IntelliVue Patient Monitor

IntelliVue Patient Monitor

I NS T R U C T I O N S FO R U S E

IntelliVue Patient Monitor

MP2 0 / 3 0 , MP4 0 / 5 0 , M P 6 0 / 70 / 8 0 / 9 0

R e l e a s e D . 0 w i t h S o f t w a r e R e v is i o n D . 0 0 . x x

P a t i e n t M o n i t o r i n g

Part Number M8000-9001G

Printed in Germany 02/06

4512 610 13551

*M8000-9001G*

M8000-9001G

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Table Of Contents

1 Basic Operation

Introducing the IntelliVue Family

IntelliVue MP20/MP30

MP20/MP30 Major Parts and Keys

IntelliVue MP40/MP50

MP40/MP50 Major Parts and Keys

IntelliVue MP60/MP70

MP60/MP70 Major Parts and Keys

IntelliVue MP80/MP90

MP80/MP90 Major Parts and Keys

D80 Intelligent Display

Remote Alarm Device

Docking Station

Related Products

Flexible Module Server (M8048A)

Measurement Modules

Multi-Measurement Server (M3001A)

Measurement Server Extensions

M3014A, M3015A and M3016A Capnography Extensions

M3012A Hemodynamic Measurement Server Extension

Operating and Navigating

Selecting Screen Elements

Using the Setup Menu

Using the Touchscreen

Disabling Touchscreen Operation

Using the SpeedPoint

Using the Navigation Point

Using a Mouse or Trackball

Using Keys

Permanent Keys

SmartKeys

Hardkeys

Pop-Up Keys

Using the On-Screen Keyboard

Using the On-Screen Calculator

Operating Modes

Standby Mode

Understanding Screens

Switching to a Different Screen

Changing a Screen’s Content

Using Additional Displays

Using the Visitor Screen

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Understanding Profiles

Swapping a Complete Profile

Swapping a Settings Block

Default Profile

Locked Profiles

Understanding Settings

Changing Measurement Settings

Switching a Measurement On and Off

Switching Numerics On and Off

Adjusting a Measurement Wave

Changing Wave Speeds

Changing the Wave Group Speed

Changing Wave Speed for a Channel

Freezing Waves

Freezing An Individual Wave

Freezing All Waves

Measuring Frozen Waves

Changing The Wave Speed

Updating The Frozen Wave

Releasing Frozen Waves

Using Labels

About Label Sets

Changing Measurement Labels (e.g. Pressure)

Resolving Label Conflicts

Changing Monitor Settings

Adjusting the Screen Brightness

Adjusting Touch Tone Volume

Setting the Date and Time

Checking Your Monitor Revision

Getting Started

Inspecting the Monitor

Switching On

Setting up the Measurement Servers and Modules

Starting Monitoring

Disconnecting from Power

Monitoring After a Power Failure

Networked Monitoring

Using Remote Applications

Remote Application Popup Keys

2 What’s New?

What’s New in Release D.0?

What’s New in Release C.0?

What’s New in Release B.1?

What’s New in Release B.0?

What’s New in Release A.2?

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3 Alarms

Visual Alarm Indicators

Audible Alarm Indicators

Alarm Tone Configuration

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

ISO/IEC Standard 9703-2 Audible Alarms

Changing the Alarm Tone Volume

Minimum Volume for No Central Monitoring INOP

Acknowledging Alarms

Acknowledging Disconnect INOPs

Alarm Reminder (ReAlarm)

Pausing or Switching Off Alarms

To Pause All Alarms

To Switch All Alarms Off

To Switch Individual Measurement Alarms On or Off

While Alarms are Paused or Off

Restarting Paused Alarms

Resetting Arrhythmia Alarm Timeouts

Extending the Alarm Pause Time

Alarm Limits

Viewing Individual Alarm Limits

Viewing All Alarm Limits

Changing Alarm Limits

About Automatic Alarm Limits (AutoLimits)

Documenting Alarm Limits

Reviewing Alarms

Alarm Messages Window

Review Alarms Window

Understanding Alarm Messages

Latching Alarms

Viewing the Alarm Latching Settings

Alarm Latching Behavior

Testing Alarms

Alarm Behavior at On/Off

4 Patient Alarms and INOPs

Patient Alarm Messages

Technical Alarm Messages (INOPs)

5 Managing Patients

Admitting a Patient

Patient Category and Paced Status

Admitting a Centrally-Monitored Patient

Quick Admitting a Patient

Editing Patient Information

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Discharging a Patient

Transferring Patients

Transferring a Centrally-Monitored Patient

Transferring a Patient with an MMS (no Central Station)

Data Upload from an MMS

Data Exchange Between Information Centers

Resolving Patient Information Mismatch

Manually Resolving Patient Mismatch

Patient Mismatch - If One Set of Patient Data is Correct

Patient Mismatch - If Neither Patient Data Set is Correct

Patient Mismatch - If Both Patient Data Sets Are Correct

Automatically Resolving Patient Mismatch

Care Groups

Understanding the Care Group Overview Bar

Viewing the My Care Group Window

Viewing the Other Bed Window

Other Bed Pop-Up Keys

Visual Alarm Status Information in the Other Bed Window

Care Group Alarms

Telemetry Data Overview

Unpairing a Telemetry Device

Telemetry Data Overview Screen Element

Silencing Telemetry Alarms from the Bedside

Suspending Telemetry Alarms

Using Standby

6 ECG, Arrhythmia, and ST Monitoring

Skin Preparation for Electrode Placement

Connecting ECG Cables

Selecting the Primary and Secondary ECG Leads

Checking Paced Status

Understanding the ECG Display

Monitoring Paced Patients

Setting the Paced Status (Pace Pulse Rejection)

Avoiding Pace Pulse Repolarization Tails

Changing the Size of the ECG Wave

To Change the Size of an Individual ECG Wave

To Change the Size of all the ECG Waves

Changing the Volume of the QRS Tone

Changing the ECG Filter Settings

Choosing EASI or Standard Lead Placement

About ECG Leads

ECG Leads Monitored

Changing Lead Sets

ECG Lead Fallback

ECG Lead Placements

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Standard 3-Lead Placement

Standard 5-Lead Placement

Chest Electrode Placement

10-Lead Placement

Conventional 12-Lead ECG

Modified 12-Lead ECG

Choosing Standard or Modified Electrode Placement

Labelling 12-Lead ECG Reports

Capture 12-Lead

EASI ECG Lead Placement

ECG, Arrhythmia, and ST Alarm Overview

Using ECG Alarms

Extreme Alarm Limits

ECG Alarms Off Disabled

HR Alarms When Arrhythmia Analysis is Switched Off

HR Alarms When Arrhythmia Analysis is Switched On

ECG Safety Information

About Arrhythmia Monitoring

Arrhythmia Options

Where Can I Find More Information?

Switching Arrhythmia Analysis On and Off

Choosing an ECG Lead for Arrhythmia Monitoring

Aberrantly-Conducted Beats

Atrial Fibrillation and Flutter

Intermittent Bundle Branch Block

Understanding the Arrhythmia Display

Viewing Arrhythmia Waves

Arrhythmia Beat Labels

Arrhythmia Status Messages

Rhythm Status Messages

Ectopic Status Messages

Arrhythmia Relearning

Initiating Arrhythmia Relearning Manually

Automatic Arrhythmia Relearn

Arrhythmia Relearn and Lead Fallback

Arrhythmia Alarms

Yellow Arrhythmia Alarms

Arrhythmia Alarms and Latching

Switching Individual Arrhythmia Alarms On and Off

Switching All Yellow Arrhythmia Alarms On or Off

Adjusting the Arrhythmia Alarm Limits

Arrhythmia Alarm Timeout Periods

What is a Timeout Period?

Resetting the Timeout Period

How are Yellow Arrhythmia Alarms Indicated?

Behavior of Unsilenced Arrhythmia Alarms

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Behavior of Silenced Arrhythmia Alarms

Arrhythmia Alarm Chaining

Understanding PVC-Related Alarms

About ST Monitoring

Switching ST On and Off

Selecting ST Leads for Analysis

Understanding the ST Display

Updating ST Baseline Snippets

Recording ST Segments

About the ST Measurement Points

Adjusting ST Measurement Points

ST Alarms

Single- or Multi-lead ST Alarming

Changing ST Alarm Limits

Viewing ST Maps

Current View

Trend View

Viewing an ST Map

Working in the ST Map Task Window

Switching Between ST Map Views

Displaying an ST Reference Baseline

Updating an ST Map Reference Baseline

Changing the Scale of the ST Map

Changing the Trending Interval

Printing an ST Map Report

7 Monitoring Pulse Rate

Entering the Setup Pulse Menu

System Pulse Source

Switching Pulse On and Off

Using Pulse Alarms

Selecting the Active Alarm Source: HR or Pulse?

Alarm Source Selection Disabled

Changing HR/Pulse Alarm Limits

Extreme Alarm Limits

QRS Tone

8 Monitoring Respiration Rate (Resp)

Lead Placement for Monitoring Resp

Optimizing Lead Placement for Resp

Cardiac Overlay

Lateral Chest Expansion

Abdominal Breathing

Understanding the Resp Display

Changing Resp Detection Modes

Auto Detection Mode

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Manual Detection Mode

Resp Detection Modes and Cardiac Overlay

Changing the Size of the Respiration Wave

Changing the Speed of the Respiration Wave

Using Resp Alarms

Changing the Apnea Alarm Delay

Resp Safety Information

9 Monitoring SpO

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SpO

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Sensors

Applying the Sensor

Connecting SpO

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Cables

Measuring SpO

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Assessing a Suspicious SpO

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Understanding SpO

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Alarms

Reading

Alarm Delays

Adjusting the Alarm Limits

Adjusting the Desat Limit Alarm

Pleth Wave

Perfusion (Pleth) Indicator

Setting SpO

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/Pleth as Pulse Source

Setting Up Tone Modulation

Setting the QRS Volume

Calculating SpO

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Difference

10 Monitoring NBP

Introducing the Oscillometric NBP Measurement

Measurement Limitations

Measurement Methods

Reference Method

Preparing to Measure NBP

Correcting the Measurement if Limb is not at Heart Level

Understanding the NBP Numerics

Starting and Stopping Measurements

Enabling Automatic Mode and Setting Repetition Time

Choosing the NBP Alarm Source

Assisting Venous Puncture

Calibrating NBP

11 Monitoring Temperature

Making a Temp Measurement

Selecting a Temperature for Monitoring

Extended Temperature Label Set

Calculating Temp Difference

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12 Monitoring Invasive Pressure

Setting up the Pressure Measurement

Selecting a Pressure for Monitoring

Extended Pressure Label Set

Zeroing the Pressure Transducer

Zeroing ICP (or IC1/IC2)

Determining a Pressure’s Most Recent Zero

Zeroing a Pressure Measurement

Using the Zero Hardkey

Zeroing All Pressures Simultaneously

Troubleshooting the Zero

Adjusting the Calibration Factor

Displaying a Mean Pressure Value Only

Changing the Pressure Wave Scale

Optimizing the Waveform

Non-Physiological Artifact Suppression

Choosing the Pressure Alarm Source

Calibrating Reusable Transducer CPJ840J6

Making the Pressure Calibration

Troubleshooting the Pressure Calibration

Calculating Cerebral Perfusion

Calculating Pulse Pressure Variation

Measuring Pulmonary Artery Wedge Pressure

Editing the Wedge

Identifying the Pressure Analog Output Connector

13 Monitoring Cardiac Output

Hemodynamic Parameters

Using the C.O. Procedure Window

Accessing the Setup C.O. and Setup CCO Menus

Entering the HemoCalc Window

Measuring C. O. Using the PiCCO Method

Measuring Continuous Cardiac Output

Measuring Systemic Vascular Resistance

Setting Up the PiCCO C.O. Measurement

Performing PiCCO C.O. Measurements

Editing PiCCO C.O. Measurements

Saving and Calibrating PiCCO C.O. Measurements

CCO Calibration Status Indicators

Measuring C.O. Using the Right Heart Thermodilution Method

Setting up RH C.O. Measurements

Ice-Bath Setup for RH Thermodilution C.O. Measurements

Setting the Computation Constant

Performing RH C.O. Measurements

Editing and Saving RH C.O. Measurements

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Documenting C.O. Measurements

C.O. Injectate Guidelines

Guidelines for Right Heart Thermodilution C.O. Injectate

Guidelines for PiCCO C.O. Injectate

Injectate Volume, Patient Weight and ETVI Values (PiCCO Only)

C.O./CCO Curve Alert Messages

C.O./CCO Prompt Messages

C.O./CCO Warning Messages

C.O./CCO Safety Information

14 Monitoring Carbon Dioxide

Using the Capnography Extension (M3014A)

Preparing to Measure Mainstream CO

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Preparing to Measure Sidestream CO

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Using the Sidestream Sensor Holder

Removing Exhaust Gases from the System

Using the Mainstream CO

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Extension (M3016A)

Preparing to Measure Mainstream CO

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Checking Transducer Accuracy

Calibrating the Transducer

Attaching and Removing the CO

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Transducer

Using the Microstream CO

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Extension (M3015A)

Preparing to Measure Microstream CO

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Using Microstream Accessories

Using the FilterLine and Airway Adapter

Removing Exhaust Gases from the System

Suppressing Zero Calibration

Setting up Mainstream and Sidestream CO

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Adjusting the CO

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Wave Scale

Setting up CO

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Corrections

Suppressing Sampling (not Mainstream CO

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Changing CO

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Alarms

Changing the Apnea Alarm Delay

Deriving Alarms From awRR

Changing awRR Alarm Limits

15 Monitoring Airway Flow, Volume and Pressure

Attaching the Flow Sensor

Zero Calibration

Automatic Purging

Adult Mode

Neonatal and Pediatric Modes

Manual Purging

Gas Compensation

Setting up Spirometry

Optimizing Scale Settings

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Spirometry Values Window

Alarms and Alarm Limits

Changing the Apnea Alarm Delay

Automatic Alarm Suppression

Choosing Measured AWV Components

Setting the Gas Compensation Mode

Changing the Type of Balance Gas

Changing the Concentration of Inspired O2 and the Inspired Agents

Changing the Temperature of the Inspired Gas

16 Monitoring tcGas

Identifying tcGas Module Components

Setting the tcGas Sensor Temperature

Using the tcGas Site Timer

Setting the tcGas Site Timer

Restarting the tcGas SiteTimer

Disabling the tcGas Site Timer

Setting the tcGas Barometric Pressure

Remembraning the tcGas Transducer

New/Dried Out Transducers

Storing tcGas Transducers

Calibrating the tcGas Transducer

Calibration Failure

Troubleshooting tcGas Calibration

Applying the tcGas Transducer

Selecting the tcGas HeatPowerDisplay Mode

Zeroing the tcGas Relative Heat Power

Finishing tcGas Monitoring

TcGas Corrections

Temperature Correction for tcpCO

2

Metabolism Correction for tcpCO

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17 Monitoring SvO

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Preparing to Monitor SvO

2

Carrying out a Pre-insertion Calibration

Inserting the Catheter

Performing a Light Intensity Calibration

Performing In-Vivo Calibration

Setting Up the In-Vivo Calibration

Making the In-Vivo Calibration

Calculating Oxygen Extraction

18 Monitoring EEG

EEG Monitoring Setup

Using the EEG Impedance/Montage Window

Choosing an EEG Electrode Montage

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Changing the Impedance Limit

About Electrode-to-Skin Impedance

Impedance Indicators

About Compressed Spectral Arrays (CSA)

Changing CSA Settings

Changing EEG Settings

Switching EEG Numerics On and Off

Changing the Scale of the EEG Waves for Display

Changing Filter Frequencies

Changing the Speed of the EEG Wave

EEG Reports

EEG Safety Information

EEG and Electrical Interference

19 Monitoring BIS

BIS Monitoring Setup

Monitoring BIS Using the DSC and BIS Engine

Monitoring BIS using the BISx

Manufacturer’s Information

BIS Continuous Impedance Check

BIS Cyclic Impedance Check

Starting a Cyclic Impedance Check

Stopping a Cyclic Impedance Check

BIS Window

BIS Impedance Indicators

Changing the BIS Smoothing Rate

Switching BIS and Individual Numerics On and Off

Changing the Scale of the EEG Wave

Switching BIS Filters On or Off

BIS Safety Information

20 Trends

Viewing Trends

Viewing Graphic Trends

Viewing Vital Signs Trends

Trends Pop-Up Keys

Setting Up Trends

Making Segment Settings

Expanded View

Trend Scales for Segment Measurements

Optimum Scale

Trend Group

No. of Segments

Trend Groups

Trend Interval

Trend Priority

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Trend Parameter Scales

Graphical Trend Presentation

Documenting Trends

Trends Databases

Aperiodic Trends Database

Trending Multiple-Value Measurements

Screen Trends

Setting the Screen Trend Time

Changing the Selection of Screen Trends Displayed

Activating the Cursor for Screen Trends

Changing the Screen Trend View

Tabular View

Horizon View

Setting the Horizon

Setting the Horizon Trend Scale

21 Calculations

Viewing Calculations

Calculations Windows

Calculations Pop-Up Keys

Reviewing Calculations

Performing Calculations

Entering Values for Calculations

Automatic Value Substitution

Automatic Unit Conversion

Manual Unit Conversion

BSA Formula

Documenting Calculations

22 High Resolution Trend Waves

Changing the Hi-Res Trend Waves Displayed

Hi-Res Trend Wave Scales

Hi-Res Trend Waves and OxyCRG

Printing Hi-Res Trend Wave Reports

Hi-Res Trend Wave Recordings

23 Event Surveillance

Levels of Event Surveillance

Event Groups

Event Episodes

Events Pop-Up Keys

Event Triggers

Event Retriggering

Event Notification

Setting Triggers for NER and Basic Event Surveillance

Setting Triggers and Notification for Advanced Event Surveillance

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Triggering Events Manually

The Events Database

Viewing Events

Event Counter

Counting Combi-Events

Counting Neonatal Event Review (NER) Events

Event Summary Window

Event Review Window

Event Episode Window

Annotating Events

Documenting Events

Documenting Event Review

Documenting an Event Episode

Event Recordings

Event Review Recordings

Event Episode Recordings

Event Reports

Event Review Reports

Event Episode Reports

Event Summary Reports

24 Recording

Starting and Stopping Recordings

Quickstarting Recordings

Extending Recordings

Stopping Recordings

Recording Without a Template

Overview of Recording Types

All ECG Waves Recordings

Creating and Changing Recordings Templates

Changing ECG Wave Gain

Recording Priorities

Sample Recording Strip

Recording Strip Code

Recorded Waveforms

Maintaining Recording Strips

Reloading Paper

Recorder Status Messages

25 Printing Patient Reports

Starting Reports Printouts

Stopping Reports Printouts

Setting Up Reports

Setting Up ECG Reports

Setting Up Vital Signs and Graphic Trend Reports

Setting Up Auto Reports

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Setting Up Individual Print Jobs

Checking Printer Settings

Printing a Test Report

Switching Printers On Or Off for Reports

Dashed Lines on Reports

Unavailable Printer: Re-routing Reports

Printer Status Messages

Sample Report Printouts

Alarm Limits Report

Realtime Report

Cardiac Output Report

ECG Reports

Other Reports

26 Using the Drug Calculator

Accessing the Drug Calculator

Performing Drug Calculations

About the Rule of Six

Performing Calculations for a Non-Specific Drug

Performing Calculations for a Specific Drug

Charting Infusion Progress

Using the Titration Table

Documenting Drug Calculations

27 VueLink Modules

Connecting an External Device

Changing VueLink Waves and Numerics Displayed

Viewing the VueLink Device Data Window

Using VueLink Screens

Switching VueLink On and Off

Alarms/INOPs From External Devices

Language Conflict with External Device Drivers

28 Using Timers

Viewing Timers

Notification

Timer Types

Timer Setup Pop-up Keys

Setting Up Timers

Timer Label

Run Time

Timer Counting Direction

Displaying Timers On The Main Screen

Main Screen Timer Pop-up Keys

Displaying A Clock On The Main Screen

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29 Respiratory Loops

Viewing Loops

Capturing and Deleting Loops

Showing/Hiding Loops

Changing Loops Display Size

Using the Loops Cursor

Changing Loops Type

Setting Up Source Device

Documenting Loops

30 Care and Cleaning

General Points

Cleaning

Disinfecting

Cleaning Monitoring Accessories

Sterilizing

Cleaning the Recorder Printhead (M1116B only)

Cleaning the Batteries and Battery Compartment

31 Using the Batteries

Battery Power Indicators

Battery LED

Battery Status on the Main Screen

Battery Status Window

Viewing Individual Battery Status

Recording Battery Status

Printing Battery Reports

Checking Battery Charge

Replacing Batteries

Optimizing Battery Performance

Display Brightness Setting

Charging Batteries

Conditioning Batteries

Unequally-Charged Batteries

Battery Safety Information

32 Maintenance and Troubleshooting

Inspecting the Equipment and Accessories

Inspecting the Cables and Cords

Maintenance Task and Test Schedule

Troubleshooting

Disposing of the Monitor

Disposing of Empty Calibration Gas Cylinders

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33 Accessories

ECG/Resp Accessories

Trunk Cables

3-Electrode Cable Sets

5-Electrode Cable Sets

10-Electrode Cable Sets

3-Electrode One Piece Cables

5-Electrode One Piece Cables

Set Combiners and Organizers

NBP Accessories

Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs

Reusable Cuff Kits

Adult/Pediatric Antimicrobial Coated Reusable cuffs

Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs

Neonatal/Infant Cuffs (Disposable, non-sterile)

Invasive Pressure Accessories

SpO

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Accessories

Temperature Accessories

Cardiac Output (C.O.) Accessories

Mainstream CO

2

Sidestream CO

Accessories (for M3014A)

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Accessories (for M3014A)

Accessories (for M3016A)

Mainstream CO

2

Microstream CO

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Accessories

Spirometry Accessories

tcGas Accessories

EEG Accessories

BIS Accessories

BIS Sensors

Other BIS Accessories

SvO

2

Accessories

Recorder Accessories

34 Installation and Specifications

Intended Use

Indication for Use

Manufacturer’s Information

BIS Manufacturer’s Information

Trademark Acknowledgement

Symbols

Installation Safety Information

Connectors

MP20/MP30

MP40/MP50

MP60/MP70

MP80/MP90

xvi

309

310

310

311

311

309

309

309

310

310

320

320

320

321

313

313

318

319

321

322

322

322

311

311

312

312

312

323

323

323

324

325

325

326

326

327

328

329

329

330

331

332

334

325

802.11 Bedside Adapter (Wireless Network Adapter)

Altitude Setting

Monitor Safety Specifications

Physical Specifications

Environmental Specifications

M4605A Battery Specifications

Monitor Performance Specifications

Measurement Specifications

ECG/Arrhythmia/ST

Respiration

SpO

2

NBP

Invasive Pressure and Pulse

Temp

CO

2

Interfering Gas and Vapor Effects On CO

2

Measurement Values

Spirometry

Cardiac Output / Continuous Cardiac Output

tcGas

SvO

2

EEG

BIS

Safety and Performance Tests

Electromagnetic Compatibility (EMC) Specifications

Accessories Compliant with EMC Standards

Electromagnetic Emissions

Avoiding Electromagnetic Interference (Resp and BIS)

335

355

356

359

359

361

362

363

363

364

348

350

350

352

354

336

336

337

339

341

342

348

365

365

365

365

365

Electromagnetic Immunity

Recommended Separation Distance

366

366

Recommended separation distances from portable and mobile RF communication equipment

367

Electrosurgery Interference/Defibrillation/Electrostatic Discharge

Fast Transients/Bursts

Restart time

368

368

368

35 Default Settings Appendix

Alarm Default Settings

ECG, Arrhythmia, and ST Default Settings

Pulse Default Settings

Respiration Default Settings

SpO

2

Default Settings

NBP Default Settings

Temperature Default Settings

Invasive Pressure Default Settings

Cardiac Output Default Settings

CO

2

Default Settings

Spirometry Default Settings

374

375

375

376

370

370

373

374

377

378

378

369

xvii

tcGas Default Settings

SvO

2

Default Settings

EEG Default Settings

BIS Default Settings

VueLink Default Settings

379

379

380

380

381

xviii

1

1

Basic Operation

These Instructions for Use are for clinical professionals using the IntelliVue MP20/MP30 (M8001A/

M8002A), MP40/50 (M8003A/M8004A) and MP60/70/80/90 (M8005A/M8007A/M8008A/

M8010A) patient monitors. Unless otherwise specified, the information here is valid for all the above

IntelliVue patient monitors.

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

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

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

In this guide:

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

• A caution alerts you to where special care is necessary for the safe and effective use of the product.

Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.

Monitor refers to the entire patient monitor. Display refers to the physical display unit. Display

Screen and Screen refer to everything you see on monitor’s display, such as measurements, alarms, patient data and so forth.

Introducing the IntelliVue Family

The Philips IntelliVue family of patient monitors offers a monitoring solution optimized for the surgical, cardiac, medical and neonatal care environments. Combining patient surveillance and data management, it allows multi-measurement monitoring by linking separate modules with “plug-andplay” convenience.

1

2

1 Basic Operation

Introducing the IntelliVue Family

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

There is a choice of monitor configurations, as explained below. All models can also use computer devices such as a mouse, a trackball and a keyboard.

IntelliVue MP20/MP30

The IntelliVue MP20/MP30 (M8001A/M8002A) patient monitor has a 10-inch TFT LCD flat panel

SVGA display. The standard input devices for the

MP30 are the Touchscreen and integrated navigation point; the MP20 is supplied with an integrated navigation point only. Up to six waves can be shown on MP20/MP30 Screens (USA - up to four waves). 12

ECG traces can be shown on the 12-Lead ECG

Screen.

The MP20/MP30 can be connected to one Multi-

Measurement Server (MMS) and any one of the measurement server extensions. There is an optional built-in recorder. The Flexible Module Server

(M8048A) and all plug-in modules cannot be used with the MP20/MP30. With an optional Interface board Bispectral Index (BIS) monitoring is possible.

MP20Junior and MP20L are options of MP20

(M8001A) and are not referred to separately in these

Instructions for Use.

Introducing the IntelliVue Family

MP20/MP30 Major Parts and Keys

MP20/MP30 left side

1 2

1

2

3 3

4

4

5

5

6

7

6

7

1 Basic Operation

5

6

7

3

4

1

2

Color-coded alarm lamps

Alarms off lamp

Model indicator

ECG out

Navigation Point

Part number and serial number

Mounting quick-release lever

MP20/MP30 front panel

3

4

5

6

7

1

2

On/Standby switch

On/Standby LED

Error LED

Battery status LED

AC power operation LED

“read the documentation” symbol

Mounting quick-release lever

1 2 3 4

5

6 7

MP20/MP30 LED Colors and their Meanings

On/Standby LED

Green when monitor is switched on

Error LED

Red if there is a problem with the monitor

Battery LED

AC Power LED

Green, yellow, and red.

See the section on Using the Batteries for details

Green while the monitor is connected to AC power (mains)

3

4

1 Basic Operation

Introducing the IntelliVue Family

IntelliVue MP40/MP50

The IntelliVue MP40/MP50 (M8003A/M8004A) patient monitor has a 12-inch TFT LCD flat panel

SVGA display. The standard input devices for the MP50 are the Touchscreen and integrated navigation point; the

MP40 is supplied with an integrated navigation point only. Up to six waves can be shown on MP40/MP50

Screens, 12 ECG traces can be shown on the 12-Lead

ECG Screen.

The MP40/MP50 can be connected to one Multi-

Measurement Server (MMS) and any one of the measurement server extensions. The IntelliVue family plug-in measurement modules can be connected to its four integrated plug-in module slots with plug-and-play convenience (the only exception is the SvO

2 module, M1021A, which cannot be used with the MP40/MP50). The Flexible Module Server

(M8048A) cannot be used with the MP40/MP50.

MP40/MP50 Major Parts and Keys

MP40/MP50 left side

7

8

5

6

3

4

1

2

Color-coded alarm lamps

Alarms off lamp

Model indicator

ECG out

Navigation Point

Part number and serial number

Mounting quick-release lever

Plug-in module slots

Introducing the IntelliVue Family

MP40/MP50 front panel

1 Basic Operation

3

4

1

2

5

6

7

On/Standby switch

On/Standby LED

Error LED

Battery status LED

AC power operation LED

“read the documentation” symbol

Mounting quick-release lever

1

2 3

4 5 6 7

MP40/MP50 LED Colors and their Meanings

On/Standby LED

Green when monitor is switched on

Error LED

Red if there is a problem with the monitor

Battery LED

AC Power LED

Green, yellow, and red.

See the section on Using the Batteries for details

Green while the monitor is connected to AC power (mains)

IntelliVue MP60/MP70

The IntelliVue MP60/MP70 (M8005A/M8007A) patient monitors integrate the display unit, with a

15” color LCD display, and the data processing unit into one. Up to eight waves can be shown on the screens, as well as the 12-Lead ECG Screen. The MP60 uses the SpeedPoint as its primary input device while the MP70 uses touch screen operation but may have an optional SpeedPoint.

The monitors can be connected to the Multi-Measurement Server (MMS) and any one of the measurement server extensions, and to the Flexible Module Server (M8048A). The IntelliVue family plug-in measurement modules can be connected to its FMS module slots with plug-and-play convenience.

The MP60/MP70 has two integrated slots for plug-in modules. You can combine one each of the following modules in these slots: Pressure, Temperature, C.O., SpO

2

and VueLink. Two of the same type of module cannot be used. You can also use the two-slot recorder module in the integrated slots.

5

6

1 Basic Operation

MP60/MP70 Major Parts and Keys

Introducing the IntelliVue Family

1

2

3

5

4

4

5

6

1

2

3

Color coded alarm lamps

Alarms Off lamp

Display

Model indicator

SpeedPoint (optional for MP70)

Part number and serial number

7

8

9

Mounting quick-release lever

AC power LED

Error LED

10 Power on/standby switch

11 Power on LED

11

10 9

8

7

6

IntelliVue MP80/MP90

Note: The MP80 monitor (M8008A) is not available in the USA.

The IntelliVue MP80/MP90 (M8008A/M8010A) patient monitors have the display and the processing unit as separate components. They offer both touchscreen and the Remote SpeedPoint as standard input devices. The MP80 can display up to 8 waves simultaneously and the MP90 up to 12 waves.

The monitors can be connected to the Multi-Measurement Server (MMS) and any one of the measurement server extensions, and to the Flexible Module Server (M8048A). The IntelliVue family plug-in measurement modules can be connected to its FMS module slots. The MP90 can be connected to two Flexible Module Servers (FMS). The MP90 has the capability for two displays and can have a third main display with the D80 Intelligent Display.

Introducing the IntelliVue Family

MP80/MP90 Major Parts and Keys

AC Power LED

1 Basic Operation

Error LED

Power on LED

Power on Switch

Display Unit

Processing Unit

D80 Intelligent Display

The D80 Intelligent Display can be used as a third main display with the MP90 monitor. You then have three displays able to be configured individually and to be operated independently.

Remote Alarm Device

The Remote Alarm Device provides audio and visual indicators of alarms, in addition to those shown on the display.

1

5

2

4

3

2

3

4

1

5

Two color coded alarm lamps (right-hand lamp flashes red or yellow for patient alarms, left-hand lamp flashes light blue for INOPs)

Alarms off lamp - when illuminated it indicates that all alarms are deactivated.

Speaker - for alarm tones, QRS tones and so forth

Monitor power on /standby switch. Press to switch monitor on remotely. Press and hold for one second to turn monitor off.

Power on LED - green when monitor is on

7

1 Basic Operation

Related Products

Docking Station

MP20/30/

40/50 only

The docking station provides quick mounting and connections in a one-step operation. By placing the monitor on the docking station and closing the lever you can make the connection to power and to a wired network, if present.

WARNING

If the docking station is in a tilted position, you must hold the monitor in place while closing the locking lever.

When using the monitor for transport directly after use on the docking station, insert the batteries before placing the monitor on the docking station.

Data Connector

Power Connector

Power On LED

Open Position

8

Locked Position

Related Products

Related products extend the measurement capabilities of your monitor. None of the related devices have their own power on/standby switches. They take their power from the monitor, and switch on automatically when you turn on the monitor. A green power-on LED indicates when they are drawing power from the monitor. A permanently illuminated, or flashing, red LED indicates a problem with the unit that requires the attention of qualified service personnel.

Flexible Module Server (M8048A)

MP60/70/80

/90 only

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

With the MP60/70/80 you can connect only one FMS. With the MP90 (M8010A) you can connect two FMSs to use up to 10 measurement modules. For individual modules, the maximum that can be used simultaneously in an FMS is: five pressure modules, four temperature modules, four VueLink modules.

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

Related Products

1

2

3

1 Basic Operation

1

2

3

4

5

Multi-Measurement

Server

Measurement server mount

Flexible Module Server

Power on LED

Interruption indicator

4

5

Measurement Modules

You can use up to eight measurement modules with the Flexible Module Server (M8048A), two

additional modules in the integrated module slots in the MP60/MP70, and up to four in the integrated slots in the MP40/MP50. Available modules are:

• Invasive blood pressure (M1006B)

• Temperature (M1029A)

• Oxygen saturation of arterial blood (SpO

2

) (M1020B)

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

• Transcutaneous gas (M1018A)

• Mixed venous oxygen saturation - SvO

2

(M1021A) MP60/70/80/90 monitor only

• Recorder (M1116B)

• VueLink device interface (M1032A)

• EEG (M1027A)

• Bispectral Index - BIS (M1034A)

• Spirometry (M1014A)

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

Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label.

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

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

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

9

1 Basic Operation

Example Module (Pressure)

1 Module name

2 Setup key LED

3 Setup key to enter setup menu of measurement modules or VueLink device data window

4 Connector socket for patient cable/ transducer

5 Second module-specific key, for example Zero

4

PRESS

1

2

3

80x80

Press

5

Related Products

Multi-Measurement Server (M3001A)

The Multi-Measurement Server (MMS) can simultaneously monitor 3-, 5- or 10-lead ECG (including arrhythmia and ST monitoring), respiration, SpO

2

, NBP and either invasive pressure or temperature.

Depending on the monitor model, you can connect it to the monitor via a cable or mount it either on the left side of the FMS or on the back of the monitor, as shown here.

MMS mounted on rear of MP40/MP50

(left) and MP60/MP70

10

Related Products

1 Basic Operation

M3001A Connectors and Symbols

4

5

1

2

3

4 &

5

White ECG/Resp connector

Blue SpO

2

connector

Red NBP connector

Combined pressure (red) and temperature

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

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

3

2

1

6

6

7

NBP Start/Stop key starts or stops NBP measurements

7

3

NBP STAT key - starts NBP

STAT series of measurements

9

8

OR

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

8

9

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

MSL cable connector to the monitor

Measurement Server Extensions

The measurement server extensions connect to the MMS and use the MMS settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the measurement server. To separate an extension from the MMS, press the release lever down, and push the server forward.

11

1 Basic Operation

Related Products

WARNING

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

M3014A, M3015A and M3016A Capnography Extensions

The M3014A Capnography Extension adds mainstream capnography, and optionally one pressure plus either a pressure or a temperature, Cardiac Output and Continuous Cardiac Output to the MMS.

The optional M3015A Microstream CO

2

Extension adds microstream capnography and optionally either pressure or temperature to the MMS. The optional M3016A Mainstream CO

2

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

M3014A Capnography

M3015A Microstream

1

1

4

3

2

M3016A Mainstream

1

7

6

5

2

3

4

1

2

Pressure connectors (red)

Temperature connector (brown)

Mainstream connector CO

2

(optional)

Cardiac Output connector

2

5

6

7

Inlet

Microstream connector CO

2

Gas sample outlet

12

Related Products

M3012A Hemodynamic Measurement Server Extension

Connection to MMS

The M3012A Hemodynamic

Measurement Server Extension

(HMSE) can be connected to the

M3001A Multi-Measurement Server to provide the following additional measurements: Temperature, Pressure, an additional Pressure or Temperature, and C.O. and CCO measurements.

1 Basic Operation

Pressure connectors

(red)

Cardiac Output (orange; optional)

Temperature connectors (brown)

13

1 Basic Operation

Operating and Navigating

Operating and Navigating

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

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

For example, you might be able to access an item through its on-screen setup menu, via a hard key, or via a SmartKey. These Instructions for Use always describe how to access items via an on-screen menu.

You may use whichever way you find most convenient.

1

2

3

4

5

6 7 8

9

10

14

11

ABP Zero done at 11 Nov 02 7:31 am

18

17

16 15

14

13

12

Monitor information line

1 network connection indicator

(documented in Information

Center Instructions for Use)

2 bed label

3 patient identification

4 patient category

5 paced status

6 date and time

7 access the profiles menu

8 current screen name/enter change screen menu

9 adjust alarm volume/level indicator

Other screen elements

10 alarm status area - shows active alarm messages

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

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

13 enter Main Setup menu

14 scroll right to display more SmartKeys

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

16 scroll left to display more SmartKeys

17 Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to immediately re-enable alarm indicators.

18 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on.

Operating and Navigating

1 Basic Operation

Selecting Screen Elements

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

Patient Demographics

window, or select the HR numeric to call up the Setup ECG menu. Select the ECG wave segment to call up the

ECG lead menu.

Note that the space between each line of a menu may be configured to wide or narrow to facilitate your most common method of operation, either touch, Speedpoint or navigation point, or mouse.

Using the Setup Menu

MP20/MP30/

MP40/MP50

Only

Setup

Alarm Messages

Alarm Limits

Alarm Volume

My Care Group

Change Screens

Profiles

Admit/Dischrg

Paced No

Network

Bed Information

Date, Time

For the MP20/MP30 and MP40/MP50 monitors, the elements at the top of the Screen are grouped together for ease of navigation. Select any item at the top of the Screen to open the

Setup

menu; scroll down the menu to highlight the element you want then press the navigation point to select the element.

Using the Touchscreen

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

Disabling Touchscreen Operation

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

Screen permanent key. A padlock will appear on the Main Screen permanent key.

Press and hold the

Main Screen

permanent key again to re-enable the touchscreen operation.

15

1 Basic Operation

Using the SpeedPoint

Operating and Navigating

1

2 integrated SpeedPoint

(MP60/MP70 only)

3

4

5

6

7

Remote SpeedPoint

(all monitors)

1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior follows the Silence permanent key configuration.

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

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

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

5 SpeedPoint knob - rotate and tilt to highlight elements. Press to select.

6 Function keys on remote SpeedPoint - function identical to the first five SmartKeys configured for a screen.

7

On/standby key

Rotate the SpeedPoint knob left or right. With each click, the highlight jumps to the neighboring screen element. Alternatively, tilt the knob to move it in the direction of a screen element. A cursor moves across the screen, following the direction of the knob. Any screen element under the cursor is highlighted. When you reach the screen element you want, press the knob to select the element.

Using the remote SpeedPoint, you can operate the monitor from a distant location such as at the foot of the bed. The remote SpeedPoint can be used with all monitors.

16

Operating and Navigating

Using the Navigation Point

MP20/MP30/

MP40/MP50

Only

1 Basic Operation

3

4

5

1

2

Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Exact behavior depends on permanent key configuration

Alarms Off/Pause Alarms - pauses alarm indicators. Exact behavior depends on Pause

Alarms permanent key configuration

Main Screen -

closes all open menus and windows and return to the main screen.

Back - takes you back one step to the previous menu.

Navigation Point knob

To use the navigation point, rotate it left or right. With each click, the highlight jumps to the neighboring screen element. The element under the cursor is highlighted. When you reach the screen element you want, press the knob to select the element.

Using a Mouse or Trackball

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

Using Keys

The monitor has four different types of keys.

Permanent Keys

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

Pause Alarms

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

Alarms Off

.

Select again to immediately re-enable alarm indicators.

Silence

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

Main Screen

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

Main Setup

- enter main setup menu.

17

1 Basic Operation

Operating and Navigating

SmartKeys

A SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased. enter profile menu, or revert to default profile show BIS Sensor change Screen, or revert to default screen previous Screen freeze waves set alarm limits change alarm volume change QRS volume enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained.

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

- start/stop manual NBP measurement

- start auto series

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

18

Operating and Navigating

1 Basic Operation

start a delayed recording set wide automatic alarm limits access wedge procedure window review vital signs trend access event surveillance access the calculator gas analyzer - exit standby mode unpair equipment start 12-Lead Capture (only available if Information Center is connected) access EEG CSA

Realtime Record SmartKey to access popup recording keys set narrow automatic alarm limits access the Loops window review graph trend access calculations access the Drug Calculator suppress zero for all gas measurements access ST Map application access remote applications (if Application

Server is connected) access the EEG montage display VueLink information access timers access the spirometry data window switch CO

2

pump off

Hardkeys

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

Pop-Up Keys

Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the confirm pop-up key appears only when you need to confirm a change.

19

1 Basic Operation

Operating and Navigating

Using the On-Screen Keyboard

Use this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the

Shift

and capital

Lock

keys to access uppercase letters. Use the

Back

key to delete single characters, or use the

Clr

key to delete entire entries. Select

Enter

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

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

Using the On-Screen Calculator

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

To access the on-screen calculator, select the

Calculator

SmartKey, or select

Main Setup

->

Calculations

->

Calculator

.

Calculator

Back

MC

MR

M+

C/CE

20

Operating Modes

1 Basic Operation

Operating Modes

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

1

Select the

Main Setup

menu.

2

Select

Operating Modes

and choose the mode you require.

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

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

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

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

Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks.

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

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

Config

When the monitor is in Demonstration Mode, Configuration Mode, or

Service Mode, this is indicated by a box with the mode name in the center of the Screen and in the bottom right-hand corner. Select this field to change to a different mode.

Standby Mode

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

To enter Standby mode,

♦ select the

Monitor Standby

SmartKey or

♦ select

Main Setup

, followed by

Monitor Standby

.

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

Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special

Standby

screen is displayed. If a patient location is entered at the Information Center, this will also be displayed on the

Standby

screen

(availability depends on Information Center revision).

To resume monitoring,

Select anything on the screen or press any key.

21

1 Basic Operation

Understanding Screens

Understanding Screens

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

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

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

Switching to a Different Screen

1

2

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

Change Screen

SmartKey.

Choose the new Screen from the pop-up list.

Changing a Screen’s Content

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

To change the selection of elements on a Screen,

1

2

Select the element you want to change.

From the menu that appears, select

Change Wave

,

Change Numeric

, or

Change HiResTrend

, and then select the wave or numeric you want, or select the highresolution trend wave you want from the list of available waves.

If you do not see

Change Numeric

in the menu, this Screen may be configured to always display the numeric beside its wave. Changing the wave will automatically change the numeric.

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

22

Using Additional Displays

1 Basic Operation

In the

Change Screen

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

Up to three modified Screens can be accessed via the

Change Screen

menu.

To recall Screens, either

♦ select the name of the Screen in the

Change Screen

menu

Change Screen

6 Waves A

Split Screen A

Loops

or

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

Change Screen menu to move back and forth in the

Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed.

Cardiac Output

Vital Signs A

Vital Signs A*

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

Change Screen

menu.

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

Automat. Default

is configured to

Yes

).

Using Additional Displays

A second display, showing the same Screen as the main display, can be connected to any of the monitors, for viewing only.

The MP90 can have two main displays and additionally, as a third main display, the D80 Intelligent

Display connected. All main displays can be configured and operated individually using standard input devices.

For MP90 monitors with multiple displays and multiple input devices, the usage and behavior can be configured according to specific requirements at installation (for example, use for two independent operators or tracking of mouse input across two displays). For details refer to the Service Guide.

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

• Patient monitoring operations such as

Silence

or

Pause

alarms take effect for the monitor as a whole, the results will be seen on both displays.

• Display operations such as the

Main Screen

key and Back hardkey will take effect only on the display being operated.

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

1

Move the highlight to the

Main Screen

key and then turn one click further.

The highlighting moves to a special “jump” field at the edge of the Screen

2

Press the knob on the SpeedPoint to confirm; the highlighting will automatically move to the other display.

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

23

1 Basic Operation

Understanding Profiles

1

2

Select

Profiles

in the monitor info line of the first display,

Select

Display 1

,

Display 2,

or

Display 3

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

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

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

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

Using the Visitor Screen

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

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

To activate this Screen, select the Screen name in the monitor info line to open the

Screen

menu, then select the name of the visitor Screen configured for your monitor from the list of available Screens.

Select any element on the Screen to open the

Screen

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

Understanding Profiles

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

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

• Display (screens)

– Each profile can have a choice of many different predefined screens. If you are using a second display, each display can have its own individual screen selection. When you change the profile, the screen selection configured for the new profile becomes active.

• Measurement Settings

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

NBP alarm source, NBP repeat time, temperature unit ( o

F or o

C) pressure unit (mmHg or kPa).

• Monitor Settings

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

24

Understanding Profiles

1 Basic Operation

Profile

Profiles

: Profile A

Patient Category: Adult

Paced : No

Measurement A

Measurement B

Measurement C

Measurement D

Meas Settings: Measurement A

Monitor Settings: Monitor A

Profiles Menu, showing current settings Available choices in measurement menu

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

You might find it helpful to think of the three categories in terms of a restaurant menu. The Screens are like the first course, offering you a choice of “starters” (many different screen configurations from which you can choose the one that best suits your requirements). The Monitor Settings category is like the main course, offering a choice of different “main dishes” from which you can pick one. The

Measurement Settings are like the dessert course. From these you build your meal. You can choose one from the “starters”, one from the main course, then one from the dessert or simply pick one or two courses without having a full meal.

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

WARNING

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

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

Swapping a Complete Profile

3

4

1

2

Select

Profiles

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

In the

Profiles

menu, select

Profile

.

Chose a profile from the pop-up list.

Confirm your selection.

25

1 Basic Operation

Understanding Settings

Swapping a Settings Block

3

4

1

2

Select

Profiles

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

In the

Profiles

menu, select

Display

or

Measmnt. Settings

or

Monitor Settings

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

Choose a settings block from the pop-up list.

Confirm your selection.

Default Profile

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

Locked Profiles

Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol.

Understanding Settings

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

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

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

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

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

• when you discharge a patient

• when you load a Profile

• when the monitor is switched off for more than one minute (if

Automat. Default

is set to

Yes

).

Changing Measurement Settings

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

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

Setup ECG

menu, select the HR (heart rate) numeric.

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

26

Changing Wave Speeds

1 Basic Operation

• via the

Main Setup

SmartKey - if you want to setup a measurement when the measurement is switched off, use the

Main Setup

SmartKey and select

Measurements

. Then select the measurement name from the popup list. With this SmartKey you can access any setup menu in the monitor.

• via the Measurement Selection key.

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

Switching a Measurement On and Off

When a measurement is off, its waves and numerics are removed from the monitor’s screen. The monitor stops data acquisition and alarming for this measurement. A measurement automatically switches off if you disconnect its module or measurement server. If you disconnect a transducer, the monitor replaces the measurement numeric with question marks.

1

2

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

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

Switching Numerics On and Off

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

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

For example in the

Setup EEG

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

Adjusting a Measurement Wave

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

Wave

menu, which has only waverelated measurement settings.

Changing Wave Speeds

Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.

The monitor distinguishes three groups of wave speed settings,

RespiratorySpeed

, for all respiratory waves: CO

2

, Resp. anesthetic agents and O

2

EEG Speed

, for all EEG and BIS waves

Global Speed

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

Changing the Wave Group Speed

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

To change the wave speed of a wave speed group,

1

Select

Main Setup

->

User Interface

2

Select

Global Speed

,

RespiratorySpeed

, or

EEG Speed

as required

27

1 Basic Operation

Freezing Waves

3

Select a value from the list of available speeds.

Changing Wave Speed for a Channel

To change the wave speed of an individual wave channel,

1

2

Enter the

Wave

menu for a measurement by selecting its wave.

Select

Change

Speed

.

3

To set the speed to the wave group speed, select

RespiratorySpeed

,

EEG Speed

, or

Global Speed

.

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

Freezing Waves

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

Freezing An Individual Wave

To freeze a wave,

1

Enter the

Wave

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

2

Select

Freeze Wave

.

The realtime wave is replaced with the frozen wave.

Freezing All Waves

To freeze all waves on the screen,

1

Select the

Freeze Waves

SmartKey.

All realtime waves are replaced with frozen waves.

Measuring Frozen Waves

To measure a frozen wave,

1

Select the frozen wave.

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

2

3

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

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

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

The horizontal cursor measures the wave value, which is displayed above the cursor line.

28

Using Labels

1 Basic Operation

Changing The Wave Speed

Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.

To change the wave speed:

1

2

Select the frozen wave.

Select

Change Speed

.

3

Select a speed from the list.

Updating The Frozen Wave

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

1

Select the frozen wave.

2

Select

Freeze Again

.

Releasing Frozen Waves

To release frozen waves,

1

2

Select a frozen wave.

Select

Unfreeze Waves

.

All frozen waves are released.

Using Labels

You can measure multiple invasive pressures, temperatures, and SpO

2

simultaneously. The monitor uses labels to distinguish between them. The default settings defined in the profile (such as measurement color, wave scale, and alarm settings) are stored within each label. When you assign a label to a measurement, the monitor automatically applies these default settings to the measurement.

The labels assigned are used throughout the monitor, in reports, recordings, and in trends.

About Label Sets

Your monitor may be configured to use a

Restricted

or

Full

label set. The

Full

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

If you connect a measurement server from a monitor using a

Full

label set to an IntelliVue monitor using a

Restricted

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

Be aware that connecting a monitor using the

Full

label set to an Information Center with certain software revisions may affect the availability of measurement information from the additional labels on the Information Center. See the Information Center documentation and your monitor’s

Configuration Guide for information on label set compatibility.

Changing Measurement

Labels (e.g. Pressure)

To change a measurement label of a measurement with multiple labels (invasive pressure, temperature, or SpO

2

),

29

1 Basic Operation

Using Labels

1

2

Enter the

Wave

menu of the measurement.

Select

Label

.

3

Choose a label from the list.

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

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

Give me an example Let’s imagine you used a Press module to monitor your previous patient’s CVP.

Now you want to use the same module to measure ABP with a new patient. You’ve set up your arterial line. When you connect the pressure transducer to the module, the pressure shown on the screen still uses the CVP color and wave scale and is labeled CVP. To rectify this, just change the pressure label to

ABP. Now the pressure has the correct color, the wave is shown in the correct scale, and the appropriate alarm limits for ABP are active.

Resolving Label Conflicts

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

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

Depending on your configuration, the monitor will either

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

• display the

Measurement Selection

window automatically for you to resolve the conflict measurement selection key with question marks indicating a label conflict

• take no action, you must enter the

Measurement

Selection

window and resolve the conflict

All the currently available measurement devices are depicted in the

Measurement Selection

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

Conflicting measurement labels are shown in red

Measurement Selection

SpO2 BIS Tskin C.O.

EcgRsp SpO2 NBP ABP

De-activated labels are grayed-out

CO2

Temp

To resolve a label conflict,

1

Select the measurement selection key or select

Main Setup

->

Measurement Selection

to display the

Measurement Selection

window.

30

Changing Monitor Settings

1 Basic Operation

2

Select the device whose label you want to correct.

3

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

Change Label

to assign a different label to the conflicting label

De-activate:

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

XXX

.

Setup <Measurement label>

: to enter the Setup menu for the measurement and change the conflicting device’s label to a different label.

Modify Driver

(VueLink only) - change the VueLink device driver.

Changing Monitor Settings

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

Main Setup

SmartKey and then select the setting you want to change, or select

User

Interface

to enter a submenu where you can change user interface settings.

Adjusting the Screen Brightness

1

2

Select the

Brightness

SmartKey.

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

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

If you are using an MP80 or MP90 with an external display, the

Brightness

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

Adjusting Touch Tone Volume

The touch tone volume is the tone you hear when you select any field on the monitor screen. To adjust the touch tone volume,

1

2

In the

Main Setup

menu, select

User Interface

Select

TouchToneVolume

, then select the appropriate setting for the touch tone volume: 10 is the loudest and 1 is the quietest. Selecting zero switches the touch tone volume off.

Setting the Date and Time

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

WARNING

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

1

Select the

Date, Time

screen element from the monitor’s info line to enter the

Date

,

Time

menu.

31

1 Basic Operation

Checking Your Monitor Revision

2

3

Select, in turn, the

Year, Month, Day, Hour

(in 24 hour format, only) and

Minute

as necessary. Select the correct values from the pop-up list.

Select

Store Date, Time

to change the date and time.

Checking Your Monitor Revision

1

2

3

Select

Main Setup

->

Revision

to open the

Monitor Revision

menu.

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

From the

Monitor Revision

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

Getting Started

Once you understand the basic operation principles, you can get ready for monitoring.

Inspecting the Monitor

WARNING

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

1

Before you start to make measurements, carry out the following checks on the monitor including all connected Measurement Servers, modules, or measurement server extensions.

– Check for any mechanical damage.

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

2

3

Plug the power cord into the AC power source. If you are using battery power, ensure that the battery has sufficient power for monitoring. When you use a battery for the first time, you must charge it, following the instructions given in the section on Charging Batteries.

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

Switching On

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

CO2 Sensor Warmup

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

CAUTION

When using an MP90 monitor with a D80 Intelligent Display, always switch power on directly at the

MP90 or at a remote SpeedPoint or remote alarm device directly connected to the MP90.

Setting up the Measurement Servers and Modules

1

Decide which measurements you want to make.

32

Disconnecting from Power

1 Basic Operation

2

3

Connect the required modules, Measurement Servers, or measurement server extensions.

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

Starting Monitoring

After you switch on the monitor,

1

2

Admit your patient to the monitor.

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

3

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

Disconnecting from Power

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

Monitoring After a Power Failure

If the monitor is without power for less than one minute, monitoring will resume with all active settings unchanged. If the monitor is without power for more than one minute, the behavior depends on your configuration. If

Automat. Default

is set to

Yes

, the default profile will be loaded when power is restored. If

Automat. Default

is set to

No

, all active settings are retained, if power is restored within 48 hours. The

Automat. Default

setting is made in Configuration Mode.

Networked Monitoring

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

MP20/MP30/MP40/MP50 - select the monitor info line to enter the

Bed Information

.

Setup

menu, then select

MP60/MP70/MP80/MP90 - in the monitor info line, select the bed label.

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

Using Remote Applications

If your monitor is connected to a Philips Application Server, you can access applications hosted remotely on the Application Server and display and operate them on the bedside monitor screen. The

Application Server provides portal technology to allow information access through a web browser, terminal emulation, or served applications. The applications available depend on the Application

Server configuration: see the device documentation for details. A Remote Application window can also be embedded in a monitoring Screen.

To display remote applications on the monitor,

33

1 Basic Operation

Using Remote Applications

1

2

3

In the

Main Setup

menu, select

Remote Applics

, or select the

Remote Applications

SmartKey.

Select the required application from the pop-up list of available applications.

Operate the application with your preferred monitor input device: touchscreen, SpeedPoint, navigation point, keyboard or mouse.

Remote Application Popup Keys

Pop-Up Keys Selecting this pop-up key lets you....

Minimize

Keyboard

Refresh

Close

minimize the Remote Application window; the session continues running in the background. Select the Remote Application symbol to show the window at full size again.

start a keyboard application to show a keyboard on the display. This key is not available if the keyboard application is not installed or not supported on the Philips Application

Server.

update the content of the Remote Application window.

close the Remote Application session.

The Remote Application window occupies a pre-defined area on the monitor Screen. The maximum size of the area depends on the resolution of your display. If the pre-defined area for the Remote

Application covers the full monitor Screen (on independent second displays only), the pop-up keys are not displayed. In this case a small window appears with two keys: one (with the Remote Application symbol) to display the pop-up keys and another to move the small window if it is obstructing viewing.

If you change the monitor Screen while a Remote Application is running, and the pre-defined area on the second Screen is smaller, the Remote Application cannot be shown at full size. You must select a suitable monitor Screen to display the Remote Application again.

34

2

2

What’s New?

This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book.

You may not have all of these features, depending on the monitor configuration purchased by your hospital.

What’s New in Release D.0?

M1014A Spirometry Module

The spirometry module produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics. It is designed to be used in combination with Philips-branded airway flow sensors and combined CO

2

/airway flow sensors.

M3014A Capnography Extension

The M3014A Capnography Extension offers an additional measurement method - sidestream CO

2 with the M2741A sensor.

M8016A D80 Intelligent Display

The D80 Intelligent Display can be used as a third main display with the MP90 monitor. You then have three displays able to be configured individually and to be operated independently.

IntelliVue 802.11 Bedside Adapter

The 802.11 Bedside Adapter is a wireless ethernet adapter which can be built in to the patient monitor

(option J35). It provides wireless connectivity to standard IEEE 802.11a/b/g wireless networks.

Improved Multiple Display Support

• Wide and Tall screen layouts are supported which allow screen content to be spread over two screens next to each other (wide acreen) or one above the other (tall screen).

• An additional main display used for a surgeon can be configured not to show alarm information.

The permanent keys and SmartKeys can also be configured not to display.

• Input devices can be assigned to an operator, independent of physical connector location.

New SmartKeys

For the new spirometry module there is a SmartKey to provide direct access to the spirometry data window. For microstream and sidestream CO

2

SmartKey

CO2 Pump Off

.

, sampling can now be suppressed directly with the

35

2 What’s New?

What’s New in Release C.0?

What’s New in Release C.0?

IntelliVue MP80

The MP80 patient monitor is a new addition to the IntelliVue patient monitor family. The functionality is similar to that of the MP70 but with the flexibility of component modularity as in the

MP90.

M3014A Capnography Extension

The M3014A Capnography Extension offers a new measurement combination - mainstream CO

2 cardiac output, invasive pressure and invasive pressure/temperature.

,

M8045A Docking Station

The docking station provides quick mounting and connections for the MP20/MP30/MP40/MP50 in a one-step operation. By placing the monitor on the docking station and closing the lever you can make the connection to AC power and to a network, if present.

BIS Interface Board

This interface board allows use of Bispectral Index monitoring with the MP20 and MP30.

Timers Application

The new Timers application allows you to set timers to notify you when a specific time period has expired. The timers can have varying characteristics and can be located on the Main screen for easy viewing.

IntelliVue Instrument Telemetry (USA only)

Wireless network capabilities via the IntelliVue Instrument Telemetry network using a built-in interface (MP20/MP30) or an external adapter (MP40/MP50).

Remote Applications

Remote applications can now be embedded in a monitoring Screen. The display colors for remote applications have been enhanced.

Basic Operation

• Selection and order of SmartKeys can now be configured in the monitor’s Configuration mode.

• A new SmartKey exits Standby mode at the gas monitor.

• Direct operation of a second independent display with the MP90, using standard input devices.

• Networked monitors can now show Telemetry information for the “Own Bed” in an overview window or embedded in a Screen.

• Overview bed information can be configured to display in the colors used at the Information Center

(with Information Center System G or higher).

• Support for Unit-based Care Group model for up to 64 beds (with Information Center System G or higher).

• Battery status information on the main screen now includes estimated monitoring time available during battery charging.

• Barcode reader support during patient admission.

• Direct entry to graphical trends when a limit alarm is selected in alarm review and to the event episode window when an event alarm is selected.

• MP90: screen trends can now also be viewed on the second display.

36

What’s New in Release B.1?

2 What’s New?

Trends

• In graphical trends, a segment menu allows direct adjustment of trend scales, automatic scale optimization, expanded view for an individual segment.

• In graphical and horizon Screen Trends a cursor is available.

• In the Vital Signs window, the values can be shown with the parameter color.

Events

• Events can be configured to be signaled as alarms (advanced event surveillance only).

• Deviation triggers can be set which trigger an event when measured values change by a defined amount over a set time (advanced event surveillance only).

• Up to six event groups can be active simultaneously (advanced event surveillance only).

Measurements

• Pulse Pressure Variation is a new derived measurement calculated from beat-to-beat arterial pressure values.

• MAC value calculations

Applications

• Improved Drug Calculator meeting JCAHO requirements.

• The ST Map application shows ST changes over time in two multi-axis spider diagrams.

• Freeze and measure waves on the Main Screen.

What’s New in Release B.1?

IntelliVue MP20/MP30

The MP20/MP30 patient monitor is a new addition to the IntelliVue patient monitor family. It is smaller and lighter than the MP40/MP50 monitors and can be powered by battery. It can be used with the measurement server and server extensions and has a built-in recorder.

Basic Operation

• New Measurement Selection window makes it easier to resolve measurement label conflicts

• New Previous/Next Screen function provides access to the ten most recently modified Screens

• Wave speeds can now be set for individual wave channels

Trends

• Cursor in graphical trend window improves navigation in the trends database

• Vital Signs and Graphical Trend screen elements can be embedded on a Screen

• New band style format for displaying trends of measurements with multiple numerics

• Horizon trend is a new format for screen trends, showing the deviation from a stored baseline

• Aperiodic measurements now stored with a timestamp in Vital Signs

• New symbol representing NBP measurements in Graphical Trends

Measurements

• ST numerics in the Alarm Limits window can be shown and hidden

37

2 What’s New?

What’s New in Release B.0?

• ST Point can be set directly by selecting a numeric value

• New NBP countdown timer shows the time remaining until the next NBP measurement in a series

• Networked monitors can now show Other Bed information embedded on Screen

• Additional labels available for Pressure and Temp

• Additional options for SpO

2

, support for an extended list of accessories

• Suppress Zero function for Microstream CO

2

Applications

• Drug Calculator can now be configured to include a list of commonly-used drugs

• Cursor in the Loops window improves navigation through the stored loops

• Volume-flow loops added to the list of respiratory loops types

• Loops Report for documentation of stored loops

• EEG CSA can now be called up and viewed in a window over the currently displayed Screen

What’s New in Release B.0?

IntelliVue MP40/MP50 The MP40/MP50 patient monitor is a new addition to the IntelliVue patient monitor family. It uses the same measurement devices as the MP60/MP70/MP90 monitors and shares the same technological platform and user interface, but is more compact in size and can be operated by battery.

M3012A Measurement Server Extension The new Hemodynamic Measurement Server Extension extends measurement capability by adding two additional pressures and Cardiac Output.

M1020B SpO

2

Module New SpO

2

measurement module, M1020B, enables dual SpO

2 measurement without the need to use the VueLink module. Two options are available:

– Option A01 for use with Philips reusable and disposable sensors and Nellcor “R-Cal” disposable sensors.

– Option A02 for use with Nellcor OxiMax sensors, including the MAX-FAST forehead sensor.

M1020B Option A02 for use with Nellcor OxiMax sensors may not be available in all countries.

PV Loops: compares graphic representations of airway waves to help detect changes in the patient airway condition.

High-resolution waves per Screen: the number of high-resolution waves that can be shown on a

Screen is increased, limited only by the Axx Option purchased.

Alarms symbols: New alarm symbols are introduced, and “short” yellow alarms were renamed “onestar” yellow alarms (yellow arrhythmia alarms).

Aperiodic measurements available as Screen Trends: patient trend information for NBP, C.O., C.I., and Wedge can now be permanently displayed on the Screen in tabular and graphical form.

38

What’s New in Release A.2?

2 What’s New?

What’s New in Release A.2?

12-Lead ECG recordings: 12-Lead ECG waves and numerics can be sent to a connected recorder

High-Resolution Trend Report: high-resolution trend report can be sent to a connected printer

ST Snippets ST snippets, showing a one second wave segment for each measured ST lead, can be permanently displayed on the Screen or called up as required.

EEG Wave Speed: new EEG-specific wave speeds have been added to the list of wave speeds available

Drug Calculator: this new feature helps you to calculate drug dosages for your patients

On-Screen Calculator: a mathematics calculator can be used on the Screen

Visitor Screen: this new Screen is designed to hide sensitive patient information from the Screen.

Monitoring and alarm generation function as usual.

Touch selection volume control: The volume of the audio prompt given when a screen element is selected is now adjustable

VueLink interface: the VueLink on-screen appearance and controls are improved

M3001A: Trend upload from the Multi-Measurement Server (M3001A) improved

Screen Trends: lets you display patient trend information in graphic form permanently on the Screen

Alarm Limits Page: lets you view and control alarm settings for all measurements in one window

New Option for Event Surveillance: a new neonatal event review option #C04 is introduced

Second display To simultaneously show two different Screens, a second display can be connected to the MP90. The second display is for viewing only.

39

2 What’s New?

What’s New in Release A.2?

40

3

3

Alarms

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

The monitor has three alarm levels: red, yellow, and INOP.

Red and yellow alarms are patient alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Yellow arrhythmia alarms are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy).

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

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

If more than one alarm is active, the alarm messages are shown in the alarm status area in succession. An arrow symbol next to the alarm message informs you that more than one message is active.

**

HR HIGH

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

41

3 Alarms

Visual Alarm Indicators

Visual Alarm Indicators

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

INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms,

** for yellow alarms, * for yellow arrhythmia alarms. INOPs are displayed without asterisks.

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

• in text form, for example “

**SpO2 LOW

” or

• in numeric form, for example “

**SpO2 94<96

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

Flashing numeric: The numeric of the measurement in alarm flashes.

Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly.

Alarm lamp: A lamp on the monitor’s front panel flashes. This has the same color as the alarm priority.

Nurse call systems: Alarm conditions are indicated on any device connected to the nurse call relay, if configured to do so.

Audible Alarm Indicators

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

WARNING

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

Alarm Tone Configuration

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

• increase the alarm volume of unacknowledged alarms at regular intervals

• change the interval between alarm sounds (ISO/IEC Standard 9703-2 alarms only)

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

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

42

Audible Alarm Indicators

3 Alarms

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

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

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

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

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

ISO/IEC Standard 9703-2 Audible Alarms

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

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

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

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

Changing the Alarm Tone Volume

The alarm volume symbol at the top right of the monitor screen gives you an indication of the current volume. To change the volume, select the volume symbol and then select the required volume from the pop-up selection.

If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, select the

Alarm Volume

SmartKey. The volume scale pops up.

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

Alarm

When the alarm volume is set to zero (off), the alarm volume symbol reflects this. If you switch the alarm volume off, you will not get any audible indication of alarm conditions.

Minimum Volume for No Central Monitoring INOP

If your monitor is connected to an Information Center, and the connection is interrupted, the INOP message

No Central Monit.

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

43

3 Alarms

Acknowledging Alarms

Acknowledging Alarms

To acknowledge all active alarms and INOPs, select the

Silence

permanent key. This switches off the audible alarm indicators and alarm lamps. Alternatively, you can acknowledge alarms by pressing the

Silence

hardkey on the MMS or on the SpeedPoint. The hardkeys follow the behavior configured for the permanent key.

Silence

A check mark beside the alarm message indicates that the alarm has been acknowledged. If the monitor is configured to re-alarm, a dashed check mark will be shown.

If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message stays on the screen with a check mark symbol beside it.

APNEA

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

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

Acknowledging Disconnect INOPs

Acknowledging an INOP that results from a disconnected transducer switches off the associated measurement. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the

Information Center switches off the audible INOP indicator but does not switch off the measurement.

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

Alarm Reminder (ReAlarm)

If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). There is no alarm reminder for INOPs.

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

Pausing or Switching Off Alarms

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

To view the alarm pause setting chosen for your unit,

1

Select

Main Setup

->

Alarm Settings

2

Check the

Alarms Off

setting.

This setting can only be changed in Configuration Mode.

44

Pausing or Switching Off Alarms

3 Alarms

To Pause All Alarms

Select the

Pause Alarms

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

Alarms Off

, and selecting it switches alarms off.

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

Pause

Alarms

To Switch All Alarms Off

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

Alarms Off

.

Select the

Alarms Off

permanent key.

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

Pausing alarms infinitely is the same as switching them off.

To Switch Individual Measurement Alarms On or Off

1

2

Select the measurement numeric to enter its setup menu.

Select

Alarms

to toggle between

On

and

Off

.

The alarms off symbol is shown beside the measurement numeric.

While Alarms are Paused or Off

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

Alarms

Off

• In the alarm field, the monitor displays the message

Alarms Paused

or

Alarms Off

, together with the alarms paused symbol and the remaining pause time in minutes and seconds, or alarms off symbol.

ALARMS PAUSED 1:28

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

ALARMS OFF

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

The only exceptions are the INOPs

Battery

/

Batteries Empty

,

Battery

/

Batteries Malfunction

,

Batt 1/2 Missing

, and

NBP Cuff Overpressure

.

These INOPs are sounded even if alarms are paused or off.

• The nurse call relay is not active.

If a disconnect INOP is present and alarms are paused or switched off, the measurement in question is switched off.

45

46

3 Alarms

Alarm Limits

Restarting Paused Alarms

To manually switch on alarm indication again after a pause, select the permanent key

Pause Alarms

(or

Alarms Off

) again.

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

Alarms Off

again to restart alarm indication.

Resetting Arrhythmia Alarm Timeouts

To reset the arrhythmia alarm timeout period, select the

Alarms Off

or

Pause Alarms

permanent key and then reselect it.

Extending the Alarm Pause Time

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

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

1

Select one of the alarm fields. This calls up the

Alarm Messages

window.

2

Select either the pop-up key

Pause Al. 5 min

or the pop-up key

Pause Al. 10 min

.

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

Alarm Limits

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

2

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

WARNING

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

Viewing Individual Alarm Limits

HR

120

50

85

Alarm limits

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

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

Alarm Limits

3 Alarms

Viewing All Alarm Limits

The

Alarm Limits

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

Apnea alarm delay time is set, this is also shown. The

Alarms Off

symbol is shown beside the measurement label of any measurement whose alarm switched off.

To open the

Alarm Limits

window, either select any alarm field to open the

Alarm

Messages

window, then select the

Alarm Limits

pop-up key, or select the

Alarm

Limits

SmartKey, if configured.

Alarm Limits

ST-V4

ST-V5

ST-V6

SpO2

Pulse (SpO2)

NBPs

ABPs

PAPd awRR

Apnea Time

Off sec

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

Off

indicates the measurement is switched off

Measurement labels, with alarms off symbol where appropriate

Current alarm limits

Select

Show ST Limits

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

Selecting

Hide ST Limits

hides the list again.

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

Alarm Limits

window to perform common tasks:

All Al. On

/

All Al. Off

,

All Lim. Narrow

/

All Lim. Wide

to set narrow or wide alarm AutoLimits for all measurements.

Print Limits

/

Record Limits

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

47

3 Alarms

Alarm Limits

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

Alarm Limits

window.

Changing Alarm Limits

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

1

2

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

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

Alternatively, you can use the keys in the measurement Change Limits window, which you access by selecting the measurement label in the

Alarm Limits

window.

High red alarm (view only)

High yellow alarm field

HR

Up/down arrow keys for changing high yellow alarm limits

Alarms

On/Off

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

Preview Alarm AutoLimits for a measurement before applying

Select to apply wide AutoLimits

Select to apply narrow

AutoLimits

Up/down arrow keys for changing low yellow alarm limits

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

(MP40/50/60/70/90 only)

Graphic view of alarm limits with currently measured value

Low yellow alarm field

Low red alarm (view only)

To change alarm limits,

1

In the

Change Limits

window,

– if you are using touch, select the up or down arrow buttons to adjust the high and low alarm limits as required.

– if you are using a SpeedPoint or Navigation Point, position the cursor in the high yellow alarm field, then press the knob inwards. Rotate the knob to the left or right to adjust the limit. Press the knob again to set the displayed limit.

2

Repeat to set the low yellow alarm limit.

48

Alarm Limits

3 Alarms

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

When an ST measurement is in the

Change Limits

window there are also two pop-up keys available labeled

All ST Narrow

/

All ST Wide

. With these keys you can set Auto Limits for all

ST Leads.

About Automatic Alarm Limits (AutoLimits)

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

Alarm Limits function. This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds.

The defined safe limits never exceed the non-pathological range.

Limits Narrow

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

Limits Wide

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

Use the keys in the

Change Limits

window to apply AutoLimits for individual measurements.

These keys are not available if AutoLimits have been disabled for the measurement in the monitor’s

Configuration Mode.

High alarm limit, wide

High alarm limit, narrow

Alarm limits

Low alarm limit, narrow

Low alarm limit, wide

Measurement value

Lower limit clamps

Upper limit clamps

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

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

Documenting Alarm Limits

The alarm limits pop-up keys appear with the

Alarm Limits

and

Change Limits

windows.

Select the printer.

Print Limits

pop-up key to print an overview of all alarm limits on a connected

Select the

Record Limits

pop-up key to send a recording of the alarm limits to a recorder.

49

3 Alarms

Reviewing Alarms

Reviewing Alarms

To review the currently active alarms and INOPs, select any of the alarm status areas on the monitor screen. The

Alarm Messages

window pops up. All alarms and INOPs are erased from the monitor’s alarm history when you discharge a patient, or if you change to Demonstration Mode.

Alarm Messages Window

The

Alarm Messages

window shows all the currently active alarms and INOPs in chronological order, beginning at the top with the most recent. INOPs are shown on the left hand side and patient alarms are shown on the right hand side. Any active red alarms are shown first, followed by yellow alarms. Acknowledged alarms or INOPs are shown with the check mark symbol.

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

Review

Alarms

pop-up key opens the

Review Alarms

window.

Alarm

Limits

Review

Alarms

Pause Al.

5 Min.

Pause Al.

10 Min.

Review Alarms Window

Review Alarms

The

Review Alarms

window contains a list of up to 100 of the most recent alarms and INOPs with date and time information. If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit. The

Review Alarms

window also shows any changes made to the Alarms On/Off or Silence status.

5 Apr 16:55:18 *** Apnea

5 Apr 16:55:18 ** ABPs HIGH (120 >95)

5 Apr 16:55:18 Alarms On

5 Apr 16:45:15 ** SpO2 NON-PULSAT.

5 Apr 16:44:57 Alarms Off

5 Apr 16:44:46 ** awRR LOW (14<15)

5 Apr 16:44:39 ** SpO2 LOW (95<99)

If you select a high or low limit alarm in the list, the

Graphical Trends

window will open to provide further data. If you select an alarm resulting

5 Apr 16:44:28 ** ABPs HIGH

from an event alarm notification, the

Event Episode

window for that event will open. When you close these windows you will return to the

Review Alarms

window.

The information in the Review Alarms window is deleted when a patient is discharged, when the monitor is switched off for longer than one minute, and when you leave Demonstration Mode.

The

Review Alarms

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

Active Alarms

pop-up key opens the

Alarm Messages

window.

Alarm

Limits

Active

Alarms

Pause Al.

5 Min.

Pause Al.

10 Min.

50

Understanding Alarm Messages

3 Alarms

Understanding Alarm Messages

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

In the

Alarm Messages

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

Alarm Messages

Resp LEADS OFF

LL LEAD OFF

** awRR LOW

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

Attach the missing electrode or select <New

Lead Setup> to confirm the new lead set

Latching Alarms

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

Viewing the Alarm Latching Settings

To see the alarm latching setting for your monitor

1

2

In the monitor’s

Main Setup

menu, select

Alarms

.

Select

Alarm Settings

, and see the

Visual Latching

and

Audible Latching

settings.

This setting can only be changed in Configuration Mode. You should be aware of the settings chosen for your unit. There are three possible choices each for visual and audible latching, Red, Red and

Yellow, and Off. These choices can be combined to give the following settings:

Visual Latching

Audible latching

R&Y

R&Y

R = red alarms, Y = yellow alarms

R&Y

R

R&Y

Off

R

R

R

Off

Off

Off

51

3 Alarms

Testing Alarms

Alarm Latching Behavior

Red and Yellow Measurement

Alarms

Non-latching alarms

Visual and audible latching

Visual latching, audible non-latching

Alarm has not been acknowledged.

Alarm has been acknowledged.

Alarm condition still present.

Alarm condition no longer present.

Alarm condition still present.

Alarm condition no longer present.

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

All audible and visual alarm indicators automatically stop.

Alarm tone on.

Alarm lamp on.

Alarm message.

Flashing numerics.

Alarm message. Flashing numerics.

Audible alarm indicators automatically stop.

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

Audible and visual alarm indicators automatically stop.

All INOPs except

DISCONNECT

and

UNPLUGGED

INOPs from measurement servers and modules

are non-latching. See “Yellow Arrhythmia Alarms” on page 113 for information on short yellow

arrhythmia alarms latching behavior.

Testing Alarms

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

2

or CO

2

) or use a simulator. Adjust alarm limits and check

Alarm Behavior at On/Off

When you switch alarms on, the settings defined in the currently active Profile are used.

If the monitor is switched off for longer than one minute and then switched on again, or after a loss of power lasting longer than one minute, or when a patient is discharged, the monitor can be configured to restore either the alarm settings from the monitor's configured default Profile, or the most recently used alarm settings. After any of these situations, you should check that the alarm settings are appropriate for your patient, and if necessary, select the correct Profile and patient category.

If power is lost for less than one minute, the alarm settings prior to the power loss are restored.

52

4

4

Patient Alarms and INOPs

This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their

priority. INOPs start on page 59.

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

Use.

Patient Alarm Messages

The measurement labels and abbreviations for pressure, temperature, SpO

2

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

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

IntelliVue Instrument Telemetry (USA only). These shortened alarm texts are included in the list and identified with the note “at Information Center”.

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

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

Alarm Message

***APNEA

or

***APNEA xxx sec

***ASYSTOLE

**awRR HIGH

**awRR LOW

**BIS HIGH

**BIS LOW

From

CO

2

, Resp,

AGM

ECG

CO

2

, Resp,

AGM

CO

2

, Resp,

AGM

BIS

BIS

Condition Indication

Respiration has stopped for longer than the preset apnea time. “xxx” denotes the

Apnea duration.

numeric flashes, red alarm lamp, alarm tone.

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

numeric flashes, red alarm lamp, alarm tone.

The airway respiration rate has exceeded the high alarm limit.

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

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

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

The Bispectral Index value has exceeded the high alarm limit.

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

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

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

53

4 Patient Alarms and INOPs

Patient Alarm Messages

Alarm Message

***BRADY (Pulse) or

***BRADY xxx<yyy

**CCO/CCI HIGH

**CCO/CCI LOW

**CPP HIGH

**CPP LOW

***DESAT

***DESAT xxx<yyy

**et <Agent label>

HIGH

**et <Agent label>

LOW

**etCO2 HIGH

**etCO2 LOW

**etO2 HIGH

**etO2 LOW

*/**/***

or

EVENT:<GRP>

*/**/*** EVENT

at Information center

***EXTREME BRADY

***EXTREME TACHY

From

Press, SpO

CCO

CCO

CPP

CPP

SpO

AGM

AGM

2

CO

2

, Resp,

AGM

CO

2

, Resp,

AGM

O

O

2

2

2

, AGM

, AGM

Event surveillance

Event surveillance

ECG

ECG

Condition Indication

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

numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.

Continuous Cardiac Output or CC

Index is above the high alarm limit.

Continuous Cardiac Output or CC

Index is below the low alarm limit.

The CPP value has exceeded the high alarm limit.

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

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

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

The CPP value has fallen below the low alarm limit.

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

The SpO

2

value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. numeric flashes, red alarm lamp, alarm tone.

The end tidal agent high alarm limit has been exceeded.

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

The end tidal agent value has fallen below the low alarm limit.

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

The end tidal CO

2 been exceeded.

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

The end tidal CO

2

value has fallen below the low alarm limit.

The end tidal O been exceeded.

2

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

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

The end tidal O

2

value has fallen below the low alarm limit. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone.

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

<GRP> is the event group event group name flashes, yellow or red alarm lamp and alarm tone

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

Check on the monitor for more details on event group.

The bradycardia limit has been exceeded.

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone

The tachycardia limit has been exceeded.

numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.

numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.

54

Patient Alarm Messages

4 Patient Alarms and INOPs

Alarm Message From Condition Indication

**HR HIGH

**HR LOW

**imCO2 HIGH

**in <Agent label>

HIGH

**in <Agent label>

LOW

ECG

ECG

CO

2

, Resp,

AGM

AGM

AGM

The heart rate high alarm limit has been exceeded.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. The sound switches off after 5 seconds if

Arrhythmia is On.

The heart rate has fallen below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. The sound switches off after 5 seconds if

Arrhythmia is On.

The inspired minimum CO

2 limit has been exceeded.

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

The inspired agent high alarm limit has been exceeded.

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

The inspired agent value has fallen below the AGT low alarm limit.

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

**inN2O HIGH

**inO2 HIGH

**inO2 LOW

***inO2 LOW OXYGEN

*/**IRREGULAR HR

*/**MISSED BEAT

**NBP HIGH

**NBP LOW

N

2

O, AGM The inspired N

2 been exceeded.

O high alarm limit has

O

2

, AGM The inspired O been exceeded.

2

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

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

O

2

, AGM

O

2

, AGM

ECG/

*/**MULTIFORM PVCs

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

NBP

NBP

The inspired O the low alarm limit.

The inspired O

18 vol.%.

2

2

value has fallen below

value has fallen below numeric flashes, low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low limit is highlighted, red alarm lamp, alarm tone.

Consistently irregular heart rhythm.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

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

numeric flashes, yellow alarm lamp, short yellow audible alarm.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

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

The measured NBP value is above the high alarm limit.

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

The measured NBP value is below the low alarm limit.

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

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

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

55

4 Patient Alarms and INOPs

Patient Alarm Messages

Alarm Message From Condition Indication

*/**NON-SUSTAIN VT

ECG/

Arrhythmia

A run of Vs having a ventricular HR>V-

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

numeric flashes, yellow alarm lamp, short yellow audible alarm.

*/**PACER NOT CAPT

ECG/

Arrhythmia

(paced patients only)

A missed beat with a pace pulse was detected.

*/**PACER NT

PACING

*/**PAIR PVCs

ECG/

Arrhythmia

(paced patients only)

A missed beat without a pace pulse was detected.

ECG/

Arrhythmia

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

numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

*/**PAUSE

ECG/

Arrhythmia

***<Pressure>

DISCONNECT

PRESS

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

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

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

ART, Ao, BAP, FAP, PAP, UAP).

numeric flashes, yellow alarm lamp, short yellow audible alarm.

numeric flashes, red alarm lamp, alarm tone.

**<Pressure> HIGH

PRESS

**<Pressure> LOW

**PULSE HIGH

**PULSE LOW

*/**PVCs/min HIGH

*/**R-ON-T PVCs

PRESS

PRESS

SpO

2

PRESS

SpO

2

ECG/

Arrhythmia

ECG/

Arrhythmia

The measured pressure value is above the high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

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

The measured pressure value is below the low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

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

The pulse rate has exceeded the high alarm limit.

The pulse rate has dropped below the low alarm limit.

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

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

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

numeric flashes, yellow alarm lamp, short yellow audible alarm.

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

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

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

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

numeric flashes, yellow alarm lamp, short yellow audible alarm.

56

Patient Alarm Messages

4 Patient Alarms and INOPs

Alarm Message

**RR HIGH

**RR LOW

**SvO2 HIGH

**SvO2 LOW

*/**SVT

**Tblood HIGH

**Tblood LOW

RESP

*/**RUN PVCs HIGH

ECG/

Arrhythmia

**<SpO2 label>

HIGH

**<SpO2 label> LOW

**ST<n> HIGH

**ST<n> LOW

**ST MULTI <n>,<n>

ECG/

Arrhythmia

**ST MULTI

at Information Center

***TACHY (Pulse) or

***TACHY xxx>yyy

**tcpO2 HIGH/

**tcpCO2 HIGH

From

RESP

SpO

SpO

SvO

SvO

C.O.

C.O.

2

2

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

2

2

ECG/

Arrhythmia

Press, SpO tcGas

2

Condition Indication

The respiration rate has exceeded the high alarm limit.

The respiration rate has dropped below the low alarm limit.

A run of PVCs greater than 2 was detected.

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

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

numeric flashes, yellow alarm lamp, short yellow audible alarm.

The arterial oxygen saturation has exceeded the high alarm limit.

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

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

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

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

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

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

The ST depression or elevation is outside of the limit in two or more leads

<n> and <n> numeric flashes, yellow alarm lamp, alarm tone

The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor for more details about which leads are affected.

The SvO

2

value has exceeded the high limit.

(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone.

The SvO

2 limit.

value has fallen below the low numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone.

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

SVT HR limit.

numeric flashes, yellow alarm lamp, alarm tone.

The heart rate from the Pulse signal has exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit.

numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone.

The blood temperature value has exceeded the high alarm limit.

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

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

The tcpO

2

or tcpCO

2

value has exceeded the high alarm limit.

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

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

57

4 Patient Alarms and INOPs

Patient Alarm Messages

Alarm Message

**tcpO2 LOW/

**tcpCO2 LOW

**<Temperature label> HIGH

**<Temperature label> LOW

**/***VueLink

ALARM

at Information Center

From

tcGas

TEMP

TEMP

*/**VENT BIGEMINY

ECG/

Arrhythmia

***VENT FIB/TACH

*/**VENT RHYTHM

*/**VENT TRIGEMINY

ECG/

Arrhythmia

***VTACH

ECG

ECG/

Arrhythmia

ECG,

Arrhythmia

VueLink

Condition Indication

The tcpO

2

or tcpCO

The temperature has fallen below the low alarm limit.

2 value has fallen below the low alarm limit.

The temperature has exceeded the high alarm limit.

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

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

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

numeric flashes, yellow alarm lamp, short yellow audible alarm.

A fibrillatory waveform for 4 consecutive seconds was detected.

numeric flashes, red alarm lamp, alarm tone.

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

VTach HR limit was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

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

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

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

Check the monitor display for more detailed alarm information.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

Ventricular tachycardia has been detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach

HR limit).

numeric flashes, yellow alarm lamp, short yellow audible alarm.

(on monitor) yellow or red alarm lamp, alarm tone

58

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

The measurement labels and abbreviations for pressure, temperature, SpO

2

, anesthetic agent, and

VueLink INOP messages are explained in the individual chapters.

INOP Message, Indication Source What to do

ABP

INOPS

ALL ECG ALARMS OFF

PRESS

ECG/

Arrhythmia

See <Pressure label> INOPS (under Pressure).

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

ECG alarms on or select ECG as the alarms source.

See <Pressure label> INOPS (under Pressure).

Ao INOPS

ART INOPS

AWF CHANGE SCALE

AWP CHANGE SCALE

AWV CHANGE SCALE

Bad Serverlink

INOP tone

INOP tone, battery LED flashes

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

PRESS

PRESS See <Pressure label> INOPS (under Pressure).

Spirometry Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave.

Spirometry Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave

Spirometry Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave.

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

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

PRESS See <Pressure label> INOPS (under Pressure).

BAP

INOPS

BATTERIES EMPTY

or

BATT 1/

BATT 2 EMPTY

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

Replace the batteries immediately.

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

BATTERIES INCOMPAT

or

BATT

1/BATT 2 INCOMPAT

Batteries

INOP tone

BATTERIES LOW

or

BATT 1/

BATT 2 LOW

Batteries

INOP tone

BATTERIES MALF

or

BATT 1/

BATT 2 MALFUNCTION

INOP tone, battery LED flashes

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

BATT 1/BATT 2 MISSING

INOP tone.

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

Batteries

Batteries

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

(M4605A)

.

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

The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this

INOP is re-issued two minutes after you acknowledge it.

Place the batteries in a different monitor or in a battery charger.

If the same INOP is shown, contact your service personnel.

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

59

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

BIS CABLE INCOMPAT

INOP tone.

BIS CABLE USAGE

INOP tone.

BIS DSC DISCONN

INOP tone

BIS DSC INCOMPT

INOP tone

BIS DSC MALFUNC

BIS DSC UPDATE

INOP tone

BIS ELECTR. DISC

INOP tone.

BIS ENGINE DISC.

INOP tone

BIS ENGINE INCOMPT

INOP tone

BIS ENGINE MALFUNC

INOP tone

BIS EQUIP MALF

INOP tone

BIS HIGH IMPEDANCE

INOP tone may sound

BIS IMPEDANCE CHCK

INOP tone may sound

Source

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

What to do

The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philipssupported sensor cable.

The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.

DSC is not properly connected OR either DSC or BIS engine may be faulty.

Make sure that the DSC is properly connected to the BIS

Engine. If INOP persists, replace DSC with a known good one of the same type.

If INOP persists replace BIS engine.

Silencing this INOP switches the measurement off.

DSC is not supported by the BIS engine or new DSC connected to an old BIS engine. A software upgrade may be required. Contact your service personnel.

Electrocautery used during self-test OR malfunction in the

DSC hardware.

Make sure not to use electrocautery during the self-test procedure. Disconnect and reconnect the DSC to the BIS engine. If the INOP persists, replace the DSC or contact your service personnel.

DSC update currently being carried out. This INOP will disappear when the DSC update is finished. Do not disconnect the DSC during the update. No action is needed.

One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections.

BIS engine not connected OR Module Cable defective.

Make sure that the Module Cable is properly connected. If

INOP persists, replace the Module Cable.

Silencing this INOP switches the measurement off.

BIS engine software is not supported. A software upgrade may be required. Contact your service personnel.

MP20/30 - BIS engine not supported.

Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine.

There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists, contact your service personnel.

Impedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question using correct skin preparation.

If INOP persists, contact your service personnel.

The Cyclic Impedance check is running. It will stop automatically if all impedances are within the valid range. If any electrodes do not pass the impedance test, check the sensor montage and press the electrode pads firmly.

To manually stop the Cyclic Impedance Check, select

Cyclic Check Off

in the

Setup BIS

menu.

60

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

BIS ISOELECTRC EEG

BIS LEAD OFF

INOP tone may sound

BIS OVERCURRENT

INOP tone

BIS SENSOR DISCONN

INOP tone

BIS SENSOR INCOMPAT

INOP tone

BIS SENSOR MALFUNC

INOP tone

BIS SENSOR USAGE

INOP tone

BIS SQI < 15%

(INOP tone)

OR

BIS SQI < 50%

(no INOP tone)

BIS

BIS

BIS UNPLUGGED

INOP tone

BISx DISCONNECTED

INOP tone

Source

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

What to do

No discernible EEG activity is detected for longer than one minute.

Check the patient. Check that the electrodes are properly connected.

One or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly.

If this INOP persists, replace the sensor(s) in question, using correct skin preparation.

Unplug and replug the BIS module or, f or the MP20/MP30, disconnect and reconnect the BISx from the Interface board. If the INOP persists, contact your service personnel.

The sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the

DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty.

Check all the connections.

Disconnect and reconnect the sensor, PIC, DSC, BISx.

If the INOP persists, replace the sensor.

If the INOP persists, replace PIC. If INOP persists, contact your service personnel.

Silencing this INOP switches the measurement off.

Unsupported sensor connected or sensor type unknown or not supported by your software revision. Replace the sensor, using only Philips supported sensors.

Malfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR patient interface cable (PIC) or DSC or BISx may be faulty.

Replace the sensor. Manually initiate a Cyclic Impedance

Check. Make sure all electrodes pass the test. Make sure that the both sides of the PIC connector (between PIC and sensor) are dry. If you are not sure that the connector is dry, replace the

PIC until it has dried. If this INOP persists, contact your service personnel.

Excessive sensor usage. Replace sensor.

A Cyclic Impedance Check will start automatically.

If the signal quality is below 50%, BIS numerics cannot be reliably derived.

If the signal quality is below 15%, no BIS numerics can be derived.

This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices. Make sure the sensor is properly attached to the patient. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure the patient is completely relaxed (even small motions of the facial muscles affect the signal quality).

Plug in the BIS module. Silencing this INOP switches off the measurement.

The BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches the measurement off.

61

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

BISx INCOMPATIBLE

INOP tone

BISx MALFUNCTION

INOP tone

CANNOT ANALYZE ECG

CANNOT ANALYZE ST

CCI NO BSA

CCI numeric unavailable

INOP tone

CCO BAD PRESS SIGN

numeric is replaced by -?-

INOP tone

CCO NO <Pressure label>

numeric is replaced by -?-

INOP tone may sound

CCO NO CALIBRATION

numeric is replaced by -?-

CCO NO PRESS

at Information Center

CCO NOT SUPPORTED

numeric is replaced by -?-

INOP tone

Source

BIS

BIS

ECG/

Arrhythmia

ST

C.O.

C.O.

C.O.

C.O.

What to do

The BISx software is not compatible with the BIS module or with the MP20/MP30 monitor software. A software upgrade may be required. Contact your service personnel.

The BISx is faulty. Disconnect and reconnect it to the module or BIS interface board. If the INOP persists, replace the BISx.

MP20/MP30 - Malfunction on interface board. If the INOP persists, contact your service personnel.

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

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

The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points.

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

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

The arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia.

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

Setup CCO

menu under

CCO From

matches the pressure measured with the arterial catheter for

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

The CCO measurement is currently not calibrated.

C.O.

C.O.

C.O.

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

Setup CCO

menu under

CCO From

matches the pressure measured with the arterial catheter for

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

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

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

CCO/CCI OVERRANGE

numeric is replaced by -?-

INOP tone

CCO <Pressure label>

INVALID

numeric is replaced by -?-

INOP tone may sound

C.O.

The arterial pressure selected for pulse contour calculation for

CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.

62

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

CCO PRESS INVALID

at Information Center

CCO PRESS OVERRANG

numeric is replaced by -?-

INOP tone

CCO PULSE OVERRANG

numeric is replaced by -?-

INOP tone

CCO/Tbl NO TRANSD

Numeric is replaced by -?-

INOP tone

CCO RECALIBRATE

numeric is replaced by -?-

Charge BATT1/BATT2 now

INOP tone

CHARGER MALFUNCT

INOP tone, battery LED may flash

Check Alarm Lamps

INOP tone.

Batteries

Batteries

Monitor

CHECK BATT TEMP

INOP tone

Battery

Check Flex Texts

INOP tone

Monitor

CheckInternVoltage

at Information Center

Check Keyboard

INOP tone

Check Main Board 2

INOP tone.

Check MCC

Check Monitor Func

INOP tone.

Check Monitor Temp

INOP tone

Source

C.O.

C.O.

C.O.

C.O.

C.O.

Monitor

Monitor

Monitor

Monitor

Monitor

Monitor

What to do

The arterial pressure selected for pulse contour calculation for

CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.

The mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0 mmHg or above 300 mmHg.

The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm.

No transducer attached to the module or catheter disconnected.

The most recent CCO or CCI calibration was made over 8 hours ago. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed.

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

There is a problem with the battery charger in the monitor.

Connect the monitor to mains power and contact your service personnel.

Perform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps.

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

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

Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP will appear on the monitor as

Check Monitor Func

.

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

There is a problem with the second main board in the monitor.

Contact your service personnel.

The monitor cannot communicate with the D80 Intelligent

Display. Check the MSL coupling cable. The end with the grey connector must be connected to the Intelligent Display.

Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP may appear on the Information Center as

CheckInternVoltage

.

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

63

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

Check Mouse Device

INOP tone.

Check MSL Voltage

INOP tone

Check Network Conf

INOP tone

Check Nurse Relay

INOP tone

Check Screen Res

INOP tone

Check Settings

INOP tone

Check Speedpoint

INOP tone.

Check Touch Input

Check Waves

INOP tone

Chk IndepDsp Cable

C LEAD OFF

HR Numeric is replaced by -?- for 10 seconds. INOP tone.

CO

2

AUTO ZERO

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

CO

2

CAL MODE

CO

2

numeric displays current CO value for accuracy check

2

CO

2

CAL RUNNING

Numeric is replaced by a - ? -

CO

2

CHANGE SCALE

CO

2

CHECK ADAPTER

Numeric is replaced by a - ? -

INOP tone.

Source What to do

Monitor

Monitor/

Measuremt

Server

Monitor

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

There is a problem with the voltage of the Measurement Server

Link (MSL). Contact your service personnel.

Monitor

Monitor

Monitor

Monitor

Monitor

Monitor

Monitor

ECG

CO

2

CO

2

CO

2

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

Application Server. Contact your service personnel.

There is a problem with the connection to the nurse relay.

Contact your service personnel.

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

Screen instead until you select a different Screen.

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

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

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

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

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

Select a different Screen with fewer waves.

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

The monitor cannot communicate with the D80 Intelligent

Display. Check the MSL coupling cable. The end with the grey connector must be connected to the Intelligent Display.

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

New Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

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

2

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

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

Wait until calibration is finished.

CO

2

CO

2

The CO

2

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

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

64

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

CO

2

CHECK CAL

Numeric is replaced by a - ? -

INOP tone.

C.O. EQUIP MALF

Numeric is replaced by a - ? -

INOP tone.

CO

2

EQUIP MALF

Numeric is replaced by - ? -

INOP tone.

CO

2

FAILED CAL

Numeric is replaced by -?-

INOP tone.

CO

2

NO SENSOR

Numeric is replaced by - ? -

INOP tone.

CO

2

NO TRANSDUC

Numeric is replaced by - ? -

INOP tone.

CO

2

NO TUBING

Numeric is replaced by - ? -

INOP tone.

CO

2

OCCLUSION

Numeric is replaced by a - ? -

INOP tone.

CO

2

OVERRANGE

Numeric is replaced by - ? -

INOP tone.

CO

2

PUMP OFF

Numeric is replaced by a - ? -.

CO

2

PURGING

Numeric is replaced by a - ? -

INOP tone.

CO

2

SENSOR WARMUP

Numeric is displayed with a - ? -

Microstream CO

2

Mainstream CO

2

: INOP tone.

: no INOP tone

C.O. UNPLUGGED

numeric is replaced by -?-

INOP tone.

CO

2

UPDATE FW

Numeric is replaced by a - ? -

INOP tone.

CO

2

WAIT CAL2

Numeric is replaced by a - ? -

C.O.

CO

2

CO

2

Source

CO

2

C.O.

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

What to do

The CO

2

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

There is a problem with the C.O. hardware. Contact your service personnel.

The Measurement Server Extension is faulty. Unplug and replug the Measurement Server with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel.

Make sure that the Cal cell was changed between CAL1 and

CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel.

There is no CO

2 the CO

2 sensor connected. If you silence this INOP

measurement will be switched off.

There is no CO

2

transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO

2

measurement will be switched off.

Either the FilterLine is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another

Microstream

Filterline (only Microstream accessories can be used).

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

The FilterLine or exhaust tube is blocked. Check the FilterLine and exhaust tube, then disconnect and reconnect the

FilterLine. If the INOP persists, connect a new FilterLine.

The CO

2

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

The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the Setup CO

2

menu.

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

CO2 OCCLUSION

is displayed.

Wait until the sensor reaches operating temperature and the

INOP disappears.

Plug in the C.O. module. Silencing this INOP switches off the measurement.

The software in the Measurement Server Extension does not match the software in the MMS. Contact your service personnel.

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

65

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

CO

2

ZERO FAILED

Numeric is replaced by a - ? -

INOP tone.

Source

CO

2

CO

2

ZERO REQUIRED

Numeric is replaced by a - ? -

INOP tone

CO

2

ZERO RUNNING

CPP CHK SOURCES

Numeric is replaced by a - ? -

CPP CHK UNITS

Numeric is replaced by a - ? -

CUFF NOT DEFLATED

Numeric is displayed with a - ? -

INOP tone.

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

CO

2

CO

2

CPP

CPP

NBP

CVP

INOPS

ECG EQUIP MALF

Numeric is displayed with a - ? -

INOP tone.

<ECG LEAD> LEAD OFF

Numeric is displayed with a - ? -

INOP tone.

PRESS

ECG

ECG

ECG EL. NOISY <ECG LEAD>

ECG

ECG NOISY SIGN.

INOP tone.

EcgOut EQUIP MALF

INOP tone

EEG EQUIP MALFUNC

INOP tone

EEG IMPEDANCE HIGH

or

EEG1

and/or

EEG2 IMPED.

HIGH

EEG<X> LEAD OFF <n>

[X = channel, n = electrode]

ECG

ECG

EEG

EEG

EEG

What to do

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

Perform zero calibration for the CO

2

sensor. If the INOP persists, contact your service personnel.

Wait until zero calibration is finished.

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

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

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

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

Stop

All

SmartKey is selected.

[Adult or pediatric patients: The NBP cuff pressure has exceeded

15mmHg (2kPa) for more than 3 minutes.

Neonatal patients: The NBP cuff pressure has exceeded 5mmHg

(0.7kPa) for more than 90 seconds.]

See <Pressure label> INOPS (under Pressure).

Contact your service personnel.

The ECG hardware is faulty.

Not all the required leads for ECG monitoring are connected.

Check the ECG connections and make sure that the electrode indicated by <ECG lead> [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected.

The ECG signal from the named ECG electrodes [RA, LA, LL,

RL, V (or C)] is noisy. Check the ECG connections and make sure that the electrode indicated is attached.

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

The ECG signal may be saturated or overloaded.

Check that the ECG out cable is securely connected. Contact your service personnel.

The EEG hardware is faulty. Contact your service personnel.

The signal electrode in one or both channels exceeds the userselected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines.If the INOP persists, contact your service personnel.

Reconnect specified electrode.

66

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

EEG<X> LEAD OFF

[X = channel] at Information Center

EEG<X> LEADS OFF

[X = channel]

EEG LINE NOISE

EEG 1

or

2 LINE NOISE

EEG MUSCLE NOISE

EEG 1

or

2 MUSCLE NOISE

EEG NO TRANSDUCER

INOP tone

EEG UNPLUGGED

INOP tone

EEG OVERRANGE

, or

EEG<X> OVERRANGE

FAP

INOPS

FMS UNPLUGGED

INOP tone.

FMS UNSUPPORTED

INOP tone.

IC1

/

IC2

INOPS

ICP

INOPs

Indep.Dsp Malfunc.

Indep.Dsp NotSupp.

Intell.Dsp Malf.

INOP tone

Intell.Dsp Missing

Intell.Dsp Unsupp.

Internal.Comm.Malf

INOP tone

LA LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

LAP

INOPs

FMS

PRESS

PRESS

Display

Display

Source

EEG

EEG

EEG

EEG

EEG

EEG

EEG

PRESS

FMS

Display

Display

Display

Monitor

ECG

PRESS

What to do

One or more electrodes are not connected. Check in the

EEG

Impedance/Montage

window on the monitor which electrode(s) are affected and reconnect the electrodes.

Two or more electrodes are not connected. Check in the

EEG

Impedance/Montage

window which electrodes are affected and reconnect the electrodes.

Excessive line noise has been detected in either channel EEG1 or EEG2, or in both EEG channels.

Keep all cables together and away from metallic bodies, other cables & radiated fields.

Too much power above 30 Hz has been detected in channel

EEG1 or EEG2, or both.

Check the Electrode-to-Skin Impedance and reposition the electrode away from possible muscle activity, if necessary.

The trunk cable is disconnected from the EEG plug-in module.

Reconnect the trunk cable.Silencing this INOP switches the measurement off.

Plug in module. Silencing this INOP switches off the measurement.

Input signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electrosurgery.

X denotes the EEG channel.

See <Pressure label> INOPS (under Pressure).

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

The Flexible Module Server is not supported by your monitor.

Contact your service personnel.

See <Pressure label> INOPS (under Pressure).

See <Pressure label> INOPS (under Pressure).

A problem has occurred with the second main display. Contact your service personnel.

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

There is a problem with the Intelligent Display. Check the

MSL coupling cable then contact your service personnel.

The monitor has lost contact with the connected Intelligent

Display. Contact your service personnel.

The monitor does not support the connected Intelligent

Display. The monitor software is incompatible.

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

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

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

See <Pressure label> INOPS (under Pressure).

67

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

LEADS OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

LL LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

MCC Reversed

MCC Unsupported

Measserv Unsupportd

MMS UNPLUGGED

INOP tone.

MMS UNSUPPORTED

INOP tone.

MSL Power High

MSL Power Off

INOP tone.

MSL Power Overload

INOP tone.

NBP EQUIP MALF

Numeric is replaced by -?-

INOP tone.

Source

ECG

ECG

Monitor

Monitor

Monitor

MMS

MMS

Monitor

Monitor

Monitor

NBP CUFF OVERPRESS

Numeric displayed with -?- ; INOP tone.

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

NBP

NBP

What to do

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

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

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

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

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

The measurement server is not supported by the monitor.

Contact your service personnel.

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

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

The power consumption of the devices connected to the

Measurement Server Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel.

The power consumption of the devices connected to the

Measurement Server Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel.

The power consumption of the devices connected to the

Measurement Server Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off.

Contact your service personnel.

The NBP cuff pressure exceeds the overpressure safety limits.

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

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

Stop All

SmartKey is selected.

Remove the cuff from the patient. The NBP hardware is faulty.

Contact your service personnel.

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

Stop All

SmartKey is selected.

68

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

NBP INTERRUPTED

Numeric is replaced by -?-

INOP tone.

NBP MEASURE FAILED

Numeric may be displayed with a -?-

INOP tone.

NBP

No Central Monit.

INOP tone

Source

NBP

Monitor

NO PPV FROM MeasSrv

at Information Center

NO PPV FROM <Server>

MMS or

FMS

MMS or

FMS

P

/

P1

/

P2

/

P3

/

P4

INOPS

PAP

INOPS

PRESS

PRESS

PPV BAD <Pressure Label>

SIGNAL

PRESS

PRESS

PPV BAD SIGNAL

at Information Center

PPV CHK SOURCES

PRESS

<Pressure label> ARTIFACT

Numeric displayed with -?-

PRESS

PRESS

<Pressure label>

DEACTIVATED

INOP tone

What to do

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

If the INOP occurs repeatedly, contact your service personnel.

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

Stop All

SmartKey is selected.

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

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

If numerics are displayed, the monitor is able to measure mean only and the alarm source is set to S, D or S&D.

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

Stop All

SmartKey is selected.

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

There is a problem with the communication to the network.

Central monitoring is currently not possible (no patient alarms or information). Check the connection. Contact your service personnel.

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

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

See <Pressure label> INOPS (under Pressure).

See <Pressure label> INOPS (under Pressure).

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

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

The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off.

A non-physiological event is detected (for example, a flush or blood sample). A resulting high limit alarm will be suppressed.

A Pressure measurement label in the measurement server or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either reconnect a

Pressure transducer or reactivate the measurement label in the

Measurement Selection window.

69

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

<Pressure label> EQUIP

MALF

Numeric displayed with -?-

INOP tone.

<Pressure label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone.

<Pressure label> NOISY

SIGNAL

Pulse numeric is replaced by -?-

INOP tone.

<Pressure label> NON-

PULSATILE

Pulse numeric is replaced by -?-

INOP tone.

Source

PRESS

PRESS

PRESS

PRESS

<Pressure label>

OVERRANGE

Numeric is replaced by -?-

INOP tone.

PRESS

<Pressure label> REDUCE

SIZE

PRESS

<Pressure label> TRANSDUC

MALF

Numeric is replaced by -?-

INOP tone.

PRESS

<Pressure label>

UNPLUGGED

PRESS

PRESS

What to do

Contact your service personnel.

The pressure hardware is faulty.

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

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

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

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

Check the catheter and connections to the patient.

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

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

Increase the scale for the pressure wave.

Contact your service personnel.

The transducer is faulty.

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

Measurement Selection window.

The measurement automatically disappears from the display.

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

Selection window.

Perform a zero and check the calibration of the transducer.

<Pressure label>

ZERO+CHECK CAL

Numeric is replaced by -?-

RA LEAD OFF

Numeric is replaced by -?-

INOP tone.

RAP INOPS

Rem.Alarmdev.Malf

INOP tone

RESP EQUIP MALF

Numeric is replaced by -?-

INOP tone.

ECG

PRESS

Monitor

RESP

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

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

See <Pressure label> INOPS (under Pressure).

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

Contact your service personnel. The RESP hardware is faulty.

70

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

RESP ERRATIC

Numeric is replaced by -?-

RESP LEADS OFF

Numeric is replaced by -?-

INOP tone.

RL LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

Settings Malfunc.

INOP tone.

SOME ECG ALARMS OFF

Speaker Malfunct.

INOP tone

SPIRO MALFUNCTION

SPIRO INCOMPATIBLE

SPIRO UPGRADE

SPIRO CANNOT MEAS

SPIRO PURGE FAILED

SPIRO UNKN. SENSOR

SPIRO ALARMS SUPPR

SPIRO PURGING

SPIRO NO SENSOR

SPIRO NO BREATH

SPIRO GAS COMPENS?

SPIRO PATIENT CAT.

SpO

2

CHK SOURCES

Numeric is replaced by -?-

SpO

2

CHK UNITS

Numeric is replaced by -?-

Source

RESP

RESP

What to do

The monitor has detected too many artifacts in the measured

Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out.

Not all the required leads for Resp monitoring are attached.

Make sure that the RA and LL leads are attached.

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

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

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

Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current

Profile.

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

Spirometry Module failure detected. Contact your service personnel.

Spirometry Module revision not compatible with the host monitor software revision. Contact your service personnel.

Spirometry The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring.

Spirometry Measurement is at its limit, e.g. ambient pressure out of range.

Spirometry The purge operation could not be completed successfully.

Check for kinked sensor tubings, hard occlusions and make sure that the pump is running and all valves are switching.

Spirometry An unknown sensor ID code was detected. Use only the sensors listed in the Accessories chapter.

Spirometry Alarming is suppressed for the spirometry module.

Spirometry A purge operation is in progress - no data update on the screen.

Wait until purge is complete.

Spirometry No sensor detected. Make sure the correct sensor is attached to the breathing circuit.

Spirometry No breath was detected for more than 25 seconds. Breath derived numerics are not available.

Spirometry Gas compensation is set to “gas analyzer” but not all gases necessary for compensation are measured by a gas monitor.

Some of the fall-back values provided by the user are used.

Measurement accuracy might be reduced.

Spirometry Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the Spirometry chapter.

SpO

2

Difference

SpO

2

Difference

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

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

71

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

<SpO

2

label> DEACTIVATED

INOP tone

Source

SpO

2

<SpO

2

label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

SpO

2

<SpO

2

label> ERRATIC

Numeric is replaced by -?-

INOP tone.

<SpO

2

label> EXTD. UPDATE

Label is displayed with a -?-

(questionable numeric)

SpO

SpO

2

2

<SpO

2

label> INTERFERNCE

Numeric is replaced by -?-

INOP tone.

SpO

2

<SpO

2

label> LOW PERF

Label is displayed with a -?-

(questionable numeric)

<SpO

2

label> NOISY SIGN.

Numeric is replaced by -?-

INOP tone.

<SpO

2

label> NON-PULSAT.

Numeric is replaced by -?-

INOP tone.

SpO

2

SpO

2

SpO

2

<SpO

2

label> NO SENSOR

Numeric is replaced by -?-

INOP tone.

SpO

2

<SpO

2

LABEL> POOR SIGNAL

Label is displayed with a - ? -

(questionable numeric)

SpO

2

<SpO

2

LABEL> PULSE?

Numeric is replaced by -?-

INOP tone

SpO

2

<SpO

2

LABEL> SEARCHING

Numeric unavailable

<SpO

2

LABEL> UNKN.SENSOR

Numeric is replaced by a - ? -

SpO

2

<SpO

2

label> SENSOR MALF

Numeric is replaced by -?-

INOP tone.

SpO

2

SpO

2

<SpO

2

LABEL> SENSOR OFF

Numeric is replaced by -?-

INOP tone

SpO

2

What to do

You have connected a measurement server that uses a label the monitor has already assigned to a different source. To activate the new source, choose a new label in the Measurement

Selection window.

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

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

The update period of displayed values is extended due to an

NBP measurement on the same limb or an excessively noisy signal.

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

Accuracy may be compromised due to very low perfusion.

Stimulate circulation at sensor site. If INOP persists, change the measurement site.

Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce patient movement or to relieve the cable strain on the sensor.

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

NBP measurement is finished.

Make sure the SpO

2

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

The signal condition of the SpO

2

measurement is poor and measurement accuracy may be compromised.

The detectable pulsations of the SpO

2 specified pulse rate range.

signal are outside the

SpO

2

is analyzing the patient signal to derive Pulse, SpO

2

and

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

The SpO

2

sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.

The SpO

2

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

The connected sensor or adapter cable is not supported by the

SpO

2

measurement. Use only specified sensors and cables.

72

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication Source

<SpO

2

LABEL> UPGRADE

Label is displayed with a -?-, numeric is unavailable

SpO

2

Sp - vO

2

CHK SOURCES

Numeric is replaced by -?-

Sp - vO

2

Sp - vO

2

CHK UNITS

Numeric is replaced by -?-

Sp - vO

2

SvO

2

CAL FAILED

SvO

2

numeric is displayed with ?

SvO

2

SvO

2

SvO

2

What to do

The SpO

2

measurement is currently in UPGRADE mode.

Monitoring is not possible in this mode.

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

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

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

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

There is no valid calibration data in the Optical Module.

Perform either a pre-insertion or an in-vivo calibration.

SvO

2

CAL MODE

SvO

2

numeric is replaced by -?-

SvO

2

CAL REQUIRED

SvO

2

numeric is replaced by -?-.

INOP tone may sound

SvO

2

CONFIGURATION

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

CONNCT OPTMOD

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

EQUIP MALF

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

IN-VIVO CALIB

SvO

2

numeric is replaced by -?-.

SvO

2

SvO

2

SvO

2

SvO

2

The Optical Module has been configured to SaO

2

Mode. Use

Change to SvO2

in the

Setup SvO2

menu to reconfigure to SvO

2

Mode.

The Optical Module was disconnected during data storage.

Reconnect the Optical Module for at least 20 seconds.

SvO

2

LIGHT INTENS

SvO

2

numeric is replaced by -?- or numeric is displayed with ?

INOP tone with -?- display

SvO

2

LOW LIGHT

SvO

2

numeric is replaced by -?- or numeric is displayed with ?

INOP tone may sound

SvO

2

NO OPTMOD

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

OPTMOD DEFECT

SvO

2

OPTMOD WARMUP

SvO

2

numeric is displayed with ?

SvO

2

PRE-INS CALIB

SvO

2

numeric is replaced by -?-

INOP tone

SvO

2

SvO

2

SvO

2

SvO

2

SvO

2

SvO

2

The SvO

2

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

2

module. Exchange the modules. If the INOP persists, contact your service personnel.

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

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

The intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow.

Reposition the catheter and perform a light intensity calibration.

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

Check the catheter-to-Optical Module connection. If INOP persists, try another catheter and Optical Module.

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

Optical Module. Silencing this INOP switches the measurement off.

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

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

The pre-insertion calibration is running. This typically takes one minute. During this time SvO

2

alarms are switched off.

Wait until the calibration is complete.

73

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

SvO

2

UNABL TO MEAS

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

UNPLUGGED

SvO

2

numeric is replaced by -?-.

INOP tone

SVR/SVRI CHK SOURCES

Numeric is replaced by -?-

tcpO

2

(or tcpCO

2 or tcGas)

CAL RUNNING

Numeric displays first -?- , then numeric is displayed with a ?

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

CHECK TIME

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

CHANGE SITE

If Heat Switch Off is configured to Yes, numeric is replaced by -?-

INOP tone. tcGas

SvO

SvO

2

2

The signal is out of the normal range, and no SvO

2

value can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter.

Measurement switched on and SvO

2 the rack.

module unplugged from

The measurement automatically disappears from the display.

Silencing this INOP switches off the measurement.

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

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

SVR/SVRI CHK UNITS

Numeric is replaced by -?-

SVR/SVRI SET CVP USED

Numeric is replaced by -?-

SVR/SVRI A CVP value is required for this calculation, but is not currently being measured. The monitor is using the CVP value preset in the

Setup SVR

menu.

TEMP See <Temp label> INOPs (under Temp)

T

/

T1

/

T2

/

T3

/

T4

INOPs

Tamb

Tart

INOPs

INOPs

TEMP

TEMP

C.O.

Tblood NO TRANSDUC

Numeric is replaced by -?-

INOP tone

Tblood OVERRANGE

Numeric is replaced by -?-

Tcereb

INOPS

C.O.

TEMP

Tcore

INOPs TEMP

tcpO

2

(or tcpCO

2 or tcGas)

CAL FAILED

Numeric is replaced by -?-

INOP tone.

tcGas

See <Temp label> INOPs (under Temp)

See <Temp label> INOPs (under Temp)

No transducer attached to the module or catheter disconnected.

Tblood out of range 17°C - 43°C.

See <Temp label> INOPs (under Temp)

See <Temp label> INOPs (under Temp).

A calibration failed. Check the cal. unit, gas pressure, and tubing connections, then restart the cal. If the cal. has failed more than once, remembrane the transducer and restart the calibration. If this INOP persists, contact your service personnel.

tcpO

2

(or tcpCO

2 or tcGas)

CAL REQUIRD

Numeric is replaced by -?-

INOP tone.

tcGas Calibration is required before applying the transducer to the patient.

Insert a membraned transducer into the cal. chamber on the module, connect the cal. unit to the cal. chamber, open the gas valve and start the calibration. If this INOP occurs during a calibration, there may be a module or transducer malfunction: contact your service personnel.

Wait until the tcpO

2

/tcpCO

2

calibration is finished.

Site Timer due to time out in 15 minutes or less.

Site Timer has timed out. Change the application site to avoid skin burns. To reset the Site Timer, either calibrate and change the measurement site, or change the measurement site and reset the Site Timer manually by selecting the appropriate site time from the

Setup TCGas

menu.

74

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication Source tcpO

2

(or tcpCO

2 or tcGas)

EQUIP MALF

Numeric is replaced by -?-

INOP tone.

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

NO TRANSDUC

Numeric is replaced by -?-

INOP tone.

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

STABILIZING

Numeric is displayed with a ?

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

UNPLUGGED

Numeric is replaced by -?-

INOP tone.

<

Temp> CHK SOURCES

Numeric is replaced by -?-

<

Temp> CHK UNITS

Numeric is replaced by -?- tcGas

TEMP

Difference

TEMP

Difference

<Temp label> DEACTIVATED

INOP tone

TEMP

TEMP

What to do

There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel.

No transducer is connected to the tcpO

2

/tcpCO

2

module.

Silencing the alarm switches off the measurement.

The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes.

The measurement is switched on but the module is unplugged.

The measurement automatically disappears from the display.

Silencing this INOP switches off the measurement.

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

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

A Temp measurement label in the measurement server or extension has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.

The measurement automatically disappears from the display.

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

Measurement Selection window.

Contact your service personnel.

The temperature hardware is faulty.

<Temp label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

<Temp label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone.

<Temp label> UNPLUGGED

INOP tone

TEMP

TEMP

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

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

TEMP

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

Measurement Selection window.

The measurement automatically disappears from the display.

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

Selection window.

Try changing the application site of the transducer.

[The temperature is less than -1

°

C, or greater than 45

°

C.]

<Temp label> OVERRANGE

Numeric is replaced by -?-

INOP tone.

Tesoph

INOPS

TimeExpired:<

timer label

>

INOP tone

Tnaso

INOPS

Trect

INOPS

Tskin

INOPS

TEMP

Monitor

TEMP

TEMP

TEMP

See <Temp label> INOPs (under Temp).

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

Clearing the timer clears the INOP.

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp).

75

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

Ttymp

INOPS

Tven

INOPS

Tvesic

INOPS

UAP

INOPS

Unsupported LAN

INOP tone

User I/F Malfunct

.

INOP tone.

UVP

INOPS

V LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

<VueLink option> CHK

CABLE

INOP tone.

<VueLink option> CHK

CONF.

INOP tone.

VueLnk NO CONFIG

INOP tone.

VueLnk UNPLUGGED

INOP tone.

Source

TEMP

TEMP

TEMP

PRESS

Monitor

Monitor

PRESS

ECG

VueLink

VueLink

<VueLink option> CHECK

SETUP

INOP tone.

VueLink

VueLnk EQUIP MALF

INOP tone.

VueLink

VueLink

VueLink

What to do

See <Temp label> INOPs (under Temp)

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp)

See <Pressure label> INOPS (under Pressure).

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

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

See <Pressure label> INOPS (under Pressure).

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

New Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

No cable or the wrong cable connected to the VueLink module, or incorrect device selected. Silencing this INOP switches the measurement off.

VueLink INOP abbreviations may differ slightly depending on the device category.

The wrong external device has been selected on the VueLink module, or the external device has not been correctly setup, or the wrong cable has been used to connect the device to the

VueLink module.

VueLink INOP abbreviations may differ slightly depending on the device category.

No information was received from the external device. The device may be switched off or disconnected.

VueLink INOP abbreviations may differ slightly depending on the device category.

Malfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.

VueLink INOP abbreviations may differ slightly depending on the device category.

The VueLink module has not been configured during installation. The installation process should be completed by either your biomedical engineering department or the Philips service engineer.

VueLink INOP abbreviations may differ slightly depending on the device category.

The VueLink module has been unplugged from the rack, or the whole rack has been disconnected. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.

VueLink INOP abbreviations may differ slightly depending on the device category.

76

5

5

Managing Patients

Use the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer

(ADT) patients.

All patient demographic and ADT information is shared between the patient monitor and the

Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center.

Admitting a Patient

The monitor displays physiological data and stores it in the trends as soon as a patient is connected.

This lets you monitor a patient who is not yet admitted. It is however important to admit patients properly so that you can identify your patient on recordings, reports, and networked devices.

During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

To admit a patient,

Patient Demographics

1

2

Select the patient name field or select the

Admit/Dischrge

SmartKey to open the

Patient Demographics

window.

Clear any previous patient data by selecting the

Dischrge Patient

or

End Case

pop-up key and then

Confirm

.

If you do not discharge the previous patient, you will not be able to distinguish data from the previous and current patients, for example, in the trend database.

Last Name

First Name

MRN

Patient Cat.

Paced

Height

Weight

BSA (D)

Adult

No

3

Select

Admit Patient

.

Date of Birth

Age

Gender

Notes (1):

4

Enter the patient information: select each

Notes (2):

field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information. If a conventional keyboard or a barcode scanner is connected to the monitor you can use this to enter patient information.

Last name

: Enter the patient’s last name (family name), for example

Smith.

77

5 Managing Patients

Quick Admitting a Patient

5

First name

: Enter the patient’s first name, for example

Joseph.

MRN

: Enter the patient’s medical record number (MRN), for example

12345678.

Patient Cat

: Choose the patient category, either Adult, Pediatric, or Neonatal.

Paced

: Choose

Yes

or

No

(You must use “Yes” if your patient has a pacemaker).

Height

: Enter the patient’s height.

Weight

: Enter the patient’s weight.

BSA

: The monitor calculates the body surface area automatically.

Date Of Birth

: Enter the patient’s date of birth. Enter this in the form dd/mm/yyyy.

Age

: The monitor calculates the patient age automatically.

Gender

: Choose

Male

or

Female

.

Notes

: Enter any extra information about the patient or treatment.

Select

Confirm.

The patient status changes to admitted.

Patient Category and Paced Status

The patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

The paced setting determines whether the monitor shows pacemaker pulses or not. When

Paced

is set to

No

, pace pulses are filtered and therefore do not show in the ECG wave.

WARNING Patient Category

and

Paced

status will always contain a value, regardless of whether the patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the default settings from the current profile, which might not be correct for your patient.

Patient category Changing the patient category may change the arrhythmia and NBP alarm limits.

Always check alarm limits to make sure that they are appropriate for your patient.

Paced status For paced patients, you must set

Paced

to

Yes

. If it is incorrectly set to

No

, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole.

Admitting a Centrally-Monitored Patient

You can admit a patient at either the bedside or the Information Center. When you admit a patient, the patient’s name appears on the bedside monitor and the Information Center.

If you do not fill in all patient information required by the Information Center, the Information

Center may reject the admission. Complete all the required fields and try again to admit the patient.

Quick Admitting a Patient

Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later. If you do not, the patient name will not be written on reports and on information stored in the database or sent to an Information Center.

1

Select the

Quick Admit

SmartKey.

2

Enter the required data (MRN or Last Name depending on configuration) with the keyboard or a barcode scanner.

78

Editing Patient Information

5 Managing Patients

3

4

Select

Enter

.

In the confirmation window, select

Confirm

to discharge the previous patient (if confirmation is configured).

5

Check that patient category and paced status are correct for the new patient.

If the monitor is connected to an Information Center and only the MRN is entered, the patient name is set to - - - . The patient name field on the monitor shows

Not Admitted

and the patient name space on printed reports is blank. To fully admit this patient, select

Admit

Patient

again and complete all required fields.

Editing Patient Information

To edit the patient information after a patient has been admitted, select the patient name field on the

Main Screen to open the

Patient Demographics

window, and make the required changes.

Discharging a Patient

You should always perform a discharge even if your previous patient was not admitted. A discharge:

– clears the information in the

Patient Demographics

window

– erases all patient data (such as trend, event, and calculation data) from the monitor, measurement servers and Information Center. This ensures that data from a previous patient are not mixed with data from the new patient.

– resets patient category and paced settings to the settings defined in the default Profile

– resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile

– discharges the patient from the Information Center.

When a patient is discharged from the monitor or from an Information Center, all patient data is deleted. Make sure that you have printed out any required reports before discharging. Check that a functioning local or central printer is available before you use

End Case

.

To discharge a patient,

1

Select the patient name field to display the

Patient Demographics

window and associated pop-up keys.

2

Select the pop-up key for either:

End Case

- to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an

End Case

SmartKey is configured for your monitor, you can also select this instead and then confirm.

To see which end case reports are set up for your monitor, select

Main Setup

->

Reports

->

Auto Reports

. For each auto report, if

End Case Report

is set to

On

, this report will be printed when you select

End Case

. See the section on AutoReports for information on setting up end case reports.

Dischrge Patient

- to discharge the patient without printing any reports.

79

5 Managing Patients

Transferring Patients

Transferring Patients

To save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, information can be shared between measurement servers, patient monitors, and

Information Centers.

– patient demographic information is shared between connected measurement servers, patient monitors, and Information Centers

– measurement settings and calibration data can be uploaded from an MMS to a patient monitor, if configured

– trend information can be uploaded from an MMS to a patient monitor, if configured.

Different sets of patient- and measurement-related data are stored in the monitor and the Multi-

Measurement Server. Understanding this will help you to understand what happens to patient data when you transfer patients.

Patient Information Stored in Monitor

yes

Patient demographics (name,

DOB, MRN)

Monitor settings (alarm pause time, alarm volume)

yes yes

Measurement settings for all measurements (alarm limits, measurement on/off, etc.)

Trend data

Calculation data (HemoCalc data)

yes, for all MMS and extensions measurements (up to a maximum of 16 or 32, depending on your database configuration) yes

Events data

yes

Stored in MMS and extensions

yes no yes, for all MMS and extensions measurements most recent 8 hours of information, for all MMS and extensions measurements no no

WARNING

If the monitor is not battery-powered, you cannot monitor during transport.

Transferring a Centrally-Monitored Patient

Scenario: A centrally-monitored patient is moved to another monitoring location on the same

Information Center database server without interrupting the collection of patient trend information.

1

2

Before you disconnect the MMS from the monitor, select the patient name in the monitor info line to enter the

Patient Demographics

window, then select the

Transfer

pop-up key. If the patient is not admitted or not monitored by an Information Center, the

Transfer

key is inactive (“grayed-out”).

This step preserves the patient’s demographic data during the transfer.

Remove the MMS and any connected extensions from the monitor.

3

Connect the MMS to the transfer monitor and monitor your patient during the move.

80

Data Upload from an MMS

5 Managing Patients

4

5

At the new location, connect the MMS to the monitor. If the monitor detects a patient conflict, the patient selection window will be displayed.

Select

Continue MMS

and

Confirm

your selection. This re-admits the patient from the transfer list to the new monitor, completing the transfer. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MMS to the receiving monitor.

6

Verify that the settings for patient category and paced mode are correct.

If you accidentally transfer a patient, use

Re-admit

to restore this patient’s data to the Information

Center. If you are not connected to the network, select

Clear Transfer

to leave transfer mode.The patient data remains in the monitor.

Transferring a Patient with an MMS (no Central Station)

Scenario: A patient is moved to another monitoring location using a transport monitor and readmitted at the new monitor.

1

Disconnect the MMS from the original monitor and silence the resulting

MMS UNPLUGGED

INOP.

If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient’s data.

2

3

4

Connect the MMS to the transport monitor and move the patient.

At the new monitoring location, remove the MMS from the transport monitor and connect it to the new monitor.

If prompted, re-admit the patient to the new monitor: in the

Patient Selection

window, select

Continue MMS

to retain the data in the MMS. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MMS to the monitor. Verify that the settings for patient category and paced mode are correct.

Data Upload from an MMS

The Multi-Measurement Server stores eight hours of patient trend data at one-minute resolution. It also stores patient demographic information and the measurement settings and calibration data for the measurements carried out by the MMS and any connected extensions. This data can be uploaded to an

IntelliVue patient monitor, if your monitor is configured to do so and if at least five minutes of trend information is stored in the MMS.

Your monitor’s data upload settings are defined in Configuration Mode to suit your patient transfer use model.

How data is uploaded to the host monitor depends on the configuration mode settings

MMS Trend Upload

and

MMS Settings Upload

.

If there is a patient conflict and you select Continue Monitor, no data will be uploaded from the

MMS.

81

5 Managing Patients

Data Exchange Between Information Centers

Data Exchange Between Information Centers

You can transfer demographic data and trend data from one IIC to another by selecting

Transfer

on the patient monitor. Trend data is not shared between Information Centers and monitors.

Resolving Patient Information Mismatch

When you connect an MMS to a monitor, or a monitor to the network, the monitor compares patient category, paced status, and a unique patient identification number that is internally stored in both the

MMS and the monitor. The monitor indicates a mismatch if the information is not identical.

Depending on your monitor’s configuration, this mismatch may be automatically resolved or you may have to resolve it manually. If your monitor is configured to resolve mismatches automatically, depending on the configuration, either the monitor or the Multi-Measurement Server data is automatically retained.

WARNING

USA only When a monitor is connected to an Information Center by the wireless IntelliVue

Instrument Telemetry interface, the patient data will automatically be merged in the case of a transfer.

This means there is no patient discharge at the monitor and settings and trend data will be retained.

You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary.

Manually Resolving Patient Mismatch

The patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor

Info Line and in the

Patient Demographics

window. The monitor displays a message such as

Different patients in Central and Monitor

. The

Patient Selection

window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, however, the indicators remain until you do. There can be up to three columns of data in the

Patient Selection

window if the patient is different in the Information Center, monitor, and MMS.

After you resolve the mismatch, the monitor displays a confirmation window that explains the consequences of your choice, telling you where the patient will be continued/discontinued. Confirm your choice. The monitor automatically displays the

Patient Demographics

window after confirmation. Verify that the settings shown are correct for the patient.

Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the MMS. Always check the Patient

Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.

WARNING

After resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient.

82

Resolving Patient Information Mismatch

5 Managing Patients

Patient Mismatch - If One Set of Patient Data is Correct

If there is a mismatch between an

Information Center and a monitor, choose the data set you want to continue using for this patient, either:

Continue Central: to continue with the patient demographics from the

Information Center, discharge the patient in the monitor, and use the default monitor profile.

Continue Monitor: to continue with the patient in the monitor and discharge the patient in the

Information Center, permanently deleting all data in the Information

Center.

Patient Selection

Last name

First name

Central

DOE

JOHN

MRN 1234HG9556

Patient Cat Adult

Paced No

Neo

Yes

Continue

Central

Continue

Monitor

New

Monitor

MILLER

Patient

Same

Patient

If there is a mismatch between a monitor and a measurement server, choose the data set you want to continue using for this patient, either:

Patient Selection

Last name

First name

Monitor

MILLER

MeasServ

ADAMS

PETER

Continue Monitor: to continue with the patient demographics, trend data, and settings in the monitor.

This discharges the patient in the measurement server, and resets all

MMS settings to the defaults currently active for the monitor.

MRN

Patient Cat Neo

Paced

Continue

Yes

Continue New

Neo

No

Same

Monitor MMS Patient Patient

Continue MMS: to upload the data

- patient demographics, trend data

(if configured), and measurement settings (if configured) - stored in the MMS to the monitor. This clears all data in the monitor, resets the monitor to the default Profile, and discharges the patient in the monitor.

Patient Mismatch - If Neither Patient Data Set is Correct

A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring.

Select

New Patient

if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient.

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Patient Mismatch - If Both Patient Data Sets Are Correct

A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the

MMS that was used during the patient transport to the monitor.

Select

Same Patient

if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and

MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor.

Patient Information This information is taken from...

Patient name

MRN

Screen Notes

Patient Category

Date of Birth

Height

Weight

Gender

Paced Status the monitor, if the patient was admitted there. For centrally-admitted patients, this information is taken from the Information Center. the Multi-Measurement Server. if connected, otherwise the data is taken from the monitor.

Trend data

Paced status is always set to Yes where there is a conflict in patient information.

if there is newer trend data stored in the MMS, it is uploaded to the monitor.

Automatically Resolving Patient Mismatch

Your monitor can be configured to automatically resolve mismatches in one of two ways.

• continue using the patient in the MMS, and delete the old data in the monitor. This is suitable for transport monitors.

• continue with the patient in the monitor, and delete the data in the MMS.

Care Groups

If your monitor is connected to an Information Center, you can group bedside monitors into Care

Groups. This lets you:

• view information on the monitor screen from another bed in the same or in a different Care Group.

• be notified of yellow or red alarm conditions at the other beds in the Care Group.

• see the alarm status of all the beds in the Care Group on each monitor screen.

There are two main types of Care Groups:

• standard care group (

Bed-based Care Group

) - up to 12 patients monitored by up to 4

Information Centers

• unit group (

Unit-based Care Group

) - for a complete unit with up to 64 patients monitored by up to 4 Information Centers

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Monitors must be assigned to these Care Groups at the Information Center. There is a third care group which can be assigned locally at the bedside. This is the My Central care group which includes all beds

(up to 16) from the Information Center your bed is connected to. This care group setting is typically used in facilities with only one Information center. The selection of beds is automatic and cannot be changed.

The functions available with Care Groups depend on the Information Center revision your monitors are connected to. See your Information Center Instructions for Use for further details.

Understanding the Care Group Overview Bar

The Care Group monitors’ status is shown in symbol form in the Care Group overview bar. Flashing symbols indicate active alarms, symbols that are not flashing indicate alarms that have been acknowledged. Selecting a bed symbol calls up the

Other Patient

window for that bed.

Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed 7 Bed 8 Bed 9 Bed11 Bed 12 Bed 13 Bed 14

The Care Group overview bar must be configured to display on the monitor Screen. If it is not visible on your monitor, select a Screen which has been configured to show the bar.

Care Group Symbols (four alternative display possibilities depending on space available)

No data from this bed

Bed 8

Bed 5

Bed 14

Bed 9

Bed 7

Bed 11

Bed 8

Bed 5

Bed 14

Bed 9

Bed 7

Bed 11

The alarms are on but there are no currently active alarms at this monitor

The highest priority alarm at this monitor is an INOP condition

The highest priority alarm at this monitor is a yellow alarm

The highest priority alarm at this monitor is a red alarm

The alarms at this monitor are suspended

The monitor is in standby mode

The monitor is in Demonstration mode

The current monitor

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5 Managing Patients

Care Groups

Care Group Symbols (used in the Care Group overview bar and the My Care Group window)

This is a telemetry bed

This bed is on a wireless network

This bed is on a wired network

This is a “paired” bed, with a bedside monitor and a telemetry transmitter assigned.

Viewing the My Care Group Window

This window shows the alarm status, bed name, and patient name for every bed in the Care

Group.

The window for the Unit group (shown here) shows first the beds of the Information Center this bed is connected to. By selecting the

Information Center name you can display a list of all Information Centers associated with the

Unit group, and select another Information

Center to view.

To enter the

My Care Group

window,

♦ select the

Other Patients

configured, or

SmartKey, if

♦ in the

Main Setup

Group

.

menu, select

My Care

My Care Group

Beds From:

Room 2

Room 4

Bed 2

Bed 4

Bed 8

Room 1

Room 3

Room 5

Smith, Mary

Jones, Paul

Murphy, Sarah

Miller, John

Baker, Jane

Green, Liza

Scott, James

Black, Harald

Use the My Care Group pop-up keys to navigate through the Care Groups:

My Unit

lets you view a list of all the Information Centers in your Care Unit. Select an Information

Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed.

Other Units

lets you view a list of all the Care Units in your Care Domain. Select any Care Unit to view a list of the Information Centers connected to it. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed.

Alarming Beds

lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity.

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5 Managing Patients

Viewing the Other Bed Window

The Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network. Waves and numeric information from another bed are delayed. If configured, Other Bed information is displayed in color, using the colors defined by the Information

Center.

To open the Other Bed window,

MP60/MP70/MP80/MP90: select the required bed label or patient name in the Care Group

Overview Bar. If you are in a Unit Group with many beds, the My Care Group window may open for you to select the bed.

MP20/MP30/MP40/MP50: select any field in the monitor info line to enter the

Setup

menu, then select

My CareGroup

and select the required bed, or

Select the

Other Patients

SmartKey, if configured, and select the required bed.

Bed Label, Patient Name

NO TRANSDUC

** HR HIGH

HR

110

SpO2

99

Next

Wave

More

Vitals

Next

Bed

My Care

Group

Silence

Bed

The Other Bed window may be configured to display embedded in a specially designed Screen.

To display the embedded Other Bed screen element, in the

Change Screen menu, select a Screen designed to show the Other Bed information permanently.

Note that a Screen with an embedded Other Bed screen element cannot be displayed on the D80 Intelligent

Display.

Bed Label Patient Name

VTACH

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5 Managing Patients

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Note that changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check if the correct other bed is displayed.

Other Bed Pop-Up Keys

Select the

Other Patients

SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys:

Next Wave

lets you view waveforms not currently shown in the other bed window.

More Vitals

lets you view more numerics not currently shown in the other bed window.

Next Bed

lets you view waveforms and numerics from the next available bed in the Care Group.

My Care Group

lets you call up the Care Group window to select another bed.

Alarming Beds

lets you view a list of all beds in your care group with an unacknowledged alarm.

The beds are listed in order of alarm severity.

Silence Bed

lets you silence active alarms at the other bed. (Whether you see this key depends on the revision and configuration of the Information Center your monitors are connected to.)

WARNING

The

Silence Bed

pop-up key in the Other Bed window silences alarms at a remote bed. Be aware that accidental use of this key could silence alarms for the wrong patient.

To silence own bed alarms use the Silence permanent key on screen or the Silence hardkey.

Visual Alarm Status Information in the Other Bed Window

• If individual alarms are switched off at the other bed, this is indicated by the crossed alarm symbol beside the measurement numeric.

• If alarms are switched off at the other bed, the message

Alarms Off

is shown in the other bed window.

• In the embedded Other Bed window, the crossed speaker symbol in the upper right hand indicates that the volume of the audible alarm status change notification for the other beds in the care group is set to zero at the overview monitor.

Care Group Alarms

Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group. The visual and audible indicators used depend on the monitor and

Information Center configuration.

When an alarm is detected at another bed in the Care Group,

• the alarm status is shown in the Care Group overview bar as an icon.

• a message informing you about the care group alarm is shown in the monitor status line.

• if configured, the Other Bed window, the Alarming Beds window or the My Care Group window may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at the Information Center). The automatic alarm notification is suppressed when a window, menu or pop-up keys are active.

• if configured, an audible status change notification is issued. The tone type and volume can be configured.

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5 Managing Patients

Automatic alarm notification can be switched off permanently in the monitor’s Configuration Mode or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode:

1

Select the network symbol on the monitor screen to call up the Network menu.

2

Select

Auto Window

to toggle between the settings

Enabled

and

Disabled

.

This setting resets to the default at discharge and when the monitor is switched on. Always re-enable the Auto Window as soon as possible.

Telemetry Data Overview

You can assign a monitor and a telemetry device to the same patient. This is called “pairing” and is done at the Information Center. In paired mode, the telemetry data can be displayed as a permanent overview session on the monitor. To do this, one of the available Screens must have the Telemetry

Data Overview screen element embedded. If configured, this Screen will automatically display when the monitor is paired with a telemetry device at the Information Center. Be aware that the data from a paired telemetry device is stored at the Information Center and not in the monitor.

Unpairing a Telemetry Device

To disconnect the patient from the telemetry device and reconnect them to the monitor

(for example, to see realtime waves),

♦ select the

Unpair Equipment

SmartKey to have the Information Center receive the ECG data from the monitor again. In this case data from the telemetry device will no longer be monitored at the Information Center. (Behavior depends on the revision of your

Information Center.) or

♦ use the Unpair function at the Information Center. In this case you can decide whether the

Information Center will continue to monitor data from the telemetry device.

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5 Managing Patients

Care Groups

Telemetry Data Overview Screen Element

Bed1

Room3

Bed4 Bed5

Mayer, John Adult

Bed7

Bed9

23Feb 17:51

Room1 Room3

Room1

Room4

Profiles Telemetry

Tele 3

HR

PVC

MCL

1mV

Pleth

1mV

CO

2

Delayed etCO

2 mmHg

Pulse

Perf awRR rpm

Telemetry data overview screen element

Temp

NBP mmHg

WARNING

Waves and numeric information on the telemetry screen element are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry.

Silencing Telemetry Alarms from the Bedside

When a telemetry device is paired with the monitor, an audible status change notification is issued for new telemetry alarms. The volume can be configured.

If configured, alarms generated from a paired telemetry device can be silenced at the bedside.

To silence telemetry alarms from the bedside,

1

2

select the telemetry screen element select the

Silence Bed

pop-up key

Depending on your configuration, the

Silence Bed

key may silence both telemetry alarms and bedside alarms.

Suspending Telemetry Alarms

When you select

Pause Alarms

or

Alarms Off

at the monitor, the alarms are off or paused for the bedside measurements.

Refer to the Information Center Instructions for Use for the Suspend/Pause alarms behavior of the

Information Center and telemetry device.

Using Standby

When you select Standby mode at the monitor, the bedside goes into Standby mode.

Refer to the Information Center Instructions for Use for the Standby behavior of the Information

Center and telemetry device.

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6

6

ECG, Arrhythmia, and ST

Monitoring

The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see

page 107) and ST monitoring (see page 117).

Skin Preparation for Electrode Placement

Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity.

1

Select sites with intact skin, without impairment of any kind.

2

3

Clip or shave hair from sites as necessary.

Wash sites thoroughly with soap and water, leaving no soap residue.

We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.

4

5

Dry skin thoroughly.

Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site.

Connecting ECG Cables

1

2

Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.

Place the electrodes on the patient according to the lead placement you have chosen.

3

4

Attach the electrode cable to the patient cable.

Plug the patient cable into the white ECG connector on the measurement server. An ECG waveform and numeric appears on the monitor display.

ECG Connector

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6 ECG, Arrhythmia, and ST Monitoring

Selecting the Primary and Secondary ECG Leads

CAUTION

To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips.

Selecting the Primary and Secondary ECG Leads

The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.

The secondary lead setting is used only if your monitor is configured for multi-lead (instead of singlelead) arrhythmia analysis. It determines which additional lead will be used for arrhythmia analysis.

You should choose a lead as primary or secondary lead that has 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 0.2 mV

To select a lead as primary or secondary lead:

In the

Setup ECG

menu, select

Primary Lead

or

Secondary Lead

, then select the appropriate lead. You can assign any available lead whether it is currently displayed or not.

Checking Paced Status

It is important to set the paced status correctly when you start monitoring ECG.

To change the paced status in the

Setup ECG

menu, select

Paced

, then select

Yes

or

No

.

WARNING

Pace pulse rejection must be switched on for paced patients by setting “Paced” to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole alarm from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient.

Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias.

Keep pacemaker patients under close observation.

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Understanding the ECG Display

6 ECG, Arrhythmia, and ST Monitoring

Understanding the ECG Display

Your display may be configured to look slightly different.

Lead label of the displayed wave

1 mV calibration bar

M

Pace pulse marks

Pacer spikes

EASI

ECG Filter label

EASI lead placement label

Defibrillator synchronization marks

Current heart rate alarm limits

HR

Current heart rate

ECG numeric: This is derived from the monitored ECG.

Pace pulse markers: These are shown if the

Paced

status has been set to

Yes

and the patient has a paced signal.

Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave.

ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the bottom left.

Monitoring Paced Patients

An ECG optimized for monitoring a paced patient should look like this:

Normal Beats

Pace Pulses/Beats

You should choose a lead as primary or secondary lead that has these characteristics:

• the normal QRS should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.

• the QRS should be tall and narrow

• the P-waves and the T-waves should be less than 0.2 mV.

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6 ECG, Arrhythmia, and ST Monitoring

Changing the Size of the ECG Wave

Setting the Paced Status (Pace Pulse Rejection)

In the

Setup ECG

menu, select

Paced

to toggle between

Yes

and

No

.

You can also change the paced status in the Patient Demographics window.

Paced

When

Paced

is set to

Yes

:

– Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes.

Non-Paced

– pace pulse marks are shown on the ECG wave as a small dash

– the paced symbol is displayed on the main screen.

When

Paced

is set to

No

, pacer spikes are not shown in the ECG wave. Be aware that switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole alarm from being detected.

Avoiding Pace Pulse Repolarization Tails

Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as

QRSs in the event of cardiac arrest or other arrhythmias.

If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.

Repolarization tail

(note width)

Changing the Size of the ECG Wave

If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the

ECG waves on the screen.

Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor.

Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose AutoSize, the calibration bar may be a different size for each wave.

To Change the Size of an Individual ECG Wave

1

Select the wave segment you want to change. This calls up the lead menu for this segment.

2

In the lead menu, select

Size Up

to increase wave size or

Size Down

to decrease the size.

Selecting

AutoSize

lets the monitor choose the optimal adjustment factor for all displayed ECG waves.

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Changing the Volume of the QRS Tone

6 ECG, Arrhythmia, and ST Monitoring

To Change the Size of all the ECG Waves

To change the size of all the ECG waves on the screen by a fixed adjustment factor,

1

In the

Setup

ECG

Lead menu, select

Adjust Size

.

2

Select the required adjustment factor from the line of pop-up keys.

Size x0.5

to halve the wave size

Size x1

to display the wave without zoom

Size x2

to double the wave size

Size x4:

to multiply the wave size by four

Previous Size

: to return one step to the previous size

Auto Size

: to let the monitor choose the optimal adjustment factor for all the ECG waves.

Changing the Volume of the QRS Tone

The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off).

To change the QRS volume, in the

Setup ECG

appropriate volume from the pop-up list.

menu select

QRS Volume

and then select the

Changing the ECG Filter Settings

The ECG filter setting defines how ECG waves are smoothed. A letter indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.

12-Lead ECG captures are analyzed in the PIC using the diagnostic filter and displayed on the

Information Center using the filter setting from the bedside monitor. Any changes you make to the filter setting at the bedside monitor may take up to a minute to be reflected at a connected Information

Center. For this reason, you should wait one minute between changing the filter setting and sending a

12-lead capture to an Information Center.

To change the filter setting, in the appropriate setting.

Setup ECG

menu, select

Filter

and then select the

Monitor

: Use under normal measurement conditions.

Filter

: The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electrosurgical units. Under normal measurement conditions, selecting

Filter

may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor.

If

AutoFilter

is set to

On

in Configuration Mode, the filter setting will automatically be set to

Filter

if electromagnetic interference is detected.

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6 ECG, Arrhythmia, and ST Monitoring

Choosing EASI or Standard Lead Placement

Diag

(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 segments are visible.

The setting

Diag

selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the

Adult and 0.5 to 150 Hz for the Pedi and Neo patient category. The term “diagnostic” relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/AAMI standard EC11-1991.

Choosing EASI or Standard Lead Placement

If EASI™ monitoring is available on your monitor, you must enable either standard lead placement or

EASI lead placement.

In the

Setup ECG

menu, select

Lead Placement

and then

Standard

or

EASI

.

EASI

is shown beside the 1mV calibration bar on the ECG wave on the display, and

EASI

is marked on any recorder strips and printouts.

See the section on EASI ECG Lead Placement for electrode placement diagrams.

About ECG Leads

To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called “leads.” To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor.

When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis.

Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location.

ECG Leads Monitored

If you are using

a 3-electrode set a 5-electrode set a 10-electrode set

these leads are available:

I, II, III

I, II, III, aVR, aVL, aVF, V and MCL

Resp is measured between electrodes:

RA and LL

RA and LL

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A

Changing Lead Sets

To change the ECG lead set,

1

2

Remove the electrodes and then replace them as required.

If the new lead set has more leads than the previous, the monitor automatically recognizes the new lead placement. If the new lead set has fewer leads, then you must select

New Lead Setup

in the

Setup ECG

menu. If you remove electrodes and do not select

New Lead Setup

, the monitor

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ECG Lead Fallback

6 ECG, Arrhythmia, and ST Monitoring

will issue a Lead Off INOP message. Select

New Lead Setup

and the INOP message will disappear.

ECG Lead Fallback

If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback.

When the Leads Off condition is corrected, the leads are automatically switched back.

This setting can only be changed in Configuration Mode.

ECG Lead Placements

The labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.

Electrode labels

AAMI EASI IEC

V3

V4

V5

V6

RA I

LA S

LL A

RL N

V E

V1

V2

N

C

C1

C2

R

L

F

C3

C4

C5

C6

Electrode colors

AAMI

White

Black

Red

Green

Brown

Brown/Red

Brown/Yellow

Brown/Green

Brown/Blue

Brown/Orange

Brown/Violet

IEC

Red

Yellow

Green

Black

White

White/Red

White/Yellow

White/Green

White/Brown

White/Black

White/Violet

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6 ECG, Arrhythmia, and ST Monitoring

Standard 3-Lead Placement

RA

ECG Lead Placements

LA

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

LL

Standard 5-Lead Placement

RA

II aVR

V

I aV

L aV

F

III

LA

RA placement:

directly below the clavicle and near the right shoulder

LA placement:

directly below the clavicle and near the left shoulder

RL placement:

on the right lower abdomen

LL placement:

on the left lower abdomen

V placement:

on the chest, the position depends on your required lead selection

RL

LL

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ECG Lead Placements

6 ECG, Arrhythmia, and ST Monitoring

Chest Electrode Placement

For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space.

1

2

Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.

Palpate and count down the chest until you locate the fourth intercostal space.

Angle of

Lewis

2

3

4

V4R

V3R

V1

VE

V2

V3

V4

V5

V6

V7

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 to 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

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6 ECG, Arrhythmia, and ST Monitoring

ECG Lead Placements

10-Lead Placement

When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement.

Conventional 12-Lead ECG

RA

V1 - V6

LA

In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.

Limb electrodes:

– Place arm electrodes on the inside of each arm, between the wrist and the elbow.

– Place leg electrodes inside of each calf, between the knee and the ankle.

Chest electrodes:

V1 - on the 4th intercostal space at the right sternal border

V2 - on the 4th intercostal space at the left sternal border

V3 - midway between the V2 and V4 electrode positions

V4 - on the 5th intercostal space at the left midclavicular line

V5 - on the left anterior axillary line, horizontal with the V4 electrode position

V6 - on the left midaxillary line, horizontal with the V4 electrode position

RL

LL

100

ECG Lead Placements

Modified 12-Lead ECG

Angle of Lewis

RA

6 ECG, Arrhythmia, and ST Monitoring

LA

V1 - V6

If your institution uses modified 10

Lead ECG electrode placement (the

Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen.

The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.

RL LL

Choosing Standard or Modified Electrode Placement

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch

Mod. Lead Placment

to

On

in the monitor. To do this,

♦ in the

Setup ECG

menu, select

Mod. LeadPlacement

to toggle between

On

and

Off

.

– When

Mod. Lead Placment

is set to

On

, 12 Lead ECG Reports will be labelled

12 Lead

ECG Report (Mason-Likar)

, and captured 12-lead ECGs will be labelled

Mason-

Likar

to the right of the bandwidth annotation at the Information Center.

– When

Mod. LeadPlacment

is set to

Off

, 12 Lead ECG Reports will be labelled

12

Lead ECG Report

, and captured 12-lead ECGs will not be annotated at the Information

Center.

WARNING

Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead

ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and

ST slope.

Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.

Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label.

Labelling 12-Lead ECG Reports

To label 12-lead ECG monitor reports and Captured 12-lead ECGs reports:

In the

Setup ECG

menu, select

Mod. LeadPlacement

to toggle between

On

and

Off

.

When

Mod LeadPlacement

is set to

On

:

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6 ECG, Arrhythmia, and ST Monitoring

Capture 12-Lead

– 12 Lead ECG Reports will be labelled

12 Lead ECG Report (Mason-Likar)

.

– Captured 12-lead ECGs will be labelled Mason-Likar to the right of the bandwidth annotation at the Information Center.

When

Mod. LeadPlacement

is set to

Off

,

– 12 Lead ECG Reports will be labelled

12 Lead ECG Report

.

– Captured 12-lead ECGs will have no annotation next to the bandwidth annotation at the

Information Center.

Capture 12-Lead

If the monitor is connected to an Information Center via a wired network, the

Capture 12-Lead

SmartKey may be configured to show on the screen. Selecting this exports 12-Lead ECG information to the Information Center for analysis. For details see the Instructions for Use supplied with the

Information Center.

EASI ECG Lead Placement

Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia. EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.

Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I and A electrodes.

Place the electrodes as accurately as possible to obtain the best quality EASI measurements.

When EASI lead placement is selected,

EASI

is shown beside the 1mV calibration bar on the ECG wave on the display, and

EASI

is marked on any recorder strips and printouts.

EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP condition (for example,

LEAD OFF

), a flat line is displayed. After 10 seconds, the directly acquired

EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn.

102

EASI ECG Lead Placement

4

3

1

6 ECG, Arrhythmia, and ST Monitoring

2

EASI Electrode Placement

1

E (V)

2

A (LL) on the lower sternum at the level of the fifth intercostal space on the left midaxillary line at the same level as the E electrode

3

S (LA)

4

I (RA) on the upper sternum on the right midaxillary line at the same level as the E electrode

5

N reference electrode - can be anywhere, usually below the sixth rib on the right hip

5

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6 ECG, Arrhythmia, and ST Monitoring

ECG, Arrhythmia, and ST Alarm Overview

ECG, Arrhythmia, and ST Alarm Overview

The ECG, arrhythmia, and ST alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.

• Cardiotach alarms are available when HR is on and the active alarm source is ECG

• Basic arrhythmia alarms are available when Arrhythmia is switched on

• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced

Arrhythmia option has been enabled for your monitor

• ST alarms are available when ST analysis is switched on and ST leads are selected for analysis.

Cardiotach Alarms

***Asystole

***Ventricular

Fibrillation/Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**High heart rate

**Low heart rate

Alarms with Basic

Arrhythmia Option

***Ventricular Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**Frequent PVCs (PVC > limit/min)

Alarms with Enhanced

Arrhythmia Option

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Nonsustained V-Tach

**Multiform PVCs

ST Alarms

**ST <Lead> High

**ST <Lead> Low

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Using ECG Alarms

6 ECG, Arrhythmia, and ST Monitoring

Using ECG Alarms

ECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to

ECG are described here.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm limits. You need to know what value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the extreme rate alarms set for your monitor, in the

Setup ECG

menu, see the menu items

ExtrTachy

and

ExtrBrady

.

ECG Alarms Off Disabled

Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitor’s Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring

Mode. If you try to switch off the HR alarms, you will see the message

To activate enter

Config and enable Alarms Off

.

HR Alarms When Arrhythmia Analysis is Switched Off

When arrhythmia analysis is switched off, only these HR-related alarms will be detected:

• the asystole alarm

• the ventricular fibrillation/ventricular tachycardia alarm

• the extreme tachycardia/extreme bradycardia alarms

• the high heart rate/low heart rate alarms.

HR Alarms When Arrhythmia Analysis is Switched On

WARNING

When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This means that the yellow alarm lamp and the tones are active for a configured number of seconds only, after which the flashing numeric and the alarm message remain for up to three minutes. Alarm reminders are not provided for yellow arrhythmia alarms. Red alarms behave as usual.

ECG Safety Information

CAUTION

Interference from instruments near the patient and ESU interference can cause problems with the

ECG wave. See the monitor specifications for more information.

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6 ECG, Arrhythmia, and ST Monitoring

ECG Safety Information

WARNING

Defibrillation and Electrosurgery: Do not touch the patient, or table, or instruments, during defibrillation.

After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions.

According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your

ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.

When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal.

General: When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth.

During surgery: Use the appropriate orange electrode ECG safety cable for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. These cables cannot be used for measuring respiration.

Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves

(greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest.

Patients exhibiting intrinsic rhythm: When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest.

The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patient’s heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined.

Filtered ECG signal from external instruments: Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance.

External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse.

This may result in the arrhythmia algorithm’s failure to detect pacemaker noncapture or asystole.

Fusion beat pacemakers: Pacemakers that create fusion beats (pace pulse on top of the QRS complex) cannot be detected by the monitor’s QRS detector.

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.

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About Arrhythmia Monitoring

6 ECG, Arrhythmia, and ST Monitoring

About Arrhythmia Monitoring

Arrhythmia analysis provides information on your patient’s condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously

• optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.

• detects beats, for example, QRS complexes, identifying them for further analysis.

• measures signal features such as R-wave height, width, and timing.

• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.

• examines the ECG signal for ventricular fibrillation, asystole, and noise.

Arrhythmia Options

Your monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labelling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different

options are listed in the section “ECG, Arrhythmia, and ST Alarm Overview” on page 104, the rhythm

and ectopic messages detected are listed in “Arrhythmia Status Messages” on page 110.

Where Can I Find More Information?

See the Application Notes on ST and Arrhythmia supplied on your documentation CD-Rom for detailed information on the arrhythmia algorithm and its clinical application.

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6 ECG, Arrhythmia, and ST Monitoring

Switching Arrhythmia Analysis On and Off

Switching Arrhythmia Analysis On and Off

1

2

In the

Setup Arrhythmia

menu, select

Arrhythmia

to toggle between

On

and

Off

.

Select the

Confirm

pop-up key which appears at the bottom of the screen.

Be aware that when arrhythmia analysis is switched off,

– the message

Arrythmia OFF

appears beside the ECG wave, if configured to do so

– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/ventricular tachycardia alarm, the extreme tachycardia/extreme bradycardia alarms, the high heart rate/ low heart rate alarms)

– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.

Choosing an ECG Lead for Arrhythmia Monitoring

It is important to select a suitable lead for arrhythmia monitoring.

Guidelines for non-paced patients are:

– QRS should be tall and narrow (recommended amplitude > 0.5 mV)

– R-Wave should be above or below the baseline (but not bi-phasic)

– T-wave should be smaller than 1/3 R-wave height

– the P-wave should be smaller than 1/5 R-wave height.

For paced patients, in addition to the above, the pace pulse should be:

– not wider than the normal QRS

– the QRS complexes should be at least twice the height of pace pulses

– large enough to be detected, with no re-polarization.

To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for

QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.

Aberrantly-Conducted Beats

As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.

Atrial Fibrillation and Flutter

Since P-waves are not analyzed, it is not possible to discriminate atrial rhythms. If there is constant variance in the R-R interval, the rhythm is classified as Irregular. It is extremely important for accurate analysis of the rhythm to have p-waves with an amplitude of less than 1/5 the height of the R-wave or

< 0.15 mV. If the p-waves are larger than this, they may be counted as QRS complexes.

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Understanding the Arrhythmia Display

6 ECG, Arrhythmia, and ST Monitoring

Intermittent Bundle Branch Block

Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the

QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.

Understanding the Arrhythmia Display

Your monitor screen may look slightly different from the illustration.

II

M

Beat label

P

Delayed

1mV

Delayed arrhythmia wave

P

Pace pulse marks

P

Rhythm status message

Paced Rhythm

Pair PVCs

PVC Numeric

HR Numeric

PVC

HR

2

75

Ectopic status message

Viewing Arrhythmia Waves

To review arrhythmia beat labels, in the

Setup Arrhythmia

menu, select

Annotate Arrhy

.

The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey background. Beat labels will be annotated above the ECG wave and

Delayed

will be written beside it.

To return to the normal ECG primary lead display, select

Annotate Arrhy

again.

Arrhythmia Beat Labels

Arrhythmia beat labels tell you how the monitor is classifying beats.

N

= Normal

V

= Ventricular Ectopic

S

= Supra-ventricular Premature

P

= Paced

'

= Pacer spike

L

= Learning patient's ECG

A

= Artifact (noisy episode)

?

= Insufficient information to classify beats

I

= Inoperative condition (e.g., LEADS OFF)

M

= Pause or missed beat

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6 ECG, Arrhythmia, and ST Monitoring

Understanding the Arrhythmia Display

Arrhythmia Status Messages

The monitor displays two types of status messages:

• Rhythm Status Messages -- to indicate the patient’s rhythm.

• Ectopic Status Messages -- to indicate the presence of ectopic beats.

These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.

The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats.

If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level.

Rhythm Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Rhythm Status Message Description B or E

ASYSTOLE

VENT FIB/TACH

V-TACH

SUST V-TACH

VENT RHYTHM

VENT BIGEMINY

VENT TRIGEMINY

PACED RHYTHM

IRREGULAR HR

No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal

A fibrillatory wave for 4 consecutive seconds

B, E

B, E

A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart

Rate Limit

B, E

Ventricular tachycardia rhythm for more than 15 seconds

A dominant rhythm of adjacent PVCs and a HR

≤ the V-Tach HR

Limit

E

E

A dominant rhythm of N, V, N, V

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

A dominant rhythm of paced beats

Consistently irregular rhythm

A dominant rhythm of SV beats preceded by P-waves

E

E

B, E

E

B, E

SINUS BRADY

SINUS RHYTHM

SINUS TACHY

SV BRADY

SV RHYTHM

SV TACHY

A dominant rhythm of SV beats not preceded by P-waves

UNKNOWN ECG

RHYTHM

Rhythm cannot be determined

LEARNING ECG

Algorithm is learning the ECG beat morphology

LEARNING RHYTHM

Algorithm is learning the rhythm of the classified beats

CANNOT ANALYZE

ECG

ECG signal is predominantly invalid and therefore cannot be analyzed

B, E

B, E

B, E

B, E

B, E

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Arrhythmia Relearning

6 ECG, Arrhythmia, and ST Monitoring

Ectopic Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Ectopic Status Message Explanation B or E

(No message displayed) No ectopic activity within the last minute

RUN PVCs

PAIR PVCs

More than 2 consecutive PVCs within the last minute

Pair PVCs within the last minute

PACER NOT CAPT

PACER NOT PACE

PAUSE

Pause with pace pulse (paced patient only) within the last minute

E

E

B, E

Pause without pace pulse (paced patient only) within the last minute B, E

No beat detected for 1.75 x average R-R interval for HR <120, or

No beat for 1 second with HR >120 (non-paced patient only), or

No beat detected for more than the set pause threshold.

E

R-ON-T PVCs

MULTIFORM PVCs

FREQUENT SVPBs

SVPBs

SV BEATS

PACED BEATS

R-ON-T detected within the last minute

Multiform PVCs detected within the last minute

SVPB count within last minute is greater than 5

1-5 SVPBs in the last minute with a sinus rhythm and no Vs

SV count within last minute and rhythm status is PACED

Paced beat count within last minute and rhythm status is NOT

PACED

E

E

E

E

B, E

B, E

Arrhythmia Relearning

During a learning phase:

• Alarm timeout periods are cleared

• Stored arrhythmia templates are cleared

Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.

Initiating Arrhythmia Relearning Manually

1

To initiate relearning manually, in the

Setup Arrhythmia

menu, select

Relearn Arrhy

.

– While the monitor is learning, the delayed arrhythmia wave displays the beat label

L

and the rhythm status message

LEARNING ECG

.

– Next, the monitor determines the dominant rhythm. The beats are labeled

N

, and the rhythm status message changes to

LEARNING RHYTHM

.

2

3

After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly.

If beats are still not classified correctly, check that the ECG is optimized for arrhythmia monitoring. You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves.

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6 ECG, Arrhythmia, and ST Monitoring

Arrhythmia Alarms

Automatic Arrhythmia Relearn

Arrhythmia relearning is initiated automatically whenever:

• ECG monitoring is switched on

• The ECG Lead or Lead Label is changed manually, or when fallback occurs

• A

Leads Off

INOP condition (that has been active for > 60 seconds) ends.

If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled

L

and there is no

LEARNING ECG

rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active.

Arrhythmia Relearn and Lead Fallback

Lead fallback triggers an automatic arrhythmia relearn.

WARNING

If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-

Fib.

For this reason you should:

• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free

• be aware that arrhythmia relearning can happen automatically

• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)

• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads

• always ensure that the arrhythmia algorithm is labeling beats correctly.

Arrhythmia Alarms

Arrhythmia alarms can be switched on and off and the settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here.

The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter.

The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).

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Arrhythmia Alarms

6 ECG, Arrhythmia, and ST Monitoring

Yellow Arrhythmia Alarms

Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions.

Depending on your monitor and Information Center revision, they may be shown with one or two stars.

WARNING

When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This means that the yellow alarm lamp and the tones are active for a configured number of seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. Red alarms behave as usual.

Arrhythmia Alarms and Latching

When using arrhythmia analysis,

Visual Latching

and

Audible Latching

should be on for red alarms, or at least

Visual Latching

should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in Configuration Mode.

Switching Individual Arrhythmia Alarms On and Off

Some arrhythmia alarms can be individually switched on or off. They are:

Pacer not capture, Pacer not pace, Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T

PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, Irregular HR, Missed Beat, PVCs/min.

To switch individual alarms on or off, in the

Setup Arrhythmia

menu, select the alarm from the list to toggle between

On

and

Off

. The monitor displays the INOP message SOME ECG

ALRMS OFF.

Switching All Yellow Arrhythmia Alarms On or Off

All yellow arrhythmia alarms can be switched on and off together. To do this,

In the

Setup Arrhythmia

menu, select

All Yellow Off

or

All Yellow On

.

Adjusting the Arrhythmia Alarm Limits

Some arrhythmia alarms have limits which can be individually adjusted. They are:

Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause

Threshold.

1

To adjust alarm limits, in the

Setup Arrhythmia

menu, select the alarm to be adjusted.

2

Select the appropriate setting from the pop-up list.

Arrhythmia Alarm Timeout Periods

Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:

• if a more serious alarm condition is active in the same chain

• if a timeout period is in effect for a particular alarm

• if a timeout period is in effect for a higher alarm in that chain.

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6 ECG, Arrhythmia, and ST Monitoring

Arrhythmia Alarms

What is a Timeout Period?

Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm. Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see

“Arrhythmia Alarm Chaining” on page 115).

This setting can only be changed in Configuration Mode.

To view the timeout period configured for your monitor, in the see the menu items

TimeOut 1st

and

TimeOut 2nd

.

Setup Arrhythmia

menu,

To reset the timeout period, select the then reselect it.

Alarms Off

or

Pause Alarms

permanent key and

Resetting the Timeout Period

Switching alarms off and then on again cancels all visual and audible indicators and resets the timeout periods.

Silencing an alarm cancels all visual and audible indicators, if the alarm condition is no longer present.

How are Yellow Arrhythmia Alarms Indicated?

When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators.

Behavior of Unsilenced Arrhythmia Alarms

Yellow arrhythmia alarms are always set to latch visually for three minutes.

Yellow arrhythmia alarms that have not been silenced behave as explained in this table:

Alarm condition Example

Single alarm instance Non-sustained

V-tach

Continuous alarm condition HR LOW

Same intermittent alarm condition, occurring frequently (more than once per minute)

Pair of PVCs

Configured time out period

Short yellow alarm tone sounds ...

Alarm message displayed ...

All settings when alarm condition is initially detected for 3 minutes (latching time)

All settings

2 minutes or less

3 minutes or more each time the alarm condition is detected, provided that the timeout period has expired and the alarm message has cleared until the alarm condition stops, plus a maximum of

3 minutes latching time

Behavior of Silenced Arrhythmia Alarms

If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will not get a realarm for the same condition or another condition lower down on the same chain until the alarm condition has stopped and reoccurred, and the timeout period has expired.

If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared. Silencing an alarm does not reset its time out period, so you will not get a realarm for the same condition or lower on the chain until the time out expires.

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Arrhythmia Alarms

6 ECG, Arrhythmia, and ST Monitoring

Arrhythmia Alarm Chaining

When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm “chains”: PVC Alarms; Beat Detection Alarms, and Rate Alarms.

Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are occurring.

See “ECG, Arrhythmia, and ST Alarm Overview” on page 104 for information on which alarms are

included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 113

for an explanation of how alarm timeouts work.

Red Arrhythmia Alarms

Asystole

PVC Alarms Chain

Non-sustain VT/

Vent Rhythm

Run PVCs

Pair PVCs

R-on-T PVCs

Vent Bigeminy

Vent Trigeminy

PVCs > xx/min

Multiform PVCs

Vent Fib/Tach

V-Tach

Extreme Tachy/Extreme Brady

Yellow Arrhythmia Alarms

Beat Detection Alarms Chain

Rate Alarms Chain

Pause

Pacer Not Captured/

Pacer Not Pacing/

Missed Beat

SVT

HR High/ HR Low

Irregular HR

(occurs only if no other arrhythmia alarms are present)

First level timeout period

(

TimeOut

1st

)

Second level timeout period

(

TimeOut

2nd

)

– If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain.

– Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated.

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6 ECG, Arrhythmia, and ST Monitoring

Arrhythmia Alarms

Understanding PVC-Related Alarms

PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). Changing one alarm limit automatically changes linked alarm limits.

Example: This diagram illustrates the conditions under which PVC alarms would be generated if the

Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to eight, and the V-Tach HR Limit is set to 100.

V-Tach Run Limit

**Pair

PVCs

PVC =

2

** Non-Sustain

VT

PVC Run < 8

HR > 100

***V-Tach

PVC Run

HR > 100

8

100

V-Tach

Heart Rate

Limit

** Run PVCs

PVC Run > 2 but

12

HR

100

** Vent Rhythm

PVC Run > 12

HR

100

1 2 3 4 5 6 7 8 9 10 11 12

Number of Consecutive PVCs (PVC Run)

Ventricular Rhythm

Run Limit

You will see that

• if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated

• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated.

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About ST Monitoring

6 ECG, Arrhythmia, and ST Monitoring

About ST Monitoring

The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor.

All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the Screen for ST Segment analysis.

ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for

ST monitoring in neonatal and pediatric modes is

ST Analysis: Off

.

ST analysis is always performed using a dedicated filter which ensures diagnostic quality. If you are monitoring ECG using an ECG filter mode other than Diagnostic, the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave. For diagnostic evaluation of the ST segment, always switch to Diagnostic filter mode or use the ST snippet.

WARNING

Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example:

• if you are unable to get a lead that is not noisy

• if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline

• if the patient is continuously ventricularly paced

• if the patient has left bundle branch block.

You should consider switching ST monitoring off if these conditions are present.

This monitor provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.

Switching ST On and Off

To switch all ST monitoring on or off, in the

Setup ST Analysis

menu, select

ST Analysis

to toggle between

On

and

Off

.

Selecting ST Leads for Analysis

To switch ST monitoring for individual leads on or off, in the

Setup ST Analysis

menu, select

Setup ST Leads

. In the pop-up window, the leads in the left column under

Choices

are the leads you can choose from, and the leads in the right-hand column

Selected

are the leads chosen to be displayed. Select the ST leads on the left and use the arrow keys to move the leads from one list to the other, then select

Done

to apply the changes.

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6 ECG, Arrhythmia, and ST Monitoring

Understanding the ST Display

Understanding the ST Display

Your monitor screen may be configured to look slightly different from the illustrations.

ST Numerics Up to 12 ST numerics plus the

ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG

Current HR alarm limits

Current heart rate wave, or beside the ST snippet.

A positive ST value indicates ST segment elevation; a negative value indicates depression.

ST numerics

ST-II 1.2

ST-V 2.5

ST-aVR -3.0

ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the

Setup ST Analysis

->

Setup ST Leads

->

Choices

list. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric.

ST Index The ST index numeric (

STindx

) is the sum of the absolute values for the ST leads V2, V5, aVF. Because it is based on absolute values, it is always a positive number. If you haven’t selected one of the leads V2, V5, and aVF for ST analysis, the STindx numeric will display a question mark “?”.

To switch the ST index numeric on or off for display, in the select

ST-Index

to toggle between

On

and

Off

.

Setup ST Analysis

menu,

ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient.

The information is updated once per minute.

If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select a Screen configured to show snippets from the pop-up list of available Screens.

ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid. The current

ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between these two numerics.

A “?” in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored.

The Baseline Window opens with the ST pop-up keys

Update Baseline

,

Record ST

,

Change ST Lead

,

Adjust ST Points

,

ST Map

and arrow keys for scrolling through the available leads.

To view the

ST Baseline

window, select any snippet on the Screen.

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Updating ST Baseline Snippets

6 ECG, Arrhythmia, and ST Monitoring

ST label and numeric

Baseline ST numeric and difference since baseline was stored

ST-II

-0.8

1.9

?-2.7

1mV calibration bar

Current snippet

ST baseline

ST Baseline

ST Baseline stored at 14 Feb 03 9:38

Timestamp of most recently stored baseline snippet

Updating ST Baseline Snippets

ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear.

The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines,

1

Select an ST snippet to open the

ST Baseline

window.

2

In the

ST Baseline

window, select

Update Baseline

to store all current snippets as baselines. This deletes all previously-stored baselines.

Recording ST Segments

To record all currently available ST snippets and baselines, in the

ST Baseline

window, select the pop-up key

Record ST

.

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6 ECG, Arrhythmia, and ST Monitoring

About the ST Measurement Points

About the ST Measurement Points

The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.

R-wave peak at 0 msec

J point, for example, 48 msec

T

P

Difference = ST value

Isoelectric point set to -80 msec

Q

S

ST measurement point, for example, J + 60 msec

CAUTION

The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus the placement of the ST point. Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set.

Always ensure that ST measurement points are appropriate for your patient.

Adjusting ST Measurement Points

Depending on your monitor’s configuration, the ST point can be positioned either

• relative to the J-point.

In the

Adjust ST Points

window, the pop-up keys ISO Point, J Point and ST Point are visible and can be adjusted. or

• directly. by selecting a numeric value for the ST point.

In the

Adjust ST Points

window, you can adjust the ISO and ST point.

The

ST Uses

setting can only be changed in Configuration Mode.

To adjust the ST measurement points,

1

2

In the

Setup ST Analysis

menu, select

Adjust ST Points

to open the

Adjust ST

Points

window. Alternatively, you can use the

Adjust ST Points

pop-up key in the

ST

Baseline

window.

Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads.

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About the ST Measurement Points

6 ECG, Arrhythmia, and ST Monitoring

3

Use the

Select Point

pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active.

ST label and the ST numeric that would apply using the current points

ST-I

0.0

Adjust ST Points

1mV calibration bar

Cursors for adjusting ST points

Timestamp of most recent ST point adjustment

ST Points adjusted at 04 Apr 03 11:38

ISO Point -80

J Point 48

ST Point J+60

Highlighted ST point

ISO

The ISO-point cursor positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds. Position the

ISO-point in the middle of the flattest part of the baseline (between the P and

Q waves or in front of the P wave).

The J-point cursor positions the J-point relative to the R-wave peak. It helps you to correctly position the ST-point. Position the J-point at the end of the

QRS complex and the beginning of the ST segment.

The J-point cursor is not available if your monitor is configured to let you set the ST point directly.

4

To position the ST-point relative to the J-point: select either

J + 60

or

J + 80

. Select

J Point

and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment.

To position the ST-point directly: select

ST Point

and use the left and right arrow keys to position the ST point at the midpoint of the ST segment.

Select the

Apply Changes

pop-up key to activate the new ST measurement points and recalculate all ST values.

The most recent ST Points adjustment time is displayed in the

Adjust ST Points

window.

This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor.

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6 ECG, Arrhythmia, and ST Monitoring

ST Alarms

5

To update the ST snippet shown in the

Adjust ST Points

window, select the

Update

pop-up key.

ST Alarms

ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads.

If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits.

Single- or Multi-lead ST Alarming

Be aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead will be announced.

To choose individual or multi-lead ST alarming,

In the

Setup ST Analysis

Multi ST

.

menu, select

ST Alarm Mode

and select either

Single ST

or

Changing ST Alarm Limits

The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.

1

2

In the

Setup ST Analysis

menu, select

ST Alarm Mode

and select

Single ST

or

Multi ST

.

Select the alarm to be adjusted.

3

Select the appropriate setting.

Viewing ST Maps

The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in

ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the

ECG parameter.

Current View

In current view, the monitor displays an ST map that corresponds to the current ST values. Three or more leads per plane are necessary to display a map.

The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads.

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Viewing ST Maps

6 ECG, Arrhythmia, and ST Monitoring

alarm status indicator

12-Lead EASI indicator

ST Map (Current)

EASI Limb leads EASI Chest Leads

ST index (for EASI)

ST map ST label, value and polarity of corresponding lead

If an ST lead is switched off, its axis is not shown in the map.

If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is unplugged), the area formed by the remaining ST leads is left open.

Trend View

In trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old.

The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values on the diagrams show the current ST values.

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6 ECG, Arrhythmia, and ST Monitoring

Viewing ST Maps

If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off 20 seconds ago. The current ST values and the first trended value reflect this change in the lead setup. All other maps are displayed the way in which they were recorded.

Limb Leads

ST Map (Trend)

Chest Leads

Interval

12 sec trending interval current ST values

In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed.

Viewing an ST Map

To display an ST map,

In the

Setup ST Analysis

menu, select

ST Map

.

Working in the ST Map Task Window

You may need to activate the ST map task window to see all the data, and to access the pop-up keys.

Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here.

Switching Between ST Map Views

To switch between views,

Select

Current View

or

Trend View

to toggle between views.

If your trend view is empty, you need to adjust the priority of this measurement in the trending

priority list. See “Trend Priority” on page 227.

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6 ECG, Arrhythmia, and ST Monitoring

Displaying an ST Reference Baseline

You can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request.

Select

Show Baseline

/

Hide Baseline

to toggle between baseline display on and off.

Updating an ST Map Reference Baseline

To update the baseline,

In the

Setup ST Analysis

menu, select

ST Baseline -> Update baseline

.

Changing the Scale of the ST Map

To change scale,

Select

Size Up

or

Size Down

to alter the size at which monitor displays the map.

Changing the Trending Interval

To determine how frequently the monitor displays a trended sample,

1

2

In Trend view, select

Select Interval

.

Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.

Printing an ST Map Report

To print the most recently viewed (current or trend) window,

1

2

Select

Main Setup

- >

Reports

.

Select

ST Map

.

3

Press

Print

.

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6 ECG, Arrhythmia, and ST Monitoring

Viewing ST Maps

126

7

7

Monitoring Pulse Rate

The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO

2

signal (pleth wave) or any arterial pressure (ABP, ART, Ao, BAP, FAP, PAP, UAP, P: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the

Setup Pulse

menu to check whether it is switched on.

Entering the Setup Pulse Menu

If a pulse numeric is displayed on the screen, select it to enter the

Setup Pulse (Pulse Source)

menu. If no pulse numeric is visible, in the

Setup SpO

2

menu or an

Setup

arterial pressure menu, select

Pulse

(Pulse Source)

.

System Pulse Source

The currently active system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:

• is monitored as system pulse and generates alarms when you select pulse as the active alarm source

• is sent via the network to the Information Center, if available

• is trended in the HighRes Trends and stored in the monitor’s databases.

To define which pulse rate is used as system pulse,

1

In the

Setup Pulse

menu, select

System Pulse

.

2

Select one of the SpO

2

or arterial pressure labels from the pop-up list, or select

Auto

.

If you select

Auto

, the monitor automatically chooses a pulse rate to be used as system pulse. It looks through the list from top to bottom and activates the first pulse rate that is switched on and available.

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7 Monitoring Pulse Rate

Switching Pulse On and Off

Switching Pulse On and Off

To switch a particular pulse numeric on or off, enter the

Setup Pulse

menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO

2

pulse numeric on or off,

1

Enter the

Setup Pulse

menu by selecting the Pulse numeric or by selecting

Pulse

in the

Setup SpO2

menu.

2

In the

Setup Pulse

menu, select

Pulse (Pulse source)

to toggle between

On

and

Off

.

To switch the system pulse on or off, in any

Setup Pulse (Pulse Source)

menu, check which measurement is currently selected as pulse source. Enter the

Setup Pulse

menu for this pulse source and then switch off the pulse measurement as described.

Using Pulse Alarms

You can change pulse rate alarm limits in the

Setup Pulse

menu accessed via any Pulse source, or in the

Setup ECG

menu. Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms.

Pulse alarms are only generated when the active alarm source is set to Pulse and a pulse source is set as system pulse.

Selecting the Active Alarm Source: HR or Pulse?

In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the monitor uses either HR or Pulse as its active alarm source. To change the alarm source, select

Alarm Source

in the

Setup ECG

or

Setup Pulse

menu, then select either

HR: if you want the HR to be the alarm source for HR/Pulse.

Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off.

Auto: If the

Alarm Source

is set to

Auto

, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and no

ECG

LEADS OFF

INOP is active.

The monitor will automatically switch to Pulse as the alarm source if:

– a Pulse source is switched on and available, and

– the heart rate becomes unavailable and the

ECG LEADS OFF

inop is active.

The monitor then uses the pulse rate from the measurement currently selected as system pulse.

While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If the HR becomes available again, the monitor automatically uses this as alarm source.

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Using Pulse Alarms

7 Monitoring Pulse Rate

WARNING

Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the

section “ECG, Arrhythmia, and ST Alarm Overview” on page 104, and the heart rate alarms. This is

indicated by the message

All ECG Alarms Off

(unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.

High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.

Alarm Source Selection Disabled

If Alarm Source Selection is disabled, you cannot change the alarm source. If you try to change the source, the monitor displays the message

To activate enter Config and enable

AlarmSourceSel

. This setting can only be changed in Configuration Mode.

Changing HR/Pulse Alarm Limits

As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the

Setup Pulse

menu, the high or low alarm limits for HR in the

Setup ECG

menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO

2

Pressure 25 bpm.

is 30 bpm; for HR 15 bpm, and for

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm limits. You need to know what value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the values added to the high and low limit alarms to create the extreme rate alarms for your monitor, in the

Setup ECG

menu, see the menu items

ExtrTachy

and

ExtrBrady

.

QRS Tone

The active alarm source is also used as a source for the QRS tone. You can change the tone volume in the

Setup SpO2

and

Setup ECG

menus and the QRS tone modulation in the

Setup SpO2

menu.

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7 Monitoring Pulse Rate

Using Pulse Alarms

130

8

8

Monitoring Respiration Rate

(Resp)

For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two

ECG electrodes on the patient’s chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).

Lead Placement for Monitoring Resp

Correct patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG.

The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, or 10-lead, using either standard or EASI™ placement - to measure Resp, as long as you use ICU ECG cables.

The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI™

ECG electrode placement, Resp is measured between the I and A electrodes.

Optimizing Lead Placement for Resp

If you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients. Repositioning

ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation.

Cardiac Overlay

Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is particularly important for neonates.

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Understanding the Resp Display

8 Monitoring Respiration Rate (Resp)

Lateral Chest Expansion

Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient’s maximum point of breathing movement to optimize the respiratory wave.

Abdominal Breathing

Some patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave.

Understanding the Resp Display

The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text

HR = RR

next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration.

1 Ohm calibration bar

Manually-set Resp detection level

Resp numeric and label

Resp

RR

22

1 Ohm

Changing Resp Detection Modes

The Resp detection level can be set either automatically or manually.

To change the resp detection mode, in the between the settings.

Setup Resp

menu, select

Auto/Manual

to toggle

Auto Detection Mode

In Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode,

• the detection level (a dotted line) is not displayed on the waveform,

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Changing the Size of the Respiration Wave

8 Monitoring Respiration Rate (Resp)

• the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.

Use Auto Detection Mode for situations where:

• the respiration rate is not close to the heart rate

• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)

• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).

Manual Detection Mode

In Manual Detection Mode you must set the Resp detection level.

In the

Setup Resp

menu, select

Manual Up

or

Manual Down

. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached.

Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.

Use Manual Detection Mode for situations where:

• the respiration rate and the heart rate are close.

• patients have Intermittent Mandatory Ventilation.

• respiration is weak. Try repositioning the electrodes to improve the signal.

Resp Detection Modes and Cardiac Overlay

In Auto Detection Mode: If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration.

In Manual Detection Mode: Cardiac overlay can in certain situations trigger the respiration counter.

This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you

may need to optimize the electrode placement as described in the section ”Lateral Chest Expansion”.

Changing the Size of the Respiration Wave

WARNING

When monitoring in Manual Detection Mode, make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave.

In the

Setup Resp

menu, select

Size Up

to increase the size of the wave or

Size Down

to decrease it.

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8 Monitoring Respiration Rate (Resp)

Changing the Speed of the Respiration Wave

Changing the Speed of the Respiration Wave

Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.

Select the Resp wave to enter the

Resp Wave

menu, then select

Change Speed

. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).

Using Resp Alarms

Resp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter.

Changing the Apnea Alarm Delay

The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm.

1

2

In the

Setup Resp

menu, select

Select the appropriate setting.

Apnea

Time

.

Resp Safety Information

WARNING

Respiration detection level If you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of apnea.

Apnea The respiration measurement does not recognize obstructive and mixed apneas — it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.

The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

Interference If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated

Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit.

Resp Accessories To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electro-surgery is being performed.

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Resp Safety Information

8 Monitoring Respiration Rate (Resp)

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.

135

8 Monitoring Respiration Rate (Resp)

Resp Safety Information

136

9

9

Monitoring SpO

2

Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact suppression technology (FAST). It provides four measurements:

• Oxygen saturation of arterial blood (SpO

2

) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).

• Pleth waveform - visual indication of patient’s pulse.

• Pulse rate (derived from pleth wave) - detected pulsations per minute.

• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation.

The monitors are also compatible with SpO

2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information.

SpO

2

Sensors

Depending on the purchased SpO

2

option, different sensors and adapter cables can be used. The sensors for the different options are color-coded to match the connectors. See the section on

Accessories for a compatibility table.

Familiarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site.

CAUTION

Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors on patients who have allergic reactions to the adhesive. Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor.

Applying the Sensor

1

2

3

Follow the SpO

2

sensor’s instructions for use, adhering to all warnings and cautions.

Remove colored nail polish from the application site.

Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor,

137

9 Monitoring SpO

2

Connecting SpO

2

Cables

4

select a finger or toe with a diameter of between 7 and 8 mm (0.27” and 0.31”). When applying a

M1193A neonatal sensor do not overtighten the strap.

Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient’s tissue.

WARNING

Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site at least every four hours.

Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.

Ambient Temperature: Never apply an SpO

2

sensor at ambient temperatures from above 37 o

C because this can cause severe burns after prolonged application.

Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line.

Connecting SpO

2

Cables

Connect the sensor cable to the color-coded socket on the measurement device (MMS or module). If you are using a disposable sensor, plug the sensor into the adapter cable and connect this to the measurement device. Connect reusable sensors directly to the measurement device.

SpO

2

CAUTION

Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “long” cable version).

Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.

Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.

Measuring SpO

2

1

2

Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO

2

and pulse numerics.

During measurement, ensure that the application site:

– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.

138

Assessing a Suspicious SpO

2

Reading

9 Monitoring SpO

2

– has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.

WARNING

Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours.

Using an SpO

2

sensor during MR imaging can cause severe burns. Minimize this risk by positioning the cable so that no inductive loops are formed. If the sensor does not appear to be operating properly, remove it immediately from the patient.

CAUTION

Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.

Interference can be caused by:

• High levels of ambient light. (Hint: cover application site with opaque material.)

• Electromagnetic interference.

• Excessive patient movement and vibration.

Assessing a Suspicious SpO

2

Reading

Traditionally, pulse rate from SpO

2

was compared with heart rate from ECG to confirm the validity of the SpO

2

reading. With newer algorithms, such as FAST-SpO

2

, this is no longer a valid criteria because the correct calculation of SpO

2

is not directly linked to the correct detection of each pulse.

When pulse rate is very low, or strong arrhythmia is present, the SpO

2

/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO

2

value.

If you doubt the measured SpO

2

, use the pleth wave and perfusion indicator instead to assess the signal quality.

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9 Monitoring SpO

2

Understanding SpO

2

Alarms

Understanding SpO

2

Alarms

This refers to SpO

2

specific alarms. See the Alarms section for general alarm information. SpO

2

offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit.

CAUTION

If you measure SpO

2

on a limb that has an inflated NBP cuff, a non-pulsatile SpO

2

INOP can occur.

If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating critical patient status, such as sudden pulse loss or hypoxia.

Alarm Delays

There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components:

• The time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and the configured averaging time. The longer the averaging time configured, the longer the time needed until the numerical values reflect the physiological event.

• The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the combination of the configured alarm delay time plus the general

system delay time (see “Monitor Performance Specifications” on page 342).

Adjusting the Alarm Limits

In the

Setup SpO

2

menu:

• Select

High Limit

then choose the upper alarm limit.

• Select

Low Limit

then choose the lower alarm limit.

WARNING

High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off. Transcutaneous pO

2 monitoring is recommended for premature infants receiving supplemental oxygen.

Adjusting the Desat Limit Alarm

The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation.

1

2

In the

Setup SpO

2

menu, select

Desat Limit

.

Adjust the limit.

Pleth Wave

The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.

140

Perfusion (Pleth) Indicator minimum size for reliable SpO

2

value

9 Monitoring SpO

2

Perfusion (Pleth) Indicator

The perfusion indicator gives a numerical value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow.

As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion indicator as a quality indicator for the SpO

2

measurement. Above 1 is optimal, between 0.3-1 is acceptable.

Below 0.3 is marginal; reposition the sensor or find a better site.

Setting SpO

2

/Pleth as Pulse Source

1

2

In the

Setup SpO2

menu, select

Pulse (SpO

2

)

to enter the

Setup Pulse

menu.

In the

Setup Pulse

menu, select

System Pulse

and select

SpO

2

from the pop-up list.

Setting Up Tone Modulation

If tone modulation is on, the QRS tone pitch lowers when the SpO

2

level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.

In the

Setup

(for off ).

SpO

2

menu

,

select

Tone Modulation

to toggle between

Yes

(for on) and

No

Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett

Incorporated, a Tyco Healthcare company.

Setting the QRS Volume

In the

Setup SpO

2

menu, select

QRS Volume

and set the appropriate QRS tone volume.

Calculating SpO

2

Difference

When a second SpO

2

measurement is present (either through the SpO

2

module or through VueLink), the monitor displays both SpO is subtracted from the first.

2

values, and calculates the difference between them. The second value

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9 Monitoring SpO

2

3

4

1

2

5

From the

Main Setup

menu, select

Measurements

.

From the

SpO

2

Setup

menu, select

First SpO

2

.

Choose the first measurement source.

Select

Second SpO

2

.

Choose the second measurement source.

Calculating SpO

2

Difference

142

10

10

Monitoring NBP

This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National

Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements

(depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure.

In neonatal mode, the blood pressure measurements determined with this device comply with the

American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-

1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.

The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30/EN 60601-2-30.

A physician must determine the clinical significance of the NBP information.

Introducing the Oscillometric NBP Measurement

Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish.

Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques.

WARNING

Patient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients.

Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.

Skin Damage: Do not measure NBP on patients with sickle-cell disease or any condition where skin damage has occurred or is expected.

Unattended measurement: Use clinical judgement to decide 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.

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10 Monitoring NBP

Preparing to Measure NBP

CAUTION

If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the MMS, contact your service personnel.

Measurement Limitations

Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine.

The measurement may be inaccurate or impossible:

• if a regular arterial pressure pulse is hard to detect

• with cardiac arrhythmias

• with excessive and continuous patient movement such as shivering or convulsions

• with rapid blood pressure changes

• with severe shock or hypothermia that reduces blood flow to the peripheries

• with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery

• on an edematous extremity.

Measurement Methods

There are three methods of measuring NBP:

Manual - measurement on demand.

Auto - continually repeated measurements (between one and 120 minute adjustable interval).

STAT - rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients.

Reference Method

The NBP measurement reference method can be Auscultatory (manual cuff) or Invasive (intraarterial). For further information, see the Application Note on NBP supplied on the monitor documentation CD-ROM.

In Adult and Pediatric mode to check the current setting, select

Main Setup

->

Measurements

->

NBP

, and check whether the

Reference

setting is set to

Auscultatory

or

Invasive

. This setting can only be changed in Configuration Mode.

In Neonatal mode, to comply with safety standards, invasive is always used as the reference method.

This setting cannot be changed and is not visible in any operating mode.

Preparing to Measure NBP

1

2

Connect the cuff to the air tubing.

Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes.

Air must pass unrestricted through the tubing.

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Preparing to Measure NBP

10 Monitoring NBP

NBP

3

4

Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted.

A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb.

Apply the cuff to a limb at the same level as the patient’s heart. If it is not, you must use the measurement correction formula to correct the measurement.

The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements.

Correcting the Measurement if Limb is not at Heart Level

To correct the measurement if the limb is not at heart level, to the displayed value add 0.75mmHg (0.10kPa) for each centimeter higher or add 1.9mmHg (0.25kPa) for each inch higher.

deduct 0.75mmHg (0.10kPa) for each centimeter lower or deduct 1.9mmHg (0.25kPa) for each inch lower.

Understanding the NBP Numerics

Alarm source

Measurement Mode

Sys.

NBP mmHg

Auto

Auto

60min

17:15

Mean

120

90

Timestamp/

Timer

Alarm limits Systolic

Diastolic

Mean pressure

Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values.

Alarm Sources if you have parallel alarm sources, the sources are displayed instead of the alarm limits.

NBP Timestamp depending on the configured

NBP Time

setting, the time shown beside the NBP numeric can be:

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10 Monitoring NBP

Starting and Stopping Measurements

Meas Time

: the time of the most recent NBP measurement, or

Next Meas

: the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here.

During measurements the cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement.

Starting and Stopping Measurements

Use the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements.

MMS hardkey

Start/Stop

Action to be performed NBP Setup menu SmartKeys

Start/Stop

Start/Stop manual measurement

Start Auto series

Stop current automatic measurement

Stop Automatic, Manual or

STAT measurement AND series

Stop All

Start

STAT measurement

NBP STAT

---

STAT (for MMS without Pressure/Temp measurement)

Start/Stop

Stop current

STAT

measurement and end series

Start/Stop

NBP STAT

STAT (for MMS without Pressure/Temp measurement)

CAUTION

Use clinical judgement to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff.

Enabling Automatic Mode and Setting Repetition

Time

1

2

3

In the

Setup NBP

menu, select

Auto/Man

.

Toggle between

Auto/Man

, if necessary, to pick the measurement method.

If making an automatic measurement, select

Repeat Time

and set the time interval between two measurements.

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Choosing the NBP Alarm Source

10 Monitoring NBP

Choosing the NBP Alarm Source

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic. In the

Setup NBP

menu, select

Alarms from

and choose from:

Menu option Pressure value monitored

Sys.

Dia.

Mean

Sys&Dia

Dia&Mean

Sys&Mean

S&D&M systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel

Assisting Venous Puncture

You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.

1

2

In the

NBP Setup

menu select

VeniPuncture

.

Puncture vein and draw blood sample.

3

Reselect

VeniPuncture

to deflate the cuff.

During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode.

Cuff pressure

NBP

Venous puncture measurement mode

Time left in venous puncture mode

(60)

VP

01:45

Calibrating NBP

NBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at least once every two years by a qualified service professional. See the Service Guide for details.

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10 Monitoring NBP

Calibrating NBP

148

11

11

Monitoring Temperature

You can measure temperature using the Multi-Measurement Server (MMS), one of the measurement server extensions, or the temperature plug-in module. Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.

Making a Temp Measurement

1

2

3

Select the correct type and size of probe for your patient.

If you are using a disposable probe, connect the probe to the temperature cable.

Plug the probe or temperature cable into the temperature connector socket.

4

5

6

Temp connector socket

Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.

Select an appropriate temperature label.

Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement.

WARNING

Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.

Selecting a Temperature for Monitoring

Tell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that label’s stored color and alarm settings.

1

In the

Setup <Temp>

menu, select

Label.

2

Select the appropriate label from the list.

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11 Monitoring Temperature

Calculating Temp Difference

Temp

Tart

Tcore

Tesoph non-specific temperature label.

arterial temperature core temperature esophageal temperature

Trect

Tskin

Tven

Tnaso rectal temperature skin temperature venous temperature nasopharyngeal temperature

Extended Temperature Label Set

The following additional labels are available if

Label Set

is set to

Full

. This setting can only be changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.

T1, T2, T3, T4

Tamb

Tcereb

Ttymp

Tvesic

Non-specific temperature labels ambient temperature cerebral temperature tympanic temperature vesical temperature

Calculating Temp Difference

4

5

The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled

Temp

.

1

2

In the

Setup Main

menu, select

Measurements

.

In the

Setup

Temp

menu, select

First Temp

.

3

Label the measurement source as appropriate.

Select

Second Temp

.

Label the measurement source as appropriate.

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12

12

Monitoring Invasive Pressure

You can measure pressure using the Multi-Measurement Server (MMS), one of the measurement server extensions or the pressure plug-in module.

Setting up the Pressure Measurement

1

Plug in the pressure cable.

MMS

Module

2

3

Prepare the flush solution.

Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.

WARNING

If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading.

4

5

6

Connect the pressure line to the patient catheter.

If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.

Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.

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12 Monitoring Invasive Pressure

Zeroing the Pressure Transducer

WARNING

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.

Selecting a Pressure for Monitoring

Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure. When you chose a label, the monitor uses that label’s stored color, wave scale and alarm settings.

1

2

In the

Setup

<

Press>

menu, select

Label

.

Select the appropriate label from the list.

Label

ABP

ART

Ao

CVP

ICP

LAP

Description

Arterial blood pressure

Arterial blood pressure (alternative)

Aortic pressure

Central venous pressure

Intracranial pressure

Left atrial pressure

Label Description

P

PAP

RAP

UAP

UVP

Non-specific pressure label

Pulmonary artery pressure

Right atrial pressure

Umbilical arterial pressure

Umbilical venous pressure

Extended Pressure Label Set

The following additional labels are available if

Label Set

is set to

Full

. This setting can only be changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.

Label Description

BAP

FAP

Brachial arterial pressure

Femoral arterial pressure

IC1, IC2

Alternative intracranial pressures

P1, P2, P3, P4

Alternative non-specific pressure labels

Zeroing the Pressure 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). You must perform a zero:

• when you use a new transducer or tubing

• every time you reconnect the transducer cable to the monitor

• if you think the monitor’s pressure readings are not correct.

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Zeroing the Pressure Transducer

12 Monitoring Invasive Pressure

Zeroing ICP (or IC1/IC2)

Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values are automatically stored and you will not be prompted to repeat the zero procedure.

If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the measurement server or module while zeroing. Reconnecting the transducer recalls the stored values.

WARNING

If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero.

Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturer’s instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient.

Determining a Pressure’s Most Recent Zero

The monitor displays the most recent zero on the status line. If this has “timed-out” after you have performed a zero, redisplay the information in the status line by entering the pressure’s setup menu.

Zeroing a Pressure Measurement

WARNING

Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing.

3

4

1

2

Turn off the stopcock to the patient.

Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer.

In the setup menu for the pressure, select

Zero <Press>

.

When you see the message <

Press> zero done at <date and time>

on the status line,

(for example,

ABP zero done at 13 Mar 02 23.35

) close the stopcock to atmospheric pressure, and open the stopcock to the patient.

Using the Zero Hardkey

Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module.

Pressing the Zero hardkey for two seconds on the M3001A Multi-Measurement Server zeros the pressure being measured by the measurement server and the pressures from any connected measurement extensions.

Zeroing All Pressures Simultaneously

WARNING

Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.

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12 Monitoring Invasive Pressure

Adjusting the Calibration Factor

If you are measuring pressures with more than one measuring device, using the

Zero

SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select

All Press

to zero all pressures simultaneously.

Troubleshooting the Zero

The status line lists the probable cause of an unsuccessful zero:

Message Corrective Action unable to zero - equipment malfunction

The hardware is faulty. Contact your service personnel.

unable to zero - excessive offset

Make sure the transducer is vented to air and try again. If this fails, the hardware may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel.

unable to zero - unstable signal unable to zero - no transducer

Make sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer.

unable to zero - pulsatile pressure

Make sure that the transducer is vented to air, not to the patient, and try again.

unable to zero - timed out

Try pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel.

switch <Press> on first

Pressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressure’s label.

Adjusting the Calibration Factor

Each time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same.

1

2

In the

Setup <Press>

menu, select

Cal. Factor

.

If the value here does

not

match that on the transducer, select the corresponding value from the list now in accordance with your hospital’s procedure.

To confirm you want to use the new calibration factor, select the Confirm popup.

Displaying a Mean Pressure Value Only

Use this when you want to see only the mean pressure.

In the pressure’s setup menu, select

Mean Only

.

Toggle between

On

to display mean pressure value only, and

Off

to display all pressure values (systolic, diastolic and mean).

Changing the Pressure Wave Scale

1

2

Select the label of the pressure wave whose scale you want to set to enter the

Setup

menu.

In the

Setup

<Press>

menu, (for example

ABP

) select

Scale

.

154

Optimizing the Waveform

12 Monitoring Invasive Pressure

3

Select a value from the pop-up list:

– a positive value sets the top gridline. The bottom gridline is set at zero.

– a negative value sets the bottom gridline. The middle gridline is set at zero.

Optimizing the Waveform

In the

Setup <Press>

menu, select

Optimum Scale

to let the monitor select the best minimum and maximum scales for the current wave.

Non-Physiological Artifact Suppression

Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample.

Your monitor may be configured to suppress these non-physiological artifacts for a specified duration

(

Artifact Suppression

is configured to 30, 60, or 90 seconds). During artifact suppression, the monitor shows the INOP message

<Pressure label> ARTIFACT

, and a question mark is shown beside the pressure numerics. Pressure alarms and the

Pulse Non-Pulsatile

INOP are suppressed during the configured period. The CPP high alarm is not suppressed.

Choosing the Pressure Alarm Source

WARNING

Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.

In the

Setup <Press>

menu, select

Alarms from

and choose the source.

Menu option

Sys.

Dia.

Mean

Sys&Dia

Dia&Mean

Sys&Mean

Sys&Dia&Mean

Pressure value monitored

systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel

Select and set the

High Limit

and

Low Limit

for the pressure(s) you have selected.

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12 Monitoring Invasive Pressure

Calibrating Reusable Transducer CPJ840J6

Calibrating Reusable Transducer CPJ840J6

Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:

• standard sphygmomanometer.

• sterile 10cc syringe with heparinised solution.

• 3-way stopcock.

• approximately 25cm of tubing.

Making the Pressure Calibration

WARNING

Never perform the invasive pressure calibration while a patient is being monitored.

1

2

Zero the transducer.

Connect the syringe and manometer.

a. Attach the tubing to the manometer.

b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient.

c. Attach the syringe to one port and the manometer tubing to the other port.

d. Open the port to the manometer.

tubing to manometer

156

Syringe with heparinised solution

Patient connection stoppered

PRESS M1006A

T

Off

PRESS ZERO

12

PIN

3

4

Move the syringe barrel in and raise the mercury to 200mmHg (30kPa). 200mmHg is the recommended calibration pressure.

In the

Setup Pressure

menu, select

Cal. Press

.

Calculating Cerebral Perfusion

12 Monitoring Invasive Pressure

5

6

7

8

9

Select the calibration pressure from the list, for example 200 mmHg.

Select

Confirm

to recalculate the calibration factor using the applied pressure.

When the monitor displays <

Press> calibration done at <date and time>

, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones.

Label the transducer with the calibration factor shown in the

Cal. Factor

field in the pressure’s setup menu.

Reconnect the patient and start measuring again.

Troubleshooting the Pressure Calibration

The status line lists the probable cause of an unsuccessful calibration.

Message Corrective Action unable to calibrate - equipment malfunction unable to calibrate - unstable signal unable to calibrate - perform zero first

Contact your service department. The pressure hardware is faulty.

unable to calibrate - out of range

Make sure that you have selected the value for

Cal. Press

that you are applying to the transducer, and repeat the calibration.

unable to calibrate - no transducer

Make sure that the transducer is connected and try again.

Make sure there are no disturbances to the transducer, and repeat the calibration.

No valid zero. Zero the transducer.

Calculating Cerebral Perfusion

The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.

The difference is labeled CPP.

1

2

In the

Main Setup

menu, select

Measurements

.

In the

Setup CPP

menu, select

ABP

,

ART

,

Ao

,

BAP

or

FAP

as the arterial pressure source.

Calculating Pulse Pressure Variation

Note: The derived measurement Pulse Pressure Variation is not available in the USA.

Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. The average variation in pulse pressure is calculated over periods of 32 seconds.

WARNING

• This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician.

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12 Monitoring Invasive Pressure

Measuring Pulmonary Artery Wedge Pressure

• The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.

To select an arterial pressure as PPV source:

1

In the

Main Setup

menu, select

Measurements

.

2

In the

Setup PPV

menu, select

ABP

,

ART

,

Ao

,

BAP

,

P

or

FAP

as the arterial pressure source.

CAUTION

Older measurement servers cannot supply a beat-to-beat arterial pressure value. In this case the monitor shows a

NO PPV FROM <Server>

INOP.

At respiration rates below 8 rpm, PPV calculation may lead to inaccurate values.

Measuring Pulmonary Artery Wedge Pressure

Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:

• Fluid status

• Myocardial contractility

• Valve and pulmonary circulation integrity

Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the inflated balloon occludes the artery allowing the monitor to record changes in the intrathoraic pressures that occur throughout the respiration cycle. The pulmonary wedge pressure is the left ventricular end diastolic pressure (preload).

The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoraic pressure is fairly constant. Use the ECG waveform to determine the waveform of the wedge pressure.

You can use the respiration waveform as a reference when assessing the PAWP waveform, to ensure constant measurement timing relative to the respiratory cycle. The monitor displays the PAWP value for up to 48 hours or until you admit a new patient.

WARNING

The pressure receptor in the catheter records pressure changes that occur only in front of the occlusion. Even though the catheter tip is in the pulmonary artery, the receptor records pressure changes transmitted back through the pulmonary circulation from the left side of the heart.

While performing the wedge procedure, the monitor switches off the pressure alarms for pulmonary artery pressure (PAP).

Due to a slight measurement delay, you should not use Microstream (sidestream) CO

2

as a direct reference for determining the end expiratory point in the pressure curve.

To start the Wedge procedure,

1

In the

Main Setup

menu, select

Wedge

to display the wedge procedures window.

2

Prepare and check the pressure line according to your hospital policy. If the PAP waveform scale is set to

Optimum

prior to the wedge procedure, it is possible that after wedging the catheter, the resulting pressure waveform will fall below the lower scale. In this case, the wedge waveform will

158

Editing the Wedge

12 Monitoring Invasive Pressure

4

5

3

6

7

not be displayed or recorded properly. To avoid this, switch out of optimum scale before performing a wedge procedure.

Use the

Reference Wave

1

and

2

popup keys to select any ECG or respiratory wave as reference waves.

Select

Wave Speed

if you want to synchronize all displayed waves to your preferred speed.

Inflate the balloon when the monitor prompts you:

Ready for balloon inflation

. The waveform changes from the PAP to the PAWP wave. The measurement takes approximately 12 seconds. On completion, the monitor stores the PAWP waveform display and prompts you to deflate the balloon. If the monitor cannot detect a wedging waveform you must use

Store

Trace

to store the wedge and two reference waves manually.

Deflate the balloon when the monitor prompts you:

Ready for balloon deflation

and verify that the waveform returns to pulmonary artery shape.

If you need to start a new measurement, select

Restart Wedge

.

Editing the Wedge

3

4

5

1

2

Select the

Edit Wedge

pop-up key to see the stored waveforms.

The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any previously stored value and the time it was stored.

Move the cursors up, down, right and left to set them on the correct wedge position.

Select

Store Wedge

to store the PAWP value.

Select

Print Wedge

to print the PAWP waveform and any reference waves or

Record Wedge

to record them. While recording or printing, you cannot perform any more Wedge tasks.

WARNING

Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the minimum time necessary to get an accurate measurement.

If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon, the pulmonary artery pressure waveform assumes a wedged appearance. Take appropriate action, in accordance with standard procedures, to correct the situation.

If the PAWP (mean) is greater than the PAP (systolic), deflate the balloon and report the incident in accordance with hospital policy, because the pulmonary artery could be accidently ruptured, and the wedge value derived will not reflect the patient’s hemodynamic state, but will merely reflect the pressure in the catheter or balloon.

159

12 Monitoring Invasive Pressure

Identifying the Pressure Analog Output Connector

Identifying the Pressure Analog Output Connector

analog output

(module M1006B, option C01 only)

160

13

13

Monitoring Cardiac Output

The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window, and the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to the area under the curve. As cardiac output varies continuously, a series of measurements must be carried out to achieve a reliable C.O. average value. Always use the average of multiple thermodilution measurements for therapy decisions.

The measurements can be carried out using the right heart thermodilution method or the PiCCO method (transpulmonary thermodilution).

• The right heart method is available with

– C.O. module M1012A, standard and option #C10

– M3012A Hemodynamic Measurement Server Extension, options #C05 and #C10

– M3014A Capnography Measurement Server Extension, option #C05 and #C10

• The PiCCO method is available with

– C.O. module M1012A, option #C10

– M3012A Hemodynamic Measurement Server Extension. option #C10

– M3014A Capnography Measurement Server Extension, option #C10

The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing pulse contour analysis on the blood pressure waveform.

161

13 Monitoring Cardiac Output

Hemodynamic Parameters

Hemodynamic Parameters

This table illustrates the hemodynamic parameters available with each method, whether they are measured continuously, and whether they can be shown on the monitor’s resting display or in the

HemoCalc Window.

PiCCO Method

(Transpulmonary

Thermodilution) Right Heart Thermodilution

Measured and Calculated Hemodynamic

Parameters and Indexes

Blood Temperature (Tblood)

C.O./C.I.: Cardiac Output

CCO/CCI: Continuous Cardiac Output

SVR/SVRI: Systemic Vascular Resistance

SV/SI: Stroke Volume/SV Index

SVV: Stroke Volume Variation Y

*dPmax: Left Ventricular Contractility Index Y

N and Y Y

N and Y Y

Y

Y

CFI: Cardiac Function Index

ITBV/ITBVI: Intrathoracic Blood Volume

N

N

*EVLW/EVLWI: Extravascular Lung Water N

*GEDV/GEDVI: Global End-Diastolic Volume N

Y

Y

Y

Y

PVR/PVRI: Pulmonary Vascular Resistance

LCW/LCWI: Left Cardiac Work

Not available

N N

RCW/RCWI: Right Cardiac Work Not available

RVSW/RVSWI: Right Ventricular Stroke Work Not available

Continu ous?

Resting

Display

HemoCalc

Window

Contin uous?

Resting

Display

Y

N

Y

Y

Y

Y

Y

Y

N

Y

Y

Y

N

N

N

Y

Y

N

Y

Y

Y (in the

C.O. field)

Not available

N

N

N

N

Not available

Not available

Not available

Not available

Not available

Not available

Y

N

N

N

N

N

N

N

N

Y

Y

Y

Y

Y

Y

HemoCalc

Window

N

Y

*

currently not available in the U.S.A or in clinical environments under FDA control.

162

Using the C.O. Procedure Window

13 Monitoring Cardiac Output

Using the C.O. Procedure Window

The C.O. procedure window displays up to six trials (measurement curves) with the trial number and the C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys automatically appears to let you carry out C.O.-related tasks. This example shows the procedure window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly different on your monitor.

To open the C.O. procedure window,

Select

Cardiac Output

in the

Setup C.O.

or

Setup CCO

menu, or

Select the

Cardiac Output

SmartKey on the Screen, if configured, or

Press the

START

hardkey on the front of the C.O. plug-in module, if available, or

Press a remote start switch, if you are using one.

Trial curves

Results table of current trial

Cardiac Output (Transpulmonary)

Trial curve scale

Averaged values

0.3

o

C

Setup information

Current trial number

Curve alert message field

Trial

CCO-CAL

C.O.

CFI

C.I

ITBVI

ETVI

Tinj

InjVol

#1

Cal

8.53

5.5

4.42

996

6.0

2.0

10

CathCt

#2

Cal

11.4

6.0

5.88

1225

5.0

2.0

10

InjVol

#3

Cal

8.49

5.5

4.40

998

6.1

2.0

10

C.I. 4.40

BSA 1.93

Tblood

Thermodilution curve of current trial

C.O. 8.49

Average

8.51

5.5

4.41

996

Unit l/min l/min/m

2 ml/m

2 o

C ml

Tblood 37.0

Continuously measured numeric

Ready for new measurement

Prompt message field

Start Stop

C.O.

C.O.

Select

Trial

Accept/

Reject

Save C.O.&

Cal CCO

Print/

Record

Table

Contents

Hemo

Calc

Change Setup

Scale C.O.

To change the measurement parameters shown in the results table of the C.O. procedure window, select the

Table Contents

pop-up key and choose from the list of available parameters.

To view the currently-used temperature unit, see the “grayed-out” setting

Temperature Unit

in the

Setup C.O.

menu. This setting can only be changed in Configuration Mode.

The Cardiac Output screen element may be configured to display permanently on a specially designed Screen. Selecting the screen element opens the cardiac output pop-up keys.

163

13 Monitoring Cardiac Output

Accessing the Setup C.O. and Setup CCO Menus

Accessing the Setup C.O. and Setup CCO Menus

C.O. settings can be changed in the

Setup C.O.

menu. To access this menu,

♦ press the C.O. hard key on the C.O. module

♦ select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen.

CCO/CCI settings can be changed in the

Setup CCO

menu. To access this menu,

♦ select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen.

Entering the HemoCalc Window

From the C.O. procedure window, select the pop-up key

HemoCalc

to open the HemoCalc window.

Measuring C. O. Using the PiCCO Method

The PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the blood pressure waveform. A fluid with a known volume and temperature is injected into the right atrium through a CVP catheter. The injectate bolus mixes with the blood in the heart and the change in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery.

The PiCCO Method requires a pressure measurement made using either the M1006B Pressure module, or a M3001A MMS, or a measurement server extension M3015A, M3014A, or M3012A. (A

VueLink pressure may not be used.) You will also need a conventional central venous (CVP) line and an arterial catheter from Pulsion Medical Systems. You must use the approved catheters and puncture locations.

Measuring Continuous Cardiac Output

Every time C.O. is measured with the PiCCO method, the monitor uses this C.O. value and the result of the pulse contour analysis to calculate a patient-specific calibration factor. The monitor uses this value to compute CCO and the other continuous hemodynamic parameters. CCO values are calculated on a beat-to-beat basis and then averaged over a 12-second time frame. The calculated values are displayed as numerics on the monitor screen.

Measuring Systemic Vascular Resistance

The monitor uses CCO, an arterial pressure, and CVP to calculate a continuous SVR value. If a continuously measured CVP value is not available, the monitor uses a preset, static CVP value to calculate the SVR (you will see the INOP message

SVR SET CVP USED

). If the BSA is available, the monitor uses the CCI to calculate the SVRI.

SVR/SVRI settings can be changed in the

Setup SVR/SVRI

menu. To enter the menu, select ->

Main Setup

->

Measurements

->

SVR

or

SVRI

.

To display a SVR/SVRI numeric on the Screen, select any numeric, then select

Change Numeric

and select

SVR

or

SVRI

from the list of available numerics.

164

Measuring C. O. Using the PiCCO Method

13 Monitoring Cardiac Output

Setting Up the PiCCO C.O. Measurement

1

2

Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit from Pulsion Medical

Systems. It must be placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery. You must use the approved catheters and puncture locations.

Set up the central venous line.

Remote

Switch

C.O. Module

C.O.

Interface

Cable

Press Module

Pulsion

Pressure

Transducer

Pressure

Adapter

Cable

3

Connect the injectate temperature probe housing to the venous line.

4

Plug the C.O. interface cable into the

C.O. module or measurement server extension and connect the following devices to the C.O. interface cable:

– Injectate temperature probe

– Thermistor connector

– Remote start switch (if used).

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin.

5

Injectate

Temperature

Probe

Injectate

Syringe

Injectate

Temperatur e Probe

Housing

CVP

Line

Thermistor

Connection

Cable

Thermistor

Connection

Pulsion Arterial

Catheter

If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories.

6

Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the

Setup C.O.

menu, select

Method

and then select

Transpulmonary

.

7

Check that the

Tinj Probe Type

setting in the

Setup C.O.

menu matches the type of injectate temperature probe used. The probe type is usually printed on the plug of the probe.

To change the probe type, in the

Setup C.O.

menu, select

Tinj Probe Type

to call up a list of available probes.

23001:

it is recommended to use this probe with cold injectate

M1646:

this probe can be used with room temperature injectate or with cold injectate.

165

13 Monitoring Cardiac Output

Measuring C. O. Using the PiCCO Method

8

Check that the correct arterial catheter constant is selected.

If the catheter is recognized by the monitor, the catheter constant is automatically displayed and cannot be changed manually. If it is not recognized, in the C.O. procedure window, select

CathCt

and use the pop-up keypad to enter the correct value. The catheter constant is usually written either on the catheter or on the catheter packaging.

9

Make sure that the injectate volume setting matches the injectate volume you will use. To change the volume, in the C.O. procedure window, select

InjVol

and select the correct injectate volume from the pop-up list.

If there is a problem with the volume or temperature you have chosen, the monitor will issue a curve alert message to inform you of this.

10

If you are measuring CCO or CCI, check that the correct pressure source is selected in the

Setup CCO

menu. The pressure label under

CCO from

must match the pressure measured with the arterial catheter. To change the pressure source, select

CCO from

to call up a list of available pressure labels and select the correct label.

11

If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item

Alarms From

. To change the alarm source, select

Alarms From

and choose either

CCO

or

CCI

.

Performing PiCCO C.O. Measurements

Always wait for the monitor to indicate readiness for the next step before proceeding.

If you are measuring CCO, all measurements should be conducted within 15 minutes. Older measurements “expire” for CCO calibration.

1

Enter the C.O. procedure window.

2

When you see the message

...Ready for new measurement

, start the measurement by selecting the pop-up key

Start C.O.

or pressing the Start hardkey on the C.O. module, or pressing the remote start switch.

3

4

When you hear the ready tone and see the message

...Stable baseline, inject now!

, inject the solution into the CVP catheter.

At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and

EVLW values and any curve alerts are displayed and a message will appear “

...Wait before starting new measurement

”.

When you see the

...Ready for new measurement

message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of 6 measurements before editing. If you perform more than 6 measurements without rejecting any, the oldest will automatically be deleted when a 7th curve is stored.

Editing PiCCO C.O. Measurements

It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output.

1

2

Review the trials. Irregular trials or trials marked with a “?” should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.

Reject unsatisfactory trials: use the

Select Trial

pop-up key to move between trials, then select the

Accept Reject

pop-up key to accept or reject trials. If you are using a touch screen

166

Measuring C. O. Using the PiCCO Method

13 Monitoring Cardiac Output

you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials.

If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.

Saving and Calibrating PiCCO C.O. Measurements

When you have finished editing the trials, you must save the results. This closes the measurement series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases.

Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate

CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the same direction over 15 minutes, or if there are large or sudden changes in the patient’s condition.

The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO.

To save and calibrate,

In the C.O. procedure window, select the pop-up key

Save C.O. & Cal CCO

averaged C.O. value to calibrate Continuous Cardiac Output (CCO).

to use the

Your monitor may be configured to have two separate pop-up keys,

Save C.O.

and

Cal CCO

, instead of the combined

Save C.O. & Cal CCO.

WARNING

CCO calibration is patient-specific. When the C.O. module or measurement server extension is plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in doubt perform a new CCO calibration first.

CCO Calibration Status Indicators

Each measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial’s validity to be used in a CCO calibration.

For a trial to be eligible for calibration, the pressure signal must be continuously available and undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the pressure measurement, change the pressure label, or disturb the pressure signal in any other way during this time.

CAL

A pressure signal for CCO was available during the measurement (valid for calibration)

?CAL

A disturbed pressure signal for CCO was available during the measurement (valid for calibration)

N/A

No adequate pressure signal for CCO was available during the measurement (no valid calibration data)

EXP

This trial is more than 15 minutes older than the most recent trial and has expired for CCO calibration (no valid calibration data)

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13 Monitoring Cardiac Output

Measuring C.O. Using the Right Heart Thermodilution Method

Measuring C.O. Using the Right Heart

Thermodilution Method

In the right heart thermodilution method, a fluid of known volume and temperature is injected into the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter. The injectate bolus mixes with the blood in the right ventricle and the change in blood temperature is measured with a thermistor at the distal end of the catheter in the pulmonary artery.

Setting up RH C.O. Measurements

1

2

3

Plug the C.O. interface cable into the

C.O. module or measurement server extension and connect the following devices into the C.O. interface cable:

– injectate temperature probe

– remote start switch (if used).

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin.

4

5

Plug the thermistor connection cable of the PA catheter into the thermistor connector.

Connect the injectate temperature probe to the injectate temperature probe housing.

6

Set up the PA line using a PA catheter.

Attach the injectate temperature probe housing to the PA line.

Injectate

Temperature

Probe

Injectate

Syringe

Injectate

Temperature

Probe Housing

PA Catheter

C.O. Module

C.O. Interface Cable

Remote Start Switch

Thermistor

Connector

Thermistor

Connection

Cable

Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the

Setup C.O.

menu, select

Method

and then select

Right Heart

.

Ice-Bath Setup for RH Thermodilution C.O. Measurements

If you are using the flow-through method illustrated above, the injectate temperature is measured at the time of injection by the temperature probe in the injectate temperature probe housing.

168

Documenting C.O. Measurements

13 Monitoring Cardiac Output

If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in an ice-bath and the probe measures the temperature of the contents of the ice bucket.

Setting the Computation Constant

Check that the correct

Computation Constant

is entered in the C.O. procedure window. This can be found in the documentation supplied with the catheter and is based on the injectate volume, injectate temperature and catheter type. To change the value, in the C.O. procedure window, select

Computation Constant

and use the pop-up keypad to enter the correct value.

Performing RH C.O. Measurements

1

Enter the C.O. procedure window.

2

When you see the message

...Ready for new measurement

, select the pop-up key

Start

C.O.

3

4

When you hear a ready tone and see the message

...Inject now!

, inject the solution into the right atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second.

At the end of the measurement the thermodilution curve, cardiac output, index values and curve alerts (if necessary) are displayed and a message will appear

...Wait before starting new measurement

.

When you see the

...Ready for new measurement

message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of six measurements before editing. If you perform more than six measurements without rejecting any, the oldest will automatically be deleted when a seventh curve is stored.

Editing and Saving RH C.O. Measurements

It is important to identify and reject erroneous measurements (called “trials”), as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output.

1

2

Review the trials. Irregular trials or trials marked with a “?” should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.

Reject unsatisfactory trials: use the

Select Trial

pop-up key to move between trials, then select the

Accept Reject

pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials.

If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.

3

Save average C.O. values. To close a measurement series, you must save the average values by selecting the pop-up key

Save C.O.

This sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases.

Documenting C.O. Measurements

You can document C.O. measurements on the default printer or recorder.

1

In the C.O. procedure window, select the pop-up key

Print/Record.

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13 Monitoring Cardiac Output

C.O. Injectate Guidelines

2

From the pop-up list, choose:

Print Results

to print the contents of the C.O. procedure window

Record Results

to record the contents of the C.O. procedure window

Record Trial

to send an individual trial curve to the recorder.

C.O. Injectate Guidelines

The greater the injectate volume and the colder the temperature, the more accurate the measurement.

Reduced injectate volume or higher injectate temperature may reduce the specified accuracy.

For adult patients, to ensure the greatest measurement accuracy, use a cold injectate (< 8

°

C) of 10 ml volume, if not contra-indicated by the patient's condition. Your choice of injectate volume should be based on the injectate temperature and the patient’s cardiac output.

Guidelines for Right Heart Thermodilution C.O. Injectate

If you are using the right heart thermodilution method, the use of injectate with a temperature less than 8

°

C lower than the blood temperature may cause incorrect values for the thermodilution.

Guidelines for PiCCO C.O. Injectate

If you are using the PiCCO method, the use of injectate with a temperature less than 12

°

C lower than the blood temperature may cause incorrect values for the thermodilution and CCO calibration.

Injectate Volume, Patient Weight and ETVI Values (PiCCO Only)

When deciding on an injectate volume and temperature, you must consider your patient’s weight and extra-vascular thermal volume index (ETVI).

High ETVI: The dilution of injectate is influenced by extravascular tissue and fluid. The accuracy of the PiCCO method may be reduced in patients with high extra-vascular thermal volume index (ETVI) values. Use the table below as a guide in selecting the correct injectate temperature. As shown in the table, if your patient has an ETVI > 10, you must use cold injectate.

Weight: Use the table below as a guide in choosing an injectate volume appropriate for the patient weight.

Patient Weight Cold Injectate

< 3 kg

< 10 kg

< 25 kg

< 50 kg

< 100 kg

100 kg

ETVI < 10

2 ml

2 ml

3 ml

5 ml

10 ml

15 ml

ETVI

10

2 ml

3 ml

5 ml

10 ml

15 ml

20 ml

Room Temperature Injectate

ETVI < 10 ETVI

10

3 ml

3 ml

5 ml

10 ml

15 ml

20 ml

Use cold injectate

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C.O./CCO Curve Alert Messages

13 Monitoring Cardiac Output

C.O./CCO Curve Alert Messages

After each measurement trial, the monitor analyzes the thermodilution curve. If the curve appears abnormal, a curve alert message appears in the C.O. procedure window. A question mark symbol (“

?

”) may appear next to the cardiac output numeric if any of these messages appear. The curve alert messages are not error messages and do not necessarily mean that the measured values are invalid.

C.O./CCO Curve Alert Messages Possible Causes

Tinj off scale

Noisy Baseline

Temperature Baseline

Drift

Small signal, more indicator required

Injectate Temperature too High

High ETVI, use cold injectate or greater inj. volume

Disturbed Injection

The Tinjectate is out of the range -1°C and 30°C. Cool down or heat up the injectate or change the injectate solution and repeat the measurement.

A blood temperature baseline drift that could not be compensated was detected during the C.O. measurement. Possible causes are:

- Interference may be caused by a ventilator.

- Interference may be caused by an infusion pump: infusions of significant volume through the central line should be paused at least

30 seconds before the first thermodilution measurement in a series and should not recommence until the measurement series is completed.

- Do not administer injections through the central line during a measurement series.

- Electrical devices in the vicinity can cause interference: check for infusion pumps connected to the central catheter, cables parallel to the thermodilution cable, electrocautery. Make sure all devices are properly grounded.

- Wait until measurement results are displayed before moving the patient or catheter.

- Close the stopcock to the injectate syringe after the injection.

- Do not rinse the catheter during measurement, to avoid temperature fluctuations.

May occur if patient is recovering from open heart surgery, or if patient was cooled down for surgery and is in the process of regaining normal body temperature when the measurement is made.

The peak of the transpulmonary thermodilution curve was below

0.1ºC. Increase injectate volume and/or lower injectate temperature.

The difference between the blood and injectate temperatures is too small. The calculated value for C.O. may not be accurate.

The ETVI value is too high. The accuracy of the transpulmonary thermodilution measurement may be reduced. Increase injectate volume and/or lower injectate temperature following the guidelines

given in the section “Guidelines for PiCCO C.O. Injectate” on page 170.

The injection should be performed quickly and with a steady pressure. Shaking, unsteady pressure, or injections that take longer than six seconds may cause this message to appear; you should bear this in mind if you are using a large injectate volume (> 10 ml).

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13 Monitoring Cardiac Output

C.O./CCO Prompt Messages

C.O./CCO Curve Alert Messages Possible Causes

Check Injectate

Temperature Probe Type

Unsteady Baseline

Multiple Peaks

Abnormal Decay Time

Very Long Curve

Very Short Curve

Irregular Curve

Delayed Injection

The recorded Tinj signal is uncharacteristic for the M1646 injectate temperature probe. The probe may be defective or an incorrect probe type may have been used.

There is a noisy baseline, and thermal baseline drift.

Caused by faulty injection technique.

May be caused by low cardiac output. Calculated value for C.O. may not be accurate.

The decay time of the curve is longer than 15 seconds.

Decay time of the curve is less than 0.5 seconds. If there is a noisy baseline, part of the baseline may have been mistaken for a thermodilution curve. Calculated value for C.O. may not be accurate.

Any combination of curve alert messages.

Injection is given more than 15 seconds after

Start C.O.

is selected. Calculated value for C.O. may not be accurate.

If you have followed all of these guidelines, your measurement values should be valid, even if you still see a curve alert message. Ensure that at least three subsequent measurements within the current series do no differ by more than 15%. If the difference exceeds 15%, use your clinical judgement to determine the appropriate intervention.

C.O./CCO Prompt Messages

Prompt messages appear in the C.O. procedure window if a C.O. measurement trial must be terminated.

C.O./CCO Prompt Messages Possible Causes

Curve Below Baseline, measurement terminated

May be caused by thermal baseline drift. No C.O. value calculated.

Excessive Curve Height, measurement terminated

The curve exceeds the upper limit. This may be caused by an injectate that was too cold. No C.O. value calculated.

Unstable Baseline, injection not recommended

The baseline is unstable. Wait until the baseline is stable before injecting. If this does not occur within a reasonable time, injection is possible but the accuracy of the measured values may be reduced.

Excessive baseline drift, don’t inject now

No measurement is possible. Measured values are incorrect.

172

C.O./CCO Warning Messages

13 Monitoring Cardiac Output

C.O./CCO Warning Messages

Warning messages contain important information about the C.O. measurement.

C.O./CCO Warning Messages Possible Causes

Next measurement erases older curve

Six curves are stored, this is the maximum possible. If another measurement is stored, the oldest thermodilution curve will be erased.

Previous C.O. Setup Data replaced

A C.O. module or measurement server extension has been plugged in with different C.O. setup data from the previous data. The new C.O. setup data is read from the new C.O. device, and replaces the current data. The message disappears when the

Start C.O.

pop-up key is pressed.

Verify the C.O. Setup

Data

Check arterial pressure,

CCO cal currently not possible

A new transpulmonary thermodilution catheter has been connected to the C.O. Interface Cable.

Poor or invalid pressure signal, for example if pressure was not zeroed.

Verify the Computation

Constant

Previous Comp. Constant replaced

A new catheter has been plugged in, or the computation constant has been changed and

Start C.O.

has not been selected.

A new C.O. module or measurement server extension with a different computation constant from the current one has been connected. The new computation constant is read from the new C.O. device, and replaces the current one. The message disappears when

Start

C.O.

is selected.

C.O./CCO Safety Information

WARNING

Catheter constant: Make sure that the arterial catheter constant for the measurement is appropriate to the catheter used.

Computation Constant: Make sure that the computation constant for the measurement is appropriate to the injectate volume, injectate temperature and catheter type used.

IABP: Do not perform transpulmonary thermodilution measurements on patients undergoing IABP treatment.

CCO accuracy: Accuracy of the CCO measurement and all the derived values may be influenced by patients with valve diseases or artificial valves.

C.O. and MRI: Do not use the Cardiac Output Interface Cable in Magnetic Resonance Imaging

(MRI) Applications.

Aortic graft patients: Do not use an arterial catheter in the arteria femoralis when it is contra indicated, for example, with patients who have an aortic graft.

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13 Monitoring Cardiac Output

C.O./CCO Safety Information

CAUTION

During the cardiac output measurement procedure the blood temperature alarms are inactive. This is indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive during this procedure prevents false alarms. The alarms are automatically reactivated when you have completed the measurement procedure.

174

14

14

Monitoring Carbon Dioxide

Use the CO

2 measurement to monitor the patient’s respiratory status and to control patient ventilation.

There are two methods for measuring carbon dioxide in the patient’s airway:

• Mainstream measurement uses a CO

2 sensor attached to an airway adapter directly inserted into the patient’s breathing system. This method is available with the M3014A Capnography Extension and the M3016A Mainstream Extension to the M3001A Multi-Measurement Server.

• Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient’s airway and analyzes it with a remote CO

2 sensor built into the measurement system. Philips offers the sidestream CO

2

measurement in the M3014A Capnography Extension and the

Microstream method of sidestream CO

2

measurement in the M3015A Microstream CO

2

Measurement Extension.

In both cases, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO

2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO

2

.

When using a wet ventilator circuit, monitor mainstream CO

2

if available, in preference to sidestream

CO

2

.

The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure.

The measurement provides:

• a CO

2

waveform.

• an end tidal CO

2

(etCO

2

) value: the CO

2

value measured at the end of the expiration phase.

• an inspired minimum CO

2

(imCO

2

): the smallest value measured during inspiration.

• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO

2 waveform.

Depending on the

Max Hold

setting configured for your monitor, the etCO

2

numeric shows either the highest CO

2

value measured within the configured time period (

Max Hold

set to

10 sec

or

20 sec

) or the etCO

2

numeric shows breath-to-breath value (

Max Hold

set to

Off

).

Refer to your Gas Module Instructions for Use, if you are using a Gas Module to monitor CO

2

.

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14 Monitoring Carbon Dioxide

Using the Capnography Extension (M3014A)

WARNING

Correlation: The etCO

2

readings do not always correlate closely with paCO

2

, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.

Pharmaceuticals in aerosols: Do not measure CO

2

in the presence of pharmaceuticals in aerosols.

Explosion Hazard: Do not use in the presence of flammable anesthetics, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide.Use of the devices in such an environment may present an explosion hazard.

Failure of operation: if the measurement extension or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel.

Low etCO

2

values: Leakages in the breathing system or sampling system may cause the displayed etCO

2

values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO

2

readings. Even with combined nasal oral cannulas, the etCO readings may be slightly lower than actual in patients breathing through the mouth only.

2

Using the Capnography Extension (M3014A)

The M3014A Capnography Extension measures partial pressure of carbon dioxide in a patient’s expired gas using the mainstream method or the sidestream method. The mainstream CO

2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO

2

measurement can be used, with appropriate accessories, with intubated and nonintubated adult, pediatric and infant patients. With intubated patients, a sample of the respiratory gas is drawn from the patient’s breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.

WARNING

Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation.

Before the CO

2

measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO

5% for every 1000m difference.

2

readings. The CO

2

readings will typically deviate

Electrical Shock Hazard: Do not open the measurement extension. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor or measurement server. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel.

CAUTION

Use the M3014A measurement extension with Philips approved accessories only. Refer to the instructions for use provided with the accessory.

Preparing to Measure Mainstream CO

2

You must perform a zero as described in this procedure each time you use a new airway adapter.

1

2

Attach the sensor connector to the CO

2

connector on the measurement extension.

Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition.

176

Using the Capnography Extension (M3014A)

14 Monitoring Carbon Dioxide

3

Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly.

4

To zero the sensor:

– expose the sensor to room air and keep it away from all sources of CO

2 including the ventilator, the patient’s breath and your own.

– in the setup menu for the CO

2

, select

Start Zero

Cal

.

– When you see the message

Zero done at <date and time>

on the status line, the zero calibration is finished and you can begin monitoring.

5

Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section.

WARNING

To prevent stress on the endotrachial tube, support the sensor and airway adapter.

Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable.

Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the CO

2 waveform changes unexpectedly without a change in patient status.

To avoid infection, use only sterilized, disinfected or disposable airway adapters.

Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population.

Preparing to Measure Sidestream CO

2

1

Plug the sensor cable into the monitor’s CO

2 two minutes warm up time

input connector. Allow the sensor

2

Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly.

3

To zero the sensor:

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14 Monitoring Carbon Dioxide

Using the Capnography Extension (M3014A)

4

– expose the sensor to room air and keep it away from all sources of CO

2 including the ventilator, the patient’s breath and your own.

– In the setup menu for the CO

2

, select

Start Zero Cal

.

– When you see the message

Zero done at <date and time>

on the status line, the zero calibration is finished and you can begin monitoring.

For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection.

For intubated patients with an integrated airway adapter in the breathing

circuit.: Connect the male luer connector on the straight sample line to the female port on the airway adapter.

For non-intubated patients: Place the nasal cannula onto the patient.

For patients prone to mouth breathing use an oral-nasal cannula. Trim the oral sampling tip if necessary to fit the patient. It should extend down past the teeth and be positioned in the mouth opening. Remove the cannula from the patient if the tip needs to be trimmed.

For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow.

WARNING

Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor.

CAUTION

Always disconnect the cannula, airway adapter or sample line from the sensor when not in use.

Using the Sidestream Sensor Holder

The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.

178

Using the Mainstream CO

2

Extension (M3016A)

1

2

Push the sensor into the holder until it clicks into position.

Clamp the holder onto an IV pole, a shelf or another appropriate location.

To remove the sensor from the holder, release the clip and pull the sensor out of the holder.

14 Monitoring Carbon Dioxide

clip

Removing Exhaust Gases from the System

WARNING

Anesthetics: When using the sidestream CO

2

measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ ventilator, to avoid exposing medical staff to anesthetics.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.

Using the Mainstream CO

2

Extension (M3016A)

The M3016A Measurement Server Extension measures partial pressure of carbon dioxide in a patient’s expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO

2

measurement with ventilated adults, pediatric and neonatal patients.

WARNING

Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation during use. This may cause incorrect readings.

Preparing to Measure Mainstream CO

2

1

2

Attach the transducer connector to the CO

2

connector on the measurement extension.

Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition.

3

Perform an accuracy check and then, if necessary, calibrate the transducer.

Checking Transducer Accuracy

WARNING

Check transducer accuracy at least once a week or if you doubt the CO

2

readings.

1

2

3

In

Setup CO2

menu, select

Cal. Mode

to switch on calibration mode.

Look at the calibration value displayed in the

Setup CO2

menu next to

Start Cal 1:.

Is it the same as the value on the calstick? If not, calibrate the transducer now.

Place the transducer on the low cell of the calstick (labelled 0.0 mmHg or “ZERO”). The reading on the screen should be zero within ±1 mmHg within one minute.

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14 Monitoring Carbon Dioxide

Using the Mainstream CO

2

Extension (M3016A)

4

5

Place the transducer on the high cell of the calstick. The reading on the screen should be within ±1 mmHg of the value on the calstick within one minute.

If both readings are in range, you can leave calibration mode and begin monitoring. If either of the readings is out of range, calibrate the transducer.

Calibrating the Transducer

1

Check that the windows on the calstick are clean and clear.

2

Place the transducer on one of the calstick cells and select

Start Cal 1

.

3

4

5

6

Enter the calibration value printed on the calstick then press

Confirm

to start calibration.

When the message

CO2 CAL 1 calibration done - start CAL 2 calibration

appears, put the transducer on the other cell and select

Start Cal 2

then press

Confirm

.

When you see the message

CO2 calibration completed. Leave calibration mode.

, calibration is complete.

Select

Cal Mode

to switch calibration mode off. You cannot monitor in calibration mode.

Attaching and Removing the CO

2

Transducer

Airway Adapter

1

Open the latch and place the transducer onto the airway adapter.

Place the airway adapter in the patient’s breathing circuit between the endotracheal tube and the Ypiece. You may see the

CO2 SENSOR

WARM UP

message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement.

CO

2

Transducer

180

Using the Microstream CO

2

Extension (M3015A)

2

To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.

14 Monitoring Carbon Dioxide

WARNING

To prevent stress on the endotrachial tube, support the transducer and airway adapter.

To avoid infection, use only sterilized airway adapters.

Using the Microstream CO

2

Extension (M3015A)

The M3015A Microstream CO

2

Extension measures the partial pressure of carbon dioxide in a patient’s expired gas using Microstream technology.

In intubated patients, a sample of the respiratory gas is drawn from the patient’s breathing circuit through an airway adapter and a gas sampling tube. In non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.

When using the appropriate accessories, you can use the Microstream CO

2

measurement with adult, pediatric, and neonatal patients.

The M3015A is equipped with an automatic barometric pressure compensation.

Preparing to Measure Microstream CO

2

Use appropriate accessories for:

• the patient type (adult, pediatric or neonatal),

• the ventilation situation (including humidification)

• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).

All accessories are for single patient use only.

Using Microstream Accessories

M3015A can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory.

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14 Monitoring Carbon Dioxide

Using the Microstream CO

2

Extension (M3015A)

For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set.

For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine

(which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO

2

, oxygen (O

2

) may be delivered to the patient to support gas exchange. This is done by using an O

2 or a Smart CapnoLine O

2

(a combined oral-nasal O

2

/CO

2

FilterLine).

/CO

2

FilterLine,

Using the FilterLine and Airway Adapter

1

Attach the female Luer connector to the CO

2

inlet connector on the measurement extension by pushing the socket cover down and screwing the connector into place.

inlet connector cover outlet connector

2

3

Check that the FilterLine is not kinked.

Change the FilterLine if a “CO

2

OCCLUSION” INOP appears on the monitor or if the readings become extremely erratic.

Disconnect the FilterLine during suctioning and nebulizing therapies.

For best results change the FilterLines for non-humidified use (with orange connectors) after 24 hours of continuous use and the FilterLines H, for humidified use, (with yellow connectors) after 72 hours of continuous use.

CO

2

values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blocked

Removing Exhaust Gases from the System

WARNING

Anesthetics: When using the Microstream CO

2

measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ ventilator, to avoid exposing medical staff to anesthetics.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the Measurement

Server Extension at the outlet connector.

182

Setting up Mainstream and Sidestream CO

2

14 Monitoring Carbon Dioxide

Suppressing Zero Calibration

To prevent an automatic zero calibration from being started in the next five minutes,

♦ in the

Setup CO

2

menu, select

No Zero for 5 Min

, or select the

Suppress CO2 Zero

SmartKey, if configured.

Selecting

No Zero for 5 Min

or selecting the

Suppress CO2 Zero

SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.

Setting up Mainstream and Sidestream CO

2

These tasks are common to all CO

2

measurements except where otherwise noted.

Adjusting the CO

2

Wave Scale

1

2

In the

CO

2

Wave

menu or the

Setup CO

2

menu, select

Scale

.

Choose a suitable scale range from the pop-up list.

Setting up CO

2

Corrections

Temperature, water vapor in the patient’s breath, barometric pressure, and the proportions of O

2,

N

2

O and Helium in the mixture all influence CO

2

absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections.

Correction

Altitude

(M3014A only)

Altitude is set during installation. The monitor automatically applies an appropriate correction.

O

2

(M3014A only)

In the

Setup CO2

menu, select

100%, the default value is 16%.

Oxygen Corr

and select a value between 0% and

Humidity

If the O

2

correction is not available in the

Setup CO2

menu, the CO in your Measurement Server Extension does not require O

2

correction.

2 measurement

At installation, the monitor is configured to automatically apply either Body Temperature

Pressure Saturated (BTPS) or Standard Temperature Pressure Dry (STPD). To see which, go to the

Setup CO2

menu, and scroll down to look at

HumidtyCorr.

N

2

O

(M3016A mainstream and M3015A microstream only)

In the

Setup CO2

menu, select

N2O Corr

and turn on or off. If N

2

O is present in the ventilation gas mixture, you must turn this on.

If the N

2

O correction is not available in the

Setup CO2

menu, the CO

2 measurement in your Measurement Server Extension does not require N

2

O correction or it is setup with

Gas Corr

(see below).

Gas

(M3014A only)

In the

Setup CO2

menu, select

Gas Corr

and select Helium, N2O or turn off. If

Helium or N

2

O is present in the ventilation gas mixture, you must make the appropriate selection.

If the Gas correction is not available in the

Setup CO2

menu, the CO

2 measurement in your Measurement Server Extension does not require N the N

2

O correction is setup with

N2O Corr

(see above).

2

O or Helium correction or

183

14 Monitoring Carbon Dioxide

Setting up Mainstream and Sidestream CO

2

Correction

Agent

(M3014A only)

In the

Setup CO2

menu, select

Agent Corr

and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration.

Suppressing Sampling (not Mainstream CO

2

)

To temporarily stop sampling,

♦ in the

Setup CO

available.

2

menu, select

Pump 15Min Off

or use the

CO2 Pump Off

SmartKey if

Selecting

Pump 15Min Off

again before fifteen minutes have passed resets the timer to fifteen minutes.

To re-start the pump,

♦ in the

Setup CO

2

menu, select

Pump On

.

Changing CO

2

Alarms

This refers to CO

2

specific alarms. See the Alarms section for general alarm information.

1

In the

Setup CO

2

menu, select

etCO

2

High

or

imCO

2

High

and choose the upper alarm limit.

2

Select

etCO

2

Low

and choose the lower alarm limit.

Changing the Apnea Alarm Delay

This determines the time limit after which the monitor alarms if the patient stops breathing.

1

2

In the

Setup CO

2

menu, select

awRR

.

In

Setup awRR

menu, select

Apnea Time

.

3

Choose the apnea alarm delay time.

WARNING

Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A) measurement only.

Deriving Alarms From awRR

1

2

In the

Setup CO

2

menu, select

awRR

.

In the

Setup awRR

menu, select

Alarms

.

3

Choose

On

to derive alarms from the airway respiration signal or

Off

to disable them.

Changing awRR Alarm Limits

1

In the

Setup CO

2

menu, select

awRR

.

184

Setting up Mainstream and Sidestream CO

2

2

3

Select

High Limit

to set the upper alarm limit.

Select

Low Limit

to set the lower alarm limit.

Select the appropriate setting.

14 Monitoring Carbon Dioxide

185

14 Monitoring Carbon Dioxide

Setting up Mainstream and Sidestream CO

2

186

15

15

Monitoring Airway Flow,

Volume and Pressure

The M1014A Spirometry Module is designed to be used in combination with Philips-branded airway flow sensors and combined CO

2

/airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics.

The measurement provides:

• Airway flow, airway volume and airway pressure waveform.

• Numerics for:

– respiratory rate

– tidal volume

– minute volume

– PEEP (positive end-expiratory pressure)

– PIP (peak inspiration pressure)

– dynamic compliance

– airway resistance

• Numerics for: (only visible in Spirometry Values Window, no alarming, no trending)

– peak inspiratory flow

– peak expiratory flow

– negative inspiratory pressure

– mean airway pressure

– plateau pressure numeric

– I:E ratio

The measurement also provides pressure-volume loops, flow-volume loops and pressure-flow loops.

Please see the Respiratory Loops chapter for details on loops.

When using combined CO

2

/Flow sensors you can also perform mainstream capnography with intubated adult, pediatric and neonatal patients. See the Measuring CO

2 chapter for details on the CO

2 measurement and the Accessories chapter for a list of compatible accessories.

WARNING

Electrical Shock Hazard: Do not open the module. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the module. Refer servicing to qualified service personnel.

187

15 Monitoring Airway Flow, Volume and Pressure

Attaching the Flow Sensor

Attaching the Flow Sensor

CAUTION

Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory.

1

Select the appropriate flow sensor. Make sure that you are using the correct sensor for the respective patient category. Otherwise accuracy may be reduced.

Pediatric/Adult Flow Sensor (M2785A). Color: clear

For intubated patients with endotracheal tube diameters >4 mm. Adds approximately 6.5 cc of deadspace.

Infant/Neonatal Flow Sensor (M2786A) Color: violet

For intubated patients with endotracheal tube diameters

4 mm.

Adds less than 1 cc of deadspace.

You can also use combined CO

2

/flow sensors. Note that the M3014A Capnography Extension is required to measure CO

2

.

2

3

4

Pediatric/Adult Combined CO

2

/Flow Sensor (M2781A). Color: clear

For intubated patients with endotracheal tube diameters >5.5 mm.

Adds 8 cc of deadspace.

Pediatric Combined CO

2

/Flow Sensor (M2783A): Color: green

For intubated patients with endotracheal tube diameters of 3.5 -

6 mm. Adds less than 4 cc of deadspace.

Infant/Neonatal Combined CO

2

Color: violet

/Flow Sensor (M2782A).

For intubated patients with endotracheal tube diameters of 2.5 -

4 mm. Adds less than 1 cc of deadspace.

If you are using a combined CO

2

/Flow sensor, connect it to the CO

2

sensor head first. The airway adapter clicks into place when seated correctly.

Click the connector into place in the flow sensor receptacle on the monitor before connecting to the breathing circuit.

Install the flow sensor or the combined CO

2

/Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y-piece. Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards. The correct position is also indicated by an arrow on some of the sensors. (Graphic shows combined CO

2

/Flow Sensors).

188

Attaching the Flow Sensor

15 Monitoring Airway Flow, Volume and Pressure

Pediatric/adult sensor

Pediatric sensor Infant/Neonatal sensor

WARNING

To prevent stress on the endotrachial tube, support the sensor and airway adapter.

Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable or tubing.

Replace the sensor, if excessive moisture or secretions are observed in the tubing and cannot be removed by a purge cycle.

Reuse poses a patient hazard. Do not disassemble, clean, disinfect or sterilize the sensor.

A system leak may significantly affect readings of flow, volume, pressure and other respiratory mechanics parameters.

Do not leave the sensor in the patient circuit when not connected to the monitor.

NOTE

• Do NOT place the airway adapter between the endotrachial tube and the elbow (pediatric/adult circuit), as this may allow patient secretions to block adapter windows.

• The striped tubing of the flow sensor should always be proximal to the patient.

• Position the airway adapter with the spirometry tubing pointing upwards.

• To prevent “rain-out” and moisture from draining into the airway adapter, do NOT place the airway adapter in a gravity dependent position.

• Periodically check the flow sensor and tubing for excessive moisture or secretion build up. Perform a purge cycle if droplets are visible within the sensor or tubing. Repeat if necessary. If purging does not remove the droplets, replace the sensor.

• For routine performance of airway care, separate the system between the endotrachial tube and the airway adapter (neonatal circuit), or between the endotracheal tube and elbow (pediatric/adult circuit). Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows.

• Measurement values provided by a ventilator may differ significantly from the values provided by the spirometry module, due to different locations of the flow sensor.

• Incorrect entry of gas compensation parameters (i.e. temperature, gas composition) may reduce the accuracy of the measured values.

189

15 Monitoring Airway Flow, Volume and Pressure

Zero Calibration

• A volume waveform as displayed below on the left may be an indicator of an air leak:

Normal waveform

Abnormal waveform due to leak

In general, if MVexp or TVexp are significantly smaller than MVin or TVin, the tubing should be checked for leaks.

Zero Calibration

The zero calibration maintains the accuracy of the spirometry waves and numerics by regularly compensating for drifts within the measurement section. It is performed automatically without user interaction and takes about 2 seconds to complete. The automatic zero calibration is normally carried out every ten minutes. During warm-up or when the ambient pressure changes, this interval may be reduced to two minutes.

During the zero calibration the waveform is flat but the numerics remain on the screen. Typically, a zero calibration is started at the beginning of a respiration cycle, therefore a waveform may begin normally and then immediately become flat for the time of the zero calibration.

Zero Calibration

Automatic Purging

A double lumen connecting line (tubing) connects the flow sensors to the patient monitor. The

M1014A Spirometry Module includes an automatic and manual purge feature which provides a flush of room air to keep the sensor tubing free from water condensation and patient secretions. This feature is available for the adult, pediatric, and neonatal modes. The purge will begin with the exhalation portion of the ventilator cycle.

N O T E

• During the purge cycle the pump will be heard

• If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced

• With each purge cycle, a zero calibration is automatically performed

190

Manual Purging

15 Monitoring Airway Flow, Volume and Pressure

Adult Mode

The system automatically purges the sensor tubing every ten minutes or less, depending on system conditions. In adult mode, the system will purge both sides of the line, one at a time, during each purge cycle. The higher the pressure, the more frequent the purging. This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure.

Neonatal and Pediatric Modes

The automatic purge cycles used in the neonatal or pediatric mode is fixed at every three minutes regardless of circuit pressure. Only one side of the sensor tubing will be purged during each purge cycle.

Unlike the adult purge mode, the neonatal or pediatric purge mode does not use the full force of the internal pump, but rather pressurizes an internal reservoir which is used for the purge. This minimizes the pressure delivered to the ventilator circuit, but does deliver a sufficient pressure to purge the sensor tubing.

Manual Purging

Occasionally, purging may be required in between the automatic purge cycles. The manual purge may be used as often as needed. Check the orientation of the flow sensor if repeated manual purge cycles become necessary.

To manually purge, press the

Purge

button on the module (marked by on international versions of the module) or select

Purge

in the

Setup Spirometry

window to initiate a combined purge and zero cycle.

Gas Compensation

Temperature and the proportions of individual gases influence the flow measurement. If values seem inaccurately high or low, check that the monitor is using the appropriate gas compensation. Gas compensation can be done using either manually entered gas concentrations or gas concentrations from the gas analyzer.

N O T E

If you unintentionally switch the gas compensation to the incorrect setting, the accuracy of the measured flow and volume values may be significantly reduced. The tables below show examples of incorrect gas compensation settings and the resulting inaccuracies:

N

2

O

2

N

2

O Agent Difference between measured and actual values

Actual Gas Composition

Gas Compensation Setting

60 40

40 60

Table 1 Incorrect Balance Gas Setting (N

2

O instead of N

2

)

15%

191

15 Monitoring Airway Flow, Volume and Pressure

Setting up Spirometry

N

2

O

2

Actual Gas Composition

Gas Compensation Setting

55

60

40

40

Table 2 Incorrect Agent Percentage Setting

N

2

O Agent Difference between measured and actual values

5

0

15%

Setting up Spirometry

The following settings can be accessed through the

Setup Spirometry

menu.

Optimizing Scale Settings

In the

Setup Spirometry

menu, select

Optimize Scales

.The scale settings for all three spirometry waves (AWF, AWP, AWV) will be optimized.

Spirometry Values Window

You can view all spirometry measurement data in the spirometry data window. In the

Setup

Spirometry

menu, select

Show All Values.

Spirometry

Adult/Pedi Flow Sensor

RRspir 10 rpm

I:E 1:

COMP

Raw

1.9

MVexp

MVin

24 ml/cmH

2

O TVexp

4 cmH

2

O/l/s TVin

PEF

PIF

7.2 l/min

7.3 l/min

720 ml

720 ml

8 l/min

12 l/min

PIP

PEEP

MnAwP

Pplat

NgInsP

31 cmH

2

O

4 cmH

2

O

17 cmH

2

O

30 cmH

2

O

-5 cmH

2

O

Figure 1 Example for Spirometry Values Window

Alarms and Alarm Limits

Alarms can be derived from PEEP, PIP, MV and RRspir. In the

Setup Spirometry

menu you can set the alarm limits. Please refer to the Alarms chapter of this manual for details on alarm settings.

Changing the Apnea Alarm Delay

This determines the time limit after which the monitor alarms if the patient stops breathing.

1

2

In the

Setup Spirometry

menu, select

RRspir

.

In

Setup RRspir

menu, select

Apnea Time

.

3

Choose the apnea alarm delay time.

192

Setting up Spirometry

15 Monitoring Airway Flow, Volume and Pressure

WARNING

Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

WARNING

If an apnea occurs during a zero calibration, the time delay between the start of apnea and the activation of the apnea alarm could be up to 10 seconds plus the configured apnea delay time.

Automatic Alarm Suppression

If the automatic alarm suppression is switched on, all spirometry alarms are suppressed until breathing activity has been detected. This setting must be made in configuration mode.

Choosing Measured AWV Components

1

In the

Setup Spirometry

menu, select

AWV

.

2

Select

MV

to choose the measured components for Minute Volume

(inspiratory and/or expiratory or off ).

Select

TV

to choose the measured components for Tidal Volume

(inspiratory and/or expiratory or off ).

N O T E

If MV and TV are set to off, there will be no alarming for these parameters.

Setting the Gas Compensation Mode

1

In the

Setup Spirometry

menu, select

Gas Compensation

.

2

Select

Mode

to choose the Gas Compensation mode:

– select

Manual

for manually entered gas concentrations or

– select

Gas Analyzer

for gas concentrations from the gas analyzer.

N O T E

• Gas concentrations from the gas analyzer are only available for Philips gas analyzers, not for devices connected via the Vuelink module.

• If gas concentrations from the gas analyzer are selected but not all data is available, the missing data is taken from manually entered values. In case of invalid data or no data at all, the INOP message

SPIRO GAS COMPENS? is displayed.

Changing the Type of Balance Gas

1

In the

Setup Spirometry

menu, select

Gas Compensation

.

2

Select

Balance Gas

to change the type of balance gas.

3

Select the appropriate setting (N

2

or N

2

O).

Changing the Concentration of Inspired O

2

and the Inspired Agents

1

In the

Setup Spirometry

menu, select

Gas Compensation

.

2

Select

Inspired O2

to change the concentration of inspired O

2

.

Select

Inspired Agent

to change the concentration of the inspired agent(s).

193

15 Monitoring Airway Flow, Volume and Pressure

Setting up Spirometry

3

Select the appropriate setting.

Changing the Temperature of the Inspired Gas

Depending on the type of ventilator environment (e.g. if you are using a Heat Moisture Exchanger) you may want to change the temperature setting of the inspired gas:

1

2

In the

Setup Spirometry

menu, select

Gas Compensation

.

Select

Inspired Temp

to change the temperature of the inspired gas.

3

Select the appropriate temperature setting.

N O T E

Changing the temperature setting unintentionally will result in approximately 3% reduced accuracy per 10°C ( 18°F) temperature setting change.

194

16

16

Monitoring tcGas

The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood.

The monitor’s settings for altitude and barometric pressure influence the measurement. The tcpO

2

/ tcpCO

2

measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as halothane, can cause incorrect or drifting readings.

Transcutaneous measurements cannot replace arterial blood gas monitoring. However, you can use transcutaneous monitoring to reduce the frequency of arterial sampling. The values at tissue level will

not be the same as those measured arterially because the measurement is transcutaneous. They correlate with (track closely) the arterial values. For example, a drop in transcutaneous values usually indicates a corresponding drop in arterial values.

Transcutaneous values will not always correlate with blood samples taken from the capillary blood of the heel (heelsticks or astrups).

Identifying tcGas Module Components

1 press to enter

Setup tcGas

menu

2 press to start calibration

3 calibration chamber

4 transducer connector

1 tcGas

M1018A

O2/CO2

CAL

2

80 x 70

3

4

195

16 Monitoring tcGas

Setting the tcGas Sensor Temperature

Setting the tcGas Sensor Temperature

1

2

In the

Setup tcGas

menu, select

Transducer Temp

.

Choose a temperature value appropriate for your patient’s age, weight and physical condition in accordance with your hospital policy.

Usually, a higher transducer temperature gives a better correlation and a quicker response time.

However, higher temperatures also increase the risk of skin burns. Most physicians prefer a temperature between 42°C (107° F) and 44°C (111° F), and a site time of four hours or less.

Usually, the higher the transducer temperature, the less the site time should be. Whenever you change the temperature setting, the monitor forces you to make a new calibration.

Using the tcGas Site Timer

Availability and behavior of the site timer depend on your monitor’s configuration.

WARNING

Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics, such as irritation, reddening, blistering or burns. If the site timer is disabled, the transducer will heat indefinitely while on a patient. Change the site regularly, in accordance with medical procedures in your hospital.

Setting the tcGas Site Timer

The site timer helps reduce the risk of skin burn by ensuring that the transducer is used at one site for no longer than a predefined period. It reminds you when this period expires.

1

2

In the

Setup tcGas

menu, select

Site Time

.

Choose the time you want the transducer to remain on the measurement site. The optimum time depends on the transducer temperature and your patient’s skin sensitivity.

The site timer starts automatically when you remove the calibrated transducer from the calibration chamber. If you return the transducer to the chamber and then remove it again, the site time continues to count down the remaining time; it does not start a new time period. The time remaining before the site timer expires appears in the status line which is visible as long as the

Setup tcGas

menu is open. When the time expires, the monitor sounds a tone and a displays a change site INOP. The monitor either switches off the transducer heating or continues monitoring, depending on its configuration. Although you can reuse the transducer for up to two hours after the heating is switched off, without making a new calibration, you are recommended to recalibrate before applying it to a patient. After two hours without heat, you must recalibrate.

During the initial few minutes of use, the monitor eliminates false alarms by temporarily suppressing tcGas alarms. It displays the “STABILIZING” INOP. After you apply the transducer to the skin, the instrument reading slowly assumes a steady value. The reading stabilizes when the measurement site is warm and local hyperemization is complete. This takes 10 to 20 minutes for the tcpO

2

reading and three to seven minutes for tcpCO

2

.

196

Setting the tcGas Barometric Pressure

16 Monitoring tcGas

Restarting the tcGas SiteTimer

To restart the site timer without recalibration (for example, after the site time has elapsed):

1

2

In the

Setup tcGas

menu, select

Site Time

.

Enter and confirm your desired time.

Disabling the tcGas Site Timer

Depending on your monitor’s configuration, you might be able to disable the site timer. Remember, this means that the transducer heats indefinitely while on a patient.

1

In

Setup tcGas

menu, select

Site Timer

and switch this to

Disabled

.

2

Select the

Confirm

popup key.

Setting the tcGas Barometric Pressure

Altitude and barometric pressure affect tcGas values. The monitor derives barometric pressure from its altitude setting. If you want to set the true barometric pressure you must do this before starting a calibration - changes after calibration do not influence tcGas values. The monitor remembers this pressure setting until you enter a new one.

1

In the

Setup tcGas

menu, select

AmbientPress

.

2

3

Enter the current barometric pressure reading indicated by your barometer.

Select the

Confirm

popup key.

Remembraning the tcGas Transducer

CAUTION

The tcGas transducer is thin and flexible. You must treat it with care. Avoid kinking, bending or pulling the cable.

Remembrane the transducer if the electrolyte in your transducer has dried out or:

• if the transducer is new

• if you are using the transducer with a new patient

• if the membranes are damaged (scratched or wrinkled)

• after five days of continued use or 28 days of storage.

197

16 Monitoring tcGas

1

Unscrew the protection cap from the transducer and hook the O-ring remover under both O-rings to remove them.

Remembraning the tcGas Transducer

2

Remove both of the clear plastic membranes using your fingers.

3

Clean the transducer head, including the groove and rim, with absorbent paper to remove all old electrolyte

(old electrolyte causes incorrect values) and apply approximately two drops of electrolyte solution to the transducer head.

4

Press the transducer head downwards into an unused membrane replacer until the replacer retracts as far as it can and you hear a click. Discard used replacer.

5

6

7

Remove any surplus electrolyte solution on the outside of the membranes with a soft tissue.

Make sure that the new membranes are secured by two O-rings on the transducer. If any air bubbles are visible under the membranes, repeat this procedure - air bubbles will cause incorrect readings.

After 24 hours you can calibrate the transducer. You must remembrane all new and dried out transducers twice before calibration.

New/Dried Out Transducers

Remembrane all new or dried out transducers twice before using. After the first remembraning, unplug the transducer from the module and leave it for 24 hours with the cap on. Remembrane again before calibrating.

Storing tcGas Transducers

If you need to store a sensor for more than 24 hours, protect it for up to 28 days by putting two drops of electrolyte solution into the cap. Screw the cap on the sensor. Remembrane if it dries out or after 28 days.

198

Calibrating the tcGas Transducer

16 Monitoring tcGas

Calibrating the tcGas Transducer

You can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the ‘out-of-gas’ zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not prompt you to do so. You MUST calibrate when:

• you remembrane the transducer

• you change the transducer heat setting

• you doubt the measurement accuracy

• you start a new monitoring period or use a new site

• the monitor displays the “calibration required” INOP message.

1

Connect the calibration unit to the inlet on the side of the module’s calibration chamber using the recommended gas tubing. Different tubing will cause inaccurate measurements.

2

Plug the transducer cable into the module. Swing the calibration chamber cover open and insert the transducer into the chamber. Close the cover to secure the transducer. Set the transducer temperature at the monitor now.

3

On the 15210B calibration unit, turn the timer control clockwise as far as you can. On the

Radiometer calibration unit, press the button with the green arrow once.

199

16 Monitoring tcGas

Calibrating the tcGas Transducer

4

Press CAL on the module until the light above the key comes on and wait (three - 20 minutes) for the “calibration complete” message to appear on the monitor. Alternatively, in the

Setup tcGas

menu, select

Start Calibration

. To save gas on 15210B, if the timer control dial is not in the start position when the monitor displays the calibration complete message, turn the dial counterclockwise to the start position. For TCC3, if the green light is still flashing when INOP “tcGas

CalRunning” disappears, press the green arrow button again.

Calibration Failure

If calibration fails, the monitor displays “...

tcGas transducer or Cal Unit malf

” and the

CAL FAILED INOP for the measurement.

Troubleshooting tcGas Calibration

Perform each of the following steps, in order, until calibration is successful.

1

2

Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the calibration unit. If the pressure indicator reading is in the out of gas zone, there is insufficient gas in the cylinder. Connect the gas tubing firmly to the calibration unit and to the module’s calibration chamber.

If Step 1 fails, check whether you need to activate the transducer (necessary if the electrolyte has dried out or if you have a new transducer). Remembrane the transducer, removing the old membranes, and cleaning the transducer head thoroughly.

3

Calibrate a second time.

4

5

If Step 2 is unsuccessful, calibrate again. This calibration may be required to stabilize the electrochemical system in the transducer.

Only if the above steps are unsuccessful (you have activated and remembraned the transducer and calibration has still failed twice), replace the transducer.

200

Applying the tcGas Transducer

16 Monitoring tcGas

Applying the tcGas Transducer

1

Peel protection film from fixation ring. Using a finger, press the sticky side of the ring on to clean, dry skin. Press around the outside to ensure a good seal. Apply three to five drops of contact fluid in the ring’s center. Remove transducer from chamber.

2

Align the arrow on the transducer with the tab on the ring and fasten by turning turn a quarterturn clockwise. Wait 10-20 minutes for readings to stabilize.

3

Apply the transducer as soon as possible after you see the “...calibration complete” message. If you wait longer than 30 minutes, the heat supply to the transducer switches off to prevent the electrolyte from drying out and a new calibration is necessary.

Optimize the measurement by selecting a site with high capillary density and blood flow, thin epidermis and no cardiovascular disorders. Most physicians use the abdomen, chest and back.

WARNING You must either remove the transducer before defibrillating, or remembrane and calibrate the transducer after defibrillating.

CAUTION

To avoid transducer damage, remove it from the patient during high frequency surgical procedures.

201

16 Monitoring tcGas

Finishing tcGas Monitoring

Selecting the tcGas HeatPowerDisplay Mode

The heat power display gives an indication of the skin’s perfusion below the transducer and of the transducer’s contact with the skin. If the transducer loses contact, the heat power value drops significantly. When perfusion is poor you need less heat power to maintain the transducer temperature.

In the

Setup tcGas

menu, select

HeatPowerDisplay

to toggle between

Relative

and

Absolute

. Choose

Relative

when the skin temperature is stable (the

STABILIZING

INOP disappears). This indicates subsequent changes in the relative heat power (and therefore changes in perfusion or transducer contact) since the last zeroing.

Zeroing the tcGas Relative Heat Power

When you start a calibration, the

HeatPowerDisplay

is set to

Absolute

. When you switch to

Relative

, it automatically zeros. Zero again if you change application site.

Finishing tcGas Monitoring

Replace the transducer in the calibration chamber.

When changing the application site after a measuring period, some users leave the fixation rings in position to allow them to quickly move the transducer from site to site. Always unscrew the transducer from the fixation ring before removing the fixation ring from the skin.

TcGas Corrections

Transcutaneous pCO

2

values tend to be higher than arterial values due to the metabolic processes of the skin and the effect of heating on the blood under the transducer. Depending on your monitor’s configuration, one or both of these corrections may automatically apply.

Temperature Correction for tcpCO

2

The transducer temperature causes an increase in partial CO

2

pressure. Your monitor may be configured to correct this.

In the

Setup tcpGas

menu, look at the menu item

CO2 Correction

. If correction is enabled, it is set to

On

.

Metabolism Correction for tcpCO

2

CO

2

production in the epidermis increases the CO

2

value. Your monitor may be configured to automatically deduct a metabolism factor (only applies when

CO2 Correction

is on).

In the

Setup tcGas

menu, look at the value shown for the menu item

MetabolismFactor

.

This is deducted from the CO

2

value.

202

17

17

Monitoring SvO

2

MP60/70/

80/90 monitors only

The SvO

2

module measures the percentage of mixed venous oxygen saturation continuously and invasively using the Hospira, Inc. (formerly Abbott Laboratories) OptiCath family of catheters routed via the right side of the heart into the pulmonary artery. Can be used only with the MP60/MP70/

MP80/MP90 monitors.

WARNING

Injected dyes, such as methylene blue, or intravascular dyshemoglobin may lead to inaccurate measurements.

Do not monitor oxygen saturation during infusion of I.V. fat emulsion or other turbid substances through the distal lumen of the OptiCath catheter. These liquids might temporarily modify the blood scattering and absorption characteristics at the catheter tip. This interferes with the optical measurement of oxygen saturation. After infusion is complete, you can again monitor oxygen saturation accurately.

During injection of the bolus for thermodilution cardiac output measurements, the SvO

2 measurement might be disturbed.

203

17 Monitoring SvO

2

Preparing to Monitor SvO

2

Preparing to Monitor SvO

2

In addition to an SvO

2

module, you need a Hospira OptiCath catheter, and 50131 Optical Module.

Use only the Hospira accessories listed in the Accessories section.

1 optical module

2 balloon inflation stopcock

3 Hospira fiber optic catheter

4 optical reference

5 enter setup/ calibration

4

5

1

3

2

Connect the optical module (Hospira 50131) to the SvO

2

module. Allow the optical module to warm up before you perform a calibration. Although the warm up message disappears from the screen after one minute, Hospira recommends letting the optical module warm up for 15 minutes for best accuracy. Please refer to the instructions for the optical module.

To avoid false alarms during the pre-insertion calibration and insertion of the catheter into the patient, the monitor automatically suspends alarms during the pre-insertion calibration, for up to three minutes after you remove the catheter tip from the optical reference. After light intensity calibration, or after three minutes (whichever comes first), the monitor returns to the alarm state it was in prior to preinsertion calibration.

Carrying out a Pre-insertion Calibration

WARNING

It is strongly recommended to carry out a pre-insertion calibration prior to all insertions. If this is not possible, you must perform an in-vivo calibration after insertion.

1

2

Refer to the instructions for use that accompany the catheter. Do not use the catheter if the packaging is damaged. If you have to disconnect the monitor from the patient (for example, when transferring the patient from one location to another), you must disconnect at the SvO

2

module. The catheter should remain in the optical module, otherwise you need to recalibrate.

Remove outer wrapping from catheter tray to uncover optical connector.

Place the optical module on the catheter tray in the space provided and open the lid.

204

Inserting the Catheter

17 Monitoring SvO

2

3

4

5

Place the optical connector into the optical module (with the label “TOP” facing upwards) and close the lid.

In the

Setup SvO2

menu, select

Start Pre-InsCal

. Ensure that the tip of the catheter is still in the optical reference.

Insert the catheter when you see the message

SvO2 calibration completed - catheter ready for insertion

. If the calibration fails, repeat the calibration before inserting the catheter. If it fails a second time, replace the optical module.

Inserting the Catheter

1

2

Remove the inner cover of the catheter tray.

Remove the catheter tip from the optical reference. Check the catheter's proper operation (for example: the balloon tip).

3

Prepare and insert the catheter in accordance with standard hospital practice.

The SvO

2

catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and sudden decrease in intensity readings. Refer to the documentation provided with the fibre-optic catheter, paying special attention to any precautions, warnings or contraindications.

Secure the optical module directly or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient. Position the optical module to avoid contact with liquids, because fluid entering the catheter-optical module connection may impair light transmission.

If you place the catheter in the patient without performing the pre-insertion calibration, you must perform an in-vivo calibration once the catheter is in place.

Performing a Light Intensity Calibration

Perform a light intensity calibration after the catheter is in its proper position. When the catheter is positioned properly, the light intensity indicator must cover at least two small divisions above the midpoint.

SvO2

80

60

67

In the

Setup SvO2

menu, select

Start Light Cal

.

Calibration is complete after a few seconds. If you doubt existing light intensity readings, recalibrate.

205

17 Monitoring SvO

2

Performing In-Vivo Calibration

Performing In-Vivo Calibration

Perform an in-vivo calibration:

• if you place the catheter in a patient without performing a pre-insertion calibration.

• if the catheter was disconnected from the optical module.

• when the catheter has been in the patient for 24 hours.

• if any significant change in light intensity occurs that the monitor cannot correct automatically.

Setting Up the In-Vivo Calibration

Check for:

• proper positioning of the catheter in the patient.

• relatively stable oxygen saturation in patient.

• that the SvO

2

light intensity indicator covers at least two divisions above the midpoint.

Making the In-Vivo Calibration

1

Be prepared to draw a blood sample from the patient.

2

In the

Setup SvO2

menu, select

Start In-VivoCal

.

3

4

5

6

7

8

To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.

Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice.

Obtain laboratory analysis of the sample using direct measurements.

Compare the results with the stored calibration value displayed in the

Setup SvO2

menu. If the difference is less, or equal, to 4%, you can skip the next step.

If there is a difference of more than 4% between the stored value and the laboratory value, select

CalibrationValue

to adjust the stored value. Selecting

Recall PreviousC

recalls the previously stored calibration value.

Complete the calibration by selecting

Store In-VivoCal

(even if you did not adjust the calibration value). This updates the data stored in the optical module.

Calculating Oxygen Extraction

Oxygen extraction is the difference between the measured SpO

2

and SvO

2

values. If you are monitoring SpO

2

and SvO

2

, the monitor can calculate this value and display it as a numeric.

To switch oxygen extraction calculation on or off, in the and toggle between

On

and

Off

.

Setup Sp-vO2

menu, select

Sp-vO2

If more than one SpO

2

value is available, you must choose which value is used in the calculation.

In the

Setup Sp-vO2

menu, select

SpO2 Source

and select the required source.

If one of the calculation sources becomes unavailable, the monitor displays the INOP

Sp-vO2 CHK SOURCES

for one minute. After this time, the calculation automatically switches off.

If the missing source becomes available again, the calculation automatically switches on again.

206

18

18

Monitoring EEG

The Electroencephalograph (EEG) module monitors the patient’s cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics:

Spectral Edge Frequency (SEF): The SEF is the frequency below which a defined percentage of the

Total Power lies. The percentage is set in Configuration Mode.

Mean Dominant Frequency (MDF): The MDF is the mean value of the frequency which dominates the measured EEG.

Peak Power Frequency (PPF): The PPF is the frequency with the highest measured amplitude.

Total Power (TP): The TP numeric indicates the power in the measured frequency band.

Percentage of total power in each frequency band:

Alpha

waves (8 to 13 Hz)

Beta

waves (13 to 30 Hz)

Theta

waves (4 to 8 Hz)

Delta

waves (0.5 to 4 Hz).

207

18 Monitoring EEG

EEG Monitoring Setup

EEG Monitoring Setup

7

8

1

Plug the trunk cable into the EEG module in the Flexible Module Server.

2

Prepare the patient’s skin prior to placing the electrodes. Good electrode-to-skin contact is important for a good EEG signal, as the skin is a poor conductor of electricity.

– Shave hair from sites, if necessary.

– Wash sites thoroughly with soap and water. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.

– Use a skin preparation paste to remove skin cells and oil before placing the electrodes.

3

4

5

6

Select the desired electrode montage in the

Setup EEG

menu or in the

EEG Impedance/

Montage

window.

Attach the reference electrode first.

Place the electrodes on the patient’s head according to the selected montage. Use electrode gel if you are not using pre-gelled electrodes. Remember to select a site where the signal will not be interfered with by muscle artifacts.

Connect the electrode connector end to the trunk cable.

Check the electrode-to-skin impedance in the

EEG Impedance/Montage

window.

For good signal quality, keep all lead wires together and away from other electric devices and metallic bodies.

Using the EEG Impedance/Montage Window

To open the window, in the

Setup EEG

menu, select

Show Montage

, or select the

EEG Montage

SmartKey.

The window may be configured to look slightly different on your monitor.

Electrode locations on the patient’s head. The symbols represent the electrode-to-skin impedance.

Wiring and impedance values for the selected montage

EEG Impedance/Montage

+ -

EEG 1

1 1 kOhm

-

+

EEG 2

1

1

ImpedanceLimit:5kOhm

EEG 1: F3-P3

EEG 2: F4-P4

Montage A

208

Using the EEG Impedance/Montage Window

18 Monitoring EEG

Choosing an EEG Electrode Montage

1

To activate one of the five pre-configured electrode montages, select the arrow beside the label in the

EEG Impedance/Montage

window and choose a montage from the list.

2

Attach the electrodes as illustrated in the

EEG Impedance/Montage

window.

The five default electrode montage configurations can be modified and renamed in Configuration

Mode.

Montage Name

Mont.A

Mont.B

Mont.C

Mont.D

Mont.E

EEG1+

Fp1

O1

F3

C3

Fp1

EEG1- Label1

T3

T3

C3

P3

T5

Fp1-T3

O1-T3

F3-C3

C3-P3

Fp1-T5

EEG2+ EEG2-

Fp2

O2

F4

C4

Fp2

T4

T4

C4

P4

T6

Label2

Fp2-T4

O2-T4

F4-C4

C4-P4

Fp2-T6

The electrode locations are labeled according to the international 10-20 electrode placement system.

Changing the Impedance Limit

The impedance limit can be set for all electrodes simultaneously in the

Setup EEG

menu, or in the

EEG Impedance/Montage

window using the pop-up keys. If the limit is exceeded during monitoring, an INOP will appear and the graphic impedance indicator will change.

To change the impedance limit, either

♦ use the pop-up keys that appear with the

EEG Impedance /Montage

window, or

♦ in the

Setup EEG

menu, select

Impedance Limit

to call up a list of selections between 1 and

30 kOhm, then select the required limit from this list.

209

18 Monitoring EEG

Using the EEG Impedance/Montage Window

About Electrode-to-Skin Impedance

Electrode-to-skin impedance is the main quality indicator for the measured EEG signal. During normal EEG monitoring, electrode-to-skin impedance is measured continuously and disconnected electrodes are detected. The impedance value for each single, independent signal electrode is displayed in the

EEG Impedance/Montage

window. If the measured electrode-to skin impedance of one or more electrodes is above the limit, an INOP will be issued.

For impedance measurement at least two electrodes, plus the reference electrode, must be connected.

Impedance Indicators

Electrode/Skin Impedance

Electrode not connected

Noisy signal

Electrode connected, impedance above limit

Electrode connected, impedance at or below limit

Symbol Color Displayed

Impedance

Value

red no value

Action

connect electrode gray 60 k

Ω ( fixed) check electrode-to-skin connections yellow measured value

(e.g 15 k

) check limit, check electrode-to-skin contact green measured value

(e.g. 3 k

Ω) no action necessary

210

About Compressed Spectral Arrays (CSA)

18 Monitoring EEG

About Compressed Spectral Arrays (CSA)

The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA).

The CSA window provides an overview of the patient’s EEG values over time. It may be configured to look slightly different on your monitor.

To view the CSA window permanently embedded on a Screen, select a Screen configured to display the CSA window.

To view the

CSA

window over the current Screen, select the select

Setup EEG

or

Main Setup

then

Show CSA

.

EEG CSA

SmartKey, if configured, or

Fp1-T3 Filter:0.5 - 30 Hz

CSA1 Buffer: A (2 Sec)

Montage: Montage A

SEF (90%) PPF

Fp2-T4

CSA2

The CSA contains the following information

Status line

Spectral lines

Lead label

CSA label

Montage label

Filter settings for example, Fp1-T3, Fp2-T4

CSA1 or CSA2 according to EEG channel for example, Montage A for example, 1-30 Hz

Buffer label and time the buffer and interval between spectral lines on the CSA

Current SEF Threshold can only be changed in Configuration Mode

The energy at each frequency is computed and displayed as a spectral line

Trendlines

Annotations:

EEG values are sampled at configured time intervals and displayed as color-coded trendlines.

Trendlines are available for the three frequency numerics (SEF, PPF, MDF)

INOP marker

?

Filter change marker

Montage change marker

211

18 Monitoring EEG

Changing EEG Settings

Changing CSA Settings

When CSAs are shown embedded on the Main Screen, select the CSA to show the pop-up keys. When the CSA is shown in a window over the current screen, the pop-up keys are always displayed.

Setup CSA

This menu entry lets you

Buffer

choose one of the three pre-configured buffers. A buffer defines the interval between the spectral lines displayed in the CSA.

On/Off SEF/MDF/PPF

switch the trendline of the specific numeric on or off

Changing EEG Settings

Be aware that any changes made to EEG settings apply to both EEG channels.

Switching EEG Numerics On and Off

Each EEG numeric can be individually switched on or off in the

Setup EEG

menu.

1

2

In the

Setup EEG

menu, select the numeric label.

Select

On

/

Off

to toggle between the settings.

Changing the Scale of the EEG Waves for Display

This only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings.

1

2

In the

Setup EEG

menu, select

Wave Scale

to call up a list of wave scales.

Select the required scale from this list.

Scaling information is displayed with each EEG wave.

• If

Show Gridlines

is set to

On

in Configuration Mode, gridlines and the current wave scale values are shown with the EEG wave.

• If

Show Gridlines

is set to

Off

in Configuration Mode, the current wave scale is indicated by a size bar beside the EEG wave.

212

EEG Reports

18 Monitoring EEG

Changing Filter Frequencies

The low and high pass filters screen out undesirable interference from the raw EEG wave display. The current EEG filter frequency settings are shown in the header of the CSA. Changing filter settings affects the EEG wave and all the EEG numerics. Whenever the filter setting is changed, a filter change marker appears next to the spectral lines.

To change the filter settings:

1

2

In the

Setup EEG

menu, select

Low Filter

or

High Filter

to call up a list of available frequencies.

Select the required frequency from this list.

Changing the Speed of the EEG Wave

The EEG measurement has its own speed control and is not affected by the wave speed settings of the other measurements.

In the

Setup EEG

menu, select

Wave Speed

. Choose the required speed from the pop-up list.

This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/ s).

EEG Reports

The content of EEG Reports is always the same and does not need to be configured.

♦ To print an EEG Report, in the

Setup EEG

menu, select

Print Report

.

Alternatively, you can select the CSA and use the

Print Report

pop-up key to start the report.

To modify the buffer and trendline settings on the CSA Report, in the

Reports

menu, select

CSA On EEG Rep.

. If you do not change these settings, the monitor will use the default settings SEF Trendlines: On, Buffer: C.

CSA on Report

This menu entry lets you

Buffer

choose one of the three pre-configured buffer times

Trend SEF/MDF/PPF

switch the trendline of the specific numeric on or off

213

18 Monitoring EEG

EEG Safety Information

EEG Safety Information

EEG Configuration and Monitor Upgrades The A.2 monitor release (software revision A.20.xx) introduced a new feature that lets you rename EEG montages. It is not possible to clone EEG settings between montages with different names, therefore all EEG settings are reset to factory defaults during any upgrade/downgrade/cloning actions that mix releases/software revisions/configurations before A.2/

A.20.xx with subsequent versions. You must check that all EEG settings are correct before resuming monitoring with a monitor that has been upgraded or cloned.

WARNING

Do not touch the patient, or table, or instruments during defibrillation.

When connecting electrodes and/or patient cables, ensure that the EEG leads and connectors do not come into contact with other conductive parts or earth.

High-frequency Surgery To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the EEG electrodes should not be located between the surgical site and the electro-surgical unit return electrode.

EEG and Electrical Interference

CAUTION

Interference from a non-grounded instrument near the patient and electrosurgery interference can cause problems with the waveform and the CSA.

Radiated field strengths above 1 V/m and patient signals

50

µ

V may cause noise on the EEG waves at various frequencies. Therefore, it is recommended to avoid the use of electrical radiating equipment in close proximity to the patient monitor. The noise does not influence the measurement accuracy.

Interference from ECG can be eliminated by adjusting the low filter settings.

214

19

19

Monitoring BIS

Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient’s forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS intended use statement.

The BIS Module or BIS Interface board (for MP20/MP30) provides the monitor with an EEG wave and the following numerics:

Bispectral Index (BIS). The BIS numeric reflects the patient’s level of consciousness. It ranges from

100 (fully awake) to 0 (suppression; no electrical brain activity).

Signal Quality Index (SQI). The SQI numeric reflects signal quality and provides information about the reliability of the BIS, SEF, TP, SR, and Bursts numerics during the last minute.

It ranges from 0 to 100%:

SQI < 15%: the numerics cannot be derived

SQI 15% to 50%: the numerics cannot be reliably derived

SQI 50% to 100%: the numerics are reliable.

Electromyographic Activity (EMG). The EMG numeric reflects the electrical power of muscle activity and high frequency artifacts.

EMG < 55 dB: this is an acceptable EMG

EMG

30 dB: this is an optimal EMG

(note that the minimum possible EMG is approximately 25 dB).

Suppression Ratio (SR). The SR is the percentage of time over the last 63-second period during which the EEG is considered to be in a suppressed state.

Spectral Edge Frequency (SEF). The SEF is the frequency below which 95% of the Total Power is measured.

Total Power (TP). The TP numeric indicates the power in the frequency band 0.5 to 30 Hz. The useful range is 30 - 100 dB.

Bursts (BISx module used with the Extend Sensor only) The Bursts numeric helps you quantify suppression by measuring the number of EEG bursts per minute, where an EEG burst is defined as a period of activity followed and preceded by inactivity (at least 0.5 second).

215

19 Monitoring BIS

BIS Monitoring Setup

BIS Monitoring Setup

There are two BIS solutions available for use with the M1034A BIS module: using the DSC and BIS engine or using the BISx.

Monitoring BIS Using the DSC and BIS Engine

Aspect

BIS Engine

185-0111

BIS

Module

Aspect

Digital Signal

Converter

185-0124

BIS

Engine

Cable

Aspect Patient

Interface Cable

186-0131

Aspect BIS Sensor

1

If you are monitoring BIS with the DSC and BIS engine, a. Connect the BIS engine to the BIS module using the BIS Engine Cable.

b. Connect the digital signal converter (DSC) to the digital signal converter port on the front of the BIS Engine. Use the attachment clip to secure the digital signal converter near, but not above the patient’s head.

c. Attach the patient interface cable (PIC) to the digital signal converter (DSC).

2

3

Attach the BIS sensor to the patient following the instructions supplied with the sensor.

Make sure that the patient’s skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.

A variety of sensors are available for use in the OR and ICU environments: see the chapter on accessories for information.

Connect the BIS sensor to the patient interface cable.

As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window.

216

BIS Monitoring Setup

Monitoring BIS using the BISx

19 Monitoring BIS

BIS Module

Aspect BISx

185-0145-PH

Aspect Patient

Interface Cable

186-0131

Aspect BIS Sensor

Aspect BIS Sensor

BIS Interface

Board

Aspect BISx

185-0145-PH

1

If you are monitoring BIS using the BISx, a. Connect the BISx device to the BIS module or BIS Interface board connector (MP20/MP30)

2

b. Use the clip on the rear of the BISx device to affix it in a position convenient for your patient, not above the patient’s head.

Attach the BIS sensor/BIS electrodes to the patient following the instructions supplied with the sensor.

Make sure that the patient’s skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.

A variety of sensors are available for use in the OR and ICU environments: see the chapter on accessories for information.

CAUTION

Ensure that the BISx does not come into prolonged contact with your patient’s skin, as it may generate heat and cause discomfort.

The BISx may remain connected to a patient during defibrillation as long as the sensor is not located between the defibrillator pads.

3

With sensors for single-patient use: a. Attach the patient interface cable (PIC) to the BISx device.

b. Connect the BIS sensor to the PIC.

With Semi Re-usable Sensors: a. Attach the sensor cable to the BISx device.

b. Snap the sensor cable onto the electrodes.

As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window. The number of uses remaining for the semi re-usable sensor is shown in the status line when the BIS window is open.

217

19 Monitoring BIS

BIS Continuous Impedance Check

Manufacturer’s Information

BISx, the BIS Engine, the DSC, the Patient Interface Cable and the BIS Sensors are manufactured by

Aspect Medical Systems.

BIS Continuous Impedance Check

This checks:

• the combined impedance of the signal electrodes plus the reference electrode.

This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results.

• the impedance of the ground electrode.

This is done every ten minutes and takes approximately 4 seconds. It causes an artifact in the EEG wave, and the message

Ground Check

is shown on the monitor screen during the check. If the ground electrode does not pass this check, another check is started. This continues until the ground electrode passes the check.

If the Continuous Impedance Check interferes with other measurements, it can be switched off. To do this:

1

2

In the

Setup BIS

menu, select

Cont.Imp.Check.

Select

On

/

Off

to toggle between the settings.

CAUTION

Switching the continuous impedance check off will disable automatic notification to the user of impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done if the check interferes with or disturbs other measurements.

When a Semi-reusable Sensor is in use the continuous impedance check cannot be switched off. If it is switched off when the sensor is connected, it will automatically be switched on again.

BIS Cyclic Impedance Check

This measures the exact impedance of each individual electrode. It causes a disturbed EEG wave, and the INOP

BIS IMPEDANCE CHCK

is shown on the monitor screen during the check.

Starting a Cyclic Impedance Check

The Cyclic Impedance Check is automatically started when a sensor is connected. To manually start a

Cyclic Impedance Check:

♦ select

Cyclic Check

in the

BIS Setup

menu to toggle between On and Off, or

♦ select

Start Cyclic Check

in the BIS window.

Stopping a Cyclic Impedance Check

The Cyclic Impedance Check stops automatically if the impedances of all electrodes are within the valid range. To manually stop a Cyclic Impedance Check:

♦ select

Cyclic Check

in the

BIS Setup menu

to toggle between On and Off, or

218

BIS Window

19 Monitoring BIS

♦ select

Stop Cyclic Check

in the BIS Impedance Check Window.

If you stop a Cyclic Impedance Check before the ground electrode has passed, a ground electrode impedance check will be started automatically. This cannot be switched off.

BIS Window

To open the BIS window, in the

Setup BIS

menu, select

Show Sensor.

The window may look slightly different on your monitor. The graphic in the BIS Window automatically adapts to show the type of sensor you are using, showing three or four electrodes as required. Each symbol in the graphic represents an electrode and illustrates the most recently-measured impedance status of the electrodes. Although BIS may still be measured when the electrode status is red or yellow, for best performance, all electrodes should be green.

In addition, if the measured electrode-to skin impedance of any electrode or electrode combination is above the limit, or if disconnected electrodes are detected, an INOP will be issued, either

BIS HIGH

IMPEDANCE

or

BIS LEAD OFF.

Signal Electrode(s)

Reference Electrode

Ground Electrode

BIS - Quatro Sensor

Cyclic Check: 15 May 11:05

Start Cyclic Check

Time of the most recent cyclic check

BIS Impedance Indicators

Electrode-to-Skin Impedance Symbol Color Action

Electrode has no skin contact red Reconnect electrode, or check the sensor-toskin contact. If necessary, clean and dry skin.

Too much signal noise, impedance cannot be measured gray Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.

Impedance above limit

Impedance within valid range yellow Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.

green No action necessary

219

19 Monitoring BIS

Changing the BIS Smoothing Rate

Changing the BIS Smoothing Rate

The smoothing rate defines how the monitor averages the BIS value.

To change the smoothing rate, in the choose either:

Setup BIS

menu, select

BIS Smoothing Rate

then

– 15 seconds: this provides increased responsiveness to changes in the patient’s state.

– 30 seconds: this provides a smoother BIS trend with decreased variability and sensitivity to artifacts.

Switching BIS and Individual Numerics On and Off

To switch the BIS measurement on or off:

In the

Setup BIS

menu, select

BIS

to toggle between On and Off.

To switch individual numerics provided by the BIS Module on or off:

In the

Off

.

Setup BIS

menu, select

SQI

,

TP

,

SEF

,

SR

,

EMG

, or

BURSTS

to toggle between

On

and

Changing the Scale of the EEG Wave

Changing the scale only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings.

The scale information shown depends on whether gridlines are switched on or off for display. This setting can only be changed in Configuration Mode.

1

In the

Setup BIS

menu, select

Change Scale

to call up a list of wave scales.

2

Select the required scale from this list.

• When gridlines are switched off, you can choose from the available scale values: 50

200

µ

V, 100

µ

V,

µ

V, and 500

µ

V. Scaling information is displayed as a vertical bar on the EEG wave together with its height equivalent in

µ

V.

• When gridlines are switched on, scales are defined as a range, either

±

25

µ

V,

±

50

µ

V,

±

100

µ

V, or

±

250

µ

V. Scaling information is shown in the form of gridlines.

Switching BIS Filters On or Off

The low and high pass filters screen out undesirable interference from the raw EEG wave display. The notch filter removes line frequency interference. Filter settings affect the EEG wave and the SEF and

TP values, but they do not affect the BIS, EMG, SR, and SQI values.

The filter settings are set in Configuration Mode. You can switch all the filters on or off together in

Monitoring Mode.

1

In the

Setup BIS

menu, select

Filters

.

2

Select

On

/

Off

to toggle between all filters On or Off.

220

BIS Safety Information

19 Monitoring BIS

BIS Safety Information

For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and

Etomidate, please contact Aspect Medical Systems to request a copy of their publication “A Clinician’s

Guide to the Bispectral Index®”.

Considerations for Use Due to limited clinical experience in the following applications, BIS values should be interpreted cautiously in patients with known neurological disorders, those taking psychoactive medications, and in children below the age of 1.

WARNING

Conductive Parts The conductive parts of sensors and connectors should not contact other conductive parts, including earth.

High-frequency Surgery To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the BIS sensor should not be located between the surgical site and the electrosurgical unit return electrode.

Defibrillation The BIS sensor must not be located between defibrillator pads when a defibrillator is used on a patient connected to the patient monitor.

Securing Cables To minimize the risk of patient strangulation, the patient interface cable (PIC) must be carefully placed and secured.

CAUTION

Revisions The system will only function if all component revisions are compatible. Otherwise, an incompatibility INOP is displayed.

If the DSC has an older software revision than the BIS Engine, the DSC will automatically be upgraded by the BIS Engine. Do not disconnect the DSC from the BIS Engine, or disconnect the BIS module from the monitor, or switch the monitor power off within the first ten seconds after connection, as this will disrupt a possible software upgrade and cause damage to the DSC.

The BIS Interface board for the MP20/MP30 can only be used with BISx, not with the BIS engine. If the BIS engine is connected to the MP20/MP30 a

BIS ENGINE INCOMPT

INOP will be issued.

Impedance Checks Impedance checks may influence data acquisition of other electroencephalographic devices.

221

19 Monitoring BIS

BIS Safety Information

222

20

20

Trends

Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient’s condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodicallymeasured parameters, such as Cardiac Output.

Viewing Trends

Trend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.

To view trends embedded as a screen element, select the Screen name in the monitor info line to enter the

Change Screen

menu, then select a Screen designed to show an embedded trend window.

To open the tabular trends window over the current Screen, select the

Vitals

Trend

SmartKey.

To open the graphic trends window over the current Screen, select the

Graph

Trends

SmartKey.

Vital

The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the latest available measurement value. The preview column is updated every five minutes or whenever an

NBP or other aperiodic measurement is completed.

Graph

A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement.

Your monitor screen may look slightly different to the examples shown here.

223

20 Trends

Viewing Graphic Trends

Graphical Trends: All

HR

SpO2

ABP

Viewing Trends

9 Apr

Select

Group

Graphical Trends

Select

Interva

Print

Vital

Signs

A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column.

In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.

To use the trend cursor to navigate in time through the trends database,

1

2

Select the graphical trend or the arrow pop-up keys to activate the cursor.

Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or

3

Place the cursor at a specific time by touching the graph.

Viewing Vital Signs Trends

Vital Signs: Standard

HR

NBPs

NBPd

NBPm

RR

20 Feb

Aperiodic values are shown with a timestamp

224

Setting Up Trends

20 Trends

The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.

Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets

If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow.

Trends Pop-Up Keys

When you open the trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks.

Pop-Up Keys Selecting this pop-up key lets you....

Select

Group

Select

Interval

see a pop-up list of trend groups and select a group for viewing.

Print/

Record

Print

see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.

print a tabular trends report or make a tabular trend recording of the data in the current window. The report will use the current trend interval settings.

print a graphic trends report of the data in the current window. The report will use the current trend interval settings.

move the cursor one step to the left or right to navigate through the trends database timeline.

Vital

Signs

Graph

Trends

move the cursor one page to the left or right to navigate through the trends database timeline.

jump to the beginning or the end of the trends database to see the most recent or oldest trend information stored.

scroll up and down the screen to see measurement trends that do not fit in the current view.

open the current trend view in tabular form. The displayed time period and resolution stay the same.

open the current trend view in graphic form. The displayed time period and resolution stay the same.

Setting Up Trends

Trends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under

Main Setup

->

Trends.

Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu.

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20 Trends

Setting Up Trends

Making Segment Settings

The

Graphical Trends

window is divided into measurement segments, each of which has its own settings.

To enter the segment menu,

♦ select the left hand column of the segment, where the measurement label is displayed.

Expanded View

To expand the segment to fill the

Graphical Trends

window,

♦ in the

Segment

menu, select

Expand

to have that segment enlarged to fill the window.

In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement,

♦ in the

Segment

measurement.

menu, select

Highlight

repeatedly until the highlight is on the required

To return the segment to its original size,

♦ in the

Segment

menu, select

Expand

again.

Trend Scales for Segment Measurements

To change the trend scales for a measurement in the current segment:

1

2

In the segment menu, select the measurement label

Select

Upper

to change the upper limit of the scale or

Lower

to change the lower limit of the scale.

Optimum Scale

To have the monitor automatically select an optimum scale for viewing, based on current values,

♦ in the

Segment

menu, select

Optimum Scale

.

This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in

Parameter Scales

.

To switch off automatic optimum scaling,

♦ in the

Segment

menu, select

Optimum Scale

again.

Trend Group

To add or remove measurements for this trend group or change the order of the existing measurements:

1

2

In the

Segment

menu, select

Change Group

Use the

Add

,

Change

,

Sort Up

and

Sort Down

popup keys to change or re-order the group as required.

No. of Segments

In an embedded graphical trend window, you can select the number of segments to be displayed in the

Segment

menu:

226

Setting Up Trends

20 Trends

1

2

In the

Segment

menu, select

No. of Segments

Select

1

,

2

, or

3

segments.

Trend Groups

The measurements grouped in trend groups define the trends displayed together in the Vital Signs or

Graphics Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group

All

contains all available measurements, you cannot change the order or selection of this group.

To change the selection of measurements in a trend group, either use the

Change Group

setting in the

Segment

menu or:

1

Select

Main Setup

->

Trends

->

Trend Groups

2

Select the Trend Group you want to change and use the pop-up keys to

Add

,

Change

, or

Delete

the selection of measurements trended.

To temporarily change the order in which the measurements are displayed in a group,

1

Select

Main Setup

->

Trends

->

Trend Groups

2

Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort

Down pop-up keys.

Trend Interval

The trend interval defines the resolution of trend data shown on the Screen. High-resolution data is especially suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient’s status typically changes more gradually, a longer trend may be more informative.

To set the trend resolution, in the Vital Signs or Graphical Trends window,

Select the

Select Interval

pop-up key and then select the required interval from the list.

Trend Priority

The monitor stores trend information for all monitored measurements, if configured to do so. If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements.

To see the measurement priority list for trending,

1

2

In the

Main Setup

menu, select

Trends

.

Select

Trend Priority

.

To add measurements to the priority list,

1

Select the pop-up key

Add

and choose from the pop-up list of available measurements.

2

Use the

Sort Up

and

Sort Down

pop-up keys to change the priority order.

Trend Parameter Scales

Parameter scales define how the trend waveform will appear on the screen and in trend reports.

Separate scales can be set for adult, pediatric, and neonatal patient trends.

To change the trend parameter scales settings, either use the

Scale

setting in the

Segment

menu or:

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20 Trends

Documenting Trends

3

4

1

2

5

In the

Main Setup

menu, select

Trends

.

Select

Parameter Scales

.

Select the measurement or parameter you want to change from the list.

Select the pop-up key

Change

to call up the

Scale

menu.

In the

Scale

menu, select the parameter label you want to define settings for. Select

Adult

,

Pedi

, and

Neo

and use the pop-up keypad to enter new upper and lower scale definitions.

Graphical Trend Presentation

Graphical trends and screen trends for measurements with compound values (for example ABP or

CO

2

) can be viewed in line or band form.

To change the presentation style,

1

2

Select

Main Setup

->

Trends

Select

Global Style

and choose

Line

to display the trends as a continuous line

Band

to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.

240 This sample ABP trend shows the continuouslymeasured values for the systolic, diastolic and mean pressures displayed in band form.

ABP

50

Documenting Trends

To print a Vital Signs or Graphical Trends report,

♦ in the

Vital Signs

or

Graph Trends

window, select the pop-up key for the trend group currently on the monitor screen.

Print

to print a report

Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor’s configuration. Trends reports can be printed on central or local printers.

To make a Vital Signs recording,

♦ in the

Vital Signs

Vitals

pop-up key.

window, select the

Print/Record

pop-up key, then select the

Record

Vital Signs recordings print the trend data for the current group and trend period shown in the

Vital Signs

window.

228

Trends Databases

20 Trends

Trends Databases

Depending on the purchased options and the monitor’s configuration, the trends databases store information for up to 32 measurements for up to 72 hours.

The values in the trends database are stored as measured by the monitor, they are not averaged values.

The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown.

Example database configuration In this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution.

“4 hours @ 12 second resolution” means that the monitor stores trend data every 12 seconds, for the most recent four hours.

- 48 hours

- 24 hours

- 4 hours now time

4 hours @12 second resolution

24 hours @ 1 minute resolution

48 hours @ 5 minute resolution

Aperiodic Trends Database

Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time.

Trending Multiple-Value Measurements

Some measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements.

Screen Trends

Trends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, or horizon format.

If you do not see screen trends on the monitor Screen, select a different Screen, one that is configured to show screen trends. Screen trends are only available on specially designed Screens.

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20 Trends

Screen Trends

Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended.

Measurement waves or high-res trend waves

Screen trends

Measurement numerics

ABP

240

50

Setting the Screen Trend Time

To set the

ScreenTrend Time

for all graphical and horizon screen trends (“global” trend time),

1

2

Select a screen trend then select

Setup Trend

, or select

Main Setup

->

Trends

.

Select

ScreenTrend Time

and select the required time: 30 minutes, one, two, four, eight, or twelve hours.

This is now the Global screen trend time and defines the period of trend information shown for all screen trends.

To set a different

ScreenTrend Time

for a screen trends or a group of aligned screen trends,

1

2

Select a screen trend

Select

Change TrendTime

3

Select the required trend time.

Selecting

Global

leaves the trend time set to the global screen trend time.

230

Screen Trends

20 Trends

Changing the Selection of Screen Trends Displayed

1

Select the screen trend.

2

Select

Change Trend

and select the required trend from the list of available trends.

Select

Blank

to remove the selected trend from the Screen.

If you do not see

Change Trend

in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend.

To display two or more screen trends overlapping,

1

Select the screen trend to open the screen trend menu,

2

Select

Change Trend

->

Add Trend

and select a screen trend from the pop-up list.

Activating the Cursor for Screen Trends

To activate the cursor for Screen Trends:

1

Select the screen trend.

2

Select

Activate Cursor

You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor.

To de-activate the cursor,

Select

Main Screen

.

Changing the Screen Trend View

To switch between tabular, graphic and horizon views, select the screen trend then select

Change

View

and select the required view.

Tabular View

Aperiodic measurements such as

NBP, C.O., C.I., and Wedge can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label.

NBP mmHg

15:15

15:30

15:45

16:00

16:15

120/80(95)

120/80(95)

120/80(95)

120/80(95)

120/80(95)

16:30

16:45

17:00

17:15

17:30

120/80(95)

120/80(95)

120/80(95)

120/80(95)

120/80(95)

The trend time for tabular screen trends depends on the space available on the Screen. Up to 30 measurements or 12 hours information can be shown.

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20 Trends

Screen Trends

Horizon View

The horizon view presents trend information superimposed over a defined baseline. This helps you visualize changes in your patient’s condition since the baseline was set.

The horizon view is made up of:

• a horizon, drawn in white, as a reference point or baseline to help you visualize

1

changes in your patient’s condition. The horizon can be set to represent your patient’s current condition, or a target condition.

2 3

• a graphical trend, displaying patient data for the set TrendTime (1).

• a trend indicator arrow, indicating how the patient trend has developed in the last ten minutes (2).

• a deviation bar, showing how the currently measured value deviates from the stored baseline (3). The height of the deviation bar is an indication of the extent of the change in your patient’s condition relative to the (horizon) baseline.

Your monitor may not be configured to show all three elements of the screen trend horizon view.

Setting the Horizon

The horizon is the reference value to which deviations in the measurements are compared.

1

To set the baseline, select the horizon trend

2

Select

Auto All

to reset the horizon for all horizon screen trends to the currently-measured values

Auto Horizon

to set the horizon for the selected horizon trend to the currently-measured value

Set Horizon

to set the horizon to a specific value from a pop-up list.

Setting the Horizon Trend Scale

The horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.

To set the horizon trend scale delta,

1

2

Select the horizon trend.

Select

Set Scale Delta

and select a value to define the distance between the horizon and the the upper and lower scale limits.

Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient’s condition having changed.

If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.

232

21

21

Calculations

Calculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information.

Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations.

Hemodynamic

Cardiac Index (C.I.)

Stroke Volume (SV)

Stroke Index (SI)

Systemic Vascular Resistance (SVR)

Systemic Vascular Resistance Index (SVRI)

Pulmonary Vascular Resistance (PVR)

Pulmonary Vascular Resistance Index (PVRI)

Left Cardiac Work (LCW)

Left Cardiac Work Index (LCWI)

Left Ventricular Stroke Work (LVSW)

Left Ventricular Stroke Work Index (LVSWI)

Right Cardiac Work (RCW)

Right Cardiac Work Index (RCWI)

Right Ventricular Stroke Work (RVSW)

Right Ventricular Stroke Work Index (RVSWI)

Extra Vascular Lung Water Index (EVLWI)

Intrathoracic Blood Volume Index (ITBVI)

Global End Diastolic Volume Index (GEDVI)

Oxygenation Ventilation

Arterial Oxygen Content (CaO

2

)

Venous Oxygen Content (CvO

2

)

Arteriovenous Oxygen Content

(avDO

2

)

Oxygen Availability Index (O

2

AVI)

Oxygen Consumption (VO

2

)

Oxygen Consumption Index

(VO

2

I)

Oxygen Extraction Ratio (O

2

ER)

Alveolar-Arterial Oxygen

Difference (AaDO

2

)

Percent Arteriovenous Shunt

(Qs/Qt)

Minute Volume (MINVOL)

Compliance (COMP)

Dead Space (Vd)

Dead Space/Tidal Volume

Ratio (Vd/TV)

Alveolar Ventilation

(ALVENT)

The hemodynamic calculations available depend on the Cardiac Output measurement method being used and the regulatory standards that apply for your hospital: see the C.O. chapter for availability details.

Viewing Calculations

Select the

Calculations

SmartKey to open the Calculations window.

Select the

Calc Type

field and select the required calculation type for display.

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21 Calculations

Viewing Calculations

Calculations Windows

This example calculations window shows the hemodynamic calculations window. The ventilation and oxygenation windows are similar.

Calculations input values

Output values

Indexed calculation values

Calculation type

Calculations

C.O.

HR

ABPs

ABPd

ABPm

PAPs

PAPd

PAPm

PAWP

CVPm

BSA

SV

SVR

PVR

LCW

LVSW

RCW

RVSW

Hemodynamic

C.I.

SI

SVRI

PVRI

LCWI

LVSWI

RCWI

RVSWI

Resample

Vitals

Perform

Calc

Print/

Record

Calculations

On/Off

DateTime

On/Off

Ranges

Cardiac

Output

Hemo

Review

Calculations Pop-Up Keys

Depending on the calculations group you choose, a selection of pop-up keys will appear to let you navigate through the stored events and carry out calculations-related tasks.

Pop-Up Keys

Resample

Vitals

Perform

Calc

Print/

Record

On/Off

DateTime

On/Off

Ranges

Selecting this pop-up key lets you....

tell the monitor to override the values in the calculations database and use the most recent continuously monitored values. Resampling sets the calculation time to the current time, and displays the corresponding values for the previous second. perform the displayed calculation using the currently-input values and store the calculation in the calculations database print or record the displayed calculation.

toggle between showing the date and time or the units for the calculation input values.

toggle between showing the normal ranges or the units for the calculation output values.

234

Reviewing Calculations

21 Calculations

Pop-Up Keys

Cardiac

Output

Hemo

Review

Vent

Review

Oxygen

Review

Selecting this pop-up key lets you....

access the C.O. procedure window.

open the hemodynamic calculations review window.

open the ventilation calculations review window.

open the oxygenation calculations review window.

Reviewing Calculations

To enter the calculations review window, select the

Oxy Review

,

Ventil Review

, or

Hemo

Review

pop-up key as required.

The review window lists all the input and output values for each measurement in the calculations group. The timeline in the review window lists the times the calculations were performed.

To review individual calculations, select the calculation in the Calculation Review window and then select the

Original Calc

pop-up key.

Performing Calculations

You must check that all input values are appropriate for your patient before performing calculations.

1

Select the

Calculations

SmartKey to open the Calculations window.

2

Select the

Calc Type

field and select the required calculation type for display.

3

Check the calculation time in the

Calc Time

field.

When you enter the calculation window, this field will show either the current time or the time of the most recent available C.O. measurement, depending on your monitor configuration.

– To choose a different calculation time, select the

Calc Time

field. This calls up a list showing the timestamps of calculations performed earlier. Select a time from this list, or select

Select Time

to enter a time of your choice.

– To enter the current time, select the

Resample Vitals

pop-up key. If you choose the current time, the monitor will resample all the required values that are continuously monitored.

4

Enter any values that must be entered or edited manually. Select the value field and then use the pop-up keypad to enter the required values. Select

Enter

to confirm each entered value.

Manually-entered values are marked with an asterisk (*).

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21 Calculations

Entering Values for Calculations

Entering Values for Calculations

The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available.

To enter calculations values manually or edit automatically-entered values, select the value field to open the on-screen keyboard and use this to enter the correct value. Values edited manually are marked with an asterisk symbol (*).

If you enter a value that has more decimal places than allowed for a particular input, the value you enter will be rounded off after you select

Enter

. If you enter a value which cannot be stored, the message

Warning: Value out of range

will appear. Enter a new value.

In hemodynamic calculations, if the systolic and diastolic pressures are manually entered, the mean pressure is calculated and marked with an asterisk. The formula used to estimate the mean pressure is

[systolic + (diastolic x 2)] / 3.

Automatic Value Substitution

If the monitor cannot find a value required for calculation, it automatically tries to find an equivalent source for this value. For example, if C.O. is required but unavailable, the monitor automatically looks for CCO as a alternative source of C.O. values, or a alternative Pressure label may be used instead of

ABP. The label of the value in the

Calculations

window does not change. Substituted values are marked with an asterisk (*).

Automatic Unit Conversion

The monitor needs consistent units for performing calculations. It automatically converts units where necessary before it performs the calculation, for example, pressures sourced in kPa, cmH

2 are automatically converted to mmHg, or to cmH

2

O for ventilation calculations.

O, or mbar

Manual Unit Conversion

If you need to convert units for other purposes you can use the

Unit Conversion

window:

Unit Conversion

1

2

3

Select

Main Setup

->

Calculations

Select

Unit Conversion

.

Select the field under the unit you know and use the onscreen keypad to enter the known value. The converted value automatically appears in the adjacent field.

Fahrenheit

Inch

Celsius

Centimeter

Pound Kilogram

BSA Formula

Your monitor provides both the Boyd and Dubois formulas for the calculation of body surface area

(BSA). For calculations, the monitor uses the setting defined in the Patient Demographics menu. All calculation results that use BSA are indexed to the selected formula.

236

Documenting Calculations

21 Calculations

To check the current setting, select the patient name to enter the Patient Demographics menu.

BSA(B)

indicates that the Boyd formula is used;

BSA(D)

indicates that the Dubois formula is used.

Documenting Calculations

To send a Calculations recording to a connected recorder, in the

Calculations

window, select the

Print/Record

pop-up key, then select the

Record Calc

pop-up key.

Calculations recordings print the patient demographic information and the content of the current

Calculations

window on the recorder strip.

To print a report for the calculation group currently on the monitor screen, select the pop-up key

Print Calc

. To print the Calculations Review window, select the pop-up key

Print

in the

Calculations Review window. All the calculations in the current group will be printed in the report.

Calculation Reports can be printed on central or local printers.

This example report shows the oxygen calculation group. Ventilation and hemodynamic calculation reports are similar.

Patient information

Calculation group

Three columns of calculations input and output values, with times, units and ranges, where appropriate

237

21 Calculations

Documenting Calculations

238

22

22

High Resolution Trend

Waves

High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance.

They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient’s condition across different hi-res trend waves. This can aid in the early detection of cardiorespiratory and hemodynamic problems.

The amount of data you can show on a screen depends on the display size and resolution: for example, on an eight inch (20 cm) wave trace on your monitor screen, you can view approximately six minutes of hi-res trend wave trace. The hi-res waves are drawn at a speed of 3 cm/minute.

The availability of hi-res trend waves depends on your monitor configuration and on the options purchased for your monitor.

Changing the Hi-Res Trend Waves Displayed

To change the selection of hi-res trend waves on the Screen, select the hi-res trend wave and select the required hi-res trend wave from the list of available measurements.

If there are no hi-res trend waves on the Screen, you must change to a Screen with hi-res trend waves.

Hi-Res Trend Wave Scales

High-resolution trend waves are either compressed realtime waves or fast numeric trends.

• Hi-res trend waves from compressed realtime waves include: Resp, CO

2

, ABP, PAP, CVP, ICP, AWP, anesthetic agents.

• Hi-res trend waves from fast numeric trends include: btbHR, SpO

2

, tcpO

2

, tcpCO

2

, Pulse, Perf,

CPP, BIS, CCO, inO

2

, Delta SpO

2

.

Hi-res trend waves from waves use the wave scale as their display scale. Changing the wave scale changes the hi-res trend wave scale.

Hi-res trend waves from numerics use a pre-defined display scale dependent on the patient category.

Hi-Res Trend Waves and OxyCRG

OxyCRG is a combination of three hi-res trend waves, btbHR, SpO

2

, and Resp, mainly used in neonatal monitoring.

239

22 High Resolution Trend Waves

Printing Hi-Res Trend Wave Reports

Printing Hi-Res Trend Wave Reports

To print hi-res trend waves on reports, you can choose to print either

• all

VisibleWaves

- prints all waves and hi-res trend waves currently displayed

All Waves

- prints realtime waves and hi-res trend waves for all currently-monitored measurements

HiRes Waves

- prints hi-res trend waves for the currently-monitored measurements

OxyCRG Waves

- prints hi-res trend waves for btbHR, SpO

2

, and Resp.

For each hi-res trend wave, six minutes of measurement data will be printed.

See the section on Reports for more information on setting up reports.

Hi-Res Trend Wave Recordings

The selection of waves in hi-res trend wave recordings and the printing speed are defined by the preconfigured HiResTrd recording template. See the section on Recordings for more information.

To start a hi-res trend waves recording,

1

2

select the

Realtime Record

SmartKey, if configured, or select

Main Setup

->

Recordings

select the

Start HiResTrd

pop-up key.

240

23

23

Event Surveillance

Events are electronic records of episodes in your patient’s condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations. Depending on the level of event surveillance available on your monitor, the information stored for each event episode can include:

• waveforms for up to four measurements of your choice (depending on episode type, see table on page 243 for more details)

• numeric vital signs for all the measurements monitored

• any alarm conditions active when the event episode was triggered

• any annotations connected with the event.

You can navigate through the event database to view events retrospectively, and you can document events on a recording or report marked with the patient name, bed label, and the data and time.

Levels of Event Surveillance

The appearance of the Events windows and menus and the settings you can select for events depends on the event surveillance option purchased for your monitor: basic event surveillance, advanced event surveillance, or neonatal event review. This table lists the differences between the options.

To determine which level of event surveillance your monitor has, select

Main Setup

->

Event Surveill.

->

Setup Events

and select the trigger group to see the available event groups.

• if the only event group listed is NER, your monitor has the Neonatal Event Review option

• if there is one event group and it is not NER, your monitor has the Basic Event Surveillance option

• if you see six event groups, your monitor has the Advanced Event Surveillance option.

Event Functionality

Event groups

Measurements per group

Triggers per measurement

Trigger types

Annotation

3

1

Basic Event

Surveillance

Option C06

1

Advanced Event Surveillance

Option C07

5 + NER

4

2

Simple (“at least one”) Combined (“at least two”) no yes

3

1

Neonatal Event Review

(NER)

Option C04

NER

Simple (“at least one”) no

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23 Event Surveillance

Event Groups

Event Functionality

Types of event episode

Event views

Basic Event

Surveillance

Option C06

Advanced Event Surveillance

Option C07

Average trend

Graphic Event Review window, graphic

Event Episode window

Average trend

High resolution trend

Snapshot events

Summary view, graphic and tabular

Event Review window, graphic and tabular

Event Episode window

25 events for 24 hours 25 events for 24 hours

25 events for 8 hours

50 events for 8 hours

50 events for 24 hours no yes

Neonatal Event Review

(NER)

Option C04

High Resolution Trend

Graphic and tabular

Event Review window, graphic and tabular

Event Episode window

25 events for 24 hours

25 events for 8 hours

50 events for 8 hours

50 events for 24 hours no

Database capability

Event Notification

Event Groups

The event group

• monitors the patient’s signals to detect event triggers

• defines which waveforms are recorded in the event data.

In basic event surveillance only one event group can be active at a time, with Advanced Event

Surveillance all six groups can be active simultaneously. Active event groups monitor for event triggers.

Event groups are defined in Configuration Mode. In monitoring mode the groups can be adapted to current conditions, for example episode types and threshold levels can be changed .

Event Episodes

When an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event).

Manually-triggered event episodes document patient information from the time leading up to the event trigger; they do not have a post-time.

Event trigger

Event pretime

Event post-time

Event Episode

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Events Pop-Up Keys

23 Event Surveillance

The episode type defines the level of detail captured in an event episode. The higher the data resolution, the shorter the period that the monitor can store in its memory. High-resolution data is suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient’s status typically changes more gradually, a longer trend may be more informative.

Event Episode Types

Average trend

20 minutes, five samples per minute

HiResTrnd

Four minutes, four samples per second.

Neonatal Event Review (NER) is a type of

HiResTrnd

Realtime Wave Snapshot

15 seconds

Pre-time

2 minutes

4 minutes

6 minutes

8 minutes

10 minutes

12 minutes

14 minutes

16 minutes

18 minutes

1 minute

2 minutes

3 minutes

5 seconds

10 seconds

Post-time

18 minutes

16 minutes

14 minutes

12 minutes

10 minutes

8 minutes

6 minutes

4 minutes

2 minutes

3 minutes

2 minutes

1 minute

10 seconds

5 seconds

Events Pop-Up Keys

Depending on the events view you choose, a selection of the events pop-up keys let you navigate through the stored events and carry out events-related tasks.

Pop-Up Keys

Event

Setup

Show

Episode

Show

Review

Review

Group

Show

Summary

Manual

Event

Selecting this pop-up key lets you....

open the

Event Surveillance Setup

menu.

open the

Event Episode

window to review the selected event in detail

. open the

Event Review

window. choose a different event group for reviewing in the

Event Review

window (Advanced Event Surveillance only).

open the

Event Summary

window.

start a manually-triggered event capture.

move the cursor left or right to the next event to navigate through the events database. Placing the cursor over an event highlights it and shows the event values for the selected event.

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23 Event Surveillance

Event Triggers

Pop-Up Keys Selecting this pop-up key lets you....

jump to the first or last event in the event database.

Vitals

View

Table

Review

Delete

Event

Select

Annot.

Print/

Record

Graphic

View

Graphic

Review

toggle between a tabular and graphic version of the

Event Episode

window currently viewed.

toggle between a tabular and graphic version of the

Event Review

window currently viewed.

delete the currently-selected event from the database. The monitor asks you to confirm this deletion. You cannot retrieve deleted events.

access the list of available annotations to add a nursing note for the current event episode (Advanced Event Surveillance only). access the printing and recording pop-up keys to document events.

Event Triggers

You can trigger event capture manually, for example, if you want to record a patient’s condition before a procedure. You can also set events to trigger automatically, when the patient’s values cross a predefined threshold value, or when a particular measurement or procedure is carried out, for example, when an NBP measurement or a Cardiac Output or Wedge procedure is carried out.

If more than one trigger is available for the measurements in the active event group, the trigger condition may be

AtLeast1Par

,

AtLeast2Par

,

AtLeast3Par

,or

All4Par

. If the trigger is

AtLeast1Par

(this is short for ‘at least one measurement parameter’), the monitor starts an event capture if a trigger occurs in any of this event group’s measurements. If the trigger is

AtLeast3Par

, the monitor captures events when three or more trigger thresholds from this event group’s measurements are violated. With

Enhanced Condition

you can not only select a minimum number of triggers to trigger an event but define which specific measurement triggers these must be.

For example,

AtLeast2Par

will cause an event to be captured if a trigger occurs in any two of this event group’s measurements - with

Enhanced Condition

you can select that only when triggers are in HR and SpO

2 an event will be captured.

Enhanced TriggerCondition

Single Pair

Triple

All

HR (Pulse)

SpO

2

Resp

ABP

At Least One Param

At Least Two Param At Least Three Par All Four Parameter

The trigger condition for event groups is set in the monitor’s Configuration Mode.

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Event Triggers

23 Event Surveillance

If you use alarm limits as event triggers, the event capture is triggered automatically when your patient’s values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions.

The asterisk symbols beside the trigger tell you about the alarm triggers:

*** indicates a high priority (red) alarm

** indicates a lower priority (yellow) alarm. This category includes short yellow arrhythmia alarms, which may be configured to be shown as one star alarms (*) on your monitor.

Triggers without asterisk symbols are user-defined triggers.

If you set user-defined threshold triggers, you can define event triggers that are independent of alarm limits. You must set a threshold value and a threshold time for the trigger. If you set the trigger threshold time to 12 seconds, the monitor triggers an event if the threshold is violated for more than 12 seconds.

If you set On Measurement triggers, you can set aperiodic measurements (such as NBP) or procedures (such as Cardiac Output) to trigger an event whenever they start.

If you set user-defined deviation triggers, you can define event triggers that are independent of specific limits and based instead on deviations from the current values. You must set a deviation and a period of time in which the deviation occurs. There are three types of deviation available:

ANY deviation

,

UP deviation

where only changes in a positive direction are detected and

DOWN deviation

where only changes in a negative direction are detected. The deviation can be defined either in relative terms as a percentage, for example 10%, or as an absolute value, such as 10 bpm.

Event Retriggering

If a condition that triggered an event persists and the values remain beyond the trigger threshold, a new event will not be triggered.

For a new event to be triggered by the same condition, the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold.

Event Notification

(Advanced Event Surveillance Only). You can be notified when an event is detected. For each event group you can define a type of notification depending on the severity of the event conditions. The notification can be a status message with a prompt tone or a standard *, **, or *** alarm notification.

These event alarms are handled exactly like measurement alarms; they can be silenced and are also suspended when all alarms are suspended. You should only use alarm notification for events which are comparable in severity to standard measurement alarms to avoid potential confusion due to too many alarms. Notification in the form of an alarm is not available when the trigger condition is

At Least

One Param

. Selecting

None

switches event notification off.

Setting the type of notification, or switching notification off, is done in Configuration Mode.

Setting Triggers for NER and Basic Event Surveillance

1

Select

Main Setup

->

Event Surveill.

->

Setup Events

to enter the

Event Setup

window.

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23 Event Surveillance

Event Triggers

2

3

4

5

Select the name of the current episode type to set the episode pre/post time.

Group Name:

Episode Type:

Event Setup

Group 1

Average Trend (20min): -10/+10 min

Activated

HR (Pulse)

All ***/** Alarms

Set the event trigger for each measurement.

Select each trigger name and select, if available, either an alarm trigger, or a

SpO2

Resp

HIGH

All ***/** Alarms for

user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time.

sec

Set the trigger status to

Activated

to start event triggering. If the status is

Deactivated

event surveillance is effectively switched off.

Select

Confirm

to confirm your changes.

Setting Triggers and Notification for Advanced Event Surveillance

1

Select the group name to enter the

Event Setup <Group Name>

window.

2

Set the trigger status to

Activated

, to have this event group trigger events, or

Deactivated

.

3

4

5

Set the episode type.

Select the name of the current episode type and select an episode type from the pop-up list. The pre/post episode time for the selected episode type is displayed.

Group Name:

Notification Type:

Episode Type

Trigger Condition

Standard

Screen Prompt

Activated

Average Trend (20 min): -16 / +4 min

At least one param.

Enhanced ...

HR (Pulse)

*** EXTREME TACHY

*** EXTREME BRADY

SpO2

ABP

Event Setup

Any Deviation

All ** HIGH ALARMS

All ** LOW ALARMS

%(dev) within 10 sec

Set the trigger for each measurement.

Select each trigger

Resp

HIGH

35 rpm for 35 sec

name and select either an alarm trigger or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. If a deviation trigger is configured, set the deviation and duration.

Select

Confirm

to confirm your changes.

Triggering Events Manually

To manually trigger an event, select the SmartKey

Manual Event

and (for Advanced Event

Surveillance) select the group in which the event will be triggered.

246

The Events Database

23 Event Surveillance

For manually-triggered events. patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group.

The Events Database

The maximum number of events that can be stored in the event database depends on the database configuration and the level of event surveillance used. The event database is set up in the monitor’s

Configuration Mode. Events are stored in the monitor’s event database for the configured lifetime, either 8 hours or 24 hours. Deleted events cannot be retrieved. Events are automatically deleted when:

• their configured lifetime is over

• the storage capacity of the database is exceeded (storing a further event deletes the oldest event in the memory)

• a patient is discharged.

As the event database is cleared when you discharge a patient, you should ensure that you have documented any events you require for the patient records before you confirm the discharge.

Viewing Events

• To see a summary of all the events in every group in the event database, use the

Event Summary

window.

• To review all the events in a particular event group, use the

Event Review

window.

• To review individual event episodes in detail, use the

Event Episode

window.

To start viewing events, either:

♦ in the

Main Setup

menu, select you require from the list, or

Event Surveillance

and then select the event view

♦ select the

Event Surveillance

you require from the list.

SmartKey and then select the event view

Event Counter

Vertical bars mark events in the Event

Event Counter

Event Counter (Graphic)

Summary window.

The timeline shows the position of the stored events in the event database. Selecting this view activates a cursor that lets you navigate across the timeline and select individual events for review in the

Episode Review

window. It also calls up the events pop-up keys.

The event counter counts the total number of events in the database. If more than one event group was set to trigger events within the event history, the event counter also counts the event group totals.

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23 Event Surveillance

Viewing Events

Counting Combi-Events

If one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a brady event, the brady event is not counted as a single event but as part of the apnea event.

Counting Neonatal Event Review (NER) Events

For neonatal events (NER, formerly “OxyCRG”), apnea events (

A

), bradycardia events (

B

), and combinations of these events are counted and classified by the event counter in the Event Summary. If they are associated with a Desaturation (

D

), this is also marked. Manual events (

M

) are counted separately. In the example below,

A(D):2(1)

indicates that two apnea events occurred and one of them was associated with a desaturation.

16 Stored Events: A(D):2(1) B(D):7(1) AB (D): 1(1) D:6 M:0

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Viewing Events

23 Event Surveillance

Event Summary Window

(Advanced Event Surveillance only). The Event Summary window shows the number of stored events in each event group and the total number of events in the database. Vertical bars mark events on a timeline showing the position of the stored events in the event database. The symbol next to the group name indicates the activation and notification status: symbol meaning group activated, notification set to

***alarm group activated, notification set to

**alarm group activated, notification set to

*alarm group activated, notification set to screen prompt group is activated, notification is switched off no symbol group not activated

Selecting the

Event Summary

window calls up the events pop-up keys.

Parts of the

Event Summary

window can also be embedded in Screens so that they are always visible, for example the Total row showing the total number of events with the bars on the timeline or the column showing all the groups with the activation and notification status.

Event Review Window

To enter the

Event Review

window, select the graphic event summary, if available, or select the events pop-up key

Show Review.

♦ When you open the

Event Review

window, it automatically shows the event group with the most recent event. To view other event groups, select the pop-up key

Review Group

and select the group from the list.

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23 Event Surveillance

Viewing Events

Event Review

(Total: 4)

HR

Brady

SpO2

DESAT

Resp

APNEA

Manual

Total

Event bars: Each event bar represents one event. The height indicates the event severity. Bars that extend over more than one channel represent combi-events. Manually-captured events are marked with a bar above the timeline instead of in the measurement channels.

Event values: Event information for the currently-selected event is shown on the left of the review window. The trigger measurement is highlighted.

– If an alarm triggers the event, the monitor shows the alarm conditions that triggered the event.

– If the event trigger was user-defined, instead of an alarm condition the monitor shows for example

SpO2 94<96

, where the second number is the current event trigger threshold and the first number is the maximum deviation from the set limit.

Trigger threshold: The horizontal lines show the trigger thresholds. Gaps in the line indicate that the trigger was inactive for a while, possibly because alarms were switched off or because there was an

INOP condition in the group measurements.

Timeline: The timeline at the bottom indicates the period currently stored in the event database.

Event Episode Window

To enter the

Event Episode

window, select the pop-up key

Show Episode

.

Depending on the event group settings, the

Event Episode

window shows either 20 minutes of average trend event information, four minutes of high-resolution event information, or 15 seconds of realtime wave information.

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Annotating Events

23 Event Surveillance

Event Episode

Trigger event values, highlighted

HR

Brady

104 < 110

Follow-on event values

SpO2

Desat

71 < 85

Resp

Timeline, showing episode Pre/Posttime

Active event group

7 Jul

NER

The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded. In this example,

Brady 104<110

tells you that

104 was the lowest HR value measured during the event time and that the low HR trigger threshold was set to 110 when the event was triggered. If the event was manually triggered, the event value boxes display “manual”.

Annotating Events

1

2

To annotate an event, in the Event Episode window, select the pop-up key

Select Annotation

.

Select the required annotation from the pop-up list of available annotations for the currently active event group.

Up to 20 annotations can be configured to let you add commonly-used clinical notes to event episodes for documentation purposes. To see the complete list of available annotations, in the

Event Setup

menu, select

Event Annotation

.

Documenting Events

You can print a report or make a recording of the events history stored in the database or of individual event episodes.

Documenting Event Review

1

In the

Event Review

window, select the pop-up key

Print/Record

. This calls up the event documentation pop-up keys.

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23 Event Surveillance

Documenting Events

2

For a graphic

Event Review

recording, select the

Record Graphic

pop-up key.

For a tabular

Event Review

recording, select the

Record Tabular

pop-up key.

To print an Event Report, select the

Print Review

pop-up key.

Documenting an Event Episode

1

In the

Event Episode

window, select the pop-up key

Print/Record

. This calls up the event documentation pop-up keys.

2

To make an

Event Episode

recording, select the

Record

pop-up key.

To print an

Event Episode

, select the

Print Episode

pop-up key.

Event Recordings

Event recordings can be sent to a locally-connected M1116B recorder module.

Event Review Recordings

Each event review recording strip begins with a summary of the events stored in the event database.

Recording strip annotation is explained in the

Recording chapter.

Recording strip code

Event types

Patient information and medical record no.

Event total per event group

90MIN Green, Sarah 37549201

23 Jan 02 10:43 ICU 37

Event group s

Total events in database

Standar d: Combi:

0

Single: Manual

2 : 1

Neuro: Single:

Combi: 0

Manual

: 2

0

Hemo:

Combi: 0

0

Single: Manual

: 2

(Total: 3)

(Total: 2)

(Total: 2)

In graphic event review recordings, events are represented by bars, and each event group is printed on a separate channel.

The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections).

Standa rd

09:0

11:0

15:0

19

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Documenting Events

23 Event Surveillance

In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp.

# Time Group Parameter 1

1 23 Jan 02

07:56

Neuro Resp

2 23 Jan 02

07:59

Stand ard

HR(Pulse)

TACHY 201>180

Parameter

2

BIS LOW

51<60

ST-II

Parmeter 3

ABP

SpO2

3 23 Jan 02 Neuro Resp HIGH BIS

ABP

08 02 76 60

The measurements in the event group are shown in the next columns, marked “Parameter 1, Parameter

2...”, along with the event values measured at the time of the event. For each event, the trigger values are shown.

This section of the recording is A4 or letter size, so that it fits in a patient file.

Event Episode Recordings

Event episode recordings are divided into four sections.

1

2

The first section shows the patient information and the event group of the episode with the event values for the group measurements. The trigger symbol marks the event trigger.

The second section shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording.

1.

91MIN

Green, Sarah

37549201

23 Jan 02 10:43

ICU 3

Standard:HR(Pulse)

If there are four measurements in the event group being recorded, two waveforms will be recorded in two separate waveforms segments.

6.25

II

Plet

Res

-5

2.

+10

3.

4.

HR 130 No bpm interventi

SPO2 98%

RR 80 rpm on req.

**TACHY

**Resp

HIGH

**TACHY

**Resp

HIGH

HR 130 bpm

Pulse 130 bpm

3

4

The third section shows the most important vital signs information, including numerics, active alarms, and any annotations made on the event episode.

The fourth section shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered.

Event Reports

Event reports can be printed on A4 and letter size paper on a printer connected locally or centrally to your monitor.

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23 Event Surveillance

Documenting Events

Event Review Reports

The event review report documents all the events stored in the event database for a selected group.

254

Documenting Events

23 Event Surveillance

Event Episode Reports

The event episode report documents the patient information from the currently-selected event. See the section on event recordings for an explanation of the report elements.

Event Summary Reports

(Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups.

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23 Event Surveillance

Documenting Events

256

24

24

Recording

MP40/MP50/

MP60/MP70/

MP90

The M1116B plug-in recorder records numerics for all active measurements and up to three waveforms. You can use it for local recording mounted either in the monitor’s FMS or in the integrated module slots (MP40/MP50, MP60/MP70).

Continue LED

Flashes if a continuous recording is ongoing

RUN/CONT key

Starts a delayed recording or makes the current recording continuous

STOP key

Stops the current recording

M1116B Plug-in Recorder

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24 Recording

MP20/MP30

The integrated recorder records numerics for all active measurements and up to three waveforms.

Starting and Stopping Recordings

MP20/MP30 Integrated Recorder

Central

Recording

For central recording from the bedside, your monitor must be connected via a network to an

Information Center. You can use either the M1116B recorder or the standalone M3160A 4-Channel

Recorder. Recordings made on the M3160A may look slightly different to those described here. See the documentation supplied with the Information Center for information on the 4-Channel Recorder.

Starting and Stopping Recordings

The recordings pop-up keys let you start and stop recordings. Select the

Recordings

SmartKey to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.

The selection of pop-up keys available depends on the monitor and recorder model you are using.

Delayed

Recordng

RT A

Recordng

RT B

Recordng

RT C

Recordng

Select

Waves

HiRes

Recordng

All ECG

Waves

Vital

Signs

Alarm

Limits

ST

Segments

Setup

Recordng

Stop all

Recordng

Quickstarting Recordings

To quickstart any type of recording using a preconfigured recordings template,

Select the to start.

Recordings

SmartKey and then select the pop-up key of the recording type you want

Alternatively, you can

Select the

Main Setup

SmartKey, select

Recordings

, then select the recording type.

258

Overview of Recording Types

24 Recording

To quickstart a delayed recording,

Select the SmartKey

Delayed Record

to immediately start a delayed recording.

M1116B only

You can also start a delayed recording by pressing the RUN/CONT key on the recorder module.

Extending Recordings

Timed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue until stopped manually or by an INOP condition.

To extend an ongoing recording by its runtime, reselect its

Start

pop-up key once.

To make an ongoing recording continuous, reselect its

Start

pop-up key twice within 5 seconds.

M1116B only

You can also make an ongoing recording continuous by pressing the RUN/CONT key on the recorder module.

Stopping Recordings

Recordings stop automatically when the preset runtime is over, when the recorder runs out of paper, or when the recorder has an INOP condition.

To manually stop a recording, select the

Stop all Recordng

.

Recordings

SmartKey and then select the pop-up key

M1116B only

You can also stop a recording by pressing the STOP key on the recorder module.

Recording Without a Template

To record without a preconfigured template, selecting the waves you require,

1

Select the

Recordings

SmartKey.

2

Select the pop-up key

Select Waves

and use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the

Continue

pop-up key.

3

4

Select one of the recording speed pop-up keys to set the required recording speed.

Select the

Start

pop-up key to start the recording.

Select Waves

recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping.

Overview of Recording Types

This table details settings for local recordings, using either the integrated recorder or the M1116B. For details on recordings made on the central recorder, see your Information Center Instructions for Use.

259

24 Recording

All ECG Waves Recordings

Type of recording

Delayed

manual

Alarm

automatic, triggered by defined alarm conditions

Realtime (RT)

manual

All ECG Waves HiResTrnd

manual local and central local and central local and central local only manual local only

Procedure or

Context

manual, use the context window’s popup keys to start local only

Local or

Central

Information recorded

from the start trigger minus the delay time

Number of waves

Speed

Runtime

Stops

from the start trigger minus delay time up to 3 up to 3 up to 3 all ECG waves currently monitored and available up to 3 highresolution trends

(beat-to-beat) waves up to 3 waves, or specific to the context, e.g. a C.O. trial curve or a wedge procedure

50, 25, 12.5, 6.25,

2.5 mm/sec

50, 25, 12.5, 6.25,

2.5 mm/sec

50, 25, 12.5,

6.25, 2.5 mm/sec

15, 20, 25, or 30 seconds automatically

15, 20, 25, or 30 seconds automatically

15 seconds or continuously

25 mm/sec

4 seconds per wave

1, 2, 2.5, 3, 6 cm/min

10 minutes, or continuously defined by the context defined by the context automatically if limited, manually if continuous automatically automatically if limited, manually if continuous defined by the context

Delay Time 10, 15 seconds

Overlap

up to 3 waves from the start trigger minus the delay time

10, 15 seconds up to 3 waves from the start trigger none up to 3 waves from the start trigger, in realtime none none

6, 5, 4, 3, 2, 1 minutes up to 3 waves defined by the context defined by the context defined by the context

All ECG Waves Recordings

An

All ECG Waves

recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead. All available leads are recorded sequentially in the standardized lead order.

The recording is realtime, that is, the information recorded is not simultaneous.

Creating and Changing Recordings Templates

To save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the

Setup Recording

menu. You can create templates for one delayed recording, one alarm recording, three realtime recordings, and one high resolution recording.

All ECG Waves

recordings do not need to be configured, they always use the same format.

Changing recordings templates changes the settings that will be used each time a recording of this name is triggered.

1

2

Select the

Main Setup

permanent key to call up the Main Setup menu.

Select the item

Recordings

to enter the

Setup Recordings

menu.

260

Changing ECG Wave Gain

24 Recording

3

Select the name of the template you want to create or change. Each recording name is linked to a recording type, delayed, alarm, realtime, and high res trends. Recording names can be changed in the monitor’s Configuration Mode.

4

Design the template by selecting each menu item and entering the information for the template.

Recorder

: choose which recorder the recording will print to (Local, Central 2-Ch. or Central 4-

Ch.).

Channels 1 - 4

: choose which waveform to record in each channel. If the wave assigned to a recording channel in a particular template is not available when a recording is triggered, the channel is left blank on the recording strip. The pop-up list of available (currently monitored) waves differs according to the recording type:

– Realtime, delayed and alarm recordings: the list shows all the currently available waves.

– High-resolution recordings: the list shows all the available high-resolution waves

In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:

Alarm Par

will always record the measurement in alarm in the chosen recorder channel

Primary Lead

will always record the current primary lead in the chosen recorder channel

Secondary Lead

will always record the current secondary lead in the chosen recorder channel

Agent

will always record the currently selected anesthetic agent.

For high-resolution recordings only the

Agent

setting is available.

Overlap

: define whether the recorded waveforms will be printed overlapping or beside each other.

Speed

: choose the recording print speed.

Delay Time

: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the “Delay Time” and can be set to 10 or 15 seconds. This setting can only be changed in Configuration Mode.

Runtime

: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely.

Central Config

- if available, select this setting to use the recordings settings set for the centrally-connected recorder.

Changing ECG Wave Gain

1

2

The

ECG Gain

setting in the

General

menu defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings,

In the

Setup Recording

menu select

General

Select

ECG Gain.

3

Select the required setting:

Auto

: the wave recording will use the same scale as the ECG wave on the monitor screen

5 mm/mV, 10 mm/mv, 20 mm/mV

: the wave recording will use a scale of 5, 10, or 20 millimeters per millivolt.

261

24 Recording

Recording Priorities

Recording Priorities

Manually-started recordings have priority over automatically-started recordings. If an automatically-triggered alarm recording is running, and a realtime or delayed recording is manually started, the alarm recording is stopped and the manually-requested recording is started.

More recent manually-started recordings have priority over older manually-started recordings. If a manually-started recording is running, and another manually-started recording is triggered, then the older recording is stopped and the more recent manually-started recording is started.

Alarm recordings are prioritized according to alarm priority. If an alarm recording triggered by a yellow alarm is running and a new alarm recording is triggered by a red alarm, the yellow alarm recording is stopped and the red alarm recording is started.

Sample Recording Strip

The information printed on the recording strip includes the patient name and MRN, bed number, date and time of recording, recording speed, and recording code. Active alarm and INOP messages as well as numerics for all currently monitored measurements are also printed.

Recording strip annotations are printed at the beginning of the recording strip and updated at regular intervals, every 15 minutes for recordings made at speeds lower than 6.25 mm/s, and every 60 seconds for recordings made at speeds greater or equal to 6.25 mm/s.

This sample recording strip shows a typical initial annotation:

Recording strip code

Recording speed

Measurement numerics

90DIN 25 mm/sec

23 Jan 02 10:43 Bed 3

Green, Sarah 37549201

Patient information and medical record no.

Alarms and

INOPs

*** EXTREME BRADY

** ABPs HIGH

** PAPd HIGH

CCO NO CALIBRATION

SOME ECG ALARMS OFF

ABP REDUCE SIZE

HR 120 bpm

SPO2 95%

Pulse 120 bpm

PERF 10.0

ABP 120/70 (91) mmHg

PAP 28/15 /21) mmHg

NBP 120/80 (90) mmHg 23 Jan 02

10:31

C.O.

C.I.

CCO -?- l/min

CCI etCO2 40 mmHg imCO2 0 mmHg awRR

RR 15 rpm

Tnaso 37.0×C

Tblood 37.0×C

SV 94 ml

SI 48 ml/m2

Recording Strip Code

The recording strip code printed in the first line of the initial annotation has up to seven characters, specifying recording type, operating mode, application area, patient category, and delay time, if applicable.

262

Sample Recording Strip

24 Recording

Recording type

Operating mode

Application area

Patient category

Code Meaning

A

P

N

I

O

C

N

C

S

M

D

90

8A

0B

91

Realtime

Delayed

Alarm

Context (Procedures)

Monitoring

Demo

Configuration

Service

ICU

OR

CCU

NICU

Adult

Pediatric

Neonatal

Recorded Waveforms

A selection of up to three waveforms is recorded, marked with wave labels and wave scale information.

Wave scale information can be in the form of a calibration bar, like the 1 mV calibration bar for ECG, or calibration steps before the waveform starts.

Maintaining Recording Strips

Recording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation.

263

24 Recording

Reloading Paper

Reloading Paper

M1116B

1

2

3

4

5

Use the latch on the right side of the recorder door to pull the door open.

Remove the empty core.

Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top.

Pull out some paper and fold along the front edge at a 45

°

angle. This makes it easier to feed the paper under the roller as shown.

Feed the paper through and pull some paper out from the top of the roller.

6

7

Close the recorder door.

To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper.

MP20/MP30 1

2

Use the latch on the right side of the recorder door to pull the door open.

Remove the empty core.

3

4

5

Insert a new roll and secure it in place on the paper holder. The paper feeds from the bottom of the roll and over the top of the recorder door.

With at least one inch of paper extending beyond the edge of the door, swing the recorder door up and push it firmly closed.

To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper.

CAUTION

When the recorder is disabled (by removal from its slot, door open, or out of paper), any alarm recordings will be sent to the central station recorder, if there is one. If no recorder is available, alarm recordings may be lost during the time the recorder is disabled. The message

no alarm recording available

will be displayed.

264

Recorder Status Messages

Recorder Status Messages

24 Recording

Recorder Status Messages Explanation

<Recording name> running

No <recorder name> alarm recording available

The named recording is currently running.

No alarm recording can be made on the selected recorder.

If available, try selecting another recorder. If a local recorder was selected, the monitor will try to reroute the recording. Recordings sent to a central recorder cannot be rerouted. Alarm recordings may be lost.

No alarm recording available

The selected recording cannot be made. Alarm recordings will be lost.

Check that the recording has been correctly configured.

<Recorder name> out of paper

The named recorder is out of paper.

<Recorder name> door open

The door of the specified recorder is open.

<Recorder name> not supported

The M1116A recorder is not supported. Connect a

M1116B plug-in recorder.

265

24 Recording

Recorder Status Messages

266

25

25

Printing Patient Reports

Starting Reports Printouts

Most patient reports can be printed by selecting

Main Setup

- >

Reports

(or the

Reports

SmartKey) and then selecting the report name in the top half of the

Reports

menu. Report names are shown only for reports that have been correctly set up.

Data from the time of the print request is printed, even if the print job is delayed in the printer queue.

Report types Report contents How to start printing reports

Vital Signs Report

Graphic Trends Report

Events Reports depends on selected trend group, data resolution, and period.

Event Episode with up to 5 episodes

Graphic or tabular Event Review

In the Vital Signs window, select

Print/Record

, then select

Print

In the Graphic Trends window, select

Print

In the Events window, select the pop-up key

Print/Record

, then select the pop-up key

Print Review

or

Print Episode

In the

Setup EEG

menu, select

Print Report

EEG Report EEG Waves, numerics, CSAs, montage information and impedance values

ECG Reports

ST Map Report

Depends on format selected Select the

ECG Report

SmartKeys, if configured

ST data in a transversal and/or horizontal multiaxis diagram,

In the ST Map window, select

Print

.

Cardiac Output Report Trial curves and numerics

Wedge Report Wedge numerics and reference wave

In the

Cardiac Output

window, select the popup key

Print/Record

In the

Wedge

window, select the

Print Wedge

pop-up key

Calculations Report

Drug Calculator

Report

Hemodynamic, Oxygenation, or

Ventilation Review

Titration Table

Drip Table

In the

In the

Calculations

Print/Record

Print Titr.Tbl

windows, select the

pop-up key

Titration Table

window, select the

pop-up key

In the

Drip Table

window, select the

Print

Drip Tbl

pop-up key

267

25 Printing Patient Reports

Stopping Reports Printouts

Report types Report contents How to start printing reports

Alarm Limits Report Graphic and numeric report of all current alarm limits

Realtime Reports, including oxyCRG

Reports (Neonatal

Event Review)

Loops Report patient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT waves Or all measured HiRes waves, OR oxyCRG waves (RT waves: ECG Primary lead,

Pleth, Resp; HiRes waves: btbHR, HiRes

SpO

2

, HiRes Resp)

Individual Loops diagram with timestamp, currently measured numerics

In the

Alarm Limits

Limits

window, select

Print

Select the

Realtime Reports

SmartKey, if configured

In the Loops window, select

Print Loop

Battery Report Battery serial numbers, information on the currently-measured and potential charge status of the battery or batteries

In the

Battery Status

window, select

Print

Status

.

Stopping Reports Printouts

To stop Reports printing, in the

Reports

menu, select

Stop Report

to stop the current print job

Stop All Reports

to cancel all queued report printouts

Scheduled Rep.

to toggle to

Off

and switch off scheduled reports.

Setting Up Reports

ECG, Vital Signs, Graphic Trends, and Auto Reports settings must be defined in Configuration

Mode. As the content of context-linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the procedure window, these reports do not need to be set up.

The content you define in the individual

Setup Reports

menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the

ECG Reports

menu, every ECG report will be printed at this speed, irrespective of format.

Setting Up ECG Reports

The settings you choose in the

ECG Reports

menu apply for all ECG reports printed. To set up

ECG Reports,

1

2

Select

Main Setup

->

Reports

->

ECG Reports

. Note the report layout configured for your monitor, either Internat. or Cabrera. This setting is inactive (“grayed-out”) in Monitoring Mode and can only be changed in Configuration Mode.

Select

ECG Gain

and set the required ECG Gain to define how ECG waves will appear on the

ECG report printouts.

3

4

Select

Speed

and select the report print speed.

Select

Annotation

and toggle to

On

if the printed ECG wave should be annotated with beat labels or not. See the chapter on ECG for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.

268

Setting Up Reports

25 Printing Patient Reports

Setting Up Vital Signs and Graphic Trend Reports

The settings you choose in the

Setup Vital Signs Report

and

Graphical Trend Report

menus apply for all Vital Signs and Graphic Trend reports printed.

To set up Vital Signs and Graphic Trend reports,

1

2

Select Main Setup -> Reports -> Vital Signs Rep. or Graph Trend Rep.

Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor’s trend configuration.

3

4

Select Period and select the period of time for which trend data should be printed on the report. If

Automatic Period

is configured to

On

, all trend data for the current patient will be printed, irrespective which trend period is selected.

Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report,

Setting Up Auto Reports

Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports:

Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report.

To set up Auto Reports,

1

2

3

Select Main Setup -> Reports -> Auto Reports and select the Auto Report you want to set up (A, B,

C, or D).

Select

Report

and assign a report type to the Auto Report.

Select

End Case Report

and toggle to

On

if you want the selected report to print automatically when you select

End Case

to discharge a patient.

Toggle

End Case Report

to

Off

if the report is a Scheduled Report only.

4

Select

Scheduled Rep.

and toggle to

On

if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day.

For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on.

– To set the time of day at which you want the report to print every day: select

Start Hour

and

Start Minute

and select the required time from the pop-up list

– To set the time interval in minutes between two scheduled reports: select

Rep. Freq. (Hr)

and

Rep. Freq. (Min)

and select the time interval from the pop-up list.

If you are setting up an end case report, these settings will be inactive (“grayed-out”).

Toggle

Scheduled Rep.

to

Off

if the report is an End Case Report only.

5

Repeat the procedure for all Auto Reports you want to set up.

All Auto Reports or Scheduled Reports set to

On

print automatically at the predefined trigger.

Be aware that the monitor’s memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost.

269

25 Printing Patient Reports

Setting Up Individual Print Jobs

Setting Up Individual Print Jobs

To adjust the appearance of individual print jobs, in the

Reports

menu,

1

Select

Main Setup

->

Reports

->

Setup Reports

to enter the

Setup Reports

menu.

2

3

Select

Report

and then select the report you want to set up.

Select

Report Type

and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected.

Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:

Visible Waves:

all waves currently visible, in the order they appear on the screen.

All Waves

: all measured waves,

RT Waves

: all currently measured realtime waves, according to the monitor’s priority list.

HiRes Waves

: all measured HiRes waves

OxyCRG Waves

: the OxyCRG/Neonatal Event Review waves.

Vital Signs

: trend information in tabular form.

Graph Trend

: trend information in graphic form.

ECG3X4

,

ECG6X2

,

ECG12X1

,

ECG4X2

,

ECG8X1

,

ECG12X1(2P)

: ECG reports.

EEG

: EEG reports.

Episode

: a single patient event episode.

Review

: an overview of patient events

Alarm Limits

: a list of all currently set alarm limits.

4

5

Select

Report Size

to set choose the paper size to be used for the report:

Unspecified

to use the default size for the template chosen,

Universal

,

A4

,

Letter

,

LrgUniversal

,

A3

, or

Ledger

. The list of available sizes depends on the connected printers.

Select

Orientation

to set the orientation of the report printout:

Unspec.

to use the default size for the template chosen,

Landscape

or

Portrait

.

6

Select

Target Device

choose which printer the print job will be sent to:

Unspec.

to use the default printer, or the printer name defined at the Information Center or in the monitor’s

Configuration Mode (for example,

Local 1

).

Some settings may be inactive (“grayed-out”) in this menu for reports that can only be started in a special window.

Checking Printer Settings

The printer settings for your monitor are defined in Configuration Mode. The printer settings

Paper

Size

,

Resolution

,

Color Support

, and

Duplex Option

for the active printer are visible but inactive (“grayed-out”) in the

Setup Printers

menu.

Printer names for locally-connected printers can be defined in Configuration Mode. You can see whether a specified printer is centrally or locally connected in the

Setup Printers

menu under

Port

:

Local <name>

indicates locally-connected printers,

Remote <name>

indicates centrally-connected printers.

To enter the

Setup Printers

menu, in the

Reports

menu, select

Setup Printers

.

270

Printing a Test Report

25 Printing Patient Reports

Printing a Test Report

A test report can be printed in Configuration mode, refer to the Service Guide for details.

Switching Printers On Or Off for Reports

You can enable or disable printer status to switch individual printers on or off for report printouts.

1

In the

Setup Printers

menu, select

Printer

and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.

2

Select

Printer Status

to toggle between the settings

Enable

and

Disable

. If you set this to

Disable

, no reports will be printed to the named printer.

If the monitor detects that no printer of a particular type is available, the

Enable

/

Disable

setting will automatically be set to

Disable

and “grayed out”.

Dashed Lines on Reports

If a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing.

For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place.

Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/ mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.

To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.

Unavailable Printer: Re-routing Reports

If you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitor’s memory.

If the target device of this print job was set to

Unspecified

, the monitor will periodically try to resend the print job to the first printer listed in the

Setup Printers

menu under

Printer

that is set to

Enabled

and that has paper of the correct size.

To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-rout a print job,

Enable the new target printer by selecting it in the

Setup Printers

menu and toggling to

Enabled

. As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.

If the target device of the print job was set to a specific printer, re-routing is not possible.

271

25 Printing Patient Reports

Printer Status Messages

Printer Status Messages

Printer Status Message Possible causes and suggested action

Print job could not be queued

The printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again,

OR

A report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request.

Stop All Reports

has been selected in the

Report

menu, OR

Cancelling all print jobs

The Operating Mode has been changed from Monitoring Mode to

Demonstration or Service Mode.

Cancelling N print jobs due to patient discharge

When a patient is discharged, all queued print jobs are cancelled. “

N

” is the number of print jobs queued.

Printing failed: no report configured

A report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report.

Printer <Printer name> unavailable - job suspended

The chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available.

Job on <Printer name> failed

A report cannot be started on the requested printer.

Make sure the printer is plugged in, switched on, and has paper loaded. Try another printer, if available. If this problem persists, call your service personnel.

Sample Report Printouts

Each report header contains the patient’s bed label, last name and first name, the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end.

The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the Addressograph and it can only be changed in the monitor’s Configuration Mode.

272

Sample Report Printouts

Alarm Limits Report

Patient Name

25 Printing Patient Reports

Measurement labels, with alarms off symbol where alarms are switched off

Graphic view of current alarm limits in relation to currently monitored measurement value

273

25 Printing Patient Reports

Realtime Report

Patient demographic information, time stamp

Active Alarms and INOPs, followed by vital signs

Measurement waves section, including HiRes waves

Sample Report Printouts

274

Sample Report Printouts

Cardiac Output Report

Patient information

Numbered trial curves

Trial information in tabular form

25 Printing Patient Reports

275

25 Printing Patient Reports

ECG Reports

Patient information

Numeric block

Wave area

Sample Report Printouts

Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values.

The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patient’s paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.

ECG Report type

12-Lead ECG

Multi-lead ECG

Available Formats

3X4 landscape

6X2 landscape

12X1 portrait

12X1 landscape

12X1 (2P) landscape

2X4 landscape

8X1 portrait

8X1 landscape

Available Paper Sizes

A4, letter, A3, ledger

A4, letter, A3, ledger

A4 and letter only

A4, letter, A3, ledger

A4, letter (2 pages)

A4, letter, A3, ledger

A4 and letter only

A4, letter, A3, ledger

Other Reports

See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports.

276

26

26

Using the Drug Calculator

Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time.

Term Definition Units

Dose

Rate

Amount

total quantity of drug to be delivered to the patient over time amount units per time or per kg/ time, if the drug is weight-dependent volume of the mixture to be delivered to the patient over time ml/hour amount of drug to be added to diluent to make up a mixture quantity of mixture of diluent and drug ng, mcg*, mg, g, mUnit, Unit, where g stands for gram ml

Volume

Concentration

ratio of the amount of drug to the solution volume

Standardized

Rate

amount units per ml

1ml volume of the mixture to be delivered to the patient per hour ml/hr

*Be aware that your hospital may use either ‘

µ g’ or ‘mcg’ as an abbreviation for microgram. These abbreviations are equivalent.

WARNING

Before you administer any drug, always check that the correct calculation units and patient category are selected. Consult your pharmacy if you have questions.

Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge. The Drug Calculator performs calculations based on the values input during use, it does not check the plausibility of the calculations performed.

Accessing the Drug Calculator

To access the Drug Calculator, select

Main Setup

->

Calculations

->

Drug Calculator

, or select the

Drug Calculator

SmartKey, if configured.

277

26 Using the Drug Calculator

Performing Drug Calculations

Performing Drug Calculations

Using the service Support Tool, a list of drugs can be configured for the monitor containing predefined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the

Drug Calculator window opens a list of configured drugs. Contact your pharmacist if you have any questions about the drugs in the list.

If

Any Drug

is the only entry in the list of drugs, no drugs have been preconfigured for your monitor. Drug calculations can be performed for non-specific drugs.

You must have a Support Tool to add additional drugs to the Drug Calculator.

About the Rule of Six

If the Rule of Six has been enabled for use with individual drugs in your Drug Calculator, you can use the formula in crisis situations to quickly calculate the amount of a drug needed to yield a target dose for continuous infusion for neonatal or pediatric patients (the drug amount is given in “mg”, the patient weight in “kg”). The Rule of Six can only be used with the dose unit mcg/kg/min.

CAUTION

JCAHO recommends disabling the Rule of Six. The configuration is not JCAHO-compliant if Rule of

Six is enabled.

The Drug Calculator uses the following formula for Rule of Six calculations, based on the patient’s weight:

• For a target dose of 0.1 mcg/kg/min, the Drug Calculator multiplies 0.6 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.

• For a target dose of 1.0 mcg/kg/min, the Drug Calculator multiplies 6.0 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.

Performing Calculations for a Non-Specific Drug

If a list of drugs has not been configured for your monitor, you can use the Drug Calculator to calculate drug doses for a single, generic drug called “Any Drug”. Selecting the arrow beside the drug name in the Drug Calculator window shows that are no other drugs configured.

1

Drug Calculator

ANY DRUG

Dose

Rate

Enter three of these four values: dose, amount, volume, and rate of the infusion solution.

To enter values, select the correct unit, then select each value field and use the pop-up keypad to enter the correct value.

Amount

Volume

Concentr

1 ml/hr

2

480

25

100 mg/min ml/hour mg ml

0.25

mg/ml

0.004

mg/min

2

If you have chosen a weight-dependent dose unit, you must enter the patient weight now or choose a different unit.

Weight

150 lb

If available, the patient weight from the

Patient Demographic

window is entered automatically in the Drug Calculator window when the Drug Calculator is accessed. To change the patient weight, select the

Weight

key then use the on-screen keypad to enter the correct value.

This will not change the patient weight stored in the patient demographic information.

278

Performing Drug Calculations

26 Using the Drug Calculator

3

When you have entered three values, the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field. Standardized rate and concentration are also calculated.

Performing Calculations for a Specific Drug

1

2

Select the arrow beside

Any Drug

, then select the required drug from the list of drugs.

This opens the

Drug Calculator

window for the selected drug.

Patient Category

Adult

Pedi

Neo

Select the correct patient category for your patient.

If you have a neonatal or

Reset Values

pediatric patient, the

Rule of Six

choice may be available. Select if required.

Drug Calculator

Lidocaine

Dose

Rate

Amount

Volume

Concentr.

ml/hr

Weight mg/min ml/hour mg ml mg/ml mg/min lb

3

Enter the patient weight, if necessary.

If available, the patient weight from the

Patient Demographic

window is entered automatically in the Drug Calculator window. To change the patient weight, select the

Weight

key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. Select the weight unit shown to change between

lb

and

kg

.

4

When a specific drug is selected, the initial values for

Dose

,

Amount

and

Volume

are the configured Start values for this drug. The

Rate

is then calculated. If other values are required you

can calculate any value by entering the remaining three values as described in ”Performing

Calculations for a Non-Specific Drug”.

The column on the right of the Drug Calculator window shows either drug dose or dosage rate, whichever is the calculated value. The current calculated value is shown on a scale with the recommended range in green. If the current calculated value lies outside the recommended range it is shown in red.

If you have changed values in the Drug Calculator and you want to revert to the configured values, select

Reset Values

key at any time.

279

26 Using the Drug Calculator

Charting Infusion Progress

Charting Infusion Progress

The Drip Table shows you at a glance how much of the infusion has been administered to your patient and how much time is left.

♦ To see the Drip Table, in the Drug Calculator window, select the

Drip

Table

pop-up key.

If the DripTime exceeds 24 hours, the DripTime timestamp shows - - :- - : - - .

Using the Titration Table

Lidocaine

Dose

Rate

Amount

Volume

Weight

DripTime

Drip Table mg/min ml/hour mg ml lb hr:min:sec

Amount

Volume Drip Time

Use the Titration Table to see at a glance what dose your patient would receive of a drug at different infusion rates. By clicking on the title row of the table you can switch between the Dose

Increments and Rate

Increments view.

Values outside of the recommended range are shown in red.

To see the Titration Table,

♦ in the

Drug

Calculator

window, select the pop-up key

Titr.Table.

Lidocaine

Titration Table

Dose increments

From a low of

To a high of

In increments of

Dose

Rate

Dose mg/min mg/min mg/min

Rate

The Titration Table is configured with the service Support Tool.

Dose

Rate

Amount

Volume

Weight

Dose

Rate mg/min ml/hour

Dose mcg ml lb

Rate

Documenting Drug Calculations

In the Drug Calculator window, select the pop-up key

Record DrugCalc

to immediately start a recording of the current drug calculation.

In the Titration Table window, select the pop-up key

Print Titr. Tbl

to print a report of the current Titration Table.

In the Drip Table window, select the pop-up key

Print Drip Tbl

to print a report of the current Drip Table.

280

27

27

VueLink Modules

A VueLink module transmits information from a connected external device to your monitor. Each module can be connected to up to three external devices, and supports alarms from the external device.

Although the external device may transmit more information, the number of waves and numerics you can view simultaneously on your monitor’s main screen depends on the module type. Type A modules support one wave and two numerics, type B modules support two waves and six numerics.

Module:

Auxiliary

Ventilator

Gas Analyzer B

Anesthesia Machine B

Auxiliary Plus

A

B

B

Type Max

Wave

2

2

1

2

2

a module name

b device label

c selection LED

d setup key

e external device cable connector

f setup indicator LED

g module type (A or B)

6

6

2

6

6

Max numeric

External Devices

standalone measurement module ventilators gas analyzers anesthesia machines external multi-measurement devices a b c d

VueLink

VENTILATOR

PB 7200a/ae

SIEMENS

900C/D/E NEO

SIEMENS

900C/D/E AD

M1032A

T

B

VueLink

60x145 e f g

The device labels (b) on the module indicate for which external devices the module is configured. The selection LED (C) shows which device is currently active. The device label text may differ slightly from the labels on the external devices.

See the documentation supplied with the VueLink module for a list of supported devices and accessories, and for configuration information.

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27 VueLink Modules

Connecting an External Device

Connecting an External Device

1

2

3

Insert the module into the FMS or integrated module slot.

Check that the device selection LED (c) lights to show that it has correctly identified the external device. If not, select

Main Setup

->

Measurements

-> <

VueLink Device Name

> to enter the setup menu for the connected device, headed

Setup <VueLink Device Name>

.

In the device setup menu, select

Device

, select the correct device from the list, and confirm the selection.

4

Connect the external device to the module (e) and switch it on.

Once the VueLink device has been correctly connected, you can select the

VueLink

SmartKey and then select the

Setup VueLink

pop-up key to access the

Setup VueLink

menu for the connected device.

CAUTION

Selecting the wrong device can cause unpredictable system behavior. Rectify this by switching off the external device when it is safe to do so, and selecting the correct device.

Changing VueLink Waves and Numerics Displayed

To change the waves and numerics from the VueLink module displayed on the Screen,

1

Select

Main Setup

->

Measurements

-> <

VueLink Device Name

menu for the connected device, headed

Setup <VueLink Device Name>

.

> to enter the setup

2

Select the item you want to change, then select the new item from the pop-up list, or

Select

Show Device Data

to view the device data window.

3

Close the setup menu. The monitor takes a few seconds to activate the change.

Viewing the VueLink Device Data Window

To view the VueLink device data window, either

• select the setup hardkey on the VueLink module or the

VueLink

SmartKey, and then select the

<Device Name>

pop-up key, or

• in the

Setup <Device Name>

menu, select

Show Device Data

.

Selecting the device data window opens the setup menu for the connected device.

282

Using VueLink Screens

Using VueLink Screens

Your monitor may be configured to show

VueLink device data permanently on the

Screens.

Select the device data window to display the

VueLink pop-up keys that let you access the setup menu and carry out

VueLink tasks.

27 VueLink Modules

Switching VueLink On and Off

To switch VueLink measurements on and off, in the

Setup VueLink

menu, select

Device Interface

to toggle between the settings

On

and

Off

.

Alarms/INOPs From External Devices

The VueLink module itself generates INOPs, but does not generate alarms. If the external device’s alarms are on, the module transmits these to the monitor. A message in the VueLink info window tells you either

Device Alarms Ignored

or

Device Alarms Accepted

or

No Alarms

Available.

External device alarms status symbols precede some, but not all, measurement labels.

!

the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.

alarms status of this external measurement is unknown

Alarms from external devices are:

• all transmitted to the monitor. For all numerics configured in the

Setup VueLink

menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the

Setup VueLink

menu, an alarm is announced as a text message for the highest priority alarm.

Priority is determined at the external device.

always non-latching on the monitor.

• announced as a flashing numeric while the alarm condition persists.

• announced audibly and visibly at the Information Center.

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27 VueLink Modules

Language Conflict with External Device Drivers

Language Conflict with External Device Drivers

You should avoid language conflicts between the VueLink module device driver and the monitor. Be aware that if you connect a VueLink module with a different operating language to the monitor, the monitor will show:

• measurement labels in the monitor language

• alarm and INOP texts in the VueLink module device driver language.

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28

28

Using Timers

With the Timers function you can set timers to notify you when a specific time period has expired.

CAUTION

Do not use the timers to schedule critical patient-related tasks.

Viewing Timers

You can view currently active timers in the

Timers

window or directly on the Main Screen (if a timer has been substituted for a numeric).

To open the

Timers

window:

Select the

Timers

SmartKey or

Select

Main Setup -> Timers

The maximum number of timers which can be active depends on your monitor model.

For each timer with a defined run time a progress bar is shown with the run time for that timer. Next to the progress bar the elapsed time or the remaining time is shown, depending on whether the timer is counting

Up

or

Down

. On the left, the label of the timer and a symbol indicating the type of expiry notification is shown.

Notification

When any timer expires (except a No Limit timer), the color changes to red and a message appears in the status line on the Main Screen. Be aware that if a timer has been configured to display in red, the color will not change when the timer expires.

Additional notification is also available and can be pre-configured to:

Alarm An INOP alarm indicates the expiry of the timer

Sound A single tone indicates the expiry of the timer

No Sound No additional notification

This additional notification setting is made in the monitor’s Configuration Mode and is associated with the timer label. The volume of the tone can also be set in Configuration Mode

285

28 Using Timers

Timer Setup Pop-up Keys

Timer Types

There are four types of timer:

Basic

,

Enhanced

,

Cyclic

and

No Limit

. A

Basic

timer has a single, defined run time and progress is shown in the progress bar. An

Enhanced

timer is like a

Basic

timer but the progress bar shows progress beyond the end of the run time. A

Cyclic

timer is like a

Basic

timer but restarts automatically when the run time is expired. A

No Limit

timer has no run time or progress bar and shows the time elapsed since the timer was started.

The type of timer is set in the monitor’s Configuration Mode and is associated with the timer label.

Timer Setup Pop-up Keys

When you open the

Timers

window and select a timer, the

Setup

window opens and a selection of pop-up keys appear to let you activate and control the timers.

Pop-Up Keys Selecting this pop-up key lets you....

Start

Stop

Clear

Timers

start the timer. stop the timer, allowing either restarting after a pause (

Start

key) or clearing

(

Clear

key).

clear the timer, ending this timer episode.

return to the timer window showing all active timers

Setting Up Timers

The additional notification setting is made in the monitor’s Configuration Mode and is associated with the timer label. The timer type, display color of the timer and whether a window automatically pops up on expiry are also settings made in Configuration Mode for each timer label.

The remaining timer settings can be made in Monitoring Mode. If you change settings when a timer is running it will not be stopped. The timer will continue to count but the new settings will be applied.

To display the Setup window for a timer,

♦ in the

Timers

window, select the required timer, or

♦ select a timer on the Main Screen then select

Setup Timers

Timer Label

You can select from a variety of specific labels, for example Tourniquet, Infusion, Documentation or from four non-specific labels Timer A, B, C, D. When you assign a label to a timer, the monitor automatically applies the associated configuration settings to this timer, but the timer continues counting and is not reset.

To select a label, in the

Timers

window:

1

Select the required timer to display the

Setup

window.

2

Select

Label

.

3

Select a specific or non-specific label from the list.

286

Displaying Timers On The Main Screen

28 Using Timers

Run Time

The run time can be set between 1 minute and 96 hours.

No Limit

timers have no run time.

To set the run time, in the

Timers

window:

1

Select the required timer to display the

Setup

window.

2

Select

Run Time

.

3

Select a run time from the list.

Timer Counting Direction

Timers can count up or down, showing elapsed time or remaining time.

No Limit

timers automatically count up.

To change the direction, in the

Timers

window:

1

2

Select the required timer to display the

Setup

window.

Select

Direction

to switch between

Up

and

Down

.

Displaying Timers On The Main Screen

If you want to have a timer displayed on the Main Screen, you can substitute it for a numeric which is not directly associated with a wave. If limited space is available, some elements displayed in the

Timers

window may not be displayed. The minimum information displayed is the label and the elapsed or remaining time.

TimerA

2 hrs

To display a timer on the Main Screen:

1

Select the numeric you want to substitute.

2

Select

Change Numeric

.

3

4

Select

Any Timer

.

Select the timer to be displayed.

287

28 Using Timers

Displaying A Clock On The Main Screen

Main Screen Timer Pop-up Keys

When you select a timer displayed on the Main Screen, additional pop-up keys become available:

Pop-Up Keys Selecting this pop-up key lets you....

Setup

“Label”

enter the setup screen for the currently selected timer.

Change

Timer

select a different timer for display.

Displaying A Clock On The Main Screen

In the same way that you can substitute a timer for a numeric, you can also substitute a larger clock display for a numeric.

To display a clock on the Main Screen:

1

Select the numeric you want to substitute.

2

Select

Change Numeric

.

3

Select

Clock

.

288

29

29

Respiratory Loops

Using a VueLink module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient’s lung function , and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close).

You can measure:

• Pressure-volume loops

• Pressure-flow loops

• Volume-flow loops.

Note that you cannot store loops from different patients and different source devices in the same list as they are patient and device specific.This prevents you from inadvertently comparing information from different patients.

Viewing Loops

In the loops display, the current loop is drawn in white, and up to six stored loops are color-coded to match their timestamps. The currently-used source device is shown in the window title.

To view respiratory loops permanently on your Screen,

♦ select the current Screen name to open the

Change Screen

configured to display the loops screen element.

menu, then select a Screen

Select the loops screen element to access the loops pop-up keys.

289

29 Respiratory Loops

Capturing and Deleting Loops

Loops: Ohmeda 7900

To open the

Loops

window, and its associated pop-up keys,

♦ select

Main Setup

->

Loops

, or select the

Loops

SmartKey, if configured.

In the

Loops

window, in addition to the stored loops, three realtime airway waves and six available numerics from the source device can be shown.

Loop capture in progress......

Capture

Loop

Select

Loop

Loops

Select

Size

Print

Loop

Loop

Type

Setup

Device

Capturing and Deleting Loops

Up to six loops of each kind can be stored for reference.

To capture the current Loop and display it in the

Loops

window,

♦ select the

Capture Loop

pop-up key.

The monitor will prompt you to save the loop for reference, either in addition to or in place of previously stored loops.

Status messages at the bottom of the window provide information on the loop capture process.

To delete Loops from the reference list,

Select the the list.

Select Loop

pop-up key to view the list of stored loops and delete the loops from

Showing/Hiding Loops

Colored rectangles beside the loops timestamps and color-coded with the loops tell you whether each loop is currently displayed or not:

– A filled-in rectangle marks loops currently shown in the Loops window

– A rectangle outline marks loops not currently shown.

Selecting the timestamp of the currently-displayed loop hides it and shows the next in the list; selecting the timestamp of a currently hidden loop displays it.

290

Changing Loops Display Size

29 Respiratory Loops

Changing Loops Display Size

To change the loops display size, in the

Loops

window, select the pop-up key

Select Size

then select

Size x 0.5

to display loops at half the usual size

Size x 1

to display loops at the usual size

Size x 2

to display loops at twice the usual size

This does not affect the size of loops printed in reports.

Using the Loops Cursor

To view the coordinates for any point on a stored loop,

1

Select the pop-up key

Select Loop

.

2

3

Select the required loop from the list of available loops.

Use the arrow pop-up keys to move the cursor around the loop. The values for both loop axes are shown for every point on the loop.

Select the X at the top of the loop list to exit the cursor.

Changing Loops Type

To change the loop type, in the

Loops

window, select the

Loop Type

pop-up key (only available if the source device delivers three waves), then select

Press/Volume

to display Pressure/Volume loops

Flow/Volume

to display Volume/Flow loops

Press/Flow

to display Pressure/Flow loops.

or, if the source device only delivers two waves,

1

2

In the

Loops

window, select the

Setup Device

pop-up key to enter the

Setup <VueLink Device>

menu.

Select

Wave 1

and select pressure, flow, or volume waves as required. Repeat for

Wave 2

.

Setting Up Source Device

The source device for the loops is indicated in the

Loops

window title.

Select the

Setup Device

pop-up key to view the settings of the current source device.

If the source device is changed, all reference loops from a previous device are cleared from the reference list when the first loop from the new source device is captured. Reconnecting the previous device recalls its reference list.

291

29 Respiratory Loops

Documenting Loops

Documenting Loops

1

2

In the

Loops

window, select the pop-up key

Print Loop

From the list of available loops, select an individual loop, or select Print All to print a report of all

For each loop, the report prints

• the currently-displayed loop, with the loop capture timestamp

• up to six realtime numerics provided by the loop source device

• SpO

2

, etCO

2

, PO

2

, and PCO

2

numerics from the patient monitor, if available.

Lastname, Firstname

Bed Label

Respiratory Loops Report

Source Device

Loop Captured at 10 Jan 2004 13:10

10 Jan 13:30

2.0

A

W

1.0

V

[l]

TV

MV awRR inO2

550 ml

7.15

l/min

13

100 rpm mmHg etCO2 imCO2

38

0.1

SpO2 99

SpO2 l 98

SpO2 r 99 mmHg mmHg

%

%

%

0.0

0

AWP [mmHg]

50

Philips Hospital Name Page number

292

30

30

Care and Cleaning

Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods.

Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to “Guidelines for Prevention of

Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-

Safety Workers” issued by the U.S. Department of Health and Human Services, Public Health Service,

Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country.

General Points

Keep your monitor, modules, Multi-Measurement Server, measurement server extensions, Flexible

Module Server, cables and accessories free of dust and dirt. After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first.

Observe the following general precautions:

• Always dilute according to the manufacturer’s instructions or use lowest possible concentration.

• Do not allow liquid to enter the case.

• Do not immerse any part of the equipment in liquid.

• Do not pour liquid onto the system.

• Never use abrasive material (such as steel wool or silver polish).

• Never use bleach.

WARNING

Do not operate any devices when they are wet. If you spill liquid on the equipment, battery, or accessories, contact your service personnel or Philips service engineer.

The general care and cleaning information given here meets the requirements of Aspect Medical

Systems for their BIS measurement devices.

293

30 Care and Cleaning

Cleaning

Cleaning

Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene.

Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the connectors of the

Multi-Measurement Server, the measurement server extensions and measurement modules. Wipe around, not over, connector sockets.

CAUTION

To clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by selecting and holding the Main Screen key until the padlock symbol appears on it, indicating that touch operation is disabled. Select and hold again to re-enable touch operation. Unplug a mouse before cleaning it. Switch off the monitor to disable an attached

SpeedPoint Device before cleaning the device.

Recommended cleaning agents are:

Tensides (dishwasher detergents)

Ammonias

Alcohol

Disinfecting

Edisonite Schnellreiniger

, Alconox

Dilution of Ammonia <3%, Window cleaner

Ethanol 70%, Isopropanol 70%, Window cleaner

CAUTION

Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.

Hospital policy: Disinfect the product as determined by your hospital’s policy, to avoid long term damage to the product.

Clean equipment before disinfecting. Recommended disinfecting agents are:

Alcohol based

Aldehyde based

Ethanol 70%, Isopropanol 70%, Cutasept forte, Sagrosept , Spitacid

, Sterilium fluid

, Hospisept

, Kodan

Tinktur

(only Ethanol 70% and Isopropanol 70% are tested and qualified)

Cidex

 activated dialdehyde solution, Gigasept

(only Cidex is tested and qualified)

Cleaning Monitoring Accessories

To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory.

294

Sterilizing

30 Care and Cleaning

Sterilizing

Sterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies.

Cleaning the Recorder Printhead (M1116B only)

1

2

If you run recordings at low speed (1 or 2cm/min) for extended periods, deposits of paper debris may collect on the print head making recordings unevenly fainter in horizontal stripes.

Remove the recorder.

Open the recorder door and un-thread the paper from behind the rubber roller.

3

4

Tear off or roll up the excess paper into the roll chamber to get it out of your way.

Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two inches of the strip come out from the top of the roller.

5

6

7

Close the recorder door, aligning both ends of the strip over the top of the door.

Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip through and out of the recorder.

Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the recorder.

Cleaning the Batteries and Battery Compartment

MP20/MP30

MP40/MP50

Only

Wipe with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap. Do not use strong solvents. Do not soak the battery.

295

30 Care and Cleaning

Cleaning the Batteries and Battery Compartment

296

31

31

Using the Batteries

IntelliVue

MP20/MP30/

MP40/MP50 only

MP20/MP30: one OR two Philips

M4605A rechargeable Lithium Ion batteries must be inserted into the battery compartment at the rear of the monitor to use the MP20/MP30 monitor with battery power.

Battery compartment

MP40/MP50: two Philips M4605A rechargeable Lithium Ion batteries must be inserted into the battery compartment at the rear of the monitor to use the MP40/MP50 monitor with battery power.

Battery compartment

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31 Using the Batteries

Battery Power Indicators

The MP60/MP70/MP80/MP90 monitors cannot be powered by battery.

You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring.

The batteries recharge automatically whenever the monitor is connected to mains power.

Battery operation may not be available in all geographies.

Battery Power Indicators

The battery LED and battery status information on the Main Screen, in combination with INOP messages and prompts, help you keep track of the battery power status. The indicators always show the remaining capacity in relation to the battery’s actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the

Battery Status

window.

When both batteries are empty the monitor switches off automatically.

Battery LED

The battery LED on the front panel of the monitor is indicated by a battery symbol.

Battery LED

Battery LED Colors

Green

Yellow

Red, flashing

Red, flashes intermittently

Red, flashes once when on/ standby switch is pressed

If the monitor is connected to mains power, this means

battery power is > 90% batteries charging (battery power

< 90%)

If the monitor is running on battery power, this means

battery malfunction less than 10 minutes power remaining battery malfunction not enough battery power left to power monitor

MP40/50 only

If only one battery is inserted during charging, the battery LED is yellow during charging and switches off when the battery is charged.

Battery Status on the Main Screen

Battery status information can be configured to display permanently on all Screens. It shows the status of each of the batteries detected and the combined battery power remaining, with an estimate of the monitoring time this represents.

1 2

3:40 hrs

298

Battery Power Indicators

31 Using the Batteries

Battery status symbols: These symbols tell you the status of the batteries (see table below) and which battery compartment they are in, either 1 or 2.

Battery power gauge: This shows the remaining battery power in the combined batteries. It is divided into sections, each representing 20% of the total power. If three and a half sections are shaded, as in this example, this indicates that 70% battery power remains. If no batteries are detected, the battery gauge is grayed-out. If no data is available from the batteries, questions marks are shown in the gauge.

Monitoring Time Available: Below the battery power gauge a time is displayed. This is the estimated monitoring time available with the current battery power. Note that this time fluctuates depending on the system load (the display brightness and how many measurements and recordings you carry out), the age of the battery, and the remaining capacity of the battery.

Battery malfunction symbols: If a problem is detected with a battery, these symbols alternate with the symbol indicating the position of the battery affected. They may be accompanied by an INOP message or by a battery status message in the monitor information line providing more details. Symbols indicating critical situations are colored red.

Battery status symbols Battery malfunction symbols

1

Battery 1 is present

Battery compartments are empty

Battery requires maintenance

2

Incompatible battery

(Battery 1)

2

1

Battery malfunction

(Battery 1)

Battery 2 is missing, insert battery (MP40/

50 only)

1 battery is empty battery not charging as the temperature is above or below the specified range

(red) battery temperature too high

Battery 2 has no power left

If both batteries are malfunctioning or incompatible, the monitor will switch off automatically for safety reasons, if it is not connected to AC power.

299

31 Using the Batteries

Checking Battery Charge

Battery Status Window

To access the

Battery

Status

window and its associated pop-up keys, select the battery status information on the

Screen, or select

Main

Setup

->

Battery

.

Battery Status

Capacity hrs

TimeToEmpty: 5hrs 10 min

Batt 1

Batt 2

[mAh] remaining fullCharge

[mAh]

Capacity, Remaining

tells you how much power is left in each battery.

Capacity, Full Charge

tells you how much power each battery can hold when fully charged.

Time To Empty

tells you approximately how long you can continue to use the monitor with these batteries. Note that this time fluctuates depending on the system load (the display brightness and how many measurements and recordings you carry out), the age of the battery, and the remaining capacity of the battery.

Time To Full

is shown in place of

Time To Empty

if the monitor is connected to mains power, and tells you how much time is left until the batteries are charged to 90%. When the batteries are charging you can see how much monitoring time the current charging status represents under the battery symbol.

Viewing Individual Battery Status

To view information for individual batteries, select the pop-up key

Battery 1

or

Battery 2

.

Recording Battery Status

To print the information in the

Battery Status

window on a connected recorder,

1

2

Select the battery status information on the Screen to open the

Battery Status

window

Select the

Record Status

pop-up key.

Printing Battery Reports

To print the information in the

Battery Status

window on a connected printer,

1

2

Select the battery status information on the Screen to open the

Battery Status

window

Select the

Print Status

pop-up key.

Checking Battery Charge

To check the charge status of a battery in a monitor, see the battery power gauge on the Screen or select

Main Setup

->

Battery

to enter the

Battery Status

window.

To check the charge status of a battery that is not connected to a monitor or battery charger, press the black dot marked “PUSH” on the labeled side of the battery. The remaining charge is indicated by four LEDs on the electronic fuel gauge directly above the dot. Each LED represents 25% of

300

Replacing Batteries

31 Using the Batteries

charge. If all LEDs are lit, the battery is fully charged, if only one LED is lit, 25% or less charge is left.

Replacing Batteries

MP40/MP50

You can replace batteries without switching off the monitor, if you replace them one at a time and if the remaining battery has sufficient power. The

Battery Missing

INOP is suppressed for 30 seconds while you exchange each battery.

MP20/MP30

When using the monitor with only one battery, insert the new battery before removing the previous battery, to avoid leaving the monitor without power.

To replace batteries,

1

Press the battery compartment latch to open the battery compartment door.

2

3

4

5

6

To replace battery 1, rotate the battery retainer until the battery can be removed.

To replace battery 2, rotate the battery retainer until the battery can be removed.

Pull gently on the canvas strap to move the battery towards you, then grasp the battery and pull it out fully.

Slide the new battery into position, making sure that the positive and negative poles are facing in the correct direction, as outlined on the inside of the battery compartment door.

Repeat with the second battery if required.

Center the battery retainer and close the battery compartment door.

Optimizing Battery Performance

The performance of rechargeable batteries may deteriorate over time. Maintaining your batteries as recommended here can help to slow down this process.

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31 Using the Batteries

Optimizing Battery Performance

Display Brightness Setting

In the

Main Setup

menu, select

User Interface -> Brightness

- >

Optimum

.

This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings.

Satisfy yourself that this level of brightness is suitable for your monitoring location.

Note that your monitor may be configured to dim or brighten the display brightness automatically when you disconnect from power, to suit the most common transport scenario

(“

TransportBrightn

” setting).

Charging Batteries

Batteries can be charged in monitors used to monitor patients. Charging is quicker in unused monitors. Contact your local Philips representative for information on external battery chargers. Use only Lithium Ion battery chargers approved by Philips.

1

2

Insert the batteries into a monitor connected to mains power. The battery LED will light yellow to indicate that charging is in process.

Charge the battery until it is full, the battery LED is green, and the battery power gauge is fully shaded.

Conditioning Batteries

CAUTION

Do not use a monitor being used to monitor patients to condition batteries. The monitor switches off automatically when the batteries are empty.

You must condition a battery when its “battery requires maintenance” symbol shows on the Screen. Do not interrupt the charge or discharge cycle during conditioning. To condition a battery,

1

Insert the battery into a monitor connected to mains power.

2

Charge the battery until it is completely full. Open the

Battery Status

window and check that the

Batteries fully charged

or

Battery 1

/

Battery 2 fully charged

message is displayed.

3

4

Disconnect the monitor from mains power, and let the monitor run until the battery is empty and the monitor switches itself off.

Reconnect the monitor to mains power and charge the battery until it is full for use or charge to

50% for storage.

Contact your local Philips representative for information on external battery chargers/conditioners.

Use only Lithium Ion battery chargers approved by Philips.

Unequally-Charged Batteries

If two batteries in a monitor are unequally charged, the monitor can compensate by causing the fuller battery to discharge faster. For this mechanism to work, the charge state of the two batteries should not differ by more than 50%.

302

Battery Safety Information

31 Using the Batteries

Battery Safety Information

WARNING

Use only Philips batteries part number M4605A. Use of a different battery may present a risk of fire or explosion.

Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury.

Dispose of used batteries promptly and in an environmentally-responsible manner. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements.

CAUTION

Do not disassemble, heat above 100

°

C (212

°

F) or incinerate the batteries, to avoid the risk of fire and burns. Keep batteries out of the reach of children and in their original package until you are ready to use them.

If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Clean the battery compartment according to the instructions.

303

31 Using the Batteries

Battery Safety Information

304

32

32

Maintenance and

Troubleshooting

WARNING

Schedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.

Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.

Inspecting the Equipment and Accessories

You should perform a visual inspection before every use, and in accordance with your hospital’s policy.

With the monitor switched off:

1

Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse.

2

If the MMS and Server Extensions are mounted on the monitor, make sure that they are locked into place and do not slide out without releasing the locking mechanism.

3

4

Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use.

Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier.

Inspecting the Cables and Cords

1

2

3

Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.

Inspect the Measurement Server Link cable and ensure that it makes good connection with the

MMS and the FMS. Make sure that there are no breaks in the insulation.

If the MMS is not mounted directly on the monitor, inspect the cable connecting it to the monitor. Make sure the connectors are properly engaged.

305

32 Maintenance and Troubleshooting

Maintenance Task and Test Schedule

4

5

Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.

Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.

Maintenance Task and Test Schedule

The following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation CD.

Ensure that these tasks are carried out as indicated by the monitor’s maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.

Maintenance and Test Schedule Frequency

Monitor Tests

Safety checks. Selected tests on the basis of IEC 60601-1

At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped.

Monitor Maintenance

Check ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation)

Replace backlight

(integrated displays only)

At least once every two years, or as needed.

25,000 - 30,000 hours (about three years) of continuous usage, or as needed.

Measurement Server and Module Tests

Performance assurance for all measurements not listed below.

At least once every two years, or if you suspect the measurement values are incorrect.

Measurement Server and Module Maintenance

At least once every two years, or as specified by local laws.

At least once a year or after 4000 operating hours.

NBP calibration

Microstream CO

2 performance test

calibration and

Mainstream and sidestream CO

2 calibration check (M3014A)

Battery Maintenance

Battery

At least once a year, or if you suspect the measurement values are incorrect.

See the section on Maintaining Batteries

306

Troubleshooting

32 Maintenance and Troubleshooting

Troubleshooting

If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly.

If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log,

1

In the

Main Setup

menu, select

Revision

.

2

Select a pop-up key according to the status log you want to consult, for example, to check the status log for the MMS, select the

M3001A

pop-up key.

3

View the status log by selecting the

Stat Log

pop-up key.

Disposing of the Monitor

WARNING

To avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your country’s laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste.

You can disassemble the monitor, MMS, FMS and modules as described in the Service Guide.

– There is no metal molded into the plastic case, and there are no metal sprays on the plastic.

– All plastic parts with a weight greater than 10g (0.35 ounces) are marked with the ISO code for identification.

– The sheet metal card cage uses only one kind of steel.

– The screen has a touch resistor laminate.

– You can recycle the paper Instructions for Use.

The battery can be easily removed (see “Replacing Batteries” on page 301),

and can be returned, free of charge, to the worldwide-recycling program run by the battery manufacturer (contact your local supplier).

Disposing of Empty Calibration Gas Cylinders

1

2

3

Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.

When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.

Write “Empty” on the cylinder and dispose of it appropriately for scrap metal.

WARNING

Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.

307

32 Maintenance and Troubleshooting

Disposing of Empty Calibration Gas Cylinders

308

33

33

Accessories

You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details.

WARNING

Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard.

Philips’ approval: Use only Philips-approved accessories.

Packaging: Do not use a sterilized accessory if its packaging is damaged.

ECG/Resp Accessories

This symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.

Trunk Cables

Length 3-Electrode Cable Set 5-Electrode Cable Set

0.9m

2.7m

AAMI

Part No.

M1540C

M1500A

3-Electrode Cable Sets

Description Length

OR 1.0m

IEC

Part No.

M1550C

M1510A

AAMI

Part No.

M1560C

M1520A

AAMI Part No.

M1601A

IEC

Part No.

M1570C

M1530A

IEC Part No.

M1611A

10-Electrode

Cable set

AAMI/IEC

Part No.

n/a

M1949A

309

33 Accessories

ECG/Resp Accessories

Description

ICU Grabber shielded

ICU snap shielded

ICU Clip non-shielded

ICU Clip non-shielded

5-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU Snap shielded

ICU Clip non-shielded

10-Electrode Cable Sets

Length

1.0m

1.0m

0.45m

0.7m

Length

1.0m/1.6m

1.0m/1.6m

1.0m/1.6m

0.7m/1.3m

AAMI Part No.

M1603A

M1605A

M1608A

M1609A

AAMI Part No.

M1621A

M1623A

M1625A

M1629A

IEC Part No.

M1613A

M1615A

M1618A

M1619A

IEC Part No.

M1631A

M1633A

M1635A

M1639A

Description

OR Grabber - extremities

OR Grabber - chest

ICU Extremities

ICU Chest

3-Electrode One Piece Cables

Length

1.0m/1.6m

1.0m

1.0m/1.6m

1.0m

AAMI Part No.

M1973A

M1979A

M1968A (grabber)

M1976A (grabber)

IEC Part No.

M1974A

M1984A

M1971A (grabber)

M1978A (grabber)

AAMI 3-Electrode

One Piece Cables

OR Grabber

ICU Snap

Length

1.9m

1.9m

5-Electrode One Piece Cables

AAMI

Part No.

IEC 3-electrode One

Piece Cables

IEC

Part No.

M1970A OR Grabber M1980A

M1972A ICU M1981A

AAMI 5-electrode

One Piece Cables

OR Grabber

ICU Snap

Length

2.5m

2.5m

AAMI

Part No.

M1975A

M1977A

IEC 5-electrode One

Piece Cables

OR Grabber

ICU Grabber

IEC

Part No.

M1985A

M1986A

310

NBP Accessories

33 Accessories

Set Combiners and Organizers

Set combiners and organizers

Set combiner

Set organizer

3-electrode

5-electrode

Shielded 3-electrode

Shielded 5-electrode

Bedsheet clip

Part No.

M1501A

M1502A

M1503A

M1504A

M1509A

NBP Accessories

These cuffs and tubings are designed to have special protection against electric shocks

(particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery.

Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs

Patient Category Limb

Circumference

Bladder

Width

Adult (Thigh)

Large Adult

Adult

Small Adult

Pediatric

Infant

42 to 54 cm

34 to 43 cm

20 cm

16 cm

27 to 35 cm 13 cm

20.5 to 28 cm 10.5 cm

14 to 21.5 cm 8 cm

10 to 15 cm 5.5 cm

Disposable cuff

Part No.

M1879A

M1878A

M1877A

M1876A

M1875A

M1874A

Reusable Cuff Kits

Reusable cuff

Part No.

Tubing

M1576A

M1575A

M1574A

M1573A

M1572A

M1571A

M1598B (1.5m) or

M1599B (3m)

Cuff Kits Part No.

Infant, pediatric, small adult, adult

Small adult, adult, large adult, thigh

M1577A

M1578A

Infant, pediatric, small adult, adult, large adult, thigh M1579A

311

33 Accessories

NBP Accessories

Adult/Pediatric Antimicrobial Coated Reusable cuffs

Patient Category (color) Limb

Circumference

(cm)

Adult Thigh (grey) 45 - 56.5

Large Adult X-Long (burgundy) 35.5 - 46.0

Large Adult (burgundy)

Adult X-Long (navy blue)

35.5 - 46.0

27.5 - 36.5

Adult (navy blue)

Small Adult (royal blue)

Pediatric (green)

Infant (orange)

27.5 - 36.5

20.5 - 28.5

13.8 - 21.5

9 - 14.8

Bladder Width Part No.

21.0 cm

17.0 cm

17.0 cm

13.5 cm

13.5 cm

10.6 cm

8.0 cm

5.4 cm

M4559A

M4558A

M4557A

M4556A

M4555A

M4554A

M4553A

M4552A

Tubing

M1598B

(1.5m) or

M1599B (3m)

Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs

Patient Category

Adult (Thigh)

Large Adult X-Long

Large Adult

Adult X-Long

Adult

Small Adult

Pediatric

Infant

Limb Circumference

(cm)

Bladder

Width

45 - 56.5 cm

35.5 - 46 cm

35.5 - 46 cm

27.5 - 36.5

27.5 - 36.5 cm

20.5 - 28.5 cm

15.0 - 21.5 cm

9 - 15 cm

20.4 cm

16.4 cm

16.4 cm

13.1 cm

13.1 cm

10.4 cm

8.0 cm

5.6 cm

Neonatal/Infant Cuffs (Disposable, non-sterile)

Part No.

M4579A

M4578A

M4577A

M4576A

M4575A

M4574A

M4573A

M4572A

Cuffs

Size 1

Size 2

Size 3

Size 4

Limb Circumference

(cm)

3.1 to 5.7 cm

4.3 to 8.0 cm

5.8 to 10.9 cm

7.1 to 13.1 cm

Bladder Width Part No.

2.2 cm

2.8 cm

3.9 cm

4.7 cm

M1866A

M1868A

M1870A

M1872A

Tubing

M1598B (1.5m) or

M1599B (3m)

Tubing

M1596B (1.5m) or

M1597B (3m)

312

Invasive Pressure Accessories

33 Accessories

Invasive Pressure Accessories

These transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.

If you are using the M3012A Hemodynamic Measurement Server Extension, and you want to measure temperature and invasive pressure at the same time, we recommend that you use the pressure transducer

CPJ840J6, with a round module connector piece, and not a transducer with a square connector. Pressure transducers with square connectors may make it difficult to connect the adjacent Temperature connector at the same time.

Transducer, accessories, sensor kits

Reusable pressure transducer 5

µ

V/.V/mmHg sensitivity

Sterile disposable pressure domes for CPJ840J6 (pack of 50)

Transducer holder for CPJ840J6 (pack of 4)

IV pole mount for CPJ840J6

Single channel disposable sensor kit (20) - (EU/EFTA only)

Dual channel disposable sensor kit (20) (EU/EFTA only)

Transducer holder for M1567/8A (EU/EFTA only)

IV pole mount for M1567/8A (EU/EFTA only)

Part No

CPJ840J6

CPJ84022

CPJ84046

CPJ84447

M1567A

M1568A

M2271A

M2272C

M1634A Adapter cable for disposable sensor kit 3,0m for M1567/8A

Pressure transducer kits

PiCCO monitoring kit, 30cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A

PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A

PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A and central venous pressure line

PULSION Pressure Interface Cable for disposable pressure transducer

PV8103

PV8115

PV8115CVP

PMK 206

SpO

2

Accessories

This section lists accessories for use with Philips SpO

2

technology. For accessory lists for other SpO technologies, refer to the instructions for use provided with these devices.

2

Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the

Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare.

Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “Long” version).

All listed sensors operate without risk of exceeding 41

37 o

C.

o

C on the skin if ambient temperature is below

313

33 Accessories

SpO

2

Accessories

The M1020B SpO

2

module with Option A02 may not be available in all countries. Some sensors may not be available in all countries. Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor.

Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result.

Option A01 is the Philips FAST-SpO

2

version; Option A02 is the Nellcor OxiMax-compatible version.

Product

Number

Description Compatible with:

Opt. A01 Opt. A02

Philips reusable sensors.

M1191A

M1191AL M1191A with longer cable (3 m)

M1192A Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and

50 kg. Any finger except thumb.

M1193A

Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb.

Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot.

yes yes yes yes

M1194A

M1195A

M1191T

M1192T

M1193T

Ear sensor (1.5m cable) for patients more than 40 kg.

yes

Infant sensor (1.5m cable) for patients between 4kg and 15 kg. Any finger except thumb.

yes

Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb.

yes

Small adult, pediatric sensor (0.45m cable) for patients between 15 kg and

50 kg. Any finger except thumb.

Neonatal sensor (0.9m cable) for patients between 1kg and 4 kg. Hand or foot.

yes yes no no no no no no no no no

Comments

No adapter cable required.

Requires M1943

(1 m) or M1943AL

(3 m) adapter cable

314

SpO

2

Accessories

33 Accessories

Product

Number

Description Compatible with:

M1191ANL Special Edition (SE)

Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb.

M1192AN Special Edition (SE)

Opt. A01 Opt. A02

yes yes

Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and

50 kg. Any finger except thumb.

M1193AN Special Edition (SE) yes

Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot.

M1194AN Special Edition (SE) yes

Ear sensor (1.5m cable) for patients more than 40 kg.

M1195AN Special Edition (SE) yes

Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb.

yes yes yes yes yes

Philips disposable sensors. Not available in the USA.

M1904B

M1903B

M1902B

M1901B

Identical to OxiMax MAX-A

Identical to OxiMax MAX-P

Identical to OxiMax MAX-I

Identical to OxiMax MAX-N yes yes yes yes yes yes yes yes

Comments

No adapter cable required.

No adapter cable required.

Option A01: Use adapter cable

M1943A or

M1943AL.

Option A02: Must use adapter cable

M1943NL.

Philips disposable sensors. Available worldwide.

M1131A Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg) yes no

M1132A

M1133A

Infant finger or toe sensor, 0.9m cable

(patient size 3 - 10 kg)

Adult/Infant/Neonatal, 0.9m cable

Foot or hand for neonates < 3 kg

Big toe or thumb for patients between

10kg and 20kg

Any finger except thumb for patients

> 40kg yes yes no no

Use adapter cable

M1943A or

M1943AL.

Use adapter cable

M1943A or

M1943AL.

Use adapter cable

M1943A or

M1943AL.

315

33 Accessories

SpO

2

Accessories

Product

Number

Description Compatible with:

Opt. A01 Opt. A02

NELLCOR disposable sensors (must be ordered from Nellcor)

OxiMax

MAX-A

OxiMax

MAX-AL

OxiMax

MAX-P

Adult finger sensor (patient size kg)

OxiMax MAX-A with long cable

>30

OxiMax

MAX-I

Infant foot/hand sensor (patient size

3-20 kg)

OxiMax

MAX-N

Adult finger or neonatal foot/hand sensor (patient size

MAX-FAST Forehead sensor

>40 kg or <3 kg)

OxiMax

MAX-R

OxiMax SC-

A

Pediatric foot/hand sensor (patient size

10-50 kg)

Adult nasal sensor

Adult softcare sensor

Neonatal softcare sensor OxiMax SC-

NEO

OxiMax SC-

PR

Oxisensor II

D-25

Oxisensor II

D-20

Preterm infant softcare sensor

Adult sensor (patient size

>30kg)

Pediatric sensor (patient size 10-50 kg) yes yes yes yes yes no no no no no yes yes

Oxisensor II

I-20

Oxisensor II

N-25

Infant sensor (patient size

3-20 kg)

Neonatal sensor (patient size

>40 kg)

OxiCliq A See OxiMax MAX-A

OxiCliq P See OxiMax MAX-P

OxiCliq I See OxiMax MAX-I

OxiCliq N See OxiMax MAX-N

<3 kg or yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes no no no no yes yes yes yes

Comments

Option A01: Use adapter cable

M1943A or

M1943AL.

Option A02: Must use adapter cable

M1943NL.

Must use

M1943NL adapter cable.

Must use M1943A or M1943 AL adapter cable

Option A01

: Use adapter cable

M1943A or

M1943AL together with OC3 adapter cable.

Option A02

: Must use adapter cables

M1943NL and

OC3 adapter cable.

316

SpO

2

Accessories

33 Accessories

Product

Number

Description Compatible with:

Oxiband

OXI-A/N

Oxiband

OXI-P/I

Durasensor

DS100A

Adult / neonatal sensor

Pediatric / infant sensor

Adult finger clip sensor

Dura-Y D-YS Y-sensor

Opt. A01 Opt. A02

no no no no

Extension / Adapter Cables for Philips and Nellcor Sensors

yes yes yes yes

M1941A Extension cable (2 m) yes yes

M1943A

M1943AL

M1943NL

OC 3

Adapter cable (1.1 m cable)

Adapter cable (3 m cable)

OxiMax adapter cable (3 m cable)

Adapter Cable for OxiCliq sensors yes yes no yes no no yes yes

Comments

Must use

M1943NL adapter cable

For use with Philips reusable sensors and adapter cables.

Adapter cable for

Philips/Nellcor disposable sensors.

Adapter cable for

Philips disposable/

Nellcor disposable and reusable sensors.

Available from

Nellcor only.

Product

Number

Description

Compatible with:

Opt. A01

MASIMO LNOP

reusable sensors. Require AC-1 adapter cable

Opt. A02

LNOP DC-I Adult Sensor

LNOP DC-IP Pediatric Sensor yes yes

LNOP-Y-I Reusable Multi-Site Sensor yes

LNOP TC-I Tip Clip reusable Sensor

MASIMO LNOP

 yes

disposable sensors. Require AC-1 adapter cable no no no no

LNOP Adt

LNOP Adtx

Adult Sensor

Adult Sensor

LNOP Pdt

LNOP Pdtx

Pediatric Adhesive Sensor

Pediatric Sensor

LNOP INF-L Neo/Infant Adhesive Sensor

LNOP NEO-L Neo Adhesive Sensor

LNOP NEOPT-

L

Neo Pre-Term Sensitive Skin Adhesive

Sensors

Adapter Cable for MASIMO sensors.

M1020-61101 AC-1 Adapter Cable for Masimo

Sensors (8-pin version) yes yes yes yes yes yes yes yes no no no no no no no no

Philips Part

Number

989803140321

989803140331 n/a

989803140341

989803140231 n/a

989803140261 n/a

989803140311

989803140291

989803140301

451261000771

317

33 Accessories

Temperature Accessories

The Philips M3001A option A01 Multi-Measurement server and the M1020B option

A01 SpO2 Module use Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo.

Sensors for use with the Masimo SET

SpO

2

Module and orderable from Philips

Sensors

LNOP Adult Adhesive Sensors (box of 20)

Adult Sensor Sample Pack (4 sensors)

Neo Sensor Sample Pack (4 sensors)

Pediatric Adhesive Sensors (box of 20)

LNOP Neonatal Adhesive Sensors (box of 20)

Neo Pre-term Sensitive Skin Adhesive Sensors (box of 20)

Neo Adhesive Sensors (box of 20)

Neo Pre-term Sensitive Skin Adhesive Sensors (box of 20)

Neo/Infant Adhesive Sensors (box of 20)

DC-I Adult Reusable Sensor

DCIP Pediatric Reusable Sensor

LNOP TC-I Tip Clip Reusable Sensor

Neo Sensitive Replacement Posey Wrap (12)

Neo Replacement Tapes (100)

Philps Order No

989803140231

989803140241

989803140251

989803140261

989803140271

989803140281

989803140291

989803140301

989803140311

989803140321

989803140331

989803140341

989803140351

989803140361

Temperature Accessories

Temperature Probes

Reusable

General purpose probe

Small flexible vinyl probe (Infant/Pediatric)

Attachable surface probe

Disposable

General purpose probe

Skin probe

Esophageal/Stethoscope Probe (12 French)

Esophageal/Stethoscope Probe (French 18)

Esophageal/Stethoscope Probe (French 24)

Foley Catheter Probe (12 French)

Part No.

21075A

21076A

21078A

M1837A

21091A

21093A

21094A

21095A

M2255A

Minimum measurement time for accurate readings

90 sec

60 sec

60 sec

90 sec

60 sec

180 sec

210 sec

310 sec

180 sec

318

Cardiac Output (C.O.) Accessories

33 Accessories

Temperature Probes

Foley Catheter Probe (16 French)

Foley Catheter Probe (18 French)

Adapter cable 1.5m

Adapter cable 3.0m

Part No.

21096A

21097A

21082B

21082A

Minimum measurement time for accurate readings

180 sec

180 sec

Cardiac Output (C.O.) Accessories

See Pressure accessories for PULSION continuous cardiac output accessories.

Description

Accessories common to both methods

Accessories

PiCCO inline temperature probe for warmer injectate

Set of ice buckets

Remote handswitch

Latex free

Right Heart Thermodilution

C. O. Interface Cables 2.7 meter cable (right heart only)

2.4 m + 2.4 m cable

Right heart catheter for thermodilution (from Baxter)

Baxter CO-set (only with HP 23001A/B) contact Baxter for information

Injectate Probes 2.4m injectate temp. probe (reusable)

0.5m injectate temp. probe (reusable)

Ice bath temp. probe (right heart only)

Transpulmonary Thermodilution

C. O. Interface Cables

Injectate Probes

2.4 m + 2.4 m cable

2.4m injectate temp. probe (reusable)

0.5m injectate temp. probe (reusable)

Baxter CO-set (only with HP 23001A/B) contact Baxter for information

Pressure Transducer Kits (PULSION) PV 8003 (30cm pressure line)

PV 8010 (100cm pressure line)

Pressure Interface Cable for disposable pressure transducer

PV 8015 (150cm pressure line)

PULSION PMK 206

Part No

14455A

15244A

M1646A

M1642A

M1643A

831HF75

23001A

23001B

23002A

M1643A

23001A

23001B

319

33 Accessories

Mainstream CO

2

Accessories (for M3014A)

Mainstream CO

2

Accessories (for M3014A)

Description Part No.

CO

2

Sensor M2501A

Adult/Pediatric Airway Adapter (reusable) M2513A

Infant Airway Adapter (reusable)

Adult Airway Adapter (single-patient use)

Infant Airway Adapter (single-patient use)

M2516A

M2533A

M2536A

Sidestream CO

2

Accessories (for M3014A)

Description

CO

2

Sensor

Nasal and Oral-Nasal Cannulas

CO

2

Nasal Cannula, Adult

CO

2

Nasal Cannula, Pediatric

CO

2

Nasal Cannula, Infant

CO

2

/ O

2

Nasal Cannula, Adult

CO

2

/ O

2

Nasal Cannula, Pediatric

CO

2

Oral-Nasal Cannula, Adult

CO

2

Oral-Nasal Cannula, Pediatric

CO

2

/ O

2

Oral-Nasal Cannula, Adult

CO

2

/ O

2

Oral-Nasal Cannula, Pediatric

Airway Adapters

Airway Adapter Set, ET > 4.0 mm

Airway Adapter Set H, ET > 4.0 mm

Airway Adapter Set H, ET =< 4.0 mm

Straight Sample Lines

Straight Sample Line

Straight Sample Line H

Part No.

M2741A

M2744A

M2745A

M2746A

M2750A

M2751A

M2756A

M2757A

M2760A

M2761A

M2768A

M2772A

M2773A

M2776A

M2777A

Mainstream CO

2

Accessories (for M3016A)

Description

CO

2

Sensor

Standard Airway Adapter (reusable)

Small Airway Adapter (reusable)

Part No.

M1460A

M1465A

14363A

320

Microstream CO

2

Accessories

33 Accessories

Microstream CO

2

Accessories

• “FilterLine Set” is a combination of a FilterLine with an Airway Adapter.

• “H” in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.

• “Smart CapnoLine” is a combined oral-nasal FilterLine.

• “Smart CapnoLine O

2

” is a combined oral-nasal-O

2

-CO

2

FilterLine.

• “NIV Line” is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).

• “Single purpose” means CO

2

measurement only, “dual purpose” means CO

2

measurement and O

2 delivery.

• The accessories are supplied in packs of 25.

Microstream accessory selection flowchart

Short-term

(up to 6 hours)

Yes

Long-term

(up to 72 hours)

Is the patient intubated?

No

Does the patient need oxygen?

Short term

(up to 8 hours)

Oral/Nasal

Yes

Long term

(up to 24 hours)

Nasal

No

Long-term

(up to 24 hours)

Short term

(up to 8 hours)

Short term

(up to 8 hours)

Nasal Oral/Nasal Nasal

Key Applications

Critical Care OR, EMS, ED Procedural

Sedation, Critical

Care, EMS, ED

Critical Care,

Sleep Lab, Longterm Pain

Management

Philips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate)

Critical Care,

Sleep Lab

FilterLine Set:

A/P: M1920A

FilterLine H Set:

A/P: M1921A

I/N: M1923A

Smart

CapnoLine O

2

:

A: M2522A

P: M2520A

CapnoLine HO

2

A: M4680A

P: M4681A

: CapnoLine H:

A: M4689A

P: M4690A

I/N: M4691A

Procedural

Sedation,

Critical Care,

EMS, ED

Smart

CapnoLine:

A: M2526A

P: M2524A

EMS, ED

NIV Line:

A: 4686A

P: M4687A

Spirometry Accessories

Description

Adult/Pediatric Flow Sensor

Neonatal Flow Sensor

Adult/Pediatric CO

2

/Flow Sensor

Neonatal CO

2

/Flow Sensor

Pediatric CO

2

/Flow Sensor

Part No.

M2785A

M2786A

M2781A

M2782A

M2783A

321

33 Accessories

tcGas Accessories

tcGas Accessories

This symbol indicates that the specified transducer (but not its membranes) is designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and is defibrillator proof.

Description

12x tc Accessory Kit (O-ring remover, absorbent paper, electrolyte solution, replacement membrane) tc Application Kit (4x25 disposable fixation rings, 4x20ml contact fluid)

Calibration gas - 6 gas bottles

Calibration gas - 6 gas bottles (Europe and Japan only)

Replacement tubing (5 tubes) tcpO

2

/CO

2

transducer

Calibration unit

Radiometer TCC3 calibration unit (available from Radiometer)

EEG Accessories

Part No.

15209-60010

15209-60020

15210-60010

15210-64010

M2205A

M1918A

15210B n/a

Description

Trunk Cable 2.7m

Trunk Cable, 1.0 m

Reusable 80-cm-long 5-lead cables with 10mm silver/silverchloride leadwired cup electrodes (Adult)

Reusable 80-cm-long 5-lead cables with 6mm silver/silverchloride leadwired cup electrodes (Pediatric/Neonatal)

Reusable 80 cm 5-lead cables with clip

Disposable EEG electrodes

EC2™ Electrode Cream (conductive paste)

Part No.

M2268A

M2269A

M1931A

M1932A

M1934A

M1935A

M1937A

BIS Accessories

Use only Aspect BIS sensors with the BIS module or BIS Interface board (MP20/MP30). The sensor is a silver/silverchloride electrode array that uses Aspect’s patented ZipPrep technology and a proprietary connector. The sensor/electrodes are for single patient use only. Check shelf-life before use.

The patient interface cable (Philips Ordering No. M1034-61630, Aspect Part No. 186-0131) has an estimated lifetime of one year. Do not scrap it when disposing of the BIS sensor.

The sensor cable from the Semi-Reusable Sensor is re-usable but has a maximum number of uses, the electrodes are single patient use only. The monitor displays how many uses remain for the sensor cable.

322

SvO

2

Accessories

33 Accessories

BIS Sensors

To re-order sensors outside North America, contact your nearest Philips sales office and quote the

Philips ordering number. In North America, contact Aspect Medical Systems.

Description Pieces per pack Philips Ordering No Aspect Part No

BIS and BISx - compatible

BIS Sensor Quatro (formerly Sensor XP) 50

BIS Sensor Plus

BIS Sensor Pediatric

50

25

BIS Sensor Pediatric (4 electrode) 25

BIS Semi-reusable Sensor (not available in

USA, Japan)

BIS Sensor Extend

100

50

M1997A

M4546A

M1998A

989803143581

M4615A n/a

186-0106

186-0076

186-0110

186-0200

186-0164

186-0160

Other BIS Accessories

Order the following parts from your nearest Philips sales office and quote the Philips ordering number

Description

BIS M1034A only

BIS Engine Cable - Short (0.8 m)

BIS Engine Cable - Long (2.0 m)

PIC PLUS Cable

BIS Universal Clamp Mount

BIS FMS Mount (Flexible Module Server)

BIS Mount for MP40/MP50

Philips Ordering No

M1034-61610

M1034-61620

M1034-61630

M1180A #C32

M1180A #C33

M8003- 64011

SvO

2

Accessories

Contact your local Hospira representative for information on accessories. They are not available from

Philips. Part numbers may vary according to country of purchase.

Description

Optical Module

Pulmonary artery catheter

Pulmonary artery catheter

Pulmonary artery catheter

Intravascular catheters

Intravascular catheters

Intravascular catheters

Hospira Part No. French Size

50131

50324-05

50355-03

50328-05

50404-01

50405-01

50407-01

7.5F

5.5F

8F

4F

4F

5.5F

Length

110cm

75cm

110cm

40cm

25cm

40cm

323

33 Accessories

Recorder Accessories

Description

For M1116B recorder:

10 rolls of paper

80 rolls of paper

For integrated recorder (MP20/MP30):

10 rolls of paper

80 rolls of paper

Part No.

40477A

40477B

M4816A

M4817A

Recorder Accessories

324

34

34

Installation and Specifications

The specifications in this section apply to the MP20, MP30, MP40, MP50, MP60, MP70, MP80 and

MP90 patient monitors, unless otherwise stated.

The monitors are not user installable. They must be installed by qualified service personnel.

Intended Use

The monitors are intended to be used for monitoring, recording, and alarming of multiple physiological parameters of adults, pediatrics, and neonates in health care facilities. The devices are to be used by trained health care professionals.

All the monitors are intended for use in health care facilities; the MP20/MP30/MP40/MP50 monitors are additionally intended for use in transport situations within the hospital setting.

The monitors are only for use on one patient at a time. They are not intended for home use. Rx only:

U.S. Federal Law restricts this device to sale by or on the order of a physician. Not a therapeutic device.

The transcutaneous gas measurement (tcGas) is restricted to neonatal patients only.

ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients.

The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11).

BIS is intended for use under the direct supervision of a licensed health care practitioner or by personnel trained in its proper use. It is intended for use on adult and pediatric patients within a hospital or medical facility providing patient care to monitor the state of the brain by data acquisition of EEG signals. The BIS may be used as an aid in monitoring the effects of certain anesthetic agents.

Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation.

Indication for Use

The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.

325

34 Installation and Specifications

Manufacturer’s Information

Manufacturer’s Information

You can write to Philips at this address

Philips Medizin Systeme Boeblingen GmbH

Hewlett-Packard-Str. 2

71034 Boeblingen

Germany

Visit our website at: www.philips.com.

© Copyright 2002 - 2005. Koninklijke Philips Electronics N.V. All Rights Reserved.

BIS Manufacturer’s Information

BISx, the BIS engine, the DSC, the Patient Interface Cable and the BIS Sensor are manufactured by

Aspect Medical Systems:

Aspect Medical Systems, Inc

141 Needham St

Newton,

MA 02464

USA

1-617-559-7000

Free call:

1-888-BIS_INDEX

1-888-247-4633

Email: [email protected]

Web: www.aspectmedical.com

Address of the EU Authorized Representative:

Aspect Medical Systems International B.V.

Rijnzathe 7d2

3454 PV De Meern

The Netherlands

Phone: +31.30.662.9140

Email: [email protected]

326

Manufacturer’s Information

34 Installation and Specifications

Trademark Acknowledgement

PiCCO

ΤΜ

is a trademark of Pulsion Medical Systems AG.

Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc, and are registered in the USA,

EU and other countries.

Oxisensor

ΤΜ

II, Oxi-Cliq

ΤΜ

, and OxiMax

ΤΜ

are trademarks of Tyco Healthcare Group LP, Nellcor

Puritan Bennett Division.

Microstream

, FilterLine

, and Smart CapnoLine

are trademarks or registered trademarks of Oridion

Systems Ltd.

Citrix® and ICA® (Independent Computing Architecture) are registered trademarks of Citrix

Systems, Inc.

Masimo

, Masimo SET

, and LNOP are federally registered trademarks of the Masimo Corporation.

Other product and company names mentioned in this book may be trademarks of their respective owners.

327

34 Installation and Specifications

Symbols

Symbols

These symbols appear on the monitor and its associated equipment.

Symbols

Refer to accompanying documents

Protective earth

RS-232

RS232 connector

Standby

Equipotential grounding

Connection direction indicator

Alternating current

Electrical input indicator

Electrical output indicator

(On some older measurement servers and extensions, and modules, this symbol may indicate the gas input.)

(On some older measurement servers and extensions, and modules, this symbol may indicate the gas output.)

Gas input indicator Gas output indicator

2002-

06

Identifies year and month of manufacture

Connection direction indicator

Connector has special protection against electric shocks and is defibrillator proof

Quick mount release

Serial/MIB connector Interruption indicator FMS Power On

Indicator - Ready for operation

Mouse connection indicator

Parallel interface indicator for connection to parallel printer

Measurement server link connection indicator

Keyboard connection indicator

Nurse call relay connection indicator

12 Volt DC LAN connection, for connection to wireless device

Printer connection indicator

Digital video device connection indicator for connection to independent display

LAN connection indicator for connection to a wired network

328

Installation Safety Information

34 Installation and Specifications

Symbols

device

(SpeedPoint or Alarm Device) connection indicator

Philips remote

Antenna connector

Analog interface indicator for connection to any analog video display

Digital interface indicator for connection to any digital video display

Non-ionizing radiation symbol

Locked position

Battery symbol

Data input/output symbol

12V

LAN/SER

12V

12 Volt DC LAN connection indicator for connection to serial interface

12 Volt DC socket

Unlocked position Always use separate collection for waste electrical and electronic equipment (WEEE)

Installation Safety Information

WARNING

If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1. Consult your service personnel.

Grounding

Equipotential

Grounding

The monitors or the MP80/MP90 processing unit must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a threewire to two-wire adapter.

If the monitors or MP80/MP90 processing unit are used in internal examinations on the heart or brain, ensure that the room incorporates an equipotential grounding system to which the monitor and MP80/MP90 processing unit have separate connections.

Combining equipment Combinations of medical equipment with non-medical equipment must comply with

IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment.

Fusing The monitors use double pole/neutral fusing.

Connectors

The actual placement of boards and configuration of connections for your monitor depends on how

your hardware has been configured. See the symbols table on page 328 to see which symbols are used

to mark the connections.

WARNING

Connect only medical devices to the ECG output connector socket.

329

34 Installation and Specifications

MP20/MP30

MP20/MP30 Left side of monitor

1

Installation Safety Information

2

1

2

MMS and one extension

ECG analog output/marker input connector

330

MP20/MP30 Rear of monitor

1

11

2

3

4 5 6

7

8 9

10

1 Measurement Server

Link connector

2 AC power inlet

3 Remote alarm connector

4 Analog video out connector

5 Wired network connector

6 Wireless network connector

7 Battery compartment

8 Equipotential grounding

9 Protective earth

10 Space for optional interface boards, e.g. serial/MIB (RS232) connectors, or optional parallel printer connection

11 Side cover with antenna for IntelliVue

Instrument Telemetry

Wireless Network

(USA only)

Installation Safety Information

MP40/MP50

MP40/MP50 Rear of monitor

1

14

34 Installation and Specifications

2 3 4 5 6 7

11

12

13

8 9

10

1 Space for optional interface boards, e.g. serial/MIB (RS232) connectors, or optional parallel printer connection

2 Equipotential grounding

3 Protective earth

4 AC power inlet

5 Wireless network connector for use with wireless LAN or

Instrument Telemetry adapter

6 Remote alarm connector

7 Analog video out connector

8 Wired network connector

9 Battery compartment

10 Measurement Server

Link connector

11 IntelliVue Instrument

Telemetry adapter

(USA only)

12 Monitor connector (to

5 above)

13 12V DC Power Inlet

(to 5 above)

14 Antenna connector

331

34 Installation and Specifications

MP40/MP50 Left side of monitor

1

Installation Safety Information

3

1

2

3

MMS and one extension

Plug-in module slots

ECG analog output/marker input connector

2

MP60/MP70

Right side of monitor (MP60/70)

1

2

3

7

4

6

5

8

9

10

11

1

4

5

2

3

Serial/MIB (RS232) connectors

(optional), type RJ45

Parallel printer connector

Keyboard connector

8

9

6

7

Mouse/trackball connector

Main measurement server link (MSL)

Wired network connector

Wireless network connector

Analog video out connector

Equipotential ground connector

10 AC power input

11 Protective earth screw hole

332

Installation Safety Information

Left side of monitor (MP60/70)

1

2

3

4

34 Installation and Specifications

1

2

3

4

MMS patient cable connectors

Slot for integrated recorder module or measurement module

Additional measurement server link

(MSL) cable (alternative or additional to

MSL on right of monitor)

ECG analog output/marker input connector

333

34 Installation and Specifications

Installation Safety Information

MP80/MP90

MP80/MP90 (rear of processing unit) - MP80 does not have the top row of connectors

2 3 4 5 6 7 8 9 10

1

11

21 20 19 18 17 16 15

7

8

5

6

3

4

1

2

9 Primary display - analog video out connector

10 Independent display - digital video out connector

11

Serial/MIB (RS232) connectors, type RJ45

Serial/MIB (RS232) connectors, type RJ45

12

13

Independent display - remote alarm device connector 14

Keyboard connector 15

Independent display - remote SpeedPoint connector 16

Independent display - mouse/trackball connector 17

Independent display - keyboard connector

Independent display analog video out connector

18

19

20

21

Primary display - digital video out connector

14 13 12

ECG analog output/marker input

Wired network connector

Wireless network connector

Primary measurement server link

Parallel printer connector

Additional measurement server link

Remote SpeedPoint connector

Mouse/trackball connector

Remote alarm connector

Flexible nurse call interface

334

Installation Safety Information

MP80/MP90 (front of processing unit)

1

34 Installation and Specifications

2

3

4

5 6 7 8

1

2

3

4

AC Power LED

Error LED

Power on LED

Power on switch

5

6

7

8

Power supply

AC power input

Protective earth screw hole

Equipotential grounding point

802.11 Bedside Adapter (Wireless Network Adapter)

802.11 Bedside Adapter (can be used with all monitors)

1

2

1

3

Antenna

LEDs - green and yellow LEDs light up during startup while selftests are performed. During normal operation the green LED indicates whether Radio is currently on or off; the yellow LED remains off

Combined power/network cable

2

3

335

34 Installation and Specifications

Altitude Setting

Altitude Setting

Altitude affects tcGas and CO

2

measurements. The monitor must be configured at installation to the correct altitude.

Monitor Safety Specifications

0366

The monitors, together with the Multi-Measurement Server (M3001A), and the Flexible Module

Server (M8048A), all modules and measurement server extensions, comply with the Medical Device

Directive 93/42/EEC.

In addition, the product complies with:

IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 60601-

1:2003; UL 2601.1:1994; CAN/CSA C22.2#601.1-M90; JIS T 1001-1992; IEC 60601-1-1:2000;

EN 60601-1-1:2001; IEC 60601-1-2:2001; EN 60601-1-2:2001.

Classification (according to IEC 60601-1): Class 1, Type CF, Continuous Operation. The BIS measurement uses a Type BF applied part.

The possibility of hazards arising from software errors was minimized in compliance with ISO

14971:2000, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999.

This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-

001 du Canada.

0123

185-0145-PH Aspect BISx, 185-0111 Aspect BIS Engine and 185-0124 Aspect DSC comply with the requirements of the Council Directive 93/42/EEC of 14 June 1993 (Medical Device Directive).

The MP20/30 including IntelliVue Instrument Telemetry and the MP40/50 with the IntelliVue

Instrument Telemetry adapter comply with part 15 of the FCC Rules. Operation is subject to the condition that these devices do not cause harmful interference

. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical

Telemetry Service.

IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network Adapter) - FCC and Industry

Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of

Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.

The maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210.

The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210.

The device for the band 5150-5350 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems.

336

Monitor Safety Specifications

34 Installation and Specifications

The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly

Available Interfaces (PAI) and used throughout the EEA.

CAUTION

High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and

5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices.

IntelliVue 802.11 Bedside Adapter CE compliances:

This device is compliant to Council Directive 73/23/EEC (Low voltage directive) & 89/

336/EEC (EMC directive) & 1999/5/EC (Radio Equipment and Telecommunications

Terminal Equipment Directive)

The radio component contained in this device is compliant to Council Directive 1999/5/

EC (Radio Equipment and Telecommunications Terminal Equipment Directive)

WARNING

To minimize the risk of causing severe burns during MR imaging, ensure that transducers, sensors and cables are positioned so that no inductive loops are formed. If the measurement does not appear to be operating properly, remove all transducers, sensors and cables immediately from the patient.

Physical Specifications

Product

MP20/MP30

MP40/MP50

Max Weight W x H x D

< 6 kg

< 13 lb

< 8.6 kg

< 19 lb

< 10 kg

< 22.05 lb

< 345 x 275 x 230 mm

13.6 x 11 x 9 in

< 365 x 330 x 217 mm

14 x 13 x 8.5 in

< 405 x 360 x 170 mm

15.95 x 14.17 x 6.69 in

Comments

including M3001A, recorder, and battery, without options including M3001A, recorder, and battery, without options without handle and speedpoint device, without options

MP60/MP70

(with speedpoint)

MP70

(with touchscreen operation)

MP80/MP90/D80

M3001A

Multi-Measurement Server (MMS)

M3012A

Hemodynamic Measurement Server

Extension

M3014A

Measurement Server Extension -

Capnography

M3015A

Measurement Server Extension -

Microstream CO

2

< 10 kg

< 22.05 lb

< 650g

< 1.4lb

< 550 g

1.2 lb

< 500 g

< 0.99 lb

< 550 g

< 1.21 lb

342 x 108 x 505 mm

13.47 x 4.25 x 19.88 in

188 x 96.5 x 51.5 mm

7.4

x 3.8 x 2 in

< 190 x 98 x 40 mm

< 7.5 x 4 x 1.6 in

< 190 x 98 x 40 mm

< 7.5 x 4 x 1.6 in

< 190 x 98 x 40 mm

< 7.5 x 4 x 1.6 in including AC cable, cable cover and feet

337

34 Installation and Specifications

Monitor Safety Specifications

Product

M3016A

Measurement Server Extension -

Mainstream CO

2

M8048A

Flexible Module Server (FMS)

M8045A

Docking Station

M8025A

Remote Alarm Device

M8026A

Remote SpeedPoint

M8031A

XGA Touchscreen LCD Display

M1006B

Invasive Press Module

M1029A

Temperature Module

M1012A

Cardiac Output Module

M1014A

Spirometry Module

M1018A

Transcutaneous Gas Module

M1020B

SpO

2

Module

M1021A

Mixed Venous Oxygen Saturation

Module

M1027A

Electroencephalograph Module

M1034A

BIS Interface Module

BISx

- DSC Digital Signal Converter

- BIS Engine

M1032A

Vuelink Module

M1116B

Thermal Array Recorder Module

Max Weight W x H x D

< 450 g

< 0.99 lb

< 190 x 98 x 40 mm

< 7.5 x 4 x 1.6 in

Comments

< 3500g

< 7.7lb

2700g

5.95lb

< 300 g

< 0.7 lb

< 400 g

< 0.9 lb

< 320 x 120 x 35 mm

12.6 x 4.7 x 5.3 in

250 x 160 x 270 mm

9.8 x 6.3 x 10.6 in

62 x 125 x 63 mm

2.4 x 5 x 2.5 in

103 x 139 x 63 mm

4 x 5.5 x 2.5 in

< 4.9 kg

< 10.8 lb

408 x 333 x 85 mm

16 x 13.1 x 3.4 in

190 g (6.7 oz)

Option #C01:

225 g (7.9 oz)

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

215 g (7.6 oz) 36 x 99.6 x 97.5 mm,

1.4 x 3.9 x 3.8 in

225 g (7.9 oz.) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

250 g (8.8 oz.) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in3

350 g (11.3 oz) 72.5 x 99.6 x 97.5 mm,

2.9 x 3.9 x 3.8 in

< 250 g

0.55 lb

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

460 g

(13.04 oz)

72.5 x 99.6 x 97.5 mm

2.9 x 3.9 x 3.8 in) without plug-in modules dimensions without lever with mounting bracket

210 g (7.4 oz) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

215 g

7.6 oz

450 gr

1 lb

36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

102 x 38 mm

4 x 1.5 in

130 g (4.6 oz)

(without cabling)

66 x 25 x 107 mm

2.6 x 1.0 x 4.25 in

170 g (6.0 oz) 43 x 93 x 95 mm

1.7 x 3.7 x 3.8 in

240 g (8.4 oz) 36 x 99.6 x 97.5 mm

1.4 x 3.9 x 3.8 in

507.5 g

17.9 oz.

73 x 99.6 x 97 mm

2.9 x 3.6 x 3.9 in.

without cables with PIC Plus Cable (1.22 m, 4 ft) and cable to BIS module with PIC Plus Cable (1.22 m, 4 ft)

338

Monitor Safety Specifications

34 Installation and Specifications

Environmental Specifications

The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges.

When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.

Monitor MP40, MP50, MP60, MP70, MP80, MP90

Item

Temperature Range

Condition

Operating

Non-operating

Battery storage

Range

0 to 35 °C (32 to 95 °F)

-20 to 60 °C (-4 to 140 °F)

-20 to 50 °C (-4 to 122 °F)

Monitor MP60, MP70 in conjunction with IntelliVue 802.11 Bedside Adapter (option #J35)

Temperature Range

Operating 0 to 30 o

C (32 to 86 o

F)

Monitor MP20, MP30

Item

Temperature Range

Condition Range

Operating

Operating when charging battery or when equipped with

IntelliVue Instrument

Telemetry

Non-operating

Battery storage

0 to 40 °C (32 to 104°F)

0 to 35 °C (32 to 95 °F)

-20 to 60 °C (-4 to 140 °F)

-20 to 50 °C (-4 to 122 °F)

Monitor MP20, MP30, MP40, MP50, MP60, MP70, MP80, MP90

Item

Humidity Range

Altitude Range

Condition

Operating

Non-operating

Operating

Non-operating

Range

20% to 85% Relative Humidity (RH) (non condensing)

5% to 85% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 12000 m (40000 ft)

339

34 Installation and Specifications

Monitor Safety Specifications

Measurement Server M3001A, Measurement Server Extensions M3016A M3015A, M3014A,

M3012A, Measurement Modules, and Flexible Module Server M8048A

Item

Temperature Range

Humidity Range

Altitude Range

Condition

Operating

Non-operating

Operating

Non-operating

Operating

Non-operating

Range

0 to 45 °C (32 to 113 °F)

-40 to 70 °C (-40 to 158 °F)

95% Relative Humidity (RH) max. @ 40 °C (104 °F). M3015A only non-condensing.

90% Relative Humidity (RH) max. @ 65 °C (150 °F)

-500 m to 4600 m (-1600 to 15000 ft)

-500 m to 15300 m (-1600 to 50000 ft)

D80 Intelligent Display

Item

Temperature Range

Humidity Range

Altitude Range

Condition

Operating

Non-operating

Battery storage

Operating

Non-operating

Operating

Non-operating

Range

0 to 35 °C (32 to 95 °F)

-20 to 60 °C (-4 to 140 °F)

-20 to 50 °C (-4 to 122 °F)

20% to 85% Relative Humidity (RH) (non condensing)

5% to 85% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 12000 m (40000 ft)

Docking Station M8045A

Item

Temperature Range

Humidity Range

Altitude Range

Condition

Operating

Non-operating

Operating

Non-operating

Operating

Non-operating

Range

0 to 40 °C (32 to 100 °F)

-20 to 60 °C (-4 to 140 °F)

20% to 85% Relative Humidity (RH) (non condensing)

5% to 85% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 12000 m (40000 ft)

Thermal Array Recorder Module M1116B

Item

Temperature Range

Condition

Operating

Non-operating

Range

+5 to 45 °C (41 to 113°F)

-10 to 70 °C (14 to 158 °F)

340

M4605A Battery Specifications

34 Installation and Specifications

Thermal Array Recorder Module M1116B

Item

Humidity Range

Condition

Operating

Altitude Range

Non-operating

Operating

Non-operating

Range

95% Relative Humidity (RH) max @ 40°C (104°F) (non condensing)

95% Relative Humidity (RH) max @ 65°C (150°F) (non condensing) up to 3048 m (10000 ft) up to 3048 m (10000 ft)

Remote SpeedPoint M8026A

Item

Temperature range

Humidity range

Altitude range

Condition

Operating

Storage

Operating

Storage

Operating

Storage

Range

0 ... 55

°

C (32 ...130 °F)

-20 … 60

°

C (-4 ... 140 °F)

95 %RH max. at 40

°

C (100

°

F)

85 %RH max. at 50

°

C (120

°

F)

-500 … 4.600 m (-1600 ... 15000 ft)

-500 … 13.100 m (-1600 ... 43000 ft)

Remote Alarm Device M8025A

Item

Temperature range

Humidity range

Altitude range

Condition

Operating

Storage

Operating

Storage

Operating

Storage

Range

0 ... 55

°

C (32 ...130

°

F)

-20 … 60

°

C (-4 ... 140

°

F)

95 %RH max. at 40

°

C (100

°

F)

85 %RH max. at 50

°

C (120

°

F)

-500 … 4.600 m (-1600 ... 15000 ft)

-500 … 13.100 m (-1600 ... 43000 ft)

M4605A Battery Specifications

MP20/MP30/

MP40/MP50

Only

Two batteries are required to operate the MP40/MP50 monitors. The MP20/MP30 monitors can operate with one battery.

M4605A Battery Specifications

Physical Specifications

W x D x H

Weight

Performance Specifications

Nominal Voltage

Rated Capacity at discharge C/5

Continuous Discharge Capability

Environmental Specifications

149 mm (5.866 in) x89 mm (3.504 in) x 19.8 mm (0.78 in)

490 g (1.08 lb) per battery

10.8 Volt

6000 mAh

6.5 A

341

34 Installation and Specifications

Monitor Performance Specifications

M4605A Battery Specifications

Temperature Range

Humidity Range

Battery Type

Safety

Electromagnetic Compatibility (EMC)

Communication Standard

Discharge 0 to 50

°

C (32 to 122

°

F)

Charge 0 to 45

°

C (32 to 113

°

F)

Storage -20 to 60

°

C (-4 to 140

°

F)

40% to 95% Relative Humidity (RH)

Smart Battery 10.8V, 6000mAh, Lithium Ion complies with UL 1642 (UL Recognized) and IEC 61960-2:2001 complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3 complies with the SMBus specification v1.1

Monitor Performance Specifications

MP20/30, MP40/50, MP60/70/80/90

Power Specifications

Battery Specifications

MP40/MP50

Power consumption

Line Voltage

MP60/MP70/MP80/

MP90 Current

MP20/MP30/MP40/

MP50

Current

Frequency

Operating Time

(with 2 new, fully charged batteries)

Charge Time

(

MP60/70/80/90: < 145 W

MP20/30, MP40/50: < 100 W

100 to 240 V ~

1.6 to 0.7 A

1.8 to 1.0 A

50/60 Hz ~

Basic monitoring configuration: 5 hours

Brightness

set to

Optimum

measurement every 15 minutes)

, MMS connected, NBP

Extended monitoring configuration: 4 hours

(

Brightness

set to

Optimum

, MMS and measurement server extension connected, NBP every 15 minutes, Recorder,

Pressure, Temperature modules connected)

When monitor is off: 4 hours

When monitor is in use: 5 to 12 hours, depending on monitor configuration

342

Monitor Performance Specifications

34 Installation and Specifications

MP20/30, MP40/50, MP60/70/80/90

Battery Specifications

MP20/MP30

Operating Time

(with 2 new, fully charged batteries)

Operating Time

(with 1 new, fully charged battery)

Basic monitoring configuration: 5 hours

(

Brightness

set to

Optimum

, MMS connected, NBP measurement every 15 minutes)

Extended monitoring configuration: 4 hours

(

Brightness

set to

Optimum

, MMS and measurement server extension connected, NBP every 15 minutes, Recorder, every 15 minutes)

Basic monitoring configuration: 2.5 hours

(

Brightness

set to

Optimum

, MMS connected, NBP measurement every 15 minutes)

Extended monitoring configuration: 2 hours

Indicators

Charge Time

Alarms Off

Alarms

On/Standby

AC Power

(

Brightness

set to

Optimum

, MMS and measurement server extension connected, NBP every 15 minutes, Recorder, every 15 minutes)

When monitor is off: 4 hours

When monitor is in use: 5 to 12 hours, depending on monitor configuration red (crossed-out alarm symbol) LED red/yellow/cyan LED green LED green LED

Sounds

Trends

Error

Battery LED (MP20/

30/40/50 only) red LED red/yellow/green LED

Audible feedback for user input

Prompt tone

QRS tone, or SpO

2

modulation tone

4 different alarm sounds

Remote tone for alarms on other beds in network

Tone for Timer expired

Resolution

Information

12, 16, 24 or 32 numerics @ 12 sec, 1 minute, 5 minute resolution

Multiple choices of number of numerics, resolution and duration depending on trend option and application area.

For example: neonatal extended 12 numerics, 24 hours @ 12 secs or 32 numerics 32 hours @ 1 minute intensive care extended: 16 numerics 120 hours @ 5 minutes anesthesia extended 32 numerics 9 hours @ 12 seconds

High-Res Trend Waves

Measurements available

Resolution

Update speed

HR, SpO

2

, Resp, tcpO

2

, Pulse, Perf, tcpO

2

, CO

2

, ABP, PAP,

CVP, ICP, CPP, BIS, CCO, AWP, Anesthetic Agents, Delta

SpO

2

, inO

2

Measurement samples are taken at a resolution of four samples per second waves are drawn at a speed of 3 cm/minute

343

34 Installation and Specifications

Monitor Performance Specifications

MP20/30, MP40/50, MP60/70/80/90

Events

Alarm signal

Review Alarms

Real Time Clock

Buffered Memory

Information

Episode data

Range

Accuracy

Hold Time

Hold Time

Contents trigger condition and time, event classification and associated detailed view of episode data configurable (except MP20/30), either:

4 minutes of high resolution trend or

20 minutes of numerics trend @ 12 sec. resolution or

15 seconds of 4 waves @ 125 samples/sec. (Snapshot) including all current numerics, alarms and inops

Capacity (max)

System delay

Pause duration

For MP20/30: 4 minutes of high resolution trend

25 or 50 events for either 8 or 24 hours less than 3 seconds

1,2,3 minutes or infinite, depending on configuration

Extended alarm pause 5 or 10 minutes

Information all alarms / inops, main alarms on/off, alarm silence and time of occurrence

Capacity 100 items from: January 1, 1997, 00:00 to: December 31, 2080, 23:59

< 2 seconds per day (typically) infinite if powered by AC; otherwise at least 48 hours (typical:

> 72 hours) if powered by AC: infinite without power: at least 48 hours (typical: > 72 hours)

Active settings, trends, patient data, realtime reports, events, review alarms

MMS M3001A Performance Specifications

Trends

Trend Data Buffered

Memory

Contents if powered by monitor mains connection via MSL: infinite without power applied: at least 6 hours trend data, patient identification and all active settings

D80 Intelligent Display Performance Specifications

Power Specifications

Power consumption

Line Voltage

< 145 W

100 to 240 V ~

Current

Frequency

1.6 to 0.7 A

50/60 Hz ~

Docking Station M8045A Performance Specifications

Power

Line Voltage 100 - 240V

Frequency 50/60 Hz

Power Consumption negligible (for Power On LED)

Current to attached patient monitor max. 3.5 A

344

Monitor Performance Specifications

34 Installation and Specifications

Monitor Interface Specifications

Network

Standard

Connector

Isolation

Parallel Printer Port

Standard

Dual PS/2 Inputs

Dual MIB/RS232

Connector

Signals

Isolation

Communication

Modes

Input Voltage

Output Current

Standard

Connectors

Mode

MIB-ready/RS-232

Interface

(not available in all geographies)

Power

Isolation

Measurement data exported to external systems:

5V +/- 5%, 100mA (max.)

1.5kV

Numerics, alarms and INOPs, patient demographics, waves (up to 7; maximum number depends on the sample rate of the selected waves).

ECG Output/Marker Input (1/4” stereo phone jack with tip, ring, sleeve)

General

Connector 1/4” phone each with tip, ring, sleeve

ECG Output

(ring, tip)

Isolation

Signal Gain

500 V

320 to 3200

Full Scale on Display 3.2V

pp

Gain Error <20%

Marker Input

Requirements

(tip)

Flexible Nurse Call

Relay

Baseline Offset

Bandwidth

Output Impedance

Signal delay

Signal Type

Pulse Source

Impedance

Pulse Fall Time

Pulse Duration

Connector

Contact

Isolation

Delay

IEEE 802.3 10-Base-T

RJ45 (8 pin)

1.5 kV

IEEE 1284-I

DB-25

Level 1 and Level 2 (switchable)

1.5 kV

Compatibility (for example Centronics), Nibble, ECP, EPP

5V ±5%

250mA (comb. max) to connected PS/2 devices

IEEE 1073-3.2-2000

RJ45 (8 pin)

Software-controllable

BCC (RxD/TxD cross over) or

DCC (RxD/TxD straight through)

<150mV

1 to 80Hz

ECG Output (ring): <2.2K

±20%

ECG Output/Marker Input (tip) <2.5k

±20%

30ms

0 to -12V, negative edge pulse

<7k

<100

µ s

>4ms

20 pin MDR (Mini D-Ribbon), active open and closed contacts

3.5 mm phone jack, active closed contact only

<= 100 mA, <= 24 V DC

1.5 kV

< (Configured Latency + 0.5 sec)

345

34 Installation and Specifications

Monitor Performance Specifications

Monitor Interface Specifications

Wireless Network

Device Interface

Connector

Signals

Remote Application

Support

Technology

Capabilities

8 pin Mini-DIN

RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND

12.5 V ±20%, 3.5 W continuous

Citrix

® and

ICA

®

(Independent Computing Architecture) client, Tunneling Control Engine (TCE) a monitor connected to a Philips Application Server can show a

Windows application on the monitor display. The application can be controlled by the monitor user input devices.

Display Specifications

All displays

Integrated SVGA

Display, MP20/30

Integrated SVGA

Display, MP40/50

Integrated XGA Display,

MP60/70

External XGA Display

(e.g. M8031B),

External SXGA Display

(e.g. M8033C),

MP80, MP90, D80 only

Video Interface SVGA

MP40/MP50

Sweep Speeds

Resolution

Refresh frequency

Useful screen

Pixel size

Resolution

Refresh frequency

Useful screen

Pixel size

Resolution

Refresh frequency

Useful screen

Pixel size

Resolution

Refresh frequency

Useful screen

Pixel size

Resolution

Refresh frequency

Useful screen

Connector

60 Hz depends on size of display

Video Interface SVGA

MP20/MP30

Pixel size depends on size of display

Video Interface MP20/

30, MP40/50, MP60/70

Specifications must be the same as the integrated display

Horizontal Frequency 37.9 kHz

Video Signals

Connector

0.7 Vpp @ 75 Ohm, HSYNC/VSYNC Signals TTL

15 pin D-SUB

Horizontal Frequency

Video Signals

6.25, 12.5, 25 and 50 mm/s; additional EEG sweep speeds 15 mm/s, 30 mm/s with ±5% accuracy (guaranteed only for integrated displays)

800 x 600

60 Hz

211,2 x 158,4 mm

0.264 x 0.264 mm

800 x 600

60 Hz

246 x 184.4 mm

0.3075 x 0.3075 mm

1024 x 768

60 Hz

304 x 228 mm (12 x 9 in)

0.297 x 0.297 mm

1024 x 768

60 Hz or 75 Hz depends on size of display depends on size of display

1280 x 1024 pixel

37.5 kHz

0.7 Vpp @ 75 Ohm, HSYNC/VSYNC Signals TTL

15 pin D-SUB

346

Monitor Performance Specifications

34 Installation and Specifications

Display Specifications

Video Interface MP60/

MP70/MP80/MP90

SXGA (MP80, MP90,

D80 only), XGA

Digital Video

MP80, MP90, D80 only

Horizontal Frequency 48.4 kHz or 60.0 kHz or 64.0 kHz

Video Signals

DDC

0.7 Vpp @ 75 Ohm, HSYNC/VSYNC Signals TTL

Signals I2C compliant, 5V, 100 mA (max) (M8010 only)

Connector

Video Signals

DDC Signals

DDC Power

Connector

15 pin D-SUB

Single Link TMDS

I2C compliant

5V, 100mA (max)

DVI

Compatible Devices

Printers

PCL5 capability required Examples:

HP Laserjet 1200 (monochrome)

HP Laserjet 2100 (monochrome)

HP DeskJet 2500 C+ (color)

Do not use printers that emulate PCL5

Displays (must be approved for medical use)

MP20/30/40/50/60/70/80/90,

D80

M1097A option A02

M8031B

MP80, MP90, D80 M8033B/M8033C

Wireless Network

XGA color 15” LCD touchscreen

XGA color 15” LCD touchscreen

SXGA color 17” LCD touchscreen

Type

Technology

Frequency Band

Weight

Proxim Range LAN2 7920

Frequency Hopping Spread Spectrum (FHSS)

2.4 GHz ISM Band

300g max.

IntelliVue Instrument Telemetry Wireless Network (USA only, MP20/30/40/50 only)

Internal WMTS Adapter

(MP20/MP30)

Technology compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure

Frequency Band WMTS, 1395-1400 MHz and 1427-1432 MHz

External WMTS Adapter

M2638A

(MP40/MP50)

Technology

Frequency Band

Weight compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure

WMTS, 1395-1400 MHz and 1427-1432 MHz

350g max.

IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter)

Internal Wireless Adapter

Option J35

Technology

Frequency Band

IEEE 802.11a/b/g

2.4 GHz and 5 GHz ISM Band

347

34 Installation and Specifications

Measurement Specifications

Measurement Specifications

See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.

ECG/Arrhythmia/ST

Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-27/

EN60601-2-27:1994, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/EC13:1991/

2002.

ECG/Arrhythmia/ST Performance Specifications

Cardiotach

PVC Rate

Range

Accuracy

Resolution

Sensitivity

Range

Adult/pedi: 15 to 300 bpm

Neo range: 15 to 350 bpm

±1% of range

1 bpm

200 µV peak

0 to 300 bpm

ST Numeric

Resolution

Range

Accuracy

Resolution

Sinus and SV Rhythm

Ranges

Brady

1 bpm

-20 to +20 mm

±0.5 mm or 15%, whichever is greater

0.1 mm

Normal

Adult: 15 to 60 bpm

Pedi: 15 to 80 bpm

Neo: 15 to 90 bpm

Adult:60 to 100 bpm

Pedi: 80 to 160 bpm

Neo: 90 to 180 bpm

Tachy Adult: > 100 bpm

Pedi: >160 bpm

Neo: >180 bpm

Bandwidth

Diagnostic Mode Adult: 0.05 to 150Hz

Neo/pedi: 0.5 to 150Hz

Monitoring Mode Adult: 0.5 to 40Hz

Neo/pedi: 0.5 to 55Hz

Filter Mode

Differential Input Impedance

Common Mode Rejection Ratio

Adult/neo/pedi: 0.5 to 20Hz

>2M

RA-LL leads (Resp)

>5M

at all other leads (at 10Hz including patient cable)

Diagnostic mode: >86 dB (with a 51 k

/47 nF imbalance).

Filter mode: >106 dB (with a 51 k

/47 nF imbalance).

Electrode Offset Potential Tolerance

Auxiliary Current

(Leads off Detection)

Input Signal Range

±500mV

Active electrode: <100 nA

Reference electrode: <900 nA

±5 mV

348

Measurement Specifications

34 Installation and Specifications

ECG/Arrhythmia/ST Alarm

Specifications

HR

Range

Extreme Tachy

Extreme Brady

Run PVCs

PVCs Rate

Vent Tach HR

Vent Tach Run

Vent Rhythm Run

SVT HR

SVT Run

ST High

ST Low

Adjustment

15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard

Adult:1 bpm steps (15 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:1 bpm steps (15 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm

Difference to low limit 0 to 50 bpm

Clamping at 15 to 100 bpm

2 PVCs

5 bpm steps

5 bpm steps

5 bpm steps

Not adjustable by user

1 to 99 PVCs/minute

20 to 300 bpm

3 to 99 PVCs/minute

2 to 99 PVCs/minute

120 to 300 bpm

3 to 99 SV beats

-19.8 to +20 mm

-20 to +19.8 mm

1 PVC

5 bpm

1 PVC

1 PVC

5 bpm

1 SV beat

0.2 mm

0.2 mm

ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13

Respiration Excitation Waveform Sinusoidal signal, 260

µ

A, 39 kHz

Noise Suppression

Time to Alarm for

Tachycardia

Vent Tachycardia

1mV pp

,206 bpm

RL drive gain 44 dB max., max. voltage 1.8 Vrms

Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds

Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds

Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds

Vent Tachycardia

2 mV pp

,195bpm

Tall T-Wave Rejection Capability

Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds

Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds

Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds

Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitude

349

34 Installation and Specifications

Measurement Specifications

ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13

Heart Rate Averaging Method

Three different methods are used:

Normally, heart rate is computed by averaging the 12 most recent RR intervals.

For runs of PVCs, up to 8 RR intervals are averaged to compute the HR.

If each of 3 consecutive RR intervals is greater than 1200 ms

(that is, rate less than 50 bpm), then the 4 most recent RR intervals are averaged to compute the HR.

Response Time of Heart Rate Meter to Change in

Heart Rate

HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds

Heart Rate Meter Accuracy and Response to

Irregular Rhythm

Accuracy of Input Signal Reproduction

HR change from 80 to 40 bpm:

Range: [5.6 to 6.4 sec] Average: 6.0 seconds

Ventricular bigeminy: 80 bpm

Slow alternating ventricular bigeminy: 60 bpm

Rapid alternating ventricular bigeminy: 120 bpm

Bidirectional systoles: 90 bpm

Methods A and D were used to establish overall system error and frequency response.

Respiration

Respiration Performance Specifications

Respiration Rate

Range

Bandwidth

Noise

Accuracy

Resolution

Adult/pedi: 0 to 120 rpm

Neo: 0 to 170 rpm at 0 to 120 rpm ±1 rpm at 120 to 170 rpm ±2 rpm

1 rpm

0.3 to 2.5Hz (–6dB)

Less than 25m

(rms) referred to the input

Respiration Alarm

Specifications Range

High

Low

Adult/pedi: 10 to 100 rpm

Neo: 30 to 150 rpm

Adult/pedi: 0 to 95 rpm

Neo: 0 to 145 rpm

Apnea Alarm

10 to 40 seconds

Adjustment Delay

under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps max. 14 seconds for limits from 0 to 20 rpm: max. 4 seconds for limits above 20 rpm: max. 14 seconds

5 second steps

SpO

2

Unless otherwise specified, this information is valid for SpO

2

measured using the M3001A measurement server and the M1020B measurement module.

Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-

49:2001).

350

Measurement Specifications

34 Installation and Specifications

Measurement Validation: The SpO

2

accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements. Display Update Period: Typical: 2 seconds,

Maximum: 30 seconds. Max. with NBP INOP suppression on

:

60 seconds.

SpO

2

Performance Specifications

SpO

2

The specified accuracy is the root-meansquare (RMS) difference between the measured values and the reference values

Range

Option #A01

Accuracy

Option #A02

Accuracy

Resolution

0 to 100%

Philips Reusable Sensors:

M1191A, M1191AL, M1192A, M1192AN = 2% (70% to 100%)

M1193A, M1194A, M1195A, = 3% (70% to 100%)

M1191T, M1192T, M1193T (Adult) = 3% (70% to 100%)

M1193T (Neonate) = 4% (70% to 100%)

Philips Disposable Sensors with M1943A(L):

M1132A, M1133A (adult/infant) = 2%

M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate)

= 3% (70% to 100%)

NellcorPB

®

Sensors with M1943A(L):

MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-

25, OxiCliq A, P, I, N = 3% (70% to 100%)

Masimo Sensors

®

with AC-1:

LNOP Adt, Adtx,Pdt, Pdtx, INF-L, DC-I, DC-IP, Y-I: 2% (70% to

100%)

LNOP NEO-L, NEOPT-L: 3% (70% to 100%)

LNOP TC-I: 3.5% (70% to 100%)

Philips Reusable Sensors

M1191ANL, M1192AN = 2% (70% to 100%)

M1193AN, M1194AN, M1195AN = 3% (70% to 100%)

Philips Disposable Sensors with M1943NL:

M1901B (Adult), M1902B, M1903B, M1904B = 2% (70% to 100%)

M1901B (Neonate) = 3%

NellcorPB

®

Sensors with M1943NL:

MAX-FAST, MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N (Adult) =

2% (70 - 100%)

SC-A, OxiCliq A, P, I, N (Adult) = 2.5% (70 - 100%)

MAX-N (Neonate), Dura-Y D-YS (Infant to Adult), DS-

100A,Oxiband OXI-A/N (Adult), OXI-P/I = 3% (70 - 100%)

MAX-R, OxiCliq N (Neonate), SC-NEO (Neonate), SC-PR

(Neonate), Dura-Y D-YS with D-YSE or D-YSPD clip = 3.5% (70 -

100%)

Dura-Y D-YS (Neonate), Oxiband OXI-A/N (Neonate) = 4% (70 -

100%)

1%

351

34 Installation and Specifications

Measurement Specifications

SpO

2

Performance Specifications

Pulse

Range

Accuracy

Resolution

Sensors

Pulse Oximeter Calibration Range

30 to 300 bpm

±2% or 1 bpm, whichever is greater

1 bpm

Wavelength range: 500 to 1000 nm

Emitted Light Energy:

15mW

Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)

70 - 100%

SpO

2

Alarm

Specifications

SpO

2

Desat

Pulse

Tachycardia

Bradycardia

Range Adjustment Delay

Adult: 50 to 100%

Pedi/Neo: 30 to 100%

Adult: 50 to Low alarm limit

Pedi/Neo: 30 to Low alarm limit

30 to 300 bpm

1% steps

1% steps

(0, 1, 2, 3,... 30)

+ 4 seconds

Adult:

1 bpm steps (30 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:

1 bpm steps (30 to 50 bpm)

5 bpm steps (50 to 300 bpm) max. 14 seconds max. 14 seconds Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm 5 bpm steps

Difference to low limit 0 to 50 bpm 5 bpm steps

Clamping at 30 to 100 bpm 5 bpm steps max. 14 seconds

NBP

Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.

NBP Performance Specifications

Measurement Ranges Systolic

Accuracy

Heart Rate Range

Diastolic

Mean

Adult: 30 to 270 mmHg (4 to 36 kPa)

Pedi: 30 to 180 mmHg (4 to 24 kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Adult: 10 to 245 mmHg (1.5 to 32 kPa)

Pedi: 10 to 150 mmHg (1.5 to 20 kPa)

Neo: 10 to 100 mmHg (1.5 to 13 kPa)

Adult: 20 to 255 mmHg (2.5 to 34 kPa)

Pedi: 20 to 160 mmHg (2.5 to 21 kPa)

Neo: 20 to 120 mmHg (2.5 to 16 kPa)

Max. Std. Deviation: 8 mmHg (1.1 kPa)

Max. Mean Error: ±5 mmHg (±0.7 kPa)

40 to 300 bpm

352

Measurement Specifications

34 Installation and Specifications

NBP Performance Specifications

Measurement Time

Cuff Inflation Time

Initial Cuff Inflation Pressure

Typical at HR > 60bpm

Auto/manual: 30 seconds (adult)

25 seconds (neonatal)

Stat: 20 seconds

Maximum time: 180 seconds (adult/pediatric)

90 seconds (neonates)

Typical for normal adult cuff: Less than 10 seconds

Typical for neonatal cuff: Less than 2 seconds

Adult: 165 ±15 mmHg

Pedi: 130 ±15 mmHg

Neo: 100 ±15 mmHg

1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutes

5 minutes

Auto Mode Repetition Times

STAT Mode Cycle Time

Venipuncture Mode Inflation

Inflation Pressure Adult

Pediatric

Automatic deflation after

Neonatal

Adult/pediatric

Neonatal

20 to 120 mmHg (3 to 16 kPa)

20 to 80 mmHg (3 to 11 kPa)

20 to 50 mmHg (3 to 7 kPa)

170 seconds

85 seconds

Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated

Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure.

In neonatal mode, the blood pressure measurements determined with this device comply with the

American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 -

1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.

NBP Alarm Specifications Range

Systolic

Diastolic

Mean

Adult: 30 to 270 mmHg (4 to 36 kPa)

Pedi: 30 to 180 mmHg (4 to 24 kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Adult: 10 to 245 mmHg (1.5 to 32 kPa)

Pedi: 10 to 150 mmHg (1.5 to 20 kPa)

Neo: 10 to 100 mmHg (1.5 to 13 kPa)

Adult: 20 to 255 mmHg (2.5 to 34 kPa)

Pedi: 20 to 160 mmHg (2.5 to 21 kPa)

Neo: 20 to 120 mmHg (2.5 to 16 kPa)

Adjustment

10 to 30 mmHg: 2 mmHg (0.5 kPa)

> 30 mmHg: 5 mmHg (1kPa)

353

34 Installation and Specifications

Measurement Specifications

NBP Overpressure Settings

Adult

Pedi

Neo

> 300 mmHg (40 kPa) > 2 sec

> 300 mmHg (40 kPa) > 2 sec

> 150 mmHg (20 kPa) > 2 sec

Invasive Pressure and Pulse

Complies with IEC 60601-2-34:2000/EN60601-2-34:2000.

not user adjustable

Invasive Pressure Performance Specifications

Measurement Range

Pulse Rate

Input Sensitivity

Transducer

Range

Accuracy

Resolution

Frequency Response

Zero Adjustment

Gain Accuracy

Overall Accuracy

Range:

Accuracy

Drift

Accuracy

Drift

Non linearity and Hysteresis

(including transducer)

Analog Output

available only with

M1006B #C01 (@

CAL 200 mmHg)

Range

Level

Accuracy

Offset

Resolution

Signal delay

Volume displacement of CPJ840J6

–40 to 360 mmHg

25 to 350 bpm

±1% Full Range

1 bpm

Sensitivity:5µV/V/mmHg (37.5µV/V/kPa)

Adjustment range:±10%

Load Impedance:200 to 2000

(resistive)

Output Impedance:

3000

(resistive) dc to 12.5 Hz or 40 Hz

±200 mmHg (±26 kPa)

±1 mmHg (±0.1 kPa)

Less than 0.1mmHg/°C (0.013 kPa/°C)

±1%

Less than 0.05%/°C

Error of

0.4% FS (@CAL 200 mmHg)

± 4% of reading or ± 4 mmHg (± 0.5 kPa), whichever is greater

-0.4 V to 3.6 V

1 V / 100 mmHg

± 3% full scale

± 30 mV

8 Bit (@ 5 V range)

20 ms

0.1 mm

3

/100 mmHg

354

Measurement Specifications

34 Installation and Specifications

Invasive Pressure Alarm Specifications Range

Pressure

Pulse

Tachycardia

Bradycardia

–40 to 360 mmHg

(–5.0 to 48 kPa)

25 to 300 bpm

Adjustment

-40 to 30 mmHg

2 mmHg (0.5 kPa)

> 30 mmHg

5 mmHg (1 kPa)

Adult:

1 bpm steps (25 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:

1 bpm steps (25 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to

50 bpm

5 bpm steps

Clamping at 150 to 300 bpm

Difference to low limit 0 to

50 bpm

5 bpm steps

5 bpm steps

Clamping at 25 to 100 bpm 5 bpm steps

Delay

max. 12 seconds max. 14 seconds max. 14 seconds

Temp

Temp Performance Specifications

Temp

Range

Resolution

Average Time Constant

Accuracy

Alarms

Range

Adjustment

–1 to 45

°

C (30 to 113

°

F)

0.1

°

C (32.2

°

F)

±0.1

°

C (±0.2

°

F)

Less than 10 seconds

–1 to 45

°

C (30 to 113

°

F)

-1 to 35

°

C (30 to 95

°

F): 0.5

°

C (1.0

°

F) steps

35 to 45

°

C (95 to 113

°

F): 0.1

°

C (0.2

°

F) steps

Temp Alarm Specifications Range

Temp High/Low Alarms

Adjustment

–1 to 45 ºC (30 to 113 ºF) -1 to 35

°

C (30 to 95

°

F), 0.5

°

C (1.0

°

F) steps

35 to 45

°

C (95 to 113

°

F), 0.1

°

C (0.2

°

F) steps

355

34 Installation and Specifications

CO

2

Measurement Specifications

The CO

2

measurement in M3014A and M3015A complies with EN ISO 21647 (except alarm system; alarm system complies with IEC 60601-2-49:2001)

M3015A Microstream CO

2

Performance Specifications

CO

2

Range

Accuracy

0 to 98mmHg (0 to 13 kPa), or 13% CO

2

, whichever is lower

Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greater

After 5 minutes warmup:

0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)

Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of reading

These specifications are valid for 21% O

2

and N

2

balance, up to 35

°

C ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode.

Outside of these conditions the accuracy reaches at a minimum ±4 mmHg or ±12% of the reading, whichever is greater.

Resolution

awRR

Warm-up Time

Rise Time

Stability

Range

Accuracy

Sample Flow Rate

Gas Sampling Delay Time

Sound Pressure

Total System Response Time

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

Included in Accuracy specifications

0 to 150 rpm

0 to 40 rpm: ±1 rpm

41 to 70 rpm: ±2 rpm

71 to 100 rpm: ±3 rpm

>100 rpm: ±5% of reading

20 minutes for full accuracy specification

190 ms for neonatal mode

(measured with FilterLine H for neonatal)

240 ms for adult mode

(measured with FilterLine H for adult)

50+15/-7.5 ml/minute

Typical:2.3 seconds

Maximum:3 seconds

Acoustic noise: < 45 dBA

The total system response time is the sum of the delay time and the rise time.

Microstream CO

2

Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the Microstream CO

2 readings. The formula for the correction calculation is:

P

BTPS

= (P

STPD

.

0.94)

356

Measurement Specifications

34 Installation and Specifications

M3014A Mainstream CO

2

Performance Specifications

CO

2

Range 0 to 150 mmHg (0 to 20.0 kPa)

Accuracy

Resolution after 2 minutes warmup:

For values between 0 and 40 mmHg:±2.0 mmHg (±0.29 kPa)

For values from 41 to 70 mmHg: ±5% of reading

For values from 71 to 100 mmHg: ±8% of reading

The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, P abs

= 760 mmHg, flow rate = 2 l/min.

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

Stability:

Short term drift

Long term drift

±0.8 mmHg over four hours

Accuracy specification will be maintained over a 120 hour period

awRR

Warm-up Time

Response Time

Range

Accuracy

2 to 150 rpm

±1 rpm

2 minutes with CO

2

transducer attached for full accuracy specification

Less than 60 ms (with adult or infant reusable or disposable adapter)

M3014A Sidestream CO

2

Performance Specifications

CO

2

Range 0 to 150 mmHg (0 to 20.0 kPa)

Accuracy after 2 minutes warmup:

For values between 0 and 40 mmHg:±2.0 mmHg (±0.29 kPa)

For values from 41 to 70 mmHg: ±5% of reading

For values from 71 to 100 mmHg: ±8% of reading

For values from 101 to 150 mmHg: ±10% of reading

At respiration rates above 80 rpm, all ranges are ±12% of actual. The specifications are valid for gas mixtures of CO

2

, balance N

760 mmHg within specified operating temperature range.

2

, dry gas at

Resolution Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

awRR

Stability:

Short term drift

Long term drift

Range

Accuracy

Warm-up Time

Sample Flow Rate

Total System Response Time

Operating Temperature

±0.8 mmHg over four hours

Accuracy specification will be maintained over a 120 hour period

2 to 150 rpm

±1 rpm

2 minutes with CO

2

sensor attached for full accuracy specification

50±10 ml/minute

3 seconds

0 to 40 °C (32 to 100 °F)

M3014A Mainstream and Sidestream CO

2

Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO

2 readings. The formula for the correction calculation is:

P

STPD

= P

B TPS

P

-----------------------------

P a bs

– P

H2O

357

34 Installation and Specifications

Measurement Specifications

Where p = partial pressure, P abs

= absolute pressure, and P

H2O

= 42 mmHg @35°C and 100% RH.

M3016A Mainstream CO

2

Performance Specifications

CO

2

Range –4 to 150 mmHg (-0.5 to 20.0 kPa)

Accuracy after 20 minutes warmup and calibration:

For values between 0 and 40 mmHg:±2.2 mmHg (±0.29 kPa)

For values between 40 and 76 mmHg:±5.5% of reading

The specifications are valid for 45% O

2

and N

2

or N

2

O balance. Outside these conditions the accuracy reaches at a minimum the requirements of

EN864/ISO9918.

Resolution Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

awRR

Warm-up Time

Response Time

Stability

Range

Accuracy

±1.0 mmHg over a 7 day period

0 to 150 rpm

±2 rpm

20 minutes with CO

2

transducer attached for full accuracy specification

Less than 125 ms (for step from 10% to 90%)

Mainstream CO

2

Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO

2 readings. The formula for the correction calculation is:

P

STPD

= P

B TPS

P

-----------------------------

P a bs

– P

H2O

Where p = partial pressure, P abs

= absolute pressure, and P

H2O

= 47 mmHg @37

°

C

and 100% RH.

CO

2

Alarm

Specifications Range etCO

2

High etCO

2

Low imCO

2

High awRR High awRR Low

Apnea delay

10 to 90 mmHg (1 to 12 kPa)

2 to 20 mmHg

(0.3 to 3.0 kPa)

Adult/pedi: 10 to 100 rpm

Neo: 30 to 150 rpm

Adult/pedi: 0 to 95 rpm

Neo: 0 to 145 rpm

10 to 40 seconds

Adjustment

20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) steps of 1 mmHg (0.1 kPa) under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps

5 second steps

Delay

M3014A/M3016A: less than 14 seconds

M3015A: less than18 seconds.

M3014A/M3016A: less than 14 seconds

M3015A: less than18 seconds.

M3014A/M3016A: less than 14 seconds

M3015A: less than18 seconds.

M3015A: settings < 20 rpm: less than 8 seconds

> 20 rpm: less than 18 seconds

M3014A/M3016A settings < 20 rpm: less than 4seconds

> 20 rpm: less than 14 seconds set apnea delay time + 4 seconds

(M3014A/M3016A) or 8 seconds

(M3015A)

358

Measurement Specifications

34 Installation and Specifications

Interfering Gas and Vapor Effects On CO

2

Measurement Values

The specified deviations for M3014A are valid when the appropriate corrections are switched on and set correctly.

Gas or Vapor

Nitrous Oxide

Halothane

Enflurane

Isoflurane

Sevoflurane

Xenon

Helium

Metered dose inhaler propellants

Desflurane

Ethanol

Isopropanol

Acetone

Methane

15

0.1

0.1

0.1

1.0

Gas Level

(% volume fraction)

5

80

-

50

5

5

60

4

M3014A M3015A

Additional deviation due to gas interfence, measured at

0 - 40 mmHg CO

2

±1 mmHg

±1 mmHg

± 5%

± 5%

±1 mmHg

±1 mmHg

±1 mmHg

-5 mmHg

±1 mmHg not specified for use

± 5%

± 5%

± 5%

± 5%

± 5%

+3 mmHg

±1 mmHg

±1 mmHg

±1 mmHg

±1 mmHg

± 5%

± 5%

± 5%

± 5%

± 5%

Spirometry

The following specifications apply for 760 mmHg ambient pressure and patient gas: room air at 35°, unless otherwise noted

Spirometry Performance Specifications

Flow Wave (AWF)

Range

Accuracy

Scales

Scale Default

±

25 l/min (neonatal)

±

100 l/min (pediatric)

±

180 l/min (adult)

±

3% or

0.125 l/min (neonatal)

0.25 l/min (pediatric)

0.5 l/min (adult)

±

10,

±

20,

±

40,

±

60,

±

80,

±

100,

±

120,

±

150 l/min

±

20 l/min (neonatal

±

100 l/min (pediatric)

±

150 l/min (adult)

359

34 Installation and Specifications

Measurement Specifications

Spirometry Performance Specifications

Volume Wave (AWV) Range

Pressure Wave (AWP) Range

Accuracy

Scales

Scale Default

Respiration Rate numeric (RRspir)

Inspired Minute

Volume numeric

(MVin)

Expired Minute

Volume numeric

(MVexp)

Inspired Volume numeric (TVin)

Expired Volume numeric (TVexp)

Lung Compliance numeric

Airway Resistance numeric

Peak Inspiratory

Pressure numeric

(PIP)

Accuracy

Scales

Scale Default

Range

Resolution

Range

Resolution

Range

Resolution

Range

Resolution

Range

Resolution

Range

Resolution

Range

Resolution

Range

Resolution

0 to 100 ml (neonatal

0 to 400 ml (pediatric)

0 to 3000 ml (adult)

±

5% or

±

3 ml (neonatal)

±

12 ml (pediatric)

±

90 ml (adult),

whichever is greater

50, 100, 200, 600, 800, 1000, 2000, 3000 ml

50 ml (neonatal

200 ml (pediatric)

800 ml (adult)

-20 to 120 cmH

2

O

±

2% or

±

0.5 cmH2O whichever is greater

10, 20, 40, 60, 80, 100, 120 cmH

2

O

20 l/min (neonatal

40 l/min (pediatric)

40 l/min (adult)

2 to 120 breaths/min

1 breath/min

0.01 to 5 l/min (neonatal)

0.06 to 30 l/min (pediatric)

0.4 to 60l/min (adult)

0.01 l/min (neonatal/pediatric)

0.1 l/min (adult)

0.01 to 5 l/min (neonatal)

0.06 to 30 l/min (pediatric)

0.4 to 60l/min (adult)

0.01 l/min (neonatal/pediatric)

0.1 l/min (adult)

5 to 100 ml (neonatal)

30 to 400 ml (pediatric)

200 to 3000 ml (adult)

1 ml (neonatal/pediatric))

10 ml (adult)

5 to 100 ml (neonatal)

30 to 400 ml (pediatric)

200 to 3000 ml (adult)

1 ml (neonatal/pediatric)

10 ml (adult)

0 to 500 ml/cmH

2

O

1 ml/cmH

2

O

0 to 500 cmH

2

0 to 250 cmH

2

0 to 100 cmH

2

O/l/s (neonatal)

O/l/s (pediatric)

O/l/s (adult)

1 cmH

2

O/l/s

0 to +120 cmH

2

O

1 cmH

2

O

360

Measurement Specifications

34 Installation and Specifications

Spirometry Performance Specifications

Negative Inspiratory

Pressure numeric

Range

Resolution

Mean Airway Pressure Range

Plateau Pressure numeric

Resolution

Range

Resolution

Range

Positive End-

Expiratory Pressure numeric (PEEP)

Barometric Pressure numeric (PB)

Resolution

Range

Resolution

Peak Inspiratory Flow numeric (PIF)

Range

-20 to 0 cmH

2

O

1 cmH

2

O

-20 to +120 cmH

2

O

1 cmH

2

O

0 to +120 cmH

2

O

1 cmH

2

O

0 to 99 cmH

2

O

1 cmH

2

O

Resolution

Peak Expiratory Flow numeric (PEF)

Range

Inspiration to

Expiration ratio numeric (I:E)

Resolution

Range

Resolution

400 to 800 mmHg

1 mmHg

0.1 to 25 l/min (neonatal)

1 to 100 l/min (pediatric)

2 to 180 l/min (adult)

0.1 l/min (neonatal)

1 l/min (pediatric/adult)

0.1 to 25 l/min (neonatal)

1 to 100 l/min (pediatric)

2 to 180 l/min (adult)

0.1 l/min (neonatal)

1 l/min (pediatric/adult)

1: 0.2 ... 9.9

0.1

Cardiac Output / Continuous Cardiac Output

C.O./CCO Performance Specifications

C.O. (right heart)

C.O.

(transpulmonary)

EVLW

not available in USA

Range

Accuracy

0.1 to 20.0 l/min

Instrument Specification (electrical):+ 3% or 0.1 l/min

System Specification:+ 5%.or 0.2 l/min

Repeatability Instrument Specification (electrical):+ 2% or 0.1 l/min

System Specification:+ 3%.or 0.1 l/min

Range

Accuracy

Repeatability

Range

0.1 to 25.0 l/min

Instrument Specification (electrical):+ 4% or 0.15 l/min

System Specification:+ 5% or 0.2 l/min

Instrument Specification (electrical):+ 2% or 0.1 l/min

System Specification:+ 3% or 0.1 l/min

10 to 5000 ml

Standard Deviation 10% or 1 ml/kg

361

34 Installation and Specifications

Measurement Specifications

C.O./CCO Performance Specifications

ITBV

Range

Accuracy

Repeatability

50 to 6000 ml

+ 10% or 30 ml

+ 5% or 20 ml

CCO

Range 0.1 to 25.0 l/min

Standard Deviation 10% or 0.3 l/min

Display Update

Blood Temperature

Range

Injectate Temperature Range

2 seconds nominal

17,0 to 43°C (62,6 to 109,4°F)

-1 to 30°C

C.O./CCO Alarm Specifications Range

TBlood

CCO

17 to 43°C

Adjustment

Steps of 0.5°C (17 to 35°C)

Steps of 0.1°C (35 to 43°C)

Steps of 1°F (63 to 95°C)

Steps of 0.2°F (95 to 109°C

0.1 to 25.0 l/min 0.1 l/min (0.1 to10.0 l/min)

0.5 l/min (10.0 to 25.0 l/min)

Delay

10 seconds after the value exceeds the set limit range

10 seconds after the value exceeds the set limit range

tcGas

Complies with IEC 60601-2-23:1999/EN60601-2-23:2000.

tcGas Performance Specifications tcpO

2

Range

Accuracy

Resolution

Overall Accuracy

(incl. transducer)

tcpO

2

Temperature Drift tcpO

2

Test Signal

tcpO

2

Drift, including transducer

tcpO

2 response time, including transducer

tcpCO

2

Range

Accuracy

Resolution

Overall Accuracy

(incl. transducer)

tcpCO

2

Temperature Drift tcpCO

2

Test Signal

tcpCO

2

Drift, including transducer

0 to 750 mmHg (0 to 100 kPa)

0.5% (+ 1 digit)

1 mmHg (0.1 kPa)

0 to 160 mmHg + 5 mmHg

0.0 to 21.3 kPa + 0.7 kPa

>160 mmHg (21.3 kPA) + 3% of reading

< 0.1% / °C

60 mmHg (8.0 kPa)

< 1 mmHg / h @ 10% O

2

< 30 s

5 to 200 mmHg (0.7 to 26.7 kPa)

1.0% (1 + digit)

1 mmHg (0.1 kPa)

0 to 76 mmHg + 5 mmHg

0.0 to 10.1 kPa + 0.7 kPa

>76 mmHg (10.1 kPa) + 10% of reading

< 0.1% / °C

40 mmHg (5.3 kPa)

< 1 mmHg / h @ 5% CO

2

362

Measurement Specifications

34 Installation and Specifications tcGas Performance Specifications tcpCO

2 response time, including transducer < 50 s

Warm-up Time

< 3 minutes

Site Timer

0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hours. Change Site alarm when site time is expired and configurable automatic heating switch-off

Transducer Heating

Available Temperatures -

37.0°C, 41.0 to 45°C in steps of 0.5°C

Alarm Delay

10 seconds after the value exceeds the set limit range.

tcGas Alarm Specifications tcpO

2 tcpCO

2

Range

10 to 745 mmHg

1.0 to 99.5 kPa

10 to 195 mmHg

1.0 to 26 kPa

Adjustment

10 to 30 mmHg: 1 mmHg

1.0 to 4.0 kPa: 0.1 kPa

32 to 100 mmHg: 2 mmHg

4.2 to 13 kPa: 0.2 kPa

105 to 745mmHg: 5 mmHg

13.5 to 99.5 kPa: 0.5 kPa

10 to 30 mmHg: 1 mmHg

1.0 to 4.0 kPa: 0.1 kPa

32 to 100 mmHg: 2 mmHg

4.2 to 13 kPa: 0.2 kPa

105 to 195 mmHg: 5 mmHg

13.5 to 26 kPa: 0.5 kPa

SvO

2

SvO

2

Performance Specifications

SvO

2

Range

Accuracy

Resolution

Stability (system)

Response Time (10 % to 90%)

10% to 100%

±

2 % (i.e.

±

2 units), 1 standard deviation over 40 % to 100 % range.

1%

Drift < 2% over 24 hours

5 seconds

SvO

2

Alarm Specifications Range

SvO

2

Adjustment

10% to 100% 1%

Delay

max. 15+4 seconds after value goes beyond the low/high alarm limit settings

EEG

Complies with IEC 60601-2-26:1994/EN60601-2-26:1994.

363

34 Installation and Specifications

Measurement Specifications

EEG Performance Specifications

Leakage Current

Input Signal Range

Differential Input Impedance

Max. DC Input Offset Voltage

Input Protection

Common Mode Rejection

Noise

Electromagnetic Susceptibility

Electrode Impedance

Measurement

Range

Accuracy

Bandwidth

Low Filter Cut-Off Frequencies

High Filter Cut-Off Frequencies

<=10

µ

A @ 110V ac

1 mV p-p

>15 M

@ 10 Hz

±

320 mV

Against defibrillation (5 kV) and electrosurgery

>105 dB @ 5k

Ω imbalance and 60 Hz

<0.4

µ

VRMS (1 to 30 Hz)

<10

µ

V p-p

@ 3 V/m, 26-1000 MHz

0 to 30 k

±1 k

0.5 Hz to 50 Hz (–3 dB)

0.5, 1.0, 2.0, and 5.0 Hz

(12 dB/octave)

15 Hz (65 dB/octave)

30 Hz (75 dB/octave)

50 Hz (85 dB/octave)

BIS

BIS Performance Specifications BIS, BISx M1034A, BIS Interface board for MP20/30

Bispectral Index (BIS) Range

Signal Quality Index (SQI) Range

EMG Range

Suppression Ratio (SR)

Spectral Edge Frequency (SEF)

Total Power (TP)

Bursts

Noise

Wave Scale

Update Frequency (BIS Numeric)

Bandwidth

High Pass Filters

Low Pass Filters

Notch Filters (for line frequency)

Impedance Measurement Range

0 - 100

0 - 100%

0 - 100dB

0 - 100%

0.5 - 30.0Hz

0 - 100 dB

(BISx only) 0 - 30/minute

<0.3

µ

V RMS (2.0

µ

V peak-to-peak)

With gridlines on: ± 25

µ

V, ± 50

µ

V, ± 100

µ

V, ± 250

µ

V

With gridlines off: 50

µ

V, 100

µ

V, 200

µ

V, 500

µ

V

2048 ms

0.25 - 100Hz (-3dB)

0.25 Hz, 1 Hz, 2 Hz (-3dB)

30 Hz, 50 Hz, 70 Hz, 100 Hz (-3dB)

50 Hz, 60 Hz

0 to 999 k

BIS Alarm Specifications Range

BIS High/Low Alarm

0 - 100

Adjustment

1

Alarm Delay

Max. 2 seconds

364

Safety and Performance Tests

34 Installation and Specifications

Safety and Performance Tests

You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications are described in the Installation and Service guide.

Electromagnetic Compatibility (EMC) Specifications

Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radio frequency (RF) communications equipment can affect medical electrical equipment.

Accessories Compliant with EMC Standards

All accessories listed in the accessories section comply, in combination with the IntelliVue patient monitors, with the requirements of IEC 60601-1-2:2001.

WARNING

Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment.

Electromagnetic Emissions

The monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environment

Emissions test

Radio Frequency (RF) emissions

RF emissions CISPR 11

Compliance Avoiding Electromagnetic Interference

Group 1

Harmonic emissions IEC 61000-3-2 n/a

Voltage fluctuations IEC 61000-3-3

Class A n/a

The monitor uses RF energy only for its internal function.

Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment

The monitor is suitable for use in all establishments other than domestic and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes

Avoiding Electromagnetic Interference (Resp and BIS)

The respiration (Resp) and BIS measurements are very sensitive measurements that measure very small signals. Technological limitations don't allow higher immunity levels than 1V/m for radiated RF electromagnetic fields and 1Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of these measurements.

WARNING

The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients.

365

34 Installation and Specifications

Safety and Performance Tests

Electromagnetic Immunity

The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below.

Immunity test

IEC 60601-1-2 test level

Electrostatic discharge (ESD)

IEC 61000-4-2

±

6 kV contact

± 8kV air

Compliance level

±

6 kV contact

± 8kV air

Electromagnetic environment guidance

Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.

Electrical fast transient/burst

IEC 61000-4-4

Surge

IEC 61000-4-5

± 2 kV for power supply lines

± 1 kV for input/output lines

± 1 kV differential mode

± 2 kV common mode

± 2 kV for power supply lines

± 1 kV for input/output lines

Mains power quality should be that of a typical commercial and/or hospital environment

± 1 kV differential mode

± 2 kV common mode

Mains power quality should be that of a typical commercial and/or hospital environment

Voltage dips, short interruptions and voltage variations on power supply input lines

IEC 61000-4-

11

<5%

U

T

(> 95% dip in

U

T cycles

) for 0.5

40%

U

T

(60% dip in

U

T

) for 5 cycles

70%

U

T

(30% dip in

U

T

) for 25 cycles

< 5%

U

T

(> 95% dip in

U

T

) for 5 sec

Power frequency

(50/60 Hz) magnetic field

IEC 61000-4-8

3 A/m

<5%

U

T

(> 95% dip in

U cycles

T

) for 0.5

40%

U

T

(60% dip in

U

T

) for 5 cycles

70%

U

T

(30% dip in

U

T

) for 25 cycles

Mains power quality should be that of a typical commercial and/or hospital environment. If the user of the monitor requires continued operation during power mains interruptions, it is recommended that the monitor is equipped with an internal battery or is powered from an uninterruptible power supply.

< 5%

U

T

(> 95% dip in

U

T

) for 5 sec

3 A/m Power frequency magnetic fields should be a t levels characteristic of a typical location in a typical commercial and/or hospital environment

In this table, U

T

is the a.c. mains voltage prior to application of the test level.

Recommended Separation Distance

WARNING

The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that other equipment complies with CISPR emission requirements.

In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres

(m). The values given in brackets are for respiration and BIS.

Portable and mobile RF communications equipment should be used no closer to any part of the monitor, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter.

Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range (over the frequency range 150 kHz to 80 MHz, field strengths should be less than 1 V/m for respiration and BIS and 3 V/m for all other functions).

366

Safety and Performance Tests

34 Installation and Specifications

Interference may occur in the vicinity of equipment marked with this symbol:

Immunity test

Conducted RF

IEC 61000-4-6

IEC 60601-1-2 test level Compliance level Electromagnetic environment guidance

3 V

RMS

150 kHz to 80 MHz

3 V

RMS

(1 V

RMS

for respiration and BIS)

Recommended separation distance: d = 1.2 P

: for respiration and BIS:

Radiated RF

IEC 61000-4-3

3 V/m

80 MHz to 2.5 GHz

3 V/m

(1 V/m for respiration and BIS) d = 3.5 P

:

Recommended separation distance:

80 MHz to 800 MHz d = 1.2 P

80 MHz to 800 MHz for respiration and BIS d = 3.5 P :

800 MHz to 2,5 GHz d = 2.3 P

800 MHz to 2,5 GHz for respiration and BIS d = 7.0 P

Field strengths from fixed transmitters, such as base stations for radio (cellular, cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the monitor is used exceeds the applicable RF compliance level above, the monitor should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the monitor.

These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.

Recommended separation distances from portable and mobile RF communication equipment

The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment.

367

34 Installation and Specifications

Safety and Performance Tests

Frequency of transmitter 150 kHz to 80 MHz 150 kHz to 800 MHz 800 MHz to 2,5 GHz

Equation

d = 1.2 P d = 1.2 P d = 2.3 P

for respiration and BIS: for respiration and BIS: for respiration and BIS:

d = 3.5 p d = 3.5 P d = 7.0 P

Rated max. output power of transmitter (W) Separation distance (m) Separation distance (m) Separation distance (m)

0.01

0.1

1

10

100

0.1 (0.4)

0.4 (1.1)

1.3 (3.5)

3.8 (11.1)

12.0 (35.0)

0.1 (0.4)

0.4 (1.1)

1.3 (3.5)

3.8 (11.1)

12.0 (35.0)

0.2 (0.7)

0.7 (2.2)

2.3 (7.0)

7.3 (22.1)

23.0 (70.0)

Electrosurgery Interference/Defibrillation/Electrostatic Discharge

The equipment returns to the previous operating mode within 10 seconds without loss of any stored data. Measurement accuracy may be temporarily decreased while performing electro-surgery or defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magnetic fields (MRI).

Fast Transients/Bursts

The equipment will return to the previous operating mode within 10 seconds without loss of any stored data (M1032 within 30 seconds). If any user interaction is required, the monitor indicates with a technical alarm (INOP).

Restart time

After power interruption, an ECG wave will be shown on the display after 30 seconds maximum.

368

35

35

Default Settings Appendix

This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor’s default settings can be permanently changed in

Configuration Mode.

Settings are only entered once per table row if they are the same for all patient categories.

369

35 Default Settings Appendix

Alarm Default Settings

Alarm Default Settings

Alarm Settings

Alarm Volume

Alarms Off

Pause Al. 5min

Pause Al. 10min

Auto Alarms Off

Alarm Off Reminder

Visual Latching

Audible Latching

Alarm Reminder

Reminder Time

Alarm Sounds

Red Alarm Interval

Yel. Al. Interval

Alarm Low

Red Alarm Volume

Yell. Alarm Volume

Inop Volume

Auto Increase Vol.

Increase Vol Delay

Keep Blinking

Relay 1 Sensitiv.

Relay 2 Sensitiv.

Relay 3 Sensitiv.

Inop Relay Latency

Yel. Relay Latency

Alarm Text

No Centr Mon Min Vol

Factory Default H10 / H20 / H40

2 Steps

20 sec

No

R & Y & I

Red & Yell

Red

5 sec

2 sec

Standard

4

5

3 min.

Enabled

Enabled

Off

Off

Red & Yell

Red & Yell

On

3 min

Traditional

10 sec

20 sec

4

AlarmVol +2

AlarmVol +0

AlarmVol +0

H30 (deviations from H10/20/40)

Red Only

Off

2

ECG, Arrhythmia, and ST Default Settings

ECG Settings

High Limit

Low Limit

Alarms

Alarm Source

ECG

QRS Volume

Factory defaults H10 / H20 / H40

Adult

120 bpm

50 bpm

On

HR

On

1

Pedi

160bpm

75 bpm

Neo

200 bpm

100 bpm

H30 (deviations from H10/20/40)

Adult Pedi Neo

Auto

370

ECG, Arrhythmia, and ST Default Settings

35 Default Settings Appendix

Factory defaults H10 / H20 / H40

ECG Settings

Primary Lead

Secondary Lead

Analysis Mode

Lead Placement

Adult

II

V

Multi-lead

Standard

Mod. Lead Placment Off

Filter

Speed

Monitor

25mm/s

Pedi Neo

Auto Filter

Default ECG Size

Color

Asystole Thresh

ExtrTachy

Tachy Clamp

ExtrBrady

Brady Clamp

ALL ECG IN.

Fallback

Alarms Off

Alarm Source Sel.

Off x1

Green

4.0 sec

20 bpm

200 bpm

20 bpm

40 bpm

On

On

Enabled

Enabled

220 bpm

3.0 sec

240 bpm

50 bpm

H30 (deviations from H10/20/40)

Adult

Filter

40 bpm

Pedi

60 bpm

Neo

80 bpm

371

35 Default Settings Appendix

ECG, Arrhythmia, and ST Default Settings

Arrhythmia

Pause Threshold

VTach HR

VTach Run

Vent Rhythm

SVT HR

SVT Run

PVCs/min

Non-Sustain

Vent Rhythm

Run PVCs

Pair PVCs

R-On-T PVCs

V.Bigeminy

V.Trigeminy

PVCs/min

Multif. PVCs

Pacer N. Cap

Pacer N. Pac

Pause

Missed Beat

SVT

IrregularHR

TimeOut 1st

TimeOut 2nd

Arrhy Off Message

SOME ECG IN

Arrhythmia Settings

Factory defaults H10 / H20 / H40

Adult Pedi Neo

On Off

2.0 sec 1.5 sec

100

5

120 150

14

180

5

10

On

On

On

On

On

On

On

3 min

10 min

Yes

On

On

On

On

On

On

On

On

On

200

5

210

5

H30 (deviations from H10/20/40)

Adult

Off

Pedi Neo

Off

Off

Off

Off

Off

Off

Off

Off

Off

Off

Lead-independent ST Settings

ST Alarm Mode

Alarms

ST Analysis

ST-Index

ISO Point

J Point

ST Point

Factory Adult

Single ST

On

On

On

-80 ms

48 ms

J+60

Factory Pedi

Off

Factory Neo

372

Pulse Default Settings

35 Default Settings Appendix

Lead I, II, III, V, aVR, aVL, aVF, V1-6,

MCL Settings

Factory Adult

ST

(Label)

For Alarm Mode = Single-ST

On

Factory Pedi

Off

ST

(Label)

High +2.0

ST

(Label)

Low -2.0

For Alarm Mode = Multi-ST

ST

(Label)

High +1.0

ST

(Label)

Low -1.0

Pulse Default Settings

Factory Neo

Pulse Settings

Alarm Source

Pulse (Label)

System Pulse

Alarms Off

Alarm Source Sel.

Factory defaults H10 / H20 / H40

Adult

HR

On

SpO2

Enabled

Enabled

Pedi Neo

H30 (deviations from H10/20/40)

Adult

Auto

Pedi Neo

Auto

Pulse Alarm Settings

Factory defaults H10 / H20 / H40

Adult Pedi Neo

Pulse (SpO2)

Pulse Alarms

High Limit

Low Limit

Extr Brady

Brady Clamp

Extr Tachy

Tachy Clamp on on

120 bpm

50 bpm

20 bpm

40 bpm

20 bpm

200 bpm

160 bpm

75 bpm

40 bpm

220 bpm

200 bpm

100 bpm

50 bpm

240 bpm

H30 (deviations from H10/20/40)

Adult Pedi Neo

Pulse alarms use the settings of the currently selected Pulse alarm source.

373

35 Default Settings Appendix

Respiration Default Settings

Respiration Default Settings

Respiration Settings

Factory defaults H10 / H20 / H40

Adult Pedi Neo

H30 (deviations from H10/20/40)

Adult

High Limit

Low Limit

Apnea Time

Alarms

30 rpm

8 rpm

20 sec

On

100 rpm

30 rpm

Resp On Off

Auto/Manual Auto Mode)

Resp Speed

Color

6.25mm/s

Yellow White

Pedi Neo

SpO

2

Default Settings

SpO

2

Settings

Alarms

QRS Volume

Tone Modulation

Tone Mod. Type

Speed

Perfusion

Average

NBP Alarm Suppr.

Extd. Auto OnOff

Color

SpO

2

Alarm Default Settings

Setting

Desat Limit

Low Limit

High Limit

Desat delay

High Alarm delay

Low Alarm delay

Parameter Alarms On/Off

Label

Pulse Settings

Pulse (SpO2) On/Off

adult

80

90

100

20 sec

10 sec

10 sec on

SpO

2 on

Factory Adult

On

1

Yes

Enhanced

25mm/s

On

10 sec

On

Disabled

Cyan

Factory Pedi pediatric

80

90

100

20 sec

10 sec

10 sec on

SpO

2 on

374

Factory Neo neonatal

80

85

95

20 sec

10 sec

10 sec on

SpO

2 on

NBP Default Settings

35 Default Settings Appendix

SpO

2

Alarm Default Settings

Setting

Pulse Alarms On/Off

Pulse High Limit

Pulse Low Limit

Extr Brady

Brady Clamp

ExtrTachy

Tachy Clamp

adult

on

120 bpm

50 bpm

20 bpm

40 bpm

20 bpm

200 bpm

NBP Default Settings

pediatric

on

160bpm

75 bpm

20 bpm

40 bpm

20 bpm

220 bpm

neonatal

on

200 bpm

100 bpm

20 bpm

50 bpm

20 bpm

240 bpm

Factory defaults H10 / H20 / H40

NBP Settings

Adult Pedi Neo

Auto/Manual

Alarms from

Auto

Sys.

Manual

High Alarm Limit 160/ 90 (110) 120/ 70 (90) 90/ 60 (70)

Low Alarm Limit 90/ 50 (60) 70/ 40 (50) 40/ 20 (24)

Alarms

NBP

On

On

Repetition Time 15 min

Unit mmHg

Done Tone

Start Time

VP Pressure

Reference

Color

Off

Synchronized

60 mmHg

Auscultatory

Red

40 mmHg 30 mmHg

Invasive

H30 (deviations from H10/20/40)

Adult

180/ 90 (110)

70/ 50 (65)

3 min

On

NotSynchron.

Magenta

Pedi Neo

Temperature Default Settings

Temp Settings

Low Limit

High Limit

Alarms

Unit

Range

Color

Factory defaults H10 / H20 / H40

Adult

36

39

On

0

C

35...43

Green

Pedi Neo

H30 (deviations from H10/20/40)

Adult

35

Pedi Neo

30 ... 43

Light Green

375

35 Default Settings Appendix

Invasive Pressure Default Settings

Invasive Pressure Default Settings

Alarms from

High Limit

Low Limit

Alarms

Scale

Speed

Mean Only

Filter

Mercury Cal.

Artifact Suppr.

Unit

Color

ABP, ART, Ao, BAP,

FAP, P, P1, P2, P3,

P4, UAP Settings

Factory defaults H10 / H20 / H40

Adult Pedi Neo

H30 (deviations from H10/20/40)

Adult

Sys.

160/ 90 (110) 120/ 70 (90) 90/ 60 (70) 180/ 90 (110)

90/ 50 (70)

On

70/ 40 (50) 55/ 20 (35) 70/ 50 (70)

100 100 150

25mm/s

No

12 Hz

Yes

60 sec mmHg

Red

Pedi Neo

CVP, RAP, LAP,

UVP Settings

Alarms from

High Limit

Low Limit

Alarms

Scale

Speed

Mean Only

Filter

Mercury Cal.

Artifact Suppr.

Unit

Color

Factory defaults H10 / H20 / H40

Adult

Mean

14 / 6 (10)

6 / -4 (0)

On

30

25mm/s

Yes

12 Hz

Yes

60 sec mmHg

Cyan

Pedi

10 / 2 (4)

2 / -4 (0)

Neo

10 / 2 (4)

2 / -4 (0)

H30 (deviations from H10/20/40)

Adult

Blue

Pedi Neo

Invasive Pressure

Settings

Alarms from

High Limit

Low Limit

Alarms

Scale

Speed

PAP Settings ICP, IC1, IC2 Settings

Factory Adult Factory Pedi Factory Neo Factory Adult Factory Pedi Factory Neo

Dia.

35 / 16 (20)

10 / 0 (0)

On

30

25mm/s

Mean

60 / 4 (26) 60 / 4 (26) 14 / 6 (10) 10 / 2 (4) 10 / 2 (4)

24 / -4 (12) 24 / -4 (12) 6 / -4 (0)

On

2 / -4 (0) 2 / -4 (0)

30

25mm/s

376

Cardiac Output Default Settings

35 Default Settings Appendix

Invasive Pressure

Settings

Mean Only

Filter

Mercury Cal.

Artifact Suppr.

Unit

Color

PAP Settings ICP, IC1, IC2 Settings

Factory Adult Factory Pedi Factory Neo Factory Adult Factory Pedi Factory Neo

No

12 Hz

Yes

60 sec mmHg

Yellow

Yes

12 Hz

Yes

60 sec mmHg

Magenta

Cardiac Output Default Settings

Factory defaults H10 / H20 / H40

C.O. Settings

Adult

Auto-Calibration

Tblood High Limit

Tblood Low Limit

On

39.0 ºC

36.0 ºC

Tblood Alarm On/Off On

Temperature Unit

0

C

Color Green

Pedi Neo

H30 (deviations from H10/20/40)

Adult

Yellow

CCO/CCI Settings Factory Adult

Settings common to CCO and CCI

Alarms from CCO

CCO from

Color

ABP

Green

CCO

Alarms On

CCO High Limit

CCO Low Limit

8.5 l/min

4.0 l/min

CCI

Alarms

CCI High Limit

CCI Low Limit

On

4.3 l/min/m

2.0 l/min/m

2

2

Factory Pedi

3.7 l/min

2.6 l/min

3.7 l/min/m

2

2.6 l/min/m

2

Factory Neo

1.3 l/min

0.3 l/min

5.2 l/min/m

2

1.2 l/min/m

2

Pedi Neo

377

35 Default Settings Appendix

CO

2

Default Settings

CO

2

Settings

etCO

2

low etCO

2

high imCO

2

high

CO

2

Alarms

Unit

Factory defaults H10 / H20 / H40

Adult

30

50

4 on mmHg

Scale

ImCO

2

N

2

O Corr (only

M3015A/

M3016A)

40 mmHg on

Off

Oxygen Corr (only

M3014A)

16%

Off Gas Corr (only

M3014A)

Humidity Corr BTPS

Max Hold Off

AwRR On

AwRR Alarms On

AwRR high limit 30

AwRR low limit

Apnea time

Color

8

20 secs

Yellow

Pedi Neo

100

30

Spirometry Default Settings

Spirometry

Settings

Adult

APNEA high limit 20

MVexp low limit 4.0

MVexp high limit 8.0

PIP high limit 40

PEEP low limit 0

PEEP high limit 25

RRspir low limit 8

RRSpir high limit 30

AWF scale

±

150 l/min

AWV scale

AWP scale

±

800 ml

±

40 cmH

2

O

Pedi

20

2.5

4.0

25

0

25

8

30

±

100 l/min

±

200 ml

±

40 cmH

2

O

50

Off

White

CO

2

Default Settings

H30 (deviations from H10/20/40)

Adult

25

60

Pedi Neo

Neo

20

0.4

0.8

20

0

25

30

60

±

20 l/min

±

50 ml

±

20 cmH

2

O

378

tcGas Default Settings

tcGas Default Settings

35 Default Settings Appendix tcGas Settings

tcpO

2

High tcpO

2

Low tcpO

2

Alarms tcpCO

2

High tcpCO

2

Low tcpCO

2

Alarms

Site Time

Disable Timer

Heat Switch Off (i.e., after Site Timer elapsed)

Transducer Temp.

CO

2

Correction (Severinghaus)

Metabolism Factor

TcGas Unit

Temperature Unit tcpO

2

Color tcpCO

2

Color

SvO

2

Default Settings

Factory Adult

80 mmHg

50 mmHg

On

50 mmHg

30 mmHg

On

4.0 hours

Not Allowed

No

43.0 °C

On

8 mmHg mmHg

0

C

Blue

Green

SvO

2

Settings

Low Limit

High Limit

Alarms

Light Intensity

Color

Factory Adult

60%

80%

On

On

Yellow

Factory Pedi

Factory Pedi

Factory Neo

Factory Neo

379

35 Default Settings Appendix

EEG Default Settings

EEG Default Settings

EEG Settings

TP, SEF

MDF, PPF, Delta, Theta,

Alpha, Beta

SEF Threshold

Numeric Average

Wave Scale

Show Gridlines

Low Filter

High Filter

Impedance Limit

Smoothing CSA

Color

Factory Adult

On

Off

Factory Pedi Factory Neo

90 %

8 sec

100uV (or +/- 50uV if

Show Gridlines

is configured to

Yes

)

No

0.5 Hz

30 Hz

5 kOhm

On

Yellow

BIS Default Settings

Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40)

BIS Settings

Adult Pedi Neo Adult

SQI

EMG

SR

On

On

On

SEF

TP

Bursts

Scale

Off

Off

On

100uV (or +/- 50uV if

Show Gridlines

is configured to

Yes

)

No

Off

Show Gridlines

Filters

Low Filter

High Filter

Notch Filter

High Alarm Limit 70

Low Alarm Limit 20

On

2 Hz

70 Hz

On

Alarms On

Smoothing Rate 30 sec

Color Yellow

15 sec

Magenta

Pedi Neo

380

VueLink Default Settings

VueLink Default Settings

Device Alarms

Color

Ignored

Green

35 Default Settings Appendix

381

35 Default Settings Appendix

VueLink Default Settings

382

#

10-lead placement (ECG)

100

12-lead placement (ECG)

100

3-lead placement (ECG)

98

4-channel recorder

258

5-lead placement (ECG)

98

A

AAMI ECG lead labels

97

abdominal breathing and Resp electrode placement

132

aberrantly conducted beats

108

AC power input

332

accessories

10-electrode cable sets

310

3-electrode cable sets

309

3-electrode one piece cables

310

5-electrode cable sets

310

5-electrode one piece cables

310

Aspect Medical Systems

322

C.O.

319

CO2

176

,

181

,

188

CO2 (mainstream)

320

CO2 (microstream)

321

ECG

309

EEG

322

Hospira Inc.

323

NBP adult cuffs

312

comfort cuffs

311

disposable cuffs

311

multi-patient comfort cuff kits

311

neonatal/infant cuffs

(disposable)

312

reusable cuffs

311

single-hose disposable cuffs

312

Nellcor

313

pressure

313

Pulsion

313

recorder paper

324

resp

309

set combiners and organizers

311

SpO2

313

Nellcor adhesive sensors

(disposable)

313

Philips sensors (disposable)

313

Philips sensors (reusable)

313

SvO2

323

temperature

318

trunk cables

309

active alarms

41

address, Philips

326

addressograph (printer configuration setting)

272

adjusting ST measurement points

120

adjusting wave scale (pressure)

154

adjusting wave size (CO2)

183

,

192

admit editing information

79

quick admit

78

admitting a patient

77

advanced event surveillance

241

airway adapter

CO2, microstream accessory

182

alarm latching

51

,

52

,

113

alarm limits changing

48

checking

46

manually adjusting

48

narrow

49

report

273

setting

46

ST

122

switching auto limits on/off

49

using automatic limits

49

wide

49

window

47

alarm recording

259

choosing recorded measurements

261

alarm source selection, disabled

129

alarm status area

14

alarms acknowledging

44

active

41

active SpO2 source

141

alphabetical listing

53

apnea delay

184

,

192

apnea delay time (Resp)

134

arrhythmia

41

audible indicators

42

awrr limits

184

chaining

115

CO2 specific

184

CO2, apnea delay

184

,

192

CO2, awRR

184

desat, SpO2

140

effect on pressure alarms during zero

153

extending pause time

46

high priority

41

INOP

41

ISO/IEC standard 9703-2

43

limit, SpO2

352

NBP source

147

patient messages

53

pausing

44

physiological

53

pleth as source

141

red

41

reminder

44

restarting

46

reviewing

50

reviewing messages

50

reviewing window

50

selftest

52

silencing

44

SpO2 high and low limits

140

SpO2 specific

140

ST

122

suspended symbol

45

SvO2, behavior during measurement

204

switching on and off

45

temperature

149

testing

52

tone configuration

42

traditional

43

visual indicators

42

volume, changing

43

VueLink and external devices

283

yellow

41

alphabetical listing of alarms

53

alternating current symbol

328

analog interface symbol

329

analog output

ECG

329

pressure

160

analog video out connector

332

annotating events

251

annotation recording strip

262

apnea alarm delay

CO2

184

,

192

apnea alarm delay time (RESP)

134

apnea alarms and Resp detection modes

134

Application Server

33

arrhythmia aberrantly conducted beats

108

analysis, how it works

107

atrial fibrillation and flutter

108

beat labels

109

initiating learning

111

,

112

intermittent bundle branch block

109

learning during ventricular rhythm

112

levels of analysis

104

,

107

monitoring non-paced patients

108

monitoring paced patients

108

options

107

relearning

111

relearning and lead fallback

112

status messages

110

switching on/off

108

understanding the display

109

arrhythmia alarms

41

,

112

adjusting alarm limits

113

all yellow on/off

113

chaining

115

latching

113

multiple

115

i

pvc-related alarms

116

short yellow

105

sinus and SV rhythm ranges

350

,

352

switching on/off

113

timeout periods

113

yellow

113

arrhythmia monitoring and defibrillation

106

arrhythmia options

104

arrhythmia relearning with EASI INOP

102

arterial catheter constant (PiCCO)

166

arterial pressure source

157

,

158

arterial pulsation

137

arterial values

195

artifact suppression (pressure)

155

Aspect Medical Systems Inc

327

atrial fibrillation and flutter

108

audlatching (arrhythmia alarms)

113

auto alarm limits switching on/off

49

using

49

auto detection mode (Resp)

132

auto ECG wave gain (recordings)

261

auto window (care groups)

88

autofilter

95

automatic arrhythmia relearn

112

automatic default setting

26

automatic NBP repeat time

146

autosize

ECG wave

94

average trend events

243

awRR alarm limits

184

awRR alarms

CO2

184

B

backlight maintenance interval

306

balloon inflation, wedge measurement

159

baseline

ST map, updating

125

ST, updating

119

basic arrhythmia option

104

,

107

basic event surveillance

241

setup

245

battery and display brightness

302

battery compartment location

297

,

298

battery reports

300

battery status recording

300

battery status window

300

charge status

301

conditioning

302

conserving power

302

LED

298

malfunction symbols

298

power gauge

298

recharging

298

replacing

301

safety information

303

symbol

329

battery operation

MP20 MP30

297

MP40 MP50

297

beat labels arrhythmia

109

BIS

BIS engine software revision

221

cables, securing

221

Continuous Impedance Check

218

Cyclic Impedance Check

218

filters

220

Ground Check

218

impedance indicators

219

monitoring

215

monitoring setup

216

numeric

215

numerics on/off

220

safety information

221

smoothing rate changing

220

updating software

221

window

219

Bispectral Index monitoring

215

blood pressure. See also NBP (non-invasive) or PRESS (invasive)

Brightness SmartKey

31

brightness, adjusting

31

BSA formula (trends)

236

buffer (EEG)

211

buffer (EEG) on reports

213

buffer (EEG) on screen

212

bursts numeric (BIS)

215

C

C.I.

162

C.O.

161

accessories

319

calibrating measurements (PiCCO)

167

curve alert messages

171

documenting measurements

169

editing measurements (PiCCO)

166

editing measurements (RH method)

169

flow-through method

168

hemocalc window

164

hemodynamic parameters available

162

injectate guidelines

170

PiCCO method

164

Procedure window

163

prompt messages

172

results table

163

right heart thermodilution method

168

saving measurements (PiCCO)

167

setup for PiCCO method

165

setup for RH method

168

setup menu

164

temperature unit

163

C.O. warning messages

173

C.O./CCO safety information

173

Calc Type

233

calculating drug infusions

277

calculating cerebral perfusion

157

calculating oxygen extraction

206

calculating pulse pressure variation

157

calculating temperature difference

150

calculations

233

pop-up keys

234

calculations reports

237

calculations review

235

calculator

20

calibrating

CO2 transducer

180

tcGas transducer

199

calibrating C.O. measurements

167

calibration interval, NBP

306

NBP

147

pressure

156

pressure transducer

156

SvO2 light intensity

205

SvO2 required equipment

203

SvO2, in-vivo

206

SvO2, pre-insertion

204

calibration status indicators (C.O)

167

capnography mainstream

12

Microstream

12

capturing loops

290

carbon dioxide, see CO2

175

,

187

cardiac output how the measurement works

161

report

275

cardiac overlay and Resp detection modes

133

when measuring Resp

131

cardiotach alarms

104

care groups alarm notification

88

ii

other bed window

87

pop-up window

88

catheter

SvO2, insertion

205

catheter constant, setting (PiCCO)

166

catheter preparation

SvO2

204

cautions

1

CCO calibration status indicators

167

choosing the correct pressure source

166

how the measurement works

161

PiCCO method

164

central recorder choosing

261

cerebral perfusion

157

CFI

162

chaining

115

change screen menu

22

changing ECG lead sets

96

changing EEG wave scale

212

changing EEG wave speed

213

changing Resp detection mode

132

changing Resp wave size

133

changing Resp wave speed

134

changing screen content

22

changing screens

22

changing wave scale

EEG

220

channels recorder

261

checking battery charge

301

checking paced status

92

cleaning infection control

293

method

294

monitoring accessories

294

recommended substances

294

recorder printhead

295

CO2 airway adapter

182

alarms, apnea delay

184

,

192

alarms, awRR

184

alarms, specific

184

awRR alarm limits

184

checking transducer accuracy

179

correction, humidity

183

correction, N2O

183

corrections

183

,

192

FilterLine

182

mainstream accessories

176

,

188

measuring mainstream

176

,

179

measuring microstream

181

method, mainstream

175

method, microstream

175

method, sidestream

175

microstream accessories

181

microstream extension

181

removing exhaust gases

179

,

182

transducer, calibrating

180

transducer, using

180

troubleshooting

183

,

192

wave scale, adjusting

183

,

192

CO2 (mainstream).

accessories

320

CO2 (microstream).

accessories

321

code recording

262

combi-events

248

Compressed Spectral Arrays (CSA)

211

computation constant (RH)

169

conditioning batteries

302

configuration drug calculator

278

trends database

229

configuration mode

21

conflict label

29

connecting BIS accessories

216

connecting temperature probe

149

connection direction indicator symbol

328

connection direction symbol

328

connector

AC power input

332

additional MSL

333

analog video out

332

ECG analog (sync) output

330

,

332

,

333

equipotential ground

332

marker input

345

MMS patient cable

333

mouse

332

MSL

332

printer

332

protective earth

332

recorder module

333

trackball

332

wired network

332

wireless network

332

connectors

329

serial/MIB

330

,

331

,

332

continuous cardiac output

161

Continuous Impedance Check (BIS)

218

conventional 12-lead ECG

100

correcting the NBP measurement

145

counting events

247

CPAP (RESP)

133

CSA (Compressed Spectral Arrays)

211

cuff pressure, NBP

146

selection, NBP

145

current view

ST map

122

curve alert messages (C.O.)

171

Cyclic Impedance Check (BIS)

218

D

damage mechanical

32

database events

247

database configuration trends

229

date, setting

31

default profile

26

default settings

369

defibrillation and arrhythmia monitoring

106

and ECG monitoring

106

and monitoring BIS

221

during EEG monitoring

214

synchronization marks

93

defibrillator input

345

defibrillator proof symbol

328

defibrillator synch maintenance interval

306

delay time recording

261

delayed recording

259

deleting events

247

demonstration mode

21

desat alarm, SpO2

140

detection modes (Resp)

132

device driver language conflict with monitor

284

diagnostic (ECG filter setting)

96

digital interface symbol

329

digital video device connection symbol

328

disabling touch operation

15

discharging a patient

79

disconnect INOPs silencing

44

disinfecting infection control

293

recommended substances

294

display arrhythmia

109

ECG

93

NBP

145

Resp

132

ST

118

using a second display

23

display brightness

302

iii

display settings

24

disposal gas cylinder

307

parts and accessories

307

documenting events

251

dosemeter (drug calculator)

279

dPmax

162

drip table (drug calculator)

280

drug calculator

277

DSC (BIS) software revision

221

dual SpO2

141

dual Temp measurement

150

dyshemoglobins intravascular (SpO2)

139

E

early systolic blood pressure, NBP

146

EASI activating

96

ECG monitoring

102

lead placement

102

EASI ECG lead labels

97

ECG

91

accessories

309

alarms off (Config Mode)

105

changing lead sets

96

choosing electrode sites

96

conventional 12-lead

100

external pacing electrodes

106

filter settings

95

fusion beat pacemakers

106

intrinsic rhythm

106

modified 12-lead

100

New Lead Setup

96

pacemaker failure

106

rate adaptive pacemakers

106

unfiltered

96

wave size

94

ECG analog (sync) output

330

,

332

,

333

ECG analog output

329

ECG cable for operating room

106

ECG cables, connecting

91

ECG connector

91

ECG display

93

ECG electrode colors

97

ECG electrode placement during electrosurgery

106

ECG gain in recordings

261

in reports

268

ECG lead labels

97

ECG lead placement

iv

choosing EASI/Standard

96

ECG leads monitored

96

ECG output

345

ECG report

276

lead layout

268

ECG safety information

105

ECG wave autosize

94

calibration bar

94

ectopic status messages (arrhythmia monitoring)

111

editing C.O. measurements (PiCCO method)

166

editing C.O. measurements (RH method)

C.O.

saving measurements (RH method)

169

EEG accessories

322

monitor configuration and upgrade

214

EEG monitoring

207

buffer time

211

changing filter frequencies

213

changing wave scale

212

changing wave speed

213

choosing electrode montages

209

CSAs

211

electrical interference

214

electrode-to-skin impedance

210

gridlines

212

impedance quality indicators

210

Impedance/Montage Window

208

international 10-20 electrode placement system

209

safety information

214

setting report buffer time

213

setting screen buffer time

212

setup

208

skin preparation

208

switching numerics on and off

212

EEG wave changing scale

220

electrical input symbol

328

electrical interference during EEG monitoring

214

electrical output symbol

328

electrode montage

EEG

209

electrode placement (ECG)

91

conventional 12-lead

100

modified 12-lead

100

electrode placement (Resp)

131

with abdominal breathing

132

with lateral chest expansion

132

electrode-to-skin impedance (BIS)

219

electrode-to-skin impedance (EEG)

210

electromyographic activity numeric

(BIS)

215

electrosurgery and ECG

106

EMC interference

Resp

134

EMG numeric (BIS)

215

EMI filter for ECG

95

end case discharging a patient

79

report, printing

79

end case reports setup

269

enhanced arrhythmia option

104

,

107

entering values calculations

236

equipotential ground connector

332

equipotential grounding symbol

328

event annotation

251

combi-events

248

counting oxyCRG/NER events

248

event counter

247

event episode

242

event episode recording

253

event episode types

243

event episode window

250

event post-time

242

event pre-time

242

event retriggering

245

event review recording

252

event review window

249

event summary view

249

event time

242

event triggers

244

event values

251

manual event triggers

246

recording

251

setting up NER

245

event database

247

event episode reports

270

event groups

242

event report

254

event review reports

270

event snapshots

243

event surveillance

241

options

241

events pop-up keys

243

EVLW/EVLWI

162

exclamation mark symbol

328

exhaust gases, removing

179

,

182

extension cable for SpO2

138

external devices alarms and INOPS

283

connecting to VueLink

281

connecting via VueLink

282

external pacing electrodes and ECG monitoring

106

extreme bradycardia alarm

105

,

129

extreme rate alarms

105

,

129

extreme tachycardia alarm

105

,

129

F

fallback (ECG)

97

FAST

Fourier artefact suppression technology

137

filter (ECG filter setting)

95

filter (ECG)

95

filter frequencies (EEG)

213

FilterLine

CO2, microstream accessory

182

filters

BIS

220

flexible module server - see FMS

8

flushing invasive pressure accessories

151

FMS connecting to monitor

8

modules

8

functional arterial oxygen saturation

137

fusion beat pacemakers and ECG monitoring

106

G

gas cylinder empty, disposing of

307

gas input symbol

328

gas output symbol

328

GEDV/GEDVI

162

getting started

32

global trend time

230

graphic trend report

225

graphic trends

224

graphic trends report

228

gridlines (EEG)

212

,

220

Ground Check (BIS)

218

H

hardkeys

19

help

INOPS

51

hemodynamic calculations

233

hemodynamic measurement server extension

13

hemodynamic parameters

162

high filter (EEG)

213

high pass filter (BIS)

220

high resolution recording

259

high-res trend event episodes

243

high-res trend waves about

239

OxyCRG

239

high-res waves in reports

240

list of available measurements

343

recordings

240

HiResTrnd see high-res trend

243

horizon trend trend time

230

HR = RR (Resp)

132

HR alarms when arrhythmia off

105

HR alarms off (Config Mode)

105

HR and pulse alarm source selection

129

HR from (heart rate source)

128

humidity correction

CO2

183

I

IEC ECG lead labels

97

impedance indicators (BIS)

219

impedance quality indicators

210

IMV (Resp)

133

independent display connection symbol

328

infection control cleaning

293

disinfecting

293

sterilizing

293

Information Center central recording

258

transferring patients

80

injectate guidelines for C.O.

170

injectate volume setting (C.O.)

166

INOPs from external devices

283

indicators

41

silencing

44

input defibrillator

345

installation connectors

329

Instructions for Use intended audience

1

integrated module slots (MP40 50 60

70)

257

IntelliVue family

1

intermittent bundle branch block

109

intermittent mandatory ventilation

(Resp)

133

interruption symbol

328

intravascular dyshemoglobins (SpO2)

139

intrinsic rhythm

106

invasive pressure

151

in-vivo calibration, SvO2

206

ISO point (ST)

120

ITBV/ITBVI

162

J

J point (ST)

120

K

keyboard connection symbol

328

keys hardkeys

19

permanent keys

17

pop-up

19

SmartKeys

18

L

label conflict resolution

29

labels resolving conflict

30

language conflicts with device driver

284

latching alarms

51

alarms, behavior

52

latching arrhythmia alarms

113

lateral chest expansion (neonates) monitoring Resp

132

LCW/LCWI

162

lead fallback and arrhythmia relearning

112

lead fallback (ECG)

97

lead labels (ECG)

97

lead placement activating EASI/Standard

96

for Resp measurement

131

leads monitored (ECG)

96

Leads Off INOP (ECG)

97

LED battery status

298

levels of arrhythmia analysis

107

levels of event surveillance

241

line frequency interference (BIS)

220

loops

289

capturing

290

loop size in window

291

loops report

292

source device

291

volume-flow

289

low filter (EEG)

213

v

low pass filter (BIS)

220

LVCI

162

M

M1116B

257

M3160A recorder

258

main screen overview

14

mainstream capnography

12

mainstream CO2 accessories

176

,

188

measuring

176

,

179

maintenance cables

305

cords

305

measurements, schedule

306

microstream CO2, calibration

306

schedule

305

visual inspection

305

major parts and keys

MP20 MP30

3

MP40 MP50

4

malfunction symbols battery

298

manual detection mode (Resp)

133

and apnea alarms

134

manually triggering events

246

manufacture date symbol

328

manufacturer’s information

326

map

ST

122

marker input connector

345

Mason-Likar lead system

100

max hold setting (CO2)

175

MDF (mean dominant frequency)

207

mean dominant frequency (MDF)

207

mean pressure calculation (trends)

236

measurement adjusting a wave

27

preparation

32

setting up

26

switching on and off

27

wave speed, changing

27

measurement modules setting up

32

measurement points, ST

120

measurement selection window

31

measurement server

ECG connector

91

measurement server extension

M3012A

13

M3015A

12

M3016A

12

measurement server link cable

8

vi

measurement server link connection symbol

328

measurement servers setting up

32

measurement settings

24

mechanical damage

32

merging patient data

84

methemoglobin (SpO2)

139

MIB connector

330

,

331

,

332

Microstream capnography

12

microstream CO2

181

accessories

181

maintenance, calibration

306

measuring

181

minimize

34

mismatch patient data, resolving

82

MMS connecting to FMS

10

connecting to monitor

10

patient cable connector

333

using for patient transfer

81

modified 12-lead ECG

100

modified screen history

22

modifying screens

22

module connecting

9

reconnecting

9

removing

9

setup key

9

setup menu

9

tcGas

195

unplugging

9

VueLink

281

VueLink Type A and Type B

281

modules setting up

32

monitor inspecting before use

32

starting monitoring

33

switching on

32

monitor (ECG filter setting)

95

monitor defaults

369

monitor revision how to find

32

monitor settings

24

changing

31

monitoring preparation

32

monitoring BIS

215

monitoring EEG

207

monitoring mode

21

mouse using

17

mouse connection symbol

328

mouse connector

332

MP20

2

MP20 Junior

2

MP20 MP30 major parts and keys

3

screen menus

15

MP30

2

MP40

4

MP40 MP50 major parts and keys

4

screen menus

15

MP50

4

MR imaging and the SpO2 transducer

139

MSL cable

8

MSL connector

332

MSL, additional connector

333

multi-lead ST alarming

122

multi-measurement server (MMS)

10

N

N2O correction

CO2

183

narrow alarm limits

49

navigating

14

mouse

17

permanent keys

17

SmartKeys

18

trackball

17

navigation point

17

NBP adult cuffs

312

alarm source

147

ANSI/AAMI SP10-1992

143

automatic mode, enabling

146

calibrating

147

calibration interval

306

comfort cuff kits

311

comfort cuffs

311

cuff pressure

146

cuff, applying

145

cuff, selecting

145

cuff, tightness

145

disposable cuffs

311

how the measurement works

143

measurement correction

145

measurement limitations

144

measurement methods, auto

144

measurement methods, manual

144

measurement methods, stat

144

measurement, starting

146

measurement, stopping

146

neonatal cuffs (disposable)

312

numerics

145

oscillometric method

143

pediatric cuffs

312

preparing to measure

144

repeat time

145

repeat time for automatic

146

repetition time, setting

146

reusable cuffs

311

single-hose disposable cuffs

312

site inspection

145

time of last measurement

145

units

145

venous puncture

147

neonatal event counting

248

neonates

Resp electrode placement

132

NER setup

245

network connection indicator

14

network connector, wired

332

network connector, wireless

332

networked monitoring

33

new features

35

non-invasive blood pressure. See NBP

non-paced patients arrhythmia monitoring

108

notch filter (BIS)

220

numerics explanation of NBP display

145

nurse call

45

nurse call relay connection symbol

328

O

on screen calculator

20

operating

14

mouse

17

permanent keys

17

SmartKeys, using

18

trackball

17

operating modes

21

configuration

21

demonstration

21

monitoring

21

passcode protection

21

service

21

operating room ECG cable

106

orange ECG cable

106

organizers

311

Oridion Systems Ltd

327

Original Calc pop-up key

235

oscillometric NBP measurement method

143

other bed window

87

output

ECG

345

overlap in recordings

261

overlapping screen trends

231

oxyCRG

239

event counting

248

OxyCRG event episodes

243

oxygen extraction

206

oxygenation calculations

233

P

pace pulse rejection (ECG) about

92

switching on/off

94

paced patients arrhythmia monitoring

108

repolarization tails

94

safety information

106

setting status

106

paced status checking

92

pacemaker failure

106

paper reloading (recorder)

264

paper size for reports

270

parallel interface symbol

328

parallel printer connection symbol

328

parameter scales trends

227

passcode protection

21

patient admit

77

category, NBP

143

discharge

79

end case

79

patient alarm messages

53

patient demographics window

77

patient mismatch

82

patient reports contents

272

patient trends viewing

223

paused alarms

44

extending time

46

restarting

46

PAWP

158

peak power frequency (PPF)

207

performance specifications pressure

348

,

354

performance test

365

performing calculations

235

perfusion indicator

137

,

138

,

141

pf loops

289

Philips contact information

326

physiological alarms

41

PIC cable (BIS) securing

221

PiCCO method

C.O.

164

CCO

164

setup

165

pleth alarm source

141

pleth wave

140

pleth waveform

137

plug-in recorder

257

pop-up keys

19

events

243

power disconnecting from mains power disconnecting from

33

power on symbol

328

PPF (peak power frequency)

207

PPV

157

preparing skin for ECG

91

pressure alarms during zero

153

arterial source

157

,

158

calibration pressure

156

cerebral perfusion, calculating

157

performance specifications

348

,

354

wave scale

154

wave size

154

wedge

158

wedge, editing

159

zeroing the transducer

152

pressure accessories

313

pressure analog output

160

pressure artifact suppression

155

pressure of NBP cuff

146

pressure transducer calibration

156

zeroing

153

pressure-flow loops

289

pressure-volume loops

289

previous screen

22

primary lead (ECG) selecting

92

print job suspended

271

printer disabling

271

settings

270

status messages

272

unavailable

271

printer connection symbol

328

printer connector

332

vii

printing

C.O. measurements

169

calculations reports

237

event reports

251

ST map reports

125

status log

307

trends reports

228

wedge

159

priority list for trends

227

probes disposable temperature

149

profiles

24

default profile

26

patient category

25

swapping

25

swapping setting block

26

prompt messages

C.O.

172

protective earth

332

protective earth symbol

328

pulse alarms

128

system pulse source

127

pulse numerics for SpO2

138

pulse pressure variation

157

Pulsion Medical Systems AG

327

pv loops

289

PVC-related alarms

116

PVR/PVRI

162

Q

QRS tone

129

changing volume

31

QRS tone pitch, SpO2

141

QRS volume, changing

95

quick admit

78

quick mount release symbol

328

R

radiated field immunity

Resp

134

rate adaptive pacemakers and ECG monitoring

106

ratemeter (drug calculator)

279

RCW/RCWI

162

realtime recording

259

realtime report

274

realtime reports content

270

reconnecting a module

9

recorder

257

4-channel

258

cleaning the print head

295

viii

paper accessories

324

recorder module connector

333

recorder status messages

265

recording alarm

259

annotation

262

battery status

300

beat-to-beat

259

C.O. measurements

169

central

258

changing recording type

261

channels

261

choosing recorder

261

choosing recording speed

261

context

259

creating templates

260

delayed

259

drug calculations

280

ECG gain

261

extending

259

high resolution

259

local

257

preventing fading ink

263

procedure

259

realtime

259

recording strip

262

recording strip code

262

reloading paper

264

runtime

261

setting the runtime

261

setup menu

260

ST segments

119

starting and stopping

258

types

259

wave overlap

261

wave scale

261

waveforms recorded

263

wedge

159

with the plug-in recorder

257

recording delay time

261

recording events

251

reference waves, wedge measurement

158

refresh

34

rejecting pace pulses

92

related products power-on LED

8

problem LED

8

switching on

8

relearning arrhythmia

111

reloading recorder paper

264

remembraning tcGas transducer

197

reminder, alarm

44

remote alarm device alarms remote device

7

remote applications minimize

34

refresh

34

using

33

window size

34

remote SpeedPoint

16

removing a module

9

replacing batteries

301

repolarization tails

94

report cardiac output

275

event review

254

reports alarm limits

273

battery reports

300

calculations

237

choosing paper size

270

contents

272

drip table

280

drug calculator

280

ECG

276

end case

269

loops

292

patient trends

228

realtime report

274

re-routing

271

scheduled

269

setting up

268

ST map

125

stopping printouts

268

titration table

280

trends

225

re-routing reports

271

resampling vitals

234

resolution trends

227

resolving patient mismatch

82

resp accessories

309

Resp alarms apnea alarm delay time

134

Resp detection level and apnea detection

134

Resp detection modes and cardiac overlay

133

changing

132

Resp display

132

Resp monitoring and cardiac overlay

131

Resp safety information

134

Resp wave changing size

133

changing speed

134

respiratory loops source device

291

restarting paused alarms

46

results table (C.O.)

163

re-triggering events

245

retrolental fibroplasia (SpO2)

140

review calculations

235

reviewing alarm messages

50

reviewing alarms

50

reviewing alarms window

50

RH method computation constant

169

rhythm status messages (arrhythmia monitoring)

110

right heart thermodilution method

(C.O.)

168

right heart thermodilution setup

(C.O.)

168

rs-232 interface symbol

328

rule of six

278

runtime setting recording runtime

261

RVSW/RVSWI

162

S

safety maintenance interval

306

monitor

336

safety information batteries

303

BIS

221

C.O./CCO

173

ECG

105

Resp

134

safety test

365

same patient data merge

84

scale

ECG wave

94

Resp wave

133

scales for trends waveforms

227

scheduled reports

269

screen adjusting brightness

31

disabling touch operation

15

elements

15

using a second display

23

screen trend trend time

230

screen trends

229

screens changing

22

changing content

22

understanding

22

visitor screen

24

secondary lead (ECG) selecting

92

SEF (spectral edge frequency)

207

SEF numeric (BIS)

215

on/off

220

selecting the primary lead (ECG)

92

selecting the secondary lead (ECG)

92

selftest alarms

52

sensor disposable SpO2

137

sensor temperature tcGas

196

serial LAN interface

329

serial/MIB connector symbol

328

service mode

21

set combiners

311

setting the arterial catheter constant

(PiCCO)

166

setting the computation constant (RH)

169

setting up trends

225

setting up reports

268

settings about

26

default

369

measurement settings

26

monitor settings

26

screen settings

26

settings blocks

24

setup key, module

9

setup menu, module

9

setup menu, MP20 30 40 50

15

Setup Recording menu

260

short yellow alarms

105

signal quality index numeric (BIS)

215

signal quality of SpO2

139

sinus and SV rhythm ranges

350

,

352

site timer tcGas

196

skin preparation

ECG

91

EEG

208

SmartKeys

18

smoothing rate (BIS)

220

snapshots events

243

source device loops

291

specifications

325

arrhythmia

348

spectral edge frequency (SEF)

207

spectral edge frequency numeric (BIS)

215

speed recording

261

wave speed, changing

27

SpeedPoint

16

SpeedPoint, remote

16

SpO2 accessories

313

active alarm source

141

alarms specific to

140

arterial pulsation

137

assessing suspicious reading

139

calculating difference between values

141

connecting the cables

138

disposable sensors

137

dual SpO2

141

extension cable

138

FAST technology

137

Nellcor adhesive sensors

(disposable)

313

perfusion indicator

137

,

138

,

141

Philips sensors (disposable)

313

Philips sensors (reusable)

313

pleth as alarm source

141

pleth wave

140

pleth waveform

137

pulse numerics

138

QRS tone

141

signal quality

139

site inspection

139

site selection

137

tone modulation

141

SpO2 desat alarm

140

SpO2 limit alarms

140

Sp-vO2

206

SQI numeric on/off

220

SQI numeric (BIS)

215

SR numeric (BIS)

215

on/off

220

ST adjusting alarm limits

122

alarms

104

,

122

baseline, updating

119

ensuring diagnostic quality

117

filtering

117

measurement points, adjusting adjusting

120

multi-lead alarms

122

numerics in ECG wave

93

snippets

118

ST display

118

ST map baseline, updating

125

current view

122

report, printing printing

ST map report

125

scale, changing

ix

scale

ST map

125

task window

124

trend view

123

trending interval, changing

125

trending priority

124

ST maps

122

ST point

120

standard 10-lead placement

100

standard 3-lead placement

98

standard 5-lead placement (ECG)

98

standardized rate

277

standby symbol

328

starting monitoring

33

status line

14

status log printing

307

status messages printer

272

recorder

265

status messages (arrhythmia)

110

ectopic

111

rhythm

110

sterilizing infection control

293

stopping reports printouts

268

suppression ratio (BIS)

215

surgical ECG cable

106

suspended alarm

45

suspicious SpO2 reading

139

SV/SI

162

SvO2 accessories

323

alarms

204

calibration equipment

203

catheter insertion

205

catheter preparation

204

Hospira, accessories

203

in-vivo calibration

206

light intensity calibration

205

measurement principle

203

monitoring

204

SVR/SVRI

162

switching on monitor

32

symbols

328

battery

298

synchronization marks (defibrillator)

93

system pulse

127

systolic blood pressure, NBP, early

146

T

tabular trends

224

Tamb

150

x

task window for ST map

124

Tcereb

150

tcGas

195

sensor temperature

196

transducer, calibrating

199

transducer, remembraning

197

tcGas site timer

196

technical alarms messages see INOPs

59

temperature

149

accessories

318

alarm settings

149

connecting probe to monitor

149

difference, calculating

150

dual Temp measurement

150

extended label set

150

first

150

label

149

making a measurement

149

probe, disposable

149

probe, selecting

149

second

150

tcGas sensor

196

temperature probe connecting

149

templates creating for recordings

260

testing alarms

52

time, setting

31

Tinj Probe Type

165

titration table (drug calculator)

280

tone configuration, alarm

42

tone mod (SpO2)

141

tone modulation

141

total power (TP)

207

total power numeric (BIS)

215

touch tone volume

31

touchscreen

15

disabling

15

TP (total power)

207

TP numeric (BIS) on/off

220

trackball connector

332

trackball, using

17

trademarks

327

transcutaneous gas measurements

195

transducer

CO2, accuracy

179

CO2, calibrating

180

pressure, zeroing

152

tcGas, calibrating

199

tcGas, remembraning

197

transferring centrally-monitored patients

80

transferring patients with MMS

81

transport brightness setting

302

trend time

230

global

230

trend view

ST map

123

trending interval

ST map

125

trends automatic unit conversion

236

automatic value substitution

236

database configuration

229

resolution

227

screen trends

229

setting parameter scales

227

setup

225

viewing

223

trends pop-up keys

225

trends priority list

227

ST map

124

trigger conditions events

245

triggers for events

244

troubleshooting

CO2

183

,

192

trunk cables accessories

309

Ttymp

150

Tvesic

150

Tyco Healthcare Group LP

327

U

unfiltered ECG signal

96

unplugging a module

9

upgrading effect on EEG configuration

214

user interface settings changing

31

V

V electrode placement (ECG)

99

venous puncture

147

ventilation calculations

233

viewing arrhythmia waves

109

viewing trends

223

visible waves report

270

visitor screen

24

vislatching (arrhythmia alarms)

113

vital signs recording

225

report

225

vital signs report

228

volume alarm

43

touch tone volume

31

volume-flow loops

289

VueLink alarm messages

283

device driver conflicts

284

language conflicts

284

module

281

module options

281

module setup

282

visible waves and numerics

281

W

warnings

1

wave adjusting

27

changing speed

27

scale (CO2)

183

,

192

scale (pressure)

154

size (CO2)

183

,

192

size (pressure)

154

wave channel speed

28

wave group speed

27

wave scale (EEG) changing

220

wave size

Resp

133

wave size (ECG) changing

94

wave speed eeg speed wave speed global speed

27

respiratory speed

27

wave speed (EEG)

213

wave speed (Resp)

134

wedge balloon inflation

159

editing

159

printing

159

pulmonary artery

158

recording

159

reference waves

158

what’s new

35

wide alarms limits

49

wired network connection symbol

328

wireless device connection symbol

328

Y

yellow arrhythmia alarms

113

yellow arrhythmia alarms on/off

113

Z

zero effect on pressure alarms

153

zeroing pressure transducer

152

xi

xii

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