
With M-MiniC: Do not return the sample gas to the patient circuit.
60
61
Patient Spirometry
You need
You get
(1) Module with Patient Spirometry measurement capability
(2) Spirometry tube
(3) D-lite/Pedi-lite sensor or D-lite+/Pedi-lite+ sensor for humid
conditions
(4) Anesthesia gas sampling line
In addition to airway gas concentration, you can monitor airway
pressures, flow, volumes, compliance and resistance, breath-bybreath.
2
3
1
Sampling line
connector
4
Spirometry
connectors
NOTE: Always place the HMEF between the D-lite sensor and the patient.
61
62
Recalling a saved loop for reference
1. Press the Airway Gas key.
Starting
Connect the spirometry tube and the gas sampling line to the D-fend
water trap and D-lite sensor. Check that connections are tight.
2. Select Spirometry Loops.
3. Select Reference Loop and select the number of the loop you want
to recall.
To display Patient Spirometry values on the Normal Screen
continuously:
1. Press the Monitor Setup key.
2. Select Screen X Setup.
3. Select the Split Screen alternative: Spiro 1 is the basic view,
Spiro 2 shows all measured values (Ppeak, Pplat, Pmean, PEEPtot,
Compl, Raw, TVinsp, TVexp, MVinsp, MVexp.)
Printing the loops
• To print the currently displayed loop, press the Print Loop module
key, or
press the Airway Gas key and select Spirometry Loops - Print Loop.
• To print saved loops, press the Record/Print key and select Print
Loops.
Changing the loop type
To change the displayed loop from a pressure/volume loop to a
flow/volume loop or vice versa:
• Press the Change Loop module key, or
press the Airway Gas key and select Spirometry Loops - Paw-Vol
Loop/Flow-Vol Loop.
Monitoring pediatric patients
•
Saving reference loops
Save a loop for reference after anesthesia induction and whenever
major changes in the patient’s lung mechanics occur.
1. Press the Save Loop module key, or
press the Airway Gas key and select Spirometry Loops.
2. When the current loop is drawn, select Save Loop.
The monitor automatically displays the first saved loop as a reference
loop. You can save up to six pairs of loops. If you save another pair of
loops after the sixth one, the second oldest reference loop is erased
automatically.
When monitoring pediatric patients with tidal volumes of
15 - 300 ml, use the Pedi-lite/Pedi-lite+ sensor and change the
sensor type to Pedi through: Airway Gas - Spirometry Setup Sensor Type- Pedi.
Points to note
•
Disconnect the HME and D-lite during nebulization of
medications.
• Place all D-lite+/D-lite ports upwards with a 20to- 45° tilt to
prevent condensed water from entering the sensor interior and the
tubings.
62
63
Gas exchange
You need
You get
− M-CAiOVX module for measuring gas exchange
− Spirometry tube (2 meters, 7 feet)
− Anesthesia gas sampling line (2 meters, 7 feet)
− D-lite/Pedi-lite sensor or D-lite+/Pedi-lite+ for humid conditions
In addition to airway gas concentrations and spirometry
measurements, you can monitor oxygen consumption ( VO 2 ), carbon
dioxide production ( VCO 2 ), energy expenditure (EE), respiratory
quotient (RQ).
With HMEF
Patient connections with flexible tube
~45°
NOTE: Always place the HMEF between the D-lite sensor and the
patient.
NOTE: Place all D-lite ports upwards with a 20 to 45° tilt to prevent
condensed water from entering the sensor interior and the tubings.
NOTE: When monitoring pediatric patients with tidal volumes of
15 - 300 ml, use the Pedi-lite/Pedi-lite+ sensor. Change the sensor
type to Pedi:
1. Press the Airway Gas key.
2. Select Spirometry Setup - Sensor Type- Pedi.
63
64
If the RQ is out of the physiological range (<0.6 or >1.3), the monitor
does not store the EE and RQ values in the trend history or use them for
average calculations.
Starting
Use only 2-meter (7-ft) anesthesia gas sampling lines. Using other lines
may cause inaccurate readings. There are four different digit fields for
monitoring gas exchange data on the screen:
Measurement principle
O2 consumption is obtained by measuring the amount of inhaled O2
subtracted from the exhaled amount. CO2 production is obtained by
subtracting the amount of inhaled CO2 from the exhaled amount.
Values are obtained by multiplying each measured volume sample by
the corresponding gas concentration.
Gas exchange cannot be accurately measured when N2O is used
because the measurement is based on the fact that the amount of
nitrogen inhaled by the patient is equal to the amount of exhaled
nitrogen.
For screen configuration, press the Monitor Setup key and select
Screen Setup - Digit fields.
Points to note
Averaged EE and RQ
− Adequate VO 2 / VCO 2 values cannot be measured with a
Average values of EE and RQ update every minute. You can select the
averaging time from 2 to 24 hours. The bar in the lower part of the digit
field indicates the amount of data that the monitor uses for performing
the average calculations. The values on the screen are gray until there is
enough data for reliable calculations.
leaking airway, with FiO2 higher than 85%, or when N20+O2
mixtures are used in ventilation.
− Measurement results are valid only when the respiration rate is
below 35/min.
− Unstable oxygen delivery may cause erroneous VO 2 readings.
To select the average time:
1. Press the Airway Gas key.
2. Select Gas Exch. Setup.
3. Select the desired averaging time.
− Disconnect the D-lite during nebulization of medications.
64
65
Tonometry
You need
You get
(1)
(2)
(3)
(4)
You can monitor gastrointestinal PCO2 (PgCO2) and, if a gas module is
used, the difference between gastrointestinal and airway CO2
(P(g-Et)CO2).
Tonometrics catheter with
Built-in biofilter
Connector for the Tonometrics catheter
Module with gastrointestinal PCO2 (PgCO2) measurement
capability
Optionally, an airway gas module measuring EtCO2 to facilitate
the calculation of the difference between gastrointestinal and
airway CO2, P(g-Et)CO2.
NOTE: Use tonometry module only with Tonometrics catheters.
WARNING: Handle the Tonometrics catheter and its
contents as you would any body fluid. Infectious hazard
may be present.
4
3
2
1
65
66
Starting
Stopping
1. Insert a new Tonometrics catheter into the patient’s stomach (or
intestine). See catheter instructions for more information.
2. Connect the catheter to the tonometry module and check visually
that the connection is secure.
3. To start the tonometry measurement:
press the Start/Stop key on the module , or
press the Others key and select Tonometry - Start Cycling.
1. Press the Start/Stop module key, or
press the Others key and select Tonometry - Stop Cycling.
2. When you stop measuring tonometry, remove and dispose of the
catheter.
During monitoring
Tonometry alarm settings
The monitor measures and displays updated PgCO2 every 10 minutes.
1. In the Tonometry menu, select PgCO2/Pg-ET Alarms.
2. Adjust the parameter upper limits or set the alarms ON or OFF.
Displaying P(g-a)CO2, P(g-Et)CO2, or pHi with PgCO2
Calibrating
You can choose which calculated value is shown with PgCO2 in the digit
field. The choices are P(g-a)CO2, P(g-Et)CO2 or pHi.
1. Press the Others key.
2. Select Tonometry - Display with PgCO2 - Pg-Pa, Pg-ET or pHi.
Calibration is recommended at least every six months. If airway gases
are monitored, calibrate the airway module at the same time.
For more information, see section "Cleaning and care" in Part I of this
User's Guide.
P(g-a)CO2 is updated when PaCO2 values are entered and PgCO2
has been measured before PaCO2 is entered.
NOTE: Calibrating tonometry interrupts the tonometry measurement.
If airway gases are monitored, P(g-Et)CO2 can also be displayed.
P(g-Et)CO2 is updated every 10 minutes.
CAUTION: Do not apply pressurized air to any outlet or
tubing connected to the monitor. Pressure may destroy
sensitive elements.
pHi is updated when PaCO2 and pHa values are entered and PgCO2
has been measured before PaCO2 and pHa have been entered.
66
67
Neuromuscular transmission (NMT)
You need
(1)
(2)
(3)
(4)
Starting
Module with NMT measurement capability
NMT Sensor Cable
ElectroSensor, or
MechanoSensor (or Regional Block Adapter, not in the drawing)
• Before connecting the electrodes, clean any grease and dirt from the
application area.
• Place the stimulating electrodes (brown and white) along the ulnar
nerve. Do not place electrodes on areas with excessive body hair or
lesions. Do not let the electrodes touch each other.
• Place the piezoelectric probe or recording electrodes as indicated in
the figure below. Fix the piezoelectric probe with tape.
• Press Start-up module key. Start monitoring after the induction of
sleep but before the administration of a muscle relaxant drug.
WARNING: Make sure that the lead set clips do not touch
any electrically conductive material including earth.
WARNING: Do not place the NMT stimulating electrodes
on the patient’s chest.
WARNING: Always stop the NMT measurement before
handling the stimulating electrodes.
White
White
Brown
Brown
2
Green
Black
Red
1
3
67
4
68
Stopping
Selecting recovery note
• Press the Stop/Continue module key,
or press the Others key and select NMT - Stop.
The NMT note alarms you with a single beep and the ‘Block recovery’
message if the Count reaches the set value.
1. Press the Others key and select NMT.
2. Select Recovery Note and the Count limit for activating the note.
Continuing monitoring in OR after induction
Measuring deep relaxation
To move the module over to another Datex-Ohmeda system along with
the patient and to continue with the already determined current and
reference values, use the recall function:
1. Press the Others key and select NMT - Start-up - Recall.
When the neuromuscular block deepens, there is no stimulus
response. To monitor the relaxation level, start a five second tetanic
stimulation.
• Select NMT - Tetanic/PTC - Start.
After tetanic stimulation, single impulses are generated and the
number of responses is counted, resulting in Post Tetanic Count (PTC).
After PTC, NMT measurements are stopped for one minute after which
the previous measurement cycle continues.
Relaxation meter:
TOF and other stimulation modes
TOF (train of four) is the most common stimulation mode. In TOF, four
impulses are generated at 0.5 second intervals. The ratio of the fourth
to the first response is calculated resulting in TOF%. For safe
extubation, TOF% should be higher than 90.
In TOF mode you can also see the number of responses, the Count.
When there are less than four responses, the TOF% is no longer
available and you can only see the Count. You can also use DBS
(double burst) and ST (single twitch) stimulation modes.
100 TOF% 20
Light
4 Count 0
10 PTC 0
Deep
Locating nerve for regional block with plexus stimulation
1. Connect the Datex-Ohmeda M-NMT Regional Block Adapter to the
sensor cable.
2. Connect a disposable needle and syringe set to the adapter.
3. Press the Start-up module key.
4. Adjust the current. If you have problems with getting a response,
see section "Troubleshooting."
• To start the stimulation, press the Continue module key.
• To stop stimulation, press the Stop module key.
NMT in graphical trends
Different NMT values have their own specific colors in the graphical
trends. The bar colors indicate the following:
- white
= ratio% (TOF)
- green
= T1%
- blue
= PTC
- purple
= Count
For more information on trends, see also section "Trends and
snapshots."
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69
EEG and evoked potentials
CAUTION: Do not cover the EEG headbox as it may
overheat.
You need
(1) Module with EEG, EP and FEMG measurement capability, M-EEG
(2) EEG headbox and cable, N-EEG
(3) EEG leadset: preconfigured or your own montage
− EEG electrodes (cup, needle or stick-on)
For AEP, earphones (4) are required.
WARNING: Make sure that the electrodes do not touch
any electrically conductive material including earth.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the
patient to avoid burns at monitor measurement sites.
Also ensure that the ESU return electrode is near the
operating area.
NOTE: When measuring both AEP and BIS, see also section
"Bispectral Index (BIS)."
1
2
4
3
69
70
Starting
Using a preconfigured leadset
1. Select a preconfigured leadset or your own montage (see
instructions later in this section) according to the application, and
connect it to the headbox.
2. Clean and dry the patient’s skin in electrode locations.
3. Attach the electrodes to the patient’s head as indicated in the
leadset or your own montage.
4. For AEP measurement, connect earphones to the headbox and
place them on the patient’s ear/s. NOTE: Make sure that the
earphones do not press the patient’s head in any position (for
example, when the patient is lying on one side).
5. EEG measurement starts automatically. To start AEP, press the
EP Start/Stop key on the headbox or on the module.
6. Observe the results of the electrode check and reconnect the
electrodes if the impedance is too high.
A preconfigured leadset tells the monitor which montage (electrode
position) is used. In other words, no menu selections are necessary.
The three preconfigured montages, Basic, General and AEP, can be
used in most applications. For more information, see the "User's
Reference Manual."
Modifying a montage
If none of the preconfigured leadsets suits your application, you can
define your own montage. You can either plug the leadwires directly to
the headbox, or build your own leadset.
NOTE: If you are using other than Datex-Ohmeda supplied
headphones/earphones, verify the sound intensity. Too high an
intensity may damage the ear and too low an intensity causes a poor
response.
To define a montage:
1. Press the Others key.
2. Select EEG & EP- Montage. Go through the different menu items
and select the options to suit the application. You can also name
and save the montage for later use through Save Montage.
3. When a montage has been defined once, it can be used as any of
the preconfigured leadsets.
Changing electrodes
Stopping measurement
• Change the electrodes at least once a day.
• Check the electrode attachment by pressing the Imp. Check key.
EEG measurement continues as long as the electrodes are connected.
•
70
To stop the AEP measurement, press the EP Start/Stop key on
the headbox or on the module.
71
EEG spectrum and frequency bands
Displaying EEG
EEG is divided in four frequency bands: delta, theta, alpha and beta. To
characterize the spectral content of the signal, the following parameters
are calculated:
− Spectral Edge Frequency, SEF: the frequency below which nearly
all of the power is present.
− Median Frequency, MF: divides the spectrum in half: 50% of the
power is below and 50% above this frequency.
− Frequency band ratios (Delta%, Theta%, Alpha%, Beta%): define
what portion of the power is in a certain frequency band.
You can select EEG data to up to four waveform fields, or to digit fields
as numeric or graphic data (EEGgra or EEGnum). You can also select
EEG to the Split Screen and to snapshots.
See Part I, section "Setting up the monitor before use" for details on
how to configure snapshots.
To display compressed spectral array or numerical EEG related
calculated parameters:
1. Press the Others key.
2. Select EEG & EP - CSA or Numerical.
The spectrum is displayed graphically as a single, continuously
updating curve, Compressed Spectral Array (CSA).
Burst Suppression Ratio (BSR) is the ratio of suppressed EEG in a
time period of 60 seconds.
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72
Displaying FEMG
Saving Evoked Potentials
1. Press the Others key.
The FEMG value is displayed on the first waveform field whenever the
patient is connected for EEG monitoring and EEG is selected to be
displayed in the waveform fields.
To display the FEMG value among other numerical values:
1. Press the Others key.
2. Select EEG & EP - Numerical.
2. Select EEG & EP - EP - Save EP.
3. Set markers on the response by turning the ComWheel.
To select a saved response to be displayed simultaneously with the real
time response:
• Select Ref. EP and choose among the saved responses.
To change the stimulus frequency or volume or other AEP related
settings:
1. Press the Others key.
Select EEG & EP - AEP Setup.
Displaying Evoked Potentials
• Press the Others key and select EEG & EP - EP,
or select the split screen: Monitor Setup - Screen Setup Split Screen - EP.
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73
Bispectral Index (BIS)
You need:
NOTE: High EMG activity (like shivering or frequent eye movements)
causes artifact and may interfere with the measurement.
NOTE: BIS sensors are latex-free, disposable and for single-patient use
only. Do not use a sensor for more than 24 hours. Do not use dry sensors.
NOTE: Use only Aspect BIS sensors.
NOTE: Check the sensor expiry date on the sensor package.
(1) Module with BIS measurement capability, M-BIS
(2) Digital Signal Converter, DSC-XP
(3) Patient Interface Cable, PIC Plus
(4) BIS Sensor Quatro (in the drawing) , or BIS Sensor Pediatric
The M-BIS module is indicated for monitoring the state of the brain by
data acquisition of EEG signals. BIS may be used as an aid in
monitoring the effects of certain anesthetic agents.
CAUTION: Continuous impedance check may need to be
disabled if the 1 nA 128 Hz impedance check signal
interferes with other equipment, such as EEG module with
evoked potentials measurement.
BIS measurement is suitable for adult and pediatric patients. BIS
values should be interpreted cautiously in children less than one year old.
WARNING: Make sure that the electrodes, sensor and
connectors do not touch any electrically conductive
material, including earth.
NOTE: Make sure that the sensor connectors of the patient interface
cable are not in contact with fluids.
3
1
2
1
2
4
3
73
4
74
Digital signal converter (DSC)
BIS measurement on the monitor screen
Place the DSC close to the patient’s head where the EEG signal is less
subject to interference from other medical equipment.
NOTE: Degree of protection against harmful ingress of water as detailed
in the IEC 60529: IPX4.
The waveform field shows the BIS EEG waveform. The following BIS
related data appears in digit fields and graphical trends:
− BIS number indicates the patient’s bispectral index, ranging from
100 for wide awake to 0 in the absence of brain activity.
− Signal Quality Index (SQI) bar graph indicates the quality of the
EEG signal in the range of 0 to 100%.
− Electromyograph (EMG) bar graph represents the absolute power
in the 70 to 110 Hz frequency band and ranges from 30 to 55 dB.
This frequency band contains power from muscle activity as well as
power from high frequency artifacts.
− Suppression ratio (SR) number indicates the percentage of
suppressed (flatline) EEG detected over the last 63 seconds. It
ranges from 0 to 100%.
CAUTION: Do not autoclave the DSC. Do not open it for any
reason.
Starting
1.
2.
3.
4.
5.
6.
7.
Connect the DSC cable to the M-BIS module.
Prepare the patient. Clean the application site with alcohol and let dry.
Connect the patient interface cable to the digital signal converter.
Place the BIS sensor on the patient; see the sensor package.
Secure the DSC to a convenient location with the attachment clip.
Connect the sensor to the patient interface cable.
Observe the results of the automatic sensor check beside the
waveform or in the digit field. The measurement starts
automatically after the sensor has passed the check.
Selecting the smoothing rate
The smoothing rate is the time period over which artifact-free data is
analyzed to calculate the BIS value. It determines how often the BIS
data is updated on the screen and affects the appearance of
waveforms and trends. Factory default is 15 seconds.
1. Press the Others key.
2. Select BIS - Smoothing rate.
3. Select 30 or 15 seconds (default).
NOTE: You can turn off the automatic impedance check through Others
- BIS- BIS Setup - Automatic Check - OFF.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the
patient to avoid burns at monitor measurement sites.
Also ensure that the ESU return electrode is near the
operating area.
WARNING: Radiated field strengths above 1V/m may
cause erroneous measurements at various frequencies.
Do not use electrical radiating equipment close to the
DSC-XP.
Manual sensor check
Whenever required, the sensor check can be done manually:
1. Press the Check Sensor key on the module, or press the Others
key and select BIS - Check Sensor.
2. Observe the results on the screen. The measurement continues
automatically after the sensor has passed the check.
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Entropy
You need:
(1) Module with entropy measurement capability, M-ENTROPY
(2) Entropy sensor cable
(3) Entropy sensor
You get:
One channel of raw EEG, with two calculated entropy parameters and
Burst Suppression Ratio.
CAUTION: Automatic sensor check may need to be
disabled if the 70 Hz impedance check signal interferes
with other equipment, such as EEG module with evoked
potentials measurement.
WARNING: When using the electrosurgery unit, ensure
proper contact of the ESU return electrode to the patient
to avoid burns at monitor measurement sites. Also
ensure that the ESU return electrode is near the
operating area.
WARNING: Make sure that the electrodes, sensor and
connectors do not touch any electrically conductive
material, including earth.
WARNING: Strong 30-40 Hz magnetic fields may cause
erroneous entropy measurement. Do not use devices
with such a field close to the module or sensor.
2
1
1
2
3
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3
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Entropy measurement on the monitor screen
Manual sensor check
The waveform field shows the entropy EEG waveform. The digit field
shows the Response Entropy, RE, and State Entropy, SE, numbers and
a small trend. You can also configure the Burst Suppression Ratio,
BSR, to appear in the digit field. Entropy display format is chosen
through Others – Entropy – Display Format. Different screen
configurations are: RE, SE, RE+SE, and All (= RE, SE, and BSR).
Whenever required, the sensor check can be started manually:
1. Press the Check Sensor key on the module, or
press the Others key and select Entropy – Check Sensor.
-
Observe the results on the screen. The measurement continues
automatically after the sensor has passed the check.
RE is a fast reacting parameter, which may be used to detect the
activation of facial muscles
SE is a more stable parameter, which may be used to assess the
hypnotic effect of anesthetic drugs on the brain
BSR number gives an indication when a burst suppression
pattern appears. This may be a signal of an unnecessarily deep
anesthetic state.
Points to note
-
Starting
-
1. Connect the entropy sensor cable to the M-ENTROPY module.
2. Prepare the patient. Clean the application site with alcohol and let
it dry before attaching the sensor.
3. Place the entropy sensor on the patient's forehead according to
instructions on the sensor package.
4. Connect the sensor to the entropy sensor cable.
5. Observe the results of the automatic sensor check beside the
waveform or in the digit field. The measurement starts
automatically after the sensor has passed the check.
-
Frequent eye movements, coughing and patient movement cause
artifacts and may interfere with the measurement.
Entropy readings may be inconsistent when monitoring patients
with neurological disorders, traumas or their sequelae.
Psychoactive medication may cause inconsistent entropy
readings.
Entropy measurement has not been validated with pediatric
patients.
Entropy sensors are latex- and PVC-free, disposable and for
single-patient use only.
Do not use a sensor for more than 24 hours. Do not use expired
sensors.
Make sure that the sensor connectors of the sensor cable are not
in contact with fluids
Check the expiry date on the sensor package.
CAUTION: The entropy measurement is to be used as an
adjunct to other physiological parameters in assessing the
effects of certain anesthetic agents.
NOTE: You can also turn off the automatic sensor check through
Others – Entropy - Automatic Check - OFF.
NOTE: Always ensure that the sensor is properly attached and
connected.
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