Philips M3500B User manual

Philips M3500B User manual
H E A R T S TA R T X LT
I N STR UCTION S F OR US E
M3500B
Instructions for Use
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About This Edition
Edition 3
Printed in the USA
Publication number M3500-91900
The information in this guide applies to
the M3500B HeartStart XLT, release
Main 35 and earlier. This information is
subject to change without notice.
Philips Medical Systems shall not be
liable for errors contained herein or for
incidental or consequential damages in
connection with the furnishing, performance, or use of this material.
Edition History
Edition 1, January 3, 2000
Edition 2, May 15, 2000
Edition 3, October 30, 2002
Use of supplies or accessories other
than those recommended by Philips
Medical Systems may compromise
product performance.
THIS PRODUCT IS NOT INTENDED
FOR HOME USE.
IN THE U.S., FEDERAL LAW
RESTRICTS THIS DEVICE TO SALE
ON OR BY THE ORDER OF A PHYSICIAN.
Medical Device Directive
The M3500B HeartStart XLT Defibrillator/Monitor complies with the
requirements of the Medical Device
Directive 93/42/EEC and carries the
0123 mark accordingly.
Copyright
Copyright © 2002
Philips Electronics North America
Corporation
3000 Minuteman Road
Andover, MA USA 01810-1099
(978) 687-1501
All rights are reserved. Reproduction in
whole or in part is prohibited without
the prior written consent of the copyright holder.
SMART Biphasic is a registered trademark of Philips Medical Systems.
ii
Authorized EU-representative:
Philips Medizinsysteme Böblingen
GmbH
Hewlett Packard Str. 2
71034 Böblingen
Germany
Canada EMC:ICES-001
Device Tracking
In the USA, the Food and Drug Administration requires defibrillator manufacturers and distributors to track the
location of their defibrillators. If your
defibrillator has been sold, donated,
lost, stolen, exported, or destroyed, or if
it was not obtained directly from Philips
Medical Systems, please notify Philips
Medical Systems at (978) 659-3202.
Conventions
This guide uses the following conventions:
WARNING
Warning statements describe conditions or actions that can result
in personal injury or loss of life.
CAUTION
Caution statements describe conditions or actions that can result in
damage to the equipment or loss of data.
NOTE
Notes contain additional information on usage.
7(;7
6RIWNH\
represents messages that appear on the display
represents softkey labels that appear on the display above or
below the button to which they correspond
iii
Contents
Introduction
Overview ............................................................................................................................... 1-1
Intended Use ......................................................................................................................... 1-3
Defibrillation Therapy .......................................................................................................... 1-3
Indications for AED Therapy ......................................................................................... 1-3
Contraindications for AED Therapy ............................................................................... 1-4
Precautions for AED Therapy ......................................................................................... 1-4
Indications for Manual Defibrillation Therapy ............................................................... 1-4
Contraindications for Manual Defibrillation Therapy .................................................... 1-5
Precautions for Manual Defibrillation Therapy .............................................................. 1-5
Noninvasive Pacing Therapy ................................................................................................ 1-5
Indications ....................................................................................................................... 1-5
Contraindications ............................................................................................................ 1-5
SpO2 Monitoring .................................................................................................................. 1-6
Indications ....................................................................................................................... 1-6
Contraindications ............................................................................................................ 1-6
Learning to Use the HeartStart XLT ..................................................................................... 1-7
Safety Considerations ........................................................................................................... 1-7
Getting Started
Getting Acquainted ............................................................................................................... 2-1
Basic Orientation ............................................................................................................ 2-2
Manual Mode Controls ................................................................................................... 2-4
LCD Backlight ................................................................................................................ 2-8
Connecting to Power ............................................................................................................. 2-9
Inserting the Battery ........................................................................................................ 2-9
Removing the Battery ................................................................................................... 2-10
Low Battery Warning ................................................................................................... 2-10
Using a Data Card ............................................................................................................... 2-11
Inserting a Data Card .................................................................................................... 2-12
Removing a Data Card .................................................................................................. 2-13
v
Contents
Defibrillating in AED Mode
Overview ............................................................................................................................... 3-3
Defibrillation (with the default configuration) ............................................................... 3-3
Defibrillation (with a modified configuration) ............................................................... 3-4
Preparation ............................................................................................................................ 3-5
Defibrillating ......................................................................................................................... 3-6
Automatic Re-analysis On ...................................................................................... 3-11
Automatic Re-analysis Off ..................................................................................... 3-11
Pausing for CPR ................................................................................................................. 3-12
Monitoring Rhythm ............................................................................................................ 3-14
ERC Protocol ...................................................................................................................... 3-16
Troubleshooting .................................................................................................................. 3-18
Monitoring the ECG
Applying Monitoring Electrodes .......................................................................................... 4-2
Electrode Placement ....................................................................................................... 4-3
Selecting the Lead ................................................................................................................. 4-5
Setting the Heart Rate Alarm ................................................................................................ 4-6
Disabling the HR Alarm ....................................................................................................... 4-7
Adjusting the ECG Size ........................................................................................................ 4-7
Troubleshooting .................................................................................................................... 4-7
Monitoring SpO2
Understanding Pulse Oximetry ............................................................................................. 5-2
Selecting a Sensor ................................................................................................................. 5-3
Reusable Sensors ............................................................................................................ 5-4
Disposable Sensors ......................................................................................................... 5-4
Semi-disposable Sensors ................................................................................................. 5-4
Applying the Sensor .............................................................................................................. 5-5
Connecting the Sensor Cable ................................................................................................ 5-6
Monitoring ............................................................................................................................ 5-7
Setting Alarms ...................................................................................................................... 5-8
Responding to an Alarm ....................................................................................................... 5-8
vi
Contents
Discontinuing SpO2 Monitoring .......................................................................................... 5-9
Caring for Sensors ................................................................................................................ 5-9
Troubleshooting .................................................................................................................. 5-10
Defibrillating in Manual Mode
Enabling Manual Mode ........................................................................................................ 6-2
Preparation ............................................................................................................................ 6-3
Defibrillating ......................................................................................................................... 6-4
Returning to AED Mode ....................................................................................................... 6-6
Performing Synchronized Cardioversion
Preparing for Synchronized Cardioversion ........................................................................... 7-2
Delivering a Synchronized Shock ......................................................................................... 7-2
Delivering Additional Synchronized Shocks .................................................................. 7-4
Disabling Sync Mode ............................................................................................................ 7-4
Pacing
Demand Mode Versus Fixed Mode ...................................................................................... 8-2
Monitoring During Pacing .................................................................................................... 8-2
Preparing for Pacing ............................................................................................................. 8-3
Pacing .................................................................................................................................... 8-4
Changing Pacing Modes ....................................................................................................... 8-6
Defibrillating During Pacing ................................................................................................ 8-6
Troubleshooting .................................................................................................................... 8-7
Storing, Retrieving & Printing
Overview ............................................................................................................................... 9-1
Marking Events ..................................................................................................................... 9-2
Events Recorded ................................................................................................................... 9-3
Creating a Patient Record ..................................................................................................... 9-5
Printing the Internal Event Summary ................................................................................... 9-6
Printing Events ...................................................................................................................... 9-8
vii
Contents
Setting Up and Configuring the HeartStart XLT
Connecting/Disconnecting Patient Cables .......................................................................... 10-1
This section describes how to connect and disconnect the: .......................................... 10-1
Connecting the Pads Patient Cable ............................................................................... 10-2
Disconnecting the Pads Patient Cable .......................................................................... 10-3
Connecting the ECG Patient Cable ............................................................................... 10-4
Disconnecting the ECG Patient Cable .......................................................................... 10-4
Connecting the SpO2 Patient Cable .............................................................................. 10-5
Disconnecting the SpO2 Patient Cable ......................................................................... 10-5
Arranging Accessories in the Carrying Case ...................................................................... 10-6
Configuring the HeartStart XLT ......................................................................................... 10-7
Accessing the Configuration Menu .............................................................................. 10-7
Configurable Parameters ............................................................................................... 10-8
Setting the Manual Mode Password ........................................................................... 10-13
Modifying the Configuration ...................................................................................... 10-15
Returning to the Default Configuration ...................................................................... 10-15
Saving Settings to a Data Card ................................................................................... 10-16
Loading Settings from a Data Card ............................................................................ 10-16
Printing Settings .......................................................................................................... 10-16
Maintaining the HeartStart XLT
Operational Checks ............................................................................................................. 11-2
Before You Begin ......................................................................................................... 11-2
Every Shift .................................................................................................................... 11-3
Every Month ................................................................................................................. 11-3
Every Three Months ..................................................................................................... 11-3
Shift/System Check ....................................................................................................... 11-4
Battery Capacity Test (CT) ........................................................................................... 11-7
Battery Maintenance ........................................................................................................... 11-8
Charging Batteries ........................................................................................................ 11-8
Battery Capacity ........................................................................................................... 11-9
Battery Life-Expectancy ............................................................................................... 11-9
Storing Batteries ........................................................................................................... 11-9
Discarding Batteries ...................................................................................................... 11-9
viii
Contents
Loading Printer Paper ....................................................................................................... 11-10
Cleaning Instructions ........................................................................................................ 11-12
Cleaning the HeartStart XLT ...................................................................................... 11-12
Cleaning the Carrying Case ........................................................................................ 11-12
Cleaning the Printer Printhead .................................................................................... 11-13
Cleaning the Power Modules ...................................................................................... 11-13
Cleaning Pads, Electrodes & Cables ........................................................................... 11-14
Removing & Replacing the Carrying Case ....................................................................... 11-15
Putting On the Manual Door ............................................................................................. 11-17
Supplies & Accessories .................................................................................................... 11-18
Disposing of the HeartStart XLT ...................................................................................... 11-22
Troubleshooting
System Messages ................................................................................................................ 12-2
Momentary Messages ................................................................................................... 12-5
Troubleshooting Tips .......................................................................................................... 12-7
Calling for Service .............................................................................................................. 12-9
United States of America .............................................................................................. 12-9
Latin America ............................................................................................................... 12-9
Canada .......................................................................................................................... 12-9
Other International Areas ............................................................................................ 12-10
ix
Contents
Specifications & Safety
Specifications ...................................................................................................................... 13-2
Defibrillator .................................................................................................................. 13-2
Manual Mode .......................................................................................................... 13-2
AED Mode .............................................................................................................. 13-3
ECG Monitoring ........................................................................................................... 13-4
Display .......................................................................................................................... 13-5
Thermal Array Printer ................................................................................................... 13-5
Thermal Array Printer (cont.) ....................................................................................... 13-6
Battery and Battery Power Module .............................................................................. 13-6
Noninvasive Pacing ...................................................................................................... 13-7
SpO2/Pulse Oximetry ................................................................................................... 13-7
Event Storage ................................................................................................................ 13-8
General .......................................................................................................................... 13-8
Environmental ............................................................................................................... 13-9
Symbol Definitions ........................................................................................................... 13-10
Clinical Performance Summary - Defibrillation ............................................................... 13-14
Methods ...................................................................................................................... 13-14
Results ......................................................................................................................... 13-14
Conclusion .................................................................................................................. 13-15
Clinical Performance Summary - Cardioversion .............................................................. 13-16
Methods ...................................................................................................................... 13-16
Results ......................................................................................................................... 13-16
Conclusion .................................................................................................................. 13-18
Safety Considerations ....................................................................................................... 13-19
Electromagnetic Compatibility ......................................................................................... 13-22
Reducing Electromagnetic Interference ...................................................................... 13-22
Restrictions for Use .................................................................................................... 13-23
Immunity Level ........................................................................................................... 13-23
x
1 Introduction
1
The M3500B HeartStart XLT Defibrillator/Monitor is designed to meet your
resuscitation and monitoring needs. This guide provides instructions for safe
and proper operation, set-up, configuration, and care of your HeartStart XLT.
In this chapter, you’ll find general information that you should become familiar with before using the defibrillator/monitor.
Overview
The HeartStart XLT is a lightweight, portable, semi-automatic external
defibrillator. It offers two modes of operation for defibrillation:
z
z
Semi-Automatic External Defibrillation (AED) Mode
Manual Mode
Both modes incorporates a low energy SMART Biphasic waveform for
defibrillation.
In AED Mode, the HeartStart XLT analyzes the patient’s ECG and advises
you whether or not to deliver a shock. Voice prompts guide you through the
defibrillation process by providing instructions and patient information. The
voice prompts are reinforced by messages that appear on the display.
In Manual Mode, the HeartStart XLT turns control of the defibrillation process over to you. You assess the patient’s ECG, decide if defibrillation is
advised, and select the energy setting for defibrillation. Manual Mode also
allows you to perform synchronized cardioversion and offers optional noninvasive pacing.
M3500B HeartStart XLT Defibrillator/Monitor
1-1
Overview
Defibrillation is performed through multifunction defib electrode pads. In
addition, both AED and Manual Mode offer monitoring through pads, 3-lead
ECG monitoring electrodes, or optional 5-lead ECG monitoring electrodes.
Optional pulse oximetry (SpO2) monitoring is available in both modes, as
well. While monitoring ECG or SpO2, you may set heart rate and/or SpO2
alarms to alert you when these parameters are outside the limits defined.
The HeartStart XLT automatically stores critical events, such as shocks and
alarm violations, in its internal memory. Additional events of interest to you
may be marked for storage, as well. Events may be printed as they occur or an
Event Summary may be printed at any time. The HeartStart XLT also allows
you to store data and events on a Data Card for downloading to HeartStart
Event Review Data Management systems.
The versatile HeartStart XLT is highly configurable to better meet the needs
of diverse users. The messages and softkeys vary, depending on how the
HeartStart XLT is configured. Be sure to familiarize yourself with your configuration before using the HeartStart XLT (see “Configuring the HeartStart
XLT” on page 10-7).
The HeartStart XLT is powered by a rechargeable sealed lead acid (SLA) battery that allows the defibrillator to charge to 200 joules in less than three seconds. Proper care of your batteries will ensure that they have the energy
required to operate the HeartStart XLT and to deliver the appropriate therapy.
(See “Battery Maintenance” on page 11-8.) Similarly, following the specified
operational checks will ensure that the HeartStart XLT is functioning and
ready for use. (See “Operational Checks” on page 11-2.)
1-2
Introduction
Intended Use
Intended Use
The M3500B HeartStart XLT Defibrillator/Monitor is for use by emergency
personnel trained in the operation of the device and qualified by training in
basic life support, advanced cardiac life support, defibrillation, or other physician-authorized emergency medical response. It must be used by or on the
order of a physician.
When operating as a semi-automatic external defibrillator in AED Mode, the
HeartStart XLT is suitable for use by health care professionals trained in basic
life support that includes the use of an AED.
When operating as a defibrillator/monitor in Manual Mode, the HeartStart
XLT is suitable for use by health care professionals trained in advanced cardiac life support.
Defibrillation Therapy
Defibrillation therapy is the definitive method for termination of a variety of
potentially fatal arrhythmias. The HeartStart XLT provides this therapy
through the application of a brief biphasic pulse of electricity to the cardiac
muscle. This electrical energy is transferred through disposable multifunction
defib electrode pads applied to the patient’s bare chest.
NOTE
Successful resuscitation is dependent on many variables specific to the
patient’s physiological state and the circumstances surrounding the patient
event. Failure to have a successful patient outcome is not a reliable indicator
of defibrillator/monitor performance. The presence or absence of a muscular
response to the transfer of energy during electrical therapy is not a reliable
indicator of energy delivery or device performance.
Indications for AED Therapy
An AED is to be used in the presence of a suspected cardiac arrest on patients
that are:
z
z
z
Unresponsive
Not breathing
Pulseless
M3500B HeartStart XLT Defibrillator/Monitor
1-3
1
Defibrillation Therapy
Contraindications for AED Therapy
An AED is not to be used on patients that exhibit one or any combination of
the following:
z
z
z
Responsiveness
Spontaneous breathing
Palpable pulse
Precautions for AED Therapy
The AED algorithm is not designed to handle erratic spiking problems caused
by a properly or improperly functioning pacemaker. In patients with cardiac
pacemakers, the HeartStart XLT may have reduced sensitivity and not detect
all shockable rhythms.
NOTE
AED mode is not intended for use on children less than 8 years of age. For
children older than 8 years, the American Heart Association recommends that
standard operating procedures for AEDs be followed. American Heart Association Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Dallas, Texas; AHA; 2000"
Indications for Manual Defibrillation Therapy
Asynchronous defibrillation is the initial treatment for ventricular fibrillation
and ventricular tachycardia, in patients who are pulseless and unresponsive.
Synchronous defibrillation is indicated for termination of atrial fibrillation.
The SMART Biphasic waveform utilized in the HeartStart XLT
Defibrillator/Monitor has undergone clinical testing demonstrating its
effectiveness for cardioversion of atrial fibrillation.
The SMART Biphasic waveform utilized in the HeartStart XLT has undergone clinical testing in adults. These trials support the waveform’s effectiveness for defibrillation of ventricular tachyarrhythmias at 150J.
In manual mode operation, the HeartStart XLT incorporates some user selectable lower energy levels that were not used in the clinical trials.
1-4
Introduction
Noninvasive Pacing Therapy
Contraindications for Manual Defibrillation Therapy
Asynchronous defibrillation therapy is contraindicated in patients that exhibit
one or any combination of the following:
z
z
z
Responsiveness
Spontaneous breathing
Palpable pulse
Precautions for Manual Defibrillation Therapy
Defibrillating asystole can inhibit the recovery of natural pacemakers in the
heart and completely eliminate any chance of recovery. Asystole should not
be routinely shocked.
Noninvasive Pacing Therapy
The HeartStart XLT provides noninvasive transcutaneous pacing by delivering a monophasic, electrical stimulus to the heart. This stimulus is intended to
cause cardiac depolarization and myocardial contraction. The emergency care
provider selects the stimulus current and rate settings. The energy is delivered
through multifunction defib electrode pads applied to the patient’s bare chest.
Indications
Noninvasive pacing is one method of treating patients with symptomatic
bradycardia. It can also be helpful in patients with asystole, if performed
early.
Contraindications
Noninvasive pacing is contraindicated in the treatment of ventricular fibrillation. Noninvasive pacing in the presence of severe hypothermia may be contraindicated.
M3500B HeartStart XLT Defibrillator/Monitor
1-5
1
SpO2 Monitoring
SpO2 Monitoring
A pulse oximeter is a noninvasive device that indicates the oxygen saturation
(SpO2) of arterial blood. This measurement is obtained through a probe that
directs red and near infrared light through arterial beds. Hemoglobin absorbs
these lights differently when it is bound with oxygen. Pulse oximetry measures this difference and translates the measurement into a saturation percentage that is displayed as an SpO2 reading.
Indications
SpO2 monitoring is indicated for use when it is beneficial to assess a patient’s
oxygen saturation level.
Contraindications
None known.
NOTE
1-6
Readings should be carefully considered in the presence of certain circumstances. Inaccuracies may result from the use of pulse oximeters in the presence of certain circumstances, such as hemoglobin saturated with compounds
other than oxygen (such as carbon monoxide), hypothermia, hypovolemia,
patient movement, nail polish and excessive ambient light.
Introduction
Learning to Use the HeartStart XLT
Learning to Use the HeartStart XLT
The HeartStart XLT comes with:
z
z
1
Using the HeartStart XLT Defibrillator/Monitor, a videotape, and
About Sealed Lead Acid Batteries, an application note on battery
maintenance.
For additional training materials, please visit our website at:
www.medical.philips.com/cms.
Safety Considerations
General warnings and cautions that apply to use of the HeartStart XLT are
provided in Chapter 13. Additional warnings and cautions specific to a particular feature are provided in the appropriate section of this guide.
M3500B HeartStart XLT Defibrillator/Monitor
1-7
2 Getting Started
Your HeartStart XLT is shipped to you in its carrying case with most of the
accessories in their compartments. All you need to do before getting started is:
z
z
z
connect cables,
connect to power, and
insert the Data Card (if desired).
This chapter will acquaint you with the HeartStart XLT and then guide you
through these activities.
NOTE
To connect cables to the HeartStart XLT or to arrange accessories in the carrying case, refer to “Setting Up and Configuring the HeartStart XLT” in Chapter
10.
Getting Acquainted
This section shows the HeartStart XLT controls/buttons, connections, and display layout. An overview of control functions is also provided.
NOTE
If your HeartStart XLT does not have the SpO2 or Pacing option, disregard
these controls and the related information described in this section.
M3500B HeartStart XLT Defibrillator/Monitor
2-1
2
Getting Acquainted
Basic Orientation
The figure below shows the general layout of the controls, where the patient
cables connect, and where to insert the battery and Data Card.
Figure 2-1 Basic Orientation
Printer
Audiovisual
Controls
ECG
Connector
Print Controls
Monitoring Controls
SpO2
Connector
Manual Mode
Controls
Defibrillation
Controls
Speaker
Off On
Ambient Light
Sensor
Battery
Pads
Connector
2-2
Data Card
AC Power
Module Connector
Getting Started
Getting Acquainted
- Powers on the HeartStart XLT.
- Powers off the HeartStart XLT.
Defibrillation Controls - softkeys that perform the defibrillation function
displayed in the softkey label above each button; control both AED and Manual Mode defibrillation.
Manual Mode Controls - provide access to Manual Mode and control of synchronized cardioversion and pacing (if the option is present).
Audiovisual Controls:
2
Adjusts the display contrast.
Adjusts the size of the ECG waveform displayed, printed, and stored.
Pressing
and
simultaneously generates a 1 mV calibration pulse.
Adjusts the volume of voice prompts and the QRS beeper.
Monitoring Controls - softkeys that perform the monitoring function displayed in the softkey label below each button; control heart rate and SpO2
alarms and select the ECG source to monitor.
Print Controls - perform the function shown above each button. The print
controls from left to right are:
Print
Strip
Prints ECG data, defibrillation events, and marked events realtime or with a 6 second delay (as configured). Press to start printing; press again to stop printing.
Print
Summary
Prints the Event Summary. (See “Storing, Retrieving & Printing”
for more information.) Printing may be stopped by pressing the
Print
Summary
Mark
Event
or
Print
Strip
button.
Inserts a time-stamped annotation in the Event Summary. May be
configured to print an annotated ECG strip when pressed.
M3500B HeartStart XLT Defibrillator/Monitor
2-3
Getting Acquainted
Manual Mode Controls
The figure below shows the Manual Mode controls. These controls are
accessed by lifting the door labeled "Manual."
Figure 2-2 Manual Mode Controls
Manual
Sync
Pacer
Rate
Start
Stop
Mode
Output
LEDs indicating the function is
active (green light) or inactive (no light)
NOTE
2-4
Synchronized cardioversion and pacing controls only function when Manual
Mode is enabled.
Getting Started
Getting Acquainted
Manual
Sync
Pacer
Toggles between Manual Mode and AED Mode. Manual
Mode is enabled when the green LED next to the key is lit.
A password may be required for Manual Mode entry.
Enables synchronized cardioversion when first pressed, as
indicated by the green LED; disables synchronized cardioversion when pressed again.
Activates the pacing function buttons (as indicated by the
green LED), allowing you to use the buttons below to
define pacing rate, mode, and current output. Also turns off
the Pacer when pressed a second time.
Rate
2
Adjusts the pacing rate.
Start
Stop
Delivers pacer pulses when first pressed;
stops pacing when pressed again.
Mode
Selects Demand or Fixed Mode for pacing.
Output
Adjusts the current output for pacing.
Display Layout
The following figures show the layout of the display in:
NOTE
z
AED Mode, with ECG and SpO2 monitoring capabilities disabled.
z
AED Mode, with ECG and SpO2 monitoring capabilities enabled.
z
Manual Mode.
ECG and SpO2 monitoring capabilities for AED Mode may be enabled and
disabled independently in the configuration.
M3500B HeartStart XLT Defibrillator/Monitor
2-5
Getting Acquainted
Figure 2-3 AED Mode Display Layout (ECG and SpO2 disabled)
System Message
Momentary Message
ECG Gain
ECG
User Message
150J
Shocks: 0
00:15:02
Defibrillation
Soft Keys
NOTE
PAUSE
ANALYZE
Current Charge
Shocks Delivered
Incident Timer
SHOCK
In its default configuration, the HeartStart XLT powers on in AED Mode
where voice prompts and user messages are active.
The Incident Timer shows the elapsed time since the HeartStart XLT was
turned on. If the HeartStart XLT is powered on after being off for less than
two minutes, the Incident Timer resumes where it left off. If power is off for
more than two minutes, the Incident Timer resets to zero ().
2-6
Getting Started
Getting Acquainted
Figure 2-4 AED Mode Display Layout (ECG and SpO2 Enabled)
Lead
Displayed
Heart Rate
HR Alarm
HR ALARM
LEAD
SELECT
132
Lead II
SpO2 value
SPO2
86
PR 130
System Message
Momentary Message
SpO2 alarm
Pleth Bar
Pulse Rate
ECG
2
User Message
Selected Energy
Defibrillation
Soft Keys
150J
PAUSE
114J
Shocks: 0
00:15:02
ANALYZE
Current Charge
Shocks Delivered
Incident Timer
SHOCK
User messages accompany voice prompts to guide you through the defibrillation process.
System and Momentary Messages:
z
z
z
alert you to conditions that may require you to take action,
provide status information, or
offer recommendations.
A System Message remains on the display until the condition that generated
the message no longer exists. A Momentary Message is temporary and
appears on the display for only a few seconds. A list of messages is provided
in Chapter 12.
M3500B HeartStart XLT Defibrillator/Monitor
2-7
Getting Acquainted
Figure 2-5 Manual Mode Display Layout
Lead
Displayed
HR ALARM
Heart Rate
HR Alarm
132
LEAD
SELECT
Lead II
SpO2 value
SPO2
86
PR 130
System Message
Momentary Message
SpO2 alarm
Pleth Bar
Pulse Rate
ECG
114J
Selected Energy
Defibrillation
Softkeys
Shocks: 0
00:15:02
150J
ENERGY
SELECT
CHARGE
Current Charge
Shocks Delivered
Incident Timer
SHOCK
LCD Backlight
Under normal operation, the HeartStart XLT reads the ambient light and turns
on the LCD back light when low light conditions exist. To turn on the back
light at other times, press
and
on
simultaneously. To return to
normal operation, press the same keys again. The back light also returns to
normal operation each time you turn the HeartStart XLT on.
2-8
Getting Started
Connecting to Power
Connecting to Power
The HeartStart XLT is powered by the M3516A battery. Prior to inserting the
battery, make sure that the battery is charged and has been properly maintained (See “Battery Maintenance” on page 11-8). A fully charged battery will
last for about two hours. A second spare charged battery should be kept in the
carrying case at all times.
The HeartStart XLT can also be powered by the M3517A AC Power Module
or the M3518A DC Power Module. However the defibrillator will take longer
to charge when powered by a power module, with the battery absent. The recommended practice when using a power module is to use the module in conjunction with a battery. For information on using the power modules, see the
documentation supplied with the modules.
NOTE
To save battery capacity, the HeartStart XLT shuts itself off if a patient is not
being monitored and no one has interacted with the device for 10 minutes.
Inserting the Battery
To insert the battery, slide it into the battery receptacle as shown in Figure 2-6.
Then push the battery in until you hear an audible click.
Figure 2-6 Inserting the Battery
M3500B HeartStart XLT Defibrillator/Monitor
2-9
2
Connecting to Power
Removing the Battery
Before removing the battery, make sure the HeartStart XLT is powered off.
Then, to remove the battery, press the black battery eject button and pull the
battery out, as shown in Figure 2-7.
Figure 2-7 Removing the Battery
Low Battery Warning
The message /RZ%DWWHU\ is displayed on the HeartStart XLT when the battery
is low and needs recharging. This message indicates that the battery has sufficient remaining capacity to provide only about ten minutes of monitoring time
and six shocks before the HeartStart XLT shuts off. Replace the battery as
soon as possible.
If the power is off for less than 2 minutes, while you change the battery, the
HeartStart XLT assumes that you are continuing to treat the same patient. It
continues to store data on the Data Card and append events to the existing
Event Summary. Alarms set prior to the power loss remain active.
If power remains off for more than 2 minutes, the HeartStart XLT assumes
you are treating a different patient and assigns a new incident number. A new
Event Summary begins with the next event.
2-10
Getting Started
Using a Data Card
Using a Data Card
Use of a Data Card is optional; the defibrillator will power up without a Data
Card inserted. If you would like to collect patient information on a Data Card,
the card must be inserted into the HeartStart XLT before the device is turned
on.
CAUTION
Inserting or removing the data card while the defibrillator is on can corrupt
the Data Card and prevent the unit from powering on again. If this occurs, see
Table 12-3, Troubleshooting Tips.
The recommended practice is to use one Data Card per patient. Once a Data
Card fills, recording stops; a second Data Card may not be inserted for the
current incident, because the device will only allow the use of one Data Card
per incident. Data Cards hold up to two hours of patient information.
Multiple incidents can be recorded on a single Data Card. Each incident is
assigned a unique incident number.
Patient data from a Philips M3510A Data Card may be downloaded to a
HeartStart Event Review Data Management system. HeartStart Event Review
also allows you to erase patient data from a Data Card, allowing the card to be
reused for another patient.
It’s recommended that you use a designated Data Card to configure one or
more defibrillators/monitors.
CAUTION
Use only the M3510A Data Card. These cards are specifically formatted to
work with your Philips defibrillator. Generic cards, or other types of cards
(such as modems) will not work, and may cause the defibrillator to
malfunction.
M3500B HeartStart XLT Defibrillator/Monitor
2-11
2
Using a Data Card
Inserting a Data Card
To insert a Data Card:
1. Make sure the HeartStart XLT is powered off.
2. Press up on the release latch to open the door to the Data Card compartment.
3. If a Data Card is already in the compartment, press the black button inside
the compartment to eject the card (see Figure 2-8). Then pull the card out.
4. With the yellow label facing up and the
pointing towards the HeartStart XLT, slide the Data Card into the compartment.
5. Close the Data Card compartment door. Make sure that you hear a click,
indicating that the door is latched shut.
Figure 2-8 Inserting a Data Card
Eject
2-12
Getting Started
Using a Data Card
Removing a Data Card
To remove the Data Card:
1. Make sure the HeartStart XLT is powered off, (wait 2 seconds).
2. Press the black eject button (see Figure 2-8).
3. Pull the Data Card from the compartment.
2
M3500B HeartStart XLT Defibrillator/Monitor
2-13
3 Defibrillating in AED Mode
The HeartStart XLT’s AED Mode is designed to guide you through standard
treatment algorithms for cardiac arrest, including those provided by the American Heart Association and the European Resuscitation Council. Configuration choices allow you to customize AED Mode to better follow a specific
treatment algorithm and to meet the unique needs of your life-saving team.
This chapter describes how to use the HeartStart XLT to defibrillate in AED
Mode. It explains the prompts that guide you through the defibrillation process and describes how prompts vary depending upon the condition of the
patient and the configuration of your device.
For information on printing, storing, and retrieving patient information
acquired in AED Mode, see Chapter 9.
M3500B HeartStart XLT Defibrillator/Monitor
3-1
3
Figure 3-1 AED Mode Overview
If Patient is:
z Unresponsive
z Not Breathing
z Pulseless
Attach Pads
Insert Data Card
(Optional)
Press On
If Instructed,
Press
$1$/<=(
No Shock
Advised
Shock
Advised
Press 6+2&.
at completion of shock series
Check Patient
within a shock series
No Pulse
Pulse
Press 3$86(
Do CPR
Ventilate
if Rhythm Monitoring on
3-2
Defibrillating in AED Mode
Overview
Overview
An overview of the AED Mode defibrillation process is shown in Figure 3-1.
The process begins only after you have:
z
z
assessed that the patient is unresponsive, not breathing, and pulseless,
and
prepared for defibrillation by attaching pads and inserting a Data
Card (if desired).
Then you are ready to turn the HeartStart XLT on. The defibrillation process
is dependent upon the configuration of your HeartStart XLT, as described in
the following paragraphs.
Defibrillation (with the default configuration)
In its default configuration, the defibrillation process is:
3
Press the On button.
The HeartStart XLT checks to see if the pads patient cable and multifunction defib electrode pads are properly connected. If either connection is compromised, you are prompted to fix the problem.
Analysis begins automatically - there is no need to press $1$/<=( .
Once analysis is complete, the HeartStart XLT tells you 6KRFN$GYLVHG
or 1R6KRFN$GYLVHG.
If a shock is advised, press 6+2&. .
After the first shock is delivered, the HeartStart XLT automatically
begins analyzing the ECG and the process repeats until a shock series
is complete or no shock is advised. At this point, you are prompted to
check the patient.
M3500B HeartStart XLT Defibrillator/Monitor
3-3
Overview
Defibrillation (with a modified configuration)
Chapter 10 describes, in detail, the configurable parameters for AED Mode.
Three parameters significantly impact the defibrillation process. They are:
Device Initiated Analysis - initiates ECG analysis when the HeartStart XLT
is first turned on. The default configuration setting is On. If you choose to set
this parameter to 2II, you need to press $1$/<=( to initiate analysis in step 2
of the defibrillation process.
Automatic Re-analysis - initiates ECG analysis in between shocks within a
shock series. The default configuration setting is 2Q. If you choose to set this
parameter to 2II, you need to press $1$/<=( to initiate analysis in between
shocks within a shock series (i.e. after the first and second shock of a three
shock series).
Rhythm Monitoring - monitors the ECG for potentially shockable rhythms
when the HeartStart XLT is not analyzing, defibrillating, or paused. The
default setting is 2QIf you choose to set this parameter to 2II, the HeartStart
XLT will not look for potentially shockable rhythms during these idle times.
Idle times also include:
z
z
power on, when Device Initiated Analysis is off.
in between shocks within a shock series, when Auto Re-analysis is
off.
If Rhythm Monitoring is off, you need to observe the patient during idle times
and determine when to press $1$/<=( .
The following sections describe the defibrillation process in detail. They also
describe what happens at the completion of a shock series and if a shockable
rhythm is not detected.
3-4
Defibrillating in AED Mode
Preparation
Preparation
If the patient is:
z
z
z
unresponsive
not breathing
pulseless
Then:
1. Apply multifunction defib electrode pads to the patient, as directed on the
package. Use the anterior-anterior electrode placement.
2. Connect the pads to the pads patient cable, as shown in Figure 3-2.
3. If needed, insert a Data Card (as described in “Using a Data Card” on 211).
Figure 3-2 Connecting Pads to the Patient Cable
3
M3500B HeartStart XLT Defibrillator/Monitor
3-5
Defibrillating
Defibrillating
Follow the voice and screen prompts as they guide you through the following
steps:
1. Press On.
In this first step of the defibrillation process, the HeartStart XLT checks to
see if the pads patient cable and the pads are connected. If they are, it proceeds to step 2.
If the pads patient cable is not properly attached, you are prompted to &RQ
QHFW3DGV&DEOH.
Figure 3-3 Connect Pads Cable Display
Connect
Pads
Cable
Shocks: 0
00:00:02
Once the cable is connected, the HeartStart XLT checks to make sure the
pads are making good contact with the patient’s skin. It does this by monitoring the electrical impedance between the two pads.
3-6
Defibrillating in AED Mode
Defibrillating
If the pads have not been applied or are not making proper contact with the
patient, you are prompted to $SSO\3DGV and &KHFN&RQQHFWLRQV.
Figure 3-4 Apply Pads Display
Apply
Pads
Shocks: 0
00:00:03
3
M3500B HeartStart XLT Defibrillator/Monitor
3-7
Defibrillating
2. If instructed, press
$1$/<=(
.
If device-initiated analysis is off, the HeartStart XLT monitors the rhythm
(provided Rhythm Monitoring is on) and prompts you to press $1$/<=( if
a potentially shockable rhythm is detected.
Figure 3-5 Press ANALYZE Display
Check Patient
If No Pulse
Press ANALYZE
PAUSE
Shocks: 0
00:00:04
ANALYZE
NOTE
If monitoring capabilities are enabled on your HeartStart XLT, your display
will contain monitoring information not shown in the graphics in this section.
NOTE
ECG Analysis is always performed through multifunction defib electrode
pads. Analysis can not be performed through monitoring electrodes.
3-8
Defibrillating in AED Mode
Defibrillating
If device initiated analysis is on, you do not need to press $1$/<=( ; ECG
analysis begins automatically.
Figure 3-6 Analyzing Display
Analyzing
Do Not Touch Patient
Shocks: 0
00:00:08
STOP
ANALYSIS
WARNING
Handling or transporting the patient during ECG analysis can cause incorrect or
delayed diagnosis.
3
If a shockable rhythm is detected, as indicated by the message 6KRFN$GYLVHG,
analysis stops and the XLT automatically charges to 150J. Charging is accompanied by an intermittent charge tone.
Figure 3-7 Charging Display
Charging to 150J
97J
Shocks: 0
00:00:10
M3500B HeartStart XLT Defibrillator/Monitor
3-9
Defibrillating
3. If shock advised, press
6+2&.
.
Once charging is complete, the charge tone becomes continuous. Make
sure no one is touching the patient or anything connected to the patient.
Call out "Clear." Then press 6+2&. to deliver a shock to the patient.
Figure 3-8 Press SHOCK Display
Stand Clear!
Press SHOCK
150J
Shocks: 0
00:00:14
SHOCK
WARNING
Defibrillation current can cause operator or bystander injury. Do not touch the
patient, or equipment connected to the patient, during defibrillation.
The defibrillator automatically disarms if you do not press 6+2&. in 30
seconds.
3-10
Defibrillating in AED Mode
Defibrillating
Delivery of the shock is confirmed by the message 6KRFN'HOLYHUHG and the
shock counter is updated.
Figure 3-9 Shock Delivered Display
Shock Delivered
Shocks: 1
00:00:40
Automatic Re-analysis On
If Automatic Re-analysis is on, the HeartStart XLT analyzes the ECG following delivery of the shock. You are prompted to press 6+2&. , if an additional shock is advised. This cycle repeats until the rhythm converts or a
shock series is complete. (A shock series may be configured to 2, 3, or 4
shocks.)
Automatic Re-analysis Off
If Automatic Re-analysis is off, the HeartStart XLT monitors the ECG for
potentially shockable rhythms (provided Rhythm Monitoring is on) and
prompts you to press $1$/<=( if one is detected. You can initiate analysis,
without being prompted, by pressing $1$/<=( .
M3500B HeartStart XLT Defibrillator/Monitor
3-11
3
Pausing for CPR
Pausing for CPR
At the completion of a shock series or when no shock is advised, the HeartStart XLT prompts you to &KHFN3DWLHQW&KHFN3XOVH. It allows eight seconds for
you to check the pulse, then prompts you as follows:
Figure 3-10 Press Pause Display
If Needed
Press PAUSE
And Begin CPR
PAUSE
Shocks: 1
00:00:50
ANALYZE
If CPR is needed, press 3$86( . While paused, the Pause Timer indicates the
elapsed time and the total duration of the Pause state, in seconds. The Pause
Timer is configurable to meet your local CPR protocol needs. Rhythm, SpO2
and heart rate monitoring alarms are suspended for the duration of the pause.
NOTE
3-12
* This section describes how the Pause state functions using the default configuration. If your HeartStart XLT is configured to support the European
Resuscitation Council Guidelines for Resuscitation, refer to the “ERC Protocol” section on page 3-16 for details.
Defibrillating in AED Mode
Pausing for CPR
Figure 3-11 Pause Display
Paused
Timer: 21 / 60
RESUME
Shocks: 3
00:01:40
Elapse Time
Total Pause Duration
ANALYZE
The pause state ends when the Pause Timer reaches the preconfigured Pause
state duration, or if you press 5(680( or $1$/<=( . At the completion of the
pause state, the defibrillation process begins again. If instructed, press
$1$/<=( .
If you do not press 3$86( , the HeartStart XLT begins monitoring the ECG
rhythm (provided Rhythm Monitoring is on).
You may initiate ECG analysis at any time by pressing $1$/<=( .
M3500B HeartStart XLT Defibrillator/Monitor
3-13
3
Monitoring Rhythm
Monitoring Rhythm
When the HeartStart XLT is not analyzing, defibrillating, or paused, Rhythm
Monitoring alerts you to potentially shockable rhythms (provided Rhythm
Monitoring is set to the default configuration, 2Q). The message 0RQLWRULQJ
5K\WKP appears on the display to let you know this feature is active and
remains on the display for the duration of the monitoring.
Figure 3-12 Monitoring Rhythm Display
Monitoring Rhythm
Shocks: 3
00:00:49
PAUSE
WARNING
3-14
ANALYZE
The recommended configuration setting for Rhythm Monitoring is On. If Rhythm
Monitoring is off, you are not alerted when a patient’s rhythm changes from nonshockable to shockable (as in refibrillation or an initially nonshockable rhythm that
converts to a shockable rhythm).
Defibrillating in AED Mode
Monitoring Rhythm
If Rhythm Monitoring detects a shockable rhythm, you are prompted as follows:
Figure 3-13 Shockable Rhythm
Check Patient
If No Pulse
Press ANALYZE
PAUSE
Shocks: 3
00:00:55
ANALYZE
This prompt is repeated periodically, as configured, until $1$/<=( or 3$86( is
pressed. If you press $1$/<=( , the defibrillation process starts again.
If you press 3$86( , rhythm monitoring is suspended for the duration of the
pause. 3$86( is used when administering CPR, as noted earlier. It may also be
useful when performing medical procedures or encountering artifact during
patient transport. Active SpO2 and heart rate alarms are suspended during the
pause duration, as well.
Press 5(680( to restore rhythm monitoring. Active SpO2 and heart rate alarms
are also restored.
M3500B HeartStart XLT Defibrillator/Monitor
3-15
3
ERC Protocol
ERC Protocol
The HeartStart XLT can be configured to support the European Resuscitation
Council (ERC) Guidelines for Resuscitation (1998). If (XURSHDQ3URWRFRl is configured to 2Q, the defibrillation process described in this chapter is the same,
with the exception of how the Pause state functions (see “Pausing for CPR”
on 3-12).
As described, you can enter a Pause state:
z
z
at the completion of a shock series, or
when no shock is advised
When either of these events occurs, the ERC protocol prompts you to Check
Patient. Then it prompts you as follows:
Figure 3-14
If Needed
Press PAUSE
And Begin CPR
PAUSE
Shocks: 1
00:00:50
ANALYZE
NOTE
Using the ERC protocol, you are not prompted to (or given time to) check the
patient’s pulse.
3-16
Defibrillating in AED Mode
ERC Protocol
If CPR is needed, press 3$86( . While paused, a timer indicates the elapsed
time and the total duration of the Pause state, as shown:
Figure 3-15
Paused
Timer: 35 / 60
RESUME
Shocks: 3
00:01:40
Elapsed Time
Total Pause Duration
ANALYZE
The total pause duration depends on the event preceding the Pause state. If
you entered the Pause state:
z
z
at the completion of a shock series or shortly after a shock is delivered, the duration is equal to the 3RVW6KRFN&357LPHU configuration setting (the default setting is 60 seconds).
when no shock was advised, the duration is equal to the 16$7LPHU
configuration setting, where NSA is an acronym for No Shock
Advised (the default setting is 180 seconds).
M3500B HeartStart XLT Defibrillator/Monitor
3-17
3
Troubleshooting
Troubleshooting
When the HeartStart XLT detects a problem, it provides display and/or voice
prompts to guide you to resolution. The table below lists the prompts you may
encounter in AED Mode, the cause, and the suggested corrective action.
Prompts related to the battery and Data Card are discussed in Chapter 12.
Table 3-1 AED Mode Prompts
Prompt
Possible Cause
Corrective Action
Pads Off
The multifunction defib electrode
pads are not properly applied to the
patient.
Check that the pads are applied to
the patient, as directed on the pads’
package. Replace the pads if the
prompt continues.
Pads Cable
Off
The pads cable is not connected to
the defibrillator.
Check that the defibrillation pads
connector is locked in place.
Artifact
Detected
z Patient motion interferes with
z Attempt to eliminate patient
analysis.
z Electrical sources are causing
z
interference.
motion. Avoid analyzing
during transport or while
performing CPR.
Move hand-held communication
devices or other suspected
devices away from the defibrillator, when possible.
Shock Cancelled
Shock key not pressed within 30
seconds.
Press within 30 seconds of prompt.
No Shock
Delivered
Pads are not properly connected to
the patient.
Check pads connection.
Key
Inactive
z The key pressed only functions
z Access manual mode prior to
z
z
in Manual Mode.
The key pressed does not function during analysis or charging.
The key pressed does not function while in a pause state.
pressing the key.
z Wait for analysis or charging to
z
complete prior to pressing the
key.
Press 5(680( prior to pressing
the key.
3-18
Defibrillating in AED Mode
4 Monitoring the ECG
The HeartStart XLT can be used for short or long-term ECG monitoring. The
ECG monitoring function allows you to monitor through:
z
z
multifunction defib electrode pads, or
3- or 5-lead ECG monitoring electrodes, as configured.
When the HeartStart XLT is turned on, the ECG acquired through pads is
shown on the display. ECG monitoring allows you to continue to monitor
through the pads or to select a lead from an alternate ECG source (3- or 5lead). ECG monitoring also displays the heart rate (HR) and allows you to set
HR alarms.
ECG monitoring is always active in Manual Mode. In AED Mode, ECG monitoring is only active if /HDG6HOHFWis configured to on (the default is off).
A fully charged battery provides approximately 2.7 hours of continuous monitoring.
This chapter describes how to apply monitoring electrodes, select the lead to
monitor, and set a heart rate (HR) alarm. To apply multifunction defib electrode pads, follow the directions on the pads packaging. For information on
printing, storing, and retrieving patient information acquired while monitoring, see Chapter 9.
NOTE
If you need to connect the ECG cable to the HeartStart XLT or configure the
HeartStart XLT to use the optional 5-lead monitoring cable, see Chapter 10.
M3500B HeartStart XLT Defibrillator/Monitor
4-1
4
Applying Monitoring Electrodes
Applying Monitoring Electrodes
Proper application and placement of electrodes is essential for reliable monitoring. Good contact between the electrode and the skin reduces the effects of
motion artifact and signal interference.
To apply electrodes:
1. Identify the appropriate electrode sites. (See Figure 4-1.)
2. Shave the electrode sites or clip hair, if necessary.
3. Clean and abrade the skin at the electrode sites.
4. Dry the skin at the electrode sites.
5. Open a new package of M2202A Radio-Translucent Monitoring Electrodes; verify that the "Use Before" date has not passed.
6. Snap the lead wires onto the electrodes.
7. Apply the electrodes by peeling them, one at a time, from the protective
backing and sticking them firmly to the patient’s skin. Press around the
entire edge of each electrode to ensure that they are secure. Make sure the
lead wires do not pull on the electrodes.
WARNING
Be sure that the electrodes do not come in contact with other conductive materials,
especially when connecting or disconnecting the electrodes to/from the patient.
NOTE
If monitoring for long periods of time, new monitoring electrodes and
multifunction defib electrode pads may need to be applied periodically. Refer
to the manufacturer’s documentation for how often to replace the monitoring
electrodes or defib pads.
4-2
Monitoring the ECG
Applying Monitoring Electrodes
Electrode Placement
Figure 4-1 shows typical electrode placement for the limb leads of a 3- or 5lead patient cable. The V/C lead of the 5-lead cable can be placed in any of the
precordial lead positions (V1/C1 through V6/C6) shown in Figure 4-2.
Figure 4-1 Limb Lead Electrode Placement
AHA Labels
RA/R
LA/L
RL/N*
LL/F
IEC Labels
RA Right Arm
R Right
LA Left Arm
L Left
RL Right Leg*
N Negative*
LL Left Leg
F Foot
* Not used for 3-lead.
Table 4-1 3-Lead ECG Lead Formation
Lead
+
-
Reference
I
LA
RA
LL
II
LL
RA
LA
III
LL
LA
RA
M3500B HeartStart XLT Defibrillator/Monitor
4
4-3
Applying Monitoring Electrodes
Figure 4-2 Precordial Lead Electrode Placement
Electrode
1
2
3
5
4
6
Location
V1
C1
forth intercostal space, at right sternal
margin
V2
C2
forth intercostal space, at left sternal
margin
V3
C3
midway between V2/C2 and V4/C4
V4
C4
fifth intercostal space, at left midclavicular line
V5
C5
same level as V4/C4, on anterior axillary line
V6
C6
same level as V4/C4, at left mid axillary line
Table 4-2 5-Lead ECG Lead Formation
Lead
I
LA - RA
II
LL - RA
III
LL - LA
aVR
aVF
aVL
Vx (or Cx)
where x = 1-6
4-4
Lead Formation
RA -
LA + LL
2
LL -
RA + LA
2
LA -
RA + LL
2
V/C -
RA + LA + LL
3
Monitoring the ECG
Selecting the Lead
Selecting the Lead
Available monitoring leads are dependent upon your device configuration:
Table 4-3 Lead Select Choices
Lead Select
Choices are:
If Configured for a:
Pads, Lead I, Lead II, Lead III
3-lead ECG cable
Pads, Lead I, Lead II, Lead III, aVR,
aVL, aVF, V lead.
5-lead ECG cable
/($' until
To select a lead to monitor, cycle through the choices by pressing 6(/(&7
the desired lead is displayed.
NOTE
When V lead is selected, change to a different V lead by moving the electrode
/($' softkey.
to a new location rather than by pressing the 6(/(&7
Figure 4-3 ECG Monitoring Display
HR ALARM
LEAD
SELECT
78
Lead II
4
Monitoring Rhythm
Shocks: 3
00:00:49
PAUSE
ANALYZE
If the desired lead is not connected or the electrodes are not making proper
contact with the patient, the message /HDGV2II is displayed in the System Message Area and accompanied by a beep to alert you. A dashed line on the display indicates that there is no ECG signal.
M3500B HeartStart XLT Defibrillator/Monitor
4-5
Setting the Heart Rate Alarm
Setting the Heart Rate Alarm
The computed heart rate (number of detected QRS complexes per minute) is
displayed below the +5$/$50 sofkey, next to the . The heart rate represents
the number of QRS complexes detected in a minute. A QRS beeper, if configured to on, indicates each QRS complex detected.
If desired, a HR alarm may be set to alert you when the heart rate is outside
the specified limits. Limit choices are listed in Table 4-4.
Table 4-4 HR Alarm Limit Choices
Alarm If Over:
Or under:
100
30
140
60
160
90
200
120
To set a HR alarm, cycle through the limit choices by pressing +5$/$50 until
the desired limits are shown. The
then appears next to the heart rate value
to indicate that the HR alarm is set.
WARNING
Heart rate alarms are temporarily suspended in AED Mode during ECG analysis or
when 3$86( is pressed (for the duration of the paused period). Heart rate alarms are
also suspended while charging for defibrillation and delivering a shock.
WARNING
Heart rate displays and alarms function with internal and external pacemakers, but
they can be unreliable. Observe the patient closely if pacemakers are used.
4-6
Monitoring the ECG
Disabling the HR Alarm
Disabling the HR Alarm
If the heart rate is outside the HR alarm limits, an alarm sounds. To disable the
alarm, press +5$/$50 .
appears to indicate that the alarm is disabled.
Adjusting the ECG Size
To increase or decrease the size of the ECG, press
trol,
or
on the gain con-
.
Troubleshooting
Table 4-5 provides troubleshooting tips for ECG Monitoring.
Table 4-5 Troubleshooting Tips
Situation
Cause
Solution
/HDGV2IImessage
z The monitoring electrodes are not applied
or are not making
proper contact with the
patient.
z The monitoring cable is
not connected.
z Check that the monitoring
electrodes are properly
applied.
z Check that the monitoring
cable is properly connected.
z The pads are not making proper contact with
the patient.
z Check that the pads are
properly applied.
or
dashed line (------)
3DGV2IImessage
M3500B HeartStart XLT Defibrillator/Monitor
4-7
4
Troubleshooting
Table 4-5 Troubleshooting Tips (Continued)
Situation
4-8
Cause
Solution
Poor ECG signal
quality
z The monitoring electrodes are not making
proper contact with the
patient.
z The monitoring electrodes are outdated or
dried-out.
z Radio frequency interference (RFI) is causing
artifact.
z Check that the monitoring
electrodes are properly
applied. If necessary, prepare the patient’s skin and
apply new electrodes.
z Check the date code on
the electrodes. Do not
open the electrode package until immediately
prior to use.
z Relocate or turn off equipment that may be causing
RFI.
QRS beeper inaudible or beeps do
not occur with
each QRS complex.
z The QRS beeper is configured to Off.
z The amplitude of the
QRS complex is too
small to detect.
z Check that the QRS
beeper is configured to
On.
z Adjust the volume.
z Adjust the size of the
ECG.
Monitoring the ECG
5 Monitoring SpO2
Pulse oximetry is a noninvasive method of continuously measuring oxygen
saturation (SpO2) in arterial blood. The resultant SpO2 reading indicates the
percentage of hemoglobin molecules in the arterial blood which are saturated
with oxygen. SpO2 monitoring is one of the tools available to assist in assessing a patient’s cardiac and respiratory systems. This chapter explains how
pulse oximetry works and describes how to use the HeartStart XLT to monitor
SpO2.
SpO2 monitoring is always available in Manual Mode (if the option is purchased). In AED Mode, SpO2 monitoring is only available if SpO2 is configured to 2Q.
For information on printing, storing, and retrieving patient information
acquired while monitoring, see Chapter 9.
WARNING
Do not rely solely on SpO2 readings; assess the patient at all times. SpO2 readings
may be inaccurate in the presence of significant levels of carboxyhemoglobin or
methemoglobin, in patients with restricted blood flow to the extremities (such as
those in severe shock or hypothermia), or in the presence of excessive motion.
5
M3500B HeartStart XLT Defibrillator/Monitor
5-1
Understanding Pulse Oximetry
Understanding Pulse Oximetry
A pulse oximetry sensor sends light through patient tissue to a receiver on the
other side of the sensor. As Figure 5-1 shows, light emitting diodes transmit
red and infrared light through peripheral areas of the body, such as a finger.
Figure 5-1 Pulse Oximetry Sensor
LED
Photodetector
A photodetector positioned opposite the light emitting diodes compares light
absorption before and after pulsation. The amount of light getting through
reflects the blood flow in the arterioles. This measurement of light absorption
during pulsation is translated into an oxygen saturation percentage and an
SpO2 value is displayed.
For accurate SpO2 measurements, the following conditions must apply:
z
z
z
z
z
5-2
The patient must have perfusion in that extremity.
The light emitter and the photodetector must be directly opposite each
other.
All of the light from the emitter must pass through the patient’s tissue.
The sensor site should be free of vibration and excessive motion.
Power cables should be kept away from the sensor cable and connector.
Monitoring SpO2
Selecting a Sensor
Selecting a Sensor
Table 5-1 shows the SpO2 sensors that may be used with the HeartStart XLT.
Table 5-1 Approved Sensors
Sensor
NOTE
Type
Patient
Patient Size
Ideal Site
M1191A
Reusable
Adult
> 50 kg
Finger
M1192A
Reusable
Small adult
Pediatric
15-50 kg
Finger
M1194A
Reusable
Pediatric
Adult
> 40 kg
Fleshy part
of ear
M1903A/B
(Nellcor D-20)
Disposable
Pediatric
10-50 kg
Toe/Finger
M1904A/B
(Nellcor D-25)
Disposable
Adult
> 30 kg
Finger
M1906A
(Nellcor P/I)
Semi-reusable
Pediatric
Infant
3-40 kg
Finger/Toe
M1907A
(Nellcor A/N)
Semi-reusable
Neonate
< 3 kg
Foot/Hand
Adult
> 40 kg
Finger
To use Nellcor sensors, you must connect the M1943A Nellcor Adaptor
patient cable to the HeartStart XLT. (See “Connecting the SpO2 Patient
Cable” on page 10-5.)
5
M3500B HeartStart XLT Defibrillator/Monitor
5-3
Selecting a Sensor
The most important factor when selecting a sensor is the position of the light
emitting diodes in relation to the photodetector; when a sensor is applied, the
diodes and the photodetector must be opposite each other. Sensors are
designed for patients within a specific weight range and for specific sites. Be
sure to:
z
z
z
Select a sensor appropriate for the patient’s weight.
Select a sensor site with adequate perfusion.
Avoid application to sites with edematous tissue.
Reusable Sensors
Reusable sensors may be reused on different patients after they have been
cleaned and disinfected (see the manufacturer’s instructions supplied with the
sensor).
Disposable Sensors
Disposable sensors should be used only once and then discarded. They can be
relocated to a different application site on the patient if the first location does
not give the desired results. Disposable sensors must not be reused on different patients.
Semi-disposable Sensors
Semi-disposable sensors can be reused, but the adhesive wrap must be discarded after each use. Semi-disposable sensors are recommended for singlepatient use only.
5-4
Monitoring SpO2
Applying the Sensor
Applying the Sensor
Follow the manufacturer’s directions for applying and using the sensor, making sure to observe any warnings or cautions. For the best results:
z
z
z
z
z
z
Make sure the sensor is dry.
If the patient is moving, secure the sensor cable loosely to the patient.
Avoid excessive pressure at the sensor site; ensure that circulation is
not obstructed.
Keep power cables away from the sensor cable and connection.
Avoid placing the sensor in an environment with bright lights (if necessary, cover the sensor with opaque material).
Avoid placing the sensor on any extremity with an arterial catheter,
blood pressure cuff, or intravascular venous infusion line.
WARNING
Failure to apply the sensor properly may reduce the accuracy of the SpO2 measurment.
WARNING
Inspect the sensor application site at least every two hours for changes in skin quality, correct optical alignment, and proper sensor application. If skin quality is compromised, change the sensor site. More frequent checking may be required due to an
individual patient’s condition.
5
M3500B HeartStart XLT Defibrillator/Monitor
5-5
Connecting the Sensor Cable
Connecting the Sensor Cable
To connect a sensor cable:
1. Hold the connector with the flat side up so that the part number is visible.
2. Insert the connector into the receptacle and push until the blue portion of
the connector is no longer visible.
Figure 5-2 Connecting the Sensor Cable
5-6
Monitoring SpO2
Monitoring
Monitoring
To monitor SpO2:
1.
2.
3.
4.
If the HeartStart XLT is not on, press On.
Apply the appropriate sensor to the patient.
Make sure the sensor cable is connected to the HeartStart XLT.
Press 6S2 to turn on SpO2 monitoring.
A dashed line (---) is displayed under 6S2 , while the oxygen saturation is
measured and an SpO2 value is calculated. In a few seconds the SpO2 value is
displayed in place of the dashed line. As the patient’s oxygen saturation
changes, the SpO2 value is updated continuously.
Figure 5-3 SpO2 Monitoring Display
HR ALARM
LEAD
SELECT
78
Pads
SpO2
98
PR 62
Monitoring Rhythm
Shocks: 3
00:00:49
PAUSE
ANALYZE
To the right of the SpO2 value, a pleth bar and SpO2 alarm indicator are displayed. The pleth bar should be observed for fluctuation. It is an indication of
pulsation detected by the sensor. The pleth bar should not be used as the sole
indicator of pulsation because it can be influenced by movement and artifact.
The
symbol indicates no alarm is set.
Below the SpO2 value is the pulse rate derived from the pulse oximetry.
M3500B HeartStart XLT Defibrillator/Monitor
5-7
5
Setting Alarms
Setting Alarms
An alarm may be set to alert you if the SpO2 value falls below a specified
lower limit. Lower limit alarm choices are
(no alarm), 90, 85, or 80. Press
6S2 repeatedly to cycle through the choices. Stop when the desired choice is
displayed. A
appears in three seconds, indicating that the selected alarm is
active. To review the alarm limit, press 6S2 .
WARNING
SpO2 alarms are temporarily suspended in AED Mode during ECG analysis or when
3$86( is pressed (for the duration of the paused period). SpO2 alarms are also suspended while charging for defibrillation and delivering a shock.
Responding to an Alarm
When the SpO2 value falls below the alarm limit, a continuous tone alerts you
and the SpO2 value is displayed in inverse video.
Figure 5-4 SpO2 Alarm Triggered
HR ALARM
LEAD
SELECT
78
Pads
SpO2
87
PR 80
Monitoring Rhythm
Shocks: 3
00:00:49
PAUSE
ANALYZE
Press 6S2 to turn off the alarm. Refer to “Setting Alarms” if subsequent
alarms are desired.
5-8
Monitoring SpO2
Discontinuing SpO2 Monitoring
Discontinuing SpO2 Monitoring
To shut off SpO2 monitoring, press 6S2 repeatedly until nothing appears
below the 6S2 softkey.
Figure 5-5 SpO2 Monitoring Off
HR ALARM
LEAD
SELECT
78
Pads
SpO2
Monitoring Rhythm
Shocks: 3
00:00:49
PAUSE
ANALYZE
Caring for Sensors
Refer to the manufacturers instructions for care and cleaning of sensors. To
get the best results from your SpO2 reusable sensors, always handle the sensor
and cable with care and protect them from sharp objects. The sensor sleeve
houses a sensitive electronic device that can be damaged. Harsh treatment of
sensors will drastically reduce their lifetime.
WARNING
Do not use a damaged sensor or one with exposed electrical circuits.
5
M3500B HeartStart XLT Defibrillator/Monitor
5-9
Troubleshooting
Troubleshooting
The table below lists system messages that you may encounter when monitoring SpO2.
Table 5-2 System Messages
Problem or Message
6S21RQ3XOVDWLOH
Possible Cause
Corrective Action
z Pulse absent or too
z Check the sensor is
weak to be detected.
applied properly.
z Make sure the sensor
site has a pulse.
z Relocate the sensor to
z
6S2/RZ6LJQDO
z SpO2 signal is too low
to give an accurate reading.
a site with improved
circulation.
Try another sensor
type.
z Check the sensor is
applied properly.
z Try another sensor
type.
6S21RLV\6LJQDO
z Excessive patient move-
z Minimize patient
ment, electrical interference, or optical
interference.
z
z
6S2/LJKW,QWHUI
z The level of ambient
light is so high that the
sensor cannot obtain an
SpO2 reading.
z Sensor or cable is dam-
motion or apply sensor to site with less
movement.
Secure the sensor
cable loosely to the
patient.
Reduce sources of
electrical or optical
interference.
z Cover sensor with an
opaque material.
z Check sensor for damage; try another sensor.
aged.
5-10
Monitoring SpO2
Troubleshooting
Table 5-2 System Messages (Continued)
Problem or Message
6S2&DEOH2II
Possible Cause
z The SpO2 cable is not
connected to the device.
6S2 6HQVRU)DLO
z The transducer is broken.
6S2)DLOXUH
z There is a hardware failure in the SpO2 subsystem.
Corrective Action
z Attach the cable to the
HeartStart XLT.
z Apply a new transducer.
z Remove device from
active use and call for
service.
5
M3500B HeartStart XLT Defibrillator/Monitor
5-11
6 Defibrillating in Manual Mode
6
In Manual Mode you assess the ECG, decide if defibrillation is indicated,
select the discharge energy level, and deliver the shock. The defibrillation
process is under your control. There are no voice prompts, however, system
and momentary messages provide relevant information throughout the process. It is important to be attentive to these messages.
This chapter describes how to access Manual Mode and use it for defibrillation. For Manual Mode features such as synchronized cardioversion and pacing, see the “Performing Synchronized Cardioversion” and “Pacing” chapters.
For information on printing, storing, and retrieving patient information
acquired in Manual Mode, see Chapter 9.
M3500B HeartStart XLT Defibrillator/Monitor
6-1
Enabling Manual Mode
Enabling Manual Mode
From AED Mode, press Manual to enable Manual Mode. If prompted, use
the softkeys above the display to enter the password.
Figure 6-1: Manual Password Display
1
2
3
4
Enter Password
Shocks: 3
00:00:49
EXIT
PASSWORD
(;,7
To return to AED Mode, without entering a password, press 3$66:25' .
Once Manual Mode is enabled, the green LED next to
Manual
is lit.
In its default configuration, the HeartStart XLT powers on into AED Mode.
If you prefer, you can configure it to power on into Manual Mode. You have
the option to require users to enter a password in order to enable Manual
Mode from AED Mode. (See “Configuring the HeartStart XLT” on page 10-7.
WARNING
6-2
Use of a password for Manual Mode is recommended as a safety measure to deter
untrained personnel from entering Manual Mode.
Defibrillating in Manual Mode
Preparation
Preparation
In preparation for defibrillation:
1. Apply multifunction defib electrode pads as directed on the package. Use
either the anterior-anterior or anterior-posterior electrode placement, as
appropriate.
2. Connect the pads to the pads patient cable, as shown in Figure 6-2.
3. If needed, insert a Data Card (as described in “Using a Data Card” on 211).
4. Press On.
5. Enter Manual Mode, if AED Mode is active.
Figure 6-2 Connecting Pads to the Patient Cable
NOTE
Defibrillation is always performed through pads. However, during defibrillation, you may choose to monitor ECG using an alternate ECG source (3- or 5lead monitoring electrodes).
M3500B HeartStart XLT Defibrillator/Monitor
6-3
6
Defibrillating
Defibrillating
The defibrillation process is as follows:
1. Select Energy
The default energy setting is 150 joules. To change the energy setting,
press (1(5*<
6(/(&7 repeatedly to cycle through the energy level choices. Stop
when the desired energy is displayed. The choices are 5, 10, 25, 50, 70,
100, 150, or 200 joules.
Figure 6-3 Energy Select Display
HR ALARM
LEAD
SELECT
78
Pads
150 J
ENERGY
SELECT
SpO2
Shocks:0
00:00:8
CHARGE
2. Charge
Press &+$5*( .
As the defibrillator charges, the current charge is displayed above the
shock counter. A charging tone beeps until the desired energy level is
reached, at which point you’ll hear a continuous charge tone.
6-4
Defibrillating in Manual Mode
Defibrillating
Figure 6-4 Charging Display
HR ALARM
LEAD
SELECT
78
Pads
6
87 J
150 J
ENERGY
SELECT
SpO2
Current Charge
Shocks:0
00:00:8
DISARM
If desired, you may increase or decrease the selected energy level after
pressing the &+$5*( button. To do so, press (1(5*<
6(/(&7 repeatedly until the
desired energy level is displayed. The defibrillator charges to the selected
energy automatically. Wait until the current charge reaches the selected
energy level before proceeding.
3. Shock
Confirm that a shock is still indicated. Make sure no one is touching the
patient or anything connected to the patient. Call out “Clear.” Then press
6+2&. to deliver a shock to the patient.
To disarm the defibrillator, press ',6$50 . If 6+2&. is not pressed in 30 seconds, the defibrillator disarms automatically.
If additional shocks are indicated, repeat the defibrillation process
WARNING
Defibrillation current can cause operator or bystander injury. Do not touch the
patient, or equipment connected to the patient, during defibrillation.
M3500B HeartStart XLT Defibrillator/Monitor
6-5
Returning to AED Mode
Returning to AED Mode
To enable AED Mode, from Manual Mode, press
next to
Manual
Manual
. The green LED
goes out, indicating Manual Mode is no longer active.
If ECG and/or SpO2 monitoring are enabled in AED Mode, alarms set in
Manual Mode remain active when you switch to AED Mode.
6-6
Defibrillating in Manual Mode
7 Performing Synchronized Cardioversion
Synchronized cardioversion is a Manual Mode function that allows you to
synchronize the defibrillator shock with the R-wave of the ECG being monitored.
During synchronized cardioversion, the ECG being monitored is shown on
the display and may be derived from:
z
z
the multifunction defib electrode pads, or
the 3- or 5-lead monitoring electrodes.
When selecting a lead, choose the best lead that displays a large QRS complex. The synchronized shock is delivered through the mulifunction defib
electrode pads, regardless of the lead being monitored.
This chapter describes how to perform synchronized cardioversion with the
HeartStart XLT.
NOTE
See Chapter 4, “Monitoring the ECG” for information on how to apply electrodes and select a lead.
M3500B HeartStart XLT Defibrillator/Monitor
7-1
7
Preparing for Synchronized Cardioversion
Preparing for Synchronized Cardioversion
In preparation for synchronized cardioversion:
1. Apply multifunction defib electrode pads as directed on the package. Use
either the anterior-anterior or anterior-posterior placement, as appropriate.
2. Connect the pads to the patient cable. (See Figure 6-2.)
3. Apply monitoring electrodes, if desired. (See “Applying Monitoring Electrodes” on page 4-2.)
4. If needed, insert a Data Card (as described in “Using a Data Card” on 211).
5. Press On.
6. Enable Manual Mode. (See “Enabling Manual Mode” on page 6-2.)
/($' to select the best lead that displays a large QRS complex. (See
7. Use 6(/(&7
“Selecting the Lead” on page 4-5.)
Delivering a Synchronized Shock
To perform synchronized cardioversion:
1. Press Sync to enable Sync Mode. The green LED next to
lights up and the message 6<1& appears on the display.
Sync
2. Use the gain control,
, to adjust the ECG size so that the marker dot
appears only once with each R-wave.
3. If necessary, change the energy setting (the default setting is 150 joules),
by pressing (1(5*<
6(/(&7 repeatedly until the desired energy level is displayed.
The choices are 5, 10, 25, 50, 70, 100, 150, or 200 joules.
4. Press &+$5*( . Wait until the current charge has reached the energy level
selected and you hear a continuous charge done tone.
7-2
Performing Synchronized Cardioversion
Delivering a Synchronized Shock
Figure 7-1: Charging in Sync Mode
HR ALARM
LEAD
SELECT
78
Pads
SpO2
87 J
150 J
ENERGY
SELECT
Sync
Shocks:0
00:00:8
7
DISARM
If desired, you may increase or decrease the selected energy level after
pressing &+$5*( , by pressing (1(5*<
6(/(&7 repeatedly until the desired energy
level is displayed. The defibrillator charges to the modified energy level
automatically. Wait until the current charge reaches the selected energy
level before proceeding.
5. Make sure no one is touching the patient or anything connected to the
patient. Call out “Clear.” Then press 6+2&. and continue to hold 6+2&.
down until the shock is delivered.
The defibrillator shocks with the next detected R-wave.
WARNING
Defibrillation current can cause operator or bystander injury. Do not touch the
patient, or equipment connected to the patient, during defibrillation.
M3500B HeartStart XLT Defibrillator/Monitor
7-3
Disabling Sync Mode
Delivering Additional Synchronized Shocks
If additional synchronized shocks are indicated, make sure Sync Mode is still
enabled and repeat steps 2-5. In its default configuration, the HeartStart XLT
remains in Sync Mode after a shock is delivered, as indicated by the message
6\QF on the display and the lighted green LED next to
Sync
.
The HeartStart XLT can be configured to exit Sync Mode after each shock is
delivered.
Disabling Sync Mode
To disable Sync Mode, press Sync . The green LED next to Sync goes
out and the message 6\QF is no longer displayed. Sync Mode is also disabled
when you exit Manual Mode.
7-4
Performing Synchronized Cardioversion
8 Pacing
Noninvasive transcutaneous pacing is a Manual Mode function that is used to
deliver paced pulses to the heart. Paced pulses are delivered through multifunction defib electrode pads applied to the patient’s bare chest.
This chapter explains the pacing options and describes how to perform
pacing.
8
M3500B HeartStart XLT Defibrillator/Monitor
8-1
Demand Mode Versus Fixed Mode
Demand Mode Versus Fixed Mode
The HeartStart XLT can deliver paced pulses in either demand or fixed mode.
In demand mode, the pacer only delivers paced pulses when the patient’s
heart rate is lower than the selected pacing rate.
In fixed mode, the pacer delivers paced pulses at the selected rate.
Monitoring During Pacing
Multifunction defib electrodes pads can not be used to monitor the ECG and
deliver paced pulses simultaneously. The HeartStart XLT always uses the 3or 5-lead ECG cable and monitoring electrodes as the source of ECG during
pacing.
In demand mode, ECG electrodes must be used, because the HeartStart XLT
uses the R-wave detection from this monitoring source to determine if a paced
pulse should be delivered.
In fixed mode, ECG electrodes may or may not be used; however, an ECG
will only be displayed if ECG monitoring electrodes are used.
WARNING
Use demand mode pacing whenever possible. Use fixed mode pacing when motion
artifact or other ECG noise makes R-wave detection unreliable.
WARNING
Heart rate displays and alarms function during pacing, but they can be unreliable.
Observe the patient closely while pacing. Do not rely on heart rate alarms or the
indicated heart rate as a measure of the patient’s perfusion status.
8-2
Pacing
Preparing for Pacing
Preparing for Pacing
In preparation for pacing:
1. Apply multifunction defib electrode pads as directed on the package. Use
either the anterior-anterior or anterior-posterior placement, as appropriate.
2. Connect the pads to the patient cable. (See Figure 6-2.)
3. If needed, insert a Data Card (as described in “Using a Data Card” on 211).
4. Press On.
5. Enable Manual Mode. (See “Enabling Manual Mode” on page 6-2.)
In addition, for demand mode pacing:
1. Apply monitoring electrodes. (See “Applying Monitoring Electrodes” on
page 4-2.)
/($' to select the best lead with an easily detectable R-wave (See
2. Use 6(/(&7
“Selecting the Lead” on page 4-5.) If you do not select a lead (i.e. pads is
the selected ECG source), /HDG, is automatically selected when the pacing
function is turned on.
NOTE
If pacing for long periods of time, new monitoring electrodes and multifunction defib electrode pads may need to be applied periodically. Refer to the
manufacturer’s documentation for how often to change monitoring electrodes
or defib pads.
M3500B HeartStart XLT Defibrillator/Monitor
8-3
8
Pacing
Pacing
To perform pacing:
1. Press Pacer . The green LED next to
logue box appears.
Pacer
lights up and the dia-
Figure 8-1 Pacing Display
HR ALARM
LEAD
SELECT
78
Lead II
SpO2
Pacer Stop
Demand Mode
70ppm 30mA
150 J
ENERGY
SELECT
Shocks:0
00:00:8
CHARGE
The message 6WRS indicates that the pacing function is on but paced pulses
are not being delivered. The pacer turns on in the mode last used.
2. Verify that the dot markers appears near the middle of the QRS complexes
of the ECG.
If the dot markers do not appear, or are in the wrong location, adjust the
ECG size or select another lead. (See “Monitoring the ECG” in Chapter
4.)
The ECG will only appear if the 3- or 5-lead monitoring cable and electrodes are used.
3. Press
Mode
to change to fixed mode, if R-wave detection is unreliable.
The pacing dialogue box displays the current mode. To switch back to
demand mode, press
8-4
Mode
again.
Pacing
Pacing
4. Adjust the rate to the desired number of paced pulses per minute (ppm).
Press up,
, or down,
, on
ber of paced pulses per minute.
5. Press
Start
Stop
Rate
to increase or decrease the num-
to start pacing.
The message 3DFLQJ indicates that paced pulses are being delivered in the
selected mode at the rate and output level displayed.
Figure 8-2: Pacing Display
HR ALARM
78
150 J
ENERGY
SELECT
NOTE
LEAD
SELECT
SpO2
Lead II
Pacing
Demand Mode
70ppm 30mA
8
Shocks:0
00:00:8
CHARGE
Pacing will not start if there is a problem with the multifunction defib electrode pads connections or, in demand mode, a problem with the ECG monitoring electrodes connections. Should a problem exist, a system message is
displayed. Be attentive to system messages.
M3500B HeartStart XLT Defibrillator/Monitor
8-5
Changing Pacing Modes
6. Increase the output until cardiac capture occurs.
Press up
on
Output
to increase the output in increments of 10 mA.
7. Decrease the output to the lowest level that still maintains capture.
Press
on
Output
to decrease the output in increments of 5 mA.
Start
Press Stop
to stop pacing. Press Pacer to exit the pacing function. The
green LED next to the button goes out, indicating pacing is no longer active.
Changing Pacing Modes
If paced pulses are being delivered, you must stop pacing before changing the
pacing mode:
1. Press
Start
Stop
2. Press
Mode
to stop pacing.
to change the mode.
3. Adjust the rate, if needed.
4. Press
Start
Stop
to resume pacing.
5. Adjust the output, as needed to obtain capture.
Defibrillating During Pacing
If the patient must be defibrillated during pacing, follow the procedure for
defibrillating in Manual Mode on page 6-4.
Pacing is automatically turned off when you charge the defibrillator and the
pacing dialogue box is removed from the display. After a shock, pacing
remains off.
To resume pacing, refer to “Pacing” on page 8-4. When you resume, the rate,
mode, and output settings start at the settings selected prior to defibrillation.
8-6
Pacing
Troubleshooting
Troubleshooting
The table below lists the pacing-related system and momentary messages that
you may encounter during pacing.
Table 8-1 Pacing System Messages
Message
Possible Cause
Corrective Action
/HDGV2II
z The selected monitoring
lead is not making proper
contact with the patient.
z Pacing was attempted in
demand mode without
monitoring electrodes
attached.
z Check that the monitoring
electrodes are properly
applied.
z Check that the monitoring
cable and electrodes are
properly connected.
3DFHU)DLOXUH
The pacing system is not functioning.
Remove the device from active
use and call for service.
3DFHU2XWSXW
/RZ
High patient impedance is
resulting in the delivery of less
current to the patient than
specified in the output current
setting.
Check that the pads are applied
properly.
6WRS3DFHU
.H\,QDFWLYH
M3500B HeartStart XLT Defibrillator/Monitor
Mode
Stop pacing before changing
the pacing mode.
Pacer
Make sure Manual Mode is
active before pressing
is pressed while
paced pulses are being delivered.
, or one of the other
pacing function keys, is
pressed when Manual Mode is
not active.
Pacer
or one of the other
pacing function keys.
8-7
8
9 Storing, Retrieving & Printing
This chapter describes how the HeartStart XLT creates a patient record, called
an Event Summary, for later retrieval and printing. It covers how to mark
events for storage in the Event Summary, as well as how to print individual
events as they occur.
Overview
The HeartStart XLT automatically creates an Event Summary for each patient.
The Event Summary is stored in the HeartStart XLT’s internal memory and on
a Data Card (if one is used).
The internal Event Summary stores up to 300 pieces of critical information,
called events, and 50 ECG strips (11 seconds each). Events include things
such as charging, shocks, and alarm violations. In addition, you trigger an
event each time you press
Mark
Event
or
Print
Strip
.
Storage on a Data Card is limited only by available space on the card. In addition to storing all of the events that occur, a continuous copy of the displayed
ECG and Patient Contact Impedance is also stored.
You can print the internal Event Summary at any time. You can also configure
the HeartStart XLT to print individual events automatically as they occur and,
of course, you can activate printing of individual events and patient informaPrint
tion, at any time, by pressing Summary
.
To print the Event Summary stored on the Data Card, the information must
first be downloaded to the HeartStart Event Review Data Management
system. Refer to the HeartStart Event Review Instructions for Use for instructions.
M3500B HeartStart XLT Defibrillator/Monitor
9-1
9
Marking Events
Marking Events
Mark
The Event button allows you to annotate the ECG strip at the point in time the
button is pressed. In AED Mode, when monitoring is disabled, the event is
marked with a . In Manual Mode, or when monitoring is enabled in AED
Mode, you use the softkeys to select the annotation from the choices displayed (See Figure 9-1)*. If no selection is made, the event is marked with a
.
Figure 9-1 Annotations
EPI
72
ATRO
LIDO
Pads
150 J
ENERGY
SELECT
NOTE
OTHER
Shocks:0
00:00:8
CHARGE
*In Australia and the U.K., (3, is replaced by $'51 (adrenaline).
The marked event is stored in the Event Summary. If the printer is configured
Mark
to 3ULQWRQ0DUN, an ECG strip prints when Event is pressed. If the printer is
configured to VHFRQGGHOD\, the strip is 9 seconds and includes 6 seconds preceding the event and 3 seconds following the event. If 1R'HOD\ is configured, a
3 second ECG strip prints in real time. To stop printing before the entire strip
is printed, press Print
.
Strip
9-2
Storing, Retrieving & Printing
Events Recorded
Events Recorded
The following events and related information are stored in the Event
Summary:
Table 9-1 Event Information
Event
Related Information Stored
Power Change
Power on, Power off, Continued use, Battery
low.
Pads Change
Pads on, Pads off.
AED Mode Analysis
Analyzing, Analysis Stopped, Artifact
Detected, Cannot Analyze, Shock Advised,
No Shock Advised.
Mode Change
AED Mode or Manual Mode.
Rhythm Monitoring
Check Patient, Pause, Resume.
Charging
ECG waveform, Energy charged to.
Shock
ECG waveform, Shock#, Delivered energy,
Peak current, and Patient impedance.
Shock Failed
No Shock Delivered.
Disarm
ECG waveform.
ECG Monitoring
Leads on, Leads off, Lead change, Gain
change.
Heart Rate Alarm Violation
Lead, Heart Rate, and Heart Rate alarm limits.
M3500B HeartStart XLT Defibrillator/Monitor
9
9-3
Events Recorded
Table 9-1 Event Information (Continued)
Event
Related Information Stored
SpO2 Violation
SpO2 value and SpO2 alarm limit.
Mark
ECG waveform with annotation (
, Epi,
Atro, Lido, or Other).
9-4
Print Strip
ECG waveform.
Sync
Sync on, Sync off, Sync marker.
Pacing
Pacer start, Pacer stop, Pacer settings.
Storing, Retrieving & Printing
Creating a Patient Record
Creating a Patient Record
The HeartStart XLT creates an Event Summary patient record for each new
patient. Each record is assigned a unique incident number. The HeartStart
XLT keeps the Event Summary in its internal memory until you begin caring
for a new patient. It assumes that:
Table 9-2 Patient Record Summary
If:
Then:
Power is off for more than 2 minutes
and a new event is recorded
You are caring for a new patient. The
last internal Event Summary is deleted;
a new Event Summary is started and a
new incident record is created on the
Data Card.
Power is off less than 2 minutes
You are continuing to care for the same
patient. Additional events are appended
to the Event Summary; the annotation
"Continued Use" is printed on the
Event Summary.
The Continued Use feature allows you to change batteries or shut the HeartStart XLT off briefly (for 2 minutes), while preserving the current patient
record. Events recorded after the power interruption are appended to the
patient record. Continued use also preserves alarm settings.
M3500B HeartStart XLT Defibrillator/Monitor
9-5
9
Printing the Internal Event Summary
Printing the Internal Event Summary
To print the internal Event Summary, press
the complete summary is printed, press
Print
Summary.
To stop printing before
Print
Summary again
or press
Print
Strip
.
The Event Summary includes the following information, in the order listed:
z
z
z
a header with a place for you to write in the patient’s name and the
operator’s name.
a directory list of events that occurred during the incident and the
time of their occurrence.
ECG strips of the events in the directory list, where relevant.
Figure 9-2 shows the beginning of an Event Summary.
Figure 9-2 Event Summary
Patient ___________________
Device On
AED Mode
Operator __________________
Pads On
Leads On
Device On
03 Jan 00 12:41:00 Analyzing
Shock Advised
Last Event
03 Jan 00 01:09:04 Shock #1
Analyzing
Total Shocks 2
Shock Advised
Incident: 0000045
Shock #2
Serial Number 123456789
Manual Mode
9-6
12:41:00
12:41:00
12:41:01
12:41:03
12:41:03
12:41:11
12:41:17
12:41:24
12:41:31
12:41:38
12:41:42
Storing, Retrieving & Printing
Printing the Internal Event Summary
The Event Summary also includes waveforms and the appropriate annotation
for each of the following events:
Table 9-3 Event Waveform Information
Event
Waveform Description
Shock Advised
11 seconds of ECG just prior to the
message 6KRFN$GYLVHG
No Shock Advised
11 seconds of ECG just prior to the
message 1R6KRFN$GYLVHG
Cannot Analyze
11 seconds of ECG just prior to the
message &DQQRW$QDO\]H
Shock Delivered
11 seconds; 3 seconds prior to the
shock, plus 8 seconds after the shock.
Print Strip
11 seconds; 3 seconds prior to Strip
being pressed, plus 8 seconds after
Print
Print
Strip
Mark Event
Mark
11 seconds; 3 seconds prior to Event
being pressed, plus 8 seconds after
Mark
Event
ECG or SpO2 Alarm
M3500B HeartStart XLT Defibrillator/Monitor
is pressed.
9
is pressed.
11 seconds; 3 seconds prior to the
alarm, plus 8 seconds after the alarm.
9-7
Printing Events
Printing Events
The HeartStart XLT can be configured to print automatically when certain
events occur. The table below lists these events and the length of the strip
printed, depending on whether the printer is configured to print real-time or
with a 6-second delay.
Table 9-4 Printing Events
Event
Real-Time
Strip Length
Delayed
Strip Length
Defibrillator charges
continuous
6 seconds just prior to charging, plus
continuous printing throughout the
charge duration.
Shock Delivered
12 seconds
6 seconds just prior to shock, plus 12
seconds after shock.
Shock Failed
6 seconds
6 seconds just prior to the message
1R6KRFN'HOLYHUHG, plus 6 seconds after
the message.
Defibrillator disarmed
6 seconds
6 seconds just prior to shock, plus 6
seconds after shock.
Alarm Violation
6 seconds
6 seconds just prior to alarm violation, plus 6 seconds after alarm violation.
Mark
Event pressed
6 seconds
6 seconds just prior to marking, plus
6 seconds after button pressed.
Printing is configured independently for each of these events. You can stop
the printing before it has printed the entire strip by pressing Print
Strip .
To print additional events that you observe in the course of caring for your
patient, press Print
Strip . An ECG strip will print continuously until you press
Print
Strip
a second time to stop printing. If the printer is configured to have a 6second delay, the printout contains an additional 6 seconds of the ECG that
occurred just prior to pressing Print
Strip .
9-8
Storing, Retrieving & Printing
10 Setting Up and Configuring the HeartStart XLT
This chapter describes how to set-up and configure your HeartStart XLT. It
covers:
z
z
z
Connecting Patient Cables
Arranging Accessories in the Carrying Case
Configuring the HeartStart XLT
Connecting/Disconnecting Patient Cables
This section describes how to connect and disconnect the:
z
z
z
Pads Patient Cable
ECG Patient Cable (3- or 5-lead)
SpO2 Patient Cable
10
M3500B HeartStart XLT Defibrillator/Monitor
10-1
Connecting/Disconnecting Patient Cables
Connecting the Pads Patient Cable
To connect the pads patient cable to the defibrillator:
1. Align the white pointer on the pads patient cable with the white arrow on
the defibrillator’s pads connector, as shown in Figure 10-1.
2. Insert the patient cable into the pads connector. Push until you hear it
click in place.
Figure 10-1 Pads Patient Cable Connector
Pointer
Pads connector
10-2
Setting Up and Configuring the HeartStart XLT
Connecting/Disconnecting Patient Cables
Disconnecting the Pads Patient Cable
To disconnect the pads patient cable:
1. Rotate the green locking mechanism on the patient cable in the direction
(clockwise), of the blue arrow on the defibrillator until it stops (as shown
in Figure 10-2).
2. Hold the locking mechanism in this position as you pull the patient cable
away from the defibrillator.
Figure 10-2 Disconnecting the Pads Patient Cable
Blue arrow
10
M3500B HeartStart XLT Defibrillator/Monitor
10-3
Connecting/Disconnecting Patient Cables
Connecting the ECG Patient Cable
To connect a 3- or 5-lead ECG patient cable:
1. Align the keyed patient cable plug with the slot on the ECG connector, as
shown in Figure 10-3.
2. Push the patient cable firmly into the ECG connector, until the white portion is no longer visible.
Figure 10-3 ECG Patient Cable Connector
Disconnecting the ECG Patient Cable
To disconnect the ECG patient cable, gently pull the white patient cable plug
out of the ECG connector, as shown in Figure 10-3.
10-4
Setting Up and Configuring the HeartStart XLT
Connecting/Disconnecting Patient Cables
Connecting the SpO2 Patient Cable
To connect the SpO2 patient cable:
1. Hold the connector with the flat side up, as shown in Figure 10-4.
2. Insert the connector into the receptacle and push until the blue portion of
the connector is no longer visible.
Figure 10-4 Connecting the SpO2 Patient Cable
Disconnecting the SpO2 Patient Cable
To disconnect the SpO2 patient cable, gently pull it out of the SpO2 connector.
10
M3500B HeartStart XLT Defibrillator/Monitor
10-5
Arranging Accessories in the Carrying Case
Arranging Accessories in the Carrying Case
The HeartStart XLT carrying case is designed to hold your essential defibrillation and monitoring accessories. Figure 10-5 shows the recommended placement for each of these accessories.
Figure 10-5 Recommended Accessory Placement
Spare Battery
Paper
Pads Patient
Cable
Pads
ECG
Patient Cable
Monitoring
Electrodes
SpO2
Patient Cable
10-6
Setting Up and Configuring the HeartStart XLT
Configuring the HeartStart XLT
Configuring the HeartStart XLT
Configuration options allow you to customize the HeartStart XLT to best meet
your needs. This section describes:
z
z
z
z
z
z
How to access the configuration menu.
Configurable items and their setting options.
How to change the configuration.
How to save the configuration to a Data Card.
How to load the configuration from a Data Card.
How to print the configuration.
Accessing the Configuration Menu
There is a special combination of softkeys that, when pressed simultaneously,
turn the HeartStart XLT on in Configuration Mode. For the purposes of executing this procedure, softkeys are assigned numbers as shown in Figure 10-6.
Figure 10-6 Softkey Numbers
10
M3500B HeartStart XLT Defibrillator/Monitor
10-7
Configuring the HeartStart XLT
To turn the HeartStart XLT on in Configuration Mode:
1. If the device is already on, press Off.
2. While holding down softkeys 4 & 5, press 1.
The configuration menu appears as shown in Figure 10-7. The menu lists the
categories of settings that may be configured.
Figure 10-7 Configuration Menu
ENTER
MAIN
General Settings
AED Settings
Manual Settings
ECG Filter Settings
Save Settings to Data Card
Load Settings from Data Card
Print All Settings
Turn Off To Exit Configuration
Configurable Parameters
The following tables show the configurable parameters for each category of
settings. A description of each parameter is provided, along with the possible
choices. Default settings are in bold.
10-8
Setting Up and Configuring the HeartStart XLT
Configuring the HeartStart XLT
Table 10-1 General Settings
Parameter
Setting
Choices
Description
'DWHGGPPP\\\\
Current date, where GG is the day, PPP is
the month, and \\\\ is the year.
any valid date
7LPHKKPP
Current time, where KK is the hour and PP
is the minutes. Time is based on a 24 hour
clock.
any valid time
3ULQWRQ0DUN
3ULQWRQ&KDUJH
Prints a 3 second strip when
pressed.
Mark
Event
On / Off
is
Prints a continuous strip during charging.
Printing continues until a shock is delivered, the device is disarmed, or
pressed.
Print
Strip
On / Off
is
3ULQWRQ6KRFN
Prints a 12 second strip when a shock is
delivered.
On / Off
3ULQWRQ$ODUP
Prints a 6 second strip during alarms.
On / Off
10
M3500B HeartStart XLT Defibrillator/Monitor
10-9
Configuring the HeartStart XLT
Table 10-1 General Settings (Continued)
Parameter
10-10
Description
Setting
Choices
3ULQWHU'HOD\
Captures what you just saw. All printed
strips, including those generated by an
event (mark, charge, shock or alarm),
include an additional 6 seconds of information - the 6 seconds of information that
occurred just prior to printing being initiated.
6 Sec Delay /
No Delay
3DFH3XOVH0DUNHUV
Shows pace pulse markers on the ECG
displayed, if an internal pacemaker is
detected.
Leads & Pads /
Leads Only
(&*/HDG&DEOH
Selects the monitoring electrodes source.
3-lead / 5-lead
3RZHURQ0RGH
Defines the operating mode when the
device is turned on. Applies to a new use,
not to a continued use.
AED / Manual
456%HHSHU
Provides an audible beep with each QRS
complex detected.
Manual / AED
& Manual / Off
Setting Up and Configuring the HeartStart XLT
Configuring the HeartStart XLT
Table 10-2 AED Settings:
Parameter
Description
Setting
Choices
$('6KRFN6HULHV
Defines the maximum number of shocks to
deliver before prompting &KHFN3DWLHQW&KHFN
3XOVH,I1HHGHG%HJLQ&35.
2, 3, 4
6KRFN6HULHV7LPHU
Defines the number of seconds that must pass
before the next shock is considered the first
shock of a new shock series, rather than the
next shock of the current shock series.
30, 60, 90,
120, 150, 180,
210, Off
'HYLFH,QLWLDWHG
$QDO\VLV
Initiates ECG analysis when the HeartStart
XLT is turned on in AED Mode.
On, Off
$XWRPDWLF
5H$QDO\VLV
Initiates ECG analysis in between shocks
within a shock series.
On, Off
5K\WKP0RQLWRULQJ
Monitors the ECG for potentially shockable
rhythms when the HeartStart XLT is not analyzing, defibrillating, or paused.
On, Off
´&KHFN3DWLHQWµ
7LPHU
Defines how often (in seconds) the &KHFN
3DWLHQW prompt is repeated when Rhythm Monitoring detects a potentially shockable rhythm.
30, 45, 60, 90,
Off
(XURSHDQ3URWRFRO
Modifies Pause state prompts and replaces the
Pause Timer with either the Post Shock CPR
Timer or the "NSA" Timer, depending on the
event preceding the Pause state.
Off/On
If (XURSHDQSURWRFRO is set to On, the following two configuration choices appear:
3RVW6KRFN&35
7LPHU
M3500B HeartStart XLT Defibrillator/Monitor
Defines the duration of the Pause time (in seconds) when 3$86( is pressed and the time
since the last shock is less than or equal to the
6KRFN6HULHV7LPHU setting - typically at the completion of a shock series.
30, 60, 120,
180
10-11
10
Configuring the HeartStart XLT
Table 10-2 AED Settings: (Continued)
Parameter
16$7LPHU
Description
Defines the duration of the Pause time (in seconds) when 3$86( is pressed and the time
since the last shock is greater than the 6KRFN
6HULHV7LPHU setting - typically when 1R6KRFN
$GYLVHG
Setting
Choices
30, 60, 120,
180
If (XURSHDQ3URWRFRO is set to Off, the following configuration choice appears:
´3DXVHµ7LPHU
Defines the duration of the pause time (in seconds), when 3$86( is pressed (when (XURSHDQ
3URWRFRO is set to Off).
30, 60, 120,
180
The following two configuration choices are always available regardless of the
(XURSHDQ3URWRFRO setting.
/HDG6HOHFW
Turns on ECG monitoring.
On, Off
6S2
Turns on SpO2 monitoring. Only listed as a
configurable item if the SpO2 option was purchased.
On, Off
NOTE
* If (XURSHDQ3URWRFRO is set to 2II, the Pause Timer is used during the Pause state
and appears as a configurable parameter. If (XURSHDQ3URWRFROis set to 2Q, either
the 3RVW6KRFN&357LPHU or the ´16$µ7LPHU are used during the Pause state and
appear as configurable parameters in place of 3DXVH7LPHU.
NOTE
If (XURSHDQ3URWRFRO is set to 2Q, the setting for the 6KRFN6HULHV7LPHU must be <
3RVW6KRFN&357LPHU < 16$7LPHU. Also, the 6KRFN6HULHV7LPHU can not be configured to either 2II or .
10-12
Setting Up and Configuring the HeartStart XLT
Configuring the HeartStart XLT
Table 10-3 Manual Settings
Parameter
Description
Choices
0DQXDO0RGH
6HFXULW\
Requires entry of a password to access
Manual Mode.
On, Off
6\QF$IWHU6KRFN
Determines if the Sync function stays on
after a synchronized shock is delivered.
On, Off
Setting the Manual Mode Password
When Manual Mode Security is set to On (see “Modifying the Configuration”
on page 10-15), the password entry screen is displayed. Use the softkeys on
the top of the display to enter a four digit password.
Figure 10-8 Password Entry Screen
1
2
3
4
Enter Password
_ _ _ _
CANCEL
10
M3500B HeartStart XLT Defibrillator/Monitor
10-13
Configuring the HeartStart XLT
Table 10-4 ECG Filter Settings
Item
10-14
Description
Setting Choices
$&/LQH)LOWHU
Selects the setting used to filter out
AC line noise.
60 Hz, 50 Hz
3DGV(&*IRU
'LVSOD\
Selects the display filter frequency
for the pads ECG.
Monitor (.15-40Hz),
EMS (1-30 Hz)
3DGV(&*IRU
3ULQWHU
Selects the printer filter frequency
for the pads ECG.
Monitor (.15-40Hz),
EMS (1-30 Hz)
/HDGV(&*IRU
'LVSOD\
Selects the display filter frequency
for the monitoring electrodes ECG.
Monitor (.15-40Hz),
EMS (1-30 Hz)
/HDGV(&*IRU
3ULQWHU
Selects the printer filter frequency
for the monitoring electrodes ECG.
Diag (.05 - 150 Hz),
EMS (1 - 30 Hz,
Monitor (.15 - 40 Hz)
Setting Up and Configuring the HeartStart XLT
Configuring the HeartStart XLT
Modifying the Configuration
To modify the configuration, from the main menu:
1. Use
and
2. Press (17(5 .
to highlight the desired category of settings.
3. Use
and
to highlight the item you want to change.
&+$1*(
4. Press
.
5. Use the softkeys ( 1(;7 ,
, or
,) to select the desired setting. To
6(7
select the default setting, press '()$8/7
.
6. Press 6$9( to save the change. To exit without making the change, press
&$1&(/ .
7.
Press 0$,1 to return to the main menu.
To make additional changes, repeat steps 1-7.
Returning to the Default Configuration
Press
and
on
simultaneously, while in the main configuration
menu, to return all settings to their default settings. Although there is no visible change in the display, default settings are restored.
10
M3500B HeartStart XLT Defibrillator/Monitor
10-15
Configuring the HeartStart XLT
Saving Settings to a Data Card
Configuration settings may be saved to a Data Card and used to load the same
configuration into other HeartStart XLTs or to restore the configuration, if
necessary.
To save the configuration:
1. Make sure a Data Card is in the HeartStart XLT before turning the unit on.
2. Select 6DYH6HWWLQJVWR'DWD&DUG from the main configuration menu.
3. Press 6$9( in response to the question 6DYH6HWWLQJVWR'DWD&DUG".
The HeartStart XLT saves the configuration settings to the Data Card and
returns to the main configuration menu.
Loading Settings from a Data Card
To load configuration settings:
1. Make sure a Data Card is in the HeartStart XLT.
2. Select /RDG6HWWLQJVIURP'DWD&DUG from the main configuration menu.
3. Press /2$' in response to the question /RDG6HWWLQJVIURP'DWD&DUG".
The HeartStart XLT loads the configuration settings from the Data Card and
returns to the main configuration menu.
Printing Settings
To print the configuration settings, select 3ULQW$OO6HWWLQJV from the main configuration menu.
10-16
Setting Up and Configuring the HeartStart XLT
11 Maintaining the HeartStart XLT
11
This chapter describes how to care for your HeartStart XLT Defibrillator/
Monitor and its accessories. It provides:
z
z
z
z
z
z
z
Operational checks,
Battery maintenance procedures,
Instructions on loading printer paper,
Cleaning instructions,
Instructions for removing and replacing the carrying case,
A list of approved supplies and accessories, and
Instructions for disposal of the device.
The operational checks described must be performed at the specified intervals
in order to help prevent and detect electrical and mechanical problems. The
battery maintenance procedures specified must be adhered to in order to
ensure that your batteries have the energy required to operate the defibrillator
and deliver the appropriate therapy.
M3500B HeartStart XLT Defibrillator/Monitor
11-1
Operational Checks
Operational Checks
The following operational checks are intended to quickly verify the proper
operation of the HeartStart XLT. Perform these checks regularly, at the intervals specified, along with visual inspection of the device and all cables, controls, accessories and supplies. Also regularly check expiration dates of all
supplies, such as multifunction defib electrode pads and monitoring
electrodes.
Before You Begin
Before you run the Shift/System Check, be aware of the following conditions:
z
z
z
11-2
Do not touch any of the controls on the HeartStart XLT while the
Shift/System Check is running.
If a )DLOXUH or 6HUYLFH8QLW message is displayed, or if an unexpected 1RW
7HVWHGresult is displayed, check that the test is set up correctly. Make
sure that:
‰ the paper is in the printer
‰ the test load is attached
‰ a Data Card with enough space is inserted into the HeartStart
XLT
‰ a charged battery is inserted into the HeartStart XLT
Run the Shift/System Check again, ensuring that no one touches any
of the controls on the defibrillator unless prompted to do so.
If the Data Card is full, the message 6HUYLFH8QLW appears at the bottom
of the screen and the message 'DWD&DUG)XOO appears at the top of the
screen. Replace the Data Card and perform the Shift/System Check
again. If the message6HUYLFH8QLWcontinues to appear, do not use the
device and call for service.
Maintaining the HeartStart XLT
Operational Checks
Every Shift
Perform a “Shift/System Check” every shift (see “Shift/System Check” on
page 11-4) to verify that the HeartStart XLT is functioning properly and to
ensure that necessary supplies and accessories are present and ready for use.
Every Month
Check expiration dates on multifunction defib electrode pads and monitoring
electrodes every month. Replace them if the expiration date has passed.
Every Three Months
Perform a "Battery Capacity Test" on each battery, every three months, to
ensure that your batteries meet the specifications for safe and effective use.
M3500B HeartStart XLT Defibrillator/Monitor
11-3
11
Operational Checks
Shift/System Check
To perform the Shift/System Check:
1. Turn the HeartStart XLT off.
2. Connect a 50 ohm test load to the pads patient cable (instead of pads).
3. If a Data Card is routinely used, insert a Data Card into the HeartStart
XLT.
4. If a power module is used, unplug the power module.
5. Insert a charged battery.
6. While pressing
Print
Strip
, press On to start the test.
7. Follow the prompts on the display to proceed with the test. If the message
6HUYLFH8QLW appears, check the information in Table 12-2 and Table 12-3 .
If the message continues to appear, do not use the device, and call for
service.
The test takes less than a minute to complete. When it is done, a report is
printed, as shown in Figure 11-1. Test results are listed as Pass or Fail, with
the exception of the Data Card Test. For the Data Card Test, the results indicate either the amount of storage time remaining on the data card or that no
data card is present.
Figure 11-1 Shift/System Check Report
Shift/System Check
Current Tests:
General System Test
ECG Test
Backup Power Test
SpO2 Test:
Data Card Test
Defib Test
Pacer Test
11-4
8 Jan 1999 13:52:17
Pass
Pass
Pass
Pass
2:00
Pass
Pass
SN:US00000001
Qty/Check List:
___ Defibrillator Inspection
___ Cables/Connectors
___ Defibrillation Pads
___ Monitoring Electrodes
___ Charged Batteries
___ AC/DC Power Module
___ Printer Paper
___ Data Card
___ Ancillary Supplies
___ SpO2 Sensor
Maintaining the HeartStart XLT
Operational Checks
The report also lists additional checks that you should do. Perform each of
these checks and record the results. The guidelines for completing the checks
are as follows:
Defibrillator Inspection - make sure the HeartStart XLT is clean, clear of
objects on top and has no visible signs of damage.
Cables/Connectors - make sure there are no cracks, broken wires, or other
visible signs of damage. Make sure the connectors engage securely.
Supplies - make sure the carrying case has:
z
z
z
z
z
z
z
z
z
z
two sets of multifunction defib electrode pads in sealed packages,
within the expiration date
an adequate supply of monitoring electrodes, within the expiration
date
alcohol wipes
hand towel
scissors
a razor
an extra roll of printer paper
a spare charged battery
a Data Card
SpO2 sensors (if monitoring SpO2)
M3500B HeartStart XLT Defibrillator/Monitor
11-5
11
Operational Checks
Power Supply
Battery - make sure:
z
z
z
a charged battery is in the HeartStart XLT
another battery is charged or being charged
the batteries have no visible signs of damage
AC/Power Module
1. Make sure a battery is in the HeartStart XLT.
2. Plug the power module into a power outlet and connect it to the HeartStart XLT.
3. Verify that the power and charging indicators on the power module are
lit.
4. Remove the battery from the HeartStart XLT and verify that the charging indicator on the power module is no longer lit. Replace the battery.
Printer - make sure the printer:
z
z
11-6
has sufficient paper
prints properly
Maintaining the HeartStart XLT
Operational Checks
Battery Capacity Test (CT)
To perform a Battery Capacity Test:
1. Turn the HeartStart XLT off.
2. Place a "Test in Progress" label on the HeartStart XLT to indicate to others that it may not be used.
3. Insert a charged battery.
4. If an AC power module is connected, unplug the power module from the
Mark
HeartStart XLT. While pressing Event , press On to start the test.
5. Allow the test to proceed to completion. The test takes approximately
three hours and is complete when test results print out and the device
turns itself off.
6. Review the test results and take the appropriate action, as follows:
Table 11-1 Battery Capacity Test Results
If
Elapsed Time > 2.5 hours
and
Low Battery Time > 10 minutes
Then...
1.
2.
3.
Elapsed Time < 2.5 hours
or
Low Battery Time < 10 minutes
1.
2.
3.
M3500B HeartStart XLT Defibrillator/Monitor
The battery passed the test.
Record "pass CT" and the date on
the bottom of the battery.
Recharge the battery before use.
The battery failed the test.
Record "fail CT" and the date on
the bottom of the battery.
Discard the battery appropriately.
11-7
11
Battery Maintenance
Battery Maintenance
The HeartStart XLT uses the M3516A Battery Pack. It is a rechargeable
sealed lead acid battery. Battery maintenance begins when you receive a new
battery and continues throughout the life of the battery. Detailed information
on battery care is provided in the application note “About Sealed Lead Acid
Batteries,” that came with your HeartStart XLT.
Table 11-2 lists battery maintenance activities and when they should be performed.
Table 11-2 Battery Maintenance Activities
Activity:
When to Perform:
Perform a visual inspection
Daily, as part of the Shift/System Check.
Charge the battery
Upon receipt, after each use, and when the
message /RZ%DWWHU\ is displayed.
Perform a Battery Capacity Test
Every three months.
Store the battery appropriately
When not in use.
Charging Batteries
You may charge batteries while they are in either the HeartStart XLT or the
M3506A Battery Charger Adapter, by connecting the device with the battery
to the M3517A AC Power Module.
Refer to the charging procedures provided in the operating instructions for the
power module(s) you use. Batteries charge to 90% of their capacity in about
2.5 hours. It then takes about 12 more hours to reach a fully charged state.
Batteries should be charged at temperature between 10oC (50oF) and 30oC
(86oF) for maximum battery life.
11-8
Maintaining the HeartStart XLT
Battery Maintenance
Battery Capacity
A fully charged M3516A battery, operating at room temperature, provides
greater than 2.7 hours of monitoring or more than 50, 200-joule charge-shock
cycles.
Battery Life-Expectancy
Life-expectancy of a battery depends on the frequency and duration of use.
When properly maintained and stored, the life-expectancy of a battery is
about 2 years. For more aggressive use models, life-expectancy may be less.
Storing Batteries
Batteries should be used regularly and rotated to distribute the use evenly.
When storing batteries, make sure that the battery terminals do not come in
contact with metallic objects.
Batteries should not be stored without charging for more than one month, if
installed in the defibrillator, or more than three months, if not installed in the
defibrillator. Storage at temperatures between 15oC (59oF) and 30oC (86oF) is
recommended to maximize life-expectancy.
CAUTION
Storing at temperatures above 35oC (95oF) for extended periods of time will
significantly reduce a battery’s life-expectancy.
Discarding Batteries
Batteries should be discarded two years after the first Test Date (as written on
the battery’s back label), or sooner, if there are visual signs of damage or if
they fail the Battery Capacity Test. Batteries should be discarded in an environmentally safe manner. Properly dispose of batteries according to local regulations.
WARNING
Do not disassemble, puncture, or incinerate batteries. Be careful not to short the
battery terminals because this could result in a fire hazard.
M3500B HeartStart XLT Defibrillator/Monitor
11-9
11
Loading Printer Paper
Loading Printer Paper
To load printer paper:
1. Slide the printer door to the right until the paper roller pops up.
2. If there is an empty or low paper roll in the printer, pull up on the plastic
removal tab to remove the roll.
Figure 11-2 Opening the Printer
11-10
Maintaining the HeartStart XLT
Loading Printer Paper
3. Place a new roll of printer paper (40457C/D) into the printer paper well,
positioning the roll so that the end of the roll is on the top and the grid
faces down. Be sure to push the roll down so that it is firmly seated in the
paper well.
4. Pull the end of the paper past the paper roll.
5. Slide the printer door to the right and hold it open. Press the roller down
over the paper and release the door.
Figure 11-3 Loading Paper
M3500B HeartStart XLT Defibrillator/Monitor
11-11
11
Cleaning Instructions
Cleaning Instructions
Following are recommendations for cleaning the HeartStart XLT and its associated case, cables, etc.
Cleaning the HeartStart XLT
The following cleaning products may be used to clean the exterior surfaces of
the HeartStart XLT, as well as the battery and data card:
z
z
z
z
Isopropyl alcohol (70% in water)
Mild soap and water
Chlorine bleach (3% in water)
Quaternary ammonium compounds, such as Lysol (10% in water)
When cleaning, be sure to avoid pouring fluids on the device and do not allow
fluids to penetrate the exterior surfaces of the device. Use of a soft cloth is
recommended for cleaning the display, to prevent scratching.
CAUTION
The HeartStart XLT may not be autoclaved, ultrasonically cleaned, or
immersed. Do not use abrasive cleaners or strong solvents such as acetone or
acetone-based cleaners.
Cleaning the Carrying Case
Clean the carrying case by hand, using a mild soap and water. A brush may be
used on stubborn spots and a fabric cleaner may be used to remove grease
spots. Air dry the carrying case when cleaning is complete.
If it is necessary to remove the carrying case for cleaning, refer to directions
on page 11-15.
11-12
Maintaining the HeartStart XLT
Cleaning Instructions
Cleaning the Printer Printhead
If the printout has light or varying density printing, clean the printhead to
remove any buildup of paper residue.
To clean the printhead:
1. Slide the printer door to the right until the paper roller pops up.
2. Pull up on the plastic removal tab to remove the roll of paper.
3. Clean the printhead surface (above the brush) with a cotton swab dipped
in rubbing alcohol.
4. Replace the roll of paper (see “Loading Printer Paper” on page 11-10).
Cleaning the Power Modules
The following cleaning products may be used to clean the exterior surfaces of
the AC power modules:
z
z
z
z
Isopropyl alcohol (70% in water)
Mild soap and water
Chlorine bleach (3% in water)
Quaternary ammonium compounds, such as Lysol (10% in water)
When cleaning:
z
z
Avoid pouring fluids on the module. Do not allow fluids to penetrate
the exterior surfaces of the module.
Do not use abrasive cleaners or strong solvents such as acetone or
acetone-based compounds.
M3500B HeartStart XLT Defibrillator/Monitor
11-13
11
Cleaning Instructions
Cleaning Pads, Electrodes & Cables
Defibrillation pads and monitoring electrodes are single use and do not
require cleaning.
The pads cable may be cleaned with:
z
z
z
z
z
Alcohol-free hand soap
2% gluteraldehyde solution (such as Cidex)
Sodium hypochlorite (chlorine bleach) solution 10% in water
Quaternary ammonium compounds (such as Lysol)
Isopropyl alcohol
The ECG cable may be cleaned by wiping it with any of the following:
z
z
z
CAUTION
2% gluteraldehyde solution (such as Cidex®)
Alcohol-free hand soap
Chlorine bleach (100ml/l)
Do not ultrasonically clean, immerse, autoclave or steam sterilize the pads or
ECG cable.
Do not clean the ECG cable with alcohol. Alcohol can cause the plastic to
become brittle and may cause the cable to fail prematurely.
To clean the SpO2 sensor and cable, follow the manufacturer’s instructions.
11-14
Maintaining the HeartStart XLT
Removing & Replacing the Carrying Case
Removing & Replacing the Carrying Case
To remove the carrying case from the HeartStart XLT, follow steps 1 through
7 in Figure 11-4.
After loosening the screws (step 6), lay the unit flat and lift the defib up off
the metal mounting plates to disengage it from the two metal pins at the rear
of the case. Then slide the defib out of the case as shown in step 7.
Figure 11-4 Removing the Carrying Case
M3500B HeartStart XLT Defibrillator/Monitor
11-15
11
Removing & Replacing the Carrying Case
To put the carrying case on the HeartStart XLT, follow the steps 1 through 7 in
Figure 11-5.
Slide the unit into the case as shown in step 1, then lower it onto the two metal
pins at the rear of the case before tightening the screws (step 2).
Figure 11-5 Putting the Carrying Case On
11-16
Maintaining the HeartStart XLT
Putting On the Manual Door
Putting On the Manual Door
To put on the manual door, align the door with the door hinges as shown in
Figure 11-6. Then push, as shown in Figure 11-7, until the door snaps in place.
Figure 11-6 Aligning the Manual Door
Figure 11-7 Snapping the door in place
M3500B HeartStart XLT Defibrillator/Monitor
11-17
11
Supplies & Accessories
Supplies & Accessories
Approved supplies and accessories for the HeartStart XLT are listed in
Table 11-3 . To order:
z
z
In the USA, call 1-800-225-0230 (electrodes, cables, paper, etc.) or
1-800-934-7372 (HeartStart Pads adapters only).
Outside the USA, contact your local Philips Medical Systems Sales
Office, your authorized Philips Medical Systems Dealer or Distributor, or visit our online store at www.medical.philips.com/cms and follow the Supplies link.
Table 11-3 Supplies and Accessories
Part Number
Description
Paper
40457C
50 mm Strip Chart Thermal Paper - 1 box (10 rolls)
40457D
50 mm Strip Chart Thermal Paper - 1 box (80 rolls)
Defibrillation Pads,
Pads Cables and
Test Load
(white twist lock
connector)
11-18
M3501A
Multifunction Adult defib pads, AAMI.
M3502A
Multifunction Adult defib pads, IEC.
M3503A
Multifunction Pediatric defib pads, IEC.
M3504A
Multifunction Pediatric defib pads, AAMI.
M3507A
Defib pads cable, barrel connector.
M1781A
50 ohm defibrillator test load, barrel connector.
05-10200
HeartStart Pads Adapter, barrel connector. Connects to
M3507A pads connector cable.
Maintaining the HeartStart XLT
Supplies & Accessories
Table 11-3 Supplies and Accessories (Continued)
Part Number
Description
11
Defibrillation Pads,
Pads Cables,
Adapters and
Test Load
(gray flat connector)
M3713A
Multifunction Adult Plus Pads - Adult Plus multifunction
defib pads (general use).
M3716A
Multifunction Adult Radiolucent Pads - Adult Radiolucent
multifunction defib pads (special purpose - for X-ray and
special procedures).
M3717A
Multifunction Pediatric Plus Pads - Pediatric multifunction
defib pads (general use).
M3718A
Multifunction Adult Radiotransparent/Reduced Skin Irritation
Pads - Adult Radiotransparent/Reduced Skin Irritation multifunction defib pads (special purpose - for X-ray and special
procedures).
M3719A
Multifunction Pediatric Radiotransparent/Reduced Skin Irritation Pads - Pediatric Radiotransparent/Reduced Skin Irritation
multifunction defib pads (special purpose - for X-ray and
special procedures).
M3508A
Defibrillator pads cable, plug connector.
M3725A
50 ohm defibrillator test load, plug connector.
M3500B HeartStart XLT Defibrillator/Monitor
11-19
Supplies & Accessories
Table 11-3 Supplies and Accessories (Continued)
Part Number
Description
ECG Cables
M1733A
3-lead ECG Trunk cable, AAMI (8-pin).
M1734A
5-lead ECG Trunk cable, AAMI (8-pin).
M1735A
3-lead ECG Trunk cable, IEC (8-pin).
M1736A
5-lead ECG Trunk cable, IEC (8-pin).
M1580A
3-lead ECG Trunk cable, AAMI (8-pin)
M1600A
5-Lead ECG Trunk Cable, AAMI ((8-pin)
M1590A
3-lead ECG Trunk Cable, IEC (8-pin)
M1610A
5-Lead ECG Trunk Cable, IEC (8-pin)
Monitoring Electrodes
M2202A
High-Tack Foam ECG Electrodes - 5 electrodes/pouch
(300 electrodes/case)
SpO2 Cable/Sensors
M1191A
Adult Reusable SpO2 sensor.
M1192A
Pediatric Reusable SpO2 sensor.
M1194A
Adult/Pediatric Ear Clip, Reusable SpO2 sensor
M1941A
SpO2 extension cable (2 m).
M1943A
Nellcor SpO2 Sensor adapter cable.
Data Card
M3510A
11-20
Data Card.
Maintaining the HeartStart XLT
Supplies & Accessories
Table 11-3 Supplies and Accessories (Continued)
Part Number
Description
11
Battery/Power Modules/ Adapter
M3516A
Sealed Lead Acid Battery.
M3517A
AC power module.
M3518A
DC Power Module
M3506A
Battery charger adapter.
Extension Cable
M4748A
Adapter extension cable
Carrying Case
M3509A
M3500B HeartStart XLT Defibrillator/Monitor
Carrying case. (If a new Quick Reference Card is needed for
the carrying case, it must be ordered separately.)
11-21
Disposing of the HeartStart XLT
Prior to disposing of the HeartStart XLT, remove the battery. Then dispose of
the device and its accessories in accordance with local standards.
WARNING
Disposal of the device with the battery inserted presents a potential shock hazard.
12 Troubleshooting
If the HeartStart XLT detects an error or potential problem during use, it displays a system or momentary message. In AED Mode, these messages are
often accompanied by a voice prompt. This chapter describes the messages
and what you should do in response. In addition, this chapter provides general
troubleshooting tips and information on calling for service.
NOTE
For instructions for repair, or for further technical information, refer to the
service manual, part number M3500-90900.
M3500B HeartStart XLT Defibrillator/Monitor
12-1
12
System Messages
System Messages
System messages remain on the display until the specified action is taken or
no longer relevant. Each message is accompanied by a three second beep to
alert you. Table 12-1 lists system messages.
Table 12-1 System Messages
Message
Description
Corrective Action
$WWDFK3DGV&DEOH
The pads cable is not properly attached to
the device.
Check the cable connection.
&RQILJXUDWLRQ/RVW
The configuration is reset to the default
settings.
z Reconfigure the HeartStart XLT.
z If the message persists, call for service.
'DWD&DUG'LVDEOHG
The PC card is not in use because it is
full, incompatible, absent, or inserted
after the HeartStart XLT was turned on.
If possible, turn the HeartStart XLT off
for more than 2 minutes, insert an empty,
compatible Data Card, and turn the device
on.
(&*)DXOW
The ECG data acquisition system failed
and data is unavailable from the 3- or 5lead monitoring electrodes.
Remove the device from active use and
call for service.
/RZ%DWWHU\
The battery has sufficient capacity
remaining to provide only about ten minutes of monitoring time and six shocks
before the HeartStart XLT shuts off.
Replace the battery with a fully charged
battery.
/HDGV2II
z The monitoring electrodes are not
applied.
z The monitoring electrodes are not
making proper contact with the
patient.
z The monitoring cable is not connected.
z Check the monitoring electrodes are
properly applied.
z Check the monitoring cable is properly connected.
12-2
Troubleshooting
System Messages
Table 12-1 System Messages (Continued)
Message
Description
Corrective Action
1R3DGV
The multifunction defib electrode pads
are not properly connected to the HeartStart XLT.
Check the pads cable connection.
3DGV&DEOH2II
The pads cable is not connected to the
defibrillator.
Check pads connector is locked in place.
3DGV2II
The pads are not making proper contact
with the patient.
Make sure the pads are properly applied
to the patient.
3DFHU)DLOXUH
The pacing system is not functioning.
Remove the device from active use and
call for service.
3DFHU2XWSXW/RZ
High patient impedance is resulting in the
pacer delivering less current to the patient
than specified in the output current setting.
Check the pads are applied properly.
6HUYLFH8QLW
Appears during a Shift/System Check.
May indicate that the Data Card is full.
OR
z Replace the Data Card.
z Perform a Shift/System Check
There is a system failure.
z If 6HUYLFH8QLW continues to appear, do
not use the device and call for service.
An internal error occurred.
If this occurs during actual use:
z Substitute another defib, if possible.
Remove this unit from clinical use and
call for service.
z If no other defib is available, turn
power off, then on. If unit turns on
normally, use for this one incident.
After this incident, remove from clinical use and call for service.
z If unit does not turn on normally, it
cannot be used.
If this occurs during routine testing:
Remove this unit from clinical use and
call for service.
6\VWHP)DLOXUH&\FOH3RZHU
M3500B HeartStart XLT Defibrillator/Monitor
12-3
12
System Messages
Table 12-1 System Messages (Continued)
Message
Description
Corrective Action
6S2&DEOH2II
The SpO2 cable is not connected to the
device.
Attach the SpO2 cable to the HeartStart
XLT.
632)DLOXUH
A failure has occurred in the SPO2
circuitry.
Remove the device from active use and
call for service.
6S2/LJKW,QWHUI
The level of ambient light is so high that
the sensor cannot obtain an SpO2 reading
or the sensor or cable is damaged.
z Cover the sensor with an opaque
material.
z Check the sensor for damage; try
another sensor.
6S21RQ3XOVDWLOH
The patient’s pulse is absent or too weak
to be detected.
z Check that the sensor is applied properly.
z Make sure the sensor site has a pulse.
z Relocate the sensor to a site with
improved circulation.
z Try another sensor.
6S2/RZ6LJQDO
SpO2 signal is too low to give an accurate
reading.
z Check the sensor is applied properly.
z Try another sensor type.
6S21RLV\6LJQDO
Excessive patient movement, electrical
interference, or optical interference is
present.
z Minimize patient movement or apply
the sensor to a site with less movement.
z Secure the sensor cable loosely to the
patient.
z Reduce sources of electrical or optical
interference.
6S26HQVRU)DLO
The SpO2 transducer is broken.
Try another sensor.
12-4
Troubleshooting
System Messages
Momentary Messages
Momentary messages are temporary and only appear on the display for a few
seconds. Each message is accompanied by a three second beep to alert you.
Table 12-2 lists momentary messages.
Table 12-2 Momentary Messages
Message
Possible Cause
Corrective Action
The multifunction defib electrode pads
are not making proper contact with the
patient.
z Check the pads are applied to the
patient, as directed on the pads’ package.
z Replace the pads if the prompt continues.
$WWDFK/HDGV
An attempt was made to begin pacing in
Demand Mode without ECG leads
attached to the patient.
Attach leads to patient.
'HILE'LVDUPHG
z The pads connection is compromised.
z The mode is changed from Manual to
AED while the defibrillator is
charged.
z 6+2&. is not pressed within 30 seconds of the defibrillator being
charged.
z ',6$50 is pressed.
z Check the pads are applied to the
patient properly.
z If a shock is indicated, deliver the
shock before changing modes.
z To deliver a shock, press 6+2&.
within 30 seconds of the defibrillator
being charged.
1R6KRFN'HOLYHUHG
Patient impedance is too high.
z Make sure the pads are applied properly.
z Replace the pads, if necessary
&KHFN3ULQWHU
Printer paper is absent or jammed; the
printer door is not closed properly.
z Reload printer paper.
z Make sure the door is closed properly.
$WWDFK3DGV
M3500B HeartStart XLT Defibrillator/Monitor
12-5
12
System Messages
Table 12-2 Momentary Messages (Continued)
Message
Possible Cause
Corrective Action
'DWD&DUG)XOO
z The incident is more than 2 hours in
duration, causing the Data Card to fill.
z An empty Data Card was not inserted
for the incident, causing the Data Card
to fill sooner.
z None. A new Data Card can not be
inserted during an incident.
z Use one Data Card per incident/
patient to decrease the chance of the
card filling.
'DWD&DUG,QWHUUXSWHG
The Data Card is removed during an incident.
z None. The Data Card can not be reinserted during an incident.
z Do not remove the Data Card during
an incident.
'DWD&DUG1RW,Q6HUYLFH
The Data Card is inserted while the HeartStart XLT is on.
None. A Data Card must be inserted prior
to turning the HeartStart XLT on for the
current patient.
,QFRPSDWLEOH'DWD&DUG
A Data Card other than the M3510A is
inserted.
Use only M3510A Data Cards.
1R'DWD&DUG3UHVHQW
A Data Card is not in the HeartStart XLT.
Turn the HeartStart XLT off and insert a
Data Card prior to the first event for the
patient.
.H\,QDFWLYH
The key pressed is currently inactive (i.e.
Use the appropriate mode for the key.
Sync
and
AED Mode).
6WRS3DFHU
12-6
Mode
Pacer
are inactive in
is pressed while pacing pulses
are being delivered.
Stop pacing before changing the pacing
mode.
Troubleshooting
Troubleshooting Tips
Troubleshooting Tips
Table 12-3 lists some situations that you may encounter, causes, and actions to
take.
Table 12-3 Troubleshooting Tips
Situation
Cause
Possible Solution
There is no power.
OR
z Insert a fully charged battery.
z Attach AC Power cord.
A corrupt Data Card may prevent the unit
from powering on.
OR
z Remove the Data Card
z Insert a new Data Card, if available
z Turn on the device
Hardware failure.
z Remove this unit from clinical use and
call for service.
The display is blank
except for
“SYSTEM FAILURE
CYCLE POWER”.
An internal error occurred.
If this occurs during actual use:
z Substitute another defib, if possible.
Remove this unit from clinical use and
call for service.
z If no other defib is available, turn
power off, then on. If unit turns on
normally, use for this one incident.
After this incident, remove from clinical use and call for service.
z If unit does not turn on normally, it
cannot be used.
If this occurs during routine testing:
z Remove this unit from clinical use and
call for service.
The HeartStart XLT
appears to be on but the
display is blank.
z The contrast needs adjusting.
z The display has overheated.
z Adjust the contrast.
z Avoid exposing the display to direct
sunlight on a hot day.
The HeartStart XLT
does not turn on.
M3500B HeartStart XLT Defibrillator/Monitor
12
12-7
Troubleshooting Tips
Table 12-3 Troubleshooting Tips (Continued)
Situation
Cause
Possible Solution
There is a dashed (----)
line on the display
instead of an ECG.
ECG data is not being acquired.
z Check the patient cable is connected.
z Check the pads or electrodes are properly applied.
z Check that the desired lead is selected.
The HeartStart XLT
does not appear to be
functioning properly.
z The battery is low.
z There is a system failure.
z Change the battery.
z Take the device out of use and call for
service.
The displayed time is
incorrect.
The time was not correctly set in the configuration.
Set the time in the General Settings menu
of the Configuration Mode.
The printed date is
incorrect.
The date was not correctly set in the configuration.
Set the time in the General Settings menu
of the Configuration Mode.
12-8
Troubleshooting
Calling for Service
Calling for Service
For telephone assistance, call the Response Center nearest to you, or visit our
website at:
www.medical.philips.com/cms and follow the link for service.
United States of America
Medical Response Center
Tel: (800) 548-8833
12
Latin America
Medical Response Center
Tel: 954-835-2600
Canada
Medical Response Center
M3500B HeartStart XLT Defibrillator/Monitor
Tel: 800-323-2280
12-9
Calling for Service
Other International Areas
Australia
Tel: 131147
France
Tel: 0803 35 34 33
Germany
Tel: 0180 5 47 50 00
Netherlands
Tel: 31 20 547 2555
Fax: 31 29 547 2949
Belgium (for Dutch)
Tel: 32 2 525 7102
Fax: 32 2 525 71 91
Spain
Tel: 34 902 30 40 50
Fax: 34 91 326 39 66
Austria
Tel: 43 1 60101 820
Switzerland
Tel: 0800 80 10 23
12-10
Italy
Tel: 800-825087
United Kingdom
Tel: 00 44 7002 432584
Belgium (for French)
Tel: 32 2 525 710 3
Fax: 32 2 525 71 91
Poland
Tel: 48 22 5710499
Finland
Tel: 09 6158 0400
Russia
Tel: 7 095 933 0339
Fax: 7 095 933 0338
Troubleshooting
13 Specifications & Safety
This section provides:
z
z
z
z
z
Specifications for the HeartStart XLT,
Symbol definitions for symbols appearing on the HeartStart XLT,
A clinical performance summary,
Safety related information, and
Electromagnetic compatibility information.
13
M3500B HeartStart XLT Defibrillator/Monitor
13-1
Specifications
Specifications
Defibrillator
Waveform: Biphasic Truncated Exponential. Waveform parameters adjusted
as a function of patient impedance.
Shock Delivery: Via multifunction defib electrode pads.
Charge Time: Less than 3 seconds to 200 Joules with a new, fully charged
M3516A SLA battery pack at 25oC. Less than 15 seconds to 200 Joules when
powered by a M3517A or M3518A power module with no battery installed.
Patient Impedance Range: 25 to 180 Ohm.
Manual Mode
Manual Output Energy (Delivered): 5, 10, 25, 50, 70, 100, 150, 200
Joules.
Controls: On/Energy Select, Off, Charge/Disarm, Shock, ECG Lead
Select, SpO2, HR Alarms, Manual Mode, Sync, Pacer, Pacer Start/Stop,
Pacer Rate, Pacer Current, Pacer Mode, Display Contrast, ECG Gain, Volume, Print Strip, Print Summary, Annotated Mark Event.
Indicators: LCD display for ECG waveform and text prompts, Audio
alerts, QRS Beeper, Charging Tone, Charge Done Tone, Manual Mode
LED, Sync LED, Pacer LED, Printer.
Armed Indicators: Charge done tone and available energy indicated on
display.
Energy Selection: Front Panel "1" key.
Charge Control: Front Panel "2" key.
Shock Control: Front Panel "3" key.
Synchronizer: SYNC message appears on the monitor and is annotated on
the printer (if printing while in Sync Mode). An audible beep sounds with
each detected R-wave, while a tick mark on the monitor and printed strip
indicate the discharge points. Synchronizer delay is less than 60 msec from
peak R-wave to peak current of the defibrillation discharge.
13-2
Specifications & Safety
Specifications
Defibrillator (cont.)
AED Mode
AED Energy Protocol: Fixed Energy (150 Joules).
AED Shock Series: 2, 3, or 4.
Shock Series Timer: off, 30, 60, 90, 120, 150, 180, or 210 seconds.
Text and Voice Prompts: Extensive text audible messages guide user
through protocol.
Protocol: Follows pre-configured settings. Can be configured to meet
American Heart Association and European Resuscitation Council guidelines.
AED Controls: On, Off, Pause/Resume, Analyze/Stop Analysis, Shock,
Lead Select, SpO2, HR Alarms, Display Contrast, ECG Gain, Volume,
Print Strip, Print Summary, Annotated Mark Event, Manual Mode Entry.
Indicators: LCD Display for ECG waveform and text prompts, Audio
Alerts, Voice Prompts, QRS Beeper, Charging Tone, Charge Done Tone,
Printer.
Armed Indicators: Charge Done Tone, Available Energy indicated on
display, Voice Message.
Patient Analysis: Per protocol, evaluates patient ECG and signal quality
to determine if a shock is appropriate and evaluates connection impedance
for proper defibrillation pad contact.
Shockable Rhythms: Ventricular fibrillation with amplitude > 100 uV
and wide complex ventricular tachycardia with rates greater than 150 bpm.
Sensitivity and Specificity: Meets AAMI guidelines.
M3500B HeartStart XLT Defibrillator/Monitor
13-3
13
Specifications
ECG Monitoring
Inputs: Single channel ECG may be viewed on display and printed. PADS
ECG is obtained through two multifunction defibrillation electrode pads.
Lead I, II, or III is obtained through the 3-lead ECG cable and separate monitoring electrodes. With a 5-lead cable, lead aVR, aVL, aVF, or V can also be
obtained.
Lead Fault: LEADS OFF message and dashed line appear on the monitor if a
lead electrode or wire becomes disconnected.
Pad Fault: PADS OFF message and dashed line appear on the monitor if a
pad becomes disconnected.
Heart Rate Display: Digital readout on display from 15 to 300 bpm, with an
accuracy of +_ 10%.
Heart Rate Alarms: Configurable pairs of low and high heart rate alarm limits: 30 to 100, 60 to 140, 90 to 160, and 120 to 200 bpm.
Defibrillation Patient Cable Length: 7 ft (2.13 m).
ECG Cable Length: 10 ft (3.05 m).
Common Mode Rejection: Greater than 90 dB measured per AAMI standards for cardiac monitors (EC 13).
ECG Size: 2.5, 5, 10, 20, 40 mm/mV.
Frequency Response:
AC Line Filter:
60 Hz/50Hz.
Pads ECG for Display:
Pads ECG for Printer:
Monitor (.15-40 Hz)/EMS (1-30 Hz).
Monitor (.15-40 Hz)/EMS (1-30 Hz).
Leads ECG for Display:
Leads ECG for Printer:
Monitor (.15-40 Hz)/EMS (1-30 Hz).
Diag (.05-150 Hz)/EMS (1-30 Hz)/
Monitor (.15-40 Hz).
Patient Isolation (defibrillation proof):
ECG: Type CF
SpO2: Type CF
Defib: Type BF (multi-function defib electrode pads)
13-4
Specifications & Safety
Specifications
Display
Display Size: 96 mm x 72 mm.
Display Type: Transflective active matrix LCD with LED backlight.
Display Resolution: 320 x 240 pixels.
Sweep Speed: 25 mm/s nominal (stationary trace; sweeping erase bar).
Viewing Time: 4 seconds.
Thermal Array Printer
Continuous Real Time Strip: User starts and stops the print strip. The Print
Strip prints the selected ECG lead with the following data:
HEADER 1: Date, Time, Heart Rate, the SpO2 Value (if available), and
the text "Delayed" if the recording has been configured for Delayed Mode.
Prints every 12 seconds.
HEADER 2: Current mode (AED/Manual) the current Lead, the current
Gain, filter setting, the text "Sync" if Sync has been enabled, and the Pacer
Settings (consisting of the Pacer Mode, Rate, and Current (if currently pacing the patient). Prints every 12 seconds, with Header 1.
HEADER 3: Changes in Mode, Gain, Lead, Sync, and Pacer Settings.
FOOTER: Drug Annotations, HR/SpO2 limits on a Limit Alarm, the
Results of an Analysis in AED Mode (No Shock Advised, Shock Advised,
or Cannot Analyze), Charging to xxxJ, Shock Delivered, No Shock Delivered, Disarm, Battery Low, Battery Critical.
SYMBOLS: Mark Triangle (for presses of the Mark key), an Alarm Bell
(Alarm Limit Violations), Lightening Bolt (Shock Delivered), Vertical
stripe Boundries/Pacer/Sync Tick Marks).
Event Printing: Mark Event key automatically documents events and ECG
during defibrillation episodes. The Mark Event key can annotate the event
with one of the following labels: Epinephrine, Atropine, Lidocaine, and
Other.
M3500B HeartStart XLT Defibrillator/Monitor
13-5
13
Specifications
Thermal Array Printer (cont.)
Auto Printing: The printer can be configured to automatically print on Mark,
Charge, Shock and Alarm.
Delayed Printing: The printer can be configured to run real time or with a six
second delay.
Reports: The following can be printed: Event Summary, Configuration,
Extended Self Test, System Log.
+
_
Speed: 25 mm/s with an accuracy of
Amplitude Accuracy:
+
_
10% or
+
_
5%.
50 uV, whichever is greater.
Paper Size: 50 mm by 30 m (100 ft).
Battery and Battery Power Module
Battery Type: 2 Ah, 12V, rechargeable, Sealed Lead Acid.
Battery Dimensions:
2.4" (H) x 0.94" (W) x 7.2" (D).
61.7 mm (H) x 23.9 mm(W) x 182 mm (D).
Weight: 1.4 lb (0.65 kg).
Charge Time:
Approximately 14.5 hours to 100%, indicated by LED on power module.
Approximately 2.5 hours to 90%, indicated by LED on power module.
Capacity: 2.7 hours ECG monitoring or 50 full-energy discharges or 2.1
hours ECG monitoring while pacing (with a new, fully charged battery and
temperature above 20oC).
Battery Indicators: LOW BATTERY message appears on monitor when at
least 10 minutes of monitoring time and 6 maximum-energy discharges
remain (with a new battery and temperature above 20oC).
Battery Storage: Should not be stored above 40oC for extended periods of
time.
Charger Output: Unit can be operated using Class I AC power module alone
with no battery installed.
13-6
Specifications & Safety
Specifications
Noninvasive Pacing
Waveform: Monophasic Truncated Exponential.
Current Pulse Amplitude: 10 mA to 200 mA (5 mA resolution); accuracy 10
mA - 50 mA +_ 5 mA, 50 mA - 200 mA +_ 10%.
Pulse Width: 20 ms with accuracy +0, -5 ms.
Rate: 30 ppm to 180 ppm (10 ppm increments); accuracy
+
_
1.5%.
Modes: Demand or Fixed Rate.
Refractory Period: 340 msec (40 to 80 ppm); 240 msec (90 to 180 ppm).
SpO2/Pulse Oximetry
Accuracy with:
M1191A sensor - 1 standard deviation 70% to 100%, +_ 2.5%.
M1192A sensor - 1 standard deviation 70% to 100%, +_ 2.5%.
M1194A sensor - 1 standard deviation 70% to 100%, +_ 4.0%.
NELLCOR sensors - 1 standard deviation 80% to 100% +_ 3.0%.
13
Resolution: 1%.
SpO2 Alarm Limits: Three preset low alarm limits: 90, 85, and 80%, default
is off.
INOP Alerts: Triggered by disconnected sensor, noisy signal, light interference or low signal (non-pulsatile).
M3500B HeartStart XLT Defibrillator/Monitor
13-7
Specifications
Event Storage
Internal Event Summary:
The internal Event Summary stores up to 300 events and up to 50 waveforms.
Events can be marked with a Mark Event symbol and, if configured for drug
annotation, the following labels can be added: Epinephrine, Atropine,
Lidocaine, or Other.
The Print Summary key on the front panel is used to print the internal Event
Summary.
Data Card Event Summary:
One Data Card can store approximately 2 hours of continuous ECG
waveforms and events.
General
Dimensions: 4.05" (H) x 11.25" (W) x 13.65" (D).
103 mm x 286 mm x 347 mm.
Weight: Standard Configuration weighs approximately 10 lbs (4.55 kg)
including battery, full roll of paper, defibrillator patient cable, 1 set of pads,
and without the carrying case.
13-8
Specifications & Safety
Specifications
Environmental
Temperature: 0o to 50oC operating, -20o to 70oC storage.
Thermal paper may darken above 55oC.
Charging the battery at temperatures above 35oC may degrade battery
life.
z Storing the battery for extended periods at temperatures above 40oC
will reduce battery capacity and degrade battery life.
z Operating and storage specifications for electrodes may vary. Refer to
the manufacturer’s specifications for details.
Humidity:
z
z
Up to 95% Relative Humidity
z
z
Printer paper may jam if paper is wet.
Thermal printer may be damaged if wet paper is allowed to dry while
in contact with printer elements.
Altitude:
13
Operating: up to 15,000 ft.
Shipping: up to 20,000 ft.
Shock (drops onto concrete): Unit survives 39" (1 m) drops onto all surfaces
(faces, corners, and edges) enclosed in carrying case. Exposed handle surfaces
survive 24" drops.
Vibration: Mil Std 810E 514.4 Category 6 Helicopter, General Storage,
UH60.
Water Resistance: IPX4, splash proof per IEC 60529, with Data Card door
closed.
EMC: Meets EN 60601-1-2. This ISM device complies with Canadian
ICES-001.
Other Considerations: Equipment not suitable for use in the presence of a
flammable anesthetic mixture with air, oxygen, or nitrous oxide.
Mode of Operation: Continuous.
M3500B HeartStart XLT Defibrillator/Monitor
13-9
Symbol Definitions
Symbol Definitions
The following table lists the meaning of each symbol shown on the HeartStart
XLT and the M3516A battery.
Table 13-1 Defibrillator and Battery Symbols
Symbol
Definition
On.
Off.
Shock hazard.
!
Attention - See operating instructions in user’s guide.
Power module input.
Input
13-10
Specifications & Safety
Symbol Definitions
Table 13-1 Defibrillator and Battery Symbols (Continued)
Symbol
Definition
Meets IEC type BF leakage current requirements and is defibrillator protected (Patient Applied Part is isolated and defib-proof suitable for direct patient contact except the heart or major arteries.)
Meets IEC type CF leakage current requirements and is defibrillator protected (Patient Applied Part is isolated and defib-proof suitable for direct patient contact including the heart and major
arteries).
Alarms are active.
Alarms are inactive.
Recyclable material.
13
Must be recycled or disposed of properly.
Unlock.
IPX4
M3500B HeartStart XLT Defibrillator/Monitor
Ingress of fluids classification; protected against splashing water.
13-11
Symbol Definitions
The following table lists the symbols that appear on the HeartStart XLT shipping carton.
Table 13-2 Shipping Carton Symbols
Symbol
Definition
Atmospheric pressure range.
Temperature range.
Relative humidity range.
Recyclable paper product.
Fragile.
Right side up.
Do not get wet.
13-12
Specifications & Safety
Symbol Definitions
Table 13-2 Shipping Carton Symbols (Continued)
Symbol
Definition
Shelf life.
Long-term storage conditions.
Short-term transport storage.
13
M3500B HeartStart XLT Defibrillator/Monitor
13-13
Clinical Performance Summary - Defibrillation
Clinical Performance Summary - Defibrillation
An international, multicenter, prospective, randomized, clinical study was
conducted to assess the effectiveness of the SMART Biphasic waveform in
out-of-hospital sudden cardiac arrests (SCAs), as compared to monophasic
waveforms. The primary objective of the study was to compare the percent of
patients with ventricular fibrillation (VF) as the initial monitored rhythm that
were defibrillated in the first series of three shocks or less.
This section summarizes the methods and results of this study.
Methods
Victims of out-of-hospital SCA were prospectively enrolled in four emergency medical service (EMS) systems. Responders used either 150J SMART
Biphasic AEDs or 200-360J monophasic waveform AEDs. A sequence of up
to three defibrillation shocks were delivered. For the biphasic AEDs, there
was a single energy output of 150J for all shocks. For monophasic AEDs, the
shock sequence was 200, 200, 360J. Defibrillation was defined as termination
of VF for at least five seconds, without regard to hemodynamic factors.
Results
Randomization to the use of monophasic or SMART Biphasic automatic
external defibrillators (AEDs) was done in 338 SCAs from four emergency
medical service systems. VF was observed as the first monitored rhythm in
115 patients. The biphasic and monophasic groups for these 115 patients were
similar in terms of age, sex, weight, primary structural heart disease, cause or
location of arrest, and bystanders witnessing the arrest or performing CPR.
The 150J SMART Biphasic waveform defibrillated 98% of VF patients in the
first series of three shocks or less, compared with 69% of patients treated with
monophasic waveform shocks. Outcomes are summarized in Table 13-3.
13-14
Specifications & Safety
Clinical Performance Summary - Defibrillation
Table 13-3 Clinical Summary - Defibrillation
Biphasic Patients
Number/(Percent)
Monophasic Patients
Number/(Percent)
P Value
(chi-square)
Defibrillation Efficacy
Single shock only
<2 shocks
<3 shocks
52/54 (96%)
52/54 (96%)
53/54 (98%)
36/61 (59%)
39/61 (64%)
42/61 (69%)
<0.0001
<0.0001
<0.0001
Patients Defibrillated
54/54 (100%)
49/58 (84%)
0.003
Return of Spontaneous
Circulation
41/54 (76%)
33/61 (54%)
0.01
Survival to Hospital
Admission
33/54 (61%)
31/61 (51%)
0.27
Survival to Hospital Discharge
15/54 (28%)
19/61 (31%)
0.69
CPC = 1 (Good)
13/15 (87%)
10/19 (53%)
0.04
13
Conclusion
The 150J SMART Biphasic waveform defibrillated at higher rates than 200360J monophasic waveforms, resulting in more patients achieving return of
spontaneous circulation (ROSC) (p=0.01). EMS system outcomes of survival
discharge were not significantly different statistically. However, patients
resuscitated with the lower energy SMART Biphasic waveform were more
likely to have good cerebral performance (CPC, cerebral performance category) (p=0.04).
M3500B HeartStart XLT Defibrillator/Monitor
13-15
Clinical Performance Summary - Cardioversion
Clinical Performance Summary - Cardioversion
An international, multicenter, prospective, double-blinded, randomized, clinical trial was conducted to assess the effectiveness of the SMART Biphasic
waveform in treatment of atrial fibrillation (AF), as compared to monophasic
waveforms. The primary objective of the study was to determine the required
energy for cardioversion of AF using the SMART Biphasic waveform, as
compared with a monophasic damped sine waveform.
This section summarizes the methods and results of this study.
Methods
Patients enrolled for this study were adults scheduled for elective cardioversion of AF at one of 11 clinical sites. Clinicians used both a defibrillator delivering the SMART Biphasic waveform, and one delivering a monophasic
waveform. A sequence of up to five shocks was administered: four with the
initial defibrillator, and a fifth cross-over shock was delivered with the other
defibrillator if necessary. The sequence of energy settings was 100J, 150J,
200J through the first three shocks on either type of defibrillator. A fourth
shock, if necessary, was delivered at 200J if the initial defibrillator was biphasic, and at 360J if the initial defibrillator was monophasic. The cross-over
shock was 360J monophasic if the initial defibrillator was biphasic, and 200J
biphasic if the initial defibrillator was monophasic. Successful cardioversion
was defined as the occurrence of two P waves uninterrupted by atrial fibrillation within 30 seconds of the shock.
Results
Randomization to the use of monophasic or SMART Biphasic defibrillators
was done in 212 elective cardioversions involving 210 patients at eleven clinical sites in the United States and Europe. Of these, 203 results met the protocol criteria for inclusion in this analysis. The biphasic and monophasic
groups were similar in terms of age, sex, weight, current medical history,
cause of heart disease, and estimated ejection fraction.
13-16
Specifications & Safety
Clinical Performance Summary - Cardioversion
The 150J SMART Biphasic waveform successfully converted far more
patients with an initial 100J shock (60% compared with 22% for the
monophasic waveform), and successfully converted patients at least as well
with a maximum energy of 200J as the monophasic did with its maximum
energy of 360J (91% compared to 85% for the monophasic waveform). Overall, the biphasic waveform required fewer shocks (1.7, compared to 2.8 for the
monophasic waveform) and lower delivered energy (217J, compared to 548J
for the monophasic waveform). Outcomes are summarized in , Table 13-4.
Table 13-4 Clinical Summary - Cardioversion
Biphasic Patients
Number (Percent)
Monophasic Patients
Number (Percent)
P Value
Cumulative
Cardioversion Efficacy
Single shock only
<2 shocks
<3 shocks
<4 shocks
58/96 (60%)
74/96 (77%)
86/96 (90%)
87/96 (91%)
24/107 (22%)
47/107 (44%)
57/107 (53%)
91/107 (85%)
<0.0001
<0.0001
<0.0001
.29
Skin “burn”
None
Mild
Moderate
Severe
25/90 (28%)
50/90 (56%)
15/90 (17%)
0/90 (0%)
15/105 (14%)
47/105 (45%)
41/105 (39%)
2/105 (2%)
1.7 + 1.0
2.8 + 1.2
<0.0001
217 + 176J
548 + 331J
<0.0001
Number of shocks
Cumulative delivered
energy
13
0.0001
Skin reaction definitions: (Evaluated 24 - 48 hours after procedure)
Mild - erythema, no tenderness
Moderate - erythema, tenderness
Severe - blistering or necrosis, tenderness
M3500B HeartStart XLT Defibrillator/Monitor
13-17
Clinical Performance Summary - Cardioversion
Conclusion
The SMART Biphasic waveform cardioverted at higher rates than the
monophasic damped sine waveform at each step of the protocol, although the
cumulative biphasic rate after 4 shocks was not significantly different from
the monophasic rate. Tissue damage was more pronounced in the monophasic
population.
13-18
Specifications & Safety
Safety Considerations
Safety Considerations
The following general warnings and cautions apply to use of the HeartStart
XLT. Additional warning and cautions specific to a particular feature are provided in the appropriate section.
WARNING
The HeartStart XLT is not intended to be deployed in settings or situations that promote use by untrained personnel. Operation by untrained personnel can result in
injury or death.
WARNING
Remain attentive to the patient during the delivery of therapy. Delay in delivering a
shock may result in a rhythm that was analyzed as shockable converting spontaneously to non-shockable and could result in inappropriate delivery of a shock.
WARNING
Use only the multifunction defib electrode pads, battery, and accessories listed in
“Supplies & Accessories” on page 11-18. Substitutions may cause the HeartStart
XLT to function improperly.
WARNING
Use multifunction defib electrode pads prior to their expiration date. Discard pads
after use. Do not reuse pads.
WARNING
In AED Mode, the multifunction defib electrode pads must be in the anterior-anterior
position as shown on the packaging. The HeartStart XLT was not designed to assess
data acquired from pads in an anterior-posterior position.
M3500B HeartStart XLT Defibrillator/Monitor
13-19
13
Safety Considerations
WARNING
Do not allow multifunction defib electrode pads to touch each other or to touch
other ECG monitoring electrodes, lead wires, dressings, etc. Contact with metal
objects may cause electrical arcing and patient skin burns during defibrillation and
may divert current away from the heart.
WARNING
During defibrillation, air pockets between the skin and multifunction defib electrode
pads may cause patient skin burns. To help prevent air pockets, make sure the pads
completely adhere to the skin. Do not use dried out pads; do not open pads package
until just prior to use.
WARNING
Never touch the patient or any equipment connected to the patient (including the
bed or gurney) during defibrillation.
WARNING
Do not operate the HeartStart XLT in standing water. When using the HeartStart XLT
in wet environments, make sure the Data Card door is securely shut.
WARNING
Do not immerse, or pour fluids on, any portion of the HeartStart XLT.
WARNING
Do not use the HeartStart XLT in a flammable or oxygen-rich atmosphere. This can
cause an explosion hazard.
WARNING
Avoid connecting the patient to several devices at once. Leakage current limits may
be exceeded. Do not use a second defibrillator on the patient while pacing with the
HeartStart XLT.
13-20
Specifications & Safety
Safety Considerations
WARNING
Avoid contact between the patient and conductive fluids and/or metal objects, such
as the gurney. Contact with metal objects could cause unintentional current pathways.
WARNING
Operating the HeartStart XLT or its accessories in conditions outside the environmental specifications can result in device or accessory malfunction.
WARNING
Avoid exposing the display to direct sunlight on a hot day. Overheating can occur and
cause the display to black out, making the HeartStart XLT temporarily unusable.
WARNING
Medical electrical equipment which does not incorporate defibrillator protection
should be disconnected during defibrillation.
WARNING
Electric shock hazards exist internally. Do not remove assembly screws. Refer servicing to qualified personnel.
CAUTION
This device has not been evaluated for use with electrosurgery equipment.
M3500B HeartStart XLT Defibrillator/Monitor
13-21
13
Electromagnetic Compatibility
Electromagnetic Compatibility
When using the M3500B defibrillator/monitor (with or without the M3517A
AC Charger), electromagnetic compatibility with surrounding devices should
be assessed.
A medical device can either generate or receive electromagnetic interference.
Testing for electromagnetic compatibility EMC) of the M3500B with and
without the appropriate accessories has been performed according to the international standard for EMC for medical devices (IEC 60601-1-2). This IEC
standard has been adopted in Europe as the European Norm (EN 60601-1-2).
The EMC standards describe tests for both emitted and received interference.
Emission tests deal with interference generated by the device being tested.
According to the EMC standards, the M3517A AC Power Module does not
generate interference.
WARNING
Radio frequency (RF) interference from nearby transmitting devices may degrade
performance of the HeartStart XLT defibrillator/monitor. Electromagnetic compatibility with surrounding devices should be assessed prior to using the defibrillator.
Reducing Electromagnetic Interference
The M3500B defibrillator/monitor and M3517A AC Charger are susceptible
to interference from other RF energy sources and continuous, repetitive,
power line bursts. Examples of other sources of RF interference are medical
devices, cellular products, information technology equipment and radio/television transmission. Should interference be encountered, as demonstrated by
artifact on the ECG or dramatic variations in SpO2 values, attempt to locate
the source. Assess:
z
z
z
z
13-22
Is the interference intermittent or constant?
Does the interference occur only in certain locations?
Does the interference occur only when in close proximity to certain
medical devices?
Does the SpO2 value change dramatically when the M3517A AC
Charger is unplugged?
Specifications & Safety
Electromagnetic Compatibility
Once the source is located, attempt to attenuate the EMC coupling path by
distancing the defibrillator from the source as much as possible. If assistance
is needed, call your local service representative.
Restrictions for Use
Artifact on the ECG caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will
negatively impact patient diagnosis or treatment.
Immunity Level
The EMC standards state that manufacturers of patient-coupled equipment
must specify immunity levels for their systems. It is recognized that the HeartStart XLT defibrillator/monitor is designed to receive and amplify low level
signals in the same bandwidth as the interference.
Immunity is defined in the standard as the ability of a system to perform without degradation in the presence of an electromagnetic disturbance. Degradation in ECG quality is a qualitative assessment which can be subjective.
Caution should, therefore, be taken in comparing immunity levels of different
devices. The criteria used for degradation is not specified by the standard and
may vary with the manufacturer.
NOTE
For additional information about compliance with the EMC standards, please
see the Philips Medical web site at http://www.medical.philips.com/cms and
follow the regulatory link.
M3500B HeartStart XLT Defibrillator/Monitor
13-23
13
Index
A
AC Power Module. See
Power modules
Accessories
arranging 10-6
checking 11-5
ordering 11-18, 13-19
AED Mode 3-1
configuring 3-4, 10-10
CPR 3-12
defibrillation process
3-6
display 2-5, 2-7
ECG monitoring 4-1
enabling from Manual
Mode 6-6
events recorded 9-3
Events Summary 9-2
indications for use 1-3
overview 1-1, 3-2, 3-3
pausing 3-12, 3-15
preparation 3-5
re-analysis 3-11
rhythm monitoring 314
specifications 13-3
SpO2 monitoring 5-1
training required 1-3
troubleshooting 3-18
Alarms
heart rate 4-6, 8-2
interruption of power
9-5
SpO2 monitoring 5-8
symbols 13-11
Analysis 3-8
AED Mode 3-8
re-analysis 3-11
settings 3-4
Artifact Detected message
3-18
Asynchronous
defibrillation 1-4
Asystole 1-5
pacing 1-5
Attach Pads message 12-5
Audiovisual controls 2-2,
2-3
Automatic Re-analysis 311
setting 3-4, 10-11
B
Batteries 1-2, 2-9
charging 11-8
checking 11-6
inserting and
removing 2-9
maintenance 11-8
operational checks 113
ordering 11-21
specifications 11-9,
13-6
storing and discarding
11-9
symbols 13-10
troubleshooting 12-2
See also Power supply
Battery Capacity Test 117
Battery charger 11-21
Bradycardia 1-5
i
Index
C
Cables
checking 11-5
cleaning 11-14
connecting 2-2, 3-6
ECG 10-4
Pads 3-6, 10-2
SpO2 5-6, 10-5
Cal Pulse 2-3
Carrying case
arranging accessories
in 10-6
cleaning 11-12
ordering 11-21
removing & replacing
11-15
Check Patient Timer
setting 10-11
Check Printer message
12-5
Cleaning
carrying case 11-12
HeartStart XLT 11-12
pads, electrodes &
cables 11-14
power modules 11-13
printer printhead 1113
Clinical Performance 1314, 13-16
ii
Configuration 10-7
accessing menu 10-7
AED Mode 3-4
Automatic Reanalysis 3-4
default 10-15
Device Initiated
Analysis 3-4
ECG filters 10-14
heart rate alarm 4-6
list of configurable
items 10-8
modifying 10-15
password 10-13
printing settings 10-16
Rhythm Monitoring 34, 3-14
saving and loading
from Data Card
10-16
Configuration Lost
message 12-2
Continued Use feature 95
Controls 2-2
CPR 3-12
D
Data Card 2-11
downloading and
erasing
information 9-1
inserting and
removing 2-12
ordering 11-20
saving and loading
settings 10-16
specifications 13-8
troubleshooting 12-2,
12-6
Date 10-9, 12-8
DC Power Module. See
Power modules
Default settings. See
Configuration
Defib Disarmed message
12-5
Defib electrode pads. See
Pads
Defibrillation 1-1
AED Mode 3-3, 3-6
defined 1-3
Manual Mode 6-4
pacing 8-6
Defibrillation controls 2-3
Defibrillator. See
HeartStart XLT
Index
Device Initiated Analysis
settings 3-4, 10-11
Display
AED Mode 2-7
controls 2-2
layout 2-5
Manual Mode 2-8
specifications 13-5
troubleshooting 12-8
E
ECG analysis. See
Analysis
ECG cables
cleaning 11-14
connecting 10-4
ordering 11-20
See also Cables
ECG electrodes. See
Electrodes
ECG Fault message 12-2
ECG Filter Settings 10-14
ECG monitoring 4-1
controls 2-3
electrodes 4-2, 10-10
events recorded 9-3
heart rate alarm 4-6
leads 4-5
settings 10-10, 10-12,
10-14
signal quality 4-8
size 4-7
specifications 13-4
synchronized
cardioversion 7-1
troubleshooting 4-7
Electrode pads. See Pads
Electrodes
applying 4-2
checking 11-3
cleaning 11-14
ordering 11-20
placing 3-5, 4-3
settings 10-10
Electromagnetic
compatibility (EMC)
13-22
Environmental
specifications 13-9
safety precautions 1320, 13-21
Erratic spiking 1-4
European 10-11
European Protocol 10-11
Event Review 2-11
Event Summary 9-1
events recorded 9-3
information included
9-6
interruption of power
9-5
marking events 9-2
printing 9-6, 9-8
specifications 13-8
F
Failure message 8-7
H
Heart rate alarm
disabling 4-7
events recorded 9-3
interruption of power
9-5
pacing 8-2
settings 4-6
specifications 13-4
See also ECG
monitoring
HeartStart Event Review
9-1
iii
Index
HeartStart XLT 1-1
assessment of 1-3
cleaning 11-12
configuring 10-7
controls 2-2
operational checks 113, 11-4
safety precautions 1320
specifications 13-2,
13-8
symbols 13-10
training materials 1-7
training required 1-3
troubleshooting 12-7
HR alarm. See Heart rate
alarm
Hypothermia
pacing 1-5
SpO2 monitoring 5-1
I
Incident number. See
Event Summary
Incident Timer 2-6
Incompatible Data Card
message 12-6
Indications for use
AED mode 1-3
Manual Mode 1-4
pacing 1-5
SpO2 monitoring 1-6
iv
INOP Alerts 13-7
K
Key Inactive message 318, 8-7, 12-6
L
Leads
formation 4-3
Lead Select setting
10-12
selecting 4-5, 7-1, 8-3
troubleshooting 4-7,
8-7, 12-2
Leads Off message 4-7, 87, 12-2
Loading
printer paper 11-10
settings from Data
Card 10-16
Low Battery message 122
M
Maintenance
batteries 11-8
carrying case 11-15
cleaning 11-12
operational checks 112
supplies and
accessories 11-18
Manual Mode 6-1
controls 2-2, 2-4
current charge 6-4
defibrillation process
6-4
delivering shock 6-5
display 2-5, 2-8
ECG monitoring 4-1
enabling 2-5, 6-2
energy setting 6-4
Events Summary 9-2
indications for use 1-4
overview 1-1
password 10-13
preparation 6-3
returning to AED
Mode 6-6
settings 10-10
specifications 13-2
SpO2 monitoring 5-1
training required 1-3
Marking events 9-2
See also Event
Summary
Messages
defined 2-7
list of 12-2
Momentary messages 2-7
list of 12-5
Monitoring. See ECG
monitoring
Index
Monitoring electrodes.
See Electrodes
Monitoring Rhythm. See
Rhythm Monitoring
Multifunction defib
electrode pads. See
Pads
N
Nellcor sensors 5-3
No Data Card Present
message 12-6
No Pads message 12-3
No Shock Advised Timer
3-17, 10-12
No Shock Delivered
message 3-18, 12-5
Non Pulsatile message 510, 5-11
Noninvasive
transcutaneous
pacing. See Pacing
O
Operational checks 11-2
Output Low message 8-7
Oxygen saturation. See
SpO2 monitoring
P
Pace Pulse Markers 10-10
Pacemakers
AED therapy 1-4
heart rate alarm 4-6
Pacing 8-1
defibrillation 8-6
defined 1-5, 8-1
demand v. fixed mode
8-2, 8-4, 8-6
ECG monitoring 8-2
events recorded 9-4
function buttons 2-5
indications for use 1-5
messages 12-3
preparation 8-3
procedure 8-4
selecting leads 8-3, 87
specifications 13-7
system messages 8-7
troubleshooting 8-5,
8-7, 12-6
Pads
applying 3-6, 13-19,
13-20
cleaning 11-14
ECG monitoring 4-1,
4-7
events recorded 9-3
safety precautions 1319
troubleshooting 3-18,
12-3, 12-5
Pads Cable Off message
3-18, 12-3
Pads cables
cleaning 11-14
connecting 10-2
See also Cables
Pads Off message 3-18, 47, 12-3
Paper. See Printer paper
Password 10-13
exiting 6-2
Patient information. See
Data Card
Pausing
AED Mode 3-12, 3-15
settings 10-12
Post 10-11
Post Shock CPR Timer 317, 10-11
v
Index
Power modules 2-9
cleaning 11-13
electromagnetic
compatibility 1322
ordering 11-21
specifications 13-2
Power supply
checking 11-6
events recorded 9-3
interruption of power
9-5
overview 2-9
specifications 13-2
troubleshooting 12-7
See also Batteries
vi
Precautions 13-19
asystole 1-5
batteries 11-9
defibrillation current
(shock) 3-10
ECG analysis 3-9
electrodes 4-2
electromagnetic
compatibility 1322
heart rate alarms 4-6,
8-2
pacemakers 1-4, 4-6
rhythm monitoring 314
safety symbols 13-10
sensors 5-5, 5-9
SpO2 alarm 5-8
SpO2 monitoring 5-1
Print strip
contents 13-5
controls 2-2
events recorded 9-4
settings 10-9
See also Event
Summary
Printer
checking 11-6
cleaning printhead 1113
specifications 13-5
Printer paper
loading 11-10
ordering 11-18
specifications 13-9
troubleshooting 12-5
Printing
controls 2-3
Event Summary 9-6
events automatically
9-8
settings 10-16
Pulse, checking 3-12, 510, 5-11
Pulse oximetry
defined 1-6, 5-1
described 5-2
specifications 13-7
See also SpO2
monitoring
Q
QRS beeper 4-6
adjusting 2-2
settings 10-10
troubleshooting 4-8
R
Radio frequency (RF)
interference 13-22
Re-analysis 3-4, 3-11
Recording events. See
Event Summary
Index
RF interference 13-22
Rhythm Monitoring 3-4,
3-14
AED Mode 3-8
configuring 3-14, 1011
events recorded 9-3
S
Safety precautions. See
Precautions
Saving settings to Data
Card 10-16
Security (password) 1013
Semi-Automatic External
Defibrillation. See
AED Mode
Sensors 5-3
applying 5-5
caring for 5-9
cleaning 11-14
ordering 11-20
selecting 5-3
troubleshooting 12-4
Service 12-9
Settings. See
Configuration
Shipping carton symbols
13-12
Shock
AED Mode 3-9
events recorded 9-3
settings 10-11
troubleshooting 3-18,
12-5
Shock Series Timer 10-11
Softkeys 2-3
See also Controls
Specifications
AED Mode 13-3
batteries 13-6
defibrillator 13-2
display 13-5
ECG monitoring 13-4
environmental 13-9
Event Summary 13-8
HeartStart XLT 13-8
Manual Mode 13-2
pacing 13-7
power supply 13-2
printer 13-5
SpO2 monitoring 13-7
SpO2 alarm 5-8
specifications 13-7
SpO2 cable
cleaning 11-14
connecting 10-5
ordering 11-20
SpO2 Light Interf
message 5-10
SpO2 monitoring 5-1
cable connection 5-6
controls 2-3
defined 1-6, 5-1
discontinuing 5-9
events recorded 9-4
inaccuracies 1-6
indications for use 1-6
noisy signal 5-10
procedure 5-7
process 5-2
sensors, applying 5-5
sensors, caring for 5-9,
11-14
settings 10-12
specifications 13-7
troubleshooting 5-10,
12-4
SpO2 Noisy Signal
message 5-10
SPO2 Non Pulsatile
message 12-4
Stop message 8-7
Stop Pacer message 12-6
Strip. See Print strip
Supplies
checking 11-5
ordering 11-18
Symbols, list of 13-10
Sync After Shock setting
10-13
vii
Index
Sync control 2-5
Synchronized
cardioversion 7-1
delivering shock 7-2
disabling Sync Mode
7-4
enabling 2-5
indications for use 1-4
preparation 7-2
selecting leads 7-1
synchronizer
specifications 132
System Failure Service
Unit message 12-3
System messages 2-7
list of 12-2
System tests. See
Maintenance
T
Telephone assistance 12-9
Thermal Array Printer.
See Printer
Time 10-9, 12-8
Training materials 1-7
Training required 1-3, 1319
viii
Troubleshooting 12-1
AED Mode 3-18
Data Card 12-6
display 12-7
ECG monitoring 4-7
pacing 8-5, 8-7, 12-3,
12-6
SpO2 monitoring 510, 12-4
time and date 12-8
U
User messages 2-7
V
Ventricular fibrillation
manual defibrillation
1-4
pacing 1-5
Ventricular tachycardia 14
W
Warnings. See
Precautions
Web site 12-9
M3500-91900
Edition 3
Copyright © 2002
Philips Electronics
North America Corporation
Printed in the U.S.A. October 2002
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