DPM6 Operators Manual - Mindray North America

DPM6 Operators Manual - Mindray North America
Revision History
This manual has a revision number. This revision number changes whenever the manual is
updated due to software or technical specification change. Contents of this manual are
subject to change without prior notice.
„
Revision number: 1.0
„
Release time:
201
© Copyright 2008-201 Mindray DS USA, Inc. All rights reserved.
WARNING
z
Federal Law (USA) restricts this device to sale by or on the order of a physician.
I
Intellectual Property Statement
Mindray DS USA, Inc. (hereinafter called Mindray DS) owns the intellectual property
rights to this product and this manual. This manual may refer to information protected by
copyrights or patents and does not convey any license under the copyright or patent rights
of Mindray DS, nor the rights of others.
Mindray DS intends to maintain the contents of this manual as confidential information.
Disclosure of the information in this manual in any manner whatsoever without the written
permission of Mindray DS is strictly forbidden. Release, amendment, reproduction,
distribution, rental, adaptation and translation of this manual in any manner whatsoever
without the written permission of Mindray DS is strictly forbidden.
is a trademark or a registered trademark of Shenzhen Mindray
Bio-Medical Electronics Co., Ltd. All third-party trademarks that appear in this manual are
used solely for editorial purposes and are the property of their respective owners.
Contents of this manual are subject to changes without prior notice.
II
Manufacturer’s Responsibility
All information contained in this manual is believed to be correct. Shenzhen Mindray
Bio-Medical Electronics Co., Ltd. shall not be liable for errors FRQWDLQHGKHUHLQQRU
for incidental or consequential damages in connection with the IXUQLVKLQJRUXVHRIWKLV
manual.
7KHPDQXIDFWXUHUwill not be liable for the effects on safety, reliability and performance of
WKLVSURGXFWif:

any installation operations, expansions, changes, modifications or repairs of this product
are not conducted by Mindray authorized personnel; and

the electrical installation of the relevant room does not comply with the applicable
national and local requirements; and

the product is not used in accordance with the instructions for use.
Warranty
This warranty is exclusive and is in lieu of all other warranties, expressed or implied,
including warranties of merchantability or fitness for any particular purpose.
Exemptions
Mindray obligation or liability under this warranty does not include any transportation
or other charges or liability for direct, indirect or consequential damages or delay resulting
from the improper use or application of the product or the use of parts or accessories not
approved by Mindray or repairs by people other than Mindray uthorized personnel.
This warranty shall not extend to

Any Mindray product which has been subjected to misuse, negligence or accident;
or

Any Mindray product from which Mindray 's original serial number tag or
product identification markings have been altered or removed; or

Any product of any other manufacturer.
III
Return Policy
In the event that it becomes necessary to return a unit to Mindray DS, follow the instructions
below.
1.
Return authorization.
Contact the Customer Service Department and obtain a Customer Service Authorization
number. This number must appear on the outside of the shipping container. Returned
shipments will not be accepted if the number is not clearly visible. Please provide the
model number, serial number, and a brief description of the reason for return.
2.
Freight policy
The customer is responsible for freight charges when this product is shipped to Mindray
DS for service (this includes customs charges).
3.
Return address
Please send the part(s) or equipment to the address offered by the Customer Service
Department.
Contact Information
Manufacturer:
Shenzhen Mindray Bio-Medical Electronics Co., Ltd.
Address:
Mindray Building, Keji 12th Road South,Hi-tech industrial park,
Nanshan, Shenzhen 518057,P.R.China
Website:
www. mindray.com
E-mail Address
[email protected]
Tel:
+86 755 81888998
Fax:
+86 755 26582680
Distributor:
Mindray DS USA, Inc.
Address:
800 MacArthur Boulevard, Mahwah, New Jersey 07430 USA
Tel:
1.800.288.2121, 1.201.995.8000
Website:
www.mindray.com
IV
Preface
Manual Purpose
This manual contains the instructions necessary to operate the product safely and in
accordance with its function and intended use. Observance of this manual is a prerequisite
for proper product performance and correct operation and ensures patient and operator
safety.
This manual is based on the maximum configuration and therefore some contents may not
apply to your product. If you have any question, please contact us.
This manual is an integral part of the product. It should always be kept close to the
equipment so that it can be obtained conveniently when needed.
Intended Audience
This manual is geared for clinical professionals who are expected to have a working
knowledge of medical procedures, practices and terminology as required for monitoring of
critically ill patients.
Illustrations
All illustrations in this manual serve as examples only. They may not necessarily reflect the
setup or data displayed on your patient monitor.
Conventions
„
Italic text is used in this manual to quote the referenced chapters or sections.
„
[ ] is used to enclose screen texts.
„
ė is used to indicate operational procedures.
1
FOR YOUR NOTES
2
Contents
1 Safety................................................................................................................................. 1-1
1.1 Safety Information .......................................................................................................... 1-1
1.1.1 Warnings ............................................................................................................ 1-2
1.1.2 Cautions ............................................................................................................. 1-3
1.1.3 Notes .................................................................................................................. 1-3
1.2 Equipment Symbols ........................................................................................................ 1-4
2 The Basics ......................................................................................................................... 2-1
2.1 Monitor Description ........................................................................................................ 2-1
2.1.1 Intended Use ...................................................................................................... 2-1
2.1.2 Contraindications ............................................................................................... 2-1
2.1.3 Components ....................................................................................................... 2-1
2.2 Main Unit ........................................................................................................................ 2-2
2.2.1 Front View.......................................................................................................... 2-2
2.2.2 Side View ........................................................................................................... 2-4
2.2.3 Rear View........................................................................................................... 2-5
2.3 Satellite Module Rack ..................................................................................................... 2-7
2.4 Modules........................................................................................................................... 2-8
2.4.1 Plug-In Modules................................................................................................. 2-8
2.4.2 Multi-Parameter Module.................................................................................... 2-9
2.5 Display Screen .............................................................................................................. 2-10
2.6 QuickKeys..................................................................................................................... 2-12
3 Basic Operations .............................................................................................................. 3-1
3.1 Installation....................................................................................................................... 3-1
3.1.1 Unpacking and Checking ................................................................................... 3-2
3.1.2 Environmental Requirements............................................................................. 3-3
3.2 Getting Started ................................................................................................................ 3-4
3.2.1 Turning Power On .............................................................................................. 3-4
3.2.2 Starting Monitoring ............................................................................................ 3-4
3.3 Disconnecting from Power.............................................................................................. 3-5
3.4 Using a mouse................................................................................................................. 3-5
3.5 Using Keys...................................................................................................................... 3-6
3.6 Using Keyboards............................................................................................................. 3-6
3.7 Using the Touchscreen .................................................................................................... 3-6
3.8 Setting the Screen............................................................................................................ 3-7
3.9 Using the Main Menu ..................................................................................................... 3-8
3.10 Setting Parameters......................................................................................................... 3-9
3.10.1 Accessing the Parameters Menu....................................................................... 3-9
1
3.10.2 Removing a Module Conflict......................................................................... 3-10
3.10.3 Removing a Label Conflict ............................................................................ 3-10
3.11 Using a CF Storage Card..............................................................................................3-11
3.12 Changing General Settings.......................................................................................... 3-12
3.12.1 Setting up a Monitor....................................................................................... 3-12
3.12.2 Changing Language ....................................................................................... 3-12
3.12.3 Adjusting the Screen Brightness .................................................................... 3-13
3.12.4 Showing/Hiding the Help............................................................................... 3-13
3.12.5 Setting the Date and Time .............................................................................. 3-13
3.12.6 Adjusting Volume........................................................................................... 3-14
3.13 Managing Configurations............................................................................................ 3-15
3.13.1 Restoring the Latest Configuration Automatically......................................... 3-15
3.13.2 Setting Default Configuration at Startup........................................................ 3-15
3.13.3 Saving as User Configuration ........................................................................ 3-16
3.13.4 Deleting a User Default Configuration .......................................................... 3-16
3.13.5 Restoring Default Configuration Manually.................................................... 3-17
4 Managing Patients............................................................................................................ 4-1
4.1 Admitting a Patient.......................................................................................................... 4-1
4.2 Quick Admitting a Patient............................................................................................... 4-2
4.3 Editing Patient Information............................................................................................. 4-3
4.4 Discharging a Patient ...................................................................................................... 4-3
4.5 Transferring a Patient ...................................................................................................... 4-3
4.6 Connecting to PanoramaTM Central Station .................................................................... 4-6
5 User Screens...................................................................................................................... 5-1
5.1 Tailoring Your Screens .................................................................................................... 5-1
5.1.1 Setting the Waveform Sweep Mode ................................................................... 5-1
5.1.2 Changing the Wave Line Size ............................................................................ 5-1
5.1.3 Changing Measurement Colors.......................................................................... 5-1
5.1.4 Changing Screen Layout .................................................................................... 5-2
5.2 Viewing Minitrends......................................................................................................... 5-3
5.2.1 Having a Split-Screen View of Minitrends ........................................................ 5-3
5.2.2 Setting Minitrends.............................................................................................. 5-4
5.3 Viewing oxyCRG ............................................................................................................ 5-4
5.4 Viewing Other Patients ................................................................................................... 5-5
5.4.1 Care Group ......................................................................................................... 5-5
5.4.2 Viewing the Care Group Overview Bar ............................................................. 5-6
5.4.3 Understanding the View Other Patient Window ................................................ 5-7
5.5 Understanding the Big Numerics Screen ........................................................................ 5-8
6 Alarms ............................................................................................................................... 6-1
6.1 Alarm Categories............................................................................................................. 6-1
6.2 Alarm Levels ................................................................................................................... 6-2
2
6.3 Alarm Indicators.............................................................................................................. 6-2
6.3.1 Alarm Lamp ....................................................................................................... 6-2
6.3.2 Alarm Message................................................................................................... 6-3
6.3.3 Flashing Numeric ............................................................................................... 6-3
6.3.4 Audible Alarm Tones.......................................................................................... 6-3
6.3.5 Reminder Tones.................................................................................................. 6-4
6.3.6 Alarm Status Symbols ........................................................................................ 6-4
6.4 Alarm Tone Configuration .............................................................................................. 6-5
6.4.1 Setting the Minimum Alarm Volume ................................................................. 6-5
6.4.2 Changing the Alarm Volume .............................................................................. 6-5
6.4.3 Setting the Interval between Alarm Sounds ....................................................... 6-6
6.4.4 Changing the Alarm Tone Pattern ...................................................................... 6-7
6.4.5 Setting the Reminder Tones ............................................................................... 6-7
6.5 Understanding the Alarm Setup Menu ............................................................................ 6-7
6.5.1 Setting Alarm Properties for All Parameters ...................................................... 6-8
6.5.2 Adjusting Alarm Limits Automatically .............................................................. 6-8
6.5.3 Setting Alarm Delay Time................................................................................ 6-13
6.5.4 Entering CPB Mode ......................................................................................... 6-13
6.6 Pausing Alarms ............................................................................................................. 6-14
6.7 Silencing the Alarm Sound............................................................................................ 6-14
6.8 Latching Alarms............................................................................................................ 6-14
6.9 Silencing Technical Alarms........................................................................................... 6-15
6.10 Testing Alarms ............................................................................................................ 6-15
6.11 When an Alarm Occurs ............................................................................................... 6-16
6.12 Using Care Group Alarms........................................................................................... 6-16
6.12.1 Care Group Auto Alarms................................................................................ 6-16
6.12.2 Silencing Care Group Alarms ........................................................................ 6-16
7 Monitoring ECG .............................................................................................................. 7-1
7.1 Introduction..................................................................................................................... 7-1
7.2 Safety .............................................................................................................................. 7-2
7.3 Preparing to Monitor ECG .............................................................................................. 7-3
7.3.1 Preparing the Patient and Placing the Electrodes............................................... 7-3
7.3.2 Choosing AHA or IEC Lead Placement ............................................................. 7-4
7.3.3 ECG Lead Placements........................................................................................ 7-4
7.3.4 Checking Paced Status ....................................................................................... 7-7
7.4 Understanding the ECG Display..................................................................................... 7-8
7.5 Changing ECG Settings .................................................................................................. 7-9
7.5.1 Accessing ECG Menus....................................................................................... 7-9
7.5.2 Setting Pacemaker Rate (For Mortara only)....................................................... 7-9
7.5.3 Choosing the Alarm Source ............................................................................... 7-9
7.5.4 Setting the ECG Lead Set .................................................................................. 7-9
7.5.5 Choosing an ECG Display Screen ..................................................................... 7-9
7.5.6 Changing the ECG Filter Settings.................................................................... 7-10
3
7.5.7 Switching the Notch Filter On or Off............................................................... 7-10
7.5.8 About the Defibrillator Synchronization ...........................................................7-11
7.5.9 Changing ECG Wave Settings ..........................................................................7-11
7.5.10 Choosing the Heart Rate Source .................................................................... 7-12
7.5.11 Enabling Smart Lead Off ............................................................................... 7-12
7.5.12 Setting the Alarm Level for ECG Lead Off Alarms ....................................... 7-12
7.5.13 Adjusting QRS Volume .................................................................................. 7-12
7.6 About ST Monitoring .................................................................................................... 7-13
7.6.1 Switching ST On and Off................................................................................. 7-13
7.6.2 Changing ST Filter Settings ............................................................................. 7-13
7.6.3 Understanding the ST Display ......................................................................... 7-14
7.6.4 Changing the ST Alarm Limits ........................................................................ 7-14
7.6.5 Setting the ST Alarm Delay Time .................................................................... 7-14
7.6.6 Adjusting ST Measurement Points ................................................................... 7-14
7.7 About Arrhythmia Monitoring ...................................................................................... 7-16
7.7.1 Understanding the Arrhythmia Events ............................................................. 7-17
7.7.2 Changing Arrhythmia Alarm Settings .............................................................. 7-18
7.7.3 Changing Arrhythmia Threshold Settings........................................................ 7-18
7.7.4 Reviewing Arrhythmia Events ......................................................................... 7-19
7.7.5 Initiating an ECG Relearning Manually........................................................... 7-19
7.7.6 Automatic ECG Relearning.............................................................................. 7-19
7.8 12-Lead ECG Monitoring ............................................................................................. 7-20
8 Monitoring Respiration (Resp) ....................................................................................... 8-1
8.1 Introduction..................................................................................................................... 8-1
8.2 Safety Information .......................................................................................................... 8-1
8.3 Understanding the Resp Display..................................................................................... 8-2
8.4 Placing Resp Electrodes.................................................................................................. 8-2
8.4.1 Optimizing Lead Placement for Resp ................................................................ 8-3
8.4.2 Cardiac Overlay ................................................................................................. 8-3
8.4.3 Abdominal Breathing ......................................................................................... 8-3
8.4.4 Lateral Chest Expansion .................................................................................... 8-4
8.5 Choosing the Respiration Lead ....................................................................................... 8-4
8.6 Changing the Apnea Alarm Delay................................................................................... 8-4
8.7 Changing Resp Detection Mode ..................................................................................... 8-4
8.8 Changing Resp Wave Settings ........................................................................................ 8-5
8.9 Setting RR Source........................................................................................................... 8-5
8.10 Setting alarm properties ................................................................................................ 8-6
8.11 Switching Resp Measurement On/Off........................................................................... 8-6
9 Monitoring PR.................................................................................................................. 9-1
9.1 Introduction..................................................................................................................... 9-1
9.2 Setting the PR Source ..................................................................................................... 9-2
9.3 Selecting the Active Alarm Source ................................................................................. 9-3
4
9.4 QRS Tone ........................................................................................................................ 9-3
10 Monitoring SpO2.......................................................................................................... 10-1
10.1 Introduction................................................................................................................. 10-1
10.2 Safety .......................................................................................................................... 10-2
10.3 Identifying SpO2 Modules.......................................................................................... 10-3
10.4 Applying the Sensor .................................................................................................... 10-3
10.5 Changing SpO2 Settings ............................................................................................. 10-4
10.5.1 Accessing SpO2 Menus .................................................................................. 10-4
10.5.2 Adjusting the Desat Alarm ............................................................................. 10-4
10.5.3 Setting SpO2 Sensitivity................................................................................. 10-4
10.5.4 Changing Averaging Time.............................................................................. 10-4
10.5.5 Monitoring SpO2 and NIBP Simultaneously.................................................. 10-5
10.5.6 Sat-Seconds Alarm Management ................................................................... 10-5
10.5.7 Changing the Speed of the Pleth Wave .......................................................... 10-6
10.5.8 Setting the Alarm Level for SpO2 Sensor Off Alarm..................................... 10-6
10.5.9 Setting the SpO2 Tone Mode ......................................................................... 10-7
10.6 Measurement Limitations............................................................................................ 10-7
10.7 Masimo Information ................................................................................................... 10-8
10.8 Nellcor Information..................................................................................................... 10-8
11 Monitoring NIBP...........................................................................................................11-1
11.1 Introduction ..................................................................................................................11-1
11.2 Safety ...........................................................................................................................11-2
11.3 Measurement Limitations.............................................................................................11-3
11.4 Measurement Methods .................................................................................................11-3
11.5 Setting Up the NIBP Measurement ..............................................................................11-3
11.5.1 Preparing to Measure NIBP ............................................................................11-3
11.5.2 Starting and Stopping Measurements ..............................................................11-4
11.5.3 Correcting the Measurement if Limb is not at Heart Level.............................11-4
11.5.4 Enabling NIBP Auto Cycling and Setting the Interval....................................11-4
11.5.5 Starting a STAT Measurement.........................................................................11-5
11.6 Understanding the NIBP Numerics ..............................................................................11-5
11.7 Changing NIBP Settings ..............................................................................................11-6
11.7.1 Setting the Initial Cuff Inflation Pressure........................................................11-6
11.7.2 Setting NIBP Alarm Properties........................................................................11-6
11.7.3 Displaying NIBP List ......................................................................................11-6
11.7.4 Setting the Pressure Unit .................................................................................11-7
11.8 Assisting Venous Puncture ...........................................................................................11-7
11.9 Resetting NIBP.............................................................................................................11-7
11.10 NIBP Leakage Test.....................................................................................................11-8
11.11 NIBP Accuracy Test ...................................................................................................11-9
11.12 Calibrating NIBP......................................................................................................11-10
5
12 Monitoring Temp.......................................................................................................... 12-1
12.1 Introduction................................................................................................................. 12-1
12.2 Safety .......................................................................................................................... 12-1
12.3 Making a Temp Measurement..................................................................................... 12-2
12.4 Understanding the Temp Display ................................................................................ 12-2
12.5 Setting the Temperature Unit ...................................................................................... 12-2
13 Monitoring IBP ............................................................................................................ 13-1
13.1 Introduction................................................................................................................. 13-1
13.2 Safety .......................................................................................................................... 13-1
13.3 Setting Up the Pressure Measurement ........................................................................ 13-2
13.4 Understanding the IBP Display................................................................................... 13-3
13.5 Changing IBP Settings ................................................................................................ 13-4
13.5.1 Changing a Pressure for Monitoring .............................................................. 13-4
13.5.2 Setting Alarm Properties ................................................................................ 13-4
13.5.3 Changing Averaging Time.............................................................................. 13-4
13.5.4 Setting the Pressure Unit................................................................................ 13-5
13.5.5 Setting Up the IBP Wave................................................................................ 13-5
13.6 Measuring PAWP ........................................................................................................ 13-6
13.6.1 Preparing to Measure PAWP .......................................................................... 13-7
13.6.2 Setting Up the PAWP Measurement............................................................... 13-8
13.6.3 Understanding the PAWP Setup Menu........................................................... 13-9
13.7 Zeroing the Transducer ............................................................................................... 13-9
14 Monitoring Cardiac Output ........................................................................................ 14-1
14.1 Introduction................................................................................................................. 14-1
14.2 Understanding the C.O. Display ................................................................................. 14-2
14.3 Influencing Factors ..................................................................................................... 14-2
14.4 Setting Up the C.O. Measurement .............................................................................. 14-3
14.5 Measuring the Blood Temperature .............................................................................. 14-6
14.6 Changing C.O. Settings............................................................................................... 14-6
14.6.1 Setting the Temperature Unit ......................................................................... 14-6
14.6.2 Setting Alarm Properties ................................................................................ 14-6
15 Monitoring CCO/SvO2................................................................................................ 15-1
15.1 Introduction................................................................................................................. 15-1
15.2 Safety .......................................................................................................................... 15-1
15.3 Automatic Communication Detection......................................................................... 15-2
15.4 Connecting the Vigilance II® Monitor ....................................................................... 15-2
15.5 Understanding CCO Parameters ................................................................................. 15-4
15.6 Understanding the CCO Display................................................................................. 15-4
15.7 Changing CCO Settings .............................................................................................. 15-5
15.7.1 Selecting Vascular Resistance Unit ................................................................ 15-5
6
15.7.2 Selecting the Displayed Parameters ............................................................... 15-5
15.7.3 Checking the C.O. Measurements.................................................................. 15-5
15.7.4 Setting Signal Output ..................................................................................... 15-5
15.7.5 Selecting Alarm Properties............................................................................. 15-6
15.8 Understanding SvO2 Parameters ................................................................................ 15-6
15.9 Understanding the SvO2 Display................................................................................ 15-6
15.10 Changing SvO2 Settings ........................................................................................... 15-7
15.10.1 Setting Signal Output ................................................................................... 15-7
15.10.2 Selecting Alarm Properties........................................................................... 15-7
16 Monitoring Carbon Dioxide ........................................................................................ 16-1
16.1 Introduction................................................................................................................. 16-1
16.2 Identifying CO2 Modules ........................................................................................... 16-2
16.3 Preparing to Measure CO2.......................................................................................... 16-3
16.3.1 Using a Sidestream CO2 Module ................................................................... 16-3
16.3.2 Using a Microstream CO2 Module................................................................. 16-4
16.3.3 Using a Mainstream CO2 Module .................................................................. 16-5
16.4 Changing CO2 Settings............................................................................................... 16-6
16.4.1 Accessing CO2 Menus.................................................................................... 16-6
16.4.2 Entering the Standby Mode............................................................................ 16-6
16.4.3 Setting the CO2 Unit...................................................................................... 16-6
16.4.4 Setting up Gas Compensations....................................................................... 16-7
16.4.5 Setting up Humidity Compensation ............................................................... 16-8
16.4.6 Setting the Apnea Alarm Delay...................................................................... 16-8
16.4.7 Choosing a Time Interval for Peak-Picking ................................................... 16-9
16.4.8 Setting the Flow Rate ..................................................................................... 16-9
16.4.9 Setting up the CO2 Wave................................................................................ 16-9
16.4.10 Setting RR Source ........................................................................................ 16-9
16.5 Setting Barometric Pressure Compensation .............................................................. 16-10
16.6 Measurement Limitations.......................................................................................... 16-10
16.7 Troubleshooting the Sidestream CO2 Sampling System ...........................................16-11
16.8 Removing Exhaust Gases from the System ...............................................................16-11
16.9 Zeroing the Sensor .....................................................................................................16-11
16.9.1 For Sidestream and Microstream CO2 Modules............................................16-11
16.9.2 For Mainstream CO2 Modules ..................................................................... 16-12
16.10 Calibrating the Sensor ............................................................................................. 16-12
16.11 Oridion Information ................................................................................................ 16-13
17 Monitoring AG ............................................................................................................. 17-1
17.1 Introduction................................................................................................................. 17-1
17.2 Identifying AG Modules ............................................................................................. 17-1
17.3 Understanding the AG Display ................................................................................... 17-2
17.4 MAC Values................................................................................................................ 17-3
17.5 Preparing to Measure AG............................................................................................ 17-4
7
17.6 Changing AG Settings................................................................................................. 17-5
17.6.1 Setting Gas Unit ............................................................................................. 17-5
17.6.2 Setting the Apnea Alarm Delay...................................................................... 17-5
17.6.3 Changing the Sample Flow Rate.................................................................... 17-6
17.6.4 Setting up the O2 Compensation .................................................................... 17-6
17.6.5 Entering the Standby Mode............................................................................ 17-6
17.6.6 Setting up the AG Wave ................................................................................. 17-7
17.6.7 Setting RR Source .......................................................................................... 17-7
17.7 Changing the Anesthetic Agent................................................................................... 17-7
17.8 Measurement Limitations............................................................................................ 17-7
17.9 Troubleshooting .......................................................................................................... 17-8
17.9.1 When the Gas Inlet is Blocked ....................................................................... 17-8
17.9.2 When an Internal Occlusion Occurs............................................................... 17-8
17.10 Removing Exhaust Gases from the System .............................................................. 17-8
18 Monitoring ICG............................................................................................................ 18-1
18.1 Introduction................................................................................................................. 18-1
18.2 Safety .......................................................................................................................... 18-1
18.3 Understanding ICG Parameters................................................................................... 18-2
18.3.1 Measured Parameters ..................................................................................... 18-2
18.3.2 Calculated Parameters.................................................................................... 18-2
18.4 Understanding the ICG Display .................................................................................. 18-3
18.5 ICG Limitations .......................................................................................................... 18-3
18.6 Preparing to Monitor ICG ........................................................................................... 18-4
18.6.1 Preparing the Patient ...................................................................................... 18-4
18.6.2 Placing ICG Sensors ...................................................................................... 18-4
18.6.3 Setting up the Patient Information ................................................................. 18-5
18.7 Changing ICG Settings ............................................................................................... 18-5
18.7.1 ICG Averaging ............................................................................................... 18-5
18.7.2 Selecting Secondary Parameters .................................................................... 18-6
18.7.3 Checking Sensors ........................................................................................... 18-6
18.7.4 Changing the ICG Wave Speed...................................................................... 18-6
19 Monitoring BIS............................................................................................................. 19-1
19.1 Introduction................................................................................................................. 19-1
19.2 Safety Information ...................................................................................................... 19-2
19.3 Understanding the BIS Display................................................................................... 19-3
19.3.1 BIS Parameter Area........................................................................................ 19-3
19.3.2 BIS Waveform Area ....................................................................................... 19-4
19.4 Setting up the BIS Measurement................................................................................. 19-5
19.5 Continuous Impedance Check..................................................................................... 19-6
19.6 Cyclic Impedance Check............................................................................................. 19-6
19.7 BIS Sensor Check Window......................................................................................... 19-7
19.8 Choosing the BIS Smoothing Rate ............................................................................. 19-8
8
19.9 Changing the Secondary Parameters........................................................................... 19-8
19.10 Changing the EEG Wave Size................................................................................... 19-8
19.11 Changing the Speed of the EEG Wave...................................................................... 19-8
19.12 Setting the Trend Length........................................................................................... 19-8
20 Monitoring RM ............................................................................................................ 20-1
20.1 Introduction................................................................................................................. 20-1
20.2 Safety Information ...................................................................................................... 20-3
20.3 Preparing to Monitor RM............................................................................................ 20-4
20.4 Understanding the RM Display................................................................................... 20-5
20.5 Changing RM Settings ................................................................................................ 20-6
20.5.1 Accessing RM Menus .................................................................................... 20-6
20.5.2 Setting the Apnea Alarm Delay...................................................................... 20-6
20.5.3 Selecting TV or MV for Display .................................................................... 20-6
20.5.4 Selecting Flow or Vol Waveform for Display ................................................ 20-6
20.5.5 Changing the Wave Sweep Speed .................................................................. 20-7
20.5.6 Changing the Wave Scale............................................................................... 20-7
20.5.7 Setting RR Source .......................................................................................... 20-7
20.6 Understanding the Respiratory Loops......................................................................... 20-8
20.7 Zeroing the RM Module.............................................................................................. 20-9
20.8 Calibrating the Flow Sensor........................................................................................ 20-9
21 Freezing Waveforms .................................................................................................... 21-1
21.1 Freezing Waveforms ................................................................................................... 21-1
21.2 Viewing Frozen Waveforms ........................................................................................ 21-1
21.3 Unfreezing Waveforms ............................................................................................... 21-2
21.4 Recording Frozen Waveforms..................................................................................... 21-2
22 Review ........................................................................................................................... 22-1
22.1 Accessing Respective Review Windows..................................................................... 22-1
22.2 Reviewing Graphic Trends.......................................................................................... 22-2
22.3 Reviewing Tabular Trends .......................................................................................... 22-3
22.4 Reviewing Events ....................................................................................................... 22-5
22.5 Reviewing Waveforms ................................................................................................ 22-7
23 Calculations .................................................................................................................. 23-1
23.1 Introduction................................................................................................................. 23-1
23.2 Dose Calculations ....................................................................................................... 23-2
23.2.1 Performing Calculations................................................................................. 23-2
23.2.2 Selecting the Proper Drug Unit ...................................................................... 23-3
23.2.3 Titration Table ................................................................................................ 23-3
23.3 Oxygenation Calculations ........................................................................................... 23-4
23.3.1 Performing Calculations................................................................................. 23-4
23.3.2 Entered Parameters......................................................................................... 23-5
9
23.3.3 Calculated Parameters.................................................................................... 23-5
23.4 Ventilation Calculations .............................................................................................. 23-6
23.4.1 Performing Calculations................................................................................. 23-6
23.4.2 Entered Parameters......................................................................................... 23-7
23.4.3 Calculated Parameters.................................................................................... 23-7
23.5 Hemodynamic Calculations ........................................................................................ 23-8
23.5.1 Performing Calculations................................................................................. 23-8
23.5.2 Entered Parameters......................................................................................... 23-9
23.5.3 Calculated Parameters.................................................................................... 23-9
23.6 Renal Calculations .................................................................................................... 23-10
23.6.1 Performing Calculations............................................................................... 23-10
23.6.2 Entered Parameters........................................................................................23-11
23.6.3 Calculated Parameters...................................................................................23-11
23.7 Understanding the Review Window.......................................................................... 23-12
24 Recording...................................................................................................................... 24-1
24.1 Using a Recorder......................................................................................................... 24-1
24.2 Overview of Recording Types..................................................................................... 24-2
24.3 Starting and Stopping Recordings............................................................................... 24-3
24.4 Setting up the Recorder............................................................................................... 24-4
24.4.1 Accessing the Record Setup Menu................................................................. 24-4
24.4.2 Selecting Waveforms for Recording .............................................................. 24-4
24.4.3 Setting the Realtime Recording Length ......................................................... 24-4
24.4.4 Setting the Interval between Timed Recordings............................................. 24-4
24.4.5 Changing the Recording Speed ...................................................................... 24-4
24.4.6 Clearing Recording Tasks .............................................................................. 24-5
24.5 Loading Paper ............................................................................................................. 24-5
24.6 Removing Paper Jam .................................................................................................. 24-6
24.7 Cleaning the Recorder Printhead ................................................................................ 24-6
25 Printing ......................................................................................................................... 25-1
25.1 Printer.......................................................................................................................... 25-1
25.2 Connecting a printer.................................................................................................... 25-1
25.3 Setting Up the Printer.................................................................................................. 25-2
25.4 Starting Report Printouts............................................................................................. 25-2
25.5 Stopping Reports Printouts ......................................................................................... 25-4
25.6 Setting Up Reports ...................................................................................................... 25-4
25.6.1 Setting Up ECG Reports ................................................................................ 25-4
25.6.2 Setting Up Tabular Trends Reports ................................................................ 25-4
25.6.3 Setting Up Graphic Trends Reports ............................................................... 25-5
25.6.4 Setting Up Realtime Reports.......................................................................... 25-5
25.7 End Case Reports ........................................................................................................ 25-5
25.8 Printer Statuses............................................................................................................ 25-6
25.8.1 Printer Out of Paper ....................................................................................... 25-6
10
25.8.2 Printer Status Messages.................................................................................. 25-5
26 Other Functions............................................................................................................ 26-1
26.1 Marking Events ........................................................................................................... 26-1
26.2 Privacy Mode .............................................................................................................. 26-1
26.3 Night Mode ................................................................................................................. 26-2
26.4 Analog Output ............................................................................................................. 26-3
26.5 Transferring Data ........................................................................................................ 26-3
26.5.1 Data Export System........................................................................................ 26-3
26.5.2 Transferring Data by Different Means ........................................................... 26-4
26.6 Nurse Call ................................................................................................................... 26-5
26.7 Remote Display........................................................................................................... 26-6
26.8 Wireless Network........................................................................................................ 26-7
27 Batteries .........................................................................................................................27-1
27.1 Overview......................................................................................................................27-1
27.2 Installing or Replacing a Battery..................................................................................27-2
27.3 Conditioning a Battery .................................................................................................27-3
27.4 Checking a Battery.......................................................................................................27-4
27.5 Recycling a Battery ......................................................................................................27-4
28 Care and Cleaning........................................................................................................ 28-1
28.1 General Points ............................................................................................................. 28-1
28.2 Cleaning ...................................................................................................................... 28-2
28.3 Disinfecting................................................................................................................. 28-3
29 Maintenance ................................................................................................................. 29-1
29.1 Safety Checks.............................................................................................................. 29-1
29.2 Maintenance and Testing Schedule ............................................................................. 29-2
29.3 Checking Monitor and Module Information ............................................................... 29-4
29.4 Calibrating ECG.......................................................................................................... 29-4
29.5 Calibrating the Touchscreen........................................................................................ 29-4
29.6 Calibrating CO2 .......................................................................................................... 29-5
29.7 Calibrating AG ............................................................................................................ 29-6
29.8 Electrical Safty Tests................................................................................................... 29-7
29.9 Setting up IP Address .................................................................................................. 29-7
29.10 Entering/Exiting Demo Mode ................................................................................... 29-8
30 Accessories .................................................................................................................... 30-1
30.1 ECG Accessories......................................................................................................... 30-2
30.2 SpO2 Accessories ........................................................................................................ 30-3
30.3 NIBP Accessories........................................................................................................ 30-5
30.4 Temp Accessories........................................................................................................ 30-7
30.5 IBP Accessories........................................................................................................... 30-7
11
30.6 C.O. Accessories ......................................................................................................... 30-8
30.7 CCO/SvO2 Accessories ............................................................................................... 30-9
30.8 CO2 Accessories.......................................................................................................... 30-9
30.9 AG Accessories ......................................................................................................... 30-10
30.10 ICG Accessories...................................................................................................... 30-10
30.11 BIS Accessories....................................................................................................... 30-10
30.12 RM Accessories....................................................................................................... 30-10
30.13 Others...................................................................................................................... 30-10
A Product Specifications.....................................................................................................A-1
A.1 Monitor Safety Specifications........................................................................................A-1
A.2 Physical Specifications...................................................................................................A-4
A.3 Hardware Specifications ................................................................................................A-5
A.4 Data Storage ...................................................................................................................A-9
A.5 Measurement Specifications.........................................................................................A-10
B EMC and Radio Regulatory Compliance......................................................................B-1
C Factory Defaults ..............................................................................................................C-1
C.1 Patient Demographics.....................................................................................................C-1
C.2 Alarm Setup....................................................................................................................C-1
C.3 Screen Setup ...................................................................................................................C-1
C.4 ECG Setup......................................................................................................................C-2
C.5 Resp Setup......................................................................................................................C-4
C.6 PR ...................................................................................................................................C-4
C.7 SpO2 Setup.....................................................................................................................C-5
C.8 NIBP Setup.....................................................................................................................C-6
C.9 Temp Setup.....................................................................................................................C-6
C.10 IBP Setup......................................................................................................................C-7
C.11 C.O. Setup ....................................................................................................................C-8
C.12 CCO/SvO2 Setup ..........................................................................................................C-8
C.13 CO2 Setup ....................................................................................................................C-9
C.14 AG Setup ....................................................................................................................C-10
C.15 ICG Setup ................................................................................................................... C-11
C.16 BIS Setup.................................................................................................................... C-11
C.17 RM Setup....................................................................................................................C-12
D Alarm Messages...............................................................................................................D-1
D.1 Physiological Alarm Messages.......................................................................................D-2
D.2 Technical Alarm Messages.............................................................................................D-3
E Electrical Safety Inspection ............................................................................................E-1
E.1 Power Cord Plug............................................................................................................. E-1
12
E.2 Device Enclosure and Accessories ................................................................................. E-2
E.3 Device Labelling............................................................................................................. E-2
E.4 Protective Earth Resistance ............................................................................................ E-2
E.5 Earth Leakage Test ......................................................................................................... E-3
E.6 Patient Leakage Current ................................................................................................. E-3
E.7 Mains on Applied Part Leakage...................................................................................... E-4
E.8 Patient Auxiliary Current................................................................................................ E-4
F Symbols and Abbreviations............................................................................................. F-1
F.1 Symbols........................................................................................................................... F-1
F.2 Abbreviations .................................................................................................................. F-3
13
FOR YOUR NOTES
14
1 Safety
1.1 Safety Information
WARNING
z
Indicates a potential hazard or unsafe practice that, if not avoided, could result in
death or serious injury.
CAUTION
z
Indicates a potential hazard or unsafe practice that, if not avoided, could result in
minor personal injury or product/property damage.
NOTE
z
Provides application tips or other useful information to ensure that you get the
most from your product.
1-1
1.1.1 Warnings
WARNINGS
z
Before putting the system into operation, the operator must verify that the
equipment, connecting cables and accessories are in correct working order and
operating condition.
z
The equipment must be connected to a properly installed power outlet with
protective earth contacts only. If the installation does not provide for a protective
earth conductor, disconnect it from the power line and operate it on battery power,
if possible.
z
To avoid explosion hazard, do not use the equipment in the presence of flammable
anesthetics, vapors or liquids.
z
Do not open the equipment housings. All servicing and future upgrades must be
carried out by the personnel trained and authorized by our company only.
z
Do not come into contact with patients during defibrillation. Otherwise serious
injury or death could result.
z
Do not rely exclusively on the audible alarm system for patient monitoring.
Adjustment of alarm volume to a low level or off may result in a hazard to the
patient. Remember that alarm settings should be customized according to different
patient situations and always keeping the patient under close surveillance is the
most reliable way for safe patient monitoring.
z
The physiological data and alarm messages displayed on the equipment are for
reference only and cannot be directly used for diagnostic interpretation.
z
To avoid inadvertent disconnection, route all cables in a way to prevent a
stumbling hazard. Wrap and secure excess cabling to reduce risk of entanglement
or strangulation by patients or personnel.
z
Dispose of the package material, observing the applicable waste control regulations
and keeping it out of children’s reach.
1-2
1.1.2 Cautions
CAUTIONS
z
To ensure patient safety, use only parts and accessories specified in this manual.
z
At the end of its service life, the equipment, as well as its accessories, must be
disposed of in compliance with the guidelines regulating the disposal of such
products. If you have any questions concerning disposal of the equipment, please
contact us.
z
Magnetic and electrical fields are capable of interfering with the proper
performance of the equipment. For this reason make sure that all external devices
operated in the vicinity of the equipment comply with the relevant EMC
requirements. Mobile phone, X-ray equipment or MRI devices are a possible
source of interference as they may emit higher levels of electromagnetic radiation.
z
Before connecting the equipment to the power line, check that the voltage and
frequency ratings of the power line are the same as those indicated on the
equipment’s label or in this manual.
z
Always install or carry the equipment properly to avoid damage caused by drop,
impact, strong vibration or other mechanical force.
1.1.3 Notes
NOTES
z
Put the equipment in a location where you can easily see the screen and access the
operating controls.
z
Keep this manual in the vicinity of the equipment so that it can be obtained
conveniently when needed.
z
The software was developed in compliance with IEC60601-1-4. The possibility of
hazards arising from software errors is minimized.
z
This manual describes all features and options. Your equipment may not have all
of them.
1-3
1.2 Equipment Symbols
NOTE
z
Some symbols may not appear on your equipment.
Attention: Consult accompanying documents (this manual).
Power ON/OFF (for a part
of the equipment)
Battery indicator
Alternating current (AC)
Alarms paused
Alarm silenced
Record
Freeze/unfreeze waveforms
Main menu
NIBP start/stop key
Connector for satellite
module rack
Equipotential grounding
Video output
USB connector
Network connector
CIS connector
Auxiliary output
Defibrillator
Zero key
Check sensor
Calibrate key
Measure/standby
Inserted direction
Gas outlet
Serial number
CIS connector
Manufacture date
ESD warning symbol for electrostatic sensitive devices.
1-4
Type CF applied part. Defibrillator-proof protection against electric shock.
Type BF applied part. Defibrillator-proof protection against electric shock.
The following definition of the WEEE label applies to EU member states
only.
This symbol indicates that this product should not be treated as household
waste. By ensuring that this product is disposed of correctly, you will help
prevent bringing potential negative consequences to the environment and
human health. For more detailed information with regard to returning and
recycling this product, please consult the distributor from whom you
purchased it.
* For system products, this label may be attached to the main unit only.
Conforms to UL STD 60601-1, IEC 60601-2-27, IEC 60601-2-25, IEC
60601-2-34, IEC 60601-2-30, IEC 60601-2-49,IEC60601-1-1.
Certified to CSA STD C22.2 NO 601.1, NO 60601-2-27, NO 60601-2-30, NO
60601-2-34, NO60601-2-49, CSA C22.2 NO.60601-1-1.
1-5
FOR YOUR NOTES
1-6
2 The Basics
2.1 Monitor Description
2.1.1 Intended Use
The patient monitor is intended to be used for monitoring, displaying, reviewing, storing and
alarming of multiple physiological parameters including ECG(3-lead or 5-lead or 12-lead
selectable), arrhythmia detection, ST Segment analysis, heart rate(HR), respiration
rate(RESP), temperature (TEMP), pulse oxygen saturation (SpO2), pulse rate(PR),
non-invasive blood pressure (NIBP), invasive blood pressure(IBP), carbon dioxide (CO2),
anesthetic gas (AG), impedance cardiograph (ICG), bispectral index (BIS), cardiac output
(C.O.) and respiration mechanics (RM).
All the parameters can be applied for single adult, pediatric and neonatal patients with the
exception of the follows: C.O. monitoring is restricted to adult patients only; the arrhythmia
detection, ST Segment analysis, BIS and RM monitoring are not intended for neonatal
patients; the ICG is only for use on adult patients who meet the following requirements:
height: 122 to 229cm, weight: 30 to 159kg.
The monitors are to be used in healthcare facilities by clinical physicians or appropriate
medical staff under the direction of physicians. It is not intended for helicopter transport,
hospital ambulance, or home use.
WARNING
z
This patient monitor is intended for use only by clinical professionals or under
their guidance. It must only be used by persons who have received adequate
training in its use. Anyone unauthorized or untrained must not perform any
operation on it.
2.1.2 Contraindications
None.
2.1.3 Components
This patient monitor consists of a main unit, display, measurement module racks, SpO2 sensor,
NIBP cuff, IBP cables, C.O. cables, CO2 components, AG components, RM components, BIS
components, etc.
2-1
2.2 Main Unit
2.2.1 Front View
1
2
3
4
1.
5 6
7
8
9
10
11
12
13
Alarm lamp
When a physiological alarm or technical alarm occurs, this lamp will flash as defined
below.
2.
‹
High level alarms:
the lamp quickly flashes red.
‹
Medium level alarms:
the lamp slowly flashes yellow.
‹
Low level physiological alarms:
the lamp lights yellow without flashing.
‹
Low level technical alarms:
the lamp does not light.
Technical alarm lamp
This lamp will light blue when a technical alarm occurs.
3.
Display Screen
2-2
4.
Power On/Off Switch
Press this switch to turn the patient monitor on. Press it again and hold for 2 seconds to
turn the patient monitor off. An indicator is built in this switch. It turns on when the
patient monitor is on and turns off when the patient monitor is off.
5.
AC power LED
It turns on when AC power is connected.
6.
Battery LED
‹
On:
when the battery is being charged or already fully charged.
‹
Off:
when no battery is installed or no AC source is connected.
‹
Flash:
when the patient monitor operates on battery power.
7.
Press to silence all alarm sounds.
8.
Press to pause or restore alarms.
9.
Press to freeze or unfreeze waveforms.
10.
Press to start or stop recordings.
11.
Press to start or stop NIBP measurements.
12.
If no menu is displayed on the screen, pressing it will enter the main menu. If there is a
menu displayed on the screen, pressing it will close that menu.
13. Knob
Rotate the Knob clockwise or anti-clockwise. With each click, the highlight jumps to the
neighboring item. When you reach your desired item, press the Knob to select it.
2-3
2.2.2 Side View
1
2
3
1
4
5
1. Integral Module Racks
2. Compartment for CF storage card slot
3. Recorder
4. Contact
5. Battery compartment
NOTE
z
To ensure a good contact, clean the contacts regularly, as dust and dirt may collect
on them. When cleaning the contacts, wipe them with cotton, dampened with
alcohol. (using forceps is recommended)
2-4
2.2.3 Rear View
Radiator
1
9
6
4
7
3
8
5
2
2-5
2
1.
AC Power Input
2.
USB Connectors
They connect such devices as the USB mice, USB keyboard, etc.
3.
Nurse Call Connector
It connects the patient monitor to the hospital’s nurse call system. Alarms indications are
alerted to nurses through the nurse call system, if configured to do so.
4.
Micro-D Connector
It outputs ECG, IBP and defibrillator synchronization signals simultaneously, among
which the ECG signals supports pace pulses to be enhanced .
5.
Network Connector
It is a standard RJ45 connector that connects the patient monitor to the CMS.
6.
CIS Connector
It connects the patient monitor to the hospital’s clinical information system (CIS)
through an external CIS box. The CIS feature is available in China only.
7.
Digital Video Interface (DVI)
It connects a secondary display, which extends the display capability of your monitor.
The contents displayed on the secondary display screen accords with those displayed on
the monitor screen.
8.
SMR Connector
It connects the satellite module rack (SMR).
9.
Equipotential Grounding Terminal
When the patient monitor and other devices are to be used together, their equipotential
grounding terminals should be connected together, eliminating the potential difference
between them.
2-6
2.3 Satellite Module Rack
The Satellite Module Rack (SMR) provides 8 slots for mounting measurement modules. The
number of modules mounted in the SMR depends, as different modules may need different
slots.
Contact
Handle
Indicator
Slot
SMR connector
As shown in the figure above, there is an indicator telling the status of the SMR:
„
On: when the SMR works normally.
„
Off: when the SMR disconnects from the patient monitor, there is a problem with the
power, or the patient monitor shuts down.
The SMR can be connected to the patient monitor through their SMR connectors via a SMR
cable.
NOTE
z
To ensure a good contact, clean the contacts regularly, as dust and dirt may collect
on them. When cleaning the contacts, wipe them with cotton, dampened with
alcohol. (using forceps is recommended)
2-7
2.4 Modules
As shown below, the patient monitor supports the following modules:
„
MPM:
Multi-parameter module. It can simultaneously monitor ECG,
respiration, SpO2, temperature, NIBP and IBP.
„
IBP module:
Invasive blood pressure module.
„
C.O. module:
Cardiac output module.
„
CCO/SvO2
module
CCO/SvO2 interface module, used to interface with Edwards Vigilance
II嘐 monitor.
„
CO2 module:
Carbon dioxide module (including sidestream, microstream and
mainstream).
„
AG module:
Anaesthesia gas module. The functions of the O2 and BIS modules can
be incorporated into it.
„
ICG module:
Impedance cardiography module.
„
BIS module:
Bispectral index module.
„
RM module:
Respiration mechanics module.
Under the maximum configuration, the patient monitor has one two-slot module rack, one
three-slot module rack and one satellite module rack. The number of modules mounted in the
patient monitor depends, as different modules may need different slots.
2.4.1 Plug-In Modules
You can plug and unplug modules during patient monitoring. To plug a module, insert the
module until the lever on the module clicks into place and then push the lock key at the
bottom in position to lock the module. To remove a module, release the lock key, press the
lever upwards and pull the module out.
Make sure that the indicator on the module lights on after the module is plugged in.
Otherwise, re-plug the module until the indicator lights on.
2-8
2.4.2 Multi-Parameter Module
The multi-parameter module (MPM) incorporates multiple measurement modules. As shown
below, the module name is located at the upper left corner, all hardkeys on the upper part, and
all measurement connectors on the lower part. Other measurement modules look similar to
the MPM.
2
3
4
1
5
6
1.
Module name
2.
Setup key: press to enter the [MPM Setup] menu.
3.
Zero key: press to enter the [Zero IBP] menu.
4.
NIBP start/stop key: press to start or stop NIBP measurements.
5.
Indicator
6.
‹
On:
when the patient monitor works correctly.
‹
Flash:
when the module is being initialized.
‹
Off:
when the module is either unconnected or broken.
Measurement connectors
2-9
2.5 Display Screen
This patient monitor adopts a high-resolution TFT LCD to display patient parameters and
waveforms. A typical display screen is shown below.
1
2
3
4
6
5
7
8
9
1.
Patient Information Area
This area shows the patient information such as department, bed number, patient name,
patient category and paced status.
‹
: indicates that no patient is admitted or the patient information is incomplete.
‹
: indicates that the patient has a pacer.
If no patient is admitted, selecting this area will enter the [Patient Setup] menu. If a
patient has been admitted, selecting this area will enter the [Patient Demographics]
menu.
2.
Alarm Symbols
‹
indicates alarms are paused.
‹
indicates alarm sounds are paused.
2-10
‹
3.
indicates alarm sounds are turned off.
Technical Alarm Area
This area shows technical alarm messages and prompt messages. When multiple
messages come, they will be displayed circularly. Select this area and the technical
alarm list will be displayed.
4.
Physiological Alarm Area
This area shows physiological alarm messages. When multiple alarms occur, they will
be displayed circularly. Select this area and the physiological alarm list will be
displayed.
5.
Waveform Area
This area shows measurement waveforms. The waveform name is displayed at the left
upper corner of the waveform. Select this area and the corresponding measurement setup
menu will be displayed.
6.
Parameter Area A
This area shows measurement parameters. Each monitored parameter has a parameter
window and the parameter name is displayed at the upper left corner. The corresponding
waveform of each parameter is displayed in the same row in the waveform area. Select
this area and the corresponding measurement setup menu will be displayed.
7.
Parameter Area B
For the parameters displayed in this area, their corresponding waveform are not
displayed.
8.
Prompt Message Area
This area shows the prompt messages, network status icons, battery status icons, date
and time, etc. For details about battery status symbols, refer to the chapter 27 Batteries.
‹
indicates patient monitor is connected to a wire network successfully.
‹
indicates the patient monitor has failed to connect a wire network.
‹
indicates the wireless function is working.
‹
indicates the wireless function is not working.
‹
‹
‹
indicates a CF storage card is inserted.
indicates a secondary display or remote display is connected.
[Screen Setup] button
2-11
9.
QuickKeys Area
This area contains QuickKeys that give you fast access to functions.
2.6 QuickKeys
A QuickKey is a configurable graphical key, located at the bottom of the main screen. They
give you fast access to functions. Their availability and the order in which they appear on
your screen, depend on how your patient monitor is configured.
By default, the following QuickKeys are displayed on the screen:
Scroll left to display more QuickKeys.
Scroll right to display more QuickKeys.
Enter the main menu
Enter standby mode
Change alarm settings
Review the patient’s data
Enter the NIBP measurement menu
Stop all NIBP measurement
Zero IBP
Change screen
Enter the patient setup menu
Trigger a manual event
Start the realtime print
Print Setup
Have a split-screen view of minitrends
Enter the volume setup menu
2-12
Default configurations
Have the CIS view
You can also select your desired QuickKeys to display on the screen.
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Select QuickKeys >>].
2.
In the [Select QuickKeys] menu, select your desired QuickKeys and the order of them.
Up to two pages of QuickKeys can be selected.
3.
Select [Ok].
Besides the default QuickKeys listed above, there are still more QuickKeys:
Start cardiac output procedure (not available in USA)
View respiratory loops
Perform calculations
Have a split-screen view of another patient’s conditions
Have a split-screen view of oxyCRG trends
Enter the interpretation of resting 12-lead ECG screen (not available in USA)
Enter the full-screen 7-lead ECG screen
Enter the [Parameters] menu
Start NIBP STAT measurement
Enter the PAWP measurement screen
Enter the CPB mode
2-13
FOR YOUR NOTES
2-14
3 Basic Operations
3.1 Installation
WARNING
z
The equipment shall be installed by personnel authorized by us.
z
The software copyright of the equipment is solely owned by us. No organization or
individual shall resort to juggling, copying, or exchanging it or to any other
infringement on it in any form or by any means without due permission.
z
Devices connected to the equipment must meet the requirements of the applicable
IEC standards (e.g. IEC 60950 safety standards for information technology
equipment and IEC 60601-1 safety standards for medical electrical equipment).
The system configuration must meet the requirements of the IEC 60601-1-1
medical electrical systems standard. Any personnel who connect devices to the
equipment’s signal input/output port is responsible for providing evidence that the
safety certification of the devices has been performed in accordance to the IEC
60601-1-1. If you have any question, please contact us.
z
If it is not evident from the equipment specifications whether a particular
combination with other devices is hazardous, for example, due to summation of
leakage currents, please consult the manufacturers or else an expert in the field, to
ensure the necessary safety of patients and all devices concerned will not be
impaired by the proposed combination.
3-1
3.1.1 Unpacking and Checking
Before unpacking, examine the packing case carefully for signs of damage. If any damage is
detected, contact the carrier or us.
If the packing case is intact, open the package and remove the equipment and accessories
carefully. Check all materials against the packing list and check for any mechanical damage.
Contact us in case of any problem.
NOTE
z
Save the packing case and packaging material as they can be used if the equipment
must be reshipped.
WARNING
z
When disposing of the packaging material, be sure to observe the applicable waste
control regulations and keep it out of children’s reach.
z
The equipment might be contaminated during storage and transport. Before use,
please verify whether the packages are intact, especially the packages of single use
accessories. In case of any damage, do not apply it to patients.
3-2
3.1.2 Environmental Requirements
The operating environment of the equipment must meet the requirements specified in this
manual.
The environment where the equipment is used shall be reasonably free from noises,
vibration, dust, corrosive, flammable and explosive substances. If the equipment is installed
in a cabinet, sufficient space in front and behind shall be left for convenient operation,
maintenance and repair. Moreover, to maintain good ventilation, the equipment shall be at
least 2 inches (5cm) away from around the cabinet.
When the equipment is moved from one place to another, condensation may occur as a
result of temperature or humidity difference. In this case, never start the system before the
condensation disappears.
WARNING
z
Make sure that the operating environment of the equipment meets the specific
requirements. Otherwise unexpected consequences, e.g. damage to the equipment,
could result.
3-3
3.2 Getting Started
3.2.1 Turning Power On
Once the patient monitor is installed, you can get ready for monitoring:
1.
Before you start to make measurements, check the patient monitor, SMR and plug-in
modules for any mechanical damage and make sure that all external cables, plug-ins
and accessories are properly connected.
2.
Plug the power cord into the AC power source. If you run the patient monitor on
battery power, ensure that the battery is sufficiently charged.
3.
Press the power on/off switch on the monitor’s front. The start-up screens are
displayed, and the technical alarm lamp and alarm lamp are lit in blue and yellow
respectively. Then, the alarm lamp turns into red, and turns off together with the
technical alarm lamp after the system gives a beep.
4.
The monitor enters the main screen.
WARNING
z
Do not use the patient monitor for any monitoring procedure on a patient if you
suspect it is not working properly, or if it is mechanically damaged. Contact your
service personnel or us.
3.2.2 Starting Monitoring
1.
Decide which measurements you want to make.
2.
Connect the required modules, patient cables and sensors.
3.
Check that the patient cables and sensors are correctly connected.
4.
Check that the patient settings such as [Patient Cat.], [Paced], etc, are appropriate for
your patient.
5.
Refer to the appropriate measurement section for details of how to perform the
measurements you require.
3-4
3.3 Disconnecting from Power
To disconnect the patient monitor from the AC power source, follow this procedure:
1.
Confirm that the patient monitoring is finished.
2.
Disconnect the patient cables and sensors from the patient monitor.
3.
Make sure to save or clear the patient monitoring data as required.
4.
Press and hold the power on/off switch for above 2 seconds. The patient monitor shuts
down and you can unplug the power cable.
CAUTION
z
Although not recommended, you can press and hold the power on/off switch for 10
seconds to forcibly shut down the monitor when it could not be shut down
normally or under some special situations. This may cause loss of data of the
patient monitor.
3.4 Using a mouse
You can use the USB mouse supplied with the equipment as a monitor input device. The
USB mouse can be plugged and unplugged with the monitor on.
When you are using a mouse:
„
By default, the left mouse-button is the primary button and the right one the secondary
button.
„
Clicking the primary button equals to pressing the knob or selecting the touchscreen.
„
The secondary button is disabled.
You can also define the right mouse-button as the primary button by following this
procedure:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Others >>] to enter the [Others] menu.
3.
Select [Primary Button] and then select [Right] from the popup list.
3-5
3.5 Using Keys
The monitor has three types of keys:
„
Softkey: A softkey is a graphic key on the screen, giving you fast access to certain
menus or functions. The monitor has three types of softkeys:
‹
Waveform keys: Each waveform area can be seen as a softkey. You can enter a
waveform setup menu by selecting its corresponding waveform area.
‹
Parameter keys: Each parameter area can be seen as a softkey. You can enter a
parameter setup menu by selecting its corresponding parameter area.
‹
QuickKeys: QuickKeys are configurable graphical keys, located at the bottom of
the main screen. For details, refer to the section QuickKeys.
„
Hardkeys: A hardkey is a physical key on a monitoring device, such as the main menu
hardkey on the monitor’s front.
„
Pop-Up Keys: Pop-up keys are task-related keys that appear automatically on the
monitor screen when required. For example, the confirm pop-up key appears only
when you need to confirm a change.
3.6 Using Keyboards
The on-screen keyboard enables you to enter information. Use the [Back] key to delete the
previously entered character. Use the [Caps] to toggle between uppercase and lowercase
letters. Select [Enter] to confirm what you have entered and close the on-screen keyboard.
3.7 Using the Touchscreen
Select screen items by pressing them directly on the patient monitor’s screen. You can
enable or disable touchscreen operation by pressing and holding the [Main Menu]
QuickKey for 3 seconds. A padlock symbol
disabled.
3-6
is displayed if touchscreen operation is
3.8 Setting the Screen
You can enter the [Screen Setup] window as shown below by selecting the [Screen Setup]
button
in the prompt message area. In this window, you can allocate the positions
of the parameters and waveforms. The parameters or waveforms whose positions are not
allocated will not be displayed.
Area A
Area B
Area C
The ECG parameter and the first ECG waveform always display in the first row. The
configurable areas can be classified as Area A, Area B, and Area C.
„
In Area A, you can choose to display the parameters (having waveforms) and their
waveforms. Each parameter and the associated waveform are displayed in the same
row.
„
In Area B, you can choose to display the parameters and their waveforms. When there
is no parameter displayed in area C, both the parameters and their waveforms will be
displayed in area B. Otherwise, only the parameters will be displayed.
„
In Area C, you can choose to display all the parameters whose associated waveforms
will not be displayed.
The screen can automatically adjust to ensure the best view based on your screen setup.
3-7
If no corresponding parameter or waveform is displayed after the module is inserted, you
should perform the following inspections:
„
Check the connection between the module and lead, cable, sensor, or external device.
„
Check whether there are the [The display setup for XX is disabled] message and the
flashing [Screen Setup] button
in the prompt message area. If yes, select this
button to enter the [Screen Setup] window for the desired display configuration.
WARNING
z
The parameters whose positions are not allocated in the [Screen Setup] window
will not be displayed. However, the monitor can still give alarms of these
parameters.
3.9 Using the Main Menu
To enter the main menu, select the
on-screen QuickKey or the
hardkey on the
monitor’s front. Most of monitor operations and settings can be performed through the main
menu.
1
4
2
3
Other menus are similar to the main menu and contain the following parts:
1.
Heading: gives a sum-up for the current menu.
3-8
2.
Main body: displays options, buttons, prompt messages, etc. The menu button with
“>>’’ enlarges a secondary window to reveal more options or information.
3.
Online help area: displays help information for the highlighted menu item.
4.
: select to exit the current menu.
3.10 Setting Parameters
3.10.1 Accessing the Parameters Menu
Select [Parameters >>] from the main menu or select the [Parameters] QuickKey at the
bottom of the screen to enter the [Parameters] menu where you can get the access of each
parameter’s setup menu. You can further select [Module Status >>] to enter the menu as
shown below. Your display may be configured to look slightly different depending on the
modules mounted.
This menu displays the measurement modules mounted in the two-slot module rack,
three-slot module rack and satellite module rack from top to bottom. Beside each
measurement connector is the measurement label. The color in which a measurement
connector appears matches the status as follows:
(colored) indicates that the module is turned on.
(grey) indicates that the module is turned off.
indicates a module name conflict.
indicates a module error.
3-9
3.10.2 Removing a Module Conflict
Besides three independent IBP modules and the IBP module on the MPM, the patient
monitor supports only one more measurement module simultaneously. Otherwise, the
message of module conflict will de prompted.
For example, if a CO2 module (module A) is already loaded and then another CO2 module
(module B) is inserted, your patient monitor will then display module conflict. To use
module A, just pull out module B. To use module B, pull both modules A and B out and
then re-insert module B.
3.10.3 Removing a Label Conflict
Every label is unique and is assigned only once. The measurement label is stored inside the
module. The system will prompt module name conflict when two measurement modules
with the same name are used.
For example, an IBP module (module A) is already loaded and the Art label is used for
module A. Then another IBP module (module B) is inserted and the Art label is also used
for module B. In this case, your patient monitor will prompt the message of label conflict
and display the [Label] menu.
„
To use module A for Art measurement, just modify the label of module B on this
channel in the [Label] menu. If the [Label] menu already exits inadvertently, you need
to plug out and then plug in module B.
„
To use module B for Art measurement, first exit the [Label] menu. Then select the Art
parameter area on the screen and modify the label of module A on this channel in the
popup menu. Finally, plug out and then plug in module B.
3-10
3.11 Using a CF Storage Card
A CF storage card is used to prevent data loss in case of a sudden power failure. The patient
data such as trend data, waveform data, etc., will be automatically saved into the CF storage
card during patient monitoring. In case of a sudden power failure, the patient data can be
retrieved from the CF storage card after the patient monitor restarts.
Switching the patient monitor off before inserting or removing a CF card is a must. To insert
a CF storage card, open the compartment and then insert the card until the button flips out.
To remove the CF storage card, press the button until the CF storage card flips out.
To browse the data saved in the CF storage card, follow this procedure:
1.
Select [Main Menu]→[Patient Data >>]→[History Data >>].
2.
Select a patient whose data you want to view from the [Patient Data List] and then
select [Review].
3.
Select [Data Review].
As reviewing the history patient’s data is just like reviewing the current patient’s data, you
can refer to the chapter 22 Review for details.
If CF card problem occurs, you can refer to the following table for solutions.
Symptoms
Possible Cause
Corrective Action
CF card malfunctions
Wrong CF card or small
memory space
Use only SanDisk-manufactured CF storage
cards. Those with 1GB memory space are
recommended.
CF card full; data error;
CF card error
Format CF card on PC.
CF card failure
Replace the CF card.
Cable defective or
poorly connected
1. Check that the cable between CF card
board and mother board is correctly
connected.
2. Check that connecting cables and
connectors not damaged.
CF card board failure
Replace the CF card board.
Mother board failure
Replace the mother board.
3-11
NOTE
z
Data may be unable to be saved into the CF storage card when the patient monitor
is just turned on.
z
If no CF stroage card is used, all the data you have saved will get lost in case of
monitor shut-down or sudden power interrupt.
CAUTION
z
To avoid electrostatics, do not come into contact with the CF storage card when the
patient monitor is on.
z
Do not insert or remove the CF storage card when the patient monitor is on.
Otherwise it may cause damage to the CF storage card and the patient monitor.
z
Use only the CF storage card specified in this manual.
3.12 Changing General Settings
This chapter covers only general settings such as language, brightness, date and time, etc.
Measurement settings and other settings can be referred to in respective sections.
3.12.1 Setting up a Monitor
In situations where you install a patient monitor or change the patient monitor’s application
site, you need to setup the patient monitor as follows:
1.
Select [Main Menu]→[Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
In the [User Maintenance] menu, select, in turn, [Monitor Name], [Department] and
[Bed No.], and then change their settings.
3.12.2 Changing Language
1.
Select [Main Menu]→[Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
In the [User Maintenance] menu, select [Language] and then select the desired
language.
3.
Restart the patient monitor.
3-12
3.12.3 Adjusting the Screen Brightness
1.
Select the [Main Menu]→[Screen Setup >>]→[Brightness].
2.
Select the appropriate setting for the screen brightness. 10 is the brightest, and 1 is the
least bright.
If the patient monitor operates on battery power, you can set a less bright screen to prolong
the operating time of the battery. When the patient monitor enters standby mode, the screen
will change to the least brightness automatically.
3.12.4 Showing/Hiding the Help
The patient monitor provides online help information. The user can display or hide the help
as required.
1.
Select [Main Menu]→[Screen Setup >>].
2.
Select [Help] and toggle between [On] and [Off].
3.12.5 Setting the Date and Time
1.
Select [Main Menu] →[Maintenance >>]→[System Time >>].
2.
Set the date and time.
3.
Select [Date Format] and toggle between [yyyy-mm-dd], [mm-dd-yyyy] and
[dd-mm-yyyy].
4.
Select [Time Format] and toggle between [24h] and [12h].
If your patient monitor is connected to a central monitoring system (CMS), the date and
time are automatically taken from that CMS. In that case, you cannot change the date and
time settings on your patient monitor.
CAUTION
z
Changing date and time will affect the storage of trends and events and may cause
data missing.
3-13
3.12.6 Adjusting Volume
Alarm Volume
1.
Select the [Volume Setup] QuickKey, or [Main Menu]ĺ[Alarm Setup
>>]ĺ[Others].
2.
Select [Alm Volume] and then select the appropriate volume: X-10, in which X is the
minimum volume, depending on the set minimum alarm volume (refer to the chapter
Alarm), and 10 the maximum volume.
Key Volume
1.
Select the [Volume Setup] QuickKey, or [Main Menu]ĺ[Screen Setup >>].
2.
Select [Key Volume] and then select the appropriate volume. 0 means off, and 10 the
maximum volume.
QRS Volume
The QRS tone is derived from either the HR or PR, depending on which is currently
selected as the alarm source in [ECG Setup] or [SpO2 Setup]. When monitoring SpO2,
there is a variable pitch tone which changes as the patient’s saturation level changes. The
pitch of the tone rises as the saturation level increases and falls as the saturation level
decreases. The volume of this tone is user adjustable.
1.
Select the [Volume Setup] QuickKey, or the ECG parameter windowĺ[Others >>],
or the SpO2 parameter window.
2.
Select [QRS Volume] or [Beat Vol] and then select the appropriate volume. 0 means
off, and 10 the maximum volume.
3-14
3.13 Managing Configurations
3.13.1 Restoring the Latest Configuration Automatically
During operation, you may make changes to some settings. However, these changes may
not be saved as user configuration. To prevent the changes from losing in case of a sudden
power failure, the patient monitor stores the configuration in real time. The saved
configuration is the latest configuration. The monitor restore the latest configuration if
restarts within 60 seconds after the power failure. And it will restore the default
configuration rather than the latest configuration if restarts 120 seconds later after the power
failure. The monitor may load either the latest configuration or the default configuration if
restarts from 60-120 seconds after the power failure.
3.13.2 Setting Default Configuration at Startup
When the patient monitor restarts after quitting over 120 seconds, it will load the pre-set
default configuration to restore the system configuration. The default configuration can be
either the latest configuration, or a factory or user configuration.
To set default configuration at startup:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Manage Configuration >>].
2.
Select [Select Default Config. >>].
3.
In the [Select Default Config.] menu, toggle between [Load Last Config.] and [Load
Specified Config.].
When you select [Load Specified Config.], the configuration (adult, pediatric or neonate)
to be restored is subject to the patient category. This configuration can be either factory
configuration or saved user configuration. Take adult as an example, select [Default Adu
Config.] and toggle between [Factory Default Adu Config.] or user configuration(s).
NOTE
z
To know what configuration is restored when the patient monitor starts, enter the
main screen to check the prompt information at the lower part of the screen
(displayed for about 10 seconds).
3-15
3.13.3 Saving as User Configuration
You can change monitor settings as required and then save the changed settings into a user
configuration. This patient monitor can save multiple user configurations, and you can name
the saved user configurations.
1.
Change monitor setting as required and make sure that the changes are suitable for
your patient.
2.
Select [Main Menu]ĺ[Maintenance>>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Manage Configuration >>].
3.
Select [Save as User Default Config. >>].
4.
Enter a name and select [Save]. If the entered name already exists, a message box will
appear. Proceed by following the message.
The configuration name saved in the patient monitor is in the form of “entered
name+patient category+Config”. e.g., if you enter the name “ICU1” and the current patient
is an adult, the configuration name will be “ICU1 Adult Config”.
3.13.4 Deleting a User Default Configuration
You can delete an already saved user configuration.
1.
Select [Main Menu]ĺ[Maintenance>>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Manage Configuration >>].
2.
Select [Delete User Default Config. >>].
3.
Select the configuration to be deleted. Select [Delete] and then select [Yes] from the
popup menu.
3-16
3.13.5 Restoring Default Configuration Manually
You may make changes to some settings in some occasions. However, these changes may
not be appropriate or correct, especially when a new patient is admitted. Therefore, in actual
applications, you should restore the default configuration as required so as to ensure that the
applied configuration is suitable for your patient.
To restore a certain default configuration:
1.
Select [Main Menu]ĺ[Defaults >>].
2.
Select a factory or user configuration.
3.
Select [Yes].
3-17
FOR YOUR NOTES
3-18
4 Managing Patients
4.1 Admitting a Patient
The patient monitor displays physiological data and stores them in the trends as soon as a
patient is connected. This allows you to monitor a patient that is not admitted yet. However, it
is recommended that you fully admit a patient so that you can clearly identify your patient, on
recordings, reports and networking devices.
To admit a patient:
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ĺ[Patient Setup >>].
2.
Select [Discharge Patient] to clear any previous patient data. If you do not erase data
from the previous patient, the new patient’s data will be saved into the data of the
previous patient. The monitor makes no distinction between the old and the new patient
data.
3.
If [Discharge Patient] button appears dimmed, directly select [Admit Patient] and then
select:
4.
5.
‹
[Yes] to apply the data saved in the patient monitor to the new patient, or
‹
[No] to clear the data saved in the patient monitor.
In the [Patient Demographics] menu, enter the demographic details, of which:
‹
[Patient Cat.] determines the way your patient monitor processes and calculates
some measurements, and what safety and alarm limits are applied for your patient.
‹
[Paced] determines whether to show pace pulse marks on the ECG waveform.
When the [Paced] is set to [No], pace pulse marks are not shown in the ECG
waveform.
Select [Ok].
4-1
WARNING
z
[Patient Cat.] and [Paced] will always contain a value, regardless of whether the
patient is fully admitted or not. If you do not specify settings for these fields, the
patient monitor uses the default settings from the current configuration, which
might not be correct for your patient.
z
For paced patients, you must set [Paced] to [Yes]. If it is incorrectly set to [No], the
patient monitor could mistake a pace pulse for a QRS and fail to alarm when the
ECG signal is too weak.
z
For non-paced patients, you must set [Paced] to [No]. If it is incorrectly set to [Yes],
the patient monitor may be unable to detect premature ventricular beats (including
PVCs) and perform ST segment analysis.
4.2 Quick Admitting a Patient
Use [Quick Admit] only if you do not have the time or information to fully admit a patient.
Complete the rest of the patient demographic details later. Otherwise, the
always be displayed in the patient information area.
symbol will
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ĺ[Patient Setup >>].
2.
Select [Quick Admit]. If a patient has been admitted at present, select [OK] to
discharge the current patient. If .no patient is admitted, you can choose either:
3.
‹
[Yes] to apply the data in your patient monitor to the new patient, or
‹
[No] to clear any previous patient data.
Enter the patient category and paced status for the new patient, and then select [Ok].
4-2
4.3 Editing Patient Information
To edit the patient information after a patient has been admitted, or when the patient
information is incomplete, or when you want to change the patient information:
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ĺ[Patient Setup >>].
2.
Select [Patient Demographics] and then make the required changes.
3.
Select [Ok].
4.4 Discharging a Patient
To discharge a patient:
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ĺ[Patient Setup >>].
2.
Select [Discharge Patient]. In the popup dialog box, you can either:
‹
Select [Ok]. The patient monitor enters the standby mode after discharging the
current patient, or
‹
Select [Cancel] to exit without discharging the patient.
NOTE
z
Discharging a patient clears all history data in the monitor.
4.5 Transferring a Patient
You can transfer a patient with an MPM to a new location without re-entering the patient
demographic information or changing the settings. Transferring of patient data enables you to
understand the patient’s history condition.
Familiarizing yourself with the data respectively stored in the patient monitor and MPM
helps you understand the effects incurred by transferring patients with an MPM.
4-3
Contents stored
In the patient monitor
In the MPM
Data
Yes
Yes
Trend data
Yes
Yes
Calculation data
Yes
No
Yes
No
Yes
No
Yes
Yes
Patient demographics
(Name, Bed No., Gender, etc.)
(Dose calculations, oxygenation
calculations, etc.)
Event data
(Marked events, alarm events, etc.)
Settings
Monitor settings
(Alarm pause, alarm volume, etc.)
Parameter settings
(Alarm limits, measurement module
on/off, etc.)
Before transferring a patient with an MPM, set on the desired monitor as follows:
1.
Select [Main Menu]→[Maintenance]→[User Maintenance >>]→enter the required
password.
2.
Select [Others >>].
3.
Set [Transfer MPM Data] to [On].
4.
Set [Apply MPM Settings] to [On]. If your patient monitor does not have this option,
the system applies MPM settings by default.
Then, follow this procedure to transfer the patient:
1.
Disconnect the MPM from the original monitor.
2.
Connect the MPM to the monitor.
3.
If there is a mismatch between the MPM and monitor, the system will automatically
display the [Select Patient] menu, from which you can choose the data set you want to
continue using for this patient, either:
‹
[Continue Monitor]:continue with the patient data and settings in the monitor,
deleting all patient data and setting in the MPM and copying all data in the monitor
to the MPM.
‹
[Continue MPM]:continue with the patient data and settings in the MPM.
Discharge the patient in the monitor. The monitor then automatically admits the
patient and copies all data from the MPM.
4-4
4.
‹
[New Patient]: select this button if none of the information is correct. This deletes
all data in the monitor and MPM and lets you admit a new patient on the monitor.
In this case, you need to re-enter the patient demographics. The monitor will restore
the settings according to the patient category.
‹
[Same Patient]:select this button if the patient demographics are different, but it is
the same patient. This merges the patient’s trend data in the monitor and MPM and
copies the settings in the MPM to the monitor as well.
Select [Yes].
Operations
Examples of applications
Continue
Monitor
1. Replace the MPM during patient monitoring.
Continue
MPM
A patient is monitored using an MPM. You need to move the patient to a new
location, e.g. from a ward (original monitor) to the operating room (destination
monitor)
New Patient
Connect the MPM before admitting a new patient. However, the monitor and/or
MPM store the previous patient’s data and settings.
Same Patient
A patient is admitted by a monitor, to which an MPM used in another monitor for
monitoring this patient is connected.
2. After the patient is admitted, connect the MPM.
WARNING
z
After a patient is successfully transferred, check if the patient settings (especially
patient category, paced status and alarm limits settings, etc) on the monitor are
appropriate for this patient.
z
Only when you open MPM transfer function and select [Continue MPM], the IBP
labels can be transferred along with the MPM module.
4-5
4.6 Connecting to PanoramaTM Central Station
If your patient monitor is connected to a Panorama Central Station:
„
All patient information, measurement data and settings on the patient monitor can be
transmitted to the Panorama Central Station.
„
All patient information, measurement data and settings can be displayed simultaneously
on the patient monitor and Panorama. For some functions such as editing patient
information, admitting a patient, discharging a patient, etc., bi-directional control can be
achieved between your patient monitor and Panorama. The patient monitor is also
capable of bi-directional transmission of patient alarm settings with a Panorama.
For details, refer to the Panorama Operating Instructions Manual.
4-6
5 User Screens
5.1 Tailoring Your Screens
You can tailor your patient monitor’s screens by setting:
„
Waveform sweep mode
„
Wave line size
„
The color in which each measurement’s numerics and waveform are displayed
„
The parameter to be monitored.
Changing some settings may be hazardous. Therefore, those setting are password-protected
and can be modified by authorized personnel only. Once change is made, those who use the
patient monitor should be notified.
5.1.1 Setting the Waveform Sweep Mode
1.
Select [Main Menu]ĺ[Screen Setup >>].
2.
Select [Sweep Mode] and toggle between [Refresh] and [Scroll].
‹
[Refresh]: The waveforms keep stationary, being refreshed from left to right by a
moving “erase bar”.
‹
[Scroll]: The waveforms move from the right to the left with time passing by.
5.1.2 Changing the Wave Line Size
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Others >>].
3.
Select [Wave Line] and toggle between [Thick], [Mediate] and [Thin].
5.1.3 Changing Measurement Colors
1.
Select [Main Menu]ĺ[Screen Setup >>]ĺ[Measurement Color Setup >>].
2.
Select the color box next to your desired measurement and then select a color from the
popup menu.
5-1
5.1.4 Changing Screen Layout
Select the [Screens] QuickKey, or [Main Menu]ĺ[Screen Setup >>]ĺ[Screen Layout >>]
to enter the [Screens] menu.
„
You can choose the desired screen type in the [Choose Screen] window.
„
You can select the parameters and waveforms you want to view in the [Screen Setup]
window. For details, please refer to the section Setting the Screen.
„
You can select the parameters you want to view on big numerics screen in the [Big
Numerics Screen Setup] window.
5-2
5.2 Viewing Minitrends
5.2.1 Having a Split-Screen View of Minitrends
You can split the normal screen so that one part of the screen, on the left hand side,
continuously shows graphic minitrends beside waveforms as shown in the figure below.
To have a split-screen view of minitrends, you can:
„
Select [Minitrends] QuickKey, or
„
Select [Screens] QuickKeyĺ[Minitrends Screen]ĺ
„
Select [Main Menu]ĺ[Screen Setup >>]ĺ[Screen Layout >>]ĺ[Minitrends
Screen]ĺ
, or
.
Minitrend View
The split-screen view provides minitrends for multiple parameters. In each field, the label,
scale and time are respectively displayed at the top, left, and bottom as shown below.
5-3
5.2.2 Setting Minitrends
Select the minitrends area. From the pop-up [Minitrend Setup] menu, you can:
„
Select the parameters to be displayed, or
„
Select [Minitrend Length] and then select the appropriate setting.
5.3 Viewing oxyCRG
To have a split screen view of oxyCRG, you can:
„
Select [oxyCRG] QuickKey, or
„
Select [Screens] QuickKeyĺ[OxyCRG Screen]ĺ
„
Select [Main Menu]ĺ[Screen Setup >>]ĺ[Screen Layout >>]ĺ[OxyCRG
, or.
.
Screen]ĺ
1
2
3
The split-screen view covers the lower part of the waveform area and shows HR trend, SpO2
trend and RR trend (or Resp wave). At the bottom, there are controls:
1.
Trend length list box
In the trend length list box, you can select [1 min], [2 min], [4 min], or [8 min].
2.
Resp Wave (or RR Trend) list box
From this list box, you can select either [Resp Wave] or [RR Trend] for display.
3.
Record
Through this button, you can print out the currently displayed oxyCRG trends by the
recorder.
5-4
5.4 Viewing Other Patients
5.4.1 Care Group
If your patient monitor is connected to a central monitoring system, you can select up to 10
patient monitors (including telemetry connected to the same central monitoring system) into a
Care Group. This lets you:
View information on the monitor screen from another bed in the same Care Group.
Be notified of physiological and technical alarm conditions at the other beds in the same
Care Group.
To have a Care Group:
1.
Open the [View Other Patient] window by:
Selecting [Others] QuickKey, or
Selecting [Screens] QuickKey→[View Others Screen]→
Selecting [Main Menu]→[Screen Setup >>]→[Screen Layout >>]→[View Others
Screen]→
, or
.
2.
Select [Setup] in the [View Other Patient] window.
3.
Select the desired patient monitors from the [Connected Monitor List], and then select the
button. The selected patient monitors constitute a Care Group.
NOTES
View other patient function is not available between wireless monitors, nor for
wireless monitors to view wired monitors. View other patient function is available
between wired monitors, or for wired monitors to view wireless monitors.
5-5
5.4.2 Viewing the Care Group Overview Bar
The Care Group overview bar locates at the bottom of the [View Other Patient] window. In the
overview bar, the department and bed label for any Care Group beds are displayed. For telemetry,
# is displayed before the department label. The color in which a Care Group bed appears matches
its status:
Red: indicates the bed is giving high-level physiological alarms or the telemetry is giving
alarm, such as nurse call or event.
Yellow: indicates the bed is giving medium- or low-level physiological alarms, or
medium-level technical alarms.
Blue: indicates the bed is giving low-level technical alarms.
Grey: indicates the bed fails to be networked or stays in the standby mode.
You can view a Care Group bed’s alarms by selecting it from the care group, and as well you can
select the [View This Patient] button to view this bed in the [View Other Patient] window.
For more details about Care Group alarms, refer to the Alarms chapter.
5-6
5.4.3 Understanding the View Other Patient Window
When you first open the [View Other Patient] window, the patient monitor automatically selects
a monitor from the network to display in the [View Other Patient] window.
4
1
2
3
The [View Other Patient] window covers the lower part of the waveform area and consists of:
1.
Information Area: shows the patient information (including department, bed number, patient
name, etc.), network status symbol.
2.
View Area: shows physiological waveforms and parameters. You can switch a waveform
area to a parameter area by selecting your desired waveform area and then selecting [Switch
to Parameter Area], or switch a parameter area to a waveform area by selecting your
desired parameter area and then selecting [Switch to Waveform Area].
3.
Care Group Overview Bar.
4.
Message Area: shows physiological, technical and prompt messages from the currently
viewed patient monitor. It also shows the alarm given by the telemetry such as nurse call or
event. By selecting this area, you can enter the [Alarm Information List] to view all
physiological, technical and prompt messages coming from the currently viewed patient.
Additionally, you can change a waveform or parameter for viewing
To change a waveform for viewing, select the waveform segment where you want a new
waveform to appear and then select the waveform you want from the popup menu.
To change a parameter for viewing, select the parameter window where you want a new
parameter to appear and then select the parameter you want from the popup menu.
5-7
WARNING
z
The data presented in the [View Other Patient] window have delay. Do not rely on
this window for realtime data.
5.5 Understanding the Big Numerics Screen
To enter the big numerics screen:
1.
Select the [Screens] QuickKey, or [Main Menu]ĺ[Screen Setup >>]ĺ[Screen
Layout >>].
2.
Select [Big Numerics]ĺ
.
You can select your desired parameters to display in this screen: select the [Screens]
QuickKeyĺ[Big Numerics Screen Setup] and then select the parameters you want. For
parameters having a waveform, the waveform will also be displayed.
5-8
6 Alarms
Alarms, triggered by a vital sign that appears abnormal or by technical problems of the
patient monitor, are indicated to the user by visual and audible alarm indications.
WARNING
z
A potential hazard can exist if different alarm presets are used for the same or
similar equipment in any single area, e.g. an intensive care unit or cardiac
operating room.
z
If your patient monitor is connected to a CMS, remote suspension, inhibition,
silence and reset of monitor alarms via the CMS may cause a potential hazard.
6.1 Alarm Categories
By nature, the patient monitor’s alarms can be classified into three categories: physiological
alarms, technical alarms and prompt messages.
1.
Physiological alarms
Physiological alarms, also called patient status alarms, are triggered by a monitored
parameter value that violates set alarm limits or an abnormal patient condition.
Physiological alarm messages are displayed in the physiological alarm area.
2.
Technical alarms
Technical alarms, also called system status alarms, are triggered by a device malfunction
or a patient data distortion due to improper operation or mechanical problems. Technical
alarm messages are displayed in the technical alarm area.
3.
Prompt messages
As a matter of fact, prompt messages are not alarm messages. Apart from the
physiological and technical alarm messages, the patient monitor will show some
messages telling the system status. Messages of this kind are included into the prompt
message category and usually displayed in the prompt information area. But for some
measurements, their related prompt messages are displayed in their respective parameter
windows.
6-1
6.2 Alarm Levels
By severity, the patient monitor’s alarms can be classified into three categories: high level,
medium level and low level..
Physiological alarms
Technical alarms
High
level
Indicate that your patient is in a
life threatening situation, such
as Asystole, Vfib/Vtac and so
forth, and an emergency
treatment is demanded.
Indicate a severe device malfunction or an
improper operation, which could make it possible
that the monitor cannot detect critical patient status
and thus threaten the patient’s life, such as low
battery.
Medium
level
Indicate that your patient’s vital
signs appear abnormal and an
immediate treatment is
required.
Indicate a device malfunction or an improper
operation, which may not threaten the patient’s life
but may compromise the monitoring of vital
physiological parameters.
Low
level
Indicate that you patient’s vital
signs appear abnormal and an
immediate treatment may be
required.
Indicate a device malfunction or an improper
operation, which may compromise a certain
monitoring function but will not threaten the
patient’s life.
6.3 Alarm Indicators
When an alarm occurs, the patient monitor will indicate it to the user through visual or
audible alarm indications.
„
Alarm lamp
„
Alarm message
„
Flashing numeric
„
Audible alarm tones
„
Reminder Tones
6.3.1 Alarm Lamp
If a technical alarm occurs, the technical alarm lamp will turn blue. If a technical alarm or
physiological alarm occurs, the alarm lamp will flash. The flashing color and frequency
match the alarm level as follows:
„
High level alarms:
the lamp quickly flashes red.
„
Medium level alarms:
the lamp slowly flashes yellow.
„
Low level physiological alarms:
the lamp turns yellow without flashing.
„
Low level technical alarms:
the lamp does not light.
6-2
6.3.2 Alarm Message
When an alarm occurs, an alarm message will appear in the technical or physiological alarm
area. For physiological alarms, the asterisk symbols (*) before the alarm message match the
alarm level as follows:
„
High level alarms:
***
„
Medium level alarms:
**
„
Low level alarms:
*
Additionally, the alarm message uses different background color to match the alarm level:
„
High level alarms:
red
„
Medium level alarms:
yellow
„
Low level physiological alarms:
yellow
„
Low level technical alarms:
blue
You can view the alarm messages by selecting the physiological or technical alarm area.
6.3.3 Flashing Numeric
If an alarm triggered by an alarm limit violation occurs, the numeric of the measurement in
alarm will flash every second, and the corresponding alarm limit will also flash at the same
frequency indicating the high or low alarm limit is violated.
6.3.4 Audible Alarm Tones
This monitor has three choices of alarm tones and patterns: ISO, Mode 1 and Mode 2. For
each pattern, the alarm tones identify the alarm levels as follows:
„
„
ISO pattern:
‹
High level alarms:
triple+double+triple+double beep.
‹
Medium level alarms:
triple beep.
‹
Low level alarms:
single beep.
Mode 1:
‹
High level alarms:
high-pitched single beep.
‹
Medium level alarms:
double beep.
‹
Low level alarms:
low-pitched single beep.
6-3
„
Mode 2:
‹
High level alarms:
high-pitched triple beep.
‹
Medium level alarms:
double beep.
‹
Low level alarms:
low-pitched single beep.
NOTE
z
When multiple alarms of different levels occur simultaneously, the patient monitor
will select the alarm of the highest level and give visual and audible alarm
indications accordingly.
6.3.5 Reminder Tones
When alarm tones are silenced or turned off, the patient monitor will give a single beep in
case of an active alarm condition.
6.3.6 Alarm Status Symbols
Apart from the aforementioned alarm indicators, the patient monitor still uses the following
symbols telling the alarm status:
„
indicates alarms are paused.
„
indicates alarm sound is silenced.
„
indicates the alarm sound is turned off.
„
indicates individual measurement alarms are turned off.
6-4
6.4 Alarm Tone Configuration
6.4.1 Setting the Minimum Alarm Volume
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
3.
Select [Minimum Alarm Volume] and toggle between 0 and 10.
The minimum alarm volume refers to the minimum value you can set for the alarm volume,
which is not affected by user or factory default configurations. The setting of minimum alarm
volume remains unchanged when the patient monitor shuts down and restarts.
6.4.2 Changing the Alarm Volume
1.
Select the [Volume Setup] QuickKey or the [Alarm Setup] QuickKeyė[Others], or
[Main Menu]ĺ[Alarm Setup >>]ė[Others].
2.
Select the appropriate volume from [Alm Volume]: X-10, in which X is the minimum
volume, depending on the set minimum alarm volume, and 10 the maximum volume.
When alarm volume is set to 0, the alarm sound is turned off and a
screen. The alarm volume returns to 2 automatically when:
symbol appears on the
„
The patient monitor is shut down and then restarted.
„
A certain user configuration which saves alarm volume as 0 is restored.
„
The factory default configuration is restored.
„
A switch between alarm statuses is made.
6-5
6.4.3 Setting the Interval between Alarm Sounds
You cannot change the interval between alarm tones if you choose mode 1 or 2 as your
desired alarm tone pattern. For these two patterns, the interval between alarm tones identifies
the alarm levels as follows:
„
„
Mode 1:
‹
Interval between high level alarm tones:
‹
Interval between medium level alarm tones: 5 s.
‹
Interval between low level alarm tones:
continuously.
20 s.
Mode 2:
‹
Interval between high level alarm tones:
‹
Interval between medium level alarm tones: 5 s.
‹
Interval between low level alarm tones:
1 s.
20 s.
If you choose the ISO pattern, you can change the interval between alarm tones. To change
the interval between alarm tones:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
3.
Select [High Alarm Interval (s)], [Med Alarm Interval (s)] and [Low Alarm Interval
(s)] in turn and then select the appropriate settings.
WARNING
z
When the alarm sound is switched off, the patient monitor will give no audible
alarm tones even if a new alarm occurs. Therefore the user should be very careful
about whether to switch off the alarm sound or not.
z
Do not rely exclusively on the audible alarm system for patient monitoring.
Adjustment of alarm volume to a low level may result in a hazard to the patient.
Always keep the patient under close surveillance.
6-6
6.4.4 Changing the Alarm Tone Pattern
To change the alarm tone pattern:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
3.
Select [Alarm Sound] and toggle between [ISO], [Mode 1]and [Mode 2].
User or factory default configurations exert no impact on the setup of alarm tone pattern. The
alarm tone pattern remains unchanged after the monitor restarts.
6.4.5 Setting the Reminder Tones
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
‹
To switch the reminder tones on or off, select [Reminder Tones] and toggle
between [On] and [Off].
‹
To set the interval between reminder tones, select [Reminder Interval] and toggle
between []1min], [2min] and [3min].
In addition, you can set the volume of alarm reminder tones. To set the volume of alarm
reminder tones, select [Main Menu]ĺ[Alarm Setup >>]ĺ[Others] or the [Alarm Setup]
QuickKeyĺ[Others]. Then, select [Reminder Vol] and toggle between [High], [Medium]
and [Low].
6.5 Understanding the Alarm Setup Menu
Select the [Alarm Setup] QuickKey or [Main Menu]ĺ[Alarm Setup >>] to enter the
[Alarm Setup], where you can:
„
Set alarm properties for all parameters.
„
Change ST alarm settings.
„
Change arrhythmia alarm settings.
„
Set the threshold for some arrhythmia alarms.
„
Change other settings.
6-7
Please refer to the ECG section for how to change ST alarm settings, how to change
arrhythmia alarm settings and how to set the threshold for some arrhythmia alarms.
6.5.1 Setting Alarm Properties for All Parameters
In the main menu, select [Alarm Setup >>]ĺ[Parameters]. You can review and set alarm
limits, alarm level and alarm recordings for all parameters.
When a measurement alarm occurs, automatic recording of all the measurement numerics and
related waveforms is possible when the measurement’s high/low alarm limit and [Record]
are set on.
WARNING
z
Make sure that the alarm limits settings are appropriate for your patient before
monitoring.
z
Setting alarm limits to extreme values may cause the alarm system to become
ineffective. For example, High oxygen levels may predispose a premature infant to
retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to
100%, which is equivalent to switching the alarm off.
6.5.2 Adjusting Alarm Limits Automatically
The monitor can automatically adjust alarm limits according to the measured vital signs,
using the auto limits function. When auto limits are selected, the monitor calculates safe auto
limits based on the latest measured values.
To get accurate auto alarm limits, you need to collect a set of measured vital signs as a
6-8
baseline. Then, in the main menu, select [Alarm Setup >>]ĺ[Parameters]ĺ[Auto Limits]
ĺ[Ok]. The monitor will create new alarm limits based on the measured values.
Before applying these automatically created alarm limits, confirm if they are appropriate for
your patient in the mass alarm setup menu. If not, you can adjust them manually. These alarm
limits will remain unchanged until you select auto limits again or adjust them manually.
The monitor calculates the auto limits based on the following rules.
Low alarm limit
High alarm limit
Module Parameter Adult/
Adult/
Neonate
Neonate
pediatric
ECG
Resp
SpO2
NIBP
Temp
Auto alarm
limits range
pediatric
HR/PR
HRh0.8 or
40bpm
˄whichever
is greater˅
HR-30 or
90bpm
˄whichever is
greater˅
HRh1.25 or HRˇ40 or
240bpm
200bpm
˄whichever is ˄whichever is
smaller˅
smaller˅
RR
RRh0.5 or
6/min
˄whichever
is greater˅
RR-10 or
30/min
˄whichever is
greater˅
RRh1.5 or
RR+25 or
Adult/pediatric˖6
30/min
85/min
to 55
˄whichever is ˄whichever is
Neonate˖10 to 90
smaller˅
smaller˅
SpO2
Same as the Same as the
default alarm default alarm
limit
limit
NIBP-S
Adult˖45 to 270
SYS-15 or
SYSˇ15 or
Pediatric˖45 to
SYSh0.68ˇ 45mmHg
SYSh0.86ˇ 105mmHg
185
10mmHg
˄whichever is 38mmHg
˄whichever is
Neonate˖35 to
greater˅
smaller˅
115
NIBP-D
Dia-15 or
Diah0.68ˇ 20mmHg
Diah0.86ˇ
6mmHg
˄whichever is 32mmHg
greater˅
NIBP-M
Adult˖30 to 245
Mean-15 or
Meanˇ15 or
Pediatric˖30 to
Meanh0.68 35mmHg
Meanh0.86ˇ 95mmHg
180
ˇ8mmHg
˄whichever is 35mmHg
˄whichever is
Neonate˖25 to
greater˅
smaller˅
105
T1
T1ˉ0.5ć
T1ˉ0.5ć
T1ˇ0.5ć
T1ˇ0.5ć
1 to 49ć
T2
T2ˉ0.5ć
T2ˉ0.5ć
T2ˇ0.5ć
T2ˇ0.5ć
1 to 49ć
6-9
Same as the
default alarm
limit
Same as the
default alarm
limit
Diaˇ15 or
80mmHg
˄whichever is
smaller˅
Adult/pediatric˖
35 to 240
Neonate˖55 to
225
Same as the
measurement
range
Adult˖25 to 225
Pediatric˖25 to
150
Neonate˖20 to 90
Low alarm limit
High alarm limit
Module Parameter Adult/
Neonate
IBP˖
ART/
Same as the
measurement
range
pediatric
TD
Same as the Same as the
default alarm default alarm
limit
limit
Same as the
default alarm
limit
IBP-S
Adult˖45 to 270
SYS-15 or
SYSˇ15 or
Pediatric˖45 to
SYSh0.68ˇ 45mmHg
SYSh0.86ˇ 105mmHg
185
10mmHg
˄whichever is 38mmHg
˄whichever is
Neonate˖35 to
greater˅
smaller˅
115
IBP-D
Dia-15 or
Diah0.68ˇ 20mmHg
Diah0.86ˇ
6mmHg
˄whichever is 32mmHg
greater˅
UAP/
FAP/
Same as the
default alarm
limit
pediatric
Ao/
BAP/
Neonate
Auto alarm
limits range
Adult/
LV/
P1-P4
(Arterial
pressure) IBP-M
Diaˇ15 or
80mmHg
˄whichever is
smaller˅
Adult˖25 to 225
Pediatric˖25 to
150
Neonate˖20 to 90
Adult˖30 to 245
Mean-15 or
Meanˇ15 or
Pediatric˖30 to
Meanh0.68 35mmHg
Meanh0.86ˇ 95mmHg
180
ˇ8mmHg
˄whichever is 35mmHg
˄whichever is
Neonate˖25 to
greater˅
smaller˅
105
6-10
Low alarm limit
High alarm limit
Module Parameter Adult/
Adult/
Neonate
Neonate
pediatric
PA
Auto alarm
limits range
pediatric
IBP-S
SYSh0.75
SYSh0.75
SYSh1.25
SYSh1.25
IBP-D
Diah0.75
Diah0.75
Diah1.25
Diah1.25
IBP-M
Meanh0.75 Meanh0.75
Meanh1.25
Meanh1.25
IBP-M
Meanh0.75 Meanh0.75
Meanh1.25
Meanh1.25
0-32mmHg:
0-32mmHg:
0-32mmHg:
0-32mmHg:
remains the
same
remains the
same
remains the
same
remains the
same
3 to 120mmHg
IBP:
CVP/
ICP/
LAP/
RAP/
3 to 40mmHg
UVP/
P1-P4
(Venous
pressure
)
32-35mmHg: 32-35mmHg:
32-35mmHg: 32-35mmHg:
29mmHg
41mmHg
41mmHg
Same as the
measurement
etCO2-6mmH
etCO2+6mmH
etCO2-6mmHg
etCO2+6mmHg
range
g
g
35-45mmHg:
EtCO2
29mmHg
35-45mmHg:
35-45mmHg:
35-45mmHg:
45-48mmHg: 45-48mmHg:39 45-48mmHg:5 45-48mmHg:51
39mmHg
mmHg
1mmHg
mmHg
CO2
>48mmHg:
remains the
same
>48mmHg:
remains the
same
>48mmHg:
remains the
same
>48mmHg:
remains the
same
Same as the
default alarm
limit
FiCO2
N/A
N/A
Same as the
default alarm
limit
awRR
awRRh0.5
or 6/min
˄whichever
is greater˅
awRR-10 or
30/min
˄whichever is
greater˅
awRRh1.5 or awRR+25 or
Adult/pediatric˖6
30/min
85/min
to 55
˄whichever is ˄whichever is
Neonate˖10 to 90
smaller˅
smaller˅
6-11
Same as the
measurement
range
Low alarm limit
High alarm limit
Module Parameter Adult/
Adult/
Neonate
Neonate
pediatric
EtCO2
˄AG˅
Auto alarm
limits range
pediatric
Same as CO2 module
FiCO2
(AG)
awRR
AG
FiAA/
EtAA
FiO2/
EtCO2
FiN2O/
EtN2O
C.O.
ICG
BT
C.I.
awRRh0.5
or 6/min
˄whichever
is greater˅
awRR-10 or
30/min
˄whichever is
greater˅
awRRh1.5 or awRR+25 or
Adult/pediatric˖6
30/min
85/min
to 55
˄whichever is ˄whichever is
Neonate˖10 to 90
smaller˅
smaller˅
Same as the Same as the
default alarm default alarm
limit
limit
Same as the
default alarm
limit
Same as the
default alarm
limit
Same as the
measurement
range
Same as the Same as the
default alarm default alarm
limit
limit
Same as the
default alarm
limit
Same as the
default alarm
limit
Same as the
measurement
range
Same as the Same as the
default alarm default alarm
limit
limit
Same as the
default alarm
limit
Same as the
default alarm
limit
Same as the
measurement
range
Adult˖
Adult˖
N/A
Same as the
measurement
range
BTˉ1ć
N/A
BTˇ1ć
N/A
TFC
RR(RM)
PEEP
awRRh0.5
or 6/min
N/A
˄whichever
is greater˅
PEEP - 5
N/A
awRRh1.5 or
30/min
N/A
˄whichever is
smaller˅
Adult/pediatric˖6
to 55
Neonate˖10 to 90
PEEP + 5
N/A
Same as the
measurement
range
N/A
Same as the
measurement
range
N/A
Same as the
measurement
range
RM
PIP
BIS
PIP - 10
MVe
MVe - 2
BIS
N/A
N/A
PIP + 10
N/A
MVe + 2
6-12
Low alarm limit
High alarm limit
Module Parameter Adult/
Adult/
Neonate
Neonate
pediatric
Auto alarm
limits range
pediatric
CCO/
CCIǃEDV/
EDVIǃ
SVR/
CCO
N/A
SVRIǃ
SV/SVIǃ
RVEF
SvO2
SvO2 - 5
N/A
SvO2 + 5
N/A
Same as the
measurement
range
ScvO2
ScvO2 - 5
N/A
ScvO2 + 5
N/A
Same as the
measurement
range
SvO2
6.5.3 Setting Alarm Delay Time
You can set the alarm delay time for over-limit alarms of continuously measured parameters.
If the alarm-triggered condition disappears within the delay time, the patient monitor will not
give the alarm. You can set the [Alarm Delay], [Apnea Delay] and [ST Alarm Delay] in the
[Others] window of [Alarm Setup] menu.
6.5.4 Entering CPB Mode
When performing Cardiopulmonary bypass (CPB), you can set the patient monitor to enter
CPB mode in order to reduce unnecessary alarms. In the CPB mode, all the physiological
alarms are switched off except for the following alarms.
„
BIS-related alarms
„
FiCO2/EtCO2 too high (for CO2 module and AG module)
„
FiO2/EtO2 too high or too low
„
FiAA/EtAA too high (AA represents Hal, Enf, Iso, Sev, or Des)
„
FiN2O/EtN2O too high
In CPB mode, [CPB Mode] is displayed in the physiological alarm area with red background
color.
To enter CPB mode:
Select the [CPB Mode] Quickkey or select [Enter CPB Mode] in the [Others] window of
the [Alarm Setup] menu. Then select [Ok] in the popup dialog box.
6-13
6.6 Pausing Alarms
If you want to temporarily prevent alarms from sounding, you can pause alarms by pressing
hardkey on the monitor’s front. When alarms are paused:
the
„
No alarm lamps flash and no alarms are sounded.
„
No numeric and alarm limit flash.
„
No alarm messages are shown.
„
The remaining pause time is displayed in the physiological alarm area.
„
The
alarms paused symbol is displayed in the sound symbol area.
The patient monitor enters into the alarm paused status as soon as it is turned on. The alarm
pause time is fixed to be 2 minutes.
When the alarm pause time expires, the alarm paused status is automatically cancelled and
the alarm tone will sound. You can also cancel the alarm paused status by pressing the
hardkey.
You can set the alarm pause time as desired. The default alarm pause time is 2 minutes.
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password.
2.
Select [Alarm Setup >>]ĺ[Alarm Pause Time] and then select the appropriate setting
from the popup list.
6.7 Silencing the Alarm Sound
You can silence all alarm sounds by pressing the
hardkey on the monitor’s front. In that
case, the alarm lamp flashing and alarm tones are cleared and
appears in the sound
symbol area. After the physiological alarm is silenced, Ĝ appears before the alarm message
and the numeric and alarm limit still flash. For the performance after the technical alarm is
silenced, please refer to the Silencing Technical Alarms section.
The alarm silenced status will be automatically cancelled if you switch the patient monitor to
other alarm statues or when a new physiological or technical alarm occurs.
6.8 Latching Alarms
The alarm latching setting for your patient monitor defines how the alarm indicators behave
when you do not acknowledge them. When alarms are set to non-latching, their alarm
indications end when the alarm condition ends. If you switch alarm latching on, all visual and
audible alarm indications last until you acknowledge the alarms, except that the measurement
6-14
numeric and violated alarm limit stop flashing as soon as the initial alarm condition goes
away.
To set alarms to latching or non-latching:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance
required password.
2.
Select [Alarm Setup >>].
3.
Select [Latching Alarms] and toggle between [Yes] and [No].
>>]ĺenter the
6.9 Silencing Technical Alarms
For some technical alarms, their alarm lamp flashing and alarm tones are cleared and the
hardkey is pressed. After the patient
alarm messages change to prompt messages after the
monitor restores the normal status, the patient monitor can give alarm indications correctly
when these alarms are triggered again.
hardkey is
For some technical alarms, all their alarm indications are cleared after the
pressed. After the patient monitor restores the normal status, the patient monitor can give
alarm indications correctly when these alarms are triggered again.
For some other technical alarms, their alarm lamp flashing and alarm tones are cleared and
hardkey is pressed. After the patient
Ĝ appears before the alarm message after the
monitor restores the normal status, the patient monitor can give alarm indications correctly
when these alarms are triggered again.
6.10 Testing Alarms
When the monitor starts up, a selftest is performed. In the meantime, the start-up screens are
displayed, and the technical alarm lamp and alarm lamp are lit in blue and yellow
respectively. Then, the alarm lamp turns into red, and turns off together with the technical
alarm lamp after the system gives a beep. This indicates that the visible and audible alarm
indicators are functioning correctly.
For further testing of individual measurement alarms, perform the measurement on yourself
(for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate
alarm behaviour is observed.
6-15
6.11 When an Alarm Occurs
When an alarm occurs, observe the following steps and take proper actions:
1.
Check the patient’s condition.
2.
Confirm the alarming parameter or alarm category.
3.
Identify the source of the alarm.
4.
Take proper action to eliminate the alarm condition.
5.
Make sure the alarm condition is corrected.
For troubleshooting specific alarms, see appendix Alarm Messages.
6.12 Using Care Group Alarms
6.12.1 Care Group Auto Alarms
When auto alarm is set on for viewing other patient and a Care Group is set up on your monitor, a
flashing symbol will appear beside the QuickKeys area if any monitor in your Care Group, which
is not currently viewed by your monitor, is alarming. The alarm symbol is shown as below.
The department and bed label of the alarming monitor appear on the symbol. You can enter the
view other patient window by pressing this symbol.
To switch auto alarm on or off for viewing other patient:
1.
In the main menu, select [Screen Setup >>]→[Screen Layout >>]→[View Others Screen]
→ .
2.
In the view other patient window, select the care group setup button. Then, select [Auto
Alarm] and toggle between [On] and [Off].
NOTES
Care Group auto alarms function is not available between wireless monitors, nor
for wireless monitors to view wired monitors. Care Group auto alarms function is
available between wired monitors, or for wired monitors to view wireless monitors.
6-16
6.12.2 Silencing Care Group Alarms
You can silence the alarm sound of the currently viewed bed in the view other patient window.
This function can be set in the [Alarm Setup] menu from the [User Maintenance] menu only.
When the alarm silence function for other patients is active and the currently viewed bed is in
normal alarm status or alarm sound off status, press the [Silence] button in the view other patient
window. The currently viewed bed will then enter into the alarm silenced status.
Note that this button is disabled when the currently viewed bed is in alarms off or paused status.
WARNING
Silencing care group alarms may cause a potential hazard. Please act with caution.
6-17
FOR YOUR NOTES
6-18
7 Monitoring ECG
7.1 Introduction
The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on
the patient monitor as a waveform and a numeric. This patient monitor measures ECG using
the MPM module. ECG monitoring provides two algorithms:
1.
Basic algorithm
The Basic algorithm enables 3- and 5-lead ECG monitoring.
2.
Mortara algorithm
The Mortara algorithm enables 3-, 5- and 12-lead ECG monitoring, ST-segment analysis
and arrhythmia analysis.
You can select either algorithm as required.
Connector for ECG cable
The MPM module incorporating Mortara algorithm is labelled with the logo of Mortara.
7-1
7.2 Safety
WARNING
z
Use only ECG electrodes and cables specified in this manual.
z
When connecting electrodes and/or patient cables, make sure that the connectors
never come into contact with other conductive parts, or with earth. In particular,
make sure that all of the ECG electrodes are attached to the patient, to prevent
them from contacting conductive parts or earth.
z
Periodically inspect the electrode application site to ensure skin quality. If the skin
quality changes, replace the electrodes or change the application site.
z
Use defibrillator-proof ECG cables during defibrillation.
z
Do not touch the patient, or table, or instruments during defibrillation.
z
After defibrillation, the screen display recovers within 10 seconds if the correct
electrodes are used and applied in accordance with the manufacturer’s instructions
for use.
z
Interference from a non-grounded instrument near the patient and electrosurgery
interference can cause problems with the waveform.
7-2
7.3 Preparing to Monitor ECG
7.3.1 Preparing the Patient and Placing the Electrodes
1.
Prepare the patient’s skin. Proper skin preparation is necessary for good signal quality at
the electrode, as the skin is a poor conductor of electricity. To properly prepare the skin,
choose flat areas and then follow this procedure:
‹
Shave hair from skin at chosen sites.
‹
Gently rub skin surface at sites to remove dead skin cells.
‹
Thoroughly cleanse the site with a mild soap and water solution. We do not
recommend using ether or pure alcohol, because this dries the skin and increases
the resistance.
‹
Dry the skin completely before applying the electrodes.
2.
Attach the clips or snaps to the electrodes before placing them.
3.
Place the electrodes on the patient.
4.
Attach the electrode cable to the patient cable and then plug the patient cable into the
ECG connector on the MPM.
7-3
7.3.2 Choosing AHA or IEC Lead Placement
1.
Select the ECG parameter window or waveform area to enter the [ECG Setup] menu.
2.
Select [Lead Set] and then select [3-lead], [5-lead], [12-lead] or [Auto] according to
the applied electrodes.
3.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required password
4.
Select [Others >>]ĺ[ECG Standard] and then select [AHA] or [IEC] according to the
standard that is applied for your hospital.
7.3.3 ECG Lead Placements
The electrode placement illustrations in this chapter adopt the AHA standard.
3-Leadwire Electrode Placement
Following is an electrode configuration when using 3 leadwires:
„
RA placement: directly below the clavicle and near the right shoulder.
„
LA placement: directly below the clavicle and near the left shoulder.
„
LL placement: on the left lower abdomen.
7-4
5-Leadwire Electrode Placement
Following is an electrode configuration when using 5 leadwires:
„
RA placement: directly below the clavicle and near the right shoulder.
„
LA placement: directly below the clavicle and near the left shoulder.
„
RL placement: on the right lower abdomen.
„
LL placement: on the left lower abdomen.
„
V placement: on the chest.
The chest (V) electrode can be placed on one of the following positions:
„
V1 placement: on the fourth intercostal space at the right sternal border.
„
V2 placement: on the fourth intercostal space at the left sternal border.
„
V3 placement: midway between the V2 and V4 electrode positions.
„
V4 placement: on the fifth intercostal space at the left midclavicular line.
„
V5 placement: on the left anterior axillary line, horizontal with the V4 electrode
position.
„
V6 placement: on the left midaxillary line, horizontal with the V4 electrode position.
„
V3R-V6R placement: on the right side of the chest in positions corresponding to those
on the left.
„
VE placement: over the xiphoid process.
„
V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal
space.
„
V7R placement: on posterior chest at the right posterior axillary line in the fifth
intercostal space.
7-5
12-Leadwire Electrode Placement
12-lead ECG uses 10 electrodes, which are placed on
the patient’s four limbs and chest. The limb electrodes
should be placed on the soft skin and the chest
electrodes placed according to the physician’s
preference.
Lead Placement for Surgical Patients
The surgical site should be taken into consideration
when placing electrodes on a surgical patient. e.g. for
open-chest surgery, the chest electrodes can be placed
on the lateral chest or back. To reduce artifacts and
interference from electrosurgical units, you can place
the limb electrodes close to the shoulders and lower
abdomen and the chest electrodes on the left side of
the mid-chest. Do not place the electrodes on the upper
arm. Otherwise, the ECG waveform will be very small.
WARNING
z
When using electrosurgical units (ESU), patient leads should be placed in a
position that is equal distance from the Electrosurgery electrotome and the
grounding plate to avoid burns to the patient. Never entangle the ESU cable and
the ECG cable together.
z
When using electrosurgical units (ESU), never place ECG electrodes near to the
grounding plate of the ESU, as this can cause a lot of interference on the ECG
signal.
7-6
7.3.4 Checking Paced Status
It is important to set the paced status correctly when you start monitoring ECG. The paced
symbol
is displayed when the [Paced] status is set to [Yes]. The pace pulse markers “|”
are shown on the ECG wave when the patient has a paced signal.
To change the paced status, you can select either:
„
the patient information area, or
„
[Main Menu]ĺ[Patient Setup]ĺ[Patient Demographics], or,
„
the ECG parameter window or waveform areaĺ[Others >>],
and then, select [Paced] from the popup menu and toggle between [Yes] and [No].
Warning
z
For paced patients, you must set [Paced] to [Yes]. If it is incorrectly set to [No], the
patient monitor could mistake a pace pulse for a QRS and fail to alarm when the
ECG signal is too weak. Do not rely entirely on rate meter alarms when monitoring
patients with pacemakers. Always keep these patients under close surveillance.
z
For non-paced patients, you must set [Paced] to [No]. If it is incorrectly set to [Yes],
the patient monitor may be unable to detect premature ventricular beats (including
PVCs) and perform ST segment analysis.
7-7
7.4 Understanding the ECG Display
Your display may be configured to look slightly different.
1
2
3
1.
Lead label of the displayed wave
2.
ECG gain
3.
ECG filter label
4.
Notch filter status
4
Besides, pace pulse marks “|” are shown above the ECG wave if the [Paced] has been set to
[Yes] and a paced signal has been detected.
3
1
2
1.
Current heart rate alarm limits
2.
Current heart rate
3.
Heart beat symbol
For 12-lead ECG display screen, refer to the section 12-Lead ECG Monitoring.
7-8
7.5 Changing ECG Settings
7.5.1 Accessing ECG Menus
By selecting the ECG parameter window or waveform area, you can access the [ECG Setup]
menu.
7.5.2 Setting Pacemaker Rate (For Mortara only)
Some pacemaker pulses can be difficult to reject. When this happens, the pulses are counted
as a QRS complex and could result in an incorrect HR and failure to detect some arrhythmias.
You can set [Pacemaker Rate] to the pacemaker’s rate in the [ECG Setup] menu. In this
way, the patient monitor can calculate HR and detect arrhythmias more accurately. When
[Paced] is set to [No], the pacemaker rate cannot be set.
7.5.3 Choosing the Alarm Source
In most cases the HR and PR numerics are identical. In order to avoid simultaneous alarms
on HR and PR, the monitor uses either HR or PR as its active alarm source. To change the
alarm source, select [Alm Source] in the [ECG Setup] menu and then select either:
„
[HR]: if you want the HR to be the alarm source for HR/PR.
„
[PR]: if you want the PR to be the alarm source for HR/PR.
„
[Auto]: If the [Alm Source] is set to [Auto], the patient monitor will use the heart rate
from the ECG measurements as the alarm source whenever a valid heart rate is available.
If the heart rate becomes unavailable, for example the ECG module is turned off or
becomes disconnected, the patient monitor will automatically switch to PR as the alarm
source.
7.5.4 Setting the ECG Lead Set
You can set the [Lead Set] from the [ECG Setup] menu. You can set the [Lead Set] as
[Auto] if the auto lead detection function is available.
7.5.5 Choosing an ECG Display Screen
When monitoring with a 5-lead or 12-lead set, you can select the [Screens] Quickkey. In the
[Choose Screen] window, choose the screen type as:
„
[Normal Screen]: The ECG waveform area shows 2 ECG waveforms.
„
[ECG 7-Lead Full-Screen]: The whole waveform area shows 7 ECG waveforms only.
„
[ECG 7-Lead Half-Screen]: The upper half part of the whole waveform area displays 7
ECG waveforms.
When monitoring with a 12-lead set, you can also choose the screen type as [ECG 12-Lead
7-9
Full-Screen].
When the screen type is set to [Normal Screen] and [Sweep Mode] is set to [Refresh],
cascaded ECG waveforms can be displayed. To cascade ECG waveforms:
1.
Select the [Screens] Quickkeyĺ[Screen Setup].
2.
Select [ECG1 Casc.] in the second row. A cascaded waveform is displayed in two
waveform positions.
7.5.6 Changing the ECG Filter Settings
The ECG filter setting defines how ECG waves are smoothed. To change the filter setting,
select [Filter] from [ECG Setup] and then select the appropriate setting.
„
[Monitor]: Use under normal measurement conditions.
„
[Diagnostic]: Use when diagnostic quality is required. The unfiltered ECG wave is
displayed so that changes such as R-wave notching or discrete elevation or depression of
the ST segment are visible.
„
[Surgery]: Use when the signal is distorted by high frequency or low frequency
interference. High frequency interference usually results in large amplitude spikes
making the ECG signal look irregular. Low frequency interference usually leads to
wandering or rough baseline. In the operating room, the surgery filter reduces artifacts
and interference from electrosurgical units. Under normal measurement conditions,
selecting [Surgery] may suppress the QRS complexes too much and then interfere with
ECG analysis.
WARNING
z
The [Diagnostic] filter is recommended when monitoring a patient in an
environment with slight interference only.
7.5.7 Switching the Notch Filter On or Off
The notch filter removes the line frequency interference. When [Filter] is not set to
[Diagnostic], the notch filter always stays on. When [Filter] is set to [Diagnostic], you can
switch the notch filter on or off as required.
1.
Select the ECG parameter window or waveform area to enter its setup menu. Then select
[Others >>].
2.
Select [Notch Filter] and toggle between [On] and [Off]. Switching the notch filter on
is recommended when there is interference (such as spikes) with the waveform.
3.
When [Notch Filter] is set on, select [Main Menu]ĺ[Maintenance >>]ĺ[User
Maintenance >>]ĺenter the required password.
4.
Select [Others >>]ĺ[Notch Freq.] and then select [50Hz] or [60Hz] according to the
power line frequency.
7-10
7.5.8 About the Defibrillator Synchronization
If a defibrillator is connected, a defibrillator synchronization pulse (100 ms, +5V) is
outputted through the Defib. Sync Connector every time when the patient monitor detects an
R-wave. The defibrillator synchronization function is always enabled.
WARNING
z
Improper use of a defibrillator may cause injury to the patient. The user should
determine whether to perform defibrillation or not according to the patient’s
condition.
z
Before defibrillation, the user must ensure both defibrillator and monitor has
passed the system test and can be safely used jointly.
z
Before defibrillation, make sure that the [Filter] is set to [Diagnostic].
z
After defibrillation is finished, select the filter mode as required.
7.5.9 Changing ECG Wave Settings
In the [ECG Setup] menu:
„
If the wave is too small or clipped, you can change its size by selecting an appropriate
[Gain] setting. If you select [Auto] from [Gain], the patient monitor will automatically
adjust the size of the ECG waves. In normal screen, only the selected ECG wave’s size
is adjusted. In other screens, all ECG waves’ size is adjusted simultaneously.
„
You can change the wave sweep speed by selecting [Sweep] and then selecting the
appropriate setting.
7-11
7.5.10 Choosing the Heart Rate Source
For the Basic algorithm, to compute HR and to analyse and detect arrhythmia more
accurately, you can choose a lead of best quality signals as the HR lead. To select a lead as
the HR lead, select [ECG1] from the [ECG Setup] menu and then select the lead you want.
The selected lead should have the following characteristics:
„
The QRS should be either completely above or below the baseline and it should not be
biphasic.
„
The QRS should be tall and narrow.
„
The P-waves and T-waves should be less than 0.2mV.
For the Mortara algorithm, the system will analyze the ECG waveforms from multiple
channels simultaneously so as to compute HR and to analyze and detect arrhythmia.
7.5.11 Enabling Smart Lead Off
When the smart lead off function is set on and there is a “lead off” in the lead that has an
ECG waveform in filter mode and notch status, if another lead is available, this available lead
automatically becomes that lead. The system will re-calculate HR and analyze and detect
arrhythmia. When the “lead off” condition is corrected, the leads are automatically switched
back.
To switch on/off the smart lead off function, select [Others >>] from the [ECG Setup] menu;
select [Smart Lead Off] and toggle between [On] and [Off] from the popup menu.
7.5.12 Setting the Alarm Level for ECG Lead Off Alarms
Select [Alarm Setup >>] from the [User Maintenance] menu. You can set [ECGLeadOff
Lev.] from the popup menu.
7.5.13 Adjusting QRS Volume
QRS sounds are produced based on the alarm source. To adjust the QRS volume, select
[Others >>] from the [ECG Setup] menu; select [QRS Volume] from the popup menu and
select the appropriate setting. When valid SpO2 measured value is available, the system
adjusts the pitch tone of QRS sound based on the SpO2 value.
7-12
7.6 About ST Monitoring
„
ST segment analysis is not intended for neonatal patients. The default setting is off.
„
ST segment analysis calculates ST segment elevations and depressions for individual
leads and then displays them as numerics in the ST1 and ST2 areas.
„
A positive value indicates ST segment elevation; a negative value indicates ST segment
depression.
„
Measurement unit of the ST segment: mV or mm. You can set the unit in the [Unit
Setup] menu from the [User Maintenance] menu.
„
Measurement range of the ST segment: -2.0 mV to +2.0 mV.
WARNING
z
The ST algorithm has been tested for accuracy of the ST segment data. The
significance of the ST segment changes need to be determined by a clinician.
7.6.1 Switching ST On and Off
To switch ST monitoring on or off:
1.
In the [ECG Setup] menu, select [ST Analysis >>].
2.
Select [ST Analysis] to toggle between [On] and [Off].
Reliable ST monitoring can hardly be ensured if:
„
You are unable to get a lead that is not noisy.
„
Arrhythmias such as atrial fib/flutter cause irregular baseline.
„
The patient is continuously ventricularly paced.
„
The patient has left bundle branch block.
In these cases, you may consider switching ST monitoring off.
7.6.2 Changing ST Filter Settings
ST-segment analysis can be carried out only when the fileter mode is set to [Diagnostic].
When ST-segment analysis is switched on, [Filter] will automatically switch to [Diagnostic]
if it is not in the diagnostic mode. However, if you switch [Filter] to [Monitor] or [Surgery],
ST-segment analysis will turn off automatically. In case that you change [Monitor] or
[Surgery] to [Diagnostic] and ST-segment analysis keeps off, you can turn it on manually.
7-13
7.6.3 Understanding the ST Display
This example shows ST numerics with 5-lead ECG. Your monitor screen may look slightly
different from the illustration.
Select the ST parameter window and you can enter the [ST Analysis] menu.
7.6.4 Changing the ST Alarm Limits
High and low ST alarm limits can be set individually for each ECG lead. Alarm limits can
also be set separately for single-lead and multi-lead ST monitoring. You can select [ST
Alarm Setup >>] from [ST Analysis] menu and then change ST alarm settings for each lead.
7.6.5 Setting the ST Alarm Delay Time
You can set the ST alarm delay time from the [Others] window of [Alarm Setup] menu.
7.6.6 Adjusting ST Measurement Points
As shown in the figure below, the ST measured for each beat complex is the vertical
difference between two measurement points with the R-wave peak as the baseline for the
measurement.
R-wave peak
J point
P
Isoelectric point
T
ST measurement point
Difference=ST value
The ISO and ST points need to be adjusted when you start monitoring and if the patient’s
heart rate or ECG morphology changes significantly. Exceptional QRS complexes are not
considered for ST-segment analysis.
7-14
WARNING
z
Always make sure that the positions of ST measurement points are appropriate for
your patient.
To adjust the ST measurement points:
1.
In the [ST Analysis] menu, select [Adjust ST Points >>]. In the [Adjust ST Points]
window, three vertical lines represent the ISO, J and ST point positions respectively.
2.
Select [View Leads] and use the Knob to select an ECG lead with obvious J point and R
wave.
3.
Select [ISO], [J] or [ST] and then use the Knob to adjust the position of each point.
‹
The ISO-point (isoelectric) position is given relative to the R-wave peak. Position
the ISO-point in the middle of the flattest part of the baseline (between the P and Q
waves of in front of the P wave).
‹
The J-point position is given relative to the R-wave peak and helps locating the
ST-point. Position the J-point at the end of the QRS complex and the beginning of
the ST segment.
‹
The ST-point is positioned a fixed distance from the J-point. Move the J-point to
position the ST-point at the midpoint of the ST segment. Position the ST-point
relative to the J-point at either J+60 or J+80.
7-15
7.7 About Arrhythmia Monitoring
Arrhythmia analysis provides information about your patient’s condition, including heart rate,
PVC rate, rhythm and ectopics.
WARNING
z
Arrhythmia analysis program is intended to detect ventricular arrhythmias. It is
not designed to detect atrial or supraventricular arrhythmias. It may incorrectly
identify the presence or absence of an arrhythmia. Therefore, a physician must
analyze the arrhythmia information with other clinical findings.
z
The arrhythmia detection is not intended for neonatal patients.
7-16
7.7.1 Understanding the Arrhythmia Events
Arrhythmia
Message
Description
Category
Asystole
No QRS complex detected within the set time threshold (in
absence of ventricular fibrillation or chaotic signals).
Lethal
arrhythmia
Vfib
Ventricular fibrillation occurs and persists for 6 seconds.
Vtac
Ventricular HR is greater or equal to the preset threshold and the
number of consecutive PVCs is greater than the preset threshold.
PVCs
PVCs/min exceeds high limit
PNP
No pace pulse detected for (60*1000/pace rate +90) milliseconds
following a QRS complex or a pacer pulse (for paced patients
only).
PNC
No QRS complex detected for 300 milliseconds following a pace
pulse (for paced patients only).
Multif. PVC
More than 2 PVCs of different forms occur in the predefined
search window (3-31).
Couplet
Paired PVCs are detected.
VT > 2
Ventricular HR is greater than or equal to the preset threshold and
the number of PVCs is greater than or equal to 3 but less than the
preset threshold.
Vent. Rhythm
Ventricular HR is less than the preset threshold and the number of
PVCs is greater than or equal to 3.
Bigeminy
A dominant rhythm of N, V,N, V, N, V.
Trigeminy
A dominant rhythm of N, N, V,N, N, V, N, N, V.
R on T
R on T is detected.
Irr. Rhythm
Consistently irregular rhythm
Missed Beats
No beat detected for 1.75x average R-R interval for HR <120, or
No beat for 1 second with HR >120 (for non-paced patients only),
or
No beat detected for more than the set pause threshold.
Brady
The HR is less than the set bradycardia low limit.
Tachy
The HR is greater than the set tachycardia high limit.
7-17
Nonlethal
arrhythmia
7.7.2 Changing Arrhythmia Alarm Settings
To change arrhythmia alarm settings, select the ECG parameter area or waveform area and
then select [Arrh. Analysis >>]. In the popup menu, you can also switch on lethal arrhythmia
analysis alarms only or switch on/off all arrhythmia analysis alarms. In the [Alarm Setup]
menu from the [User Maintenance] menu, you can enable/disable turning off lethal
arrhythmia analysis alarms.
WARNING
z
If you switch off all arrhythmia analysis alarms, the monitor cannot give any
arrhythmia analysis alarm. Always keep the patient under close surveillance.
7.7.3 Changing Arrhythmia Threshold Settings
To change arrhythmia threshold settings, select the ECG parameter window or waveform
areaĺ[Arrh. Analysis >>]ĺ[Arrh. Threshold]. In case an arrhythmia violates its threshold,
an alarm will be triggered.
Arrh. event
Range
Default
Step
Unit
PVCs High
1 to 10
10
1
/min
Asys. Delay
2 to 10
5
1
s
Vtac Rate
100 to 200
130
5
bpm
Vtac PVC
3 to 12
6
1
beats
Multif. PVC
3 to 31
15
1
beats
Tachy High
Adult: 100 to 300
Pediatric: 160 to 300
Adult: 100
Pediatric: 160
5
bpm
Brady Low
Adult: 15 to 60
Pediatric: 15 to 80
Adult: 60
Pediatric: 80
5
bpm
7-18
7.7.4 Reviewing Arrhythmia Events
Please refer to the Review chapter.
7.7.5 Initiating an ECG Relearning Manually
During ECG monitoring, you may need to initiate an ECG relearning when the patient’s ECG
template changes dramatically. A change in the ECG template could result in:
„
incorrect arrhythmia alarms
„
loss of ST measurement, and/or
„
inaccurate heart rate
ECG relearning allows the monitor to learn the new ECG template so as to correct arrhythmia
alarms and HR value, and restore ST measurements. To initiate relearning manually, select
the ECG parameter window or waveform areaĺ [Relearn]. When the patient monitor is
learning, the message [ECG Learning] is displayed in the technical alarm area.
CAUTION
z
Take care to initiate ECG relearning only during periods of normal rhythm and
when the ECG signal is relatively noise-free. If ECG learning takes place during
ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS
complex. This may result in missed detection of subsequent events of V-Tach and
V-Fib.
7.7.6 Automatic ECG Relearning
ECG relearning is initiated automatically whenever:
„
The ECG lead or lead label is changed
„
The ECG lead is re-connected
„
A new patient is admitted
„
After the calibration is completed, select [Stop Calibrating ECG]
„
A switch happens between the options of screen type during 5/12-lead ECG monitoring.
7-19
7.8 12-Lead ECG Monitoring
Entering the 12-lead ECG Monitoring Screen
1.
Refer to the section 7.3.3 ECG Lead Placements for placing the electrodes.
2.
In the [ECG Setup] menu, select [Lead Set]ĺ[12-Lead]. Select [Screens]
Quickkeyĺ[ECG 12-Lead Full-Screen].
There are totally 12 ECG waves and 1 rhythm wave displayed on the screen. The rhythm lead
is the HR-derived lead before entering the 12-lead ECG monitoring screen. The ST numerics
are displayed in three groups:
„
ST Ant (anterior): V1, V2, V3, V4
„
ST Inf (inferior):
II, III, aVF, (aVR)
„
ST Lat (lateral):
I, aVL, V5, V6
Although aVR is displayed in the ST Inf group, it is not an inferior lead.
Additionally, the 12-lead ECG monitoring has the following features:
„
The [Filter] mode is fixed to [Diagnostic] and cannot be changed.
„
In the adult mode, the
hardkey on the monitor’s front is disabled.
7-20
8 Monitoring Respiration (Resp)
8.1 Introduction
Impedance respiration is measured across the thorax. When the patient is breathing or
ventilated, the volume of air changes in the lungs, resulting in impedance changes between
the electrodes. Respiration rate (RR) is calculated from these impedance changes, and a
respiration waveform appears on the patient monitor screen.
8.2 Safety Information
Warning
z
When monitoring the patient’s respiration, do not use ESU-proof ECG cables.
z
If you do not set the detection level for the respiration correctly in manual
detection mode, it may not be possible for the monitor to detect apnea. If you set
the detection level too low, the monitor is more likely to detect cardiac activity, and
to falsely interpret cardiac activity as respiratory activity in the case of apnea.
z
The respiration measurement does not recognize the cause of apneas. It only
indicates an alarm if no breath is detected when a pre-adjusted time has elapsed
since the last detected breath. Therefore, it cannot be used for diagnostic purpose.
z
If operating under conditions according to the EMC Standard EN 60601-1-2
(Radiated Immunity 3V/m), field strengths above 1V/m may cause erroneous
measurements at various frequencies. Therefore it is recommended to avoid the use
of electrically radiating equipment in close proximity to the respiration
measurement unit.
8-1
8.3 Understanding the Resp Display
Gain
Resp lead label
RR source Respiration rate
By selecting the waveform area or parameter area, you can enter the [Resp Waveform] menu.
By selecting the Resp parameter window, you can enter the [Resp Setup] menu.
NOTE
z
Respiration monitoring is not for use on the patients who are very active, as this
will cause false alarms.
8.4 Placing Resp Electrodes
As the skin is a poor conductor of electricity, preparing the skin is necessary for a good
Respiration signal. You can refer to the ECG section for how to prepare the skin.
As the Respiration measurement adopts the standard ECG electrode placement, you can use
different ECG cables (3-lead, 5-lead or 12-lead). Since the respiration signal is measured
between two ECG electrodes, if a standard ECG electrode placement is applied, the two
electrodes should be RA and LA of ECG Lead I, or RA and LL of ECG Lead II.
NOTE
z
To optimize the respiration waveform, place the RA and LA electrodes
horizontally when monitoring respiration with ECG Lead I; place the RA and LL
electrodes diagonally when monitoring respiration with ECG Lead II.
8-2
Lead I
Lead II
8.4.1 Optimizing Lead Placement for Resp
If you want to measure Resp and you are already measuring ECG, you may need to optimize
the placement of the two electrodes between which Resp will be measured. Repositioning
ECG electrodes from standard positions results in changes in the ECG waveform and may
influence ST and arrhythmia interpretation.
8.4.2 Cardiac Overlay
Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the
Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct
electrodes placement can help to reduce cardiac overlay: avoid the liver area and the
ventricles of the heart in the line between the respiratory electrodes. This is particularly
important for neonates.
8.4.3 Abdominal Breathing
Some patients with restricted movement breathe mainly abdominally. In these cases, you may
need to place the left leg electrode on the left abdomen at the point of maximum abdominal
expansion to optimise the respiratory wave.
8-3
8.4.4 Lateral Chest Expansion
In clinical applications, some patients (especially neonates) expand their chests laterally,
causing a negative intrathoracic pressure. In these cases, it is better to place the two
respiration electrodes in the right midaxillary and the left lateral chest areas at the patient’s
maximum point of the breathing movement to optimise the respiratory waveform.
8.5 Choosing the Respiration Lead
In the [Resp Setup] menu, select [Resp Lead] and toggle between [I] and [II].
8.6 Changing the Apnea Alarm Delay
The apnea alarm is a high-level alarm used to detect apneas. You can set the apnea alarm
delay time after which the patient monitor alarms if the patient stops breathing. In the [Resp
Setup] menu, select [Apnea Delay] and then select the appropriate setting. The [Apnea
Delay] of Resp, CO2, AG, and RM module keeps consistent with each other.
8.7 Changing Resp Detection Mode
In the [Resp Setup] menu, select [Detection Mode] and toggle between [Auto] and
[Manual].
„
In auto detection mode, the patient monitor adjusts the detection level automatically,
depending on the wave height and the presence of cardiac artifact. Note that in auto
detection mode, the detection level (a dotted line) is not displayed on the waveform.
Use auto detection mode for situations where:
„
‹
The respiration rate is not close to the heart rate.
‹
Breathing is spontaneous, with or without continuous positive airway pressure
(CPAP).
‹
Patients are ventilated, except patients with intermittent mandatory ventilation
(IMV).
In manual detection mode, you adjust the dotted detection level line to the desired level
or
beside them.
by selecting [Upper Line] or [Lower Line] and then selecting
Once set, the detection level will not adapt automatically to different respiration depths.
It is important to remember that if the depth of breathing changes, you may need to
change the detection level.
8-4
Use manual detection mode for situations where:
‹
The respiration rate and the heart rate are close.
‹
Patients have intermittent mandatory ventilation.
‹
Respiration is weak. Try repositioning the electrodes to improve the signal.
In Auto Detection Mode, if you are monitoring Resp and ECG is switched off, the monitor
cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection
level is automatically set higher to prevent the detection of cardiac overlay as respiration.
In Manual Detection Mode, cardiac overlay can in certain situations trigger the respiration
counter. This may lead to a false indication of a high respiration or an undetected apnea
condition. If you suspect that cardiac overlay is being registered as breathing activity, raise
the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising
the detection level is not possible, you may need to optimize the electrode placement as
described in the section "Lateral Chest Expansion".
8.8 Changing Resp Wave Settings
WARNING
z
When monitoring in manual detection mode, make sure to check the respiration
detection level after you have increased or decreased the size of the respiration
wave.
In the [Resp Setup] menu, you can:
„
Select [Gain] and then select an appropriate setting. The bigger the gain is, the larger the
wave amplitude is.
„
Select [Sweep] and then select an appropriate setting. The faster the wave sweeps, the
wider the wave is.
8.9 Setting RR Source
To set RR source:
1.
Enter the [Resp Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
The dropdown list displays the currently available RR source. When you select [Auto], the
system will automatically select the RR source according to the priority. When the current
RR source does not have valid measurement, the system will automatically switch the [RR
8-5
Source] to [Auto]. RR source switches back to impedance respiration if you press the
silence hardkey on the monitor’s front during an apnea alarm.
The priority of RR source is (from high to low): CO2 measurement, RM measurement and
impedance respiration measurement.
The [RR Source] settings of Resp, CO2, AG and RM module are linked.
The RR source options and description are shown in the table below.
Option
Description
Auto
RR source is automatically selected according
to the priority.
CO2
RR source is from CO2 measurement.
RM
RR source is from RM measurement.
ECG
RR source is from impedance respiration
measurement.
8.10 Setting alarm properties
Select [Alarm Setup >>] from the [Resp Setup] menu. In the popup menu, you can set
alarm properties for this parameter.
8.11 Switching Resp Measurement On/Off
To switch Resp measurement on, select [Resp Measure. ON] from the [Resp Setup] menu.
To switch Resp measurement off, select [Resp Measure. OFF] from the [Resp Setup] menu
and then select [Yes] from the popup dialog box. Then, a line is displayed in the waveform
area and no numeric but [Measurement OFF] message is displayed in the parameter area.
8-6
9 Monitoring PR
9.1 Introduction
The pulse numeric counts the arterial pulsations that result from the mechanical activity of
the heart. You can display a pulse from any measured SpO2 or any arterial pressure (see the
IBP section). The displayed pulse numeric is color-coded to match its source.
1
2
1.
PR Source
2.
PR: detected beats per minute.
9-1
9.2 Setting the PR Source
The current pulse source is displayed in the PR parameter area. The pulse rate chosen as
pulse source:
„
is monitored as system pulse and generates alarms when you select PR as the active
alarm source;
„
is stored in the monitor’s database and reviewed in the graphic/tabular trends ; in trend
graphs, as the PR curve is in the same color with the PR source , it is unlikely to
distinguish the PR source ;
„
is sent via the network to the central monitoring system, if available.
To set which pulse rate as PR source:
1.
Enter the [SpO2 Setup] menu.
2.
Select [PR Source] and then select a label or [Auto] from the popup menu.
The popup menu displays the currently available PR sources from top to bottom by priority.
When you select [Auto], the system will automatically select the first option as the PR source
from the popup menu. When the current PR source is unavailable, the system will
automatically switch [PR Source] to [Auto]. When you select [IBP], the system will
automatically select the first pressure label as the PR source from the popup menu.
9-2
9.3 Selecting the Active Alarm Source
In most cases the HR and pulse numerics are identical. In order to avoid simultaneous alarms
on HR and Pulse, the monitor uses either HR or Pulse as its active alarm source. To change
the alarm source, select [Alm Source] in the [ECG Setup] or [SpO2 Setup] menu and then
select either:
„
[HR]: The monitor will use the HR as the alarm source for HR/pulse.
„
[PR]: The monitor will use the PR as the alarm source for HR/pulse.
„
[Auto]: If the [Alm Source] is set to [Auto], the monitor will use the heart rate from the
ECG measurement as the alarm source whenever the ECG measurement is switched on
and a valid heart rate is available. If the heart rate becomes unavailable, for example if
leads becomes disconnected, and a pulse source is switch on and available, the monitor
will automatically switch to Pulse as the alarm source. When the Leads Off condition is
corrected, the monitor will automatically switch back to the heart rate as the alarm
source.
9.4 QRS Tone
When PR is used as the alarm source, the PR source will be used as a source for the QRS
tone. You can change the QRS volume by adjusting [Beat Vol] in the [SpO2 Setup] menu.
When a valid SpO2 value exists, the system will adjust the pitch tone of QRS volume
according to the SpO2 value.
9-3
FOR YOUR NOTES
9-4
10 Monitoring SpO2
10.1 Introduction
SpO2 monitoring is a non-invasive technique used to measure the amount of oxygenated
haemoglobin and pulse rate by measuring the absorption of selected wavelengths of light.
The light generated in the probe passes through the tissue and is converted into electrical
signals by the photodetector in the probe. The SpO2 module processes the electrical signal
and displays a waveform and digital values for SpO2 and pulse rate.
This device is calibrated to display functional oxygen saturation. It provides four
measurements:
1
2
3
4
1.
Pleth waveform (Pleth): visual indication of patient’s pulse. The waveform is
normalized.
2.
Oxygen saturation of arterial blood (SpO2): percentage of oxygenated hemoglobin in
relation to the sum of oxyhemoglobin and deoxyhemoglobin.
3.
Perfusion indicator: the pulsatile portion of the measured signal caused by arterial
pulsation.
4.
Pulse rate (derived from pleth wave): detected pulsations per minute.
10-1
10.2 Safety
WARNING
z
Use only SpO2 sensors specified in this manual. Follow the SpO2 sensor’s
instructions for use and adhere to all warnings and cautions.
z
When a trend toward patient deoxygenation is indicated, blood samples should be
analyzed by a laboratory co-oximeter to completely understand the patient’s
condition.
z
Do not use SpO2 sensors during magnetic resonance imaging (MRI). Induced
current could potentially cause burns. The sensor may affect the MRI image, and
the MRI unit may affect the accuracy of the oximetry measurements.
z
Prolonged continuous monitoring may increase the risk of undesirable changes in
skin characteristics, such as irritation, reddening, blistering or burns. Inspect the
sensor site every two hours and move the sensor if the skin quality changes.
Change the application site every four hours. For neonates, or patients with poor
peripheral blood circulation or sensitive skin, inspect the sensor site more
frequently.
10-2
10.3 Identifying SpO2 Modules
To identify which SpO2 module is incorporated into your MPM, see the company logo
located at the right upper corner. The color of the cable connector matches the company as
shown below:
„
MPM SpO2 module: a blue connector without logo.
„
Masimo SpO2 module: a white connector with a logo of Masimo SET.
„
Nellcor SpO2 module: a grey connector with a logo of Nellcor.
The connectors for these three SpO2 sensors are mutually exclusive.
Connector for SpO2 cable
10.4 Applying the Sensor
1.
Select an appropriate sensor according to the module type, patient category and weight.
2.
Remove colored nail polish from the application site.
3.
Apply the sensor to the patient.
4.
Select an appropriate adapter cable according to the connector type and plug this cable
into the MPM.
5.
Connect the sensor cable to the adapter cable.
10-3
10.5 Changing SpO2 Settings
10.5.1 Accessing SpO2 Menus
By selecting the SpO2 parameter window or waveform area, you can access the [SpO2 Setup]
menu.
10.5.2 Adjusting the Desat Alarm
The desat alarm is a high level alarm notifying you of potentially life threatening drops in
oxygen saturation. Select [Alarm Setup >>] from the [SpO2 Setup] menu. From the popup
menu, you can set low alarm limit, alarm switch, and alarm recording for [Desat]. When the
SpO2 value is below the desat alarm limit and desat alarm switch is set on, the message
[SpO2 Desat] is displayed.
10.5.3 Setting SpO2 Sensitivity
For Masimo SpO2 module, you can set [Sensitivity] to [Normal] or [Maximum] in the
[SpO2 Setup] menu. When the [Sensitivity] is set to [Maximum], the patient monitor is
more sensitive to minor signals. When monitoring critically ill patients whose pulsations are
very weak, it is strongly recommended that the sensitivity is set to [Maximum]. When
monitoring neonatal or non-critically ill patients who tend to move a lot, noise or invalid
signals may be caused. In this case, it is recommended that the sensitivity is set to [Normal]
so that the interference caused by motion can be filtered and therefore the measurement
stability can be ensured.
10.5.4 Changing Averaging Time
The SpO2 value displayed on the monitor screen is the average of data collected within a
specific time. The shorter the averaging time is, the quicker the patient monitor responds to
changes in the patient’s oxygen saturation level. Contrarily, the longer the averaging time is,
the slower the patient monitor responds to changes in the patient’s oxygen saturation level,
but the measurement accuracy will be improved. For critically ill patients, selecting shorter
averaging time will help understanding the patient’s state.
10-4
To set the averaging time:
„
For MPM SpO2 module, select [Sensitivity] in the [SpO2 Setup] menu and then toggle
between [High], [Med] and [Low], which respectively correspond to 7 s, 9 s and 11 s.
„
For Masimo SpO2 module, select [Averaging] in the [SpO2 Setup] menu and then
toggle between [2-4 s], [4-6 s], [8 s], [10 s], [12 s], [14 s] and [16 s].
10.5.5 Monitoring SpO2 and NIBP Simultaneously
When monitoring SpO2 and NIBP on the same limb simultaneously, you can switch [NIBP
Simul] on in the [SpO2 Setup] menu to lock the SpO2 alarm status until the NIBP
measurement ends. If you switch [NIBP Simul] off, low perfusion caused by NIBP
measurement may lead to inaccurate SpO2 readings and therefore cause false physiological
alarms.
10.5.6 Sat-Seconds Alarm Management
With traditional alarm management, high and low alarm limits are set for monitoring oxygen
saturation. During monitoring, as soon as an alarm limit is violated, an audible alarm
immediately sounds. When the patient % SpO2 fluctuates near an alarm limit, the alarm
sounds each time the limit is violated. Such frequent alarm can be distracting. Nellcor’s
Sat-Seconds alarm management technique is used to reduce these nuisance alarms.
The Sat-Seconds feature is available with the Nellcor SpO2 module to decrease the likelihood
of false alarms caused by motion artifacts. To set the Sat-Seconds limit, select [Sat-Seconds]
in the [SpO2 Setup] menu and then select the appropriate setting.
With Sat-Seconds alarm management, high and low alarm limits are set in the same way as
traditional alarm management. A Sat-Seconds limit is also set. The Sat-Seconds limit controls
the amount of time that SpO2 saturation may be outside the set limits before an alarm sounds.
The method of calculation is as follows: the number of percentage points that the SpO2
saturation falls outside the alarm limit is multiplied by the number of seconds that it remains
outside the limit. This can be stated as the equation:
Sat-Seconds= Points × Seconds
10-5
Only when the Sat-Seconds limit is reached, the monitor gives a Sat-Seconds alarm. For
example, the figure below demonstrates the alarm response time with a Sat-Seconds limit set
at 50 and a low SpO2 limit set at 90%. In this example, the patient % SpO2 drops to 88% (2
points) and remains there for 2 seconds. Then it drops to 86% (4 points) for 3 seconds, and
then to 84% (6 points) for 6 seconds. The resulting Sat-Seconds are:
% SpO2
2×
4×
6×
Seconds
2=
3=
6=
Total Sat-Seconds=
Sat-Seconds
4
12
36
52
After approximately 10.9 seconds, a Sat-Second alarm would sound, because the limit of 50
Sat-Seconds would have been exceeded.
% SpO2
Seconds
Saturation levels may fluctuate rather than remaining steady for a period of several seconds.
Often, the patient % SpO2 may fluctuate above and below an alarm limit, re-entering the
non-alarm range several times. During such fluctuation, the monitor integrates the number of
%SpO2 points, both positive and negative, until either the Sat-Seconds limit is reached, or the
patient%SpO2 re-enters the non-alarm range and remains there.
10.5.7 Changing the Speed of the Pleth Wave
In the [SpO2 Setup] menu, select [Sweep] and then select the appropriate setting. The faster
the waveform sweeps, the wider the waveform is.
10.5.8 Setting the Alarm Level for SpO2 Sensor Off Alarm
Select [Alarm Setup >>] from the [User Maintenance] menu. You can set the
[SpO2SensorOff Lev.] in the popup menu.
10-6
10.5.9 Setting the SpO2 Tone Mode
Select [Others >>] from the [User Maintenance] menu. In the popup menu, you can set
[SpO2 Tone] as [Mode 1] or [Mode 2].
WARNING
z
The same SpO2 tone mode shall be used for the same patient monitors in a single
area.
10.6 Measurement Limitations
If you doubt the measured SpO2, check patient vital signs first. Then check the patient
monitor and SpO2 sensor. The following factors may influence the accuracy of measurement:
„
Ambient light
„
Physical movement (patient and imposed motion)
„
Diagnostic testing
„
Low perfusion
„
Electromagnetic interference, such as MRI environment
„
Electrosurgical units
„
Dysfunctional haemoglobin, such as carboxyhemoglobin (COHb)and methemoglobin
(MetHb)
„
Presence of certain dyes, such as methylene and indigo carmine
„
Inappropriate positioning of the SpO2 sensor, or use of incorrect SpO2
„
Drop of arterial blood flow to immeaurable level caused by shock, anemia, low
temperature or vasoconstrictor.
10-7
10.7 Masimo Information
„
Masimo Patents
This device is covered under one or more the following U.S.A. patents: 5,758,644; 5,823,950;
6,011,986; 6,157,850; 6,263,222; 6,501,975; 7,469,157 and other applicable patents listed at:
www.masimo.com/patents.htm.
„
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with unauthorized sensors or cables which would, alone, or in combination with
this device, fall within the scope of one or more of the patents relating to this device.
10.8 Nellcor Information
„
Nellcor Patents
This device is covered under one or more the following U.S. Patents: 4,802,486; 4,869,254;
4,928,692; 4,934,372; 5,078,136; 5,351,685; 5,485,847; 5,533,507; 5,577,500; 5,803,910;
5,853,364; 5,865,736; 6,083,172; 6,463,310; 6,591,123; 6,708,049; Re.35,122 and
international equivalents. U.S.A international patents pending.
„
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with unauthorized replacement parts which would, alone, or in combination with
this device, fall within the scope of one or more of the patents relating to this device.
10-8
11 Monitoring NIBP
11.1 Introduction
The MPM uses the oscillometric method for measuring the non-invasive blood pressure
(NIBP). This measurement can be used for adults, pediatrics and neonates.
NIBP start/stop key
Connector for NIBP cuff
Automatic non-invasive blood pressure monitoring uses the oscillometric method of
measurement. To understand how this method works, we’ll compare it to the auscultative
method. With auscultation, the clinician listens to the blood pressure and determines the
systolic and diastolic pressures. The mean pressure can then be calculated with reference to
these pressures as long as the arterial pressure curve is normal.
Since the monitor cannot hear the blood pressure, it measures cuff pressure oscillation
amplitudes. Oscillations are caused by blood pressure pulses against the cuff. The oscillation
with the greatest amplitude is the mean pressure. This is the most accurate parameter
measured by the oscillometric method. Once the mean pressure is determined, the systolic
and diastolic pressures are calculated with reference to the mean.
Simply stated, auscultation measures systolic and diastolic pressures and the mean pressure is
calculated. The oscillometric method measures the mean pressure and determines the systolic
and diastolic pressures.
As specified by IEC 60601-2-30/EN60601-2-30, NIBP measurement can be performed
during electro-surgery and discharge of defibrillator.
NIBP diagnostic significance must be decided by the doctor who performs the measurement.
11-1
NOTE
z
Blood pressure measurements determined with this device are equivalent to those
obtained by a trained observer using the cuff/stethoscope auscultatory method or
an intra-arterial blood pressure measurement device, within the limits prescribed
by the American National Standard, Manual, electronic, or automated
sphygmomanometers.
11.2 Safety
WARNING
z
Be sure to select the correct patient category setting for your patient before
measurement. Do not apply the higher adult settings for pediatric or neonatal
patients. Otherwise it may present a safety hazard.
z
Do not measure NIBP on patients with sickle-cell disease or any condition where
skin damage has occurred or is expected.
z
Use clinical judgement to determine whether to perform frequent unattended
blood pressure measurements on patients with severe blood clotting disorders
because of the risk of hematoma in the limb fitted with the cuff.
z
Do not use the NIBP cuff on a limb with an intravenous infusion or arterial
catheter in place. This could cause tissue damage around the catheter when the
infusion is slowed or blocked during cuff inflation.
z
If you doubt the NIBP readings, determines the patient’s vital signs by alternative
means and then verify that the monitor is working correctly.
11-2
11.3 Measurement Limitations
Measurements are impossible with heart rate extremes of less than 40bpm or greater than
240bpm, or if the patient is on a heart-lung machine.
The measurement may be inaccurate or impossible:
„
If a regular arterial pressure pulse is hard to detect
„
With excessive and continuous patient movement such as shivering or convulsions
„
With cardiac arrhythmias
„
Rapid blood pressure changes
„
Severe shock or hypothermia that reduces blood flow to the peripheries
„
Obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming
from the artery
11.4 Measurement Methods
There are three methods of measuring NIBP:
„
Manual: measurement on demand.
„
Auto: continually repeated measurements at set intervals.
„
STAT: continually rapid series of measurements over a five minute period, then return
to the previous mode.
11.5 Setting Up the NIBP Measurement
11.5.1 Preparing to Measure NIBP
1.
Power on the monitor.
2.
Verify that the patient category is correct. Change it if necessary.
3.
Plug the air tubing into the NIBP connector on the MPM module.
4.
Select a correct sized cuff and then apply it as follows:
‹
Determine the patient’s limb circumference.
11-3
5.
‹
Select an appropriate cuff by referring to the limb circumference marked on the
cuff. The width of the cuff should be 40% (50% for neonates) of the limb
circumference, or 2/3 of the upper arm’s length. The inflatable part of the cuff
should be long enough to encircle at least 50% to 80% of the limb.
‹
Apply the cuff to an upper arm or leg of the patient and make sure the ĭ marking
on the cuff matches the artery location. Do not wrap the cuff too tightly around the
limb. It may cause discoloration, and ischemia of the extremities. Make sure that
the cuff edge falls within the marked range. If it does not, use a larger or smaller
cuff that will fit better.
Connect the cuff to the air tubing and make sure that the bladder inside the cover is not
folded and twisted.
NOTE
z
The use of the equipment is restricted to one patient at a time;
11.5.2 Starting and Stopping Measurements
Select the [NIBP Measure] QuickKey and you can start the desired measurement from the
popup menu. You can select [Stop All] QuickKey to stop all NIBP measurements. You can
also start and stop measurements by using the
or the MPM module.
hardkey on either the monitor’s front panel
11.5.3 Correcting the Measurement if Limb is not at Heart
Level
The cuff should be applied to a limb at the same level as the patient’s heart. If the limb is not
at the heart level, to the displayed value:
„
Add 0.75 mmHg (0.10 kPa) for each centimetre higher, or
„
Deduct 0.75 mmHg (0.10 kPa) for each centimeter lower.
11.5.4 Enabling NIBP Auto Cycling and Setting the Interval
1.
Select the NIBP parameter window to enter the [NIBP Setup] menu.
2.
Select [Interval] and then select a desired time interval. Selecting [Manual] switches to
manual mode.
3.
Start a measurement manually. The monitor will then automatically repeat NIBP
measurements at the set time interval.
11-4
11.5.5 Starting a STAT Measurement
1.
Select the NIBP parameter window to enter the [NIBP Setup] menu.
2.
Select [NIBP STAT]. The STAT mode initiates 5 minutes of continuous, sequential,
automatic NIBP measurements.
WARNING
z
Continuous non-invasive blood pressure measurements may cause purpura,
ischemia and neuropathy in the limb with the cuff. Inspect the application site
regularly to ensure skin quality and inspect the extremity of the cuffed limb for
normal color, warmth and sensitivity. If any abnormity occurs, move the cuff to
another site or stop the blood pressure measurements immediately.
11.6 Understanding the NIBP Numerics
The NIBP display shows numerics only as below. Your display may be configured to look
slightly different.
1
2
3
4
5
6
7
8
1.
Time of last measurement
2.
Time remaining to next measurement
3.
Measurement mode
4.
Unit of pressure: mmHg or kPa
5.
Prompt message area: shows NIBP-related prompt messages
6.
Systolic pressure
7.
Diastolic pressure
8.
Mean pressure obtained after the measurement and cuff pressure obtained during the
measurement
11-5
11.7 Changing NIBP Settings
By selecting the NIBP parameter window, you can enter the [NIBP Setup] menu.
11.7.1 Setting the Initial Cuff Inflation Pressure
You can set the initial cuff inflation pressure manually. In the [NIBP Setup] menu, select
[Initial Pressure] and then select the appropriate setting.
NOTE
z
The initial cuff inflation pressure may be different for respective patients, so the
initial cuff inflation pressure is not saved in the configuration settings.
11.7.2 Setting NIBP Alarm Properties
Select [Alarm Setup >>] from the [NIBP Setup] menu. You can set the alarm properties for
this parameter in the popup menu.
11.7.3 Displaying NIBP List
Select [Screens] QuickKey→[Screen Setup]. You can set [NIBP List] to be displayed at the
bottom area of the screen. Then, multiple sets of most recent NIBP measurements will be
displayed. And PR displayed is derived from NIBP.
You can not display NIBP list in some screens such as the big numerics screen and the
interpretation of resting 12-lead ECG screen.
11-6
11.7.4 Setting the Pressure Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select
[Press. Unit] and toggle between [mmHg] and [kPa].
11.8 Assisting Venous Puncture
You can use the NIBP cuff to cause sub-diastolic pressure to block the venous blood vessel
and therefore help venous puncture.
1.
Select [VeniPuncture >>] from the [NIBP Setup] menu. In the popup menu, verify that
the [Cuff Press.] value is appropriate. Change it if necessary.
2.
Select [VeniPuncture].
3.
Puncture vein and draw blood sample.
4.
Select the
hardkey on the monitor’s front, or the [Stop All] QuickKey to deflate the
cuff. The cuff deflates automatically after a set time if you do not deflate it.
During measurement, the NIBP display shows the inflation pressure of the cuff and the
remaining time in venous puncture mode.
11.9 Resetting NIBP
If the blood pressure pump works incorrectly but the monitor does not alarm for it, you can
check the pump by resetting it. To reset the pump, select [Reset] from [NIBP Setup].
11-7
11.10 NIBP Leakage Test
The NIBP leakage test checks the integrity of the system and of the valve. It is required at
least once every two years or when you doubt the measured NIBP. If the test failed,
corresponding prompt messages will be given. If no message is displayed, it means no
leakage is detected.
Tools required:
„
An air tubing
„
Metal container or vessel
Follow this procedure to perform the leakage test:
1.
Set the patient category to [Adu].
2.
Connect a rigid metal container or vessel with a capacity of 500 ml ± 5% to the NIBP
cuff connector of the monitor.
Monitor
Connector for
NIBP cuff
Air tubing
Metal
vessel
3.
Select [Main Menu]→[Maintenance >>]→[NIBP Leakage Test]. The NIBP display
shows [Leakage Testing…].
4.
After about 20 seconds, the monitor will automatically deflate. This means the test is
completed.
5.
If the message [NIBP Pneumatic Leak] is displayed, it indicates that the NIBP airway
may have leakages. Check the tubing and connections for leakages. If you ensure that
the tubing and connections are all correct, perform a leakage test again.
If the problem persists, contact your service personnel.
NOTE
z
The leakage test is intended for use to simply determine whether there are leakages
in the NIBP airway. It is not the same as that specified in the EN 1060-3 standard.
11-8
11.11 NIBP Accuracy Test
The NIBP accuracy test is required at least once every two years or when you doubt the
measured NIBP.
Tools required:
„
T-piece connector
„
Approprating tubing
„
Balloon pump
„
Metal Vessel (volume 500±25 ml)
„
Reference manometer (calibrated with accuracy higher than 0.75 mmHg)
Follow this procedure to perform the accuracy test:
1.
Connect the equipment as shown.
Monitor
Connector for
NIBP cuff
Manometer
Tubing
Balloon pump
Metal vessel
2.
Before inflation, the reading of the manometer should be 0. If not, open the valve of the
balloon pump to let the whole airway open to the atmosphere. Close the valve of the balloon
pump after the reading is 0.
3.
Select [Main Menu]→ [Maintenance >>]→ [NIBP Accuracy Test].
4.
Check the manometer values and the monitor values. Both should be 0mmHg.
5.
Raise the pressure in the rigid vessel to 50 mmHg with the balloon pump. Then, wait for
10 seconds until the measured values become stable.
6.
Compare the manometer values with the monitor values. The difference should be 3
mmHg. If it is greater than 3 mmHg, contact your service personnel.
7.
Raise the pressure in the rigid vessel to 200 mmHg with the balloon pump. Then, wait
for 10 seconds until the measured values become stable and repeat step 6.
11-9
11.12 Calibrating NIBP
NIBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated once
every two years by a qualified service professional. Contact your service personnel when a
calibration is necessary.
11-10
12 Monitoring Temp
12.1 Introduction
You can simultaneously monitor two temperature sites using the MPM.
Connector for Temp
probe 1
Connector for Temp
probe 2
12.2 Safety
WARNING
z
Verify that the probe detection program works correctly before monitoring. Plug
out the temperature probe cable from the T1 or T2 connector, and the monitor can
display the message [T1 Sensor Off] or [T2 Sensor Off] and give alarm tones
correctly.
12-1
12.3 Making a Temp Measurement
1.
Select an appropriate probe for your patient.
2.
If you are using a disposable probe, connect the probe to the temperature cable.
3
Plug the probe or temperature cable to the temperature connector.
4.
Attach the probe to the patient correctly.
5.
Check that the alarm settings are appropriate for this patient.
12.4 Understanding the Temp Display
The temperature monitoring is displayed on the monitor as three numerics: T1, T2 and TD.
By selecting this area, you can enter the [Alarm Setup] menu.
12.5 Setting the Temperature Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select
[Temp Unit] and toggle between [ºC] and [ºF]
.
12-2
13 Monitoring IBP
13.1 Introduction
You can measure invasive blood pressure using the MPM, or the pressure plug-in module.
The monitor can monitor up to 8 invasive blood pressures and displays the systolic, diastolic
and mean pressures and a waveform for each pressure.
2
1
1
1
1. Connector for IBP cable
2. Zero key
13.2 Safety
WARNING
z
Use only pressure transducers specified in this manual. Never reuse disposable
pressure transducers.
z
Make sure that the applied parts never come into contact with other electric
devices.
z
To reduce the hazard of burns during high-frequency surgical procedure, ensure
that the monitor’s cables and transducers never come into contact with the
high-frequency surgical units.
z
When using accessories, their operating temperature should be taken into
consideration. For details, refer to instructions for use of accessories.
13-1
13.3 Setting Up the Pressure Measurement
1.
Plug the pressure cable into the IBP connector.
2.
Prepare the flush solution.
3.
Flush the system to exhaust all air from the tubing. Ensure that the transducer and
stopcocks are free of air bubbles.
WARNING
z
If air bubbles appear in the tubing system, flush the system with the infusion
solution again. Air bubble may lead to wrong pressure reading.
4.
Connect the pressure line to the patient catheter.
5.
Position the transducer so that it is level with the heart, approximately at the level of the
midaxillary line.
6.
Select the appropriate label.
7.
Zero the transducer. After a successful zeroing, turn off the stopcock to the atmosphere
and turn on the stopcock to the patient.
Heparinized
fluid bag
Pressure
transducer
Valve
Stopcock
Flushing set
Adapter cable for using
disposable transducers
Pressure line
Monitor
WARNING
z
If measuring intracranial pressure (ICP) with a sitting patient, level the transducer
with the top of the patient’s ear. Incorrect leveling may give incorrect values.
13-2
13.4 Understanding the IBP Display
The IBP measurement is displayed on the monitor as a waveform and numeric pressures. The
figure below shows the waveform and numerics for the Art pressure. For different pressures,
this display may be slightly different.
1
5
2
1.
Waveform
2.
Systolic pressure
3.
Diastolic pressure
4.
Mean pressure
5.
Pressure unit
4
3
For some pressures, the parameter window may show the mean pressure only. For different
pressures, their defaults unit may be different. If the Art and ICP pressures are measured
simultaneously, the ICP parameter area will display numeric CPP, which is obtained by
subtracting ICP from the Art mean.
13-3
13.5 Changing IBP Settings
13.5.1 Changing a Pressure for Monitoring
1.
Select the pressure you want to change to enter its setup menu. In the menu, there is a
figure showing the current IBP measurement connector.
2.
Select [Label] and then select your desired label from the list. The already displayed
labels cannot be selected.
Label
Description
Label
Description
PA
Pulmonary artery pressure
CVP
Central venous pressure
Ao
Aortic pressure
LAP
Left atrial pressure
UAP
Umbilical arterial pressure
RAP
Right atrial pressure
BAP
Brachial arterial pressure
ICP
Intracranial pressure
FAP
Femoral arterial pressure
UVP
Umbilical venous pressure
Art
Arterial blood pressure
LV
Left ventricular pressure
13.5.2 Setting Alarm Properties
Select [Alarm Setup >>] from the parameter setup menu. You can set alarm properties for
this parameter in the popup menu.
13.5.3 Changing Averaging Time
The IBP value displayed on the monitor screen is the average of data collected within a
specific time. The shorter the averaging time is, the quicker the patient monitor responds to
changes in the patient’s blood pressure. Contrarily, the longer the averaging time is, the
slower the patient monitor responds to changes in the patient’s blood pressure, but the
measurement accuracy will be improved. For critically ill patients, selecting shorter
averaging time will help understanding the patient’s state.
To set the averaging time, in the parameter setup menu, select [Sensitivity] and toggle
between [High], [Med] and [Low], the corresponding averaging time is about 1 s, 8 s and 12
s respectively.
13-4
13.5.4 Setting the Pressure Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select
[Press. Unit] and toggle between [mmHg] and [kPa]. Select [CVP Unit] and toggle between
[mmHg], [cmH2O] and [kPa].
13.5.5 Setting Up the IBP Wave
In the setup menu for the pressure, you can:
„
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the
wider the wave is.
„
Select [Scale] and then select the appropriate setting. If [Auto] is selected, the size of
the pressure’s waveform will be adjusted automatically.
„
Select [Filter] and then select either:
‹
[No Filter] to get the unfiltered IBP wave.
‹
[Normal] to get the relatively smooth IBP wave.
‹
[Smooth] to get the smoothest IBP wave.
13-5
13.6 Measuring PAWP
Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are
affected by fluid status, myocardial contractility, and valve and pulmonary circulation
integrity.
Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter
into the pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the
inflated balloon occludes the artery allowing the monitor to record changes in the
intrathoracic pressures that occur throughout the respiration cycle.
The pulmonary wedge pressure is the left ventricular end diastolic pressure when the airway
pressure and valve function are normal. The most accurate PAWP values are obtained at the
end of the respiration cycle when the intrathoracic pressure is fairly constant and the artifact
caused by respiration is minimal.
13-6
13.6.1 Preparing to Measure PAWP
1.
Prepare the same accessories as in the C.O. measurement. Connect the parts such as
catheter, syringe, etc. following the C.O. measurement steps and use the balloon
inflation port.
2.
Connect the PAWP cable into the IBP connector on the monitor. Since PAWP is
measured on PA, selecting [PA] as the IBP label is recommended.
3.
Select the PA parameter window or waveform area to enter its setup menu. Then, select
[PAWP] to enter the PAWP measurement window. You can also enter the PAWP
measurement window from the P1-P4 parameter window.
13-7
NOTE
z
After entering the PAWP measurement window, the monitor will turn off the PA
alarm automatically.
13.6.2 Setting Up the PAWP Measurement
1.
Wedge the flotation catheter into the pulmonary artery. Then inflate the balloon and pay
attention to PA waveform changes on the screen.
2.
After obtaining a stable PAWP waveform, press the [Freeze] key to freeze the
waveform and deflate the balloon.
3.
or
You can adjust the PAWP scale to an appropriate position by adjusting
beside the [Adjust] button. Press the [Confirm] key to save one PAWP measurement.
4.
If you need to start a new measurement, select [Next Measure].
WARNING
z
Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate
the balloon for the minimum time necessary to get an accurate measurement.
z
If the PAWP is greater than the PA (systolic), deflate the balloon and report the
incident in accordance with hospital policy. Because the pulmonary artery could be
accidentally ruptured, and the PAWP value derived will not reflect the patient’s
hemodynamic state, but will merely reflect the pressure in the catheter or balloon.
13-8
13.6.3 Understanding the PAWP Setup Menu
Select [Setup] to enter the [PAWP Setup] menu. In this menu, you can:
„
Select a ECG lead wave as the first reference wave.
„
Select a respiration wave as the second reference wave.
„
Select a sweep speed for the displayed waveform.
„
Change the size of the PA waveform by adjusting the scale height.
13.7 Zeroing the Transducer
To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer
in accordance with your hospital policy (at least once per day). Zero whenever:
„
A new transducer or adapter cable is used.
„
You reconnect the transducer cable to the monitor.
„
The monitor restarts.
„
You doubt the readings.
1.
Turn off the stopcock to the patient.
Pressure transducer
3-way stopcock
Pressure adapter cable
Monitor
2.
Vent the transducer to the atmospheric pressure by turning on the stopcock to the air.
3. Press the
hardkey on the module, or, in the setup menu for the pressure (e.g. Art),
select [Art Zero >>]ĺ[Zero]. During zero calibration, the [Zero] button appears
dimmed. It recovers after the zero calibration is completed.
4.
After the zero calibration is completed, close the stopcock to the air and open the
stopcock to the patient.
13-9
NOTE
z
Your hospital policy may recommend that the ICP transducer is zeroed less
frequently than other transducers.
13-10
14 Monitoring Cardiac Output
14.1 Introduction
The cardiac output (C.O.) measurement invasively measures cardiac output and other
hemodynamic parameters using the right heart (atria) thermodilution method. A cold solution of
known volume and temperature is injected into the right atrium through the proximal port of a
pulmonary artery (PA) catheter. The cold solution mixes with the blood in the right ventricle and
the change in blood temperature is measured with a thermistor at the distal end of the catheter in
the pulmonary artery. The temperature change is displayed as a curve in the C.O. split screen, and
the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to
the area under the curve. As cardiac output varies continuously, a series of measurements must be
carried out to achieve a reliable C.O. average value. Always use the average of multiple
thermodilution measurements for therapy decisions. The monitor is capable of storing 6
measurements.
Setup key
C.O. start key
Connector for C.O. cable
NOTE
z
C.O. monitoring is restricted to adult patients only.
14-1
14.2 Understanding the C.O. Display
The C.O. measurement is displayed on the monitor as numeric C.O., C.I. and TB in the C.O.
parameter window as shown below. To enter the [C.O. Setup] menu, select the C.O. parameter
window.
2
3
1
4
1.
Cardiac output
2.
Time at which the C.O. average is calculated
3.
Cardiac index
4.
Blood temperature
14.3 Influencing Factors
The factors that affect cardiac output are:
„
temperature of injectate solution,
„
volume of injectate solution,
„
patient’s baseline blood temperature,
„
patient’s inspiratory/expiratory cycle,
„
placement of catheter with relation to proximity of lung field,
„
the catheter itself,
„
the patient rhythm and hemodynamic status, and
„
any other rapid IV solutions which are infused while the C.O. measurement is being
performed.
Followings are some technique suggestions to obtain accurate C.O.:
„
Injectate solution must be cooler than the patient’s blood.
„
Inject solution rapidly and smoothly.
„
Inject at end expiration.
14-2
14.4 Setting Up the C.O. Measurement
WARNING
z
Use only accessories specified in this manual. Make sure that the accessories never
come into contact with conductive parts.
1.
Connect the C.O. cable to the C.O. connector on the monitor.
2.
Interconnect the C.O. module, catheter and syringe as shown below. Make sure that:
‹
The module is securely inserted.
‹
The PA catheter is in place in the patient.
‹
The C.O. cable is properly connected to the module.
Injectate
C.O. cable
C.O. module
Syringe
PA catheter
Stopcock
Hole
In-line probe
Ice water
Balloon inflation port
NOTE
z
The above figure adopts TI sensor (PN: 6000-10-02079) for your reference.
14-3
3.
Select the C.O. parameter window to enter the [C.O. Setup] menu. Check if the height
and weight are appropriate for your patient. Change if necessary.
4.
In the [C.O. Setup] menu:
‹
Check that the correct computation constant is entered. Refer to the Instruction for
Use of pulmonary artery catheter to determine the [Comp. Const] according to the
entered injectate volume and temperature. To change the computation constant,
select [Comp. Const] and then enter the correct value. When a new catheter is used,
the computation constant should be adjusted in accordance with the manufacturer’s
instructions for use.
‹
Switch [Auto TI] on and the injectate temperature is automatically obtained. When
[Auto TI] is switched off, you can enter the injectate temperature in the [Manual
TI(℃)] field.
‹
Set the [Measuring Mode] to [Auto] or [Manual]. In [Auto] mode, the monitor
automatically takes the C.O. measurement after establishing a baseline blood
temperature. In this mode, it is not necessary to select the [Start] button in the C.O.
measurement window. In [Manual] mode, the monitor takes the C.O. measurement
after [Start] button is selected.
5.
Select [Enter C.O. Screen] to enter the C.O. measurements window.
A
F
B
E
C
D
A.
Currently measured numeric
B.
Currently measured C.O. curve
C.
Prompt message area
D.
Buttons
E.
Averaged values
F.
Measurement windows
14-4
6.
7.
Proceed as follows.
‹
In [Manual] measure mode, when you see the message [Ready for new set of
measurement], select the [Start] button and then inject the solution quickly. As
shown in the figure above, during the measurement, the currently measured
thermodilution curve is displayed. At the end of the measurement, the
thermodilution curve is transferred to one of the 6 measurement windows and the
monitor prompts you to wait for a certain period of time before starting a new
measurement.
‹
In [Auto] measure mode, the C.O. measurements can be performed consecutively,
without the need for pressing the [Start] button between measurements. A new
thermodilution measurement is possible as soon as [Inject now!] is displayed on
the screen. The patient monitor automatically detects further thermodilution
measurements.
Perform 3 to 5 single measurements direct after each other as described in Step 6.
A maximum of 6 measurements can be stored. If you perform more than six measurements
without rejecting any, the oldest will automatically be deleted when a seventh curve is stored.
Select from the 6 measurement curves and the system will automatically calculate and display the
averaged C.O. and C.I. values. Then select the [Accept Average] button to accept and store the
averaged values.
When injecting, the stopcock to the PA catheter is open and the stopcock to the injectate solution
is closed. After the measurement is completed, turn off the stopcock to the PA catheter and turn on
the stopcock to the injectate solution, and then draw the injectate solution into the injectate
syringe.
In the buttons area, you can:
„
Select [Start] to start a C.O. measurement.
„
Select [Stop] to stop the current measurement.
„
Select [Cancel] during a measurement to cancel the measurement.
„
Select [Record] to print out the curves selected for average calculation, numerics and
averaged values by the recorder.
„
Select [Setup >>] to access the [C.O. Setup] menu.
„
Select [Calc >>]→[Hemodynamic >>] to access the [Hemodynamic Calculation]
menu.
The system can automatically adjust the X-axis scale range to 30 s or 60 s and Y-axis scale range
to 0.5℃, 1.0℃, or 2.0℃.
14-5
NOTE
z
Starting measuring without blood temperature being stable yet may cause
measuring failure.
z
During the cardiac output measurement, blood temperature alarms are inactive.
z
Please refer to the Instructions for Use of pulmonary artery catheter delivered with
the patient monitor to determine the [Comp. Const] and the volume of injectate.
14.5 Measuring the Blood Temperature
As shown below, the blood temperature is measured with a temperature sensor at the distal end of
the catheter in the pulmonary artery. During C.O. measurements, blood temperature alarms are
suppressed to avoid false alarms. They will automatically recover as soon as the C.O.
measurements are completed.
Pulmonary artery
Balloon
PA catheter
Right atrium
Sensor
Right ventricle
14.6 Changing C.O. Settings
14.6.1 Setting the Temperature Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [Temp
Unit] to toggle between [ºC] and [ºF].
14.6.2 Setting Alarm Properties
Select [Alarm Setup >>] from the [C.O. Setup] menu. You can set alarm properties for this
parameter in the popup menu.
14-6
15 Monitoring CCO/SvO2
15.1 Introduction
Edwards Vigilance II® monitor measures continuous cardiac output (CCO), mixed venous
oxygen saturation (SvO2), central venous oxygen saturation (ScvO2) etc. It also calculates
hemodynamic and oxygenation parameters. This patient monitor can be connected to the
Vigilance II® monitor and can display, store, and review the measured and calculated
parameter values from the Vigilance II® monitor. This patient monitor can also give alarms
of these measured parameters. You must set alarm on/off, alarm limits, alarm level, and alarm
record separately on this monitor. The alarm is Off by default.
Signal output setup menu
CCO setup menu
Indicator
CCO/SvO2 cable connector
15.2 Safety
WARNING
z
The Vigilance II® monitor is manufactured by Edwards Lifesciences. This
company provides the technology of measuring and calculating the relevant
parameters. We only provide the connection between this patient monitor and
Vigilance II® monitor.
z
If you have any doubts about the operation and maintenance of the Vigilance II®
monitor, please read the Vigilance II® monitor Operator’s Manual or contact
Edwards Lifesciences (www.edwards.com) directly.
z
Fully observe the Vigilance II® monitor Operator’s Manual to make settings and
to connect the monitor with the patient.
15-1
15.3 Automatic Communication Detection
The relevant parameter window is not displayed on the screen if this patient monitor detects
communication failure between the CCO/SvO2 module and Vigilance II® monitor
automatically.
15.4 Connecting the Vigilance II® Monitor
The following figure shows how to connect this patient monitor to the Vigilance II® monitor
through cables.
The following figure shows the rear housing of the Vigilance II® monitor.
Serial ports
ECG signal input port
15-2
Analog signal input ports
To connect the Vigilance II® monitor,
1.
Connect CN1 with the CCO/SvO2 connector on the patient monitor.
2.
Insert the ECG signal end into the ECG signal input port marked
on the rear
housing of the Vigilance II® monitor.
3.
Insert the MAP signal end into the analog signal input port 1 marked
signal end into port 2 marked
, the CVP
, and SPO2 signal end into port 3 marked
respectively on the rear housing of the Vigilance II® monitor.
4.
Insert UART into either of the serial ports (marked
Vigilance II® monitor
5.
Set the Vigilance II® monitor as follows:
„
Access the [Serial Port Setup] menu.
‹
„
) on the rear housing of the
Set [Device] to [IFMout], [Baud Rate] to [19200], [Parity] to [None], [Stop Bits]
to [1], [Data Bits] to [8], and [Flow Control] to [2 s].
Access the [Analog Input Setup] menu.
‹
For port 1, set [Parameter] to [MAP], [Voltage Range] to [0-5 v], [Full Scale
Range] to 500 mmHg (66.7 kPa), [Simulated High Value] to 500 mmHg (66.7
kPa), and [Simulated Low Value] to 0 mmHg (0.0 kPa).
‹
For port 2, set [Parameter] to [CVP], [Voltage Range] to [0-5 v], [Full Scale
Range] to 100 mmHg (13.3 kPa), [Simulated High Value] to 100 mmHg (13.3
kPa), and [Simulated Low Value] to 0 mmHg (0.0 kPa).
‹
For port 3, set [Parameter] to [SaO2], [Voltage Range] to [0-10 v], [Full Scale
Range] to [100%], [Simulated High Value] to [100%], and [Simulated Low
Value] to [0%].
Refer to the Vigilance II® Operator’s Manual for the operation of the monitor.
WARNING
z
Calibrate the Vigilance II® monitor before monitoring. Refer to the Vigilance II®
Operator’s Manual for the calibration of the monitor.
Notes
z
For the Vigilance II® monitor, [Flow Control] must be set to 2 seconds.
15-3
15.5 Understanding CCO Parameters
By selecting the CCO parameter windowė[Hemodynamic Parameters >>], you can view
the hemodynamic parameters for evaluation of the patient’s hemodynamic status.
Abbreviation
Unit
Full spelling
CCO
L/min
continuous cardiac output
CCI
L/min/m2
continuous cardiac index
C.O.
L/min
cardiac output
C.I.
L/min/m2
cardiac index
EDV
ml
end diastolic volume
EDVI
ml/m2
end diastolic volume index
SV
ml/b
stroke volume
SVI
ml/b/m2
stroke volume index
SVR
DS/cm5 or kPa-s/l
systemic vascular resistance
SVRI
DS·m2/cm5 or
kPa-s-m2/l
systemic vascular resistance index
RVEF
%
right ventricular ejection fraction
BT
ć or
ESV
ml
end systolic volume
ESVI
ml/m2
end systolic volume index
CVP
cmH2O, kPa or
mmHg
central venous pressure
MAP
mmHg or kPa
mean arterial pressure
HR
rpm
heart rate
̧
blood temperature
15.6 Understanding the CCO Display
In the continuous measurement mode, the CCO parameter window displays the values of one
primary parameter and up to three secondary parameters. You can select the desired
parameter to be displayed through the menu. The default secondary parameters displayed are
SVR, EDV and SV.
15-4
In the intermittent measurement mode, the CCO parameter window displays the values of
two primary parameters and two secondary parameters. You can also select the desired
parameter to be displayed through the menu.
15.7 Changing CCO Settings
15.7.1 Selecting Vascular Resistance Unit
1.
Access the [CCO Setup] menu.
2.
Select [Vascular Resistance Unit] and toggle between [DS/cm5] and [kPa-s/l].
15.7.2 Selecting the Displayed Parameters
1.
Access the [CCO Setup] menu.
2.
Select [Select Parameters >>].
3.
Select the parameters to be displayed from the pop-up menu.
15.7.3 Checking the C.O. Measurements
You can check the C.O. measurements in the intermittent measurement mode.
1.
Access the [CCO Setup] menu.
2.
Select [C.O. Measurements >>].
15.7.4 Setting Signal Output
This patient monitor outputs analog signals for the Vigilance II® monitor. You can select
[Signal Output Setup >>] from the [CCO Setup] menu to set the source of MAP signals.
You can also select [Simulated High Value] or [Simulated Low Value] to provide simulated
high value or low value signals for calibrating the Vigilance II® monitor. Refer to the
Vigilance II® Operator’s Manual for the calibration of the monitor.
15-5
15.7.5 Selecting Alarm Properties
You can select [Alarm Setup >>] from the [CCO Setup] menu to set the alarm properties
for the relevant parameters.
WARNING
z
Because the alarm limits of the relevant measured parameters can be set on this
patient monitor, the alarms of these parameters on this patient monitor may be
different from those on the Vigilance II® monitor. Please pay special attention to
the alarms on the Vigilance II® monitor.
z
The alarm of the relevant measured parameters on this patient monitor is Off by
default. Please pay special attention to the alarms on the Vigilance II® monitor.
15.8 Understanding SvO2 Parameters
By selecting the SvO2 parameter windowė[SvO2 Setup]ė[Oxygenation Parameters >>],
you can view all the oxygenation parameters.
Abbreviation
Unit
Full spelling
SvO2
%
mixed venous oxygen saturation
ScvO2
%
central venous oxygen saturation
SaO2
%
arterial oxygen saturation
DO2
ml/min
oxygen delivery
VO2
ml/min
oxygen consumption
O2EI
%
oxygen extraction index
15.9 Understanding the SvO2 Display
The parameter window displays the primary parameter, secondary parameter and SQI
bargraph.
15-6
15.10 Changing SvO2 Settings
15.10.1 Setting Signal Output
This patient monitor outputs analog signals for the Vigilance II® monitor. You can select
[Signal Output Setup >>] from the [SvO2 Setup] menu to set the source of MAP signals.
You can also select [Simulated High Value] or [Simulated Low Value] to provide simulated
high value or low value signals for the Vigilance II® monitor. Refer to the Vigilance II®
Operator’s Manual for the calibration of the monitor.
15.10.2 Selecting Alarm Properties
You can select [Alarm Setup >>] from the [SvO2 Setup] menu to set the alarm properties
for the relevant parameters.
15-7
FOR YOUR NOTES
15-8
16 Monitoring Carbon Dioxide
16.1 Introduction
CO2 monitoring is a continuous, non-invasive technique for determining the concentration of
CO2 in the patient’ airway by measuring the absorption of infrared (IR) light of specific
wavelengths. The CO2 has its own absorption characteristic and the amount of light passing
the gas probe depends on the concentration of the measured CO2. When a specific band of IR
light is passed through respiratory gas samples, some of IR light will be absorbed by the CO2
molecules. The amount of IR light transmitted after it has been passed through the respiratory
gas sample is measured with a photodetector. From the amount of IR light measured, the
concentration of CO2 is calculated.
There are two methods for measuring CO2 in the patient’s airway:
1.
Mainstream measurement uses a CO2 sensor attached to an airway adapter directly
inserted into the patient’s breathing system.
2.
Sidestream/Microstream measurement samples expired patient gas at a constant sample
flow from the patient’s airway and analyzes it with a CO2 sensor built into the CO2
module.
The measurement provides:
1.
A CO2 waveform
2.
End tidal CO2 value (EtCO2): the CO2 value measured at the end of the expiration phase.
3.
Fraction of inspired CO2 (FiCO2): the smallest CO2 value measured during inspiration.
4.
Airway respiration rate (awRR): the number of breaths per minute, calculated from the
CO2 waveform.
16-1
16.2 Identifying CO2 Modules
From left to right are sidestream CO2 module, microstream CO2 module and mainstream CO2.
1
3
1
1
2
2
3
4
5
6
1.
Setup key to enter the CO2 setup menu
2.
Measure/standby
3.
Gas outlet
4.
Slot for CO2 watertrap
5.
Connector for sampling line
6.
Connector for CO2 transducer
If you measure CO2 using the AG module, see the section Monitoring AG.
16-2
2
16.3 Preparing to Measure CO2
16.3.1 Using a Sidestream CO2 Module
1.
Attach the watertrap to the module and then connect the CO2 components as shown
below.
Watertrap fixer
Sampling line
Watertrap
2.
By default, the sidestream CO2 module is in measure mode. The [CO2 Startup]
message appears on the screen when the CO2 module is plugged.
3.
After start-up is finished, the CO2 module needs time to warm up to reach the operating
temperature. The message [CO2 Sensor Warmup] is displayed. If you perform CO2
measurements during warm-up, the measurement accuracy may be compromised.
4.
After warm-up is finished, you can perform CO2 measurements.
NOTE
z
To extend the lifetime of the watertrap and module, disconnect the watertrap and
set the operating mode to standby mode when CO2 monitoring is not required.
16-3
CAUTION
z
The watertrap collects water drops condensed in the sampling line and therefore
prevents them from entering the module. If the collected water reaches a certain
amount , you should drain it to avoid blocking the airway.
z
The watertrap has a filter preventing bacterium, water and secretions from
entering the module. After a long-term use, dust or other substances may
compromise the performance of the filter or even block the airway. In this case,
replace the watertrap. It is recommended to replace the watertrap once every two
months, or when the watertrap is found leaky, damaged or contaminated.
16.3.2 Using a Microstream CO2 Module
1.
Connect the sampling line to the module and then connect the CO2 components as
shown below.
Connector for
sampling line
Sampling line
2.
By default, the microstream CO2 module is in measure mode. The message [CO2
Sensor Warmup] appears on the screen when the CO2 module is plugged.
3.
After warm-up, you can perform CO2 measurements.
16-4
16.3.3 Using a Mainstream CO2 Module
1.
Connect the sensor to the module.
2.
By default, the mainstream CO2 module is in measure mode. The message [CO2 Sensor
Warmup] appears on the screen when the CO2 module is plugged.
3.
After warm-up is finished, connect the transducer to the airway adapter.
4.
Perform a zero calibration per the Zeroing the Sensor section.
5.
After the zero calibration is finished, connect the airway as shown below.
Connect to monitor
Sensor
Airway adapter
Connect to patient
6.
Make sure there are no leakages in the airway and then start a measurement.
NOTE
z
Always position the sensor with the adapter in an upright position to avoid
collection of fluids on the windows of the adapter. Large concentrations of fluids at
this point will obstruct gas analysis.
16-5
16.4 Changing CO2 Settings
16.4.1 Accessing CO2 Menus
By selecting the CO2 parameter window or waveform, you can access the [CO2 Setup]
menu.
16.4.2 Entering the Standby Mode
The standby mode of the CO2 module relates to the standby mode of the monitor as follows:
„
If the monitor enters the standby mode, the CO2 module will also enter the standby
mode.
„
If the monitor exits the standby mode, the CO2 module will also exit the standby mode.
„
If the CO2 module enters or exits the standby mode, it will not affect the monitor.
To enter or exit the standby mode manually,
„
select the
„
select [Operating Mode] in the [CO2 Setup] menu and then toggle between [Standby]
and [Measure].
hardkey on the module, or
When you set the sidestream CO2 module to the strandby mode, the CO2 gas sample intake
pump automatically sets the sample flow rate to zero. When exiting the standby mode, the
CO2 module continues to work at the preset sample flow rate with no need to warm up again.
After nearly 1 minute, the module enters the full accuracy mode.
For the microstream CO2 module, you can set a period of time after which the CO2 module
enters the standby mode if no breath is detected since the CO2 module is powered on or the
CO2 module switchs to the measuring mode or the automatic standby time is re-set. To set
the standby time, in the [CO2 Setup] menu, select [Auto Standby] and then select the
appropriate setting.
16.4.3 Setting the CO2 Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [CO2.
Unit] and toggle between [mmHg], [%] and [kPa].
16-6
16.4.4 Setting up Gas Compensations
WARNING
z
Make sure that the appropriate compensations are used. Inappropriate
compensations may cause inaccurate measurement values and result in
misdiagnosis.
For the sidestream CO2 module:
1.
Select [CO2 Setup].
2.
According to the actual condition, set the concentration required for the following
compensations:
‹
[O2 Compen]
‹
[N2O Compen]
‹
[Des Compen]
For the microstream CO2 module, gas compensations are not required.
For the mainstream CO2 module, in the [CO2 Setup] menu, respectively select:
„
[Balance Gas] and toggle between [Room Air] and [N2O]. Select [Room Air] when
air predominates in the ventilation gas mixture and select [N2O] when N2O
predominates in the ventilation gas mixture and select [He] when He predominates in
the ventilation gas mixture.
„
[O2 Compen] and then select [Off] or an appropriate setting according to the amount of
O2 in the ventilation gas mixture. When the amount of O2 is less than 30%, you’d better
switch this compensation off.
„
[AG Compen] and enter the concentration of anesthetic gas present in the ventilation
gas mixture. This could compensate for the effect of AG on the readings.
16-7
16.4.5 Setting up Humidity Compensation
Sidestream and microstream CO2 modules are configured to compensate CO2 readings for
either Body Temperature and Pressure, Saturated Gas (BTPS), to account for humidity in the
patient’s breath, or Ambient Temperature and Pressure, Dry Gas (ATPD).
1.
ATPD: Pco 2 (mmHg) CO2 (vol%) u Pamb / 100
2.
BTPS: PCO 2 ( mmHg )
CO2 (vol %) u ( Pamb 47 ) / 100
Where, PCO 2 = partial pressure, vol % = CO2 concentration, Pamb = ambient pressure, and
unit is mmHg.
As the mainstream CO2 module has a built-in heating component to prevent water vapour
from condensing, setting humidity compensation is not needed. For the sidestream and
microstream CO2 module, you can set the humidity compensation on or off according to the
actual condition. To set the humidity compensation:
1.
In the [CO2 Setup] menu, select [BTPS Compen].
2.
Select either [On] for BTPS or [Off] for ATPD, depending on which compensation
applies.
16.4.6 Setting the Apnea Alarm Delay
In the [CO2 Setup] menu, select [Apnea Delay] and then select the appropriate setting. The
monitor will alarm if the patient has stopped breathing for longer than the preset apnea time.
The [Apnea Delay] of Resp, CO2, AG, and RM module keeps consistent with each other.
WARNING
z
The respiration measurement does not recognize the cause of apneas. It only
indicates an alarm if no breath is detected when a pre-adjusted time has elapsed
since the last detected breath. Therefore, it cannot be used for diagnostic purpose.
16-8
16.4.7 Choosing a Time Interval for Peak-Picking
For microstream and mainstream CO2 modules, you can select a time interval for picking the
highest CO2 as the EtCO2 and the lowest as the FiCO2.
In the [CO2 Setup] menu, select [Max Hold] and toggle between [Single Breath], [10 s],
[20 s] and [30 s].
„
[Single Breath]: EtCO2 and FiCO2 are calculated for every breath.
„
[10 s] or [20 s]: EtCO2 and FiCO2 are calculated using 10, 20 or 30 seconds of data.
16.4.8 Setting the Flow Rate
For the sidestream CO2 module, you can change the sampling rate of respiratory gas in the
patient’s airway by setting the flow rate. To set the flow rate, enter the [CO2 Setup] menu
and select an appropriate setting from [Flow Rate].
WARNING
z
Please consider the patient’s actual bearing capability and select the appropriate
flow rate when setting the flow rate.
16.4.9 Setting up the CO2 Wave
In the [CO2 Setup] menu, you can:
„
Select [Wave Type] and toggle between [Draw] and [Fill]:
‹
[Draw]: The CO2 wave is displayed as a curved line.
‹
[Fill]: The CO2 wave is displayed as a filled area.
„
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the
wider the wave is.
„
Change the size of the CO2 waveform by adjusting the wave [Scale].
16.4.10 Setting RR Source
To set RR source:
1.
Enter the [CO2 Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
16-9
The [RR Source] settings of Resp, CO2, AG and RM module are linked. For details, please
refer to the section Setting RR Source of chapter Resp.
16.5 Setting Barometric Pressure Compensation
Both sidestream and microstream CO2 modules have the function of automatic barometric
pressure compensation (the system automatically measures the barometric pressure which the
patient monitor is exposed to). However, the mainstream CO2 module does not have such
function. For the mainstream CO2 module, the default barometric pressure is 760 mmHg. You
must modify the barometric pressure based on the actual situation as follows:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Maintain CO2 >>]ĺ[Calibrate CO2 >>].
2.
Select [Barometric Pressure] and then enter the value of barometric pressure to which
the patient monitor is exposed to.
WARNING
z
Be sure to set the barometric pressure properly before using the mainstream CO2
module. Improper settings will result in erroneous CO2 reading.
16.6 Measurement Limitations
The following factors may influence the accuracy of measurement:
„
Leaks or internal venting of sampled gas
„
Mechanical shock
„
Cyclic pressure up to 10 kPa (100 cmH2O)
„
Other sources of interference, if any
16-10
16.7 Troubleshooting the Sidestream CO2 Sampling
System
When the sampling system of the sidestream CO2 module works incorrectly, check if the
sampling line is kinked. If not, remove it from the watertrap. If the monitor gives a message
indicating the airway still works incorrectly, it indicates that the watertrap must have been
blocked, and you should replace with a new one. Otherwise, you can determine that the
sampling line must have been blocked. Replace with a new sampling line.
16.8 Removing Exhaust Gases from the System
WARNING
z
Anesthetics: When using the Sidestream or Microstream CO2 measurement on
patients who are receiving or have recently received anesthetics, connect the outlet
to a scavenging system, or to the anesthesia machine/ventilator, to avoid exposing
medical staff to anesthetics.
To remove the sample gas to a scavenging system, connect an exhaust tube to the gas outlet
connector of the module.
16.9 Zeroing the Sensor
The zero calibration eliminates the effect of baseline drift during CO2 measurement exerted
on the readings and therefore maintains the accuracy of the CO2 measurements.
16.9.1 For Sidestream and Microstream CO2 Modules
For sidestream and microstream CO2 modules, a zero calibration is carried out automatically
when necessary. You can also start a manual zero calibration if necessary. To manually start a
zero calibration, select [Maintain CO2 >>] from the [User Maintenance] menu. Then select
[Calibrate CO2 >>]ĺ[Start Zero Cal.]. Disconnecting the patient airway is not required
when performing a zero calibration.
16-11
16.9.2 For Mainstream CO2 Modules
For mainstream CO2 modules, zero the sensor whenever:
„
A new adapter is used;
„
You reconnect the sensor to the module;
„
You see the message [CO2 Zero Required]. In this case, check the airway adapter for
any blockage, e.g. mucus, etc. If a blockage is detected, clear or replace the adapter.
To zero the sensor, follow this procedure:
1.
Connect the sensor to the module.
2.
In the [CO2 Setup] menu, set the [Operating Mode] to [Measure]. The message [CO2
Sensor Warmup] is displayed.
3.
After warm-up is finished, connect the sensor to a clean, dry airway adapter. The adapter
should be vented to the air and isolated from CO2 sources, such as ventilator, the
patient’s breathing, your own breathing, etc.
4.
Select [Start Zero Cal.] in the [CO2 Setup] menu. The message [CO2 Zero Running]
is displayed.
5.
It takes about 15 to 20 seconds. The message disappears when the zero calibration is
completed.
WARNING
z
When perform a zero calibration during the measurement, disconnect the
transducer from the patient’s airway first.
16.10 Calibrating the Sensor
For sidestream or microstream CO2 modules, a calibration should be performed once every
year or when the readings go far beyond the range. For mainstream CO2 modules, no
calibration is required. For details, refer to the chapter 29 Maintenance.
16-12
16.11 Oridion Information
This trademark is registered in Israel, Japan, German and America.
Oridion Patents
This device and the CO2 sampling consumables designed for use herewith is covered by one
or more of the following USA patents: 4,755,675; 5,300,859; 5,657,750; 5,857,461 and
international equivalents. USA and international patents pending.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with unauthorized CO2 sampling consumables which would, alone, or in
combination with this device, fall within the scope of one or more of the patents relating to
this device and/or CO2 sampling consumable.
16-13
FOR YOUR NOTES
16-14
17 Monitoring AG
17.1 Introduction
The anaesthetic gas (AG) module measures the patient’s anesthetic and respiratory gases, and
incorporates the features of the O2 module and BIS module as well.
The AG module determines the concentration of certain gases using the infrared (IR) light
absorption measurement. The gases that can be measured by the AG module absorb IR light.
Each gas has its own absorption characteristic. The gas is transported into a sample cell, and
an optical IR filter selects a specific band of IR light to pass through the gas. For multiple gas
measurement, there are multiple IR filters. The higher the concentration of gas in a given
volume the more IR light is absorbed. This means that higher concentration of IR absorbing
gas cause a lower transmission of IR light. The amount of IR light transmitted after it has
been passed though an IR absorbing gas is measured. From the amount of IR light measured,
the concentration of gas present can be calculated.
Oxygen does not absorb IR light as other breathing gases and is therefore measured relying
on its paramagnetic properties. Inside the O2 sensor are two nitrogen-filled glass spheres
mounted on a strong rare metal taut-band suspension. This assembly is suspended in a
symmetrical non-uniform magnetic field. In the presence of paramagnetic oxygen, the glass
spheres are pushed further away from the strongest part of the magnetic field. The strength of
the torque acting on the suspension is proportional to the oxygen concentration. From the
strength of the torque, the concentration of oxygen is calculated.
17.2 Identifying AG Modules
AG module can identify two anesthetic gases in a mixture automatically and distinguish
between them according to their contributions to the MAC value for display as the primary
and secondary anesthetis agent.
Measure/standby
Setup key
Indicator
Gas outlet
Connector for AG watertrap
Connector for BIS sensor
For details on BIS, refer to the chapter 19 Monitoring BIS.
17-1
NOTE
z
The AG module is configured with automatic barometric pressure compensation
function.
17.3 Understanding the AG Display
The AG module can send waves and numerics for all measured anesthetic gases for display
on the monitor, including:
„
CO2, O2, N2O and AA waves
„
awRR: airway respiratory rate
„
MAC: minimum alveolar concentration
„
End tidal (Et) and fraction of inspired (Fi) numerics for CO2, O2, N2O and AA
Where AA represents Des (desflurane), Iso (isoflurane), Enf (enflurane), Sev (sevoflurane),
or Hal (halothane).
The AA waveform area displays the primary anesthetic gas’s waveform. When O2 module
does not exist, no O2 waveform will be displayed. When O2 module exists, the O2 waveform
will be displayed only when the O2 waveform is currently switched on.
WARNING
z
To avoid explosion hazard, do not use flammable anesthetic agent such as ether
and cyclopropane for this equipment.
17-2
17.4 MAC Values
Minimum alveolar concentration (MAC) is the minimum concentration of the agent in the
alveoli. It is a basic index to indicate the depth of anesthesia. The standard ISO 21647 defines
MAC as this: alveolar concentration of an inhaled anesthetic agent that, in the absence of
other anesthetic agents and at equilibrium, prevents 50% of patients from moving in response
to a standard surgical stimulus.
Minimum alveolar concentration (MAC) values are listed below:
Agent
Des
Iso
Enf
Sev
Hal
N2O
1 MAC
7.3%*
1.15%
1.7%
2.1%
0.77%
105%**
* The data is taken from a patient of 25 years old.
** indicates 1 MAC nitrous oxide can only be reached in hyperbaric chamber.
NOTE
z
The MAC values shown in the table above are those published by the U.S. Food
and Drug Administration for a healthy 40-year-old adult male patient.
z
In actual applications, the MAC value may be affected by age, weight and other
factors.
The formula to calculate the MAC value is as follows:
N 1
MAC
EtAgent i
¦ AgentVol
i 0
i
Where N is the number of all agents (including N2O) that the AG module can measure,
EtAgenti is the concentration of each agent and AgentVoli is the concentration of each agent
at 1 MAC.
For example, the AG module measures there are 4% of Des, 0.5% of Hal and 50% of N2O in
the patient’s end-tidal gas:
MAC
4.0% 0.5% 50%
1.67
7.3% 0.77% 105%
NOTE
z
The formula mentioned above is intended for adult patients only.
17-3
17.5 Preparing to Measure AG
1.
Select an appropriate watertrap according to patient category and attach it to the module.
2.
Connect the gas sample line to the connector of the watertrap.
3.
Connect the other end of the gas sampling line to the patient via the airway adapter.
4.
Connect the gas outlet to a scavenging system using an exhaust tube.
AG module
Airway adapter
Exhaust tube
Gas sample line
Connect to the patient
5.
Insert the AG module into the SMR or the patient monitor and the patient monitor will
prompt [AG Startup]. Within 10 minutes after startup is finished, the AG module enters
the iso accuracy mode. After that, the module enters the full accuracy mode.
CAUTION
z
Position the airway adapter so that the part connecting to the gas sample line is
pointing upwards. This prevents condensed water from passing into the gas sample
line and causing an occlusion.
z
The watertrap collects water drops condensed in the sampling line and therefore
prevents them from entering the module. If the collected water reaches to a certain
amount, you should drain it to avoid blocking the airway.
z
The watertrap has a filter preventing bacterium, water and secretions from
entering the module. After a long-term use, dust or other substances may
compromise the performance of the filter or even block the airway. In this case,
replace the watertrap. Replacing the watertrap once a month is recommended.
17-4
WARNING
z
Make sure that the connections are tight. Any leak in the system can result in
erroneous readings due to ambient air mixing with patient gases.
z
Do not apply adult watertrap to the neonate patient. Otherwise, patient injury
could result.
z
Using high-frequency electrosurgical units may increase the risk of skin burn. In
this case, do not use antistatic or conductive respiratory tubing.
17.6 Changing AG Settings
17.6.1 Setting Gas Unit
For N2O and AA, the unit of the measured gas is fixed to “%”.
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, you can
select [CO2 Unit] or [O2 Unit] and toggle between [mmHg], [%] and [kPa].
17.6.2 Setting the Apnea Alarm Delay
In the [AG Setup] menu, select [Apnea Delay] and select the appropriate setting. The
monitor will alarm if the patient has stopped breathing for longer than the preset apnea time.
The [Apnea Delay] of Resp, CO2, AG, and RM module keeps consistent with each other.
WARNING
z
The respiration measurement does not recognize the cause of apneas. It only
indicates an alarm if no breath is detected when a pre-adjusted time has elapsed
since the last detected breath. Therefore, it cannot be used for diagnostic purpose.
17-5
17.6.3 Changing the Sample Flow Rate
In the setup menu for any gas, select [Flow Rate] and then choose either:
„
[High]: 200 ml/min for adult and pediatric patients, and 120 ml/min for neonatal
patients.
„
[Med]: 150 ml/min for adult and pediatric patients, and 90 ml/min for neonatal patients.
„
[Low]: 120 ml/min for adult and pediatric patients, and 70 ml/min for neonatal patients.
17.6.4 Setting up the O2 Compensation
If the AG module does not incorporate the O2 module, you need to manually select [O2
Compen] and then select [Off] or an appropriate setting according to the amount of O2 in the
ventilation gas mixture. When the amount of O2 is less than 30%, you’d better switch this
compensation off.
If the AG module incorporates the O2 module, the system will directly use the O2
concentration detected by the O2 module to make compensation. At this time, the [O2
Compen] in the setup menu for any gas is fixed to [Off].
17.6.5 Entering the Standby Mode
For the AG module, the default operating mode is measure. When you set the AG module to
the standby mode, the AG gas sample intake pump automatically sets the sample flow rate to
zero. When exiting the standby mode, the AG module continues to work at preset sample
flow rate with no need to warm up again. After nearly 1 minute, the module enters the full
accuracy mode. The standby mode of the AG module relates to the standby mode of the
monitor as follows:
„
If the monitor enters the standby mode, the AG module will also enter the standby
mode.
„
If the monitor exits the standby mode, the AG module will also exit the standby mode.
„
If the AG module enters or exits the standby mode, it will not affect the monitor.
To enter or exit the standby mode manually, in the agent’s setup menu, select [Operating
Mode] and then toggle between [Standby] and [Measure]. You can also set a period of time
after which the AG module enters the standby mode automatically if no breath is detected
since the last detected breath. To set the standby time, in the agent’s setup menu, select [Auto
Standby (min)] and then select the appropriate setting.
17-6
17.6.6 Setting up the AG Wave
In the [AG Setup] menu, you can:
„
Select [CO2 Wave Type] and toggle between [Draw] and [Fill]:
‹
[Draw]: The CO2 wave is displayed as a curved line.
‹
[Fill]: The CO2 wave is displayed as a filled area.
„
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the
wider the wave is.
„
Change the size of the waveform by adjusting the scale.
17.6.7 Setting RR Source
To set RR source:
1.
Enter the [AG Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
The [RR Source] settings of Resp, CO2, AG and RM module are linked. For details, please
refer to the section Setting RR Source of chapter Resp.
17.7 Changing the Anesthetic Agent
When the anesthetic agent used on the patient is changed, the AG module can detect the
mixed anesthetic gas during the transition of two anesthetic agents. The time required for
completing the replacement of anesthetic agent depends on anesthesia type (low flow or high
flow) and the characteristics of anesthetic agents (pharmacokinetics). During the transition of
two anesthetic agents, the patient monitor gives no prompt messages and the MAC value
displayed may be inaccurate.
The AG module can identify two anesthetic agents automatically. When the proportion of the
primary and secondary anesthetic agents in the mixture changes, the AG module can
distinguish between them according to their contributions to the MAC value. Then the
primary and secondary anesthetic agents will be exchanged for display.
17.8 Measurement Limitations
The following factors may influence the accuracy of measurement:
„
Leaks or internal venting of sampled gas
„
Mechanical shock
„
Cyclic pressure up to 10 kPa (100 cmH2O)
17-7
„
Other sources of interference, if any
17.9 Troubleshooting
17.9.1 When the Gas Inlet is Blocked
If the gas inlet (including watertrap, sampling line and airway adapter) is occluded by
condensed water, the message [AG Airway Occluded] will appear.
To remove the occlusion:
„
Check the airway adapter for an occlusion and replace if necessary.
„
Check the sampling line for an occlusion or kinking and replace if necessary.
„
Check the watertrap for a build up of water. Empty the watertrap. If the problem persists,
replace the watertrap.
17.9.2 When an Internal Occlusion Occurs
Condensed water may enter the module and cause contamination and/or internal occlusions.
In this case, the message [AG Airway Occluded] will be displayed.
To remove the occlusion:
„
Check for any occlusion in the gas inlet and/or outlet system.
„
If the problem persists, internal occlusions may exist. Contact your service personnel.
17.10 Removing Exhaust Gases from the System
WARNING
z
Anesthetics: When using the AG measurement on patients who are receiving or
have recently received anesthetics, connect the outlet to a scavenging system, or to
the anesthesia machine/ventilator, to avoid exposing medical staff to anesthetics.
To remove the sample gas to a scavenging system, connect an exhaust tube to the gas outlet
connector of the module.
17-8
18 Monitoring ICG
18.1 Introduction
Impedance cardiography (ICG) measures a patient’s hemodynamic status using a safe,
non-invasive method based on thoracic electrical bioimpedance (TEB) technology. ICG uses
four pairs of sensors to transmit a small electrical signal through the thorax. As velocity and
volume of blood in the aorta change, the ICG measures the changes in impedance from
systole to diastole to calculate hemodynamic parameters.
Setup key
Check sensor
Indicator
Connector for ICG cable
18.2 Safety
WARNING
z
Apply ICG monitoring to adult patients in height of 122 to 229 cm, weight of 30 to
159 kg (67 to 341 pounds) only.
z
ICG monitoring should not be used concurrently on patients with minute
ventilation pacemakers when the MV sensor function is activated.
z
During ICG monitoring, make sure that the conductive paste on the ICG sensors
never come into contact with other conductive parts.
z
ICG sensors are for single patient use only.
18-1
18.3 Understanding ICG Parameters
By selecting the ICG parameter windowĺ[ICG Setup]ĺ[Hemodynamic Parameters >>],
you can view the hemodynamic parameters for evaluation of the patient’s hemodynamic
status.
18.3.1 Measured Parameters
Abbreviation
Unit
Full spelling
ACI
/100s2
acceleration index
VI
/1000s
velocity index
PEP
ms
Pre-ejection period
LVET
ms
Left ventricular ejection time
TFI
ȍ
Thoracic fluid index
TFC
/kȍ
thoracic fluid content
HR*
bpm
heart rate
*The HR value is directly derived from the ICG module.
18.3.2 Calculated Parameters
Abbreviation
Unit
Full spelling
2
BSA
m
Body surface area
C.O.
L/min
Cardiac output
2
C.I.
L/min/m
Cardiac index
SV
ml
Stroke volume
2
SVI
ml/m
Stroke volume index
SVR
DS/cm5
2
Systemic vascular resistance
5
SVRI
DS·m /cm
Systemic vascular resistance index
PVR
DS/cm5
Pulmonary vascular resistance
2
5
PVRI
DS·m /cm
Pulmonary vascular resistance index
LCW
kg·m
Left cardiac work
2
LCWI
kg·m/m
Left cardiac work index
LVSW
g·m
Left ventricular stroke work
2
LVSWI
g·m/m
Left ventricular stroke work index
STR
none
Systolic time ratio
VEPT
ml
Volume of electrically participating tissue
18-2
18.4 Understanding the ICG Display
The ICG monitoring provides a continuous display of the impedance waveform and four
numerics. Of four numerics, one is the primary parameter C.I. and the other three are
secondary parameters. The secondary parameters are user-selectable, and C.O., SVR and
TFC are the defaults.
ICG wave
Primary parameter
Secondary parameters
By selecting the ICG waveform area or ICG parameter window, you can access the [ICG
Setup] menu.
18.5 ICG Limitations
The measurement accuracy may be compromised when patients present with the following
conditions or anomalies:
„
Septic shock.
„
Aortic valve regurgitation.
„
Severe hypertension (Art mean>130 mmHg).
„
The patient’s weight and height are out of range.
„
Connection to an intra-aortic balloon pump.
„
With excessive and continuous patient movements such as shivering.
„
Signal interference from cable connections and/or power cords.
„
Open-chest surgeries that could result in changes in the normal pattern of blood flow
and/or the electrical current through the chest cavity.
18-3
18.6 Preparing to Monitor ICG
1.
Insert the ICG module into the monitor.
2.
Connect the patient cable to the ICG module.
3.
Prepare the patient’s skin and place ICG sensors on the patient.
4.
Connect the ICG sensor connector end to the patient cable lead wires.
5.
Enter the patient information.
18.6.1 Preparing the Patient
Proper skin preparation is necessary for good signal quality at the sensor, as the skin is a poor
conductor of electricity. To properly prepare the skin, choose flat, non-muscular areas and
then follow this procedure:
1.
Shave hair from skin at chosen sites.
2.
Gently rub skin surface with a gauze pad at sites to remove dead skin cells.
3.
Thoroughly cleanse the site with a mild soap and water solution. Be sure to remove all
oily residue, dead skin cells, and abrasives. Leftover abrasion particles can be a source
of noise.
4.
Dry the skin completely before applying the sensor.
18.6.2 Placing ICG Sensors
Appropriate sensor placement is important for good signal quality and accurate
measurements. Attach ICG sensors to the patient as shown below:
18-4
1.
Two neck sensors placed on each side of the neck, with the rectangular shaped end of
the sensor (2) placed at the base (or root) of the neck and the circular shaped end of the
sensor (1) placed directly superior and in line with the earlobe.
2.
Two thorax sensors placed on each side of the thorax, with the rectangular shaped end of
the sensor (3) at the level with the xyphoid process and the circular shaped end of the
sensor (4) directly inferior and in line with the midaxillary line. Each pair of sensors
should be opposite directly to each other (180°) as shown in the figure above.
18.6.3 Setting up the Patient Information
1.
Enter the [ICG Setup] menu.
2.
Select [Patient Demographics >>].
3.
Select [Height] and [Weight] and then select the appropriate settings. The patient’s
height and weight are important for ICG monitoring. The system will automatically
check them when an ICG module is connected. If no values are entered or the entered
values do not meet the requirements, corresponding prompt messages will be given in
the ICG parameter window.
4.
If the mean arterial blood pressure (Art mean) is not obtained automatically from either
IBP or NIBP module, then enter Art mean. Enter CVP and PAWP, obtained from
invasive catheters or enter an assumed value. (Note: CVP and PAWP are used only in
the calculation of SVR, SVRI, LCW, LCWI, LVSW, and LVSWI and the value of CVP
and PAWP do not normally have a significant effect on the calculated parameters.)
18.7 Changing ICG Settings
18.7.1 ICG Averaging
The ICG value is the average of multiple measurements. You can select an interval (heart
beats) for averaging ICG, ranging from 5-60 beats.
1.
Enter the [ICG Setup] menu.
2.
Select [Averaging] and then select the appropriate setting. The greater the averaging
interval is, the less the ICG value is affected by human interference and vice versa.
18-5
18.7.2 Selecting Secondary Parameters
C.O., SVR and TFC are the default three secondary parameters. You can also select your
desired secondary parameter for display.
1.
Enter the [ICG Setup] menu.
2.
Select [Change Secondary Parameters >>].
3.
Select three parameters from the popup menu.
18.7.3 Checking Sensors
During ICG monitoring, the ICG sensors should be checked regularly to ensure that no sensor
becomes disconnected. During sensor checking, the ICG waveform is displayed as a straight
line and the message [ICG Sensor Check] is displayed. Once a disconnected sensor is
detected, a prompt message in which the sensor’s application site is indicated will be
displayed.
To initiate a sensor check:
„
In the [ICG Setup] menu, select [Check Sensor].
„
Press the
hardkey.
18.7.4 Changing the ICG Wave Speed
1.
Enter the [ICG Setup] menu.
2.
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the
wider the wave is.
18-6
19 Monitoring BIS
19.1 Introduction
Bispectral index (BIS) monitoring is for use on adult and pediatric patients within a hospital
or medial facility providing patient care to monitor the state of the brain by data acquisition
of EEG signals.
The BIS, a processed EEG variable, may be used as an aid in monitoring the effects of certain
anesthetic agents. Use of BIS monitoring to help guide anesthetic administration may be
associated with the reduction of the incidence of awareness with recall during general
anesthesia or sedation.
The BISx equipment must be used under the direct supervision of a licensed healthcare
practitioner or by personnel trained in its proper use.
Setup key
Check sensor
Indicator
Connector for BIS cable
19-1
19.2 Safety Information
For patients with neurological disorders, patients taking psychoactive medication, and
children below the age of 1 year, BIS values should be interpreted cautiously.
WARNING
z
The conductive parts of sensors and connectors should not come into contact with
other conductive parts, including earth.
z
To reduce the hazard of burns in the high-frequency surgical neutral electrode
connection, the BIS sensor should not be located between the surgical site and the
electro-surgical unit return electrode.
z
The BIS sensor must not be located between defibrillator pads when a defibrillator
is used on a patient connected to the patient monitor.
z
The BIS component using on our monitor is purchased from Aspect Medical
System. It is important to recognize this index is derived using solely that
company's proprietary technology. Therefore, it is recommended that clinicians
have reviewed applicable information on its utility and/or risks in published
articles and literature/web site information from Aspect Medical Systems, Inc. or
contact that company itself at www.aspectmedical.com, if you have clinical-based
BIS questions relating to this module portion of the patient monitor. Failure to do
so could potentially result in the incorrect administration of anesthetic agents
and/or other potential complications of anesthesia or sedation. We recommend that
clinicians also review the following practice advisory (that includes a section on
BIS monitoring): The American Society of Anesthesiologists, Practice Advisory for
Intraoperative Awareness and Brain Function Monitoring (Anesthesiology
2006;104:847-64). Clinicians are also recommended to maintain current knowledge
of FDA or other federal-based regulatory, practice or research information on BIS
and related topics.
z
The Bispectral Index is a complex technology, intended for use only as an adjunct
to clinical judgment and training.
z
The clinical utility, risk/benefit and application of the BIS component have not
undergone full evaluation in the pediatric population.
19-2
19.3 Understanding the BIS Display
19.3.1 BIS Parameter Area
The BIS parameter area displays the following parameters:
1.
Bispectral Index (BIS)
The BIS numeric reflects the patient’s level of consciousness. It ranges from 100 for
wide awake to 0 in the absence of brain activity.
2.
BIS
numeric
Description
100
The patient is widely awake.
70
The patient is underdosed but still unlikely to become aware.
60
The patient is under general anesthesia and loses consciousness.
40
The patient is overdosed and in deep hypnosis.
0
The EEG waveform is displayed as a flat line, and the patient has no
electrical brain activity.
Electromyograph (EMG)
EMG bar graph reflects the electrical power of muscle activity and high frequency
artifacts. The minimum possible EMG is about 25 dB.
3.
‹
EMG<55 dB: this is an acceptable ECG.
‹
EMG”30 dB: this is an optimal EMG.
Suppression Ratio (SR)
SR numeric is the percentage of time over the last 63-second period during which the
EEG is considered to be in a suppressed state.
4.
Spectral Edge Frequency (SEF)
The SEF is a frequency below which 95% of the total power is measured.
19-3
5.
Signal Quality Index (SQI)
The SQI numeric reflects signal quality and provides information about the reliability of
the BIS, SEF, TP, and SR numerics during the last minute. It ranges from 0-100%:
6.
‹
0 to 15%: the numerics cannot be derived.
‹
15% to 50%: the numerics cannot be reliably derived.
‹
50% to 100%: the numerics are reliable.
Total Power (TP)
TP numeric which only monitors the state of the brain indicates the power in the
frequency band 0.5-30Hz. The useful range is 40-100db.
7.
Burst Count (BC)
A burst means a period (at least 0.5 second) of EEG activity followed and preceded by
inactivity. The BC numeric helps you quantify suppression by measuring the number of
EEG bursts per minute. This parameter is intended for the BIS module with the Extend
Sensor only.
19.3.2 BIS Waveform Area
The BIS waveform area allows you to view either BIS EEG waveform or BIS trend.
1.
Enter the [BIS Setup] menu.
2.
Select [BIS Display] and then toggle between [BIS EEG] and [BIS Trend].
19-4
19.4 Setting up the BIS Measurement
1.
Connect the BISx model to the BIS module.
BIS module
BISx model
Patient cable
BIS sensor
2.
Use the attachment clip to secure the BISx model near, but not above the level of the
patient’s head.
3.
Connect the BISx model to the patient cable.
4.
Attach the BIS sensor to the patient following the instructions supplied with sensor.
NOTE
z
Make sure the patient’s skin is dry. A wet sensor or a salt bridge could result in
erroneous BIS and impedance values.
5.
Connect the BIS sensor to the patient interface cable. As soon as a valid sensor is
detected, the impedances of all electrodes are measured automatically and the
impedance value for each electrode is displayed in the sensor check window.
CAUTION
z
Do not attach the BISx model to the patient’s skin for long time. Otherwise, the
BISx heats while on the patient and may cause discomfort.
19-5
19.5 Continuous Impedance Check
By default, this check is switched on. It checks:
„
The combined impedance of the signal electrodes plus the reference electrode. This is
done continuously and does not affect the EEG wave. As long as the impedances are
within the valid range, there is no prompt message of this check or its results.
„
The impedance of the ground electrode. This is done every ten minutes and takes
approximately four seconds. It causes an artifact in the EEG wave, and the message
[BIS Ground Checking] is displayed on the monitor during the check. If the ground
electrode does not pass this check, another check is initiated. This continues until the
ground electrode passes the check.
If the continuous impedance check interferes with other measurements, it can be switched off.
To do this:
1.
Select [Sensor Check >>] in the [BIS Setup] menu to open the sensor check window.
2.
Select [Stop Cont. Imped.Check].
CAUTION
z
Switching the continuous impedance check off will disable automatic prompt to the
user of impedance value changes, which may lead to incorrect BIS values.
Therefore, this should only be done if the check interferes with or disturbs other
measurements.
19.6 Cyclic Impedance Check
This measures the exact impedance of each individual electrode. It causes a disturbed EEG
wave, and a prompt message is displayed on the monitor
„
„
The cyclic impedance check is automatically initiated when a sensor is connected. To
manually start a cyclic impedance check manually, you can either:
‹
Press the
‹
Select [Start Sensor Check] in the BIS sensor window.
hardkey on the BIS module.
The cyclic impedance check stops automatically if the impedances of all electrodes are
within the valid range. To manually stop a cyclic impedance check, you can either:
‹
Press the
‹
Select [Stop Sensor Check] in the sensor check window.
hardkey on the BIS module.
19-6
19.7 BIS Sensor Check Window
To open the sensor check window, select [Sensor Check >>] in the [BIS Setup] menu. The
graphic in the BIS sensor check window automatically adapts to show the type of sensor you
are using, show three or four electrodes as required. Each symbol in the graphic represents an
electrode and illustrates the most recently-measured impedance status of the electrodes: ķ is
the reference electrode; ĸ the ground electrode; Ĺ and ĺ are signal electrodes.
1
2
3
4
5
1.
Electrode impedance check result
2.
Time of the most recent impedance check
3.
Start/stop cyclic impedance checks
4.
Start/stop Cont. Imped. Check
5.Show sensor information
The measured electrode-to-skin impedance and electrode status are displayed above each
electrode:
Status
Description
Action
[Lead Off]
Electrode falls off and has no skin
contact
Reconnect electrode, or check the
sensor-to-skin contact. If necessary, clean
and dry skin.
[Noise]
The EEG signal is too noisy.
Impedance cannot be measured
Check the sensor-to-skin contact. If
necessary, clean and dry skin.
[High]
The impedance is above the limit
[Pass]
The impedance is within valid range
No action necessary.
Although BIS may still be measured when the electrode status is [Noise] or [High], for best
performance, all electrodes should be in [Pass] status.
19-7
19.8 Choosing the BIS Smoothing Rate
To change the smoothing rate:
1.
Select the BIS parameter window to enter the [BIS Setup] menu.
2.
Select [Smoothing Rate] and then toggle between [10 s], [15 s] and [30 s]
The smoothing rate defines how the monitor averages the BIS value. With the smoothing rate
becoming smaller, the monitor provides increased response to changes in the patient’s state.
Contrarily, the monitor provides a smoother BIS trend with decreased variability and
sensitivity to artifacts.
19.9 Changing the Secondary Parameters
If you connect an extend sensor to the BIS module, you can choose at most 4 secondary
parameters for display on the screen.
1.
Enter the [BIS Setup] menu.
2.
Select [Change Secondary Parameter>>] and then select your desired parameters from
the popup menu.
19.10 Changing the EEG Wave Size
1.
Enter the [BIS Setup] menu.
2.
Select [BIS EEG] from [BIS Display].
3.
Select [Scale] and then select the appropriate setting.
19.11 Changing the Speed of the EEG Wave
1.
Enter the [BIS Setup] menu.
2.
Select [BIS EEG] from [BIS Display].
3.
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the
wider the wave is.
19.12 Setting the Trend Length
1.
Enter the [BIS Setup] menu.
2.
Select [BIS EEG] from [BIS Display].
3.
Select [BIS Length] and then select the appropriate BIS time length setting.
19-8
20 Monitoring RM
20.1 Introduction
WARNING
z
RM monitoring is not intended for neonatal patients.
In the respiratory mechanics measurement, the airway pressures are measured, from the part
between the patient circuit and intubation tube, using a flow sensor between the Y-piece of
patient circuit and the patient connection. The pressure is transferred to the monitor through
the tube and measured by a pressure transducer in the RM module. The pressure difference
together with the gas concentration information is used to calculate flow. The volume
information is obtained by integrating the flow signal. From these three parameter, other
parameter such as RR, I:E, Compl, etc. are derived.
Setup key
Calibrate
Indicator
Connector for RM sensor
The RM monitoring enables clinicians to understand the ventilator operation and patient
respiratory status.
RM monitoring displays the following waveforms and loops:
„
Flow waveform
„
Paw waveform
„
Vol waveform
„
FV (flow-volume) loop
„
PV (paw-volume) loop
20-1
RM monitoring provides values for 15 parameters. The 15 parameters can be classified into 4
categories:
1.
2.
3.
4.
Paw parameters
‹
PIP:
peak inspiratory pressure (unit: cmH2O)
‹
Pplat:
plateau pressure (unit:cmH2O)
‹
PEEP:
positive end expiratory pressure (unit: cmH2O)
‹
Pmean:
mean pressure (unit: cmH2O)
Flow parameters
‹
PIF:
peak inspiratory flow (unit: L/min)
‹
PEF:
peak expiratory flow (unit: L/min)
Vol parameters
‹
TVi:
inspiratory tidal volume (unit: ml)
‹
TVe:
expiratory tidal volume (unit: ml)
‹
MVi:
inspirator minute volume (L)
‹
MVe:
expiratory minute volume (L)
Other parameters
‹
RR:
respiratory rate (unit: rpm)
‹
I: E:
ratio of the inspiratory and expiratory time
‹
Compl:
compliance (unit: ml/cmH2O)
‹
FEV1.0:
first second forced expiratory volume ratio (unit: %)
‹
RSBI:
rapid shallow breathing index (unit: rpm/L)
20-2
20.2 Safety Information
WARNING
z
Check for leaks in the breathing circuit system, as they may significantly affect
respiratory mechanics readings.
z
Match the airway adapter you select to the appropriate patient category. Improper
sensor selection may produce excessive ventilation resistance or introduce excessive
airway deadspace, as well as inaccurate scales and alarm limits.
z
Periodically check the flow sensor and tubing for excessive moisture or secretion
build-up and purge if necessary.
NOTE
z
To avoid the affects of excessive moisture in the measurement circuit, insert the
flow sensor airway adapter in the breathing circuit with the tubes upright.
z
Do not place the airway adapter between the endotracheal tube and an elbow as
this may allow patient secretions to block the adapter windows.
z
Measurement values provided by a ventilator may differ significantly from the
values provided by the RM module, due to different locations of the flow sensor.
20-3
20.3 Preparing to Monitor RM
1.
Select an appropriate flow sensor in accordance with the patient category.
2.
Connect the small tubes of the flow sensor to the RM connector of the module using a
color-coded adapter.
3.
Insert the flow sensor between the Y-piece of the patient circuit and the patient
connection.
Connect to the RM module
Connect to the RM module
Connect to ventilator
Flow sensor
Connect to ventilator
Connect to the patient
Connect to the patient
4.
Calibrate the flow sensor: select the RM parameter window to open the [Calibrate RM]
menu when you see the prompt message [Calibration Required] appears on the RM
parameter window. Then calibrate the flow sensor according to the procedure described
in 20.8 Calibrating the Flow Sensor.
5.
Select [Sensor Type] in the [Calibrate RM] menu and then choose [Infant One-time],
[Disposable] or [Reusable] according to the selected sensor.
20-4
20.4 Understanding the RM Display
The RM display shows either the Paw and Flow waveforms, or the Paw and Vol waveforms
in the waveform area.
1
2
3
4
1.
Paw waveform
2.
Flow waveform
3.
Paw parameter window
4.
Flow parameter window
5.
Vol parameter window
5
20-5
20.5 Changing RM Settings
20.5.1 Accessing RM Menus
„
By selecting the RM parameter window or waveform area, you can access the [RM
Setup] menu.
„
By selecting the Paw wave, you can access the [Paw Waveform] menu.
„
By selecting the Flow wave, you can access the [Flow Waveform] menu.
„
By selecting the Vol wave, you can access the [Vol Waveform] menu.
20.5.2 Setting the Apnea Alarm Delay
In the [RM Setup] menu, select [Apnea Delay] and then select the appropriate setting. The
monitor will alarm if the patient has stopped breathing for longer than the preset apnea time.
The [Apnea Delay] of Resp, CO2, AG, and RM module keeps consistent with each other.
WARNING
z
The respiration measurement does not recognize the cause of apneas. It only
indicates an alarm if no breath is detected when a pre-adjusted time has elapsed
since the last detected breath. Therefore, it cannot be used for diagnostic purpose.
20.5.3 Selecting TV or MV for Display
To select tidal volume (TV) or minute volume (MV) for display in the Vol parameter window,
in the [RM Setup] menu, select [TV/MV] and toggle between [TV] and [MV]. By default,
the Vol parameter window displays TV values.
20.5.4 Selecting Flow or Vol Waveform for Display
To select Flow or Vol waveform for display:
1.
Enter the [RM Setup] menu.
2.
Select [Flow/Vol] and toggle between [Flow] and [Vol].
20-6
20.5.5 Changing the Wave Sweep Speed
1.
Enter the [RM Setup] menu.
2.
Select [Sweep] and select the appropriate setting. The faster the wave sweeps, the wider
the wave is.
20.5.6 Changing the Wave Scale
1.
Select [Wave Scale >>] from the [RM Setup] menu..
2.
Select the appropriate settings in the popup menu.
20.5.7 Setting RR Source
To set RR source:
1.
Enter the [RM Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
The [RR Source] settings of Resp, CO2, AG and RM module are linked. For details, please
refer to the section Setting RR Source of chapter Resp.
20-7
20.6 Understanding the Respiratory Loops
Select [Respiratory Loop] in the [RM Setup] menu. The following window will be
displayed.
Select to recall a reference loop
Respiratory loop
Respiratory parameters
In this window, you can:
„
Select [Save] to save the respiratory loops in the current respiratory cycle as the
reference loops. Up to 4 groups of respiratory loops can be saved, and the saving time is
displayed above the respiratory loops.
„
Change the respiratory loops displayed on the screen: select [Setup >>]→[Display
Loop] and then toggle between [PV Loop] and [FV Loop].
„
Turn on/off reference loop: select [Setup >>]→[Reference Loop], and then toggle
between [On] and [Off].
„
Change the size of the PV and FV loops: select [Setup >>], and then adjust the [Paw
Scale], [Vol Scale] or [Flow Scale].
„
Select parameters for display: select [Setup >>]→[Select RM Parameters >>], and
then select [All RM Parameters] or [Select Desired RM Parameters]. When you
select [Select Desired RM Parameters], 6 parameters at maximum can be selected.
20-8
„
Print out all parameters for a reference loop by selecting your desired reference loop and
then selecting [Record].
20.7 Zeroing the RM Module
A zero calibration is carried out automatically every time when the patient monitor is
switched on or the RM module connected, and then a zero calibration will automatically be
triggered at a specific interval. Then, a zero calibration is triggered every 5 minutes. You can
also start a manual zero calibration when there is a drift in the zero: in the [RM Setup] menu,
select [Zero RM].
20.8 Calibrating the Flow Sensor
A calibration must be performed every time when the RM module is connected to the patient
monitor or the flow sensor is connected.
1.
When calibration is needed, the RM parameter window displays [Calibration
Required]. Select the parameter window to enter the [Calibrate RM] menu. You can
also enter the [Calibrate RM] menu by selecting [Calibration] from the [RM Setup]
menu.
2.
Select [Sensor Type] and then choose [Infant One-time], [Disposable] or [Reusable]
according to the sensor used.
3.
Enter the positive and negative factor provided on the flow sensor and select
[Calibrate].
After the calibration is completed successfully, the last calibration time and the message
[Calibration Completed!] are displayed. Otherwise, the message [Calibration Failed!] is
displayed.
20-9
FOR YOUR NOTES
20-10
21 Freezing Waveforms
During patient monitoring, the freeze feature allows you to freeze the currently displayed
waveforms on the screen so that you can have a close examination of the patient’s status.
Besides, you can select any frozen waveform for recording.
21.1 Freezing Waveforms
1.
To freeze waveforms, select the
hardkey on the monitor’s front.
2.
The system closes the displayed menu (if any), and opens the [Freeze] menu.
3.
All displayed waveforms are frozen, i.e. the waveforms stop being refreshed or
scrolling.
The freeze feature exerts no effect on the split-screen view of minitrends, oxyCRG and other
patients.
21.2 Viewing Frozen Waveforms
To view the frozen waveforms, you can either:
„
Select the [Scroll] button and then rotate the Knob clockwise or counter-clockwise, or
„
Directly select the
touchscreen.
or
beside the [Scroll] button using a mouse or through the
The frozen waveforms will scroll left or right accordingly. And meanwhile, at the lower right
corner of the bottommost waveform, there is an upward arrow. The freeze time is displayed
below the arrow and the initial frozen time is [0 s]. With the waveforms scrolling, the freeze
time changes at intervals of 1 second. This change will be applied for all waveforms on the
screen.
21-1
21.3 Unfreezing Waveforms
To unfreeze the frozen waveforms, you can either:
„
Select the
button at the upper right corner of the [Freeze] menu,
„
Select the
hardkey on the monitor’s front, or
„
Perform any other action that causes the screen to be readjusted or opens a menu, such
as plugging in or out a module, pressing the
hardkey, etc.
21.4 Recording Frozen Waveforms
1.
In the [Freeze] menu, select, in turn, [Wave 1], [Wave 2] and [Wave 3] and then select
your desired waveforms.
2.
Select the [Record] button. The selected waveforms and all numerics at the frozen time
are printed out by the recorder.
21-2
22 Review
22.1 Accessing Respective Review Windows
1.
Select the [Review] QuickKey, or [Main Menu]ĺ[Review >>].
2.
Select [Graphic Trends], [Tabular Trends], [Events], [Full Disclosure] or [12-lead
ECG] to access their respective review windows.
For details about reviewing interpretation of resting 12-lead ECG results, refer to the chapter
7 Monitoring ECG.
22-1
22.2 Reviewing Graphic Trends
In the [Review] menu, select [Graphic Trends] to access the following window.
1
2
3
4
5
1.
Event mark area
2.
Time axis
4.
Parameter area
5.
Cursor
3.
Graphic trends area
Events are marked with colors in the event mark area. Red represents high level alarm event.
Yellow represents medium/low level alarm event. Green represents manual event.
In this review window:
„
Select [Trend Group] and you can select a trend group for viewing in the popup menu.
If [Custom 1] or [Custom 2] is selected, you can further select [Define Trend Group].
Then you can select the parameters for viewing in the popup menu.
„
You can set the time length of the review window by selecting [Zoom].
„
You can set the number of waves displayed in one page by selecting [Waves].
22-2
„
To browse the graphic trends, you can either:
‹
Select
or
beside [Scroll] to move the cursor one step to the left or right to
navigate through the graphic trends, or
‹
Select
or
to move the cursor one page to the left or right to navigate
through the graphic trends.
A time indicating your current position is displayed above the parameter area. Numeric
measurement values corresponding to the cursor location change as the cursor is moved.
The measurement value that triggered high level alarm has red background. The one that
triggered medium/low level alarm has yellow background.
„
By selecting
time.
„
By selecting the [Record] button, you can print out the currently displayed graphic
trends by the recorder.
„
By selecting the [Print] button, you can set and print out the graphic trends report by the
printer. For how to set the graphic trends report, please refer to the Print chapter.
or
beside [Event], you can position the cursor to different event
22.3 Reviewing Tabular Trends
In the [Review] menu, select [Tabular Trends] to access the following window.
22-3
Events are marked with colors in window’s top area. Red represents high level alarm event.
Yellow represents medium/low level alarm event. Green represents manual event.
In this review window:
„
Select [Trend Group] and you can select a trend group for viewing in the popup menu.
If [Custom 1] or [Custom 2] is selected, you can further select [Define Trend Group].
Then you can select the parameters for viewing in the popup menu.
„
You can change the resolution of the trend data by selecting [Interval] and then
selecting the appropriate setting:
„
‹
[5 s] or [30 s]: select to view up to 4 hours of tabular trends at 5- or 30-second
resolution.
‹
[1 min], [5 min], [10 min], [15 min], [30 min], [1 h], [2 h] or [3 h]: select to view
up to 120 hours of tabular trends at your selected resolution.
‹
[NIBP]: select to view the tabular trends when NIBP measurements were acquired.
To browse the tabular trends, you can either:
‹
Select
or
beside [Scroll] to drag the scrollbar left or right to navigate
through the trend database, or
‹
Select
or
to scroll left or right to navigate through the trend database.
The measurement value that triggered high level alarm has red background. The one that
triggered medium/low level alarm has yellow background.
„
By selecting
time.
„
By selecting the [Record] button, you can access the [Record Setup] menu and set the
start and end time of the tabular trends you want to record. This feature is not available
when reviewing a history patient. By further selecting [Record], you can print out the
currently displayed tabular trends by the recorder.
„
By selecting the [Print] button, you can set and print out the tabular trends report by the
printer. For how to set the tabular trends report, please refer to the Print chapter.
or
beside [Event], you can position the cursor to different event
22-4
22.4 Reviewing Events
In the [Review] menu, select [Events] to access the following window.
The events that can be reviewed include parameter alarm events, arrhythmia alarm events and
manual events. When an event occurs, all the measurement numerics at the event trigger time
and related waveforms 4 seconds respectively before and after the event trigger time are
stored.
In this window:
„
You can view the desired events by selecting [Event].
„
You can view the desired events according to the level by selecting [Level].
22-5
After selecting the desired event, you can select [Details] to access the following window. In
this window, the waveform area displays the waveforms related to the event, and the
parameter area displays the parameter values happened at the event trigger time.
2
1
1. Waveform area
2. Parameter area
In this window:
„
You can select
or
to navigate through the waveforms.
„
You can select
or
beside the [Event] button to switch between events.
„
You can set the desired [Gain] for ECG waveform.
„
You can set the desired [Sweep].
„
By selecting the [Record] button, you can print out the currently displayed alarm events
by the recorder.
„
By selecting the [Print] button, you can print out the currently displayed alarm events
by the printer.
„
By selecting the [Events List] button, you can view the events list.
22-6
22.5 Reviewing Waveforms
In the [Review] menu, select [Full Disclosure] to access the following window.
A
B
A. Waveform area
B. Parameter area
22-7
In this review window:
„
To review full-disclosure waveforms, you need to save waveforms first. Select [Save
Waves >>] and then select the parameters whose waveforms you want to view. To save
full-disclosure waveform, your monitor must be equipped with a CF storage card.
„
To view the waveforms, you can either:
‹
Select
or
beside the [Scroll] button to move the cursor one step left or
right to navigate through the waveforms, or
‹
Select
or
to move the cursor one page left or right to navigate through
the waveforms.
A time indicating your current position is displayed at the top of the waveform area.
Numeric measurement values corresponding to the cursor location are displayed in the
parameter area, and change as the cursor is moved.
„
You can change the ECG wave gain by selecting [Gain] and then selecting the
appropriate setting.
„
You can change the waveform sweep speed by selecting [Sweep] and then selecting the
appropriate setting.
„
By selecting the [Record] button, you can print out the first three waveforms and
measurement numerics by the recorder.
„
By selecting
events.
or
beside the [Event] button, you can position the cursor between
22-8
23 Calculations
23.1 Introduction
The calculation feature is available with your patient monitor. The calculated values, which
are not directly measured, are computed based on the values you provide.
Your can perform the following calculations:
„
Dose calculations
„
Oxygenation calculations
„
Ventilation calculations
„
Hemodynamic calculations
„
Renal calculations
To perform a calculation, select [Main Menu] → [Calc >>], or the [Calculations]
QuickKey and then select the calculation you want to perform.
NOTE
z
The calculation feature is independent of other monitoring functions and can be
therefore used for patients being monitored by other monitors. Any operation in a
calculation window does not affect the patient monitoring by the local patient
monitor and the changes in patient demographics in this window are not saved
permanently.
WARNING
z
Before the hemodynamic calculation is started, verify the entered hemodynamic
values such as C.O. and heart rate are recorded as close to one another as possible
in time of recording. For example, in calculating stroke volume via measured
values of cardiac output and heart rate, the cardiac output and heart should be
measured during the same recording session, in order to generate the correct
stroke volume for this cardiac output and heart rate. After the calculation is
finished, verify the entered values are correct and the calculated values are
appropriate. We assume no responsibility for any consequences caused by wrong
entries and improper operations.
23-1
23.2 Dose Calculations
23.2.1 Performing Calculations
To perform a dose calculation:
1.
Select [Main Menu]ĺ[Calculations >>]ĺ[Dose >>], or select [Calculations]
QuickKeyĺ[Dose >>].
2.
Select, in turn, [Patient Cat.] and [Drug Name] and then select the appropriate
settings. The dose calculation program has a library of commonly used drugs, of which
Drug A through Drug E are for those not specified in this library.
‹
Drug A, B, C, D, E
‹
Isuprel
‹
Aminophylline
‹
Lidocaine
‹
Dobutamine
‹
Nipride
‹
Dopamine
‹
NItroglycerin
‹
Epinephrine
‹
Pitocin
‹
Heparin
3.
The system gives a set of default values when the above steps are finished. However,
these values cannot be used as the calculated values. The user must enter values
following the doctor’s instructions, and then the calculated values can only be used
4.
Enter the patient’s weight.
5.
Enter other values.
6.
Verify if the calculated values are correct.
23-2
23.2.2 Selecting the Proper Drug Unit
Each drug has its fixed unit or unit series. Among a unit series, one unit may change to
another automatically depending on the entered value.
The units for each drug are as follows:
„
Drug A, B, C, Aminophylline, Dobutamine, Dopamine, Epinephrine, Isuprel,
Lidocaine, Nipride and NItroglycerin use the unit series: g, mg and mcg.
„
Drug D, Heparin and Pitocin use the unit series: Unit, KU (kilo units) and MU (million
units).
„
Drug E uses the unit: mEq (milli-equivalents).
You must select the proper drug name (A, B, C, D or E) according to the units when you
define a drug not listed in this library.
NOTE
z
For neonate patients, [Drip Rate] and [Drop Size] are disabled.
23.2.3 Titration Table
To open the titration table, select [Titration Table >>] in the [Dose Calculation] window
after the dose calculation is finished.
In the titration table, when you change:
„
[Reference]
„
[Interval]
„
[Dose Type]
The titrated values change accordingly.
You can also:
„
Select
„
Select [Record] to print out the currently displayed titrated values by the recorder.
or
, or
or
beside the vertical scrollbar to view more values.
23-3
23.3 Oxygenation Calculations
23.3.1 Performing Calculations
To perform an oxygenation calculation:
1.
Select [Main Menu]ĺ[Calculations >>]ĺ[Oxygenation >>], or select
[Calculations] QuickKeyĺ[Oxygenation >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow.
You can select [Range] to view its normal range in the unit field. For those who
are within the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Oxygenation Calculation] window, you can:
„
Change the pressure unit, Hb unit and oxygen content unit by selecting [Press. Unit],
[Hb Unit] and [OxyCont Unit] and then selecting the appropriate settings. The
changes take effect automatically.
„
Trigger a recording by selecting the [Record] button. The currently displayed
oxygenation calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
23-4
23.3.2 Entered Parameters
Abbreviation
Unit
Full spelling
C.O.
L/min
cardiac output
FiO2
%
percentage fraction of inspired oxygen
PaO2
mmHg
partial pressure of oxygen in the arteries
PaCO2
mmHg
partial pressure of carbon dioxide in the arteries
SaO2
%
arterial oxygen saturation
PvO2
mmHg
partial pressure of oxygen in venous blood
SvO2
%
venous oxygen saturation
Hb
g/L
hemoglobin
RQ
None
respiratory quotient
ATMP
mmHg
atmospheric pressure
Height
cm
height
Weight
kg
weight
23.3.3 Calculated Parameters
Abbreviation
Unit
Full spelling
BSA
m2
body surface area
VO2
ml/min
oxygen consumption
C(a-v)O2
ml/L
arteriovenous oxygen content difference
O2ER
%
oxygen extraction ratio
DO2
ml/min
oxygen transport
PAO2
mmHg
partial pressure of oxygen in the alveoli
AaDO2
mmHg
alveolar-arterial oxygen difference
CcO2
ml/L
capillary oxygen content
CaO2
ml/L
arterial oxygen content
CvO2
ml/L
venous oxygen content
Qs/Qt
%
venous admixture
23-5
23.4 Ventilation Calculations
23.4.1 Performing Calculations
To perform a ventilation calculation:
1.
Select [Main Menu]ĺ[Calculations >>]ĺ[Ventilation >>], or select [Calculations]
QuickKeyĺ[Ventilation >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow.
You can select [Range] to view its normal range in the unit field. For those who
are within the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Ventilation Calculation] window, you can:
„
Change the pressure unit by selecting [Press. Unit] and then selecting the appropriate
setting. Corresponding pressure values shall convert and update automatically.
„
Trigger a recording by selecting the [Record] button. The currently displayed
ventilation calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
23-6
23.4.2 Entered Parameters
Abbreviation
Unit
Full spelling
FiO2
%
percentage fraction of inspired oxygen
RR
rpm
respiration rate
PeCO2
mmHg
partial pressure of mixed expiratory CO2
PaCO2
mmHg
partial pressure of carbon dioxide in the arteries
PaO2
mmHg
partial pressure of oxygen in the arteries
TV
ml
tidal volume
RQ
None
respiratory quotient
ATMP
mmHg
atmospheric pressure
23.4.3 Calculated Parameters
Abbreviation
Unit
Full spelling
PAO2
mmHg
partial pressure of oxygen in the alveoli
AaDO2
mmHg
alveolar-arterial oxygen difference
Pa/FiO2
mmHg
oxygenation ratio
a/AO2
%
arterial to alveolar oxygen ratio
MV
L/min
minute volume
Vd
ml
volume of physiological dead space
Vd/Vt
%
physiologic dead space in percent of tidal volume
VA
L/min
alveolar volume
23-7
23.5 Hemodynamic Calculations
23.5.1 Performing Calculations
To perform a hemodynamic calculation:
1.
Select [Main Menu]ĺ[Calculations >>]ĺ[Hemodynamic >>], or select
[Calculations] QuickKeyĺ[Hemodynamic >>].
2.
Enter values for calculation.
3.
‹
For a patient who is being monitored, [HR], [Art mean], [PA mean] and [CVP]
are automatically taken from the currently measured values. If you just have
performed C.O. measurements, [C.O.] is the average of multiple thermodilution
measurements. [Height] and [Weight] are the patient’s height and weight you
have entered. If the monitor does not provide these values, their fields appear
blank.
‹
For a patient who is not being monitored, confirm the values you have entered.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow.
You can select [Range] to view its normal range in the unit field. For those who
are within the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Hemodynamic Calculation] window, you can:
„
Trigger a recording by selecting the [Record] button. The currently displayed renal
calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
23-8
23.5.2 Entered Parameters
Abbreviation
Unit
Full spelling
C.O.
L/min
cardiac output
HR
bpm
heart rate
PAWP
mmHg
pulmonary artery wedge pressure
Art Mean
mmHg
artery mean pressure
PA Mean
mmHg
pulmonary artery mean pressure
CVP
mmHg
central venous pressure
EDV
ml
end-diastolic volume
Height
cm
height
Weight
kg
weight
23.5.3 Calculated Parameters
Abbreviation
Unit
Full spelling
Formula
BSA
m2
body surface area
Ht0.725(cm)×Wt0.425(kg)×0.007184
C.I.
L/min/m2
cardiac index
C.O./BSA
SV
ml
stroke volume
(C.O./HR)×1000
SI
ml/m2
stroke index
SV/BSA
5
SVR
DS/cm
systemic vascular resistance
((Art Mean -CVP)/C.O.)×79.96
SVRI
DS·m2/cm5
systemic vascular resistance
index
SVR×BSA
PVR
DS/cm5
pulmonary vascular resistance
((PA Mean -PAWP)/C.O.)×79.96
PVRI
DS·m2/cm5
pulmonary vascular resistance
index
PVR×BSA
LCW
kg·m
left cardiac work
0.0136×Art Mean×C.O.
LCWI
kg·m/m2
left cardiac work index
LCW/BSA
LVSW
g·m
left ventricular stroke work
SV×(Art Mean -PAWP)×0.0136
LVSWI
g·m/m2
left ventricular stroke work
index
LVSW/BSA
RCW
kg·m
right cardiac work
0.0136×PA mean×C.O.
2
RCWI
kg·m/m
right cardiac work index
RCW/BSA
RVSW
g·m
right ventricular stroke work
SV×(PA Mean -CVP)×0.0136
RVSWI
g·m/m2
right ventricular stroke work
index
RVSW/BSA
EF
%
ejection fraction
100×SV/EDV
23-9
Reference Sources
Source: Kinney M, Dunbar S, Brooks-Brunn J, Molter N, and Vitello-Cicciu J. AACN's
Clinical Reference for Critical Care Nursing. St. Louis: Mosby, 1996.
Source: DuBois D, Dubois EF. A formula to estimate the approximate surface height and
weight be known. Arch Intern Medicing. 1916; 17:863-71.
Source: Baxter Healthcare Corporation. Model COM-2 Cardiac Output Computer
Operations Manual Software Version 2.2. Santa Ana: 1989.
23.6 Renal Calculations
23.6.1 Performing Calculations
To perform a renal calculation:
1.
Selecting [Main Menu]→[Calculations >>]→[Renal >>], or select [Calculations]
QuickKey→[Renal >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current
settings and displays the calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow.
You can select [Range] to view its normal range in the unit field. For those who
are within the range, their unit fields appear blank.
‹
Invalid values are displayed as [---].
In the [Renal Calculation] window, you can:
„
Trigger a recording by selecting the [Record] button. The currently displayed renal
calculations are printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
23-10
23.6.2 Entered Parameters
Abbreviation
Unit
Full spelling
URK
mmol/L
urine pstassium
URNa
mmol/L
urinary sodium
Urine
ml/24h
urine
Posm
mOsm/ kgH2O
plasm osmolality
Uosm
mOsm/ kgH2O
urine osmolality
SerNa
mmol/L
serum sodium
Cr
Pmol/L
creatinine
UCr
Pmol/L
urine creatinine
BUN
mmol/L
blood urea nitrogen
Height
cm
height
Weight
kg
weight
23.6.3 Calculated Parameters
Abbreviation
Unit
Full spelling
URNaEx
mmol/24h
urine sodium excretion
URKEx
mmol/24h
urine potassium excretion
Na/K
%
sodium potassium ratio
CNa
ml/24h
clearance of sodium
Clcr
ml/min
creatinine clearance rate
FENa
%
fractional excretion of sodium
Cosm
ml/min
osmolar clearance
CH2O
ml/h
free water clearance
U/P osm
None
urine to plasma osmolality ratio
BUN/Cr
None*
blood urea nitrogen creatinine ratio
U/Cr
None
urine-serum creatinine ratio
*: BUN/Cr is a ratio under the unit of mol.
23-11
23.7 Understanding the Review Window
With the review feature, you can review oxygenation, ventilation, hemodynamic and renal
calculations. The review window for each calculation is similar. Take the hemodynamic
calculations review window for example, you can access it by selecting [Review] in the
[Hemodynamic Calculation] window.
In this review window:
„
You can select
„
The values that exceed the range are displayed in yellow background. The [Unit] field
displays parameter units. If some parameter values are outside of their normal ranges,
you can view their normal range in the [Unit] field by selecting [Range].
„
You can review an individual calculation by selecting its corresponding column and
then selecting [Original Calc]. You can record the currently displayed calculations or
perform another calculation is this window.
,
or
to view more values.
23-12
24 Recording
24.1 Using a Recorder
The thermal recorder records patient information, measurement numerics, up to three
waveforms, etc.
2
1
5
3
4
1.
Start/Stop key: press to start a recording or stop the current recording.
2.
Indicator
‹
On: when the recorder works correctly.
‹
Off: when the monitor is switched off.
‹
Flashes: if an error occurred to the recorder, e.g., the recorder runs out of paper.
3.
Paper outlet
4.
Recorder door
5.
Latch
24-1
24.2 Overview of Recording Types
By the way recordings are triggered, the recordings can be classified into the following
categories:
„
Manually-triggered realtime recordings.
„
Timed recordings.
„
Alarm recordings triggered by an alarm limit violation or an arrhythmia event.
„
Manually-triggered, task-related recordings.
The task-related recordings include:
„
Frozen wave recording
„
Graphic trends recording
„
Tabular trends recording
„
Events recording:parameter alarm recording, arrh. alarm recording, manual events
recording
„
Wave review recording
„
Interpretation of resting 12-lead ECG result recording
„
Titration table recording
„
Hemodynamic calculations recording
„
Oxygenation calculations recording
„
Ventilation calculations recording
„
Renal calculations recording
„
oxyCRG recording
„
C.O. curve recording
„
PAWP recording
„
Respiratory loops recording
„
Monitor information recording
NOTE
z
For details about alarm recording, refer to the chapter 6 Alarms.
z
For details about task-related recordings, refer to respective sections of this
manual.
24-2
24.3 Starting and Stopping Recordings
To manually start a recording, you can either:
„
Select the
or
„
Select the [Record] button from the current menu or window.
hardkey on the front of either the patient monitor or the recorder module,
Automatic recordings will be triggered in the following conditions:
„
Timed recordings will start automatically at preset intervals.
„
If both [Alarm] and [Alm Rec] for a measurement are set on, an alarm recording will be
triggered automatically as alarms occur.
To manually stop a recording, you can either:
„
Select the
„
Select [Clear All Tasks] in the [Record Setup] menu.
hardkey again, or
Recordings stop automatically when:
„
The runtime is over.
„
The recorder runs out of paper.
„
When the recorder has an alarm condition.
24-3
24.4 Setting up the Recorder
24.4.1 Accessing the Record Setup Menu
By selecting [Main Menu]ĺ[Record Setup >>], you can access the [Record Setup] menu.
24.4.2 Selecting Waveforms for Recording
The recorder can record up to 3 waveforms at a time. You can select, in turn, [Waveform 1],
[Waveform 2] and [Waveform 3] in the [Record Setup] menu, and then select the
waveforms you want. You can also turn off a waveform recording by selecting [Off]. These
settings are intended for realtime and scheduled recordings.
24.4.3 Setting the Realtime Recording Length
After starting a realtime recording, the recording time depends on your monitor’s settings. In
the [Record Setup] menu, select [Length] and toggle between [8 s] and [Continuous].
„
[8 s]: record 8-second waveforms from the current moment.
„
[Continuous]: record the waveforms from the current moment until stopped manually.
24.4.4 Setting the Interval between Timed Recordings
Timed recordings start automatically at preset intervals. Each recording lasts 8 seconds. To
set the interval between timed recordings: in the [Record Setup] menu, select [Interval] and
then select the appropriate setting.
24.4.5 Changing the Recording Speed
In the [Record Setup] menu, select [Paper Speed] and toggle between [25 mm/s] and [50
mm/s]. This setting is for all recordings containing waveforms.
24-4
24.4.6 Clearing Recording Tasks
In the [Record Setup] menu, select [Clear All Tasks]. All queued recording tasks are cleared
and the current recording is stopped.
24.5 Loading Paper
1.
Use the latch at the upper right of the recorder door to pull the door open.
2.
Insert a new roll into the compartment as shown below.
3.
Close the recorder door.
4.
Check if paper is loaded correctly and the paper end is feeding from the top.
Paper roll
24-5
CAUTION
z
Use only specified thermal paper. Otherwise, it may cause damage to the
recorder’s printhead, the recorder may be unable to print, or poor print quality
may result.
z
Never pull the recorder paper with force when a recording is in process.
Otherwise, it may cause damage to the recorder.
z
Do not leave the recorder door open unless you reload paper or remove troubles.
24.6 Removing Paper Jam
If the recorder works incorrectly or produces unusual sounds, check if there is a paper jam
first. If a paper jam is detected, follow this procedure to remove it:
1.
Open the recorder door.
2.
Take out the paper and tear off the draped part.
3.
Reload the paper and close the recorder door.
24.7 Cleaning the Recorder Printhead
If the recorder has been used for a long time, deposits of paper debris may collect on the
printhead compromising the print quality and shortening the lifetime of the roller. Follow this
procedure to clean the printhead:
1.
Take measures against the static electricity such as Disposable Wrist Strap for the work.
2.
Open the recorder door and take out the paper.
3.
Gently wipe around the printhead using cotton swabs dampened with alcohol.
4.
After the alcohol has completely been dried, reload the paper and close the recorder
door.
CAUTION
z
Do not use anything that may destroy the thermal element.
z
Do not add unnecessary force to the thermal head.
24-6
25 Printing
25.1 Printer
The monitor can output patient reports via a connected printer. So far, the monitor supports
the following printer:
„
HP LaserJet 1505N
„
HP LaserJet 2035N
The specifications of the reports the monitor prints are:
„
Paper: A4, Letter
„
Resolution: 300 dpi
„
Print on One/Both Sides : printing on one and both sides are supported if the printer
supports
For more details about the printer, see the document accompanying the printer. With the
upgrading of products, the monitor will support more printers and no prior notice will be
given. If you have any doubt about the printer you have purchased, contact our company.
25.2 Connecting a printer
To print the reports or the trend data of a patient, you can choose either:
„
the local printer
Connect the printer and the patient monitor directly with a network cable, and then start
printing what you want, or
„
the Central Monitoring System
If your monitor is connected to a central monitoring system, it is recommended to use
the central monitoring system for printing.
25-1
25.3 Setting Up the Printer
To set the printer’s properties, select [Main Menu]ĺ[Print Setup >>]ĺ[Printer Setup >>].
In the [Printer Setup] menu, you can:
„
Select a connected printer
Select [Printer] and then select a connected printer as the monitor’s printer. If [Central
Station] is selected, a printout will be sent to the printer associated with the Central
Station.
„
Search for a printer
If your selected printer is not in the list or a new printer is added into the network, you
can select the [Search Printer] to re-search for all printers in the network.
„
Set up the paper
Select [Paper Size] and toggle between [A4] and [Letter].
„
Print on both sides
By default, the monitor prints out patient reports on one side. If you set [Print On Both
Sides] to [On], the monitor will print out patient reports on both sides.
25.4 Starting Report Printouts
Reports
Contents
Procedures
ECG reports
ECG waveforms and relevant
parameter values
Select [Main Menu]ĺ[Print Setup
>>]ĺ[ECG Reports >>]ĺ[Print]
Tabular trends
Depend on the selected
parameter group, resolution
and time period
Select [Main Menu]ĺ[Print Setup
>>]ĺ[Tabular Trends Reports
>>]ĺ[Print], or select [Main
Menu]ĺ[Review >>]ĺ[Tabular
Trends]ĺ[Print]ĺ[Print]
Graphic trends
Depend on the selected
parameter group, resolution
and time period
Select [Main Menu]ĺ[Print Setup
>>]ĺ[Graphic Trends Reports
>>]ĺ[Print], or select [Main
Menu]ĺ[Review >>]ĺ[Graphic
Trends]ĺ[Print]ĺ[Print]
Arrh. alarm review
ECG waveforms and relevant
parameter values
Select [Print] in [Arrh. Events]
(unavailable when
[Printer] is set to
[Central Station])
(unavailable when
[Printer] is set to
[Central Station])
25-2
Parameter alarm
review
Depend on the selected alarms
Select [Main Menu]ĺ[Review
>>]ĺ[Alarms]ĺ[Print]
12-lead ECG waveforms and
analysis results
Select [12-lead Analysis]ĺ[Print] when
a interpretation of resting 12-lead ECG
is completed, or select [Main
Menu]ĺ[Review >>]ĺ[12-lead
Analysis]ĺ[Print]
Depend on the selected
waveforms
Select [Main Menu]ĺ[Print Setup
>>]ĺ[Realtime Reports >>]ĺ[Print]
(unavailable when
[Printer] is set to
[Central Station])
Interpretation of
resting 12-lead
ECG
(unavailable when
[Printer] is set to
[Central Station])
Realtime waves
25-3
25.5 Stopping Reports Printouts
To stop report printouts, select [Main Menu]ĺ[Print Setup >>]ĺ[Stop All Reports].
25.6 Setting Up Reports
25.6.1 Setting Up ECG Reports
You can print out ECG reports only under full-screen, half-screen or 12-lead monitoring
screen. To set up ECG reports, select [Main Menu]ĺ[Print Setup >>]ĺ[ECG Reports
>>].
„
[Amplitude]: set the amplitude of the ECG waveforms.
„
[Sweep]: set the wave print speed.
„
[Auto Interval]: If [Auto Interval] is set to [On], the system will automatically adjust
the space between waveforms to avoid overlapping.
„
[Gridlines]: choose whether to show gridlines.
„
[12-Lead Format]: If you select [12X1], 12 waveforms will be printed on a paper from
top to bottom. If you select [6X2], 12 waveforms will be printed from left to right with 6
waveforms on each half part and a rhythm waveform will be printed at the bottommost.
25.6.2 Setting Up Tabular Trends Reports
To set up tabular trends reports, select [Main Menu]ĺ[Print Setup >>]ĺ[Tabular Trends
Reports >>].
„
Start time: You can set a time period whose trend data will be printed out by setting
[From] and [Back]. For example, if you set [From] as 2007-4-2 10:00:00 and [Back] as
[2 h], the outputted data will be from 2007-4-2 08:00:00 to 2007-4-2 10:00:00. In
addition, the [Back] can be set to either:
‹
[Auto]: If [Report Layout] is set to [Time Oriented], the report will be printed by
time. If [Report Layout] is set to [Parameter Oriented], the report will be printed
by parameters.
‹
[All]: If you select [All], all trend data will be printed out. In this case, it is no need
to set [From].
„
[Interval]: choose the resolution of the tabular trends printed on the report.
„
[Report Layout]: If you select [Time Oriented], the report will be printed by time. If
you select [Parameter Oriented], the report will be printed by parameters.
25-4
„
[Select Parameter >>]: from the popup menu, you can:
‹
[Currently Displayed Trended Parameters]: print the parameter trend data
selected from the [Tabular Trends].
‹
[Standard Parameter Group]: select the standard parameter group for printing.
‹
[Custom]: You can define a parameter group for printing from the parameters
displayed in the low part of the menu.
25.6.3 Setting Up Graphic Trends Reports
To set up graphic trends reports, select [Main Menu]ĺ[Print Setup >>]ĺ[Graphic Trends
Reports >>]. As setting up graphic trends reports is similar with tabular trends reports, you
can refer to the Setting Up Tabular Trend Reports section for details.
25.6.4 Setting Up Realtime Reports
To set up realtime reports, select [Main Menu]ĺ[Print Setup >>]ĺ[Realtime Reports
>>].
„
[Sweep]: set the wave print speed.
„
[Select Wave >>]: from the popup menu, you can:
‹
[Current]: select the currently displayed waves for printing.
‹
[Select Wave]: select the desired waves for printing.
25.7 End Case Reports
ECG reports, tabular trends reports, graphic trends reports, NIBP review reports and realtime
reports can be set as end case reports. When you discharge a patient, the system will
automatically print out all contents that are set as end case reports.
For example, to set ECG report as end case report:
1.
select [Main Menu]ĺ[Print Setup >>]ĺ[ECG Report >>].
2.
select [End Case Report]ĺ[Set as End Case Report] and then select [Ok] from the
popup dialog box.
3.
set as described in the 25.6.1 Setting Up ECG Reports.
25-5
25.8 Printer Statuses
25.8.1 Printer Out of Paper
When the printer runs out of paper, the print request will not be responded. If there are too
many print jobs that are not responded, a printer error may occur. In these cases, you need to
install paper and then re-send the print request. Restart the printer if necessary.
Therefore, you’d better ensure that there is enough paper in the printer before sending a print
request.
25.8.2 Printer Status Messages
Printer Status Message
Possible causes and suggested action
Printer unavailable
The selected printer is not available. Check if the printer is switched
on or correctly connected or installed with paper.
25-6
26 Other Functions
26.1 Marking Events
During patient monitoring, some events may exert effects on the patient and as a result
change the waveforms or numerics displayed on the monitor. To help analysing the
waveforms or numerics at that time, you can mark these events.
Select [Main Menu]→[Mark Event >>]. In the popup menu, you can select the waves to be
stored when a manual event is triggered. You can select [Trigger Manual Event] from the
[Mark Event] menu or the [Manual Event] QuickKey to trigger a manual event and store it
at the same time.
When you are reviewing graphic trends, tabular trends or full-disclosure waveforms, the
manual event symbol is displayed at the time the event is triggered.
26.2 Privacy Mode
Privacy mode is only available when a patient who is admitted at a patient monitor is also
monitored by the Hypervisor CMS.
To activate the privacy mode:
1.
Select [Main Menu]→[Screen Setup >>].
2.
Select [Privacy Mode] to activate the privacy mode. The button appears greyed out and
is not selectable if the patient is not admitted at the central station.
The patient monitor behaves as follows as soon as the privacy mode is activated:
„
The screen turns blank and [Under monitoring. Press any key to exit the privacy
mode.] is displayed.
„
Monitoring and data storing continue but patient data is only visible at the central
station.
„
Alarms can still be triggered. But all audible alarms are suppressed and the alarm light is
deactivated at the patient monitor.
„
All system sounds are suppressed, including heart beat tone, pulse tone, all prompt tones,
etc.
26-1
WARNING
z
During privacy mode, all audible alarms are suppressed and the alarm light is
deactivated at the patient monitor. Alarms sound only at the central station.
To cancel the privacy mode, proceed as follows:
„
Press any key.
The patient monitor exits the privacy mode automatically in one of the following situations:
„
The patient monitor disconnects from central station.
„
The alarm of [Battery Too Low] and [The monitor will quit soon. Please use AC
power.] message appear.
26.3 Night Mode
To avoid disturbing the patient, night mode may be used. Night mode is available when
[Hypervisor] is chosen in [Factory Maintenance] menu.
To activate the night mode:
1.
Select the [Night Mode] QuickKey or [Main Menu]→[Screen Setup >>]→[Night
Mode >>].
2. In the pop-up menu, set the desired brightness, alarm volume, QRS volume, key volume,
and set whether to stop NIBP measurement or not.
3.
Select the [Enter Night Mode] button.
To cancel the night mode:
1.
Select the [Night Mode] QuickKey or [Main Menu]→[Screen Setup >>]→[Night
Mode >>].
2.
Select [Ok] in the popup.
26-2
26.4 Analog Output
The patient monitor provides analog output signals to accessory equipment via the Micro-D
connector on the rear of the monitor. To obtain analog output signals, connect the accessory
equipment such as an oscillograph, etc. to the monitor and then follow this procedure:
1.
Select [Main Menu] then [Analog Output Setup>>].
2.
Select [Analog Out.] and then select [On].
NOTE
z
The analog output feature is seldom applied in clinical applications. You can
contact your service personnel for more details.
26.5 Transferring Data
You can transfer the patient data saved in the monitor to a PC via a crossover network cable
or CF storage card, or within a LAN for data management, review or print.
26.5.1 Data Export System
You must install the data export system on the intended PC before performing the data
transfer operation. Refer to the document accompanying the installation CD-ROM for
installation instructions.
The data transfer feature supports patient management, data review, data format conversion,
print, etc. in addition to data transfer. Refer to the help file of the system software for more
details.
26-3
26.5.2 Transferring Data by Different Means
NOTE
z
Never enter the data transfer mode when the patient monitor is in normal
operation or performs monitoring. You must re-start the patient monitor to exit
the data transfer mode.
Transfer data via a crossover network cable
Before transferring data using a crossover network cable, do as follows:
1.
Connect one end of the crossover network cable to the patient monitor and the other end
to the PC.
2.
Set the IP address of the PC. This IP address must be in the same network segment with
that of the patient monitor.
3.
Make sure that the data export system is active on the PC.
Then, follow this procedure to transfer data:
1.
Select [Main Menu]→[Patient Data >>]→[Transfer Data].
2.
Select [Yes] from the popup message box.
3.
Input the IP address already set on the PC.
4.
Select [Start] to start transferring data.
26-4
Transfer data within a LAN
Before transferring data within a LAN, do as follows:
1.
Connect the patient monitor and the intended PC into the same LAN and acquire the
PC’s IP address.
2.
Make sure that the data export system is active on the PC.
Follow the same procedure as via a crossover network cable to transfer data.
Transfer data via a CF storage card
1.
Power off the patient monitor and remove the CF storage card from it. Refer to the Basic
Operations section for details.
2.
Run the data export system on the PC.
3.
Insert the CF storage card into the card reader that connects the PC.
4.
Perform the data transfer operation following the help file of the system software.
26.6 Nurse Call
The patient monitor also provides nurse call signals to a nurse call system connected to the
monitor via the Nurse Call connector. To obtain nurse call signals, connect a nurse call
system to the monitor and then follow this procedure:
1.
Select [Main Menu]→[Maintenance >>]→[User Maintenance >>]→enter the
required password.
2.
Select [Others >>] to access the [Others] menu.
3.
Select [Nurse Call Setup] to change the nurse call settings as follows:
„
Select [Signal Type] and toggle between [Pulse] and [Continuous].
„
‹
[Pulse]: the nurse call signals are pulse signals and each pulse lasts 1 second. When
multiple alarms occur simultaneously, only one pulse signal is outputted. If an
alarm occurs but the previous one is not cleared yet, a new pulse signal will also be
outputted.
‹
[Continuous]: the nurse call signal lasts until the alarm ends, i.e. the duration of a
nurse call signal equals to that of the alarm condition.
Select [Contact Type] and toggle between [Normally Open] and [Normally Closed].
‹
[Normally Open]: select if your hospital’s nurse call relay contact is normally
open.
26-5
‹
[Normally Closed]: select if your hospital’s nurse call relay contact is normally
closed.
„
Select [Alm Lev] and set the alarm level for nurse call-triggering alarms.
„
Select [Alarm Cat.] and then select the category to which the nurse call-triggering
alarms belong.
Alarm conditions are indicated to nurses only when:
„
The nurse call system is enabled,
„
An alarm that meets your preset requirements occurs, and
„
The monitor is not in the alarm paused or silence status.
NOTE
z
If no setting is selected from [Alm Lev] or [Alarm Cat.], no nurse call signal will be
triggered whatever alarms occur.
WARNING
z
Do not rely exclusively on the nurse call system for alarm notification. Remember
that the most reliable alarm notification combines audible and visual alarm
indications with the patient’s clinical condition.
26.7 Remote Display
This monitor enables remote display. It allows remote displays to be connected to the bedside
monitor through network. The information coming from the monitor will be displayed on the
remote display through the remote display driver so that clinical professionals can
conveniently observe the patient’s conditions from distance.
For details about remote display features, refer to the instructions for use accompanying the
remote display driver.
NOTE
z
The contents displayed on the remote display are for convenient observance only
and cannot be used for diagnostic interpretation.
z
The user cannot operate the monitor through the remote display driver, namely,
any operations performed through the remote display driver will not affect the
monitor you observe.
26-6
26.8 Wireless Network
The patient monitors, each equipped with a wireless network card, constitute a wireless
network via AP (access point). The designated service engineer or personnel shall be
responsible for installing and configuring the wireless network for you and perform relative
performance tests as well.
The radio device used in the monitor is in compliance with the essential requirements and
other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications
Terminal Equipment Directive).
NOTE
z
The design, installation, restruction and maintenance of the wireless network’s
distribution shall be performed by authorized service personnel of our company.
z
The existence of obstacles (such as wall) will exert impact on data transferring or
even cause network interruption.
z
The Central Monitoring System is capable of connecting up to 16 bedside monitors
via the wireless network.
26-7
FOR YOUR NOTES
26-8
27 Batteries
27.1 Overview
The monitor is designed to operate on one or two rechargeable Lithium-ion battery whenever
AC power supply is interrupted. The battery is charged whenever the patient monitor is
connected to an AC power source regardless of whether or not the patient monitor is currently
on. Since no external battery charger is supplied, the battery can only be charged inside the
monitor so far. Whenever the AC power is interrupted during patient monitoring, the patient
monitor will automatically run power from the internal batteries.
On-screen battery symbols indicate the battery status as follows:
Indicates that batteries work correctly. The solid portion represents the current
charge level of the batteries in proportion to its maximum charge level.
Indicates that the batteries have low charge level and need to be charged.
Indicates that the batteries are almost depleted and need to be charged
immediately.
Indicates that no batteries are installed or only one battery is installed.
The capacity of the internal battery is limited. If the battery capacity is too low, a technical
alarm will be triggered and the [Battery Too Low] message displayed. At this moment, apply
AC power to the patient monitor. Otherwise, the patient monitor will power off automatically
before the battery is completely depleted.
NOTE
z
Take out the battery before the monitor is transported or will not be used for a
long time.
WARNING
z
Keep the battery out of children’s reach.
z
Use only specified batteries in this manual.
27-1
27.2 Installing or Replacing a Battery
When the patient monitor uses two battery packs, one battery pack can be easily exchanged
while the patient monitor operates from the other. If the patient monitor uses one battery pack,
you should insert a new battery pack before the old one depletes.
To install or replace a battery, follow this procedure:
1.
Push down the button on the battery door and then slide backward as indicated to open
the battery door.
2.
Push aside the latch latch fixing the battery and then remove the battery.
3.
Place the new battery into the slot with its face up and its contact point inward.
4.
If necessary, replace the other battery following the steps above.
5.
Restore the latch to the original position and close the battery door.
NOTE
z
Using two batteries are recommended when SMR is connected.
CAUTION
z
Take out the batteries when CIS and SMR are used together.
27-2
27.3 Conditioning a Battery
A battery needs at least two conditioning cycles when it is put into use for the first time. A
battery conditioning cycle is one complete, uninterrupted charge of the battery, followed by
an uninterrupted discharge of the battery. Batteries should be conditioned regularly to
maintain their useful life. Condition the batteries once when they are used or stored for two
months, or when their run time becomes noticeably shorter.
To condition a battery, follow this procedure:
1.
Disconnect the patient monitor from the patient and stop all monitoring and measuring
procedures.
2.
Insert the battery in need of conditioning into the battery slots of the patient monitor.
3.
Apply AC power to the patient monitor and allow the battery to charge uninterruptedly
for above 6 hours.
4.
Remove AC power and allow the patient monitor to run from the battery until it shuts
off.
5.
Apply AC power again to the patient monitor and allow the battery to charge
uninterruptedly for above 6 hours.
6.
This battery is now conditioned and the patient monitor can be returned to service.
27-3
27.4 Checking a Battery
The performance of a rechargeable battery may deteriorate over time. To check the
performance of a battery, follow this procedure:
1.
Disconnect the patient monitor from the patient and stop all monitoring and measuring
procedures.
2.
Apply AC power to the patient monitor and allow the battery to charge uninterruptedly
for above 6 hours.
3.
Remove AC power and allow the patient monitor to run from the battery until it shuts
off.
4.
The operating time of the battery reflects its performance directly.
If the operating time of a battery is noticeably shorter than that stated in the specifications,
replace the battery or contact your service personnel.
NOTE
z
Life expectancy of a battery depends on how frequent and how long it is used. For
a properly maintained and stored lithium-ion battery, its life expectancy is about 3
years. For more aggressive use models, life expectancy can be less. We recommend
replacing lithium-ion batteries every 3 years.
z
The operating time depends on the configuration and operation. For example,
monitoring NIBP repeatedly will also shorten the operating time of the batteries.
27.5 Recycling a Battery
When a battery has visual signs of damage, or no longer holds a charge, it should be replaced.
Remove the old battery from the patient monitor and recycle it properly. To dispose of a
battery, follow local laws for proper disposal.
WARNING
z
Do not disassemble batteries, or put them into fire, or cause them to short circuit.
They may ignite, explode, or leak, causing personal injury.
27-4
28 Care and Cleaning
Use only the substances approved by us and methods listed in this chapter to clean or
disinfect your equipment. Warranty does not cover damage caused by unapproved substances
or methods.
We make no claims regarding the efficacy of the listed chemicals or methods as a means for
controlling infection. For the method to control infection, consult your hospital’s Infection
Control Officer or Epidemiologist.
Sterilization is not recommended for this monitor, related products, accessories or supplies
unless otherwise indicated in the Instructions for Use that accompany the accessories and
supplies.
To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer
to the instructions delivered with the accessory.
28.1 General Points
Keep you equipment and accessories free of dust and dirt. To avoid damage to the equipment,
follow these rules:
„
Always dilute according the manufacturer’s instructions or use lowest possible
concentration.
„
Do not immerse part of the equipment into liquid.
„
Do not pour liquid onto the equipment or accessories.
„
Do not allow liquid to enter the case.
„
Never use abrasive materials (such as steel wool or silver polish), or erosive cleaners
(such as acetone or acetone-based cleaners).
28-1
WARNING
z
Be sure to shut down the system and disconnect all power cables from the outlets
before cleaning the equipment.
CAUTION
z
If you spill liquid on the equipment or accessories, contact us or your service
personnel.
NOTE
z
To clean or disinfect reusable accessories, refer to the instructions delivered with
the accessories.
28.2 Cleaning
Your equipment should be cleaned on a regular basis. If there is heavy pollution or lots of
dust and sand in your place, the equipment should be cleaned more frequently. Before
cleaning the equipment, consult your hospital’s regulations for cleaning the equipment.
Recommended cleaning agents are:
„
mild soap (diluted)
„
ammonia (diluted)
„
sodium hypochlorite bleach (diluted)
„
Hydrogen peroxide (3%)
„
Ethanol (70%)
„
Isopropanol (70%)
To clean your equipment, follow these rules:
1.
Shut down the patient monitor and disconnect it from the power line.
2.
Clean the display screen using a soft, clean cloth dampened with a glass cleaner.
3.
Clean the exterior surface of the equipment using a soft cloth dampened with the
cleaner.
4.
Wipe off all the cleaning solution with a dry cloth after cleaning if necessary.
5.
Dry your equipment in a ventilated, cool place.
28-2
28.3 Disinfecting
Disinfection may cause damage to the equipment and is therefore not recommended for this
patient monitor unless otherwise indicated in your hospital’s servicing schedule. Cleaning
equipment before disinfecting is recommended.
The recommended disinfectants include: ethanol 70%, isopropanol 70%, glutaraldehyde-type
2% liquid disinfectants
CAUTION
z
Never use EtO or formaldehyde for disinfection.
28-3
FOR YOUR NOTES
28-4
29 Maintenance
WARNING
z
Failure on the part of the responsible individual hospital or institution employing
the use of this equipment to implement a satisfactory maintenance schedule may
cause undue equipment failure and possible health hazards.
z
The safety checks or maintenance involving any disassembly of the equipment
should be performed by professional servicing personnel. Otherwise, undue
equipment failure and possible health hazards could result.
z
If you discover a problem with any of the equipment, contact your service
personnel or us.
29.1 Safety Checks
Before every use, after your patient monitor has been used for 6 to 12 months, or whenever
your patient monitor is repaired or upgraded, a thorough inspection should be performed by
qualified service personnel to ensure the reliability.
Follow these guidelines when inspecting the equipment:
„
Make sure that the environment and power supply meet the requirements.
„
Inspect the equipment and its accessories for mechanical damage.
„
Inspect all power cords for damage, and make sure that their insulation is in good
condition.
„
Make sure that only specified accessories are applied.
„
Inspect if the alarm system functions correctly.
„
Make sure that the recorder functions correctly and the recorder paper meets the
requirements.
„
Make sure that the batteries meet the performance requirements.
„
Make sure that the patient monitor is in good working condition.
„
Make sure that the grounding resistance and leakage current meet the requirement.
In case of any damage or abnormity, do not use the patient monitor. Contact the hospital’s
biomedical engineers or your service personnel immediately.
29-1
29.2 Maintenance and Testing Schedule
The following maintenance and tests, except for visual inspection, power on test, touchscreen
calibration, battery check and recorder check, shall be carried out by the service personnel
only. Contact your service personnel if any maintenance is required. Make sure to clean and
disinfect the equipment before any test and maintenance.
Check/Maintenance Item
Recommanded Frequency
Preventative Maintenance Tests
Visual inspection
1. When first installed or reinstalled.
Pressure check
NIBP test
Leakage test
Calibration
Sidestream and
Microstream
CO2 tests
Leakage test
Performance test
Calibration
Leakage test
AG tests
1. If the user suspects that the measurement is
incorrect.
2. Following any repairs or replacement of relevant
module.
3. At least once a year.
Performance test
Calibration
Performance Tests
ECG test and
calibration
Performance test
Calibration
Resp performance test
SpO2 test
Pressure check
NIBP test and
calibration
Leakage test
1. If the user suspects that the measurement is
incorrect.
2. Following any repairs or replacement of relevant
module.
3. At least once every two years.
Note: At least once a year is recommended for NIBP,
CO2 and AG test and calibration.
Calibration
Temp test
IBP test and
calibration
Performance test
Pressure calibration
C.O. test
Mainstream CO2 test and calibration
29-2
Check/Maintenance Item
Sidestream and
Microstream
CO2 tests and
calibration
Recommanded Frequency
Leakage test
Performance test
Calibration
Leakage test
AG test
Performance test
Calibration
ICG test
BIS test
RM test
CCO/SvO2 test
Interconnecting
function
Output calibration
Nurse call relay performance test
Analog output performance test
If the user suspects that the analog output does not
work well.
Electrical Safety Tests
Electrical safety tests
At least once every two years.
Other Tests
1. When first installed or reinstalled.
Power on test
2. Following any maintenance or the replacement of
any main unit parts.
1. When the touchscreen appears abnormal.
Touchscreen calibration
2. After the touchscreen is replaced.
Recorder check
Following any repair or replacement of the recorder.
1. When first installed.
Network print test
2. Whenever the printer is serviced or replaced.
Functionality test
Battery check
Performance test
1. When first installed.
2. Whenever a battery is replaced.
Once a year or if the battery run time reduced
significantly.
29-3
29.3 Checking Monitor and Module Information
To view the information about system start time, selftest, etc., select [Main
Menu]ĺ[Maintenance >>]ĺ[Monitor Information >>]. You can print out the information
for the convenience of troubleshooting. The information will not be saved during shut down.
You can also view the information about the monitor configuration and system software
version by selecting [Main Menu]ĺ[Maintenance >>]ĺ[Software Version >>].
29.4 Calibrating ECG
The ECG signal may be inaccurate due to hardware or software problems. As a result, the
ECG wave amplitude becomes greater or smaller. In that case, you need to calibrate the ECG
module.
1.
Select the ECG parameter window or waveform areaĺ[Filter]ĺ[Diagnostic].
2.
Select [Main Menu]ĺ[Maintenance >>]ĺ[Calibrate ECG]. A square wave appears
on the screen and the message [ECG Calibrating] is displayed.
3.
Compare the amplitude of the square wave with the wave scale. The difference should
be within 5%.
4.
After the calibration is completed, select [Stop Calibrating ECG]
You can print out the square wave and wave scale and then measure the difference between
them if necessary. If the difference exceeds 5%, contact your service personnel.
29.5 Calibrating the Touchscreen
1.
2.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Cal. Touchscreen].
will, in turn, appear at different positions of the screen.
3.
Select each
4.
After the calibration is completed, the message [Screen Calibration Completed!] is
displayed. Select [Ok] to confirm the completion of the calibration.
as it appears on the screen.
29-4
29.6 Calibrating CO2
For sidestream and microstream CO2 modules, a calibration is needed every year or when the
measured values have a great deviation. For maintream CO2 module, no calibration is
needed.
Tools required:
„
A steel gas cylinder with 6±0.05% CO2 and balance gas N2
„
T-shape connector
„
Tubing
Follow this procedure to perform a calibration:
1.
Make sure that the sidestream or microstream CO2 module has been warmed up or
started up.
2.
Check the airway for leakage and perform a leakage test as well to make sure the airway
has no leakage.
3.
Select [Main Menu]ĺ [Maintenance >>]ĺ [User Maintenance >>]ĺ enter the
required passwordĺ [Maintain CO2 >>]ĺ [Calibrate CO2 >>].
4.
In the [Calibrate CO2] menu, select [Zero].
5.
After the zero calibration is finished successfully, connect the equipment as follows:
Flowmeter
Tubing
Relief valve
T-shape connector
Monitor
Gas cylinder
6.
Turn on and adjust the relief valve to make the flowmeter reads within 10-50mL/min
and keeps stable as well.
29-5
7.
In the [Calibrate CO2] menu, enter the vented CO2 concentration in the [CO2] field.
8.
In the [Calibrate CO2] menu, the measured CO2 concentration is displayed. After the
measured CO2 concentration becomes stable, select [Calibrate CO2] to calibrate the
CO2 module.
9.
If the calibration is finished successfully, the message [Calibration Completed!] is
displayed in the [Calibrate CO2] menu. If the calibration failed, the message
[Calibration Failed!] is displayed. In this case, perform another calibration.
29.7 Calibrating AG
Calibrate the AG module every year or when the measured value has a great deviation.
Tools required:
„
Gas bottle, with a certain standard gas or mixture gas. Gas concentration should meet
the following requirements: AA>1.5%, CO2>1.5%, N2O>40%, O2>40%, of which AA
represents an anesthetic agent. a/cİ0.01 (a is the gas absolute concentration accuracy; c
is the gas concentration˅
„
T-shape connector
„
Tubing
Follow this procedure to perform a calibration:
1.
Select [Main Menu]ĺ[Maintenance >>]ĺ[User Maintenance >>]ĺenter the
required passwordĺ[Calibrate AG >>].
2.
Check the airway and make sure that there are no occlusions or leaks.
3.
‹
Vent the tubing to the air and check if the [Current FlowRate] and [Set FlowRate]
are approximately the same. If the deviation is great, it indicates that there is an
occlusion in the tubing. Check the tubing for an occlusion.
‹
Perform a leakage test to make sure that the airway has no leakage.
Connect the test system as follows:
Flowmeter
Tubing
Relief valve
T-shape connector
Gas cylinder
29-6
Monitor
4.
Open the relief valve and vent a certain standard gas or gas mixture. Adjust the relief
valve to make the flowmeter reads within 10-50mL/min and keeps stable as well.
5.
In the [Calibrate AG] menu, the concentration and flowrate of each measured gas are
displayed
‹
If the difference between the measured gas concentration and the actual one is very
small, a calibration is not needed.
‹
If the difference is great, you should perform a calibration. Select [Calibrate >>] to
enter the calibrate menu.
6.
Enter the vented gas concentration. If you use only one gas for calibration, set other
gases’ concentration to 0.
7.
Select [Calibrate] to start calibration.
8.
If the calibration is finished successfully, the message [Calibration Completed!] is
displayed. If the calibration failed, the message [Calibration Failed!] is displayed.
Perform another calibration.
CAUTION
z
If the O2 module has been transported for long distance, calibrate it when
installing the monitor.
29.8 Electrical Safty Tests
Refer to E Electrical Safty Inspection.
29.9 Setting up IP Address
1.
Select [Main Menu]→[Maintenance >>]→[User Maintenance >>]→enter the
required password and then select [Network Setup >>] from the popup menu.
2. If your monitor is equipped with a wireless AP, you can set [Network Type] to [WLAN]
in the network setup menu. Otherwise, the default setting is [LAN].
3.
Set [IP Address].
If the patient monitor is connected to a CMS, its IP address should be set up. The user should
not change the patient monitor’s IP address randomly. If you want to know details about IP
address setup, contact the technical personnel in charge of the CMS.
29-7
29.10 Entering/Exiting Demo Mode
To enter the Demo mode:
1.
Select [Main Menu]→[Maintenance >>].
2.
Select [Demo >>]. Enter the required password and then select [Ok].
To exit the Demo mode:
1.
Select [Main Menu]→[Maintenance >>].
2.
Select [Exit Demo] and then select [Ok].
3.
The patient monitor exits the Demo mode.
WARNING
z
The Demo mode is for demonstration purpose only. To avoid that the simulated
data are mistaken for the monitored patient’s data, you must not change into
Demo mode during monitoring. Otherwise, improper patient monitoring and
delayed treatment could result.
29-8
30 Accessories
WARNING
z
Use accessories specified in this chapter. Using other accessories may cause
damage to the patient monitor or not meet the claimed specifications.
z
Single-use accessories are not designed to be reused. Reuse may cause a risk of
contamination and affect the measurement accuracy.
z
Check the accessories and their packages for any sign of damage. Do not use them
if any damage is detected.
30-1
30.1 ECG Accessories
ECG Electrodes
Model
Quantity
Patient Category
Part No.
210
10 pieces
Adult
0010-10-12304
12-Pin Trunk Cables
Leadwire
supported
Compatible with
Type
3-leadwire
AHA, IEC
Defibrillator-proof
3-leadwire
AHA, IEC
ESU-proof
3/5-leadwire
AHA, IEC
Defibrillator-proof
3/5-leadwire
AHA, IEC
ESU-proof
Patient Category
Pediatric, neonate
Adult, pediatric
Part No.
0010-30-42720
0010-30-42724
0010-30-42719
0010-30-42723
Cable Sets
3-Electrode Cable Sets
Type
Compatible with
Clip
AHA
Snap
AHA
Model
Patient Category
Part No.
Remark
EL6303A
Adult, pediatric
0010-30-42731
Long
EL6305A
Neonate
0010-30-42896
/
EL6301B
Adult, pediatric
0010-30-42734
/
Model
Patient Category
Part No.
Remark
0010-30-42727
/
5-Electrode Cable Sets
Type
Compatible with
Clip
AHA
Snap
AHA
EL6501A
EL6503A
Adult, pediatric
EL6501B
30-2
0010-30-42729
Long
0010-30-42735
/
30.2 SpO2 Accessories
Extension Cable
Module type
Remarks
Part No.
MPM SpO2 Module
/
0010-20-42710
8 pins, purple connector
040-000332-00
7 pins, white connector
0010-30-42738
Masimo SpO2 Module
SpO2 Sensors
The SpO2 sensor material that patients or other staff will come into contact with have
undertaken the bio-compatibility test and is verified to be in compliance with ISO 10993-1.
MPM SpO2 Module
Type
Single
patient use
Reusable
Model
Patient Category
Part No.
520A
Adult
520A-30-64101
520P
Pediatric
520P-30-64201
520I
Infant
520I-30-64301
520N
Neonate
520N-30-64401
518B
Adult, pediatric, neonate (Multi-sites)
518B-30-72107
512F $GXOW)LQJHUW\SH
512F-30-28263
512H 3HGLDWULF)LQJHUW\SH +
30-3
Masimo SpO2 Module
Type
Model
Patient Category
Remark
Part No.
\
Adult (>30 kg)
LNCS DCI
0600-00-0126
\
Pediatric (10 to 50
kg)
LNCSDCIP
0600-00-0127
\
Adult (>30 kg)
LNCS Adtx
0600-00-0121
\
Pediatric(10 to 50
kg)
LNCS Pdtx
0600-00-0122
\
Infant (3 to 20 kg)
LNCS INF-L
0600-00-0124
LNCS NEO-L
0600-00-0158
LNCS NEO
PT-L
0600-00-0125
Reusable
Single
patient use
\
\
Neonate (<3 kg
and > 40 kg)
Neonate Pre-term
(<1kg)
„
Wavelength emitted by the sensors intended for MPM SpO2 module red right: 660 nm,
infrared light: 905 nm.
„
Wavelength emitted by the sensors intended for Masimo SpO2 module: red light: 660
nm, infrared light: 940 nm.
„
The maximum photic output consumption of the sensor is less than 18 mW.
The information about the wavelength range and maximum photic output consumption can
be especially useful to clinicians, for example, clinicians performing photodynamic therapy.
30-4
30.3 NIBP Accessories
Reusable Cuff
Model
Patient
Category
\
Child
\
Small adult
Measurem
ent Site
Arm
Limb Circumference
(cm)
Bladder
Width
(cm)
Part No.
10 to 19
9.2
0683-15-0001-01
18 to 26
12.2
0683-15-0002-01
\
Adult
\
Large adult
\
Adult
\
Blood Pressure Cuff Starter Kit
Thigh
25 to 35
15.1
0683-15-0003-01
33 to 47
18.3
0683-15-0004-01
46 to 66
22.5
0683-15-0005-01
\
0020-00-0184-01
Single-Patient Cuff
Model
Patient
Category
Measurem
ent Site
CM1500A
CM1500B
CM1500C
CM1500D
Neonate
Arm
Limb Circumference
(cm)
Bladder
Width (cm)
Part No.
3.1 to 5.7
2.2
001B-30-70692
4.3 to 8.0
2.9
001B-30-70693
5.8 to 10.9
3.8
001B-30-70694
7.1 to 13.1
4.8
001B-30-70695
30-5
Disposable Cuff
Model
Patient
Category
\
Child
\
Small adult
\
Adult
\
Large adult
\
Adult
Measurem
ent Site
Arm
Thigh
Limb Circumference
(cm)
Bladder
Width (cm)
Part No.
10 to 19
7.2
0683-14-0001-01
18 to 26
9.8
0683-14-0002-01
25 to 35
13.1
0683-14-0003-01
33 to 47
16.5
0683-14-0004-01
46 to 66
20.5
0683-14-0005-01
30-6
30.4 Temp Accessories
Extension Cable
Type
Model
Temp probe
Part No.
Reusable
MR420B
MR411, MR412
0011-30-37391
Temp Probes
Type
Model
MR401B
Reusable
MR403B
MR402B
MR404B
Disposable
MR411
MR412
Patient Category
Adult
Pediatric, neonate
Adult, pediatric, neonate
Measurement
Site
Part No.
Esophageal/Rectal
0011-30-37392
Skin
0011-30-37393
Esophageal/Rectal
0011-30-37394
Skin
0011-30-37395
Esophageal/Rectal
0011-30-37398
Skin
0011-30-37397
30.5 IBP Accessories
Accessories
Kit No.
Components
Part No.
\
IM2202 12 Pin IBP Cable (for BD)
001C-30-70757
\
IM2201 12 Pin IBP Cable (for Hospira)
001C-30-70759
\
IBP cable adapter (12 pin to 6 pin)
0010-20-42795
\
12 Pin IBP Cable for Memscap (SP844 transducer)
0010-21-43082
\
12 Pin IBP Cable for Edwards
0010-21-12179
It is proved through tests that the following accessories are compatible with the patient
monitor. Only the accessories proceeded by “*” are available from our company. If you want
to purchase other accessories, contact respective manufacturers and make sure if these
accessories are approved for sale in local.
30-7
Manufacturer
Accessories
Smith Medical
(Medex)
MX961Z14 Logical Cable, to be used in connection with the Adapter Cable
(0010-20-42795)
MX960 Reusable Transducer Kit
MX9605A Logical 84in(213cm) Single Monitoring Kit
MX960 Logical Tranducer Mounting Plate
MX261 Logical Clamp For Transducer Bracket
MX262 Logical Clamp For 2 Transducer Mount Plates
(More Logical Clamps are available from Medex. For detailed information,
contact Medex.)
Braun
IBP Reusable Cable (REF: 5203511), to be used in connection with the
Adapter Cable (0010-20-42795)
Combitrans Monitoring Set (contact Braun for detailed information)
Combitrans Attachment Plate Holder (REF: 5215800)
Combitrans Attachment Plate (contact Braun for detailed information)
Memscap
*Truck cable (0010-21-43082)
SP844 Physiological Pressure Transducer
844-26 Monitoring Line Set
84X-49 Mounting Bracket
Utah
Reusable Blood Pressure Monitor Interface Cable (REF: 650-206)
Deltran Disposable Pressure Transducer System
(More Deltran sensors are available from Utah. For detailed information,
contact Utah.)
Pole Mount Unit (ERF: 650-150)
Deltran Three Slot Organizer, Attaches to I.V. Pole Mount (REF: 650-100)
Deltran Four Slot Organizer, Attaches to I.V. Pole Mount (REF: 650-105)
Edwards
* IBP Truwave Reusable Cable (0010-21-12179)
Pressure Monitoring Kit With Truwave Disposable Pressure Transducer.
(More Truwave sensors are available from Edwards. For detailed
information, contact Edwards.)
DTSC IV Pole Clamp for Model DTH4 Backplate Holder
DTH4 Disposable Holder for DPT
30.6 C.O. Accessories
Model
Material
Part No.
COC-001-SL
12Pin C.O. cable.
0010-30-42743
SP4042
TI Sensor
6000-10-02079
SP5045
TI Sensor Housing
6000-10-02080
MX387
12CC Control Syringe W/1CC Stop W/Rotator
6000-10-02081
131HF7
Thermodilution Catheter
6000-10-02183
9850A
Cable kit with TI Sensor
0012-00-1519
30-8
30.7 CCO/SvO2 Accessories
Material
PN
CCO/SvO2 cable
009-000259-00
30.8 CO2 Accessories
Sidestream CO2 module
Material
Patient Category
DRYLINE Watertrap
Adult, pediatric
DRYLINE Watertrap
Neonate
Sampling Line, Adult 2.5m
Adult, pediatric
Remark
Part No.
9200-10-10530
Reusable
9200-10-10574
9200-10-10533
Sampling Line, Neonate, 2.5m
Neonate
Adult Nasal CO2 Sample Cannula
Adult
9200-10-10555
Pediatric Nasal CO2 Sample Cannula
Pediatric
M02A-10-25938
Infant Nasal CO2 Sample Cannula
Infant
M02B-10-64509
DRYLINE Airway Adapter
/
Disposable
M02A-10-25937
Straight
9000-10-07486
Ordion Microstream CO2 module
Material
Patient Category
Remark
Part No.
Starter kit
\
\
6800-30-50619
Mainstream CO2 Module
Material
Model
Patient
Category
6063
Airway adapter
Part No.
Disposable
0010-10-42662
6421
Adult
Disposable, with
mouthpiece
0010-10-42663
6312
Neonate
Disposable
0010-10-42664
/
0010-10-42670
Adult large
0010-10-42671
9960STD
Mask
Remark
9960LGE
Adult
9960PED
Pediatric
/
0010-10-42669
Cable management
straps
/
/
/
0010-10-42667
Sensor holding clips
/
/
/
0010-10-42668
Sensor
/
Adult, pediatric,
neonate
Reusable
6800-30-50760
30-9
30.9 AG Accessories
Material
Watertrap
Sampling line
Airway adapter
Patient Category
Adult, pediatric
Neonate
Adult, pediatric
Neonate
Remark
Reusable
Disposable
Part No.
9200-10-10530
9200-10-10574
9200-10-10533
9200-10-10555
Adult, pediatric, neonate
Disposable, straight
9000-10-07486
Adult, pediatric, neonate
Disposable, elbow
9000-10-07487
30.10 ICG Accessories
Material
Part No.
BioZ tect ICG sensor
0010-10-43258
BioZ Dx ICG Patient Cable
040-000543-00
BioZ Dx ICG Lead Wire
040-000544-00
30.11 BIS Accessories
Material
Patient Category
Part No.
BIS Cable
Adult, pediatric
6800-30-50761
Patient Category
Remark
Part No.
Adult, pediatric
Reusable
0010-30-42678
Adult, pediatric
Disposable
0010-30-42679
Infant
Disposable
0010-30-42680
/
/
6800-20-50328
30.12 RM Accessories
Material
Flow sensor
RM connector
30.13 Others
Material
Lithium battery
Part No.
022-000008-00
M05-010002-06
CF storage card
0000-10-11160
Analog output cable
6800-20-50146
Defibrillator synchronization cable
009-000027-00
Data output software package
6800-30-51213
Domestic power cord (America)
DA8K-10-14452
30-10
Power cord (Australia, orange, 10A, 1.5M)
009-002636-00
Grounding cable
1000-21-00122
Nurse call cable
8000-21-10361
Satellite module rack wall mount bracket
0010-30-42867
Main unit wall mount bracket
0010-30-42955
Display wall mount bracket
0010-30-42956
Roll stand (for DPM 6 only)
0010-30-43043
Roll stand (for DPM 7 only)
0010-30-42943 *
Thermal paper, one roll (50mm × 20 m)
0683-00-0505-01
Rolling Stand & SMR Mount (for DPM 6 only)
0010-30-43049
Rolling Stand & SMR Mount (for DPM 7 only)
0010-30-42944
6802 Transition plate kit (for DPM 6 only)
115-003441-00
* Not available in the United States.
30-11
FOR YOUR NOTES
30-12
A Product Specifications
A.1 Monitor Safety Specifications
A.1.1 Classifications
Main unit
Secondary display
I
Mode of operation
Degree of protection
against hazards of
explosion
Degree of protection
against harmful
ingress of water
Degree of protection
against electrical
shock
Components
Type of protection
against electrical
shock
The patient monitor is classified, according to IEC60601-1:
Not marked
Not marked
MPM
CF(*)
IBP module
C.O. module
BIS module
Ordinary
ICG module
NA
AG module
Not suitable
Continuous
BF(*)
CO2 module
RM module
SMR
Not marked
CCO/SvO2 module
Not marked
„
I:
Class I equipment
„
BF: Type BF applied part. (*Defibrillator-proof protection against electric shock.)
„
CF: Type CF applied part. (*Defibrillator-proof protection against electric shock.)
„
NA: Not applicable
„
Ordinary: Ordinary equipment (enclosed equipment without protection against ingress
of water)
„
Not suitable: Equipment not suitable for use in the presence of a flammable anesthetic
mixture with air with oxygen or nitrous oxide.
A-1
A.1.2 Environmental Specifications
Main unit, MPM, IBP module, C.O. module, Recorder, CCO/SvO2 module
Item
Operating conditions
Storage conditions
Temperature (ºC)
0 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (mmHg)
425 to 809
120 to 809
Item
Operating conditions
Storage conditions
Temperature (ºC)
0 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (mmHg)
430 to 795
430 to 795
Item
Operating conditions
Storage conditions
Temperature (ºC)
5 to 35
-20 to 60
Relative humidity (noncondensing)
15% to 95%
15% to 95%
Barometric (mmHg)
428 to 790
428 to 790
Item
Operating conditions
Storage conditions
Temperature (ºC)
10 to 40
-10 to 50
Relative humidity (noncondensing)
10% to 90%
0% to 90%
Barometric (mmHg)
400 to 850
400 to 850
Item
Operating conditions
Storage conditions
Temperature (ºC)
10 to 40
-20 to 70
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (mmHg)
525 to 900
525 to 900
Microstream CO2 module
Sidestream CO2 module
Mainstream CO2 module
AG module
A-2
RM module
Item
Operating conditions
Storage conditions
Temperature (ºC)
5 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (mmHg)
500 to 800
500 to 800
Item
Operating conditions
Storage conditions
Temperature (ºC)
0 to 40
-20 to 50
Relative humidity (noncondensing)
10% to 95%
10% to 95%
Barometric (mmHg)
356 to 760
356 to 760
Item
Operating conditions
Storage conditions
Temperature (ºC)
10 to 40
0 to 50
Relative humidity (noncondensing)
15% to 95%
15% to 95%
Barometric (mmHg)
619 to 780
619 to 780
BIS module
ICG module
A.1.3 Power requirements
Line voltage
100 to 240 VAC
Current
2.5 to 1.4 A
Frequency
50/60 Hz
Fuse
Time-lag 250V T3.15A
A-3
A.2 Physical Specifications
Components
Weight
Size
Equipment type
Main unit
<6.6 kg
297×336×187 mm
12.1” LCD (without modules,
batteries, recorder and
accessories)
SMR
<1.8 kg
142×402×151 mm
With no module inserted
MPM
<0.63 kg
136.5×80.5×102 mm
IBP module
<0.25 kg
136.5×40×102 mm
C.O. module
<0.25 kg
136.5×40×102 mm
Sidestream CO2 module
<0.48 kg
136.5×80.5×102 mm
Microstream CO2 module
<0.37 kg
136.5×40×102 mm
Mainstream CO2 module
<0.50 kg
136.5×40×102 mm
M-type AG module
<1.75 kg
136.5×121×102 mm
With O2 and BIS modules
A-type AG module
<1.75 kg
136.5×121×102 mm
With O2 and BIS modules
ICG module
<0.35 kg
136.5×40×102 mm
BIS module
<0.25 kg
136.5×40×102 mm
RM module
<0.27 kg
136.5×40×102 mm
CCO/SvO2 module
<0.25 kg
136.5×40×102 mm
A-4
Not available in USA
A.3 Hardware Specifications
A.3.1 Display
Host display
Screen type
Color TFT LCD
Screen Size (diagonal)
12.1"
Resolution
800×600 pixels
External display
Screen type
Medical-grade TFT LCD
Screen Size
15", 17" or above
Resolution
800×600 pixels or above
EMC
MPR II, CISPR 11B
Third certificate
UL, C-UL, TUV, CE, FCC
A.3.2 Recorder
Method
Thermal dot array
Horizontal resolution
16 dots/mm (25 mm/s paper speed)
Vertical resolution
8 dots/mm
Paper width
50 mm
Paper length
20 m
Paper speed
25 mm/s, 50 mm/s
Number of waveform channels
1, 2, or 3 (optional)
A-5
A.3.3 Battery
Size
147.5×60.4×23.8 mm
Weight
350 g
Number of batteries
1 or 2
Battery Type
Chargeable Lithium-Ion
Voltage
11.1 VDC
Capacity
4500 mAh
330 min
Run time
Charge time
Shutdown delay
when powered by two new fully-charged batteries respectively
(25ć, ECG, SpO2, Auto NIBP measurements at intervals of 15
minutes)
nearly 5.5 h to 90%
nearly 6 h to 100%
at least 5 min (after a low battery alarm first occurs)
A.3.4 LEDs
Alarm lamp
1 (two color coded: yellow and red)
Technical alarm lamp
1 (blue)
Power on LED
1 (green)
AC power LED
1 (green)
Battery LED
1 (green)
A.3.5 Audio Indicator
Speaker
Give alarm tones (45 to 85 dB), key tones, QRS tones; support
PITCH TONE and multi-level tone modulation; alarm tones
comply with IEC60601-1-8.
A-6
A.3.6 Monitor Interface Specifications
Power
1 AC power input connector
Wire network
1 RJ45 connector, 100 Base-TX, IEEE 802.3
USB
4 connectors, USB 1.1
SMR connector
1 connector, not standard USB
CF
50-pin CF revision 2.0 connector
Video interface
1 connector, standard DVI-D
Nurse call
1 connector, standard BNC
Equipotential Grounding Terminal
1
Micro-D connector
1 connector, It outputs ECG, IBP and defibrillator
synchronization signals simultaneously
CIS connector
1 connector, for connecting the CIS box.
A.3.7 Outputs
Auxiliary Output
Standard
Meets the requirements of IEC60601-1 for short-circuit
protection and leakage current
Output impedance
50ȍrating
ECG Analog Output
Bandwidth
Diagnostic mode:
0.05 to 150 Hz
(-3dB; reference frequency:
10Hz)
Monitor mode:
0.5 to 40 Hz
Surgical mode:
1 to 20 Hz
Max transmission delay
25 ms (in diagnostic mode, and with Notch off)
Sensitivity
1V/mV ±5%
Pace enhancement
PACE rejection/enhancement
Signal amplitude: Voh•2.5V
Pulse width: 10ms±5%
Signal rising and falling time: ”100μs
IBP Analog Output
Bandwidth (-3dB; reference
frequency:1Hz)
DC to 50 Hz
Max transmission delay
30 ms (with Notch off)
Sensitivity
1 V/100 mmHg ±5%
A-7
Nurse Call Signal
Output mode
Relay
Electrical requirements
”60W, ”2A, ”36VDC, ”25VAC
Isolation voltage
1500 VAC
Contact type
Normally open or normally contact (optional)
Defib Sync Pulse
Output impedance
50ȍ
Max time delay
35 ms (R-wave peak to leading edge of pulse)
Amplitude
High level: 3.5 to 5 V, providing a maximum of 1 mA output
current;
Low level: < 0.5 V, receiving a maximum of 5 mA input current.
Pulse width
100 ms ±10%
Limited current
15 mA rating
Rising and falling time
”1 ms
Digital video output (DVI-D connector)
Video signals
Single Link TMDS
DDC signals
Signals 12C compliant
A-8
A.4 Data Storage
Trends: 120 hours, at 1 min resolution
Trends
Mid-length trends: 4 hours, at 5 s resolution
Minitrends: 1 hour, at 1 s resolution
Parameter alarms
100 alarms and manual events and related parameter
waveforms. The waveform recording length can be 8s.
Arrh. events
100 arrhythmia events and relate waveforms and parameters.
The waveform recording length can be 8s.
NIBP measurements
1000 sets
Interpretation of resting
12-lead ECG results
20 sets
Full-disclosure waveforms
48 hours at maximum. The specific storage time depends on
the waveforms stored and the number of stored waveforms.
A-9
A.5 Measurement Specifications
The adjustable range of alarm limits is the same with the measurement range of signals unless
otherwise specified.
A.5.1 ECG
ECG
Standards
Meet standards of EC11, EC13, EN60601-2-27/IEC60601-2-27
and IEC60601-2-25
3-lead: I, II, III
Lead set
5-lead: I, II, III, aVR, aVL, aVF, V
12-lead: I, II, III, aVR, aVL, aVF, V1 to V6
ECG standard
AHA, IEC
Display sensitivity
1.25 mm/mV (X0.125), 2.5 mm/mV (X0.25), 5 mm/mV (X0.5),
10 mm/mV (X1), 20 mm/mV (X2), 40 mm/mV (X4), Auto
Sweep speed
6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s
Bandwidth (-3dB)
Common mode rejection ratio
(with Notch off)
Diagnostic mode:
0.05 to 150 Hz
Monitor mode:
0.5 to 40 Hz
Surgical mode:
1 to 20 Hz
Diagnostic mode:
•90 dB
Monitor mode:
•105 dB
Surgical mode:
•105 dB
50/60 Hz
Notch
Monitor and surgical mode: Notch turns on automatically.
Diagnostic mode: Notch is turned on/off manually
Differential input impedance
•5 Mȍ
Input signal range
±8 mV (peak-to-peak value)
Accuracy of reappearing input
signal
Use A and D methods based on EC11 to determine system total
error and frequency response.
Electrode offset potential
tolerance
±500 mV
Lead-off detection current
Measuring electrode: <0.1 ȝA
Drive electrode: <1 ȝA
Input offset current
”0.1 ȝA
Baseline recovery time
<5 s (after defibrillation)
Patient leakage current
<10 uA
Calibration signal
1mV (peak-to-peak value)
A-10
Cut mode: 300 W
Coagulate mode: 100 W
ESU protection
Recovery time: ”10 s
In compliance with the requirements in clause 4.2.9.14 of
ANSI/AAMI EC 13:2002
ESU noise suppression
Based on the test method in clause 5.2.9.14 of EC 13:2002, use
ECG lead wires which are in compliance with AAMI. Compared
with ECG baseline, the noise of peak to peak value ”2 mV.
Pace Pulse
Pace pulses meeting the following conditions are labelled with a
PACE marker:
Pace pulse markers
Amplitude:
±2 to ±700 mV
Width:
0.1 to 2 ms
Rise time:
10 to 100 μs
When tested in accordance with the ANSI/AAMI EC13-2002:
Sections 4.1.4.1 and 4.1.4.3, the heart rate meter rejects all
pulses meeting the following conditions.
Pace pulse rejection
Amplitude:
±2 to ±700 mV
Width:
0.1 to 2 ms
Rise time:
10 to 100 μs
Basic algorithm
HR
Measurement range
3-, 5-, and 12-lead
ECG
Neonate:
15 to 350 bpm
Pediatric:
15 to 350 bpm
Adult:
15 to 300 bpm
Resolution
1 bpm
Accuracy
3-, 5-, and 12-lead ECG: ±1 bpm or ±1%, whichever is greater.
Sensitivity
200ȝV (lead II)
In compliance with the requirements in Clause 4.1.2.1 d)of
ANSI/AAMI EC13-2002, the following method is used:
HR averaging method
If the last 3 consecutive RR intervals are greater than 1200 ms,
the 4 most recent RR intervals are averaged to compute the HR.
Otherwise, heart rate is computed by subtracting the maximum
and minimum ones from the most recent 12 RR intervals and
then averaging them.
The HR value displayed on the monitor screen is updated every
second.
Response to irregular rhythm
In compliance with the requirements in Clause 4.1.2.1 e)of
A-11
ANSI/AAMI EC13-2002, the heart rate after 20 seconds of
stabilization is displayed as follows:
Ventricular bigeminy (3a): -80±1 bpm
Slow alternating ventricular bigeminy (3b): -60±1 bpm
Rapid alternating ventricular bigeminy (3c): -120±1 bpm
Bidirectional systoles (3d): -90±2 bpm
Response time to heart rate
change
Meets the requirements of ANSI/AAMI EC13-2002: Section
4.1.2.1 f).
From 80 to 120 bpm: less than 11 s
From 80 to 40 bpm: less than 11 s
Meets the requirements of ANSI/AAMI EC13-2002: section
4.1.2.1 g).
Waveform
Time to alarm for tachycardia
(not available in USA)
Tall T-wave rejection
capability
Arrhythmia Analysis
Classifications
(Not available in USA)
4ah - range:
11 s
4a - range:
11 s
4ad - range:
11 s
Waveform 4bh - range:
11 s
4b - range:
11 s
4bd - range:
11 s
When the test is performed based on part 4.1.2.1 c)of
ANSI/AAMI EC 13-2002, the heart rate meter will reject all 100
ms QRS complexes with less than 1.2 mV of amplitude, and T
waves with T-wave interval of 180 ms and those with Q-T
interval of 350 ms.
Asystole, VFib/VTac, Couplet, Bigeminy, Trigeminy, R on T,
VT>2, PVC, Tachy, Brady, Missed Beats, PNP, PNC
ST Segment Analysis (Not available in USA)
Measurement range
Accuracy
Refreshing rate
-2.0 to 2.0 mV
-0.8 to 0.8 mV:
±0.02 mV or ±10%, whichever is greater.
Beyond this range:
Not specified.
10 s
A-12
Mortara algorithm
Only the differences from the Basic algorithm are listed.
HR
In compliance with the requirements in Clause 4.1.2.1 d)of
ANSI/AAMI EC13-2002, the following method is used:
HR averaging method
Heart rate is computed by averaging the most recent 16 RR
intervals, unless the HR by averaging the most recent 4 heart
beats is less than or equals to 48.
The HR value displayed on the monitor screen is updated every
second.
Meets the requirements of ANSI/AAMI EC13-2002: section
4.1.2.1 g).
Waveform
Time to alarm for tachycardia
Arrhythmia Analysis
Classifications
4ah – range:
11 s
4a – range:
11 s
4ad – range:
11 s
4bh – range:
11 s
4b – range:
11 s
4bd – range:
11 s
Asystole, Vfib, Vtac, Vent. Rhythm, Couplet, VT>2, Bigeminy,
Trigeminy, R on T, Multif. PVC, Irr. Rhythm, Tachy, Brady,
Missed Beats, PNP, PNC
ST Segment Analysis
Refreshing rate
per 16 heartbeats
A-13
A.5.2 Resp
Technique
Trans-thoracic impedance
Lead
Options are lead I and II. The default is lead II.
Respiration excitation
waveform
<300 μA, sinusoid, 62.8 kHz (±10%)
Respiration impedance range
0.3 to 5ȍ
Baseline impedance range
200 to 2500ȍ (using an ECG cable with 1kȍ resistance)
Differential input impedance
>2.5 Mȍ
Bandwidth
0.2 to 2 Hz (-3 dB)
Sweep speed
6.25 mm/s, 12.5 mm/s or 25 mm/s
Respiration Rate
Measurement range
Resolution
Accuracy
Adult:
0 to 120 rpm
Pediatric, neonate:
0 to 150 rpm
1 rpm
7 to 150 rpm:
±2 rpm or ±2%, whichever is greater
0 to 6 rpm:
Not specified.
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range (rpm)
RR High
Off, (low limit + 2) to 100
RR Low
Off, 0 to (high limit – 2)
A-14
Step (rpm)
1
A.5.3 SpO2
Alarm limit
Range (%)
SpO2 High
Off, (low limit + 1) to 100
SpO2 Low
Desat to (high limit – 1)
Desat
Step (%)
1
MPM, Masimo:
0 to (high limit – 1)
Nellcor:
20 to (high limit – 1)
MPM SpO2 Module
Standards
Meet standards of ISO9919
*Measurement accuracy verification: The SpO2 accuracy has been verified in human experiments
by comparing with arterial blood sample reference measured with a CO-oximeter. Pulse oximeter
measurement are statistically distributed and about two-thirds of the measurements are expected to
come within the specified accuracy range compared to CO-oximeter measurements.
Measurement range
0 to 100%
Resolution
1%
70 to 100%: ±2% (measured without motion in adult/pediatric
mode)
Accuracy
70 to 100%: ±3% (measured without motion in neonate mode)
70 to 100%: ±3% (measured with motion)
0% to 69%: Not specified.
*Studies were performed to validate the accuracy of Pulse Oximeter with neonatal SpO2 sensors
by contrast with a CO-Oximeter. Some neonates aged from 1 day to 30 days with a gestation age
of 22 weeks to full term were involved in this study. The statistical analysis of data of this study
shows the accuracy (Arms) is within the stated accuracy specification. Please see the following
table.
Sensor type
Totally neonates
Data
Arms
518B
97 (51 male & 46 female)
200 pairs
2.38%
520N
122 (65 male & 57 female)
200 pairs
2.88%
The Pulse Oximeter with neonatal SpO2 sensors was also validated on adult subjects.
Refreshing rate
1s
7 s (When the sensitivity is set to High)
SpO2 averaging time
9 s (When the sensitivity is set to Medium)
11 s (When the sensitivity is set to Low)
A-15
Masimo SpO2 Module
SpO2
Measurement range
1 to 100%
Resolution
1%
70 to 100%: ±2% (measured without motion in adult/pediatric
mode)
Accuracy
70 to 100%: ±3% (measured without motion in neonate mode)
70 to 100%: ±3% (measured with motion)
0% to 69%: Not specified.
Refreshing rate
1s
SpO2 averaging time
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
Low perfusion conditions
Low perfusion SpO2 accuracy
Pulse amplitude: >0.02%
Light penetration: >5%
±2%
Nellcor SpO2 Module
Parameter
SpO2 measurement range and
accuracy
Specifications
Sensor
Range
Precision*
MAX-A, MAX-AL, MAX-N
70 to 100%
±2%
MAX-P, MAX-I, MAX-FAST
0% to 69%
Not specified.
OxiCliq A, OxiCliq N
70 to 100%
±2.5%
OxiCliq P, OxiCliq I
0% to 69%
Not specified.
D-YS, DS-100A, OXI-A/N,
OXI-P/I
70 to 100%
±3%
0% to 69%
Not specified.
70 to 100%
±3.5%
0% to 69%
Not specified.
MAX-R, D-YSE, D-YSPD
Refreshing rate
1s
*: When the SpO2 sensor is applied for neonatal patients as indicated, the specified accuracy range
is increased by ±1%, to compensate for the theoretical effect on oximeter measurements of fetal
hemoglobin in neonatal blood.
A-16
A.5.4 PR
Alarm limit
Range (bpm)
PR High
Off, (low limit +2) to 300
PR Low
Off, 15 to (high limit-2)
Step (bpm)
1
PR from MPM SpO2 Module
Measurement range
20 to 254 bpm
Resolution
1 bpm
Accuracy
Refreshing rate
±3 bpm (measured without motion)
±5 bpm (measured with motion)
1s
7 s (when sensitivity is set to High)
SPO2 averaging time
9 s (when sensitivity is set to Medium)
11 s (when sensitivity is set to Low)
PR from Masimo SpO2 Module
Measurement range
25 to 240 bpm
Resolution
1 bpm
Accuracy
±3 bpm (measured without motion)
±5 bpm (measured with motion)
Refreshing rate
1s
SPO2 averaging time
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
Low perfusion conditions
Low perfusion PR accuracy
Pulse amplitude: >0.02%
Light penetration: >5%
±3 bpm
PR from Nellcor SpO2 Module
Measurement range
20 to 300 bpm
Resolution
1 bpm
Accuracy
Refreshing rate
20 to 250 bpm: ±3 bpm
251 to 300 bpm, not specified
1s
A-17
PR from IBP Module
Measurement range
25 to 350 bpm
Resolution
1 bpm
Accuracy
Refreshing rate
25 to 200 bpm: ±1 bpm or ±1%, which is greater
201 to 350 bpm: ±2%
1s
A.5.5 NIBP
Standards
Meet standards of EN60601-2-30/IEC60601-2-30, EN1060-1,
EN1060-3,EN1060-4 and SP10
Technique
Oscillometry
Mode of operation
Manual, Auto and STAT
Auto mode repetition intervals
1, 2, 2.5, 3, 5, 10, 15, 20, 30, 60, 90, 120, 180, 240 or 480 min
STAT mode cycle time
5 min
Max measurement time
Heart rate range
Adult, pediatric:
180 s
Neonate:
90 s
40 to 240 bpm
Adult
Pediatric
Neonate
Measurement ranges
Systolic:
40 to 270
40 to 200
40 to 135
(mmHg)
Diastolic:
10 to 210
10 to 150
10 to 100
Mean:
20 to 230
20 to 165
20 to 110
Accuracy
Resolution
Initial cuff inflation pressure
range (mmHg)
Default initial cuff inflation
pressure (mmHg)
Software overpressure
protection
Max mean error: r5 mmHg
Max standard deviation: 8 mmHg
1mmHg
Adult:
80 to 280
Pediatric:
80 to 210
Neonate:
60 to 140
Adult:
160
Pediatric:
140
Neonate:
90
Adult:
297±3 mmHg
Pediatric:
240±3 mmHg
Neonate:
147±3 mmHg
PR
Measurement range
40 to 240 bpm
Resolution
1 bpm
Accuracy
±3bpm or ±3%, whichever is greater
A-18
Alarm limit
Range (mmHg)
Step (mmHg)
Adult: Off, (low limit+5) to 270
Sys High
Pediatric: Off, (low limit+5) to 200
Neonate: Off, (low limit+5) to 135
Sys Low
Off, 40 to (high limit-5)
Adult: Off, (low limit+5) to 230
Mean High
Pediatric: Off, (low limit+5) to 165
Neonate: Off, (low limit+5) to 110
Mean Low
5
Off, 20 to (high limit-5)
Adult: Off, (low limit+5) to 210
Dia High
Pediatric: Off, (low limit+5) to 150
Neonate: Off, (low limit+5) to 100
Dia Low
Off, 10 to (high limit-5)
*Measurement accuracy verification: In adult and pediatric modes, the blood pressure
measurements measured with this device are in compliance with the American National Standard
for Electronic or Automated Sphymomanometers (ANSI/AAMI SP10-1992) in terms of mean
error and stardard deviation by comparing with intra-arterial or auscultatory measurements
(depending on the configuration) in a typical patient population. For auscultatory reference, the
5th Korotkoff sound was used to determine the diastolic pressure.
In neonatal mode, the blood pressure measurements measured with this device are in compliance
with the American National Standard for Electronic or Automated Sphymomanometers
(ANSI/AAMI SP10-1992 and AAMI/ANSI SP10A-1996) in terms of mean error and stardard
deviation by comparing with intra-arterial measurements (depending on the configuration) in a
typical patient population.
A.5.6 Temp
Standards
Meet standard of EN12470-4
Technique
Thermal resistance
Measurement range
0 to 50 qC (32 to 122 qF)
Resolution
0.1 qC
Accuracy
±0.1 qC or ±0.2 qF (without probe)
Refreshing rate
1s
Minimum time for accurate
measurement
Body surface: <100 s
Body cavity: <80 s
A-19
Alarm limit
Range
Step
Off, (low limit +1) to 50.0 qC
T1/T2 High
Off, (low limit +1.8) to 122 qF
T1/T2 Low
Off, 0.1 to (high limit -1) qC
0.1 qC
Off, 32 to (high limit -1.8) qF
0.1 qF
Off, 0.1 to 50.0 qC
TD High
Off, 0.2 to 90 qF
A.5.7 IBP
Standards
Meet standard of EN60601-2-34/IEC60601-2-34.
Technique
Direct invasive measurement
IBP
Measurement range
-50 to 300 mmHg
Resolution
1 mmHg
Accuracy
±2% or ±1 mmHg, whichever is greater (without sensor)
Refreshing rate
1s
Pressure transducer
Excitement voltage
5 VDC, ±2%
Sensitivity
5 ȝV/V/mmHg
Impedance range
300 to 3000ȍ
Volume displacement
(ABBOTT)
<0.04 mm3 /100 mmHg
Alarm limit
Range (mmHg)
ART
Sys High
Ao
Mean High
FAP
Dia High
BAP
Step (mmHg)
(low limit + 2) to 300
1
Sys Low
UAP
LV
Mean Low
0 to (high limit – 2)
Dia Low
PA
1
Sys High
Mean High
(low limit + 2) to 120
Dia High
A-20
Sys Low
-6 to (high limit – 2)
Mean Low
Dia Low
CVP, LAP
Mean High
(low limit + 2) to 40
RAP, ICP
Mean Low
-10 to (high limit – 2)
P1 to P8
Sys High
1
(low limit + 2) to 300
Mean High
Dia High
1
Sys Low
-50 to (high limit – 2)
Mean Low
Dia Low
A.5.8 C.O.
Measurement method
Measurement range
Resolution
Accuracy
Thermodilution method
C.O.:
0.1 to 20 L/min
BT:
23 to 43°C
IT:
0 to 27°C
C.O.:
0.1 L/min
BT, IT:
0.1°C
C.O.:
±5% or ±0.1 L /min, whichever is greater, as
measured using electronically generated flow
curves.
BT, IT:
±0.1°C (without sensor)
Alarm range
BT:
23 to 43°C
Repeatability
C.O.:
±2% or ±0.1 L/min, whichever is greater, as
measured using electronically generated flow
curves.
Alarm limit
Range
BT High
BT Low
Step
(low limit + 1) to 43 °C
(low limit + 1.8) to 109.4 °F
0.1 °C
23 to (high limit - 1) °C
0.1 °F
73.4 to (high limit - 1.8) °F
A-21
A.5.9 CO2
Measurement mode
Sidestream, microstream, mainstream
Technique
Infrared absorption
Sidestream CO2 Module
Standard
Meet standard of ISO 21647
CO2 Measurement range
0 to 99 mmHg
Accuracy*
0 to 40 mmHg:
±2 mmHg
41 to 76 mmHg:
±5% of the reading
77 to 99 mmHg:
±10% of the reading
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Resolution
1 mmHg
Sample flowrate
70 ml/min, 100 ml/min
Sample flowrate tolerance
15% or 15 ml/min, whichever is greater.
Warm-up time
Response time
<1 min, enter the iso accuracy mode
After 1 min, enters the full accuracy mode,
Measured with a neonatal watertrap and a 2.5-meter neonatal
sampling line:
<3.5 s @ 100 ml/min
<4 s @ 70 ml/min
Measured with a neonatal watertrap and a 2.5-meter adult
sampling line:
<5.5 s @ 100 ml/min
<7 s @ 70 ml/min
Gas sampling delay time
Measured with a neonatal watertrap and a 2.5-meter neonatal
sampling line:
<3 s @ 100 ml/min
<3.5 s @ 70 ml/min
Measured with a neonatal watertrap and a 2.5-meter adult
sampling line:
<5 s @ 100 ml/min
<6.5 s @ 70 ml/min
awRR measurement range
awRR measurement precision
Apnea time
0 to 120 rpm
0 to 70 rpm:
±2 rpm
71 to 120 rpm:
±5 rpm
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
A-22
Effect of interference gases on CO2 measurements
Gas
Concentration (%)
N2O
”60
Hal
”4
Sev
”5
Iso
”5
Enf
”5
Des
”15
Quantitive effect*
±1 mmHg
±2 mmHg
*: means an extra error should be added in case of gas interference when CO2 measurements are
performed under 0-40mmHg.
Alarm limit
Range
Step
EtCO2 High
Off, (low limit + 2) to 99 mmHg
EtCO2 Low
Off, 1 to (high limit - 2)mmHg
FiCO2 High
Off, 1 to 99 mmHg
awRR High
Off, (low limit + 2) to 100 rpm
awRR Low
Off, 0 to (high limit - 2) rpm
1 mmHg
1 rpm
* Accuracy applies for the following conditions:
1.
Measurements begin after the CO2 module warms up;
2.
Ambient pressure is from 750 to 760 mmHg, and ambient temperature from 22 to 28ºC;
3.
The measured gas is a dry gas and the balance gas N2;
4.
Gas sample flow rate is 100 ml/min, respiration rate is 50 rpm with a fluctuation
between ±3 rpm, and I:E is 1:2.
When the operating temperature (near the module detector) is 15-25°C or 50-55°C, or the
respiration rate is greater than 50 rpm, the measurement accuracy is: ±4 mmHg (0 to 40
mmHg) or 12% of the reading (41 to 99 mmHg).
A-23
Microstream CO2 Module
Standard
Meet standard of ISO 21647
CO2 Measurement range
0 to 99 mmHg
0 to 38 mmHg:
±2 mmHg
Accuracy*
39 to 99 mmHg:
±5% of the reading+0.08% of (the
reading-38)
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
* Accuracy applies for respiration rate up to 80 rpm. For respiration rate above 80 rpm, the
accuracy is 4 mmHg or ±12% of the reading, whichever is greater. for EtCO2 exceeding 18
mmHg. For respiration rate above 60 rpm, the above accuracy can be achieved by using the
CapnoLine H Set for Infant/Neonatal. In the presence of interfering gases, the above accuracy is
maintained to within 4%.
Resolution
1 mmHg
Sample flow rate
507.5
15 ml/min
Initialization time
30 s (typical)
2.9 s (typical)
Response time
(The response time is the sum of the rise time and the delay time
when using a FilterLine of standard length)
Rise time: <190 ms (10% to 90%)
Delay time: 2.7 s (typical)
awRR measurement range
awRR measurement accuracy
0 to 150 rpm
0 to 70 rpm:
±1 rpm
71 to 120 rpm:
±2 rpm
121 to 150 rpm:
±3 rpm
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range
EtCO2 High
Off, (low limit + 2) to 99 mmHg
EtCO2 Low
Off, 1 to (high limit - 2)mmHg
FiCO2 High
Off, 1 to 99 mmHg
awRR High
Off, (low limit + 2) to 100 rpm
awRR Low
Off, 0 to (high limit - 2) rpm
Step
A-24
1 mmHg
1 rpm
Mainstream CO2 Module
Standard
Meet standard of ISO 21647
CO2 Measurement range
0 to 150 mmHg
Accuracy
0 to 40 mmHg:
±2 mmHg
41 to 70 mmHg:
±5% of the reading
71 to 100 mmHg:
±8% of the reading
101 to 150 mmHg:
±10% of the reading
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Resolution
1 mmHg
Response time
<60 ms
awRR measurement range
0 to 150 rpm
awRR measurement accuracy
1 rpm
Alarm limit
Range
EtCO2 High
Off, (low limit + 2) to 99 mmHg
EtCO2 Low
Off, 1 to (high limit - 2)mmHg
FiCO2 High
Off, 1 to 99 mmHg
awRR High
Off, (low limit + 2) to 100 rpm
awRR Low
Off, 0 to (high limit - 2) rpm
Step
A-25
1 mmHg
1 rpm
A.5.10 AG
Standards
Meet standard of ISO 21647
Technique
Infrared absorption
Warm-up time
Sample flow rate
Measurement range
Resolution
Iso accuracy
Full accuracy
Iso accuracy mode:
45 s
Full accuracy mode:
10 min
Adult, pediatric:
120, 150, 200 ml/min
Neonate:
70, 90, 120 ml/min
Accuracy:
±10 ml/min or ±10%, whichever is greater
CO2:
0 to 30%
O2:
0 to 100%
N2O:
0 to 100%
Des:
0 to 30%
Sev:
0 to 30%
Enf:
0 to 30%
Iso:
0 to 30%
Hal:
0 to 30%
awRR:
2 to 100 rpm
CO2:
1 mmHg
awRR:
1 rpm
CO2:
±0.3%ABS
N2O:
±(8%REL+2%ABS)
Other anesthetic gases:
8%REL
Gases
Range (%REL)
Accuracy (%ABS)
0 to 1
±0.1
1 to 5
±0.2
5 to 7
±0.3
7 to 10
±0.5
>10
Not specified
0 to 20
±2
20 to 100
±3
0 to 25
±1
25 to 80
±2
80 to 100
±3
CO2
N2O
O2
A-26
Des
Sev
Enf, Iso, Hal
awRR
0 to 1
±0.15
1 to 5
±0.2
5 to 10
±0.4
10 to 15
±0.6
15 to 18
±1
>18
Not specified
0 to 1
±0.15
1 to 5
±0.2
5 to 8
±0.4
>8
Not specified
0 to 1
±0.15
1 to 5
±0.2
>5
Not specified
2 to 60 rpm
±1 rpm
>60 rpm
Not specified
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Refreshing rate
1s
gas sample flow rate 120ml/min, using the DRYLINE™ watertrap and
neonatal DRYLINE™ sampling line (2.5m):
CO2
”250 ms (fall time: 200ms)
N2O
”250 ms
O2
”600 ms
Hal, Iso, Sev, Des
”300 ms
Rise time
Enf
”350 ms
(10 % ~ 90%)
gas sample flow rate 200ml/min, using the DRYLINE™ water trap and
adult DRYLINE™ sampling line (2.5m):
Delay time
CO2
”250 ms (fall time: 200 ms)
N2O
”250 ms
O2
”500 ms
Hal, Iso, Sev, Des
”300 ms
Enf
”350 ms
<4 s
Primary anesthetic agent
In full accuracy mode: 0.15%,
Anesthetic agent limit
In ISO accuracy mode: 0.4%
Second anesthetic agent:
In full accuracy mode: 0.3% or 5% REL (10% in ISO accuracy mode) of
A-27
primary agent if primary agent is greater than 10%
In ISO accuracy mode: 0.5%
Effect of interference gases on AG measurements
Quantitive effect(%ABS)3)
Gas
Concentration(%)
CO2
N2O
Agent 1)
O2
/
/
0.1
0
0.2
/
0.1
/
0.1
0.2
/
0.1
0.1
0.1
1
Xenon
<100%
0.1
0
0
0.5
Helium
<50%
0.1
0
0
0.5
Ethanol
<0.1%
0
0
0
0.5
Acetone
<1%
0.1
0.1
0
0.5
Methane
<1%
0.1
0.1
0
0.5
Saturated Isopropanol
vapour
/
0.1
0
0
0.5
Metered dose inhaler
propellants,
/
Unspecified
Unspecified
Unspecified
0.5
CO2
N2O
Agent
1) 2)
1) Agent represents one of Des, Iso, Enf, Sev, and Hal.
2) Multiple agent interference on CO2, N2O and O2 is typically the same as single agent
interference.
3) For CO2, N2O and Agents, maximum interference from each gas at concentrations within
specified accuracy ranges for each gas. The total interference of all gases is never larger than
5%REL.
A-28
Alarm limit
Range
Step
EtCO2 High
Off, (low limit + 2) to 99 mmHg
EtCO2 Low
Off, 1 to (high limit - 2)mmHg
FiCO2 High
Off, 1 to 99 mmHg
awRR High
Off, (low limit + 2) to 100 rpm
awRR Low
Off, 0 to (high limit - 2)rpm
EtO2 High
Off, (low limit + 2) to 100 %
EtO2 Low
Off, 18 to (high limit - 2)%
FiO2 High
Off, (low limit + 2) to 100 %
FiO2 Low
Off, 18 to (high limit - 2)%
EtN2O High
Off, (low limit + 2) to 100 %
EtN2O Low
Off, 0 to (high limit - 2)%
FiN2O High
Off, (low limit + 2) to 100 %
FiN2O Low
Off, 0 to (high limit - 2)%
EtHal/Enf/Iso High
Off, (low limit + 0.2) to 5.0 %
EtHal/Enf/Iso Low
Off, 0 to (high limit - 0.2)%
FiHal/Enf/Iso High
Off, (low limit + 0.2) to 5.0 %
FiHal/Enf/Iso Low
Off, 0 to (high limit - 0.2)%
EtSev High
Off, (low limit + 0.2) to 8.0 %
EtSev Low
Off, 0 to (high limit - 0.2)%
FiSev High
Off, (low limit + 0.2) to 8.0 %
FiSev Low
Off, 0 to (high limit - 0.2)%
EtDes High
Off, (low limit + 0.2) to 18.0 %
EtDes Low
Off, 0 to (high limit - 0.2)%
FiDes High
Off, (low limit + 0.2) to 18.0 %
FiDes Low
Off, 0 to (high limit - 0.2)%
A-29
1 mmHg
1 rpm
1%
1%
0.1%
0.1%
0.1%
A.5.11 ICG
Technique
Measurement range
Accuracy
Thoracic electrical bioimpedance (TEB)
SV:
5 to 250 ml/beat
HR:
44 to 185 bpm
C.O.:
1.4 to 15 L/min
SV:
Not specified.
HR:
±2 bpm
C.O.:
Not specified.
Alarm limit
Range
Step
C.I. High
(low limit + 1.0) to 15.0
L/min/m2
C.I. Low
0.0 to (high limit 1.0)L/min/m2
TFC High
(low limit + 1) to 150 /kȍ
TFC Low
10 to (high limit - 1)/kȍ
0.1 L/min/m2
1 /kȍ
A.5.12 BIS
Standards
Meet standard of IEC 60601-2-26
Technique
Bispectral index
Measured parameters
Calculated parameters
EEG
BIS: 0 to 100
SQI: 0 to 100%
EMG, SR, SEF, TP
Impedance range
0 to 999 kȍ
Sweep speed
6.25 mm/s, 12.5 mm/s, 25 mm/s or 50 mm/s
Input impedance
>5 Mȍ
Noise (RTI)
<0.3 μV (0.25 to 50 Hz)
Input signal range
±1 mV
EEG bandwidth
0.25 to 100 Hz
Patient leakage current
<10 μA
Alarm limit
Range
BIS High
(low limit + 2) to 100
BIS Low
0 to (high limit – 2)
Step
1
A-30
A.5.13 RM
Technique
Flow sensor
Frequency response
•30 Hz
Dead space
”11 ml
Flow
Measurement range
Accuracy
Resolution
Adult/pediatric*:
± (2 to 120) L/min
Infant:
± (0.5 to 30) L/min
Adult/pediatric*:
1.5 L/min or ±10% of the reading, whichever is greater
Infant:
0.5 L/min or ±10% of the reading, whichever is greater
0.1 L/min
Paw
Measurement range
-20 to 120 cmH2O
Accuracy
±3%
Resolution
0.1 cmH2O
MVe/MVi
Measurement range
Accuracy
Adult/Pediatric*:
2 to 60 L/min
Infant:
0.5 to 15 L/min
±10%×reading
TVe/TVi
Measurement range
Resolution
Accuracy
Adult/Pediatric*:
100 to 1500 ml
Infant:
20 to 500 ml
1 ml
Adult/pediatric*:
±10% or 15 ml, whichever is greater
Infant:
±10% or 6 ml, whichever is greater
RR (RM)
Measurement range
Accuracy
4 to 120 rpm
4 to 99 rpm
±1 rpm
100 to 120 rpm
±2 rpm
*Pediatric in this form does not include neonate and infant.
A-31
Calculated Parameters
Measurement range
Measurement accuracy
I:E
4:1 to 1:8
Not specified.
FEV1.0%
0 to 100%
Not specified.
Pmean
0 to 120 cmH2O
±10%×reading
Adult/pediatric:
±10% or ±25 ml,
whichever is greater.
TV
20 to 1500 ml
MV
2 to 60 L
±10%×reading
PEEP
0 to 120 cmH2O
Not specified.
PEF
2 to 120 L/min
±2L/min or ±10% of reading, whichever is
greater.
PIF
2 to 120 L/min
±2L/min or ±10% of reading, whichever is
greater.
PIP
0 to 120 cmH2O
1cmH2O or ±10% of reading, whichever is
greater.
Pplat
0 to 120 cmH2O
Compl
0 to 200 ml/cmH2O
RSBI
0 to 4095 rpm/L
Alarm limit
Range
RR High
(low limit +2) to 100 rpm
RR Low
0 to (high limit -2) rpm
PEEP High
(low limit +1) to 120 cmH2O
PEEP Low
0 to (high limit -1) cmH2O
PIP High
(low limit +1) to 120 cmH2O
PIP Low
0 to (high limit -1) cmH2O
MVe High
MVe Low
Infant:
±10% or ±6 ml,
whichever is greater.
Not specified.
Step
1 rpm
1 cmH2O
1 cmH2O
Adult and pediatric: (low limit +1.0) to 60.0 L/min
Infant:(low limit +1.0) to 15.0
Adult and pediatric: 2.0 to (high limit -1.0)
Infant:0.5 to (high limit -1.0)
A-32
0.5 L/min
A.5.14 CCO
Operating mode
Interfaces with Edwards Vigilance II monitor
Measured parameter
Consistent with CCO-related parameters outputted by Vigilance
II monitor
Parameter alarm
CCO/CCI,EDV/EDVI,SVR/SVRI,SV/SVI,RVEF
Signal Outputs
Standard
Meets the requirements of EN 60601-1 for short-circuit
protection and leakage current
Output impedance
1000ȍ
Isolation voltage
1500 VAC
ECG Analog Output
Bandwidth (-3dB; reference
frequency: 10Hz)
DC to 150Hz
Sensitivity
2V/mV ±5%
MAP Analog Signal Output
Output voltage
0 to 5V (0 to 500mmHg)
Output voltage error
±5%
CVP Analog Signal Output
Output voltage
0 to 5V (0 to 100mmHg)
Output voltage error
±5%
A-33
CCO-related Parameters Outputted by Vigilance II Monitor
Name
Range
Resolution
CCO
1 to 20 L/min
0.1
CCI
0 to 20 L/min/m2
0.1
CO
1 to 20 L/min
0.1
CI
0 to 20 L/min/m2
0.1
EDV
40 to 800 ml
1
EDVI
20 to 400 ml/m2
1
SVR
0 to 3000 DS/cm5
1
SVRI
0 to 6000 DS·m2/cm5
1
SV
0 to 300 ml/beat
1
SVI
0 to 200 ml/beat/m2
1
BT
25 to 45 ć
0.1
RVEF
10 to 60%
1
ESV
10 to 700 ml
1
ESVI
5 to 400 ml/m2
1
HRavg
30 to 250 bpm
1
CVP
0 to 100 mmHg
1
MAP
0 to 500 mmHg
1
Alarm Limit
Range
CCO High
(Low limit+0.1) to 20 L/min
CCO Low
0 to(high limit-0.1)L/min
CCI High
(Low limit+0.1) to 20 L/min/m2
Step
0.1 L/min
2
CCI Low
0 to(high limit-0.1)L/min/m
EDV High
(Low limit+10)to 800 ml
EDV Low
0 to (high limit-10)ml
EDVI High
(Low limit+10) to 400 ml/m2
EDVI Low
0 to (high limit-10)ml/m2
SVR High
SVR Low
SVRI High
0.1 L/min/m2
10 ml
10 ml/m2
(Low limit+20) to 5000 DS/cm5
or (low limit+2) to 500 kPa-s/l
20 DS/cm5
0 to (high limit-20)DS/cm5
or2 kPa-s/l
or 0 to (high limit-2)kPa-s/l
(Low limit+50) to 9950 DS·m2/cm5
50 DS·m2/cm5
or(low limit+5) to 995 kPa-s-m2/l
or 5 kPa-s-m2/l
A-34
SVRI Low
0 to(high limit-50)DS·m2/cm5
or 0 to(high limit-5)kPa-s-m2/l
SV High
(Low limit+5) to 300 ml/b
SV Low
0 to (high limit-5)ml/b
SVI High
(Low limit+5) to 200 ml/b/m2
SVI Low
0 to(high limit-5)ml/b/m2
RVEF High
(Low limit+5) to 100 %
RVEF Low
0 to(High limit-5)%
5 ml/b
5 ml/b/m2
5%
A.5.15 SvO2
Operating mode
Interfaces with Edwards Vigilance II monitors
Measured parameter
Consistent with SvO2-related parameters outputted by Vigilance
monitors
Parameter alarm
SvO2,ScvO2
Signal Output
Standard
Meets the requirements of EN 60601-1 for short-circuit
protection and leakage current
Output impedance
1000ȍ
Isolation voltage
1500 VAC
SpO2 Analog Signal Output
Output voltage
0 to 10V (0 to 100%)
Output voltage error
±5%
A-35
SvO2-related Parameters Outputted by Vigilance II Monitor
Name
Measurement Range
Resolution
SaO2
40 to 100%
1
VO2
0 to 999 ml/min
1
O2EI
0.0 to 99.9%
0.1
SNR
-10 to +20 dB
0.1
DO2
0 to 2000 ml/min
1
SvO2
10 to 99%
1
ScvO2
10 to 99%
1
SQI
1 to 4
1
Alarm Limit
Range (%)
SvO2 / ScvO2 High
(Low limit+0.1)to 99
SvO2 / ScvO2 Low
0 to(high limit-0.1)
Step (%)
1
A-36
B EMC and Radio Regulatory Compliance
B.1 EMC
The product is in radio-interference protection class A in accordance with CISPR11. The product
complies with the requirement of standard IEC 60601-1-2:2007 “Electromagnetic Compatibility –
Medical Electrical Equipment”.
Note

Using accessories, transducers and cables other than those specified may result in
increased electromagnetic emission or decreased electromagnetic immunity of the
patient monitoring equipment.

The device or its components should not be used adjacent to or stacked with other
equipment. If adjacent or stacked use is necessary, the device or its components
should be observed to verify normal operation in the configuration in which it will
be used.

The device needs special precautions regarding EMC and needs to be installed and
put into service according to the EMC information provided below.

Other devices may affect this monitor even though they meet the requirements of
CISPR.

When the inputted signal is below the minimum amplitude provided in technical
specifications, erroneous measurements could result.

Portable and mobile communication equipment may affect the performance of this
monitor.

Other devices that have RF transmitter or source may affect this device (e.g. cell
phones, PDAs, PCs with wireless function).
Guidance and Declaration - Electromagnetic Emissions
The device is suitable for use in the electromagnetic environment specified below. The customer
or the user of the device should assure that it is used in such an environment.
Emission tests
Compliance
Electromagnetic environment - guidance
Radio frequency (RF)
emissions CISPR 11
Group 1
The device uses RF energy only for its internal
function. Therefore, its RF emissions are very low and
B-1
are not likely to cause any interference in nearby
electronic equipment.
RF emissions CISPR 11
Class A
Harmonic emissions
IEC61000-3-2
Class A
Voltage
Fluctuations/Flicker
Emissions IEC
61000-3-3
Complies
The device is suitable for use in all establishments
other than domestic and those indirectly connected to
the public low-voltage power supply network that
supplies buildings used for domestic purposes.
Guidance and Declaration - Electromagnetic Immunity
The device is suitable for use in the electromagnetic environment specified below. The customer
or the user of the device should assure that it is used in such an environment.
Electromagnetic
environment - guidance
Immunity test
IEC60601 test level
Compliance level
Electrostatic
discharge (ESD)
IEC 61000-4-2
±6 kV contact
±8 kV air
±6 kV contact
±8 kV air
Floors should be wood,
concrete or ceramic tile. If
floors are covered with
synthetic material, the
relative humidity should be
at least 30%.
Electrical fast
transient/burst
IEC 61000-4-4
±2 kV for power
supply lines
±1 kV I/O for
input/output lines
(>3 m)
±2 kV for power
supply lines
±1 kV I/O for
input/output lines
(>3 m)
Mains power quality should
be that of a typical
commercial or hospital
environment.
Surge IEC
61000-4-5
±1 kV differential
mode
±2 kV common mode
±1 kV differential
mode
±2 kV common mode
Voltage dips,
short
interruptions and
voltage variations
on power supply
input lines IEC
61000-4-11
<5 % UT (>95 % dip
in UT) for 0.5 cycle
<5 % UT (>95 % dip
in UT) for 0.5 cycle
40 % UT (60 % dip in
UT) for 5 cycles
40 % UT (60 % dip in
UT) for 5 cycles
70 % UT (30 % dip in
UT) for 25 cycles
70 % UT (30 % dip in
UT) for 25 cycles
<5 % UT (>95 % dip
in UT) for 5 s
<5 % UT (>95 % dip
in UT) for 5 s
B-2
Mains power quality should
be that of a typical
commercial or hospital
environment. If the user of
our product requires
continued operation during
power mains interruptions,
it is recommended that our
product be powered from
an uninterruptible power
supply or a battery.
Power frequency
(50/60 HZ)
magnetic field
IEC 61000-4-8
3 A/m
3 A/m
Power frequency magnetic
fields should be at levels
characteristic of a typical
location in a typical
commercial or hospital
environment.
Note: UT is the AC mains voltage prior to application of the test level.
Guidance and Declaration - Electromagnetic Immunity
The device is suitable for use in the electromagnetic environment specified below. The customer
or the user of the device should assure that it is used in such an environment.
Immunity test
IEC 60601 Test level
Compliance level
Conduced RF IEC61000-4-6
3 Vrms
150k to 80M Hz
3 Vrms
(BIS, ICG: 1Vrms)
Radiated RF IEC61000-4-3
3V/m
80M to 2.5G Hz
3V/m
(Resp: 1V/m)
Electromagnetic environment - guidance
Portable and mobile RF communications equipment should be used no closer to any part of the
device, including cables, than the recommended separation distance calculated from the equation
applicable to the frequency of the transmitter.
Recommended Separation Distance:
d  1.2 P (BIS, ICG: d  3.5 P )
d  1.2 P (Resp: d  3.5 P ) 80 to 800 MHz
d  2.3 P 800M to 2.5GHz
where P is the maximum output power rating of the transmitter in watts (W) according to the
transmitter manufacturer and d is the recommended separation distance in meters (m).
Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, a
should be less than the compliance level in each frequency range b Interference may occur in the
vicinity of equipment marked with the following symbol:
.
Note 1: From 80 MHz to 800 MHz, the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected
by absorption and reflection from structures, objects and people.
Note 3: The device that intentionally receives RF electromagnetic energy at the exclusion band
(2409.5MHz-2464.5MHz) is exempt from the wireless performance requirements, but remains
safe.
B-3
a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless)
telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast
cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to
fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field
strength in the location in which the device is used exceeds the applicable RF compliance level
above, the device should be observed to verify normal operation. If abnormal performance is
observed, additional measures may be necessary, such as reorienting or relocating the device.
b Over the frequency ranges 150kHz to 80MHz, field strengths should be less than 3V/m. For BIS
and ICG monitoring, the field strength should be less than 1V/m.
WARNING

The device is configured with a wireless network connector to receive wireless
signal. Other devices may interfere with this device even though they meet the
requirements of CISPR.
Recommended Separation Distances between Portable and Mobile RF
Communications Equipment and The device
The device is suitable for use in an electromagnetic environment in which radiated RF disturbance
are controlled. The customer or the user of the device can help prevent electromagnetic
interference by maintaining a minimum distance between portable and mobile RF communications
equipment (transmitters) and the device as recommended below, according to the maximum output
power of the communication equipment.
Rated Maximum Output
power of Transmitter
Watts (W)
Separation Distance Meters (m) Corresponding to Frequency of
Transmitter
800M to 2.5GHz
150k to 80MHz
80M to 800MHz
d  3.5 P
d  3.5 P
7
d  P
3
0.01
0.35
0.35
0.23
0.1
1.11
1.11
0.74
1
3.5
3.5
2.34
10
11.07
11.07
7.38
100
35
35
23.34
B-4
For transmitters at a maximum output power not listed above, the separation distance can be
estimated using the equation in the corresponding column, where P is the maximum output power
rating of the transmitter in watts (W) according to the transmitter manufacturer.
Note 1: From 80 MHz to 800 MHz, the separation distance for the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected
by absorption and reflection from structures, objects and people.
B.2 Radio Regulatory Compliance
RF parameter
Description
Item
IEEE 802.11b
IEEE 802.11g
IEEE 802.11n (20M)
Operating Frequency
Band (MHz)
2412-2462
2412-2462
Modulation
DSSS
OFDM-CCK
OFDM
Operating channel
1-11
1-11
1-11
Transmitter Output
Power (dBm)
<30
<30
<30
2412-2462
FCC ID: N6C-SDMAN
IC: 4908B-SDMAN
NOTICE
Federal Communication Interference Statement (United States only)
The wireless module of this equipment has been tested and found to comply with the limits for a class B
digital device, pursuant to Part 15 of the FCC rules. These limits are designed to provide reasonable protection
against harmful interference in a residential installation. This equipment generates, uses, and can
radiate radio frequency energy and, if not installed and used in accordance with the instructions, may
cause harmful interference to radio communications. However, there is no guarantee that interference
will not occur in a particular installation. If this equipment does cause harmful interference to radio or
television reception, which can be determined by turning the equipment off and on, the user is
encouraged to try to correct the interference by one or more of the following measures:

Re-orient or relocate the receiving antenna

Increase the separation between the equipment and receiver

Connect the equipment to an outlet on a circuit different from that to which the receiver is
connected

Consult the dealer or an experienced radio/TV technician for help
B-5
This device and its antenna(s) must not be co-located or operation in conjunction with any other
antenna or transmitter.
Canadian Depertment of Communications Industry Canada Notice (Canada only)
This Class B digital apparatus complies with Canadian ICES-003.
Cet appareil numérique de la classe B est conforme à la norme NMB-003 du Canada.
FCC Rules, Part 15./Industry Canadian
This device complies with Part 15 of FCC Rules and Industry Canada licence-exempt RSS standard(s).
Operation is subject to the following two conditions:

This device may not cause harmful interference, and

This device must accept any interference, including interference that may cause undesired
operation of this device.
Le présent appareil est conforme aux la partie 15 des règles de la FCC et CNR d'Industrie Canada
applicables aux appareils radio exempts de licence. L'exploitation est autorisée aux deux conditions
suivantes :

l'appareil ne doit pas produire de brouillage, et

l'utilisateur de l'appareil doit accepter tout brouillage radioélectrique subi, même si le
brouillage est susceptible d'en compromettre le fonctionnement.
This equipment complies with FCC/IC radiation exposure limits set forth for an uncontrolled
environment and meets the FCC radio frequency (RF) Exposure Guidelines in Supplement C to
OET65 and RSS-102 of the IC radio frequency (RF) Exposure rules. This equipment should be
installed and operated keeping the radiator at least 20cm or more away from person’s body (excluding
extremities: hands, wrists, feet and ankles).
Cet équipement est conforme aux limites d’exposition aux rayonnements énoncées pour un
environnement non contrôlé et respecte les règles les radioélectriques (RF) de la FCC lignes
directrices d'exposition dans le Supplément C à OET65 et d’exposition aux fréquences
radioélectriques (RF) CNR-102 de l’IC. Cet équipement doit être installé et utilisé en gardant une
distance de 20 cm ou plus entre le dispositif rayonnant et le corps (à l’exception des extrémités : mains,
poignets, pieds et chevilles).
WARNING

Keep a distance of at least 20cm away from the monitor when Wi-Fi function is in
use.
B-6
C Factory Defaults
This section lists the most important factory default settings. These settings are not
user-adjustable. You can restore the factory default settings if necessary.
C.1 Patient Demographics
Patient Demographics
Factory Default Settings
Patient Cat.
Adu
Paced
No
C.2 Alarm Setup
Alarm Setup
Factory Default Settings
Alarm Volume
2
Latching Alarms
No
Minimum Alarm Volume
2
Alarm Pause Time
2 min
Reminder Tone
Off
Reminder Interval
1 min
Alarm Sound
ISO
High Alarm Interval (s)
10
Med Alarm Interval (s)
20
Low Alarm Interval (s)
20
Alarm Delay (s)
6
ST Alarm Delay (s)
30
C.3 Screen Setup
Screen Setup
Factory Default Settings
Help
On
Sweep Mode
Refresh
Key Volume
2
Brightness
5
C-1
C.4 ECG Setup
ECG Setup
Adult
Pediatric
Neonate
Alm Source
HR
Alarm
On
Alm Lev
Med
Alm Rec
Off
HR High
120
160
200
HR Low
50
75
100
Beat Vol
2
Paced
No
Pacemaker Rate
60
Lead Set
Auto (if auto lead detection is available); 3-Lead (if
auto lead detection is not available)
ECG Display
Normal
Filter
Monitor
Notch Filter
On
Smart Lead Off
On
ST Analysis
Adult
ST Analysis
Off
Alarm
Off
Alm Lev
Med
Alm Rec
Off
ST-X High*
0.2
ST-X Low*
-0.2
Pediatric
*: X represents I, II, III, aVR, aVL, aVF, V, V1, V2, V3, V4, V5 or V6.
Arrh. Analysis
Adult
Alm Lev
Med
Alm Rec
Off
PVCs High
10
C-2
Pediatric
Arrh. Alarm Setup
Alarm
Alm Lev
Alm Rec
Asystole
On
High
Off
VFib/VTac
On
High
Off
PVCs
Off
Med
Off
R on T
Off
Med
Off
VT>2
Off
Med
Off
Couplet
Off
Med
Off
PVC
Off
Med
Off
Bigeminy
Off
Med
Off
Trigeminy
Off
Med
Off
Tachy
Off
Med
Off
Brady
Off
Med
Off
PNP
Off
Med
Off
PNC
Off
Med
Off
Missed Beat
Off
Med
Off
Multif. PVC
Off
Med
Off
Irr. Rhythm
Off
Med
Off
Vent. Rhythm
Off
Med
Off
Waveform X *
Adult
HR Source**
II
Gain
X1
Filter
Monitor
Sweep
25 mm/s
Pediatric
*: X represents (lead) I, II, III, aVR, aVL, aVF, V, V1, V2, V3, V4, V5 or V6
**: for lead II only.
C-3
Neonate
C.5 Resp Setup
Resp Setup
Adult
Pediatric
Neonate
Alarm
On
Alm Lev
Med
Alm Rec
Off
Resp High
30
30
100
Resp Low
8
8
30
Apnea Delay
20 s
Detection Mode
Auto
RR Source
Auto
Pediatric
Neonate
Resp Waveform
Resp Lead
II
Sweep
6.25 mm/s
Gain
X2
Detection Mode
Auto
C.6 PR
PR Setup
Adult
PR Source
SpO2
Alarm
On
Alm Lev
Med
Alm Rec
Off
PR High
120
160
200
PR Low
50
75
100
Alm Source
HR
Beat Vol
2
C-4
C.7 SpO2 Setup
SpO2 Setup
Adult
Pediatric
Neonate
Alarm
On
Alm Lev
Med
Alm Rec
Off
SpO2 High
100
100
95
SpO2 Low
90
90
90
Desat Limit
80
80
80
Sensitivity (MPM)
Med
Sensitivity (Masimo)
Normal
Averaging (Masimo)
8s
NIBP Simul
Off
Sat-Seconds (Nellcor)
0s
Pleth Waveform
Sweep
25 mm/s
C-5
C.8 NIBP Setup
NIBP Setup
Adult
Pediatric
Neonate
Alarm
On
Alm Lev
Med
Alm Rec
Off
Alm Source
All
Sys High
160
120
90
Sys Low
90
70
40
Mean High
110
90
70
Mean Low
60
50
25
Dia High
90
70
60
Dia Low
50
40
20
Press. Unit
mmHg
Interval
Manual
Cuff Press.
80
60
40
Initial Pressure
160
140
90
Temp Setup
Adult
Pediatric
Neonate
Alarm
On
Alm Lev
Med
Alm Rec
Off
T1 High
39.0
39.0
39.0
T1 Low
36.0
36.0
36.0
T2 High
39.0
39.0
39.0
T2 Low
36.0
36.0
36.0
TD High
2.0
2.0
2.0
Unit
ºC
C.9 Temp Setup
C-6
C.10 IBP Setup
IBP Setup
Adult
Alarm
On
Alm Lev
Med
Alm Rec
Off
Alm Source
All
Sensitivity
Med
Pediatric
Neonate
Systolic/Diastolic (Mean) (mmHg)
Alarm Limits
Adult
Pediatric
Adult
Art, Ao, FAP,
BAP, UAP, LV
High Limit
160/90 (110)
120/70 (90)
90/60 (70)
Low Limit
90/50 (70)
70/40 (50)
55/20 (35)
PA
High Limit
35/16 (20)
60/4 (26)
60/4 (26)
Low Limit
10/0 (0)
24/-4 (12)
24/-4 (12)
Adult
Pediatric
Adult
High Limit
10
4
4
Low Limit
0
0
0
Adult
Pediatric
Adult
High Limit
13.6
5.4
5.4
Low Limit
0.0
0.0
0.0
Mean (mmHg)
Alarm Limits
LAP, RAP, ICP,
UVP
Mean (cmH2O)
Alarm Limits
CVP
IBP Waveform
Sweep
25 mm/s
Filter
No Filter
C-7
C.11 C.O. Setup
C.O. Setup
Factory default settings
Alarm
On
Alm Lev
Med
TB High(ºC)
39.0
TB Low(ºC)
36.0
Comp. Const
0.542
Auto TI
Auto
Manual TI
2.0
Measuring mode
Manual
C.12 CCO/SvO2 Setup
CCO/SvO2 Setup
Factory default settings
Alarm
Off
Alm Lev
Med
Alm Rec
Off
Alarm Limits
Adult/pediatric/neonate
Alarm Limits
Adult/pediatric/neonate
CCO High
14
RVEF High
50
CCO Low
2
RVEF Low
0
CCI High
7
SV High
120
CCI Low
1
SV Low
20
EDV High
300
SVI High
60
EDV Low
80
SVI Low
10
EDVI High
150
SvO2 High
99
EDVI Low
60
SvO2 Low
10
SVR High
1500 DS/cm5
ScvO2 High
99
SVR Low
500 DS/cm5
ScvO2 Low
10
SVRI High
3000 DS·m2/ cm5
SVRI Low
1000 DS·m2/ cm5
C-8
C.13 CO2 Setup
Factory default settings
CO2 Setup
Adult
Pediatric
Neonate
Alarm
On
Alm Lev
Med
Alm Rec
Off
Humidity Compen (sidestream)
On
Press. Unit
mmHg
Max Hold (microstream)
20 s
Max Hold (mainstream)
10 s
Operating Mode
Measure
Flow Rate
100 ml/min
O2 Compen (sidestream)
0
O2 Compen (mainstream)
Off
N2O Compen (sidestream)
0
Des Compen (sidestream)
0
Balance Gas (mainstream)
Room Air
Auto Standby (min) (microstream)
0
EtCO2 High
50
50
45
EtCO2 Low
15
20
30
FiCO2 High
4
4
4
awRR High
30
30
100
awRR Low
8
8
30
Apnea Delay
20 s
RR Source
Auto
CO2 Waveform
Wave Type
Draw
Sweep
6.25 mm/s
C-9
C.14 AG Setup
AG Setup
Factory default settings
Alarm
On
Alm Lev
Med
Alm Rec
Off
Apnea Delay
20 s
RR Source
Auto
Flow Rate
Low
O2 Compen
Off
Operating Mode
Measure
Auto Standby
Off
Wave Type (CO2)
Draw
Sweep
6.25 mm/s
Alarm Limits
Adult/pediatric/neonate
Alarm Limits
Adult/pediatric/neonate
awRR High
30/30/100
EtO2 High
88
awRR Low
8/8/30
EtO2 Low
18
EtCO2 High
50/50/45
FiO2 High
100/100/90
EtCO2 Low
15/20/30
FiO2 Low
18
FiCO2 High
4
EtHal High
3.0
EtN2O High
55
EtHal Low
0.0
EtN2O Low
0
FiHal High
2.0
FiN2O High
53
FiHal Low
0.0
FiN2O Low
0
EtIso High
3.0
EtEnf High
3.0
EtIso Low
0.0
EtEnf Low
0.0
FiIso High
2.0
FiEnf High
2.0
FiIso Low
0.0
FiEnf Low
0.0
EtDes High
8.0
EtSev High
6.0
EtDes Low
0.0
EtSev Low
0.0
FiDes High
6.0
FiSev High
5.0
FiDes Low
0.0
FiSev Low
0.0
C-10
C.15 ICG Setup
Factory default settings
ICG Setup
Adult
Alarm
On
Alm Lev
Med
Alm Rec
Off
C.I. High
5.0
C.I. Low
1.5
TFC High
60
TFC Low
10
Averaging
30 beats
Update Rate
10 beats
ICG Waveform
Sweep
12.5 mm/s
C.16 BIS Setup
Factory default settings
BIS Setup
Adult
Alarm
On
Alm Lev
Med
Alm Rec
Off
BIS High
70
BIS Low
20
Smoothing Rate
30 s
Pediatric
BIS EEG Waveform
Sweep
25 mm/s
Scale
100 μV
Filters
On
Display BIS
BIS EEG
BIS Trend Waveform
Trend Length
6 min
C-11
C.17 RM Setup
RM Setup
Factory default settings
Adult
Alarm
On
Alm Lev
Med
Alm Rec
Off
Apnea Time
20 s
TV / MV
TV
Sensor Type
Disposable
RR Source
Auto
Pediatric
Neonate
Alarm Limits Setup
RR High
30
30
100
RR Low
8
8
30
PEEP High
10
PEEP Low
0
PIP High
40
PIP Low
1
MVe High
30.0
30.0
10.0
MVe Low
2.0
2.0
0.5
RM Waveform
Sweep
6.25 mm/s
C-12
D Alarm Messages
This chapter lists only the most important physiological and technical alarm messages. Some
messages appearing on your monitor may not be included.
In this chapter:
The “I” field indicates how alarm indications are cleared: “A” means all alarm indications are
cleared after the
hardkey is pressed, “B” indicates alarm lamp flashing and alarm tones
hardkey is
are cleared and the alarm messages change to prompt messages after the
pressed, and “C” indicates alarm lamp flashing and alarm tones are cleared and Ĝ appears
hardkey is pressed..
before the alarm message after the
The “L” field indicates the alarm level: H means high, M means medium and L means low.
“*” means the alarm level is user-adjustable.
XX represents a measurement or parameter label, such as ECG, NIBP, HR, ST-I, PVCs, RR,
SpO2, PR, etc.
In the “Cause and Solution” column, corresponding solutions are given instructing you to
troubleshoot problems. If the problem persists, contact your service personnel.
D-1
D.1 Physiological Alarm Messages
Measurement
Alarm messages
L
Cause and solution
XX Too High
M*
XX Too Low
M*
XX value has risen above the high alarm limit or fallen
below the low alarm limit. Check the patient’s
condition and check if the patient category and alarm
limit settings are correct.
XX
ECG
ECG Weak
Signal
H
Asystole
H
VFib/VTac
H
R on T
M*
VT>2
M*
Couplet
M*
PVC
M*
Bigeminy
M*
Trigeminy
M*
Tachy
M*
Brady
M*
Missed Beats
M*
Irr. Rhythm
M*
Vent. Rhythm
M*
Multif. PVC
M*
PNP
M*
PNC
M*
Apnea
SpO2
SpO2 Desat
Arrhythmia has occurred to the patient. Check the
patient’s condition and the ECG connections.
The pacer appears abnormal. Check the pacer.
H
The respiration signal was so weak that the monitor
cannot perform respiration analysis. Check the patient’s
condition and the Resp connections.
H
The patient’s heartbeat has interfered with his
respiration. Check the patient’s condition and the Resp
connections.
H
The SpO2 value has fallen below the desaturation
alarm limit. Check the patient’s condition and check if
the alarm limit settings are correct.
Resp
Resp Artifact
The ECG signal is so weak that the monitor can’t
perform ECG analysis. Check the patient’s condition
and the ECG connections.
D-2
Measurement
Alarm messages
L
Cause and solution
No Pulse
H
The pulse signal was so weak that the monitor cannot
perform pulse analysis. Check the patient’s condition,
SpO2 sensor and measurement site.
CO2
Apnea
H
AG
Apnea
H
RM
Apnea
H
AG
FiO2 Too Low
H
The patient stops breathing, or the respiration signal
was so weak that the monitor cannot perform
respiration analysis. Check the patient’s condition and
the RM connections.
Check the patient’s condition, the ventilated O2 content
and the AG connections.
D.2 Technical Alarm Messages
Measure
ment
Alarm message
L
I
Cause and solution
XX
XX SelfTest Err
H
C
XX Init Err
H
A
XX Init Err N
H
A
An error occurred to the XX module, or there is
a problem with the communications between
the module and the monitor. Re-plug the
module and restart the monitor, or plug the
module into another monitor.
XX Comm Err
H
A
XX Comm Stop
H
C
XX Limit Err
L
C
XX parameter limit is accidentally changed.
Contact your service personnel.
XX Overrange
L
C
The measured XX value is not within the
specified range for XX measurement. Contact
your service personnel.
MPM 12V Err
H
C
MPM 5V Err
H
C
An error occurred to the power supply part of
the MPM module. Contact your service
personnel.
ECG Lead Off
L*
B
ECG YY Lead Off
L*
B
N is within 1 to 8
MPM
ECG
Note: YY represents the leadwires, V
(V1, V2, V3, V4, V5, V6,), LL, LA,
RA, as per AHA standard, or C (C1,
C2, C3, C4, C5, C6), F, L and R as
per IEC standard.
D-3
The electrode has become detached from the
patient or the lead wire has become
disconnected from the adapter cable. Check the
connections of the electrodes and leadwires.
Measure
ment
Alarm message
L
I
Cause and solution
ECG Noisy
L
A
The ECG signal is noisy. Check for any
possible sources of signal noise around the
cable and electrode, and check the patient for
great motion.
ECG Artifact
L
A
Artifacts are detected on the ECG analysis lead
and as a result heart rate cannot be calculated
and Asystole, Vfib and Vtac cannot be
analyzed. Check the connections of the
electrodes and leadwires and check for any
possible source of interference around the cable
and electrode. Check the patient’s condition
and check the patient for great motion.
ECG High Freq. Noise
L
A
High frequency signals are detected on the
ECG analysis lead. Check for any possible
source of interference around the cable and
electrode.
ECG Low Freq. Noise
L
A
Low frequency signals are detected on the ECG
analysis lead. Check for any possible source of
interference around the cable and electrode.
ECG Amplitude Too
Small
L
C
The ECG amplitude didn’t reach the detected
threshold. Check for any possible source of
interference around the cable and electrode.
ECG Config. Err
L
C
ECG configuration is wrongly downloaded.
Check the downloaded configuration and
re-download the correct configuration.
Resp
Resp Disturbed
L
A
The respiration circuit is disturbed. Restart the
monitor.
Temp
Temp Cal. Err
H
C
A calibration failed. Restart the monitor.
T1 Sensor Off
L
A
T2 Sensor Off
L
A
The Temp sensor has become detached from
the patient or the module. Check the sensor
connections.
SpO2 Sensor Off
L*
B
SpO2 Sensor Fault
L
C
SpO2 No Sensor
L
B
SpO2 Unrecognized
Sensor
L
C
SpO2 Sensor
Incompatible
L
C
SpO2
D-4
The SpO2 sensor has become detached from the
patient or the module, or there is a fault with
the SpO2 sensor, or an unspecified SpO2 sensor
has been used. Check the sensor application
site and the sensor type, and make sure if the
sensor is damaged. Reconnect the sensor or use
a new sensor.
Measure
ment
NIBP
Alarm message
L
I
Cause and solution
SpO2 Too Much Light
L
C
There is too much light on the SpO2 sensor.
Move the sensor to a place with lower level of
ambient light or cover the sensor to minimize
the ambient light.
SpO2 Low Signal
L
C
SpO2 Weak Signal
L
C
SpO2 Weak Pulse
L
C
The SpO2 signal is too low or too weak. Check
the patient’s condition and change the sensor
application site. If the error persists, replace the
sensor.
SpO2 Interference
L
C
The SpO2 signal has been interfered. Check for
any possible sources of signal noise around the
sensor and check the patient for great motion.
SpO2 Board Fault
L
C
There is a problem with the SpO2 measurement
board. Do not use the module and contact your
service personnel.
NIBP Loose Cuff
L
A
NIBP Air Leak
L
A
The NIBP cuff is not properly connected, or
there is a leak in the airway.
NIBP Pneumatic Leak
L
A
Check the NIBP cuff and pump for leakages.
NIBP Cuff Type Wrong
L
A
The cuff type applied mismatches the patient
category. Verify the patient category and
replace the cuff.
NIBP Air Pressure Err
L
A
An error occurred to the air pressure. Verify
that the monitor application site meets the
environmental requirements and check if there
is any source that affects the air pressure.
NIBP Weak Signal
L
A
The patient’s pulse is weak or the cuff is loose.
Check the patient’s condition and change the
cuff application site. If the error persists,
replace the cuff.
NIBP Signal Saturated
L
A
The NIBP signal is saturated due to excess
motion or other sources.
NIBP Overrange
L
A
The measured NIBP value is not within the
specified range.
NIBP Excessive Motion
L
A
Check the patient’s condition and reduce the
patient motion.
NIBP Cuff Overpress.
L
A
The NIBP airway may be occluded. Check the
airway and measure again.
NIBP Equip Err
H
A
An error occurred during NIBP measurement
D-5
Measure
ment
IBP
Alarm message
L
I
Cause and solution
NIBP Timeout
L
A
NIBP Measure Failed
L
A
and therefore the monitor cannot perform
analysis correctly. Check the patient’s condition
and NIBP connections, or replace the cuff.
NIBP Illegally Reset
L
A
An illegal reset occurred during NIBP
measurement. Check if the airway is occluded.
YY Sensor Off
L
A
Check the sensor connection and reconnect the
sensor.
YY represents an IBP label.
C.O.
BT Sensor Off
L
A
Check the sensor connection and reconnect the
sensor.
CO2
CO2 Sensor High Temp
L
C
Check, stop using or replace the sensor.
CO2 Sensor Low Temp
L
C
Check, stop using or replace the sensor.
CO2 Temp Overrange
L
C
The operating temperature of the CO2 module
goes beyond the specified range. After it
restores within the specified range, the module
will restart automatically.
CO2 Airway High Press.
L
C
CO2 Airway Low Press.
L
C
An error occurred in the airway pressure.
Check the patient connection and patient
circuit, and then restart the monitor.
CO2 High Barometric
Press.
L
C
CO2 Low Barometric
Press.
L
C
CO2 FilterLine Occluded
L
C
The airway or watertrap was occluded. Check
the airway and remove the occlusion.
CO2 No Watertrap
L
B
Check the watertrap connections.
CO2 Check Adapter
L
A
There is a problem with the airway adapter.
Check, clean or replace the adapter.
CO2 FilterLine Err
L
C
Check if there is a leak in the CO2 sample line
or the CO2 sample line has been occluded.
CO2 Zero Failed
L
A
Check the CO2 connections. After the sensor’s
temperature becomes stabilized, perform a zero
calibration again.
CO2 System Err
L
A
Re-plug the module or restart the monitor.
CO2 Check Cal.
L
C
Perform a calibration.
CO2 Check Airway
L
C
An error occurred to the airway.
CO2 No Filterline
L
A
Make sure that the filterline is connected.
D-6
Check the CO2 connections, make sure that the
monitor application site meets the
requirements, and check for special sources
that affect the ambient pressure. Restart the
monitor.
Measure
ment
AG
RM
Alarm message
L
I
Cause and solution
CO2 No Sensor
L
A
Make sure that the sensor is connected.
CO2 Main Board Err
H
C
CO2 Checking Sensor
L
C
There is a problem with the CO2 module.
Re-plug the module or restart the monitor.
CO2 Replace
Scrubber&Pump
L
C
CO2 15V Overrange
H
C
CO2 Hardware Err
H
C
AG No Watertrap
L
B
Check the connections of the watertrap and
re-connect it.
AG Change Watertrap
L
A
Wait until the change is completed.
AG Watertrap Type
Wrong
L
A
Make sure that a correct watertrap has been
used.
O2 Accuracy
Unspecified
L
A
The measured value has exceeded the specified
accuracy range.
N2O Accuracy
Unspecified
L
A
CO2 Accuracy
Unspecified
L
A
Enf Accuracy
Unspecified
L
A
Iso Accuracy
Unspecified
L
A
Sev Accuracy
Unspecified
L
A
Hal Accuracy
Unspecified
L
A
Des Accuracy
Unspecified
L
A
awRR Accuracy
Unspecified
L
A
AG Hardware Err
H
A
Remove the AG module. Stop using the module
and contact your service personnel.
AG Airway Occluded
L
A
Check the airway and remove the occlusion.
AG Zero Failed
L
A
Re-plug the module or restart the monitor, and
then perform a zero calibration again.
RM No Sensor
L
A
Check and reconnect the sensor.
D-7
Measure
ment
BIS
ICG
Power
Alarm message
L
I
RM Sensor Reversed
L
C
RM Zero Failed
L
C
Perform a zero calibration again.
RM Power Err
L
A
There is a problem with the power supply.
Re-plug the module or restart the monitor.
BIS High Imped.
L
A
Check and reconnect the BIS sensor.
BIS Sensor Off
L
A
BIS DSC Err
L
C
An error occurred to the DSC during receiving
signals. Check the DSC.
BIS DSC Malf
L
C
The DSC automatically shuts down as a result
of malfunction. Check the DSC.
BIS No Cable
L
A
Check the BIS cables.
BISx Disconnected
L
A
Check the BISx module.
BIS No Sensor
L
A
Check the BIS sensor.
BIS Wrong Sensor Type
L
A
Check or replace the sensor.
BIS Sensor Too Many
Uses
L
A
Replace the sensor.
SQI<50%
L
A
SQI<15%
L
A
The SQI value is too low. Check the patient’s
condition and the sensor connections.
BIS Sensor Expired
L
A
Replace the sensor.
BIS Sensor Fault
L
C
Re-attach or Replace BIS Sensor
Disconnect/Reconnect
BIS
L
C
Re-plug the BIS Module
ICG Low Quality Signal
L
A
Check and reconnect the sensor.
ICG Left Neck Sensor
Off
L
A
ICG Right Neck Sensor
Off
L
A
ICG L. Thorax Sensor
Off
L
A
ICG R. Thorax Sensor
Off
L
A
ICG Sensor Off
L
A
12V Too High
H
C
12V Too Low
H
C
5V Too High
H
C
D-8
Cause and solution
There is a problem with the system power
supply. Restart the monitor.
Measure
ment
Recorder
Alarm message
L
I
Cause and solution
5V Too Low
H
C
3.3V Too High
H
C
3.3V Too Low
H
C
Battery Too Low
H
C
Connect the monitor to an AC power source
and allow the batteries to charge.
Different Battery
Voltages
M
C
The two batteries have different charge
capacity, or the batteries unspecified have been
used, or there is a problem with the batteries.
Make sure that correct batteries are used and
the batteries are not damaged, or replace the
batteries.
Battery Power Overload
H
C
The power consumption of the equipment is
too high. Power the monitor using an AC
power source.
RT Clock Not Exist
H
C
Contact your service personnel.
Recorder Init Err N
L
A
Restart the monitor.
Recorder SelfTest Err
L
A
Stop the recording and restart the monitor.
Recorder Comm Err
L
A
Recorder S. Comm Err
L
A
Recorder Unavailable
L
A
Recorder Vlt High
L
C
Recorder Vlt Low
L
C
Recorder Head Hot
L
C
The recorder has been working for too long
time. Stop the recording and resume the
recording till the recorder’s printhead cools
down.
Rec Paper Wrong Pos.
L
A
Re-load the recorder paper.
System Watchdog Err
H
C
System Software Err
H
C
An error occurred to the system. Restart the
monitor.
System CMOS Full
H
C
System CMOS Err
H
C
System FPGA Err
H
C
System Err N
H
C
N is within 1 to 8.
System
N is within 2 to 12.
D-9
An error occurred to the system power supply.
Restart the monitor.
FOR YOUR NOTES
D-10
E Electrical Safety Inspection
The following electrical safety tests are recommended as part of a comprehensive preventive
maintenance program. They are a proven means of detecting abnormalities that, if undetected,
could prove dangerous to either the patient or the operator. Additional tests may be required
according to local regulations.
All tests can be performed using commercially available safety analyzer test equipment.
These procedures assume the use of a 601PROXL International Safety Analyzer or equivalent
safety analyzer. Other popular testers complying with IEC 60601-1 used in Europe, such as
Fluke, Metron, or Gerb, may require modifications to the procedure. Please follow the
instructions of the analyzer manufacturer.
The electrical safety inspection should be periodically performed every two years .The safety
analyzer also proves to be an excellent troubleshooting tool to detect abnormalities of line
voltage and grounding, as well as total current loads.
E.1 Power Cord Plug
Test Item
The power
plug
Acceptance Criteria
The power plug
pins
No broken or bent pin. No discolored pins.
The plug body
No physical damage to the plug body.
The strain relief
No physical damage to the strain relief. No plug warmth for
device in use.
The power plug
No loose connections.
No physical damage to the cord. No deterioration to the cord.
The power cord
For devices with detachable power cords, inspect the connection
at the device.
For devices with non-detachable power cords, inspect the strain
relief at the device.
E-1
E.2 Device Enclosure and Accessories
E.2.1 Visual Inspection
Test Item
Acceptance Criteria
No physical damage to the enclosure and accessories.
The enclosure and accessories
No physical damage to meters, switches, connectors, etc.
No residue of fluid spillage (e.g., water, coffee, chemicals, etc.).
No loose or missing parts (e.g., knobs, dials, terminals, etc.).
E.2.2 Contextual Inspection
Test Item
Acceptance Criteria
No unusual noises (e.g., a rattle inside the case).
The enclosure and accessories
No unusual smells (e.g., burning or smoky smells, particularly
from ventilation holes).
No taped notes that may suggest device deficiencies or
operator concerns.
E.3 Device Labelling
Check the labels provided by the manufacturer or the healthcare facilities are present and
legible.
„
Main unit label
„
Integrated warning labels
E.4 Protective Earth Resistance
1.
Plug the probes of the analyzer into the device’s protective earth terminal and protective
earth terminal of the AC power cord.
2.
Test the earth resistance with a current of 25 A.
3.
Verify the resistance is less than limits.
LIMITS
For all countries, R = 0.2 Ω Maximum
E-2
E.5 Earth Leakage Test
Run an Earth Leakage test on the device being tested before performing any other leakage
tests. The following outlet conditions apply when performing the Earth Leakage test:
„
normal polarity( Normal Condition),
„
reverse polarity( Normal Condition),
„
normal polarity with open neutral(Single Fault Condition),
„
reverse polarity with open neutral(Single Fault Condition)
LIMITS
For UL60601-1,
‹
300 μA in Normal Condition
‹
1000 μA in Single Fault Condition
For IEC60601-1,
‹
500 μA in Normal Condition
‹
1000 μA in Single Fault Condition
E.6 Patient Leakage Current
Patient leakage currents are measured between a selected applied part and mains earth. All
measurements have a true RMS only.
The following outlet conditions apply when performing the Patient Leakage Current test.
„
normal polarity( Normal Condition);
„
reverse polarity( Normal Condition),
„
normal polarity with open neutral(Single Fault Condition);
„
reverse polarity with open neutral(Single Fault Condition).
„
normal polarity with open earth(Single Fault Condition);
„
reverse polarity with open earth(Single Fault Condition).
LIMITS
For CF
applied parts
‹
10μA in Normal Condition
‹
50μA in Single Fault Condition
For BF
applied parts
‹
100μA in Normal Condition
‹
500μA in Single Fault Condition
E-3
E.7 Mains on Applied Part Leakage
The Mains on Applied Part test applies a test voltage, which is 110% of the mains voltage,
through a limiting resistance, to selected applied part terminals. Current measurements are
then taken between the selected applied part and earth. Measurements are taken with the
test voltage (110% of mains) to applied parts in the normal and reverse polarity conditions
The following outlet conditions apply when performing the Mains on Applied Part test.
„
Normal Polarity;
„
Reversed Polarity
LIMITS
„
For CF
applied parts: 50 μA
„
For BF
applied parts: 5000 μA
E.8 Patient Auxiliary Current
Patient Auxiliary currents are measured between any selected Applied Part connector and the
remaining Applied Part connector s. All measurements may have a true RMS only response.
The following outlet conditions apply when performing the Patient Auxiliary Current test.
„
normal polarity( Normal Condition);
„
reverse polarity( Normal Condition),
„
normal polarity with open neutral(Single Fault Condition);
„
reverse polarity with open neutral(Single Fault Condition).
„
normal polarity with open earth(Single Fault Condition);
„
reverse polarity with open earth(Single Fault Condition).
LIMITS
For CF
applied parts,
‹
10μA in Normal Condition
‹
50μA in Single Fault Condition
For BF
applied parts,
‹
100μA in Normal Condition
‹
500μA in Single Fault Condition
E-4
NOTE
z
Make sure the safety analyzer is authorized comply with requirement of
IEC61010-1.
z
Follow the instructions of the analyzer manufacturer.
E-5
FOR YOUR NOTES
E-6
F Symbols and Abbreviations
F.1 Symbols
μA
microampere
μV
microvolt
μs
Microsecond
A
ampere
Ah
ampere hour
bpm
beat per minute
bps
bit per second
ºC
centigrade
cc
cubic centimeter
cm
centimeter
dB
decibel
DS
dyne second
ºF
fahrenheit
g
gram
GHz
gigahertz
GTT
gutta
h
hour
Hz
hertz
in
inch
kg
kilogram
kPa
kilopascal
L
litre
lb
pound
m
meter
mAh
milliampere hour
Mb
mega byte
mcg
microgram
mEq
milli-equivalents
mg
milligram
min
minute
F-1
ml
milliliter
mm
millimeter
mmHg
millimeters of mercury
cmH2O
centimeters of water
ms
millisecond
mV
millivolt
mW
milliwatt
Mȍ
megaohm
nm
nanometer
rpm
breath per minute
s
second
V
volt
VA
volt ampere
ȍ
ohm
W
watt
–
%
/
+
=
<
>
”
•
±
×
minus, negative
percent
per; divide; or
plus
equal to
less than
greater than
less than or equal to
greater than or equal to
plus or minus
multiply
F-2
F.2 Abbreviations
AaDO2
alveolar-arterial oxygen gradient
AAMI
Association for Advancement of Medical Instrumentation
AC
alternating current
ACI
acceleration index
Adu
adult
AG
anaesthesia gas
AHA
American Heart Association
ANSI
American National Standard Institute
Ao
aortic pressure
Art
arterial
aVF
left foot augmented lead
aVL
left arm augmented lead
aVR
right arm augmented lead
awRR
airway respiratory rate
BAP
brachial arterial pressure
BIS
bispectral index
BP
blood pressure
BPSK
binary phase shift keying
BSA
body surface area
BT
blood temperature
BTPS
body temperature and pressure, saturated
C.I.
cardiac index
C.O.
cardiac output
CaO2
arterial oxygen content
CCO
continuous cardiac output
CCU
cardiac (coronary) care unit
CE
Conformité Européenne
CIS
Clinical Information System
CISPR
International Special Committee on Radio Interference
CMOS
complementary metal oxide semiconductor
CMS
central monitoring system
C.O.
cardiac output
CO2
carbon dioxide
F-3
COHb
carboxyhemoglobin
CP
cardiopulmonary
CVP
central venous pressure
DC
direct current
Des
desflurane
Dia
diastolic
DPI
dot per inch
DVI
digital video interface
ECG
electrocardiograph
EDV
end-diastolic volume
EEC
European Economic Community
EEG
electroencephalogram
EMC
electromagnetic compatibility
EMG
electromyography
EMI
electromagnetic interference
Enf
enflurane
ESU
electrosurgical unit
Et
end-tidal
EtCO2
end-tidal carbon dioxide
EtN2O
end-tidal nitrous oxide
EtO
ethylene oxide
EtO2
end-tidal oxygen
FAP
femoral arterial pressure
FCC
Federal Communication Commission
FDA
Food and Drug Administration
FEV1.0%
first second forced expiratory volume ratio
Fi
fraction of inspired
FiCO2
fraction of inspired carbon dioxide
FiN2O
fraction of inspired nitrous oxide
FiO2
fraction of inspired oxygen
FPGA
field programmable gate array
FV
flow-volume
Hal
halothane
Hb
hemoglobin
Hb-CO
carbon mono-oxide hemoglobin
HbO2
oxyhemoglobin
HR
heart rate
F-4
I:E
inspiratory-expiratory ratio
IBP
invasive brood pressure
ICG
impedance cardiography
ICP
intracranial pressure
ICT/B
intracranial catheter tip pressure transducer
ICU
intensive care unit
ID
identification
IEC
International Electrotechnical Commission
IEEE
Institute of Electrical and Electronic Engineers
Ins
inspired minimum
IP
internet protocol
Iso
isoflurane
IT
injectate temperature
LA
left arm
LAP
left atrial pressure
Lat
lateral
LCD
liquid crystal display
LCW
left cardiac work
LCWI
left cardiac work index
LED
light emitting diode
LL
left leg
LVD
low voltage directive
LVDS
low voltage differential signal
LVET
left ventricular ejection time
LVSW
left ventricular stroke work
LVSWI
left ventricular stroke work index
MAC
minimum alveolar concentration
Art mean
mean arterial pressure
MDD
Medical Device Directive
MetHb
methemoglobin
MRI
magnetic resonance imaging
MVe
expiratory minute volume
MVi
inspiratory minute volume
N/A
not applied
N2
nitrogen
N2O
nitrous oxide
Neo
neonate
F-5
NIBP
noninvasive blood pressure
O2
oxygen
O2CI
oxygen consumption index
O2R
oxygen extraction ratio
OR
operating room
oxyCRG
oxygen cardio-respirogram
PA
pulmonary artery
Paw
airway pressure
PAWP
pulmonary artery wedge pressure
PD
photodetector
Ped
pediatric
PEEP
positive end expiratory pressure
PEF
peak expiratory flow
PEP
pre-ejection period
PIF
peak inspiratory flow
PIP
peak inspiratory pressure
Pleth
plethysmogram
Pmean
mean pressure
Pplat
plateau pressure
PR
pulse rate
PVC
premature ventricular contraction
PVR
pulmonary vascular resistance
PVRI
pulmonary vascular resistance index
R
right
RA
right arm
RAM
random access memory
RAP
right atrial pressure
Rec
record, recording
Resp
respiration
RHb
reduced hemoglobin
RL
right leg
RM
respiratory mechanics
RR
respiration rate
RSBI
rapid shallow breathing index
SaO2
arterial oxygen saturation
SEF
spectral edge frequency
Sev
sevoflurane
F-6
SFM
self-maintenance
SI
stroke index
SMR
satellite module rack
SpO2
arterial oxygen saturation from pulse oximetry
SQI
signal quality index
SR
suppression ratio
STR
systolic time ratio
SV
stroke volume
SVR
systemic vascular resistance
SVRI
systemic vascular resistance index
Sync
synchronization
Sys
systolic pressure
Taxil
axillary temperature
TD
temperature difference
Temp
temperature
TFC
thoracic fluid content
TFI
thoracic fluid index
TFT
thin-film technology
Toral
oral temperature
TP
total power
Trect
rectal temperature
TVe
expiratory tidal volume
TVi
inspiratory tidal volume
UAP
umbilical arterial pressure
UPS
uninterruptible power supply
USB
universal serial bus
UVP
umbilical venous pressure
VAC
volts alternating current
VEPT
volume of electrically participating tissue
VI
velocity index
WLAN
wireless local area network
F-7
FOR YOUR NOTES
F-8
P/N: 046-000184-00 (18.0)
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