iPM 12/iPM 10/iPM 8 Patient Monitor Operator`s Manual

iPM 12/iPM 10/iPM 8 Patient Monitor Operator`s Manual
iPM 12/iPM 10/iPM 8
Patient Monitor
Operator’s Manual
© Copyright 2011 Shenzhen Mindray Bio-Medical Electronics Co., Ltd. All rights reserved.
For this Operator’s Manual, the issue date is December 2011.
WARNING
z
Federal Law (USA) restricts this device to sale by or on the order of a physician.
I
Intellectual Property Statement
SHENZHEN MINDRAY BIO-MEDICAL ELECTRONICS CO., LTD. (hereinafter called Mindray) owns the intellectual property
rights to this Mindray product and this manual. This manual may refer to information protected by copyrights or patents
and does not convey any license under the patent rights of Mindray, nor the rights of others.
Mindray intends to maintain the contents of this manual as confidential information. Disclosure of the information in
this manual in any manner whatsoever without the written permission of Mindray is strictly forbidden.
Release, amendment, reproduction, distribution, rental, adaption and translation of this manual in any manner
whatsoever without the written permission of Mindray is strictly forbidden.
,
, and
are the registered trademarks or trademarks owned by Mindray in China
and other countries. All other trademarks that appear in this manual are used only for editorial purposes without the
intention of improperly using them. They are the property of their respective owners.
Responsibility on the Manufacturer Party
Contents of this manual are subject to changes without prior notice.
All information contained in this manual is believed to be correct. Mindray shall not be liable for errors contained herein
nor for incidental or consequential damages in connection with the furnishing, performance, or use of this manual.
Mindray is responsible for the effects on safety, reliability and performance of this product, only if:
„
all installation operations, expansions, changes, modifications and repairs of this product are conducted by
Mindray authorized personnel;
„
the electrical installation of the relevant room complies with the applicable national and local requirements;
„
the product is used in accordance with the instructions for use.
WARNING
z
This equipment must be operated by skilled/trained clinical professionals.
z
It is important for the hospital or organization that employs this equipment to carry out a reasonable
service/maintenance plan. Neglect of this may result in machine breakdown or personal injury.
II
Warranty
THIS WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE.
Exemptions
Mindray's obligation or liability under this warranty does not include any transportation or other charges or liability for
direct, indirect or consequential damages or delay resulting from the improper use or application of the product or the
use of parts or accessories not approved by Mindray or repairs by people other than Mindray authorized personnel.
This warranty shall not extend to
„
Malfunction or damage caused by improper use or man-made failure.
„
Malfunction or damage caused by unstable or out-of-range power input.
„
Malfunction or damage caused by force majeure such as fire and earthquake.
„
Malfunction or damage caused by improper operation or repair by unqualified or unauthorized service people.
„
Malfunction of the instrument or part whose serial number is not legible enough.
„
Others not caused by instrument or part itself.
Company Contact
Manufacturer:
Address:
Shenzhen Mindray Bio-Medical Electronics Co., Ltd.
Mindray Building, Keji 12th Road South, High-tech industrial park,
Nanshan,Shenzhen 518057,P.R.China
Website:
www.mindray.com
E-mail Address:
[email protected]
Tel:
+86 755 81888998
Fax:
+86 755 26582680
EC-Representative:
Shanghai International Holding Corp. GmbH(Europe)
Address:
Eiffestraβe 80, 20537 Hamburg, Germany
Tel:
0049-40-2513175
Fax:
0049-40-255726
III
Preface
Manual Purpose
This manual contains the instructions necessary to operate the product safely and in accordance with its function and
intended use. Observance of this manual is a prerequisite for proper product performance and correct operation and
ensures patient and operator safety.
This manual is based on the maximum configuration and therefore some contents may not apply to your product. If you
have any question, please contact us.
This manual is an integral part of the product. It should always be kept close to the equipment so that it can be obtained
conveniently when needed.
Intended Audience
This manual is geared for clinical professionals who are expected to have a working knowledge of medical procedures,
practices and terminology as required for monitoring of critically ill patients.
Illustrations
All illustrations in this manual serve as examples only. They may not necessarily reflect the setup or data displayed on
your patient monitor.
Conventions
„
Italic text is used in this manual to quote the referenced chapters or sections.
„
[ ] is used to enclose screen texts.
„
ė is used to indicate operational procedures.
IV
Contents
1 Safety···································································································································································1-1
1.1 Safety Information ..................................................................................................................................................................................1-1
1.1.1 Dangers .......................................................................................................................................................................................1-2
1.1.2 Warnings .....................................................................................................................................................................................1-2
1.1.3 Cautions ......................................................................................................................................................................................1-3
1.1.4 Notes ............................................................................................................................................................................................1-3
1.2 Equipment Symbols ...............................................................................................................................................................................1-4
2 The Basics ····························································································································································2-1
2.1 Monitor Description ...............................................................................................................................................................................2-1
2.1.1 Intended Use .............................................................................................................................................................................2-1
2.2 Main Unit ....................................................................................................................................................................................................2-2
2.2.1 Front View...................................................................................................................................................................................2-2
2.2.2 Side View.....................................................................................................................................................................................2-4
2.2.3 Rear View.....................................................................................................................................................................................2-6
2.3 Modules ......................................................................................................................................................................................................2-8
2.4 Display Screen ..........................................................................................................................................................................................2-9
2.5 QuickKeys................................................................................................................................................................................................ 2-11
3 Basic Operations·················································································································································3-1
3.1 Installation .................................................................................................................................................................................................3-1
3.1.1 Unpacking and Checking .....................................................................................................................................................3-1
3.1.2 Environmental Requirements .............................................................................................................................................3-2
3.2 Getting Started.........................................................................................................................................................................................3-2
3.2.1 Turning Power On ....................................................................................................................................................................3-2
3.2.2 Starting Monitoring ................................................................................................................................................................3-2
3.3 Disconnecting from Power ..................................................................................................................................................................3-3
3.4 Using Keys..................................................................................................................................................................................................3-3
3.5 Using the Touchscreen ..........................................................................................................................................................................3-3
3.6 Setting the Screen...................................................................................................................................................................................3-4
3.7 Using the Main Menu.............................................................................................................................................................................3-5
3.8 Removing a Label Conflict ...................................................................................................................................................................3-5
3.9 Changing General Settings..................................................................................................................................................................3-5
3.9.1 Setting up a Monitor...............................................................................................................................................................3-6
3.9.2 Changing Language ...............................................................................................................................................................3-6
3.9.3 Adjusting the Screen Brightness........................................................................................................................................3-6
3.9.4 Showing/Hiding the Help.....................................................................................................................................................3-6
3.9.5 Setting the Date and Time....................................................................................................................................................3-6
3.9.6 Adjusting Volume ....................................................................................................................................................................3-7
3.10 Operating Modes..................................................................................................................................................................................3-7
3.10.1 Monitoring Mode ..................................................................................................................................................................3-7
3.10.2 Night Mode..............................................................................................................................................................................3-8
3.10.3 Privacy Mode...........................................................................................................................................................................3-8
3.10.4 Demo Mode.............................................................................................................................................................................3-9
3.10.5 Standby Mode ........................................................................................................................................................................3-9
4 Managing Patients ·············································································································································4-1
4.1 Admitting a Patient.................................................................................................................................................................................4-1
4.2 Quick Admitting a Patient ....................................................................................................................................................................4-2
4.3 Editing Patient Information .................................................................................................................................................................4-2
4.4 Discharging a Patient.............................................................................................................................................................................4-2
4.5 Transferring a Patient .............................................................................................................................................................................4-3
4.6 Connecting to a Central Monitoring System.................................................................................................................................4-4
1
5 Managing Configurations ··································································································································5-1
5.1 Introduction.............................................................................................................................................................................................. 5-1
5.2 Entering the [Manage Configuration] Menu................................................................................................................................. 5-2
5.3 Changing Department.......................................................................................................................................................................... 5-2
5.4 Setting Default Configuration............................................................................................................................................................ 5-3
5.5 Saving Current Settings ........................................................................................................................................................................ 5-3
5.6 Editing Configuration ............................................................................................................................................................................ 5-4
5.7 Deleting a Configuration...................................................................................................................................................................... 5-5
5.8 Transferring a Configuration ............................................................................................................................................................... 5-5
5.9 Loading a Configuration....................................................................................................................................................................... 5-5
5.10 Restoring the Latest Configuration Automatically................................................................................................................... 5-6
5.11 Modifying Password ............................................................................................................................................................................ 5-6
6 User Screens ························································································································································6-1
6.1 Tailoring Your Screens............................................................................................................................................................................ 6-1
6.1.1 Changing the Wave Line Size.............................................................................................................................................. 6-1
6.1.2 Changing Measurement Colors ......................................................................................................................................... 6-1
6.1.3 Changing Screen Layout....................................................................................................................................................... 6-1
6.2 Viewing Minitrends ................................................................................................................................................................................ 6-2
6.2.1 Having a Split-Screen View of Minitrends ...................................................................................................................... 6-2
6.2.2 Setting Minitrends .................................................................................................................................................................. 6-2
6.3 Viewing oxyCRG....................................................................................................................................................................................... 6-3
6.4 Viewing Other Patients ......................................................................................................................................................................... 6-4
6.4.1 Care Group................................................................................................................................................................................. 6-4
6.4.2 Viewing the Care Group Overview Bar ............................................................................................................................ 6-4
6.4.3 Understanding the View Other Patient Window.......................................................................................................... 6-5
6.5 Understanding the Big Numerics Screen ....................................................................................................................................... 6-6
7 Alarms··································································································································································7-1
7.1 Alarm Categories..................................................................................................................................................................................... 7-1
7.2 Alarm Levels.............................................................................................................................................................................................. 7-2
7.3 Alarm Indicators ...................................................................................................................................................................................... 7-2
7.3.1 Alarm Lamp ............................................................................................................................................................................... 7-2
7.3.2 Alarm Message ......................................................................................................................................................................... 7-2
7.3.3 Flashing Numeric..................................................................................................................................................................... 7-3
7.3.4 Audible Alarm Tones .............................................................................................................................................................. 7-3
7.3.5 Alarm Status Symbols ............................................................................................................................................................ 7-3
7.4 Alarm Tone Configuration.................................................................................................................................................................... 7-4
7.4.1 Setting the Minimum Alarm Volume ............................................................................................................................... 7-4
7.4.2 Changing the Alarm Volume............................................................................................................................................... 7-4
7.4.3 Setting the Interval between Alarm Sounds ................................................................................................................. 7-4
7.4.4 Changing the Alarm Tone Pattern..................................................................................................................................... 7-5
7.4.5 Setting the Reminder Tones ................................................................................................................................................ 7-5
7.5 Understanding the Alarm Setup Menu........................................................................................................................................... 7-6
7.5.1 Setting Alarm Properties for All Parameters.................................................................................................................. 7-6
7.5.2 Adjusting Alarm Limits Automatically ............................................................................................................................. 7-7
7.5.3 Setting Alarm Delay Time..................................................................................................................................................... 7-9
7.5.4 Setting Recording Length ..................................................................................................................................................7-10
7.5.5 Entering CPB Mode...............................................................................................................................................................7-10
7.6 Pausing Alarms ......................................................................................................................................................................................7-10
7.7 Switching Off All Alarms.....................................................................................................................................................................7-11
7.8 Silencing the Alarm Sound................................................................................................................................................................7-11
7.9 Latching Alarms.....................................................................................................................................................................................7-11
7.10 Silencing Technical Alarms..............................................................................................................................................................7-12
7.11 Testing Alarms......................................................................................................................................................................................7-12
7.12 When an Alarm Occurs .....................................................................................................................................................................7-12
7.13 Using Care Group Alarms ................................................................................................................................................................7-13
7.13.1 Care Group Auto Alarms...................................................................................................................................................7-13
7.13.2 Silencing Care Group Alarms..........................................................................................................................................7-13
8 Monitoring ECG···················································································································································8-1
2
8.1 Introduction ..............................................................................................................................................................................................8-1
8.2 Safety ...........................................................................................................................................................................................................8-1
8.3 Preparing to Monitor ECG ....................................................................................................................................................................8-2
8.3.1 Preparing the Patient and Placing the Electrodes .......................................................................................................8-2
8.3.2 Choosing AHA or IEC Lead Placement .............................................................................................................................8-2
8.3.3 ECG Lead Placements.............................................................................................................................................................8-2
8.3.4 Checking Paced Status...........................................................................................................................................................8-4
8.4 Understanding the ECG Display.........................................................................................................................................................8-4
8.5 Changing ECG Settings .........................................................................................................................................................................8-5
8.5.1 Accessing ECG Menus ............................................................................................................................................................8-5
8.5.2 Setting Pacemaker Rate (For Mortara only) ...................................................................................................................8-5
8.5.3 Choosing the Alarm Source .................................................................................................................................................8-5
8.5.4 Setting the ECG Lead Set ......................................................................................................................................................8-5
8.5.5 Choosing an ECG Display Screen .......................................................................................................................................8-6
8.5.6 Changing the ECG Filter Settings.......................................................................................................................................8-6
8.5.7 Switching the Notch Filter On or Off ................................................................................................................................8-6
8.5.8 Changing the Pacer Reject Settings..................................................................................................................................8-7
8.5.9 About the Defibrillator Synchronization.........................................................................................................................8-7
8.5.10 Changing ECG Wave Settings ...........................................................................................................................................8-7
8.5.11 Enabling Smart Lead Off.....................................................................................................................................................8-7
8.5.12 Setting the Alarm Level for ECG Lead Off Alarms......................................................................................................8-8
8.5.13 Adjusting QRS Volume ........................................................................................................................................................8-8
8.6 About ST Monitoring .............................................................................................................................................................................8-8
8.6.1 Switching ST On and Off .......................................................................................................................................................8-8
8.6.2 Changing ST Filter Settings ..................................................................................................................................................8-9
8.6.3 Understanding the ST Display.............................................................................................................................................8-9
8.6.4 Saving the Current ST Segment as Reference ............................................................................................................ 8-10
8.6.5 Changing the Reference Segment ................................................................................................................................. 8-10
8.6.6 Deleting a Reference Segment ........................................................................................................................................ 8-10
8.6.7 Recording the ST Segment................................................................................................................................................ 8-10
8.6.8 Changing the ST Alarm Limits.......................................................................................................................................... 8-10
8.6.9 Setting the ST Alarm Delay Time..................................................................................................................................... 8-11
8.6.10 Adjusting ST Measurement Points............................................................................................................................... 8-11
8.7 About Arrhythmia Monitoring ........................................................................................................................................................ 8-12
8.7.1 Understanding the Arrhythmia Events......................................................................................................................... 8-12
8.7.2 Changing Arrhythmia Alarm Settings........................................................................................................................... 8-14
8.7.3 Changing Arrhythmia Threshold Settings ................................................................................................................... 8-14
8.7.4 Setting the Extended Arrhythmia˄For Mindray Algorithm only˅.................................................................. 8-15
8.7.5 Reviewing Arrhythmia Events.......................................................................................................................................... 8-15
8.8 ECG Relearning...................................................................................................................................................................................... 8-16
8.8.1 Initiating an ECG Relearning Manually ......................................................................................................................... 8-16
8.8.2 Automatic ECG Relearning ................................................................................................................................................ 8-16
8.9 12-Lead ECG Monitoring (for iPM 12 and iPM 10 patient monitors only)........................................................................ 8-17
9 Monitoring Respiration (Resp) ··························································································································9-1
9.1 Introduction ..............................................................................................................................................................................................9-1
9.2 Safety Information ..................................................................................................................................................................................9-1
9.3 Understanding the Resp Display .......................................................................................................................................................9-1
9.4 Placing Resp Electrodes ........................................................................................................................................................................9-2
9.4.1 Optimizing Lead Placement for Resp ...............................................................................................................................9-2
9.4.2 Cardiac Overlay.........................................................................................................................................................................9-2
9.4.3 Abdominal Breathing .............................................................................................................................................................9-3
9.4.4 Lateral Chest Expansion ........................................................................................................................................................9-3
9.5 Choosing the Respiration Lead ..........................................................................................................................................................9-3
9.6 Changing the Apnea Alarm Delay.....................................................................................................................................................9-3
9.7 Changing Resp Detection Mode........................................................................................................................................................9-3
9.8 Changing Resp Wave Settings............................................................................................................................................................9-4
9.9 Setting RR Source ....................................................................................................................................................................................9-4
9.10 Setting alarm properties ....................................................................................................................................................................9-5
9.11 Switching Resp Measurement On/Off...........................................................................................................................................9-5
10 Monitoring PR·················································································································································10-1
3
10.1 Introduction..........................................................................................................................................................................................10-1
10.2 Setting the PR Source........................................................................................................................................................................10-1
10.3 Selecting the Active Alarm Source...............................................................................................................................................10-2
10.4 QRS Tone................................................................................................................................................................................................10-2
11 Monitoring SpO2 ·············································································································································11-1
11.1 Introduction..........................................................................................................................................................................................11-1
11.2 Safety ......................................................................................................................................................................................................11-2
11.3 Identifying SpO2 Modules ...............................................................................................................................................................11-2
11.4 Applying the Sensor ..........................................................................................................................................................................11-2
11.5 Changing SpO2 Settings...................................................................................................................................................................11-2
11.5.1 Accessing SpO2 Menus......................................................................................................................................................11-2
11.5.2 Adjusting the Desat Alarm ..............................................................................................................................................11-3
11.5.3 Setting SpO2 Sensitivity ....................................................................................................................................................11-3
11.5.4 Changing Averaging Time ...............................................................................................................................................11-3
11.5.5 Monitoring SpO2 and NIBP Simultaneously ..............................................................................................................11-3
11.5.6 Sat-Seconds Alarm Management .................................................................................................................................11-3
11.5.7 Changing the Speed of the Pleth Wave ......................................................................................................................11-5
11.5.8 Setting the Alarm Level for SpO2 Sensor Off Alarm................................................................................................11-5
11.5.9 Setting the SpO2 Tone Mode...........................................................................................................................................11-5
11.6 Measurement Limitations ...............................................................................................................................................................11-5
11.7 Masimo Information..........................................................................................................................................................................11-6
11.8 Nellcor Information............................................................................................................................................................................11-6
12 Monitoring NIBP ·············································································································································12-1
12.1 Introduction..........................................................................................................................................................................................12-1
12.2 Safety ......................................................................................................................................................................................................12-2
12.3 Measurement Limitations ...............................................................................................................................................................12-2
12.4 Measurement Methods....................................................................................................................................................................12-2
12.5 Setting Up the NIBP Measurement ..............................................................................................................................................12-3
12.5.1 Preparing to Measure NIBP..............................................................................................................................................12-3
12.5.2 Starting and Stopping Measurements........................................................................................................................12-3
12.5.3 Correcting the Measurement if Limb is not at Heart Level..................................................................................12-3
12.5.4 Enabling NIBP Auto Cycling and Setting the Interval............................................................................................12-3
12.5.5 Starting a STAT Measurement ........................................................................................................................................12-4
12.6 Understanding the NIBP Numerics ..............................................................................................................................................12-4
12.7 Changing NIBP Settings ...................................................................................................................................................................12-4
12.7.1 Setting the Initial Cuff Inflation Pressure....................................................................................................................12-4
12.7.2 Setting NIBP Alarm Properties .......................................................................................................................................12-5
12.7.3 Displaying NIBP List............................................................................................................................................................12-5
12.7.4 Setting the Pressure Unit .................................................................................................................................................12-5
12.8 Assisting Venous Puncture..............................................................................................................................................................12-5
12.9 NIBP Leakage Test...............................................................................................................................................................................12-6
12.10 NIBP Accuracy Test...........................................................................................................................................................................12-7
12.11 Calibrating NIBP................................................................................................................................................................................12-7
13 Monitoring Temp ············································································································································13-1
13.1 Introduction..........................................................................................................................................................................................13-1
13.2 Safety ......................................................................................................................................................................................................13-1
13.3 Making a Temp Measurement .......................................................................................................................................................13-1
13.4 Understanding the Temp Display.................................................................................................................................................13-1
13.5 Setting the Temperature Unit ........................................................................................................................................................13-2
14 Monitoring IBP················································································································································14-1
14.1 Introduction..........................................................................................................................................................................................14-1
14.2 Safety ......................................................................................................................................................................................................14-1
14.3 Zeroing the Transducer ....................................................................................................................................................................14-2
14.4 Setting Up the Pressure Measurement.......................................................................................................................................14-3
14.5 Understanding the IBP Display......................................................................................................................................................14-4
14.6 Changing IBP Settings ......................................................................................................................................................................14-4
4
14.6.1 Changing a Pressure for Monitoring ........................................................................................................................... 14-4
14.6.2 Setting Alarm Properties ................................................................................................................................................. 14-5
14.6.3 Changing Averaging Time .............................................................................................................................................. 14-5
14.6.4 Setting the Pressure Unit................................................................................................................................................. 14-5
14.6.5 Setting Up the IBP Wave .................................................................................................................................................. 14-5
14.7 Measuring PAWP ................................................................................................................................................................................ 14-6
14.7.1 Preparing to Measure PAWP........................................................................................................................................... 14-6
14.7.2 Setting Up the PAWP Measurement............................................................................................................................ 14-7
14.7.3 Understanding the PAWP Setup Menu ...................................................................................................................... 14-7
15 Monitoring Cardiac Output ···························································································································15-1
15.1 Introduction......................................................................................................................................................................................... 15-1
15.2 Understanding the C.O. Display ................................................................................................................................................... 15-1
15.3 Influencing Factors............................................................................................................................................................................ 15-2
15.4 Setting Up the C.O. Measurement ............................................................................................................................................... 15-2
15.5 Measuring the Blood Temperature.............................................................................................................................................. 15-5
15.6 Changing C.O. Settings .................................................................................................................................................................... 15-5
15.6.1 Setting the Temperature Unit ........................................................................................................................................ 15-5
15.6.2 Setting Alarm Properties ................................................................................................................................................. 15-5
16 Monitoring Carbon Dioxide···························································································································16-1
16.1 Introduction......................................................................................................................................................................................... 16-1
16.2 Measuring CO2 .................................................................................................................................................................................... 16-2
16.2.1 Making a Sidestream CO2 Measurement ................................................................................................................... 16-2
16.2.2 Making a Microstream CO2 Measurement ................................................................................................................ 16-3
16.2.3 Making a Mainstream CO2 Measurement.................................................................................................................. 16-3
16.3 Changing CO2 Settings .................................................................................................................................................................... 16-4
16.3.1 Accessing CO2 Menus ....................................................................................................................................................... 16-4
16.3.2 Entering the Standby Mode ........................................................................................................................................... 16-4
16.3.3 Setting the CO2 Unit .......................................................................................................................................................... 16-4
16.3.4 Setting up Gas Compensations..................................................................................................................................... 16-5
16.3.5 Setting up Humidity Compensation ........................................................................................................................... 16-5
16.3.6 Setting the Apnea Alarm Delay..................................................................................................................................... 16-6
16.3.7 Choosing a Time Interval for Peak-Picking................................................................................................................ 16-6
16.3.8 Setting the Flow Rate........................................................................................................................................................ 16-6
16.3.9 Setting up the CO2 Wave.................................................................................................................................................. 16-6
16.4 Setting RR Source............................................................................................................................................................................... 16-7
16.5 Setting Barometric Pressure Compensation............................................................................................................................ 16-7
16.6 Measurement Limitations............................................................................................................................................................... 16-7
16.7 Leakage test......................................................................................................................................................................................... 16-7
16.8 Troubleshooting the Sidestream CO2 Sampling System ..................................................................................................... 16-8
16.9 Removing Exhaust Gases from the System .............................................................................................................................. 16-8
16.10 Zeroing the Sensor.......................................................................................................................................................................... 16-8
16.10.1 For Sidestream and Microstream CO2 Modules .................................................................................................... 16-8
16.10.2 For Mainstream CO2 Modules...................................................................................................................................... 16-9
16.11 Calibrating the Sensor ................................................................................................................................................................... 16-9
16.12 Oridion Information......................................................................................................................................................................16-10
17 Monitoring AG ················································································································································17-1
17.1 Introduction......................................................................................................................................................................................... 17-1
17.2 Understanding the AG Display ..................................................................................................................................................... 17-2
17.3 MAC Values........................................................................................................................................................................................... 17-2
17.4 Preparing to Measure AG ................................................................................................................................................................ 17-3
17.5 Changing AG Settings...................................................................................................................................................................... 17-4
17.5.1 Setting Gas Unit .................................................................................................................................................................. 17-4
17.5.2 Setting the Apnea Alarm Delay..................................................................................................................................... 17-4
17.5.3 Changing the Sample Flow Rate .................................................................................................................................. 17-5
17.5.4 Setting up the O2 Compensation ................................................................................................................................. 17-5
17.5.5 Entering the Standby Mode ........................................................................................................................................... 17-5
17.5.6 Setting up the AG Wave ................................................................................................................................................... 17-5
17.5.7 Setting RR Source............................................................................................................................................................... 17-6
5
17.6 Changing the Anesthetic Agent ...................................................................................................................................................17-6
17.7 Measurement Limitations ...............................................................................................................................................................17-6
17.8 Troubleshooting..................................................................................................................................................................................17-6
17.8.1 When the Gas Inlet is Blocked ........................................................................................................................................17-6
17.8.2 When an Internal Occlusion Occurs .............................................................................................................................17-7
17.9 Removing Exhaust Gases from the System...............................................................................................................................17-7
18 Freezing Waveforms ·······································································································································18-1
18.1 Freezing Waveforms ..........................................................................................................................................................................18-1
18.2 Viewing Frozen Waveforms.............................................................................................................................................................18-1
18.3 Unfreezing Waveforms .....................................................................................................................................................................18-1
18.4 Recording Frozen Waveforms ........................................................................................................................................................18-2
19 Review ·····························································································································································19-1
19.1 Accessing Respective Review Windows .....................................................................................................................................19-1
19.2 Reviewing Graphic Trends...............................................................................................................................................................19-1
19.3 Reviewing Tabular Trends................................................................................................................................................................19-2
19.4 Events......................................................................................................................................................................................................19-3
19.4.1 Marking Events ....................................................................................................................................................................19-3
19.4.2 Reviewing Events ................................................................................................................................................................19-3
19.5 Reviewing Waveforms.......................................................................................................................................................................19-5
20 Calculations·····················································································································································20-1
20.1 Introduction..........................................................................................................................................................................................20-1
20.2 Dose Calculations ...............................................................................................................................................................................20-2
20.2.1 Performing Calculations ...................................................................................................................................................20-2
20.2.2 Selecting the Proper Drug Unit......................................................................................................................................20-2
20.2.3 Titration Table.......................................................................................................................................................................20-3
20.3 Oxygenation Calculations ...............................................................................................................................................................20-3
20.3.1 Performing Calculations ...................................................................................................................................................20-3
20.3.2 Entered Parameters............................................................................................................................................................20-4
20.3.3 Calculated Parameters ......................................................................................................................................................20-4
20.4 Ventilation Calculations....................................................................................................................................................................20-4
20.4.1 Performing Calculations ...................................................................................................................................................20-4
20.4.2 Entered Parameters............................................................................................................................................................20-5
20.4.3 Calculated Parameters ......................................................................................................................................................20-5
20.5 Hemodynamic Calculations............................................................................................................................................................20-6
20.5.1 Performing Calculations ...................................................................................................................................................20-6
20.5.2 Entered Parameters............................................................................................................................................................20-6
20.5.3 Calculated Parameters ......................................................................................................................................................20-6
20.6 Renal Calculations ..............................................................................................................................................................................20-7
20.6.1 Performing Calculations ...................................................................................................................................................20-7
20.6.2 Entered Parameters............................................................................................................................................................20-8
20.6.3 Calculated Parameters ......................................................................................................................................................20-8
20.7 Understanding the Review Window............................................................................................................................................20-8
21 Recording ························································································································································21-1
21.1 Using a Recorder.................................................................................................................................................................................21-1
21.2 Overview of Recording Types ........................................................................................................................................................21-1
21.3 Starting and Stopping Recordings...............................................................................................................................................21-2
21.4 Setting up the Recorder...................................................................................................................................................................21-3
21.4.1 Accessing the Record Setup Menu...............................................................................................................................21-3
21.4.2 Selecting Waveforms for Recording.............................................................................................................................21-3
21.4.3 Setting the Realtime Recording Length .....................................................................................................................21-3
21.4.4 Setting the Interval between Timed Recordings.....................................................................................................21-3
21.4.5 Changing the Recording Speed ....................................................................................................................................21-3
21.4.6 Clearing Recording Tasks .................................................................................................................................................21-3
21.5 Loading Paper......................................................................................................................................................................................21-3
21.6 Removing Paper Jam.........................................................................................................................................................................21-4
21.7 Cleaning the Recorder Printhead .................................................................................................................................................21-4
6
22 Printing····························································································································································22-1
22.1 Printer..................................................................................................................................................................................................... 22-1
22.2 Connecting a printer......................................................................................................................................................................... 22-1
22.3 Setting Up the Printer....................................................................................................................................................................... 22-2
22.4 Starting Report Printouts................................................................................................................................................................ 22-2
22.5 Stopping Reports Printouts............................................................................................................................................................ 22-3
22.6 Setting Up Reports ............................................................................................................................................................................ 22-3
22.6.1 Setting Up ECG Reports ................................................................................................................................................... 22-3
22.6.2 Setting Up Tabular Trends Reports .............................................................................................................................. 22-3
22.6.3 Setting Up Graphic Trends Reports ............................................................................................................................. 22-4
22.6.4 Setting Up Realtime Reports.......................................................................................................................................... 22-4
22.7 End Case Reports ............................................................................................................................................................................... 22-4
22.8 Printer Statuses................................................................................................................................................................................... 22-4
22.8.1 Printer Out of Paper........................................................................................................................................................... 22-4
22.8.2 Printer Status Messages ................................................................................................................................................... 22-4
23 Other Functions··············································································································································23-1
23.1 Analog Output .................................................................................................................................................................................... 23-1
23.2 Transferring Data................................................................................................................................................................................ 23-1
23.2.1 Data Export System ........................................................................................................................................................... 23-1
23.2.2 Transferring Data by Different Means ......................................................................................................................... 23-1
23.3 Nurse Call .............................................................................................................................................................................................. 23-2
23.4 Network Connection ........................................................................................................................................................................ 23-3
23.4.1 Setting the Network Type................................................................................................................................................ 23-3
23.4.2 Wireless Network ................................................................................................................................................................ 23-3
23.4.3 Setting the IP Address, Subnet Mask and Gateway ............................................................................................... 23-4
24 Batteries ··························································································································································24-1
24.1 Overview ............................................................................................................................................................................................... 24-1
Replacing a Battery .................................................................................................................................................................................. 24-2
24.2 ................................................................................................................................................................................................................... 24-2
24.3 Battery Guidelines ............................................................................................................................................................................. 24-3
24.4 Battery Maintenance ........................................................................................................................................................................ 24-3
24.5 Battery Recycling ............................................................................................................................................................................... 24-4
25 Care and Cleaning ··········································································································································25-1
25.1 General Points ..................................................................................................................................................................................... 25-1
25.2 Cleaning ................................................................................................................................................................................................ 25-2
25.3 Disinfecting .......................................................................................................................................................................................... 25-2
26 Maintenance ···················································································································································26-1
26.1 Safety Checks....................................................................................................................................................................................... 26-1
26.2 Checking Monitor and Module Information............................................................................................................................ 26-2
26.3 Calibrating ECG................................................................................................................................................................................... 26-2
26.4 Calibrating the Touchscreen .......................................................................................................................................................... 26-2
26.5 Calibrating CO2.................................................................................................................................................................................... 26-2
26.6 Calibrating AG ..................................................................................................................................................................................... 26-3
27 Accessories······················································································································································27-1
27.1 ECG Accessories.................................................................................................................................................................................. 27-1
27.2 SpO2 Accessories ................................................................................................................................................................................ 27-3
27.3 NIBP Accessories................................................................................................................................................................................. 27-4
27.4 Temp Accessories............................................................................................................................................................................... 27-5
27.5 IBP/ICP Accessories ........................................................................................................................................................................... 27-6
27.6 C.O. Accessories .................................................................................................................................................................................. 27-7
27.7 CO2 Accessories .................................................................................................................................................................................. 27-7
27.8 AG Accessories .................................................................................................................................................................................... 27-9
27.9 Others..................................................................................................................................................................................................... 27-9
A Product Specifications······································································································································ A-1
7
A.1 Monitor Safety Specifications ............................................................................................................................................................A-1
A.2 Power Supply Specifications ..............................................................................................................................................................A-2
A.3 Physical Specifications..........................................................................................................................................................................A-3
A.4 Hardware Specifications ......................................................................................................................................................................A-3
A.5 Data Storage.............................................................................................................................................................................................A-5
A.6 Wireless Network ....................................................................................................................................................................................A-5
A.7 Measurement Specifications................................................................................................................................................................A-5
B EMC And Radio Regulatory Compliance·········································································································· B-1
B.1 EMC ..............................................................................................................................................................................................................B-1
B.2 Radio Regulatory Compliance............................................................................................................................................................B-5
C Default Configurations ····································································································································· C-1
C.1 Parameters Configuration ...................................................................................................................................................................C-1
C.2 Routine Configuration ....................................................................................................................................................................... C-12
C.3 User Maintenance Items ................................................................................................................................................................... C-15
D Alarm Messages ················································································································································ D-1
D.1 Physiological Alarm Messages.......................................................................................................................................................... D-1
D.2 Technical Alarm Messages.................................................................................................................................................................. D-2
E Symbols and Abbreviations·······························································································································E-1
E.1 Symbols ...................................................................................................................................................................................................... E-1
E.2 Abbreviations ............................................................................................................................................................................................ E-2
8
1 Safety
1.1 Safety Information
DANGER
z
Indicates an imminent hazard that, if not avoided, will result in death or serious injury.
WARNING
z
Indicates a potential hazard or unsafe practice that, if not avoided, could result in death or serious injury.
CAUTION
z
Indicates a potential hazard or unsafe practice that, if not avoided, could result in minor personal injury or
product/property damage.
NOTE
z
Provides application tips or other useful information to ensure that you get the most from your product.
1-1
1.1.1 Dangers
There are no dangers that refer to the product in general. Specific “Danger” statements may be given in the respective
sections of this manual.
1.1.2 Warnings
WARNING
z
This equipment is used for single patient at a time.
z
Before putting the system into operation, the operator must verify that the equipment, connecting cables
and accessories are in correct working order and operating condition.
z
The equipment must be connected to a properly installed power outlet with protective earth contacts
only. If the installation does not provide for a protective earth conductor, disconnect it from the power line
and operate it on battery power, if possible.
z
To avoid explosion hazard, do not use the equipment in the presence of flammable anesthetics, vapors or
liquids.
z
Do not open the equipment housings. All servicing and future upgrades must be carried out by the
personnel trained and authorized by our company only.
z
Do not come into contact with patients during defibrillation. Otherwise serious injury or death could
result.
z
Do not touch the equipment’s metal parts or connectors when in contact with the patient; otherwise
patient injury may result.
z
Verify that the DC power supply meets the requirements specified in A.2 Power Source Specifications.
z
Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume
to a low level or off may result in a hazard to the patient. Remember that alarm settings should be
customized according to different patient situations and always keeping the patient under close
surveillance is the most reliable way for safe patient monitoring.
z
The physiological data and alarm messages displayed on the equipment are for reference only and cannot
be directly used for diagnostic interpretation.
z
To avoid inadvertent disconnection, route all cables in a way to prevent a stumbling hazard. Wrap and
secure excess cabling to reduce risk of entanglement or strangulation by patients or personnel.
z
Dispose of the package material, observing the applicable waste control regulations and keeping it out of
children’s reach.
z
Ensure that the patient monitor is supplied with continuous electric power during work. Sudden power
failure leads to the loss of patient data.
1-2
1.1.3 Cautions
CAUTION
z
To ensure patient safety, use only parts and accessories specified in this manual.
z
At the end of its service life, the equipment, as well as its accessories, must be disposed of in compliance
with the guidelines regulating the disposal of such products. If you have any questions concerning
disposal of the equipment, please contact us.
z
Magnetic and electrical fields are capable of interfering with the proper performance of the equipment.
For this reason make sure that all external devices operated in the vicinity of the equipment comply with
the relevant EMC requirements. Mobile phone, X-ray equipment or MRI devices are a possible source of
interference as they may emit higher levels of electromagnetic radiation.
z
Before connecting the equipment to the power line, check that the voltage and frequency ratings of the
power line are the same as those indicated on the equipment’s label or in this manual.
z
Always install or carry the equipment properly to avoid damage caused by drop, impact, strong vibration
or other mechanical force.
z
Dry the equipment immediately in case of rain or water spray.
1.1.4 Notes
NOTE
z
Put the equipment in a location where you can easily see the screen and access the operating controls.
z
Keep this manual in the vicinity of the equipment so that it can be obtained conveniently when needed.
z
The software was developed in compliance with IEC60601-1-4. The possibility of hazards arising from
software errors is minimized.
z
This manual describes all features and options. Your equipment may not have all of them.
1-3
1.2 Equipment Symbols
Attention: Consult accompanying documents (this manual).
Power ON/OFF (for a part of the
Battery indicator
equipment)
Alternating current (AC)
Alarms paused
Alarm silenced
Record
Freeze/unfreeze waveforms
Main menu
NIBP start/stop key
Inserted direction
Alternating/Direct current
Direct current˄DC˅
Equipotential grounding
VGA output
USB connector
Network connector
Gas outlet
Multifunctional output
Manufacture date
Serial number
The product bears CE mark indicating its conformity with the provisions of the Council Directive
93/42/EEC concerning medical devices and fulfils the essential requirements of Annex I of this
directive.
European community representative
ESD warning symbol for electrostatic sensitive devices.
Type CF applied part. Defibrillator-proof protection against electric shock.
Type BF applied part. Defibrillator-proof protection against electric shock.
Dispose of in accordance to your country’s requirements.
NOTE
z
Some symbols may not appear on your equipment.
1-4
2 The Basics
2.1 Monitor Description
2.1.1 Intended Use
This patient monitor is intended to be used for monitoring, displaying, reviewing, storing and transferring of multiple
physiological parameters including ECG, heart rate (HR), respiration (Resp), temperature (Temp), SpO2, pulse rate (PR),
non-invasive blood pressure (NIBP), invasive blood pressure (IBP), cardiac output (C.O.), carbon dioxide (CO2), oxygen
(O2), and anesthetic gas (AG).
This patient monitor is intended for use only by clinical professionals or under their guidance. It must only be used by
persons who have received adequate training in its use. Anyone unauthorized or untrained must not perform any
operation on it.
The monitor can be used in pre-hospital and hospital environments, including but not limited to, ICU, general ward,
outpatient department, emergency room, operating room, recovery room and preoperative observation ward, and
etc.
2-1
2.2 Main Unit
2.2.1 Front View
1
2
3
4
6
5
7
8
10
9
2-2
11
12
1.
Alarm lamp
When a physiological alarm or technical alarm occurs, this lamp will flash as defined below.
‹
High level alarms:
the lamp quickly flashes red.
‹
Medium level alarms:
the lamp slowly flashes yellow.
‹
Low level alarms:
the lamp lights yellow without flashing.
2.
Display Screen
3.
AC power LED˄iPM 12/iPM 10˅
AC/DC power LED˄iPM 8˅
4.
Power On/Off Switch
‹
Pressing this switch turns the patient monitor on.
‹
When the monitor is on, pressing and holding this switch turns the monitor off.
An indicator is built in this switch. It turns on when the patient monitor is on and turns off when the patient
monitor is off.
5.
Battery LED
‹
On:
when the battery is installed and the AC source is connected.
‹
Off:
when no battery is installed or the installed battery is malfunction, or no AC source is
connected when the patient monitor is power off.
‹
Flash: when the patient monitor operates on battery power.
6.
Press to silence all alarm sounds.
7.
Press to pause or restore alarms.
8.
Press to freeze or unfreeze waveforms.
9.
Press to start or stop recordings.
10.
Press to start or stop NIBP measurements.
11.
If no menu is displayed on the screen, pressing it will enter the main menu. If there is a menu displayed on the
screen, pressing it will close that menu.
12. Knob
Rotate the Knob clockwise or anti-clockwise. With each click, the highlight jumps to the neighboring item. When
you reach your desired item, press the Knob to select it.
2-3
2.2.2 Side View
2.2.2.1 iPM 12
1
1
4
3
2
7
5
8
6
9
10
1.
Handle
2.
Battery compartment
3.
Recorder
4.
Parameter module slot
5.
Connector for Temp probe 1
6.
Connector for Temp probe 2
7
Connector for IBP cable
8.
Connector for SpO2 cable
9.
Connector for ECG cable
10.
Connector for NIBP cuff
2-4
2.2.2.2 iPM 10/iPM 8
1
1
4
3
2
7
5
8
6
9
1.
Handle
2.
Battery compartment
3.
Recorder
4.
Parameter module slot
5.
Connector for Temp probe 1
6.
Connector for Temp probe 2
7.
Connector for SpO2 cable
8
Connector for ECG cable
9ˊ Connector for NIBP cuff
2-5
2.2.3 Rear View
2.2.3.1 iPM 12/iPM 10
3
1
3
2
2
4
6
5
1.
AC Power Input
2.
Equipotential Grounding Terminal
1
7
When the patient monitor and other devices are to be used together, their equipotential grounding terminals
should be connected together, eliminating the potential difference between them.
3.
Parameter Module Slot
Used for connecting the parameter modules.
4.
USB Connectors
It connects a USB disk for data or configuration transfer.
5.
Multifunctional Connector
It outputs defibrillator synchronization signals, nurse call signals and analogy output signals.
6.
Network Connector
It is a standard RJ45 connector which connects the patient monitor to CMS or other patient monitor for remote
view. It also connects the patient monitor to PC for system upgrade.
2-6
7.
VGA Connector
It connects a secondary display, which extends the display capability of your monitor. The contents displayed on
the secondary display screen accords with those displayed on the monitor screen.
2.2.3.2 iPM 8
3
1
2
5
6
7
8
4
1.
Equipotential Grounding Terminal
When the patient monitor and other devices are to be used together, their equipotential grounding terminals
should be connected together, eliminating the potential difference between them.
2.AC Power Input
3.
Parameter Module Slot
Used for connecting the parameter modules.
4.
Multifunctional Connector
It outputs defibrillator synchronization signals, nurse call signals and analogy output signals.
5.
DC Power Input
It is a standard DC power input connector with positive inside and negative outside. It can be connected to the
external DC power supply.
2-7
6.
USB Connectors
It connects a USB disk for data or configuration transfer.
7.
Network Connector
It is a standard RJ45 connector which connects the patient monitor to CMS or other patient monitor for remote
view. It also connects the patient monitor to PC for system upgrade.
8.
VGA Connector
It connects a secondary display, which extends the display capability of your monitor. The contents displayed on
the secondary display screen accords with those displayed on the monitor screen.
2.3 Modules
1
2
1.
IBP+C.O. Module:
2.
IBP+C.O. + Sidestream CO2 Module:
3.
IBP+C.O. + Microstream CO2 Module:
4.
IBP+C.O.+ Mainstream CO2 Module:
5.
IBP+C.O.+AG Module:
3
4
5
Contains IBP cable connector and C.O. cable connector.
Contains IBP cable connector, C.O. cable connector, CO2
watertrap slot, and CO2 gas outlet.
Contains IBP cable connector, C.O. cable connector, CO2
sampling line connector, and and CO2 gas outlet.
Contains IBP cable connector, C.O. cable connector, and CO2
transducer connector.
Contains IBP cable connector, C.O. cable connector, AG
watertrap slot, and AG gas outlet.
NOTE
z
The above modules support 2 invasive blood pressures through a dual-receptacle extended cable.
2-8
2.4 Display Screen
This patient monitor adopts a high-resolution LED display to display patient parameters and waveforms. A typical
display screen is shown below.
1
2
3
4
6
5
7
9
8
1.
Patient Information Area
This area shows the patient information such as department, bed number, patient name, patient category and
paced status.
‹
‹
:
indicates that no patient is admitted or the patient information is incomplete.
:
indicates that the patient has a pacer.
If no patient is admitted, selecting this area will enter the [Patient Setup] menu. If a patient has been admitted,
selecting this area will enter the [Patient Demographics] menu.
2.
Alarm Symbols
‹
indicates alarms are paused.
‹
indicates alarm sounds are paused.
‹
indicates alarm sounds are turned off.
‹
indicates the system is in alarm off status.
2-9
3.
Technical Alarm Area
This area shows technical alarm messages and prompt messages. When multiple messages come, they will be
displayed circularly. Select this area and the technical alarm list will be displayed.
4.
Physiological Alarm Area
This area shows physiological alarm messages. When multiple alarms occur, they will be displayed circularly.
Select this area and the physiological alarm list will be displayed.
5.
Waveform Area
This area shows measurement waveforms. The waveform name is displayed at the left upper corner of the
waveform. Select this area and the corresponding measurement setup menu will be displayed.
6.
Parameter Area A
This area shows measurement parameters. Each monitored parameter has a parameter window and the
parameter name is displayed at the upper left corner. The corresponding waveform of each parameter is
displayed in the same row in the waveform area. Select this area and the corresponding measurement setup
menu will be displayed.
7.
Parameter Area B
For the parameters displayed in this area, their corresponding waveforms are not displayed.
8.
Prompt Message Area
This area shows the prompt messages, network status icons, battery status icons, date and time, etc. For details
about battery status symbols, refer to the chapter 24 Batteries.
‹
indicates patient monitor is connected to a wired network successfully.
‹
indicates the patient monitor has failed to connect a wired network.
‹
indicates the wireless function is working.
‹
indicates the wireless function is not working.
‹
9.
indicates a USB disk is inserted.
QuickKeys Area
This area contains QuickKeys that give you fast access to functions.
2-10
2.5 QuickKeys
A QuickKey is a configurable graphical key, located at the bottom of the main screen. They give you fast access to
functions. Their availability and the order in which they appear on your screen, depend on how your patient monitor
is configured.
The following QuickKeys can be displayed on the screen:
Display more QuickKeys.
Hide the QuickKeys.
Enter the main menu
Enter standby mode
Change alarm settings
Review the patient’s data
Enter the NIBP measurement menu
Stop all NIBP measurement
Zero IBP
Start the realtime print
Print Setup
Silence all alarm sounds
Pause or restore alarms
Change screen
Enter the patient setup menu
Trigger a manual event
Have a split-screen view of minitrends
Enter the volume setup menu
Default configurations
2-11
Start cardiac output procedure (not available in USA)
Perform calculations
Have a split-screen view of another patient’s conditions
Have a split-screen view of oxyCRG trends
Enter the interpretation of resting 12-lead ECG screen (not available in USA)
Enter the full-screen 7-lead ECG screen
Enter the [Parameters] menu
Start NIBP STAT measurement
Enter the PAWP measurement screen
Enter the CPB mode
Enter the privacy mode
Enter the night mode
You can also select your desired QuickKeys to display on the screen.
1.
Select [Main Menu]ė[Maintenance >>]ė[Manage Configuration >>]ėenter the required
passwordė[Ok].
2.
In the [Manage Configuration] menu, select [Edit Config.>>].
3.
In the pop-up menu, select the desired configuration and then select [Edit].
4.
In the pop-up menu, select [Screen Setup >>].
5.
In the [Select QuickKeys] screen, select your desired QuickKeys and the order of them.
2-12
3 Basic Operations
3.1 Installation
WARNING
z
The equipment shall be installed by personnel authorized by us.
z
The software copyright of the equipment is solely owned by us. No organization or individual shall resort
to juggling, copying, or exchanging it or to any other infringement on it in any form or by any means
without due permission.
z
Devices connected to the equipment must meet the requirements of the applicable IEC standards (e.g. IEC
60950 safety standards for information technology equipment and IEC 60601-1 safety standards for
medical electrical equipment). The system configuration must meet the requirements of the IEC 60601-1-1
medical electrical systems standard. Any personnel who connect devices to the equipment’s signal
input/output port is responsible for providing evidence that the safety certification of the devices has
been performed in accordance to the IEC 60601-1-1. If you have any question, please contact us.
z
If it is not evident from the equipment specifications whether a particular combination with other devices
is hazardous, for example, due to summation of leakage currents, please consult the manufacturers or else
an expert in the field, to ensure the necessary safety of patients and all devices concerned will not be
impaired by the proposed combination.
3.1.1 Unpacking and Checking
Before unpacking, examine the packing case carefully for signs of damage. If any damage is detected, contact the
carrier or us.
If the packing case is intact, open the package and remove the equipment and accessories carefully. Check all
materials against the packing list and check for any mechanical damage. Contact us in case of any problem.
NOTE
z
Save the packing case and packaging material as they can be used if the equipment must be reshipped.
WARNING
z
When disposing of the packaging material, be sure to observe the applicable waste control regulations
and keep it out of children’s reach.
z
The equipment might be contaminated during storage and transport. Before use, please verify whether
the packages are intact, especially the packages of single use accessories. In case of any damage, do not
apply it to patients.
3-1
3.1.2 Environmental Requirements
The operating environment of the equipment must meet the requirements specified in this manual.
The environment where the equipment is used shall be reasonably free from noises, vibration, dust, corrosive,
flammable and explosive substances. If the equipment is installed in a cabinet, sufficient space in front and behind
shall be left for convenient operation, maintenance and repair. Moreover, to maintain good ventilation, the equipment
shall be at least 2 inches (5cm) away from around the cabinet.
When the equipment is moved from one place to another, condensation may occur as a result of temperature or
humidity difference. In this case, never start the system before the condensation disappears.
WARNING
z
Make sure that the operating environment of the equipment meets the specific requirements. Otherwise
unexpected consequences, e.g. damage to the equipment, could result.
3.2 Getting Started
3.2.1 Turning Power On
Once the patient monitor is installed, you can get ready for monitoring:
1.
Before you start to make measurements, check the patient monitor and plug-in modules for any mechanical
damage and make sure that all external cables, plug-ins and accessories are properly connected.
2.
Plug the power cord into the AC power source. If you run the patient monitor on battery power, ensure that the
battery is sufficiently charged.
3.
Press the power on/off switch on the monitor’s front.
WARNING
z
Do not use the patient monitor for any monitoring procedure on a patient if you suspect it is
not working properly, or if it is mechanically damaged. Contact your service personnel or us.
3.2.2 Starting Monitoring
1.
Decide which measurements you want to make.
2.
Connect the required modules, patient cables and sensors.
3.
Check that the patient cables and sensors are correctly connected.
4.
Check that the patient settings such as [Patient Cat.], [Paced], etc, are appropriate for your patient.
5.
Refer to the appropriate measurement section for details of how to perform the measurements you require.
3-2
3.3 Disconnecting from Power
To disconnect the patient monitor from the AC power source, follow this procedure:
1.
Confirm that the patient monitoring is finished.
2.
Disconnect the patient cables and sensors from the patient monitor.
3.
Make sure to save or clear the patient monitoring data as required.
4.
Press and hold the power on/off switch. The patient monitor shuts down and you can unplug the power cable.
CAUTION
z
Although not recommended, you can press and hold the power on/off switch to forcibly shut down the
monitor when it could not be shut down normally or under some special situations. This may cause loss of
data of the patient monitor.
3.4 Using Keys
The monitor has three types of keys:
„
Softkey: A softkey is a graphic key on the screen, giving you fast access to certain menus or functions. The
monitor has three types of softkeys:
‹
Parameter keys: Each parameter area can be seen as a softkey. You can enter a parameter setup menu by
selecting its corresponding parameter area.
‹
QuickKeys: QuickKeys are configurable graphical keys, located at the bottom of the main screen. For details,
refer to the section QuickKeys.
„
Hardkeys: A hardkey is a physical key on a monitoring device, such as the main menu hardkey on the monitor’s
front.
„
Pop-Up Keys: Pop-up keys are task-related keys that appear automatically on the monitor screen when required.
For example, the confirm pop-up key appears only when you need to confirm a change.
3.5 Using the Touchscreen
Select screen items by pressing them directly on the patient monitor’s screen. You can enable or disable touchscreen
operation by pressing and holding the [Main Menu] QuickKey for 3 seconds. A padlock symbol
touchscreen operation is disabled.
3-3
is displayed if
3.6 Setting the Screen
You can enter the [Screen Setup] window as shown below by selecting [Main Menu] ė [Screen Setup] ė
[Screen Layout >>]. In this window, you can allocate the positions of the parameters and waveforms. The
parameters or waveforms whose positions are not allocated will not be displayed.
Area A
Area B
Area C
The ECG parameter and the first ECG waveform always display in the first row. The configurable areas can be classified
as Area A, Area B, and Area C.
„
In Area A, you can choose to display the parameters (having waveforms) and their waveforms. Each parameter
and the associated waveform are displayed in the same row.
„
In Area B, you can choose to display the parameters and their waveforms. When there is no parameter
displayed in area C, both the parameters and their waveforms will be displayed in area B. Otherwise, only the
parameters will be displayed.
„
In Area C, you can choose to display all the parameters whose associated waveforms will not be displayed.
The screen can automatically adjust to ensure the best view based on your screen setup.
If no corresponding parameter or waveform is displayed after the module is inserted, you should perform the
following inspections:
„
Check the connection between the module and lead, cable, sensor, or external device.
„
Enter the [Screen Setup] window for the desired display configuration.
WARNING
z
The parameters whose positions are not allocated in the [Screen Setup] window will not be displayed.
However, the monitor can still give alarms of these parameters.
3-4
3.7 Using the Main Menu
To enter the main menu, select the
on-screen QuickKey or the
hardkey on the monitor’s front. Most of
monitor operations and settings can be performed through the main menu.
4
1
2
3
Other menus are similar to the main menu and contain the following parts:
1.
Heading: gives a sum-up for the current menu.
2.
Main body: displays options, buttons, prompt messages, etc. The menu button with “>>’’ enlarges a secondary
window to reveal more options or information.
3.
4.
Online help area: displays help information for the highlighted menu item.
: select to exit the current menu.
3.8 Removing a Label Conflict
Every label is unique and is assigned only once. The measurement label is stored inside the module. The system will
prompt module name conflict when two measurement modules with the same name are used.
For example, an IBP module (module X) is already loaded and the Art label is used for module X. Then another IBP
module (module Y) is inserted and the Art label is also used for module Y. In this case, your patient monitor will
prompt the message of label conflict and display the [Label] menu.
„
To use module X for Art measurement, just modify the label of module Y on this channel in the [Label] menu.
If the [Label] menu already exits inadvertently, you need to plug out and then plug in module Y.
„
To use module Y for Art measurement, first exit the [Label] menu. Then select the Art parameter area on the
screen and modify the label of module X on this channel in the popup menu. Finally, plug out and then plug in
module Y.
3.9 Changing General Settings
This chapter covers only general settings such as language, brightness, date and time, etc. Measurement settings and
other settings can be referred to in respective sections.
3-5
3.9.1 Setting up a Monitor
In situations where you install a patient monitor or change the patient monitor’s application site, you need to setup
the patient monitor as follows:
1.
2.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
In the [User Maintenance] menu, select, in turn, [Monitor Name], [Department] and [Bed No.], and
then change their settings.
3.9.2 Changing Language
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
In the [User Maintenance] menu, select [Language] and then select the desired language.
3.
Restart the patient monitor.
3.9.3 Adjusting the Screen Brightness
1.
Select the [Main Menu]ė[Screen Setup >>]ė[Brightness].
2.
Select the appropriate setting for the screen brightness. 10 is the brightest, and 1 is the least bright.
If the patient monitor operates on battery power, you can set a less bright screen to prolong the operating time of the
battery. When the patient monitor enters standby mode, the screen will change to the least brightness automatically.
3.9.4 Showing/Hiding the Help
The patient monitor provides online help information. The user can display or hide the help as required.
1.
Select [Main Menu]ė[Screen Setup >>].
2.
Select [Help] and toggle between [On] and [Off].
3.9.5 Setting the Date and Time
1.
Select [Main Menu] ė[Maintenance >>]ė[System Time >>].
2.
Set the date and time.
3.
Select [Date Format] and toggle between [yyyy-mm-dd], [mm-dd-yyyy] and [dd-mm-yyyy].
4.
Select [Time Format] and toggle between [24h] and [12h].
If your patient monitor is connected to a central monitoring system (CMS), the date and time are automatically taken
from that CMS. In that case, you cannot change the date and time settings on your patient monitor.
CAUTION
z
Changing date and time will affect the storage of trends and events and may cause data missing.
3-6
3.9.6 Adjusting Volume
Alarm Volume
1.
Select the [Volume Setup] QuickKey, or [Main Menu]ė[Alarm Setup >>]ė[Others].
2.
Select [Alm Volume] and then select the appropriate volume: X-10, in which X is the minimum volume,
depending on the set minimum alarm volume (refer to the chapter Alarm), and 10 the maximum volume.
Key Volume
When you press the navigation knob or the touchscreen, or the hardkeys on the panel, the patient monitor prompts
you by making a sound of the key volume you have set.
1.
Select the [Volume Setup] QuickKey, or [Main Menu]ė[Screen Setup >>].
2.
Select [Key Volume] and then select the appropriate volume. 0 means off, and 10 the maximum volume.
QRS Volume
The QRS tone is derived from either the HR or PR, depending on which is currently selected as the alarm source in
[ECG Setup] or [SpO2 Setup]. When monitoring SpO2, there is a variable pitch tone which changes as the
patient’s saturation level changes. The pitch of the tone rises as the saturation level increases and falls as the
saturation level decreases. The volume of this tone is user adjustable.
1.
Select the [Volume Setup] QuickKey, or the ECG parameter windowė[Others >>], or the SpO2 parameter
window.
2.
Select [QRS Volume] or [Beat Vol] and then select the appropriate volume. 0 means off, and 10 the
maximum volume.
3.10 Operating Modes
Your monitor has different operating modes. Some are password protected. This section lists the major operating
modes.
3.10.1 Monitoring Mode
This is the normal, everyday working mode that you use for monitoring patients. Your monitor automatically enters
the monitoring mode after being turned on.
3-7
3.10.2 Night Mode
To avoid disturbing the patient, night mode may be used.
To activate the night mode:
1.
Select the [Night Mode] QuickKey or [Main Menu]ė[Screen Setup >>]ė[Night Mode >>].
2.
In the pop-up menu, set the desired brightness, alarm volume, QRS volume, key volume, or whether to stop NIBP
measurement or not. When [Stop NIBP] is selected, all the NIBP measurements terminate after entering the
night mode.
3.
Select the [Enter Night Mode] button.
To cancel the night mode:
1.
Select the [Night Mode] QuickKey or [Main Menu]ė[Screen Setup >>]ė[Night Mode >>].
2.
Select [Ok] in the popup.
WARNING
z
Before entering night mode, confirm the settings of brightness, alarm volume, QRS volume, and key
volume. Pay attention to the potential risk when the setting value is a bit low.
3.10.3 Privacy Mode
Privacy mode is only available when a patient who is admitted at a patient monitor is also monitored by the central
station.
To activate the privacy mode, select [Main Menu]ė[Screen Setup >>]ė[Privacy Mode].
The patient monitor behaves as follows as soon as the privacy mode is activated:
„
The screen turns blank and [Under monitoring. Press any key to exit the privacy mode.] is
displayed.
„
Monitoring and data storing continue but patient data is only visible at the central station.
„
Alarms can still be triggered. But all audible alarms are suppressed and the alarm light is deactivated at the
patient monitor.
„
All system sounds are suppressed, including heart beat tone, pulse tone, all prompt tones, etc.
To cancel the privacy mode, press any key.
The patient monitor exits the privacy mode automatically in one of the following situations:
„
The patient monitor disconnects from central station.
„
Plug or unplug the storage card.
The touchscreen is locked automatically in the privacy mode.
3-8
WARNING
z
During privacy mode, all audible alarms are suppressed and the alarm light is deactivated at the patient
monitor. Alarms sound only at the central station.
3.10.4 Demo Mode
In Demo mode, the monitor can demonstrate its major functions when patient or patient simulator is not connected.
The Demo mode is password protected.
To enter the Demo mode:
1.
Select [Main Menu]ė[Maintenance >>].
2.
Select [Exit Demo].
To exit the Demo mode, select [Main Menu]ė[Maintenance >>]ė[Exit Demo].
WARNING
z
The Demo mode is for demonstration purpose only. To avoid that the simulated data are mistaken for the
monitored patient’s data, you must not change into Demo mode during monitoring. Otherwise, improper
patient monitoring and delayed treatment could result.
3.10.5 Standby Mode
In standby mode, you can temperately stops patient monitoring without turning off the monitor. To enter the standby
mode, Select [Main Menu]ė[Standby].
3-9
FOR YOUR NOTES
3-10
4 Managing Patients
4.1 Admitting a Patient
The patient monitor displays physiological data and stores them in the trends as soon as a patient is connected. This
allows you to monitor a patient that is not admitted yet. However, it is recommended that you fully admit a patient so
that you can clearly identify your patient, on recordings, reports and networking devices.
To admit a patient:
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ė[Patient Setup >>].
2.
Select [Discharge Patient] to clear any previous patient data. If you do not erase data from the previous patient,
the new patient’s data will be saved into the data of the previous patient. The monitor makes no distinction
between the old and the new patient data.
3.
4.
If [Discharge Patient] button appears dimmed, directly select [Admit Patient] and then select:
‹
[Yes] to apply the data saved in the patient monitor to the new patient, or
‹
[No] to clear the data saved in the patient monitor.
In the [Patient Demographics] menu, enter the demographic details, of which:
‹
[Patient Cat.] determines the way your patient monitor processes and calculates some measurements, and
what safety and alarm limits are applied for your patient.
‹
[Paced] determines whether to show pace pulse marks on the ECG waveform. When the [Paced] is set to
[No], pace pulse marks are not shown in the ECG waveform.
5.
Select [Ok].
WARNING
z
[Patient Cat.] and [Paced] will always contain a value, regardless of whether the patient is fully admitted
or not. If you do not specify settings for these fields, the patient monitor uses the default settings from the
current configuration, which might not be correct for your patient.
z
For paced patients, you must set [Paced] to [Yes]. If it is incorrectly set to [No], the patient monitor could
mistake a pace pulse for a QRS and fail to alarm when the ECG signal is too weak.
z
For non-paced patients, you must set [Paced] to [No].
4-1
4.2 Quick Admitting a Patient
Use [Quick Admit] only if you do not have the time or information to fully admit a patient. Complete the rest of the
patient demographic details later. Otherwise, the
symbol will always be displayed in the patient information area.
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ė[Patient Setup >>].
2.
Select [Quick Admit]. If a patient has been admitted at present, select [OK] to discharge the current patient.
If .no patient is admitted, you can choose either:
3.
‹
[Yes] to apply the data in your patient monitor to the new patient, or
‹
[No] to clear any previous patient data.
Enter the patient category and paced status for the new patient, and then select [Ok].
4.3 Editing Patient Information
To edit the patient information after a patient has been admitted, or when the patient information is incomplete, or
when you want to change the patient information:
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ė[Patient Setup >>].
2.
Select [Patient Demographics] and then make the required changes.
3.
Select [Ok].
4.4 Discharging a Patient
To discharge a patient:
1.
Select the [Patient Setup] QuickKey, or [Main Menu]ė[Patient Setup >>].
2.
Select [Discharge Patient]. In the popup menu, you can either:
‹
Directly select [Ok] to discharge the current patient, or
‹
Select [Standby] then [Ok]. The patient monitor enters the standby mode after discharging the current
patient, or
‹
Select [Cancel] to exit without discharging the patient.
NOTE
z
Discharging a patient clears all history data in the monitor.
4-2
4.5 Transferring a Patient
You can transfer patient data between monitors with a USB drive without re-entering the patient demographic
information. Transferring of patient data enables you to understand the patient’s history condition. The patient data that
can be transferred includes: patient demographics, trend data, alarm events and parameters alarm limits. USB drive can
be used for patient data transfer of BeneView T Series patient monitors, iPM patient monitors, and iMEC patient
monitors.
Select [Others >>] from [User Maintenance] menu. In the popup menu, you can set [Transferred Data Length].
The default is [4 h]. You can also set [Data Transfer Method]. The default is [Off].
4.5.1.1 Transferring Data from the Monitor to a USB Drive
1.
Select [Main Menu]ė[Patient Setup >>].
2.
Select [Transfer to Storage Medium]. In the popup menu, you can:
3.
‹
Select [Ok] to transfer the patient data, or
‹
Select [Cancel] to exit the menu.
Wait until the following message appears: [Transfer to storage medium successful. Please remove the
USB drive.].
4.
Remove the USB drive from patient monitor.
4.5.1.2 Transferring Data from a USB Drive
1.
Connect the USB drive to the patient monitor.
2.
In the popup menu, you can:
3.
‹
Select [Transfer] to transfer the patient data to the monitor, or
‹
Select [Cancel Transfer] to cancel the operation of transferring patient data.
‹
Select [Unload USB Drive] to not transfer the patient data and to unload the USB drive.
After you select [Transfer], in the popup menu you can further select the patient data contents that need to be
transferred. [Patient Demographics] must be selected. After [Ok] is selected, the monitor compares the
patient information stored in both the storage medium and monitor and deals with the patient data based on the
following.
‹
Different
The monitor erases all the current patient data, transfers the patient data from the storage
Patients:
medium, and loads the configuration according to the patient category.
‹
In the popup dialog box, you can:
Same Patient:
‹
Select [Yes] to merge the patient data in the monitor and storage medium.
‹
Select [No] to erase all the current patient data in the monitor and to transfer the patient
data from the storage medium.
4.
Wait until the following message appears:[Transfer from storage medium successful.].
4-3
WARNING
z
The USB drive you use may have write-protect function. In this case, please make sure the USB drive for
data transfer is in read/write mode.
z
Do not remove the storage medium during data transfer process. Otherwise, data files may be damaged.
z
Do not discharge a patient before the patient is successfully transferred.
z
After a patient is successfully transferred, check if the patient settings (especially patient category, paced
status and alarm limits settings, etc) on the monitor are appropriate for this patient.
4.6 Connecting to a Central Monitoring System
If your patient monitor is connected to a central monitoring system (CMS):
„
All patient information, measurement data and settings on the patient monitor can be transferred to the CMS.
„
All patient information, measurement data and settings can be displayed simultaneously on the patient monitor
and CMS. For some functions such as editing patient information, admitting a patient, discharging a patient,
starting/stopping NIBP measurements, etc., bi-directional control can be achieved between your patient monitor
and the CMS.
For details, refer to the CMS’s instructions for use.
4-4
5 Managing Configurations
5.1 Introduction
When performing continuous monitoring on a patient, the clinical professional often needs to adjust the monitor’s
settings according to the patient’s condition. The collection of all these settings is called a configuration. Allowing you to
configure the monitor more efficiently, the monitor offers different sets of configuration to suit different patient
categories and departments. You can change some settings from a certain set of configuration and then save the
changed configuration as a user configuration.
The default configurations provided for your monitor are department-oriented. You can choose either from:
„
General
„
OR
„
ICU
„
NICU
„
CCU
Each department has three different sets of configurations tailored for adult, pediatric and neonatal patients.
WARNING
z
The configuration management function is password protected. The configuration management tasks
must be performed by clinical professionals.
The system configuration items can be classified as:
„
Parameter configuration items
These items relates to parameters, e.g., waveform gain, alarm switch, alarm limits..
„
Conventional configuration items
These items define how the monitor works, e.g., screen layout, record, print and alarm settings.
„
User maintenance items
These items relates to user maintenance settings, e.g., unit setup, time format and data format.
For the important configuration items and their default values and user maintenance items, see appendix Configuration
Default Information.
5-1
5.2 Entering the [Manage Configuration] Menu
1.
Press the
hardkey on the monitor’s front to enter the main menu.
2.
Select [Maintenance >>]ė[Manage Configuration >>]. Enter the required password and then select [Ok].
5.3 Changing Department
If the current department configuration is not the one you want to view, you can select [Change Department >>] in
the [Manage Configuration] menu and then choose the one you want for viewing as shown below.
NOTE
z
Changing the department will delete all current user configurations. Please act with caution.
5-2
5.4 Setting Default Configuration
The monitor will load the pre-set default configuration in the following cases.
„
The patient monitor restarts after quitting over 120 seconds.
„
A patient is admitted.
„
A patient is discharged.
„
Patient data is cleared.
„
Patient category is changed.
To set default configuration:
1.
Select [Select Default Config. >>] in the [Manage Configuration] menu.
2.
In the [Select Default Config.] menu, select [Load the Latest Config.] or [Load Specified Config.].
When you select [Load Specified Config.], the configuration (adult, pediatric or neonate) to be restored is subject to
the patient category. This configuration can be either factory configuration or saved user configuration. Take adult as an
example, select [Default Adu Config.] and toggle between [Defaults] or user configuration(s).
NOTE
z
To know what configuration is restored when the patient monitor starts, enter the main screen to check
the prompt information at the lower part of the screen (displayed for about 10 seconds).
5.5 Saving Current Settings
Current settings can be saved as user configuration. Up to 5 user configurations can be saved. To save current settings:
1.
Select [Save Current Settings As >>] in the [Manage Configuration] menu.
2.
In the popup dialog box, enter the configuration name and then select [Ok].
5-3
5.6 Editing Configuration
1.
Select [Edit Config. >>] in the [Manage Configuration] menu. The following menu appears.
2.
The popup menu shows the existing configurations on the monitor. Selecting [Config. on USB drive >>] will
show the existing configurations on the USB drive. Select the desired configuration and then select the [Edit]
button. The following menu appears.
3.
Select [Alarm Setup >>], [Screen Setup >>] or [Parameter >>] to enter the corresponding menu in which
settings can be changed. The changed items of alarm setup will be marked in red.
4.
You can select [Save] or [Save as] to save the changed configuration. Select [Save] to overwrite the original
configuration. Select [Save as] to save the changed configuration in another name.
5-4
5.7 Deleting a Configuration
1.
Select [Delete Config. >>] in the [Manage Configuration] menu.
2.
The popup menu shows the existing user configurations on the monitor. Selecting [Config. on USB drive >>]
will show the existing user configurations on the USB drive. Select the user configurations you want to delete and
then select [Delete].
3.
Select [Yes] in the popup.
5.8 Transferring a Configuration
When installing several monitors with identical user configuration it is not necessary to set each unit separately. An USB
drive may be used to transfer the configuration from monitor to monitor.
To export the current monitor’s configuration:
1.
Connect the USB drive to the monitor’s USB port.
2.
Select [Export Config. >>] in the [Manage Configuration] menu.
In the [Export Config.] menu, select the configurations and [User Maintenance Settings] to export. Then
select the [Export] button. A status message will report completion of the transfer.
To import the configuration on the USB drive to the monitor:
1.
Connect the USB drive to the monitor’s USB port.
2.
Select [Import Config. >>] in the [Manage Configuration] menu.
3.
In the [Import Config.] menu, select the configurations and [User Maintenance Settings] to import. Then
select the [Import] button. A status message will report completion of the transfer.
5.9 Loading a Configuration
You may make changes to some settings during operation. However, these changes or the pre-selected configuration
may not be appropriate for the newly admitted patient. Therefore, the monitor allows you to load a desired
configuration so as to ensure that all the settings are appropriate for your patient.
To load a configuration,
1.
2.
Select [Load Configuration >>] from the main menu.
The popup menu shows the existing configurations on the monitor. Selecting [Config. on USB drive >>] will
show the existing configurations on the USB drive.
3.
Select a desired configuration.
4.
Select [View] to view the configuration details. In the popup menu, you can select [Alarm Setup >>], [Screen
Setup >>] or [Parameter >>] to view the corresponding contents. The alarm setup items which are different
than those currently used are marked in red.
5.
Select [Load] to load this configuration.
5-5
5.10 Restoring the Latest Configuration Automatically
During operation, you may make changes to some settings. However, these changes may not be saved as user
configuration. To prevent the changes from losing in case of a sudden power failure, the patient monitor stores the
configuration in real time. The saved configuration is the latest configuration.
The monitor restore the latest configuration if restarts within 60 seconds after the power failure. And it will restore the
default configuration rather than the latest configuration if restarts 120 seconds later after the power failure. The
monitor may load either the latest configuration or the default configuration if restarts from 60-120 seconds after the
power failure.
5.11 Modifying Password
To modify the password for accessing the [Manage Configuration] menu,
1.
Select [Modify Password >>] in the [Manage Configuration] menu.
2.
Input a new password in the popup menu.
3.
Select [Ok].
5-6
6 User Screens
6.1 Tailoring Your Screens
You can tailor your patient monitor’s screens by setting:
„
Wave line size
„
The color in which each measurement’s numerics and waveform are displayed
„
The parameter to be monitored.
Changing some settings may be hazardous. Therefore, those setting are password-protected and can be modified by
authorized personnel only. Once change is made, those who use the patient monitor should be notified.
6.1.1 Changing the Wave Line Size
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Others >>].
3.
Select [Wave Line] and toggle between [Thick], [Mediate] and [Thin].
6.1.2 Changing Measurement Colors
1.
Select [Main Menu]ė[Screen Setup >>]ė[Measurement Color Setup >>].
2.
Select the color box next to your desired measurement and then select a color from the popup menu.
6.1.3 Changing Screen Layout
Select the [Screens] QuickKey, or [Main Menu]ė[Screen Setup >>]ė[Screen Layout >>] to enter the
[Screens] menu.
„
You can choose the desired screen type in the [Choose Screen] window.
„
You can select the parameters and waveforms you want to view in the [Screen Setup] window. For details,
please refer to the section Setting the Screen.
„
You can select the parameters you want to view on big numerics screen in the [Big Numerics Screen Setup]
window.
6-1
6.2 Viewing Minitrends
6.2.1 Having a Split-Screen View of Minitrends
You can split the normal screen so that one part of the screen, on the left hand side, continuously shows graphic
minitrends beside waveforms as shown in the figure below.
To have a split-screen view of minitrends, you can:
„
Select [Minitrends] QuickKey, or
„
Select [Screens] QuickKeyė[Minitrends Screen]ė
„
Select [Main Menu]ė[Screen Setup >>]ė[Screen Layout >>]ė[Minitrends Screen]ė
, or
.
Minitrend View
The split-screen view provides minitrends for multiple parameters. In each field, the label, scale and time are respectively
displayed at the top, left, and bottom as shown below.
6.2.2 Setting Minitrends
Select the minitrends area. From the pop-up [Minitrend Setup] menu, you can:
„
Select the parameters to be displayed, or
„
Select [Minitrend Length] and then select the appropriate setting.
6-2
6.3 Viewing oxyCRG
To have a split screen view of oxyCRG, you can:
„
Select [oxyCRG] QuickKey, or
„
Select [Screens] QuickKeyė[OxyCRG Screen]ė
„
Select [Main Menu]ė[Screen Setup >>]ė[Screen Layout >>]ė[OxyCRG Screen]ė
1
, or.
2
.
3
The split-screen view covers the lower part of the waveform area and shows HR trend, SpO2 trend and RR trend (or Resp
wave). At the bottom, there are controls:
1.
Trend length list box
In the trend length list box, you can select [1 min], [2 min], [4 min], or [8 min].
2.
Resp Wave (or RR Trend) list box
From this list box, you can select either [Resp Wave] or [RR Trend] for display.
3.
Record
Through this button, you can print out the currently displayed oxyCRG trends by the recorder.
6-3
6.4 Viewing Other Patients
6.4.1 Care Group
You can select up to 10 patient monitors (including telemetry) connected to the same central monitoring system into a
Care Group. This lets you:
„
View information on the monitor screen from another bed in the same Care Group.
„
Be notified of physiological and technical alarm conditions at the other beds in the same Care Group.
To have a Care Group:
1.
Open the [View Other Patient] window by:
‹
Selecting [Others] QuickKey, or
‹
Selecting [Screens] QuickKeyė[View Others Screen]ė
‹
Selecting [Main Menu]ė[Screen Setup >>]ė[Screen Layout >>]ė[View Others Screen]ė
, or
2.
Select [Setup] in the [View Other Patient] window.
3.
Select the desired patient monitors from the [Connected Monitor List], and then select the
.
button. The
selected patient monitors constitute a Care Group.
6.4.2 Viewing the Care Group Overview Bar
The Care Group overview bar locates at the bottom of the [View Other Patient] window. In the overview bar, the
department and bed label for any Care Group beds are displayed. For telemetry, # is displayed before the department
label. The color in which a Care Group bed appears matches its status:
„
Red: indicates the bed is giving high-level physiological alarms or the telemetry is giving alarm, such as nurse call
or event.
„
Yellow: indicates the bed is giving medium- or low-level physiological alarms, or medium-level technical alarms.
„
Blue: indicates the bed is giving low-level technical alarms.
„
Grey: indicates the bed fails to be networked or stays in the standby mode.
You can view a Care Group bed’s alarms by selecting it from the care group, and as well you can select the [View This
Patient] button to view this bed in the [View Other Patient] window.
For more details about Care Group alarms, refer to the Alarms chapter.
6-4
6.4.3 Understanding the View Other Patient Window
When you first open the [View Other Patient] window, the patient monitor automatically selects a monitor from the
network to display in the [View Other Patient] window.
4
1
2
3
The [View Other Patient] window covers the lower part of the waveform area and consists of:
1.
Information Area: shows the patient information (including department, bed number, patient name, etc.), network
status symbol.
2.
View Area: shows physiological waveforms and parameters. You can switch a waveform area to a parameter area by
selecting your desired waveform area and then selecting [Switch to Parameter Area], or switch a parameter
area to a waveform area by selecting your desired parameter area and then selecting [Switch to Waveform
Area].
3.
Care Group Overview Bar.
4.
Message Area: shows physiological, technical and prompt messages from the currently viewed patient monitor. It
also shows the alarm given by the telemetry such as nurse call or event. By selecting this area, you can enter the
[Alarm Information List] to view all physiological, technical and prompt messages coming from the currently
viewed patient.
Additionally, you can change a waveform or parameter for viewing
„
To change a waveform for viewing, select the waveform segment where you want a new waveform to appear and
then select the waveform you want from the popup menu.
„
To change a parameter for viewing, select the parameter window where you want a new parameter to appear
and then select the parameter you want from the popup menu.
WARNING
z
The data presented in the [View Other Patient] window have delay. Do not rely on this window for
realtime data.
6-5
6.5 Understanding the Big Numerics Screen
To enter the big numerics screen:
1.
Select the [Screens] QuickKey, or [Main Menu]ė[Screen Setup >>]ė[Screen Layout >>].
2.
Select [Big Numerics]ė
.
You can select your desired parameters to display in this screen: select the [Screens] QuickKeyė[Big Numerics
Screen Setup] and then select the parameters you want. For parameters having a waveform, the waveform will also
be displayed.
6-6
7 Alarms
Alarms, triggered by a vital sign that appears abnormal or by technical problems of the patient monitor, are indicated to
the user by visual and audible alarm indications.
WARNING
z
A potential hazard can exist if different alarm presets are used for the same or similar equipment in any
single area, e.g. an intensive care unit or cardiac operating room.
z
If your patient monitor is connected to a CMS, remote suspension, inhibition, silence and reset of monitor
alarms via the CMS may cause a potential hazard.
7.1 Alarm Categories
By nature, the patient monitor’s alarms can be classified into three categories: physiological alarms, technical alarms and
prompt messages.
1.
Physiological alarms
Physiological alarms, also called patient status alarms, are triggered by a monitored parameter value that violates
set alarm limits or an abnormal patient condition. Physiological alarm messages are displayed in the physiological
alarm area.
2.
Technical alarms
Technical alarms, also called system status alarms, are triggered by a device malfunction or a patient data distortion
due to improper operation or mechanical problems. Technical alarm messages are displayed in the technical alarm
area.
3.
Prompt messages
As a matter of fact, prompt messages are not alarm messages. Apart from the physiological and technical alarm
messages, the patient monitor will show some messages telling the system status or patient status. Messages of
this kind are included into the prompt message category and usually displayed in the prompt information area.
Some prompt messages that indicate the arrhythmia events are displayed in the physiological alarm area. For some
measurements, their related prompt messages are displayed in their respective parameter windows.
7-1
7.2 Alarm Levels
By severity, the patient monitor’s alarms can be classified into three categories: high level, medium level and low level..
Physiological alarms
Technical alarms
Indicate that your patient is in a life
Indicate a severe device malfunction or an improper operation,
threatening situation, such as Asystole,
which could make it possible that the monitor cannot detect
Vfib/Vtac and so forth, and an
critical patient status and thus threaten the patient’s life, such as
emergency treatment is demanded.
low battery.
Medium
Indicate that your patient’s vital signs
Indicate a device malfunction or an improper operation, which
level
appear abnormal and an immediate
may not threaten the patient’s life but may compromise the
treatment is required.
monitoring of vital physiological parameters.
Indicate that you patient’s vital signs
Indicate a device malfunction or an improper operation, which
appear abnormal and an immediate
may compromise a certain monitoring function but will not
treatment may be required.
threaten the patient’s life.
High level
Low level
7.3 Alarm Indicators
When an alarm occurs, the patient monitor will indicate it to the user through visual or audible alarm indications.
„
Alarm lamp
„
Alarm message
„
Flashing numeric
„
Audible alarm tones
7.3.1 Alarm Lamp
If a technical alarm or physiological alarm occurs, the alarm lamp will flash. The flashing color and frequency match the
alarm level as follows:
„
High level alarms:
the lamp quickly flashes red.
„
Medium level alarms:
the lamp slowly flashes yellow.
„
Low level alarms:
the lamp turns yellow without flashing.
7.3.2 Alarm Message
When an alarm occurs, an alarm message will appear in the technical or physiological alarm area. For physiological
alarms, the asterisk symbols (*) before the alarm message match the alarm level as follows:
„
High level alarms:
***
„
Medium level alarms:
**
„
Low level alarms:
*
Additionally, the alarm message uses different background color to match the alarm level:
„
High level alarms:
red
„
Medium level alarms:
yellow
„
Low level alarms:
yellow
You can view the alarm messages by selecting the physiological or technical alarm area.
7-2
7.3.3 Flashing Numeric
If an alarm triggered by an alarm limit violation occurs, the numeric of the measurement in alarm will flash every second,
and the corresponding alarm limit will also flash at the same frequency indicating the high or low alarm limit is violated.
7.3.4 Audible Alarm Tones
The alarm tone is distinct from heart beat tone, keystroke tone and pulse tone in frequency. This monitor has three
choices of alarm tones and patterns: ISO, Mode 1 and Mode 2. For each pattern, the alarm tones identify the alarm levels
as follows:
„
„
„
ISO pattern:
‹
High level alarms:
triple+double+triple+double beep.
‹
Medium level alarms:
triple beep.
‹
Low level alarms:
single beep.
Mode 1:
‹
High level alarms:
high-pitched single beep.
‹
Medium level alarms:
double beep.
‹
Low level alarms:
low-pitched single beep.
Mode 2:
‹
High level alarms:
high-pitched triple beep.
‹
Medium level alarms:
double beep.
‹
Low level alarms:
low-pitched single beep.
NOTE
z
When multiple alarms of different levels occur simultaneously, the patient monitor will select the alarm of
the highest level and give visual and audible alarm indications accordingly.
7.3.5 Alarm Status Symbols
Apart from the aforementioned alarm indicators, the patient monitor still uses the following symbols telling the alarm
status:
„
indicates alarms are paused.
„
indicates alarm sound is silenced.
„
indicates the alarm sound is turned off.
„
indicates individual measurement alarms are turned off or the system is in alarm off status.
7-3
7.4 Alarm Tone Configuration
7.4.1 Setting the Minimum Alarm Volume
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
3.
Select [Minimum Alarm Volume] and toggle between 0 and 10.
The minimum alarm volume refers to the minimum value you can set for the alarm volume, which is not affected by user
or factory default configurations. The setting of minimum alarm volume remains unchanged when the patient monitor
shuts down and restarts.
7.4.2 Changing the Alarm Volume
1.
Select the [Volume Setup] QuickKey or the [Alarm Setup] QuickKeyė[Others], or [Main Menu]ė[Alarm
Setup >>]ė[Others].
2.
Select the appropriate volume from [Alm Volume]: X to 10, in which X is the minimum volume, depending on
the set minimum alarm volume, and 10 the maximum volume.
3.
Select [High Alarm Volume] to set the volume of the high priority alarm as [Alm Volume+0], [Alm
Volume+1] or [Alm Volume+2].
4.
Select [Reminder Vol] to set the volume of the reminder tone as [High], [Med] or [Low].
When alarm volume is set to 0, the alarm sound is turned off and a
symbol appears on the screen.
7.4.3 Setting the Interval between Alarm Sounds
You cannot change the interval between alarm tones if you choose mode 1 or 2 as your desired alarm tone pattern. For
these two patterns, the interval between alarm tones identifies the alarm levels as follows:
„
Mode 1:
‹
Interval between high level alarm tones:
continuously.
‹
Interval between medium level alarm tones:
5 s.
‹
Interval between low level alarm tones:
20 s.
„
Mode 2:
‹
Interval between high level alarm tones:
1 s.
‹
Interval between medium level alarm tones:
5 s.
‹
Interval between low level alarm tones:
20 s.
If you choose the ISO pattern, you can change the interval between alarm tones. To change the interval between alarm
tones:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
3.
Select [High Alarm Interval (s)], [Med Alarm Interval (s)] and [Low Alarm Interval (s)] in turn and
then select the appropriate settings.
7-4
WARNING
z
When the alarm sound is switched off, the patient monitor will give no audible alarm tones even if a new
alarm occurs. Therefore the user should be very careful about whether to switch off the alarm sound or
not.
z
Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume
to a low level may result in a hazard to the patient. Always keep the patient under close surveillance.
7.4.4 Changing the Alarm Tone Pattern
To change the alarm tone pattern:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
3.
Select [Alarm Sound] and toggle between [ISO], [Mode 1]and [Mode 2].
User or factory default configurations exert no impact on the setup of alarm tone pattern. The alarm tone pattern
remains unchanged after the monitor restarts.
7.4.5 Setting the Reminder Tones
When the alarm volume is set to zero, or the alarm tone is silenced or turned off, the patient monitor issues a periodical
reminder tone. To set the reminder tones:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Alarm Setup >>] to enter the [Alarm Setup] menu.
‹
To switch the reminder tones on or off, select [Reminder Tones] and toggle between [On] and [Off].
‹
To set the interval between reminder tones, select [Reminder Interval] and toggle between []1min], [2min]
and [3min].
In addition, you can set the volume of alarm reminder tones. To set the volume of alarm reminder tones, select [Main
Menu]ė[Alarm Setup >>]ė[Others] or the [Alarm Setup] QuickKeyė[Others]. Then, select [Reminder Vol]
and toggle between [High], [Medium] and [Low].
7-5
7.5 Understanding the Alarm Setup Menu
Select the [Alarm Setup] QuickKey or [Main Menu]ė[Alarm Setup >>] to enter the [Alarm Setup], where you
can:
„
Set alarm properties for all parameters.
„
Change ST alarm settings.
„
Change arrhythmia alarm settings.
„
Set the threshold for some arrhythmia alarms.
„
Change other settings.
Please refer to the ECG section for how to change ST alarm settings, how to change arrhythmia alarm settings and how
to set the threshold for some arrhythmia alarms.
7.5.1 Setting Alarm Properties for All Parameters
In the main menu, select [Alarm Setup >>]ė[Parameters]. You can review and set alarm limits, alarm switches,
alarm level and alarm recordings for all parameters.
When a measurement alarm occurs, automatic recording of all the measurement numerics and related waveforms is
possible when the measurement’s [On/Off] and [Record] are set on.
WARNING
z
Make sure that the alarm limits settings are appropriate for your patient before monitoring.
z
Setting alarm limits to extreme values may cause the alarm system to become ineffective. For example,
High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration
do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off.
7-6
7.5.2 Adjusting Alarm Limits Automatically
The monitor can automatically adjust alarm limits according to the measured vital signs, using the auto limits function.
When auto limits are selected, the monitor calculates safe auto limits based on the latest measured values.
To get accurate auto alarm limits, you need to collect a set of measured vital signs as a baseline. Then, in the main menu,
select [Alarm Setup >>]ė[Parameters]ė[Auto Limits] ė[Ok]. The monitor will create new alarm limits based
on the measured values.
Before applying these automatically created alarm limits, confirm if they are appropriate for your patient in the mass
alarm setup menu. If not, you can adjust them manually. These alarm limits will remain unchanged until you select auto
limits again or adjust them manually.
The monitor calculates the auto limits based on the following rules.
Low alarm limit
Module
Parameter
Adult/
pediatric
(HR × 0.8) or
ECG
HR/PR
40bpm
(whichever is
greater)
(RR × 0.5) or 6
Resp
RR
Same as the
SpO2
SpO2
default alarm
limit
Adult/
Neonate
pediatric
(HR – 30) or
90bpm (whichever
is greater)
(HR + 40) or
240bpm
200bpm
(whichever is
(whichever is
smalle)
smaller)
NIBP
NIBP-D
Adult/pediatric: 35 to
240
Neonate: 55 to 225
55
Neonate: 10 to 90
smaller)
smaller)
Same as the
Same as the
Same as the default Same as the
default alarm limit default alarm limit alarm limit
(SYS × 0.68 + 10) 45mmHg
(SYS × 0.86 + 38) 105mmHg
mmHg
mmHg
(whichever is
measurement range
(SYS + 15) or
(whichever is
greater)
smaller)
(Dia – 15) or
(Dia + 15) or
(Dia × 0.68 + 6)
20mmHg
(Dia × 0.86 + 32)
80mmHg
mmHg
(whichever is
mmHg
(whichever is
smaller)
(Mean – 15) or
(Mean × 0.68 +
35mmHg
(Mean × 0.86 +
8) mmHg
(whichever is
35) mmHg
greater)
Temp
range
(RR + 25) or 85 rpm Adult/pediatric: 6 to
rpm (whichever is (whichever is
greater)
NIBP-M
Auto alarm limits
greater)
(SYS – 15) or
NIBP-S
Neonate
(HR × 1.25) or
(RR – 10) or 30 rpm (RR × 1.5) or 30
rpm (whichever (whichever is
is greater)
High alarm limit
(Mean + 15) or 95
Adult˖45 to 270
Pediatric˖45 to 185
Neonate˖35 to 115
Adult˖25 to 225
Pediatric˖25 to 150
Neonate˖20 to 90
Adult˖30 to 245
mmHg (whichever Pediatric˖30 to 180
is smaller)
Neonate˖25 to 105
T1
(T1 – 0.5)ć
(T1 – 0.5) ć
(T1 + 0.5)ć
(T1 + 0.5)ć
1 to 49ć
T2
(T2 – 0.5)ć
(T2 – 0.5) ć
(T2 + 0.5)ć
(T2 + 0.5)ć
1 to 49ć
7-7
Low alarm limit
Module
Parameter
Adult/
pediatric
Same as the
TD
default alarm
limit
High alarm limit
Adult/
Neonate
pediatric
Same as the
Same as the
IBP˖ART/
(SYS × 0.68ˇ10) 45mmHg
(SYS × 0.86 + 38) 105mmHg
mmHg
mmHg
(whichever is
(whichever is
greater)
smaller)
UAP/
(Dia – 15) or
(Dia + 15) or
FAP/
IBP-D
(Dia × 0.68ˇ
20mmHg
(Dia × 0.86ˇ
80mmHg
6)mmHg
(whichever is
32)mmHg
(whichever is
LV/
greater)
P1-P4
(Mean – 15)
(Arterial
35mmHg
pressure)
PA
IBP-M
(Mean × 0.68 +
8)mmHg
measurement range
(SYS + 15) or
Ao/
BAP/
range
Same as the default Same as the
default alarm limit default alarm limit alarm limit
(SYS – 15) or
IBP-S
Neonate
Auto alarm limits
smaller)
or
Adult˖45 to 270
Pediatric˖45 to 185
Neonate˖35 to 115
Adult˖25 to 225
Pediatric˖25 to 150
Neonate˖20 to 90
(Mean + 15) or
(whichever is
greater)
(Mean × 0.86 +
95mmHg
35)mmHg
(whichever is
smaller)
IBP-S
SYS × 0.75
SYS × 0.75
SYS × 1.25
SYS × 1.25
IBP-D
Dia × 0.75
Dia × 0.75
Dia × 1.25
Dia × 1.25
IBP-M
Mean × 0.75
Mean × 0.75
Mean × 1.25
Mean × 1.25
IBP-M
Mean × 0.75
Mean × 0.75
Mean × 1.25
Mean × 1.25
0 to 32mmHg:
0 to 32mmHg:
0 to 32mmHg:
Adult˖30 to 245
Pediatric˖30 to 180
Neonate˖25 to 105
3 to 120mmHg
IBP:
CVP/
ICP/
LAP/
RAP/
3 to 40mmHg
UVP/
P1-P4
(Venous
pressure)
0 to 32mmHg:
CO2
remains the
same
EtCO2
remains the same remains the same remains the same
32 to 35mmHg: 32 to 35mmHg:
32 to 35mmHg:
32 to 35mmHg:
29mmHg
41mmHg
41mmHg
35 to 45mmHg: 35 to 45mmHg:
35 to 45mmHg:
35 to 45mmHg:
(etCO2-6) mmHg (etCO2-6) mmHg
(etCO2+6) mmHg (etCO2+6) mmHg
45 to
48mmHg:39
mmHg
>48mmHg:
remains the
same
29mmHg
45 to 48mmHg:39 45 to 48mmHg:51 45 to 48mmHg:51
mmHg
mmHg
mmHg
>48mmHg:
>48mmHg:
>48mmHg:
remains the same remains the same remains the same
7-8
Same as the
measurement range
Low alarm limit
Module
Parameter
Adult/
pediatric
FiCO2
N/A
Neonate
N/A
High alarm limit
Adult/
pediatric
Same as the
Neonate
range
Same as the default Same as the
default alarm limit alarm limit
awRR × 0.5 or 6 (awRR – 10) or 30 awRR × 1.5 or 30 (awRR+25) or 85
awRR
Auto alarm limits
measurement range
Adult/pediatric: 6 to
rpm (whichever rpm (whichever is rpm (whichever is rpm (whichever is 55
is greater)
greater)
smaller)
smaller)
Neonate:10 to 90
EtCO2˄AG˅
FiCO2
Same as CO2 module
(AG)
awRR × 0.5 or 6 awRR – 10 or 30
awRR
AG
EtAA
FiO2/
EtCO2
FiN2O/
EtN2O
C.O.
BT
Adult/pediatric: 6 to
rpm (whichever rpm (whichever is rpm (whichever is rpm (whichever is 55
is greater)
FiAA/
awRR × 1.5 or 30 awRR + 25 or 85
Same as the
default alarm
limit
Same as the
default alarm
limit
Same as the
default alarm
limit
Adult˖
(BT – 1)ć
Neonate: 10 to 90
greater)
smaller)
smaller)
Same as the
Same as the
Same as the default Same as the
default alarm limit default alarm limit alarm limit
Same as the
Same as the
Same as the default Same as the
default alarm limit default alarm limit alarm limit
Same as the
Same as the
Adult˖
(BT – 1)ć
measurement range
Same as the default Same as the
default alarm limit default alarm limit alarm limit
N/A
measurement range
N/A
measurement range
Same as the
measurement range
7.5.3 Setting Alarm Delay Time
You can set the alarm delay time for over-limit alarms of continuously measured parameters. If the alarm-triggered
condition disappears within the delay time, the patient monitor will not give the alarm. You can set the [Alarm Delay],
[Apnea Delay] and [ST Alarm Delay] in the [Others] window of [Alarm Setup] menu.
7-9
7.5.4 Setting Recording Length
You can change the length of the recorded waveforms. In the [Others] window of the [Alarm Setup] menu, select
[Recording Length] and toggle between [8 s], [16 s] and [32 s]:
„
[8 s]: 4 seconds respectively before and after the alarm or manual event trigger moment.
„
[16 s]: 8 seconds respectively before and after the alarm or manual event trigger moment.
„
[32 s]: 16 seconds respectively before and after the alarm or manual event trigger moment.
7.5.5 Entering CPB Mode
When performing Cardiopulmonary bypass (CPB), you can set the patient monitor to enter CPB mode in order to reduce
unnecessary alarms. In the CPB mode, all the physiological alarms are switched off except for the following alarms.
„
FiCO2/EtCO2 too high (for CO2 module and AG module)
„
FiO2/EtO2 too high or too low
„
FiAA/EtAA too high (AA represents the anaesthetic gas)
„
FiN2O/EtN2O too high
In CPB mode, [CPB Mode] is displayed in the physiological alarm area with red background color.
To enter CPB mode:
Select the [CPB Mode] Quickkey or select [Enter CPB Mode] in the [Others] window of the [Alarm Setup]
menu. Then select [Ok] in the popup dialog box.
7.6 Pausing Alarms
If you want to temporarily prevent alarms from sounding, you can pause alarms by pressing the
hardkey on the
monitor’s front. When alarms are paused:
„
No alarm lamps flash and no alarms are sounded.
„
No numeric and alarm limit flash.
„
No alarm messages are shown.
„
The remaining pause time is displayed in the physiological alarm area.
„
The
alarms paused symbol is displayed in the sound symbol area.
If the time interval of the monitor’s last shutdown from this starting-up is greater that 2 minutes, the patient monitor
enters into the alarm paused status as soon as it is turned on. The alarm pause time is fixed to be 2 minutes.
When the alarm pause time expires, the alarm paused status is automatically cancelled and the alarm tone will sound.
You can also cancel the alarm paused status by pressing the
hardkey.
You can set the alarm pause time to [1 min], [2 min], [3 min], [5 min], [10 min], [15 min], or [Permanent]. The
default alarm pause time is 2 minutes.
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Alarm Setup >>]ė[Alarm Pause Time] and then select the appropriate setting from the popup list.
7-10
7.7 Switching Off All Alarms
If [Alarm Pause Time] is set to [Permanent], the patient monitor enters into the alarm off status after the
hardkey is pressed. During the alarm off status,
„
As for physiological alarms, no alarm lamps flash and no alarms are sounded.
„
As for physiological alarms, no numeric and alarm limit flash.
„
No physiological alarm messages are shown.
„
[Alarm Off] is displayed in the physiological alarm area with red background.
„
As for technical alarms, no alarms are sounded.
„
The
alarm off symbol is displayed in the sound symbol area.
You can cancel the alarm off status by pressing the
hardkey.
WARNING
z
Pausing or switching off alarms may result in a hazard to the patient. Please be very careful.
7.8 Silencing the Alarm Sound
You can silence all alarm sounds by pressing the
and alarm tones are cleared and
hardkey on the monitor’s front. In that case, the alarm lamp flashing
appears in the sound symbol area. After the physiological alarm is silenced, Ĝ
appears before the alarm message and the numeric and alarm limit still flash. For the performance after the technical
alarm is silenced, please refer to the Silencing Technical Alarms section.
The alarm silenced status will be automatically cancelled if you switch the patient monitor to other alarm statues or
when a new physiological or technical alarm occurs.
7.9 Latching Alarms
The alarm latching setting for your patient monitor defines how the alarm indicators behave when you do not
acknowledge them. When alarms are set to non-latching, their alarm indications end when the alarm condition ends. If
you switch alarm latching on, all visual and audible alarm indications last until you acknowledge the alarms, except that
the measurement numeric and violated alarm limit stop flashing as soon as the initial alarm condition goes away.
To set alarms to latching or non-latching:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Alarm Setup >>].
3.
Select [Latching Alarms] and toggle between [High only], [Hi&Med], [All] and [Off]. If you select [High
only], only high priority alarm are latched; if you select [Hi&Med], both high priority alarms and mediate priority
alarms are latched; if you select [All], all alarms are latched; if you select [Off], the alarm latching is turned off.
7-11
NOTE
z
Changing of alarm priority may affect the latching status of corresponding alarm. Please determine if you
need to reset the latching status for the specific alarm when you have changed its alarm priority.
7.10 Silencing Technical Alarms
For some technical alarms, their alarm lamp flashing and alarm tones are cleared and the alarm messages change to
prompt messages after the
hardkey is pressed. After the patient monitor restores the normal status, the patient
monitor can give alarm indications correctly when these alarms are triggered again.
For some technical alarms, all their alarm indications are cleared after the
hardkey is pressed. After the patient
monitor restores the normal status, the patient monitor can give alarm indications correctly when these alarms are
triggered again.
For some other technical alarms, their alarm lamp flashing and alarm tones are cleared and Ĝ appears before the
alarm message after the
hardkey is pressed. After the patient monitor restores the normal status, the patient
monitor can give alarm indications correctly when these alarms are triggered again.
7.11 Testing Alarms
When the monitor starts up, a selftest is performed. In this case the alarm lamp is lit in yellow and red respectively, and
the system gives a beep. This indicates that the visible and audible alarm indicators are functioning correctly.
For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO2 or CO2)
or use a simulator. Adjust alarm limits and check that appropriate alarm behaviour is observed.
7.12 When an Alarm Occurs
When an alarm occurs, observe the following steps and take proper actions:
1.
Check the patient’s condition.
2.
Confirm the alarming parameter or alarm category.
3.
Identify the source of the alarm.
4.
Take proper action to eliminate the alarm condition.
5.
Make sure the alarm condition is corrected.
For troubleshooting specific alarms, see appendix Alarm Messages.
7-12
7.13 Using Care Group Alarms
7.13.1 Care Group Auto Alarms
When auto alarm is set on for viewing other patient and a Care Group is set up on your monitor, a flashing symbol will
appear beside the QuickKeys area if any monitor in your Care Group, which is not currently viewed by your monitor, is
alarming. The alarm symbol is shown as below.
The department and bed label of the alarming monitor appear on the symbol. You can enter the view other patient
window by pressing this symbol.
To switch auto alarm on or off for viewing other patient:
1.
In the main menu, select [Screen Setup >>]ė[Screen Layout >>]ė[View Others Screen]ė
2.
In the view other patient window, select the care group setup button. Then, select [Auto Alarm] and toggle
.
between [On] and [Off].
7.13.2 Silencing Care Group Alarms
You can silence the alarm sound of the currently viewed bed in the view other patient window. This function can be set
in the [Alarm Setup] menu from the [User Maintenance] menu only.
When the alarm silence function for other patients is active and the currently viewed bed is in normal alarm status or
alarm sound off status, press the [Silence] button in the view other patient window. The currently viewed bed will then
enter into the alarm silenced status.
Note that this button is disabled when the currently viewed bed is in alarms off or paused status.
WARNING
z
Silencing care group alarms may cause a potential hazard. Please act with caution.
7-13
FOR Y0UR NOTES
7-14
8 Monitoring ECG
8.1 Introduction
The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the patient monitor as a
waveform and a numeric. This section also tells you about ST monitoring and arrhythmia monitoring. 12-lead
monitoring is available for iPM 12 and iPM 10 patient monitors only. ECG monitoring provides two algorithms:
„
Mindray algorithm
„
Mortara algorithm
The patient monitor incorporating Mortara algorithm is labelled with the logo of Mortara.
8.2 Safety
WARNING
z
Use only ECG electrodes and cables specified by Mindray.
z
When connecting electrodes and/or patient cables, make sure that the connectors never come into contact
with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are
attached to the patient, to prevent them from contacting conductive parts or earth.
z
Periodically inspect the electrode application site to ensure skin quality. If the skin quality changes,
replace the electrodes or change the application site.
z
Use defibrillator-proof ECG cables during defibrillation.
z
Do not touch the patient, or table, or instruments during defibrillation.
z
After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and
applied in accordance with the manufacturer’s instructions for use.
z
Interference from a non-grounded instrument near the patient and electrosurgery interference can cause
problems with the waveform.
8-1
8.3 Preparing to Monitor ECG
8.3.1 Preparing the Patient and Placing the Electrodes
1.
Prepare the patient’s skin. Proper skin preparation is necessary for good signal quality at the electrode, as the skin is
a poor conductor of electricity. To properly prepare the skin, choose flat areas and then follow this procedure:
‹
Shave hair from skin at chosen sites.
‹
Gently rub skin surface at sites to remove dead skin cells.
‹
Thoroughly cleanse the site with a mild soap and water solution. We do not recommend using ether or pure
alcohol, because this dries the skin and increases the resistance.
‹
Dry the skin completely before applying the electrodes.
2.
Attach the clips or snaps to the electrodes before placing them.
3.
Place the electrodes on the patient.
4.
Attach the electrode cable to the patient cable and then plug the patient cable into the ECG connector.
8.3.2 Choosing AHA or IEC Lead Placement
1.
Select the ECG parameter window or waveform area to enter the [ECG Setup] menu.
2.
Select [Lead Set] and then select [3-lead], [5-lead], [12-lead] or [Auto] according to the applied electrodes.
3.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password
4.
Select [Others >>]ė[ECG Standard] and then select [AHA] or [IEC] according to the standard that is applied
for your hospital.
8.3.3 ECG Lead Placements
The electrode placement illustrations in this chapter adopt the AHA standard.
3-Leadwire Electrode Placement
Following is an electrode configuration when using 3 leadwires:
„
RA placement: directly below the clavicle and near the right shoulder.
„
LA placement: directly below the clavicle and near the left shoulder.
„
LL placement: on the left lower abdomen.
5-Leadwire Electrode Placement
Following is an electrode configuration when using 5 leadwires:
„
RA placement: directly below the clavicle and near the right shoulder.
„
LA placement: directly below the clavicle and near the left shoulder.
„
RL placement: on the right lower abdomen.
„
LL placement: on the left lower abdomen.
„
V placement: on the chest.
8-2
The chest (V) electrode can be placed on one of the following positions:
„
V1 placement: on the fourth intercostal space at the right sternal border.
„
V2 placement: on the fourth intercostal space at the left sternal border.
„
V3 placement: midway between the V2 and V4 electrode positions.
„
V4 placement: on the fifth intercostal space at the left midclavicular line.
„
V5 placement: on the left anterior axillary line, horizontal with the V4 electrode
position.
„
V6 placement: on the left midaxillary line, horizontal with the V4 electrode position.
„
V3R-V6R placement: on the right side of the chest in positions corresponding to those on the left.
„
VE placement: over the xiphoid process.
„
V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal space.
„
V7R placement: on posterior chest at the right posterior axillary line in the fifth intercostal space.
12-Leadwire Electrode Placement
12-lead ECG uses 10 electrodes, which are placed on the patient’s four limbs and
chest. The limb electrodes should be placed on the soft skin and the chest
electrodes placed according to the physician’s preference.
Lead Placement for Surgical Patients
The surgical site should be taken into consideration when placing electrodes on a
surgical patient. e.g. for open-chest surgery, the chest electrodes can be placed on
the lateral chest or back. To reduce artifacts and interference from electrosurgical
units, you can place the limb electrodes close to the shoulders and lower abdomen
and the chest electrodes on the left side of the mid-chest. Do not place the
electrodes on the upper arm. Otherwise, the ECG waveform will be very small.
WARNING
z
When using electrosurgical units (ESU), patient leads should be placed in a position that is equal distance
from the Electrosurgery electrotome and the grounding plate to avoid burns to the patient. Never
entangle the ESU cable and the ECG cable together.
z
When using electrosurgical units (ESU), never place ECG electrodes near to the grounding plate of the ESU,
as this can cause a lot of interference on the ECG signal.
8-3
8.3.4 Checking Paced Status
It is important to set the paced status correctly when you start monitoring ECG. The paced symbol
is displayed
when the [Paced] status is set to [Yes]. The pace pulse markers “|” are shown on the ECG wave when the patient has a
paced signal.
To change the paced status, you can select either:
„
the patient information area, or
„
[Main Menu]ė[Patient Setup]ė[Patient Demographics], or,
„
the ECG parameter window or waveform areaė[Others >>],
and then, select [Paced] from the popup menu and toggle between [Yes] and [No].
If you do not set the paced status, the patient monitor issues a prompt tone when pace pulse is detected. At the same
time, the paced symbol flashes and the message “Please confirm the pace of patient” appears in the ECG waveform area.
Then, please check and set the paced status of the patient.
WARNING
z
For paced patients, you must set [Paced] to [Yes]. If it is incorrectly set to [No], the patient monitor could
mistake a pace pulse for a QRS and fail to alarm when the ECG signal is too weak. Do not rely entirely on
rate meter alarms when monitoring patients with pacemakers. Always keep these patients under close
surveillance.
z
For non-paced patients, you must set [Paced] to [No].
z
The auto pacer recognization fucntion is not applicable to neonatal patients.
8.4 Understanding the ECG Display
Your display may be configured to look slightly different.
1
1.
Lead label of the displayed wave
2.
ECG gain
3.
ECG filter label
4.
Notch filter status
2
3
4
Besides, when a paced signal has been detected, the pace pulse marks “|” are shown on the ECG wave if the [Paced] has
been set to [Yes].
8-4
3
1
2
1.
Current heart rate alarm limits
2.
Current heart rate
3.
Heart beat symbol
For 12-lead ECG display screen, refer to the section 12-Lead ECG Monitoring.
8.5 Changing ECG Settings
8.5.1 Accessing ECG Menus
By selecting the ECG parameter window or waveform area, you can access the [ECG Setup] menu.
8.5.2 Setting Pacemaker Rate (For Mortara only)
Some pacemaker pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex and
could result in an incorrect HR and failure to detect some arrhythmias. You can set [Pacemaker Rate] to the
pacemaker’s rate in the [ECG Setup] menu. In this way, the patient monitor can calculate HR and detect arrhythmias
more accurately. When [Paced] is set to [No], the pacemaker rate cannot be set.
8.5.3 Choosing the Alarm Source
In most cases the HR and PR numerics are identical. In order to avoid simultaneous alarms on HR and PR, the monitor
uses either HR or PR as its active alarm source. To change the alarm source, select [Alm Source] in the [ECG Setup]
menu and then select either:
„
[HR]: if you want the HR to be the alarm source for HR/PR.
„
[PR]: if you want the PR to be the alarm source for HR/PR.
„
[Auto]: If the [Alm Source] is set to [Auto], the patient monitor will use the heart rate from the ECG
measurements as the alarm source whenever a valid heart rate is available. If the heart rate becomes unavailable,
for example the ECG module is turned off or becomes disconnected, the patient monitor will automatically switch
to PR as the alarm source.
8.5.4 Setting the ECG Lead Set
You can set the [Lead Set] by selecting [ECG Setup]ė[Others>>]. You can set the [Lead Set] as [Auto] if the
auto lead detection function is available.
8-5
8.5.5 Choosing an ECG Display Screen
When monitoring with a 5-lead or 12-lead set, you can select the [Screens] Quickkey. In the [Choose Screen]
window, choose the screen type as:
„
[Normal Screen]: The ECG waveform area shows 2 ECG waveforms.
„
[ECG 7-Lead Full-Screen]: The whole waveform area shows 7 ECG waveforms only.
„
[ECG 7-Lead Half-Screen]: The upper half part of the whole waveform area displays 7 ECG waveforms.
When monitoring with a 12-lead set, you can also choose the screen type as [ECG 12-Lead Full-Screen].
When the screen type is set to [Normal Screen], cascaded ECG waveforms can be displayed. To cascade ECG
waveforms:
1.
Select the [Screens] Quickkeyė[Screen Setup].
2.
Select [ECG1 Casc.] in the second row. A cascaded waveform is displayed in two waveform positions.
8.5.6 Changing the ECG Filter Settings
The ECG filter setting defines how ECG waves are smoothed. To change the filter setting, select [Filter] from [ECG
Setup] and then select the appropriate setting.
„
[Monitor]: Use under normal measurement conditions.
„
[Diagnostic]: Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes
such as R-wave notching or discrete elevation or depression of the ST segment are visible.
„
[Surgery]: Use when the signal is distorted by high frequency or low frequency interference. High frequency
interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency
interference usually leads to wandering or rough baseline. In the operating room, the surgery filter reduces
artifacts and interference from electrosurgical units. Under normal measurement conditions, selecting [Surgery]
may suppress the QRS complexes too much and then interfere with ECG analysis.
„
[ST]: Use when ST monitoring is applied.
WARNING
z
The [Diagnostic] filter is recommended when monitoring a patient in an environment with slight
interference only.
8.5.7 Switching the Notch Filter On or Off
The notch filter removes the line frequency interference. When [Filter] is not set to [Diagnostic], the notch filter
always stays on. When [Filter] is set to [Diagnostic], you can switch the notch filter on or off as required.
1.
Select the ECG parameter window or waveform area to enter its setup menu. Then select [Others >>].
2.
Select [Notch Filter] and toggle between [On] and [Off]. Switching the notch filter on is recommended when
there is interference (such as spikes) with the waveform.
3.
When [Notch Filter] is set on, select [Main Menu]ė[Maintenance >>]ė[User Maintenance
>>]ėenter the required password.
4.
Select [Others >>]ė[Notch Freq.] and then select [50Hz] or [60Hz] according to the power line frequency.
8-6
8.5.8 Changing the Pacer Reject Settings
Select [ECG Setup]ė[Others>>]ė[Pacer Reject], and toggle between [On] and [Off].
When [Paced] is set to [Yes]:
„
When [Pacer Reject] is switched on, the pace pulses are not counted as extra QRS complexes.
„
The pace pulse marks “|” are shown on the ECG wave when pace pulses are detected.
When [Paced] is set to [No], the pace markers are not shown on the ECG wave, and the options of [Pacer Reject] are
invalid.
8.5.9 About the Defibrillator Synchronization
If a defibrillator is connected, a defibrillator synchronization pulse (100 ms, +5V) is outputted through the
Multifunctional Connector every time when the patient monitor detects an R-wave. The defibrillator synchronization
function is always enabled.
WARNING
z
Improper use of a defibrillator may cause injury to the patient. The user should determine whether to
perform defibrillation or not according to the patient’s condition.
z
Before defibrillation, the user must ensure both defibrillator and monitor has passed the system test and
can be safely used jointly.
z
Before defibrillation, make sure that the [Filter] is set to [Diagnostic].
z
After defibrillation is finished, select the filter mode as required.
8.5.10 Changing ECG Wave Settings
In the [ECG Setup] menu:
„
If the wave is too small or clipped, you can change its size by selecting an appropriate [Gain] setting. If you select
[Auto] from [Gain], the patient monitor will automatically adjust the size of the ECG waves. In normal screen,
only the selected ECG wave’s size is adjusted. In other screens, all ECG waves’ size is adjusted simultaneously.
„
You can change the wave sweep speed by selecting [Sweep] and then selecting the appropriate setting.
8.5.11 Enabling Smart Lead Off
When the smart lead off function is set on and there is a “lead off” in the lead that has an ECG waveform in filter mode
and notch status, if another lead is available, this available lead automatically becomes that lead. The system will
re-calculate HR and analyze and detect arrhythmia. When the “lead off” condition is corrected, the leads are
automatically switched back.
To switch on/off the smart lead off function, select [Others >>] from the [ECG Setup] menu; select [Smart Lead Off]
and toggle between [On] and [Off] from the popup menu.
8-7
8.5.12 Setting the Alarm Level for ECG Lead Off Alarms
Select [Alarm Setup >>] from the [User Maintenance] menu. You can set [ECGLeadOff Lev.] from the popup
menu.
8.5.13 Adjusting QRS Volume
QRS sounds are produced based on the alarm source. To adjust the QRS volume, select [Others >>] from the [ECG
Setup] menu; select [QRS Volume] from the popup menu and select the appropriate setting. When valid SpO2
measured value is available, the system adjusts the pitch tone of QRS sound based on the SpO2 value.
8.6 About ST Monitoring
„
ST segment analysis is not intended for neonatal patients.
„
ST segment analysis calculates ST segment elevations and depressions for individual leads and then displays
them as numerics in the ST1 and ST2 areas.
„
A positive value indicates ST segment elevation; a negative value indicates ST segment depression.
„
Measurement unit of the ST segment: mV or mm. You can set the unit in the [Unit Setup] menu from the [User
Maintenance] menu.
„
Measurement range of the ST segment: -2.0 mV to +2.0 mV.
WARNING
z
The ST algorithm has been tested for accuracy of the ST segment data. The significance of the ST segment
changes need to be determined by a clinician.
8.6.1 Switching ST On and Off
To switch ST monitoring on or off:
1.
In the [ECG Setup] menu, select [ST Analysis >>].
2.
Select [ST Analysis] to toggle between [On] and [Off].
Reliable ST monitoring can hardly be ensured if:
„
You are unable to get a lead that is not noisy.
„
Arrhythmias such as atrial fib/flutter cause irregular baseline.
„
The patient is continuously ventricularly paced.
„
The patient has left bundle branch block.
In these cases, you may consider switching ST monitoring off.
8-8
8.6.2 Changing ST Filter Settings
ST-segment analysis can be carried out only when the filter mode is set to [Diagnostic] or [ST]. When ST-segment
analysis is switched on, [Filter] will automatically switch to [ST] if it is not [Diagnostic] or [ST]. When ST-segment
analysis is switched off, the filter mode automatically switches to previous manual setting.
However, if you switch [Filter] to [Monitor] or [Surgery], ST-segment analysis will turn off automatically. In case that
you change [Monitor] or [Surgery] to [Diagnostic] or [ST], ST-segment analysis keeps off, you can turn it on
manually.
NOTE
z
When the filter mode is switched to [Diagnostic], the notch filter automatically switches to [Off]. In this
case, you can still set the notch filter to [On] manually.
z
When the filter mode is [Monitor], [Surgery] or [ST], the notch filter is fixed to [On], and can not be
changed.
8.6.3 Understanding the ST Display
8.6.3.1 ST Numerics
This example shows ST numerics with 5-lead ECG. Your monitor screen may look slightly different from the illustration.
8.6.3.2 ST Segment
ST segment shows a QRS complex segment for each measured ST lead. The current ST segment is drawn in the same
color as the ECG wave, usually green, superimposed over the stored reference segment, drawn in a different color. The
information is updated once every ten seconds.
To display the ST segment on normal screen:
1.
Enter the [ST Analysis] menu. Set [ST Analysis] to [On].
2.
Enter the [Screen Setup] window of [Screens] menu. Set [ST Segment] to be displayed.
8-9
Select the ST parameter window or ST segment area and you can enter the [ST Analysis] menu.
8.6.4 Saving the Current ST Segment as Reference
Select [Save Ref.] in the [ST Analysis] menu to save the current segment as reference. Up to 20 reference segment
groups can be saved.
NOTE
z
If the memory is full and you do not delete a group before saving a new one, the oldest saved group is
deleted automatically.
8.6.5 Changing the Reference Segment
Select the
and
arrow keys beside the [Change Ref.] to switch between different reference segment groups.
8.6.6 Deleting a Reference Segment
To delete the current ST reference segment, select [Delete Ref.] in the [ST Analysis] menu and then select [Ok] in
the popup.
8.6.7 Recording the ST Segment
To record the current ST segment and reference segment, select [Record] in the [ST Analysis] menu.
8.6.8 Changing the ST Alarm Limits
High and low ST alarm limits can be set individually for each ECG lead. Alarm limits can also be set separately for
single-lead and multi-lead ST monitoring. You can select [ST Alarm Setup >>] from [ST Analysis] menu and then
change ST alarm settings for each lead.
8-10
8.6.9 Setting the ST Alarm Delay Time
You can set the ST alarm delay time from the [Others] window of [Alarm Setup] menu.
8.6.10 Adjusting ST Measurement Points
As shown in the figure below, the ST measured for each beat complex is the vertical difference between two
measurement points with the R-wave peak as the baseline for the measurement.
R-wave peak
J point
P
T
Difference=ST value
Isoelectric point
ST measurement point
The ISO and ST points need to be adjusted when you start monitoring and if the patient’s heart rate or ECG morphology
changes significantly. Exceptional QRS complexes are not considered for ST-segment analysis.
WARNING
z
Always make sure that the positions of ST measurement points are appropriate for your patient.
To adjust the ST measurement points:
1.
In the [ST Analysis] menu, select [Adjust ST Point >>]. In the [Adjust ST Point] window, three vertical
lines represent the ISO, J and ST point positions respectively.
2.
Select [View Leads] and use the Knob to select an ECG lead with obvious J point and R wave.
3.
Select [ISO], [J] or [ST Point] and then use the Knob to adjust the position of each point.
‹
The ISO-point (isoelectric) position is given relative to the R-wave peak. Position the ISO-point in the middle of
the flattest part of the baseline (between the P and Q waves of in front of the P wave).
‹
The J-point position is given relative to the R-wave peak and helps locating the ST-point. Position the J-point at
the end of the QRS complex and the beginning of the ST segment.
‹
The ST-point is positioned a fixed distance from the J-point. Move the J-point to position the ST-point at the
midpoint of the ST segment. Position the ST-point relative to the J-point at either [J+60/80ms], [J+40ms],
[J+60ms] or [J+80ms]. When [J+60/80ms] is selected, the ST-point will be positioned 80 ms (heart rate 120
bpm or less) or 60 ms (heart rate more than 120 bpm) from the J-point.
8-11
8.7 About Arrhythmia Monitoring
Arrhythmia analysis provides information about your patient’s condition, including heart rate, PVC rate, rhythm and
ectopics.
WARNING
z
Arrhythmia analysis program is intended to detect ventricular arrhythmias. It is not designed to detect
atrial or supraventricular arrhythmias. It may incorrectly identify the presence or absence of an
arrhythmia. Therefore, a physician must analyze the arrhythmia information with other clinical findings.
z
The arrhythmia detection is not intended for neonatal patients.
8.7.1 Understanding the Arrhythmia Events
Mindray algorithm
Arrhythmia message
Asystole
Vfib/Vtac
Vtac
Vent. Brady
Description
Category
No QRS detected within the set time threshold in absence of ventricular fibrillation
or chaotic signal.
A fibrillatory wave for 6 consecutive seconds.
A dominant rhythm of adjacent Vs and a HR > the V-Tac HR limit.
The consecutive PVCs > Vtac PVCs limit, and the HR > the Vtac HR limit.
Lethal
arrhythmia
The consecutive PVCs ≥ the Vbrd threshold and the ventricular HR < the Vbrd Rate
threshold.
Extreme Tachy
The heart rate is greater than the extreme tachycardia limit.
Extreme Brady
The heart rate is less than the extreme bradycardia limit.
PVCs
PVCs/min exceeds high limit
Nonlethal
No pace pulse detected for 1.75 x average R-to-R intervals following a QRS complex
arrhythmia
Pacer Not Pacing
Pacer Not Capture
(for paced patients only).
No QRS complex detected for 300 milliseconds following a pace pulse (for paced
patients only).
PVC
One PVC detected in normal heartbeats.
Couplet
Paired PVCs detected in normal heartbeats.
VT > 2
More than 2 consecutive PVCs within the last minute.
Bigeminy
A dominant rhythm of N, V, N, V, N, V.
Trigeminy
A dominant rhythm of N, N, V,N, N, V, N, N, V.
R on T
R on T detected in normal heartbeats.
No beat detected for 1.75 x average R-R interval for HR <120, or
Missed Beats
No beat for 1 second with HR > 120 (for non-paced patients only), or
No beat detected for more than the set pause threshold.
Brady
The average heart rate is less than the bradycardia limit.
Tachy
The average heart rate is greater than the tachycardia limit.
Vent. Rhythm
The consecutive PVCs > the Vbrd PVCs limit, and the HR is between
Vbrd Rate limit and the Vtac Rate limit.
8-12
Arrhythmia message
Description
Category
Multif. PVC
Multiform PVCs detected in Multif. PVC's Window (which is adjustable).
Nonsus. Vtac
The consecutive PVCs < the Vtac PVCs limit but > 2, and HR > the Vtac
Rate limit.
Pause
No QRS detected within the set time threshold of pause.
Irr. Rhythm
Consistently irregular rhythm.
Mortara algorithm
Arrhythmia Message
Description
Category
Asystole
No QRS complex detected within the set time threshold (in absence of
Lethal
ventricular fibrillation or chaotic signals).
arrhythmia
Vfib
Ventricular fibrillation occurs and persists for 6 seconds.
Vtac
Ventricular HR is greater or equal to the preset threshold and the number of
consecutive PVCs is greater than the preset threshold.
PVCs
PVCs/min exceeds high limit
Nonlethal
PNP
No pace pulse detected for (60*1000/pace rate +90) milliseconds following a QRS
arrhythmia
complex or a pacer pulse (for paced patients only).
PNC
No QRS complex detected for 300 milliseconds following a pace pulse (for paced
patients only).
Multif. PVC
More than 2 PVCs of different forms occur in the predefined search window
(3-31).
Couplet
Paired PVCs are detected.
VT > 2
Ventricular HR is greater than or equal to the preset threshold and the number of
PVCs is greater than or equal to 3 but less than the preset threshold.
Vent. Rhythm
Ventricular HR is less than the preset threshold and the number of PVCs is greater
than or equal to 3.
Bigeminy
A dominant rhythm of N, V,N, V, N, V.
Trigeminy
A dominant rhythm of N, N, V,N, N, V, N, N, V.
R on T
R on T is detected.
Irr. Rhythm
Consistently irregular rhythm
Missed Beats
No beat detected for 1.75x average R-R interval for HR <120, or
No beat for 1 second with HR >120 (for non-paced patients only), or
No beat detected for more than the set pause threshold.
Brady
The HR is less than the set bradycardia low limit.
Tachy
The HR is greater than the set tachycardia high limit.
8-13
8.7.2 Changing Arrhythmia Alarm Settings
To change arrhythmia alarm settings, select the ECG parameter area or waveform area ė[ECG Setup]ė [Arrh.
Analysis >>]. In the pop-up menu, you can set the [Alm Lev] to [High], [Med], [Low] or [Message], or switch on lethal
arrhythmia analysis alarms only or switch on/off all arrhythmia analysis alarms. In the [Alarm Setup] menu from the
[User Maintenance] menu, you can enable/disable turning off lethal arrhythmia analysis alarms.
WARNING
z
If you switch off all arrhythmia analysis alarms, the monitor cannot give any arrhythmia analysis alarm.
Always keep the patient under close surveillance.
8.7.3 Changing Arrhythmia Threshold Settings
Select the ECG parameter window or waveform areaė[Arrh. Analysis >>]ė[Arrh. Threshold], and you can then
change threshold settings for some arrhythmia alarms. In case an arrhythmia violates its threshold, an alarm will be
triggered. The asystole delay time relates to ECG relearning. When HR is less than 30 bpm, it is recommended to set the
asystole delay time to 10 seconds.
Mindray algorithm
Arrh. event
Range
Default
Step
Unit
PVCs High
1 to 10
10
1
/min
Asys. Delay
3 to 10
5
1
s
Tachy High
60 to 300
5
bpm
Brady Low
15 to 120
5
bpm
Extreme Tachy
120 to 300
5
bpm
Extreme Brady
15 to 60
5
bpm
Multif. PVC's Window
3 to 31
15
1
/min
Vtac Rate
100 to 200
130
5
bpm
Vtac PVCs
3 to 99
6
1
/min
Pause Time
1.5, 2.0,2.5
2
/
s
Vbrd PVCs
3 to 99
5
1
/min
Vbrd Rate
15 to 60
40
5
bpm
Adult: 120
Pediatric: 160
Adult: 50
Pediatric: 75
Adult: 160
Pediatric: 180
Adult: 35
Pediatric: 50
8-14
Mortara algorithm
Arrh. event
Range
Default
Step
Unit
PVCs High
1 to 10
10
1
/min
Asys. Delay
2 to 10
5
1
s
Vtac Rate
100 to 200
130
5
bpm
Vtac PVC
3 to 12
6
1
beats
Multif. PVC
3 to 31
15
1
beats
Adult: 100 to 300
Adult: 100
Pediatric: 160 to 300
Pediatric: 160
5
bpm
Adult: 15 to 60
Adult: 60
Pediatric: 15 to 80
Pediatric: 80
5
bpm
Tachy High
Brady Low
8.7.4 Setting the Extended Arrhythmia˄For Mindray Algorithm only˅
The following arrhythmia events are defined as extended arrhythmia:
„
Extreme Tachy
„
Extreme Brady
„
Vent. Brady
„
Nonsus. Vtac
„
Multif. PVC
„
Irr. Rhythm
„
Pause
You can select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required
passwordėselect [Alarm Setup >>], and set [Extended Arrh.] to [Enable] or [Disable]. When [Extended
Arrh.] is set to [Disable], the patient monitor does not analysis the extended arrhythmia events and corresponding
alarms are not given.
CAUTION
z
Set [Extended Arrh.] to [Disable] when the patient monitor is connected to the Central Monitoring
System of version prior to 06.01.00. Failure to do so may cause the Central Monitoring System unable to
display extended arrhythmia related alarms normally when extended arrhythmia occurs.
8.7.5 Reviewing Arrhythmia Events
Please refer to the Review chapter.
8-15
8.8 ECG Relearning
8.8.1 Initiating an ECG Relearning Manually
During ECG monitoring, you may need to initiate an ECG relearning when the patient’s ECG template changes
dramatically. A change in the ECG template could result in:
„
incorrect arrhythmia alarms
„
loss of ST measurement, and/or
„
inaccurate heart rate
ECG relearning allows the monitor to learn the new ECG template so as to correct arrhythmia alarms and HR value, and
restore ST measurements. To initiate relearning manually, select the ECG parameter window or waveform
areaė[Relearn]. When the patient monitor is learning, the message [ECG Learning] is displayed in the technical
alarm area.
CAUTION
z
Take care to initiate ECG relearning only during periods of normal rhythm and when the ECG signal is
relatively noise-free. If ECG learning takes place during ventricular rhythm, the ectopics may be incorrectly
learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach
and V-Fib.
8.8.2 Automatic ECG Relearning
ECG relearning is initiated automatically whenever:
„
The ECG lead or lead label is changed
„
The ECG lead is re-connected
„
A new patient is admitted
„
After the calibration is completed, select [Stop Calibrating ECG]
„
A switch happens between the options of screen type during 5/12-lead ECG monitoring.
„
The paced status of the patient is changed.
8-16
8.9 12-Lead ECG Monitoring (for iPM 12 and iPM 10 patient monitors only)
1.
Refer to the section 8.3.3 ECG Lead Placements for placing the electrodes.
2.
In the [ECG Setup] menu, select [Lead Set]ė[12-Lead]. Select [Screens] Quickkeyė[ECG 12-Lead
Full-Screen].
There are totally 12 ECG waves and 1 rhythm wave displayed on the screen. The rhythm lead is ECGĉbefore entering the
12-lead ECG monitoring screen. The ST numerics are displayed in three groups:
„
ST Ant (anterior):
„
ST Inf (inferior): II, III, aVF, (aVR)
„
ST Lat (lateral): I, aVL, V5, V6
V1, V2, V3, V4
Although aVR is displayed in the ST Inf group, it is not an inferior lead.
Additionally, the 12-lead ECG monitoring has the following features:
„
The [Filter] mode is fixed to [Diagnostic] and cannot be changed.
„
In the adult mode, the
hardkey on the monitor’s front is disabled
8-17
FOR YOUR NOTES
.
8-18
9 Monitoring Respiration (Resp)
9.1 Introduction
Impedance respiration is measured across the thorax. When the patient is breathing or ventilated, the volume of air
changes in the lungs, resulting in impedance changes between the electrodes. Respiration rate (RR) is calculated from
these impedance changes, and a respiration waveform appears on the patient monitor screen.
9.2 Safety Information
WARNING
z
When monitoring the patient’s respiration, do not use ESU-proof ECG cables.
z
If you do not set the detection level for the respiration correctly in manual detection mode, it may not be
possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely
to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of
apnea.
z
The respiration measurement does not recognize the cause of apneas. It only indicates an alarm if no
breath is detected when a pre-adjusted time has elapsed since the last detected breath. Therefore, it
cannot be used for diagnostic purpose.
z
If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated Immunity 3V/m),
field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is
recommended to avoid the use of electrically radiating equipment in close proximity to the respiration
measurement unit.
9.3 Understanding the Resp Display
By selecting the waveform area or parameter area, you can enter the [Resp Waveform] menu. By selecting the Resp
parameter window, you can enter the [Resp Setup] menu.
NOTE
z
Respiration monitoring is not for use on the patients who are very active, as this will cause false alarms.
9-1
9.4 Placing Resp Electrodes
As the skin is a poor conductor of electricity, preparing the skin is necessary for a good Respiration signal. You can refer
to the ECG section for how to prepare the skin.
As the Respiration measurement adopts the standard ECG electrode placement, you can use different ECG cables (3-lead,
5-lead or 12-lead). Since the respiration signal is measured between two ECG electrodes, if a standard ECG electrode
placement is applied, the two electrodes should be RA and LA of ECG Lead I, or RA and LL of ECG Lead II.
NOTE
z
To optimize the respiration waveform, place the RA and LA electrodes horizontally when monitoring
respiration with ECG Lead I; place the RA and LL electrodes diagonally when monitoring respiration with
ECG Lead II.
Lead I
Lead II
9.4.1 Optimizing Lead Placement for Resp
If you want to measure Resp and you are already measuring ECG, you may need to optimize the placement of the two
electrodes between which Resp will be measured. Repositioning ECG electrodes from standard positions results in
changes in the ECG waveform and may influence ST and arrhythmia interpretation.
9.4.2 Cardiac Overlay
Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up
impedance changes caused by the rhythmic blood flow. Correct electrodes placement can help to reduce cardiac
overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is
particularly important for neonates.
9-2
9.4.3 Abdominal Breathing
Some patients with restricted movement breathe mainly abdominally. In these cases, you may need to place the left leg
electrode on the left abdomen at the point of maximum abdominal expansion to optimise the respiratory wave.
9.4.4 Lateral Chest Expansion
In clinical applications, some patients (especially neonates) expand their chests laterally, causing a negative intrathoracic
pressure. In these cases, it is better to place the two respiration electrodes in the right midaxillary and the left lateral
chest areas at the patient’s maximum point of the breathing movement to optimise the respiratory waveform.
9.5 Choosing the Respiration Lead
In the [Resp Setup] menu, select [Resp Lead] and toggle between [I] and [II].
9.6 Changing the Apnea Alarm Delay
The apnea alarm is a high-level alarm used to detect apneas. You can set the apnea alarm delay time after which the
patient monitor alarms if the patient stops breathing. In the [Resp Setup] menu, select [Apnea Delay] and then
select the appropriate setting. The [Apnea Delay] of Resp, CO2, and AG module keeps consistent with each other.
9.7 Changing Resp Detection Mode
In the [Resp Setup] menu, select [Detection Mode] and toggle between [Auto] and [Manual].
„
In auto detection mode, the patient monitor adjusts the detection level automatically, depending on the wave
height and the presence of cardiac artifact. Note that in auto detection mode, the detection level (a dotted line) is
not displayed on the waveform.
Use auto detection mode for situations where:
„
‹
The respiration rate is not close to the heart rate.
‹
Breathing is spontaneous, with or without continuous positive airway pressure (CPAP).
‹
Patients are ventilated, except patients with intermittent mandatory ventilation (IMV).
In manual detection mode, you adjust the dotted detection level line to the desired level by selecting [Upper
Line] or [Lower Line] and then selecting
or
beside them. Once set, the detection level will not adapt
automatically to different respiration depths. It is important to remember that if the depth of breathing changes,
you may need to change the detection level.
Use manual detection mode for situations where:
‹
The respiration rate and the heart rate are close.
‹
Patients have intermittent mandatory ventilation.
‹
Respiration is weak. Try repositioning the electrodes to improve the signal.
9-3
In Auto Detection Mode, if you are monitoring Resp and ECG is switched off, the monitor cannot compare the ECG and
Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection
of cardiac overlay as respiration.
In Manual Detection Mode, cardiac overlay can in certain situations trigger the respiration counter. This may lead to a
false indication of a high respiration or an undetected apnea condition. If you suspect that cardiac overlay is being
registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small
that raising the detection level is not possible, you may need to optimize the electrode placement as described in the
section "Lateral Chest Expansion".
9.8 Changing Resp Wave Settings
WARNING
z
When monitoring in manual detection mode, make sure to check the respiration detection level after you
have increased or decreased the size of the respiration wave.
In the [Resp Setup] menu, you can:
„
Select [Gain] and then select an appropriate setting. The bigger the gain is, the larger the wave amplitude is.
„
Select [Sweep] and then select an appropriate setting. The faster the wave sweeps, the wider the wave is.
9.9 Setting RR Source
To set RR source:
1.
Enter the [Resp Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
The dropdown list displays the currently available RR source. When you select [Auto], the system will automatically
select the RR source according to the priority. When the current RR source does not have valid measurement, the system
will automatically switch the [RR Source] to [Auto]. RR source switches back to impedance respiration if you press the
silence hardkey on the monitor’s front during an apnea alarm.
The priority of RR source is (from high to low): CO2 measurement, and impedance respiration measurement. The [RR
Source] settings of Resp, CO2, and AG module are linked.
The RR source options and description are shown in the table below.
Option
Description
Auto
RR source is automatically selected according to the priority.
CO2
RR source is from CO2 measurement.
ECG
RR source is from impedance respiration measurement.
9-4
9.10 Setting alarm properties
Select [Alarm Setup >>] from the [Resp Setup] menu. In the popup menu, you can set alarm properties for this
parameter.
9.11 Switching Resp Measurement On/Off
To switch Resp measurement on, select [Imped. Resp Measure. ON] from the [Resp Setup] menu. To switch Resp
measurement off, select [Imped. Resp Measure. OFF] from the [Resp Setup] menu and then select [Yes] from
the popup dialog box. Then, a line is displayed in the waveform area and no numeric but [Measurement OFF]
message is displayed in the parameter area.
9-5
FOR YOUR NOTES
9-6
10 Monitoring PR
10.1 Introduction
The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart. You can display a
pulse from any measured SpO2 or any arterial pressure (see the IBP section). The displayed pulse numeric is color-coded
to match its source.
1
.
PR: detected beats per minute.
.
PR Source
10.2 Setting the PR Source
The current pulse source is displayed in the PR parameter area. The pulse rate chosen as pulse source:
„
is monitored as system pulse and generates alarms when you select PR as the active alarm source;
„
is stored in the monitor’s database and reviewed in the graphic/tabular trends; in trend graphs, as the PR curve is
in the same color with the PR source , it is unlikely to distinguish the PR source ;
„
is sent via the network to the central monitoring system, if available.
To set which pulse rate as PR source:
1.
Enter the [SpO2 Setup] menu.
2.
Select [PR Source] and then select a label or [Auto] from the popup menu.
The popup menu displays the currently available PR sources from top to bottom by priority. When you select [Auto],
the system will automatically select the first option as the PR source from the popup menu. When the current PR source
is unavailable, the system will automatically switch [PR Source] to [Auto]. When you select [IBP], the system will
automatically select the first pressure label as the PR source from the popup menu.
10-1
10.3 Selecting the Active Alarm Source
In most cases the HR and pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the
monitor uses either HR or Pulse as its active alarm source. To change the alarm source, select [Alm Source] in the [ECG
Setup] or [SpO2 Setup] menu and then select either:
„
[HR]: The monitor will use the HR as the alarm source for HR/pulse.
„
[PR]: The monitor will use the PR as the alarm source for HR/pulse.
„
[Auto]: If the [Alm Source] is set to [Auto], the monitor will use the heart rate from the ECG measurement as
the alarm source whenever the ECG measurement is switched on and a valid heart rate is available. If the heart
rate becomes unavailable, for example if leads becomes disconnected, and a pulse source is switch on and
available, the monitor will automatically switch to Pulse as the alarm source. When the Leads Off condition is
corrected, the monitor will automatically switch back to the heart rate as the alarm source.
10.4 QRS Tone
When PR is used as the alarm source, the PR source will be used as a source for the QRS tone. You can change the QRS
volume by adjusting [Beat Vol] in the [SpO2 Setup] menu. When a valid SpO2 value exists, the system will adjust the
pitch tone of QRS volume according to the SpO2 value.
10-2
11 Monitoring SpO
2
11.1 Introduction
SpO2 monitoring is a non-invasive technique used to measure the amount of oxygenated haemoglobin and pulse rate
by measuring the absorption of selected wavelengths of light. The light generated in the probe passes through the
tissue and is converted into electrical signals by the photodetector in the probe. The SpO2 module processes the
electrical signal and displays a waveform and digital values for SpO2 and pulse rate.
This device is calibrated to display functional oxygen saturation. It provides four measurements:
1.
Pleth waveform (Pleth): visual indication of patient’s pulse. The waveform is not normalized.
2.
Oxygen saturation of arterial blood (SpO2): percentage of oxygenated hemoglobin in relation to the sum of
oxyhemoglobin and deoxyhemoglobin.
3.
Perfusion index (PI): gives the numerical value for the pulsatile portion of the measured signal caused by arterial
pulsation. PI is an indicator of the pulsatile strength. You can also use it to assess the quality of SpO2 measurement.
Above 1 is optimal, between 0.3 and 1 is acceptable. Below 0.3 indicates low perfusion; reposition the SpO2 sensor or
find a better site. If low perfusion persists, choose another method to measure oxygen saturation if possible.
PI is available for Mindray SpO2 module or Masimo SpO2 module.
4.
Perfusion indicator: the pulsatile portion of the measured signal caused by arterial pulsation.
5.
Pulse rate (derived from pleth wave): detected pulsations per minute.
11-1
11.2 Safety
WARNING
z
Use only SpO2 sensors specified in this manual. Follow the SpO2 sensor’s instructions for use and adhere to
all warnings and cautions.
z
When a trend toward patient deoxygenation is indicated, blood samples should be analyzed by a
laboratory co-oximeter to completely understand the patient’s condition.
z
Do not use SpO2 sensors during magnetic resonance imaging (MRI). Induced current could potentially
cause burns. The sensor may affect the MRI image, and the MRI unit may affect the accuracy of the
oximetry measurements.
z
Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics,
such as irritation, reddening, blistering or burns. Inspect the sensor site every two hours and move the
sensor if the skin quality changes. Change the application site every four hours. For neonates, or patients
with poor peripheral blood circulation or sensitive skin, inspect the sensor site more frequently.
11.3 Identifying SpO2 Modules
To identify which SpO2 module is incorporated into your patient monitor, see the color of the SpO2 connector and the
company logo located at the patient monitor. The color of the cable connector matches the company as shown below:
„
Mindray SpO2 module: a blue connector without logo.
„
Masimo SpO2 module: a purple connector with a logo of Masimo SET.
„
Nellcor SpO2 module: a grey connector with a logo of Nellcor.
The connectors for these three SpO2 sensors are mutually exclusive.
11.4 Applying the Sensor
1.
Select an appropriate sensor according to the module type, patient category and weight.
2.
Remove colored nail polish from the application site.
3.
Apply the sensor to the patient.
4.
Select an appropriate adapter cable according to the connector type and plug this cable into the SpO2 connector.
5.
Connect the sensor cable to the adapter cable.
11.5 Changing SpO2 Settings
11.5.1 Accessing SpO2 Menus
By selecting the SpO2 parameter window or waveform area, you can access the [SpO2 Setup] menu.
11-2
11.5.2 Adjusting the Desat Alarm
The desat alarm is a high level alarm notifying you of potentially life threatening drops in oxygen saturation. Select
[Alarm Setup >>] from the [SpO2 Setup] menu. From the popup menu, you can set low alarm limit, alarm switch,
and alarm recording for [Desat]. When the SpO2 value is below the desat alarm limit and desat alarm switch is set on,
the message [SpO2 Desat] is displayed.
11.5.3 Setting SpO2 Sensitivity
For Masimo SpO2 module, you can set [Sensitivity] to [Normal] or [Maximum] in the [SpO2 Setup] menu. When
the [Sensitivity] is set to [Maximum], the patient monitor is more sensitive to minor signals. When monitoring
critically ill patients whose pulsations are very weak, it is strongly recommended that the sensitivity is set to
[Maximum]. When monitoring neonatal or non-critically ill patients who tend to move a lot, noise or invalid signals
may be caused. In this case, it is recommended that the sensitivity is set to [Normal] so that the interference caused by
motion can be filtered and therefore the measurement stability can be ensured.
11.5.4 Changing Averaging Time
The SpO2 value displayed on the monitor screen is the average of data collected within a specific time. The shorter the
averaging time is, the quicker the patient monitor responds to changes in the patient’s oxygen saturation level.
Contrarily, the longer the averaging time is, the slower the patient monitor responds to changes in the patient’s oxygen
saturation level, but the measurement accuracy will be improved. For critically ill patients, selecting shorter averaging
time will help understanding the patient’s state.
To set the averaging time:
„
For Mindray SpO2 module, select [Sensitivity] in the [SpO2 Setup] menu and then toggle between [High],
[Med] and [Low], which respectively correspond to 7 s, 9 s and 11 s.
„
For Masimo SpO2 module, select [Averaging] in the [SpO2 Setup] menu and then toggle between [2-4 s],
[4-6 s], [8 s], [10 s], [12 s], [14 s] and [16 s].
11.5.5 Monitoring SpO2 and NIBP Simultaneously
When monitoring SpO2 and NIBP on the same limb simultaneously, you can switch [NIBP Simul] on in the [SpO2
Setup] menu to lock the SpO2 alarm status until the NIBP measurement ends. If you switch [NIBP Simul] off, low
perfusion caused by NIBP measurement may lead to inaccurate SpO2 readings and therefore cause false physiological
alarms.
11.5.6 Sat-Seconds Alarm Management
With traditional alarm management, high and low alarm limits are set for monitoring oxygen saturation. During
monitoring, as soon as an alarm limit is violated, an audible alarm immediately sounds. When the patient % SpO2
fluctuates near an alarm limit, the alarm sounds each time the limit is violated. Such frequent alarm can be distracting.
Nellcor’s Sat-Seconds alarm management technique is used to reduce these nuisance alarms.
11-3
The Sat-Seconds feature is available with the Nellcor SpO2 module to decrease the likelihood of false alarms caused by
motion artifacts. To set the Sat-Seconds limit, select [Sat-Seconds] in the [SpO2 Setup] menu and then select the
appropriate setting.
With Sat-Seconds alarm management, high and low alarm limits are set in the same way as traditional alarm
management. A Sat-Seconds limit is also set. The Sat-Seconds limit controls the amount of time that SpO2 saturation
may be outside the set limits before an alarm sounds. The method of calculation is as follows: the number of percentage
points that the SpO2 saturation falls outside the alarm limit is multiplied by the number of seconds that it remains
outside the limit. This can be stated as the equation:
Sat-Seconds= Points × Seconds
Only when the Sat-Seconds limit is reached, the monitor gives a Sat-Seconds alarm. For example, the figure below
demonstrates the alarm response time with a Sat-Seconds limit set at 50 and a low SpO2 limit set at 90%. In this example,
the patient % SpO2 drops to 88% (2 points) and remains there for 2 seconds. Then it drops to 86% (4 points) for 3 seconds,
and then to 84% (6 points) for 6 seconds. The resulting Sat-Seconds are:
% SpO2
Seconds
Sat-Seconds
2×
2=
4
4×
3=
12
6×
6=
36
Total Sat-Seconds=
52
After approximately 10.9 seconds, a Sat-Second alarm would sound, because the limit of 50 Sat-Seconds would have
been exceeded.
Saturation levels may fluctuate rather than remaining steady for a period of several seconds. Often, the patient % SpO2
may fluctuate above and below an alarm limit, re-entering the non-alarm range several times. During such fluctuation,
the monitor integrates the number of %SpO2 points, both positive and negative, until either the Sat-Seconds limit is
reached, or the patient%SpO2 re-enters the non-alarm range and remains there.
11-4
11.5.7 Changing the Speed of the Pleth Wave
In the [SpO2 Setup] menu, select [Sweep] and then select the appropriate setting. The faster the waveform sweeps,
the wider the waveform is.
11.5.8 Setting the Alarm Level for SpO2 Sensor Off Alarm
Select [Alarm Setup >>] from the [User Maintenance] menu. You can set the [SpO2SensorOff Lev.] in the
popup menu.
11.5.9 Setting the SpO2 Tone Mode
Select [Others >>] from the [User Maintenance] menu. In the popup menu, you can set [SpO2 Tone] as [Mode
1] or [Mode 2].
WARNING
z
The same SpO2 tone mode shall be used for the same patient monitors in a single area.
11.6 Measurement Limitations
If you doubt the measured SpO2, check patient vital signs first. Then check the patient monitor and SpO2 sensor. The
following factors may influence the accuracy of measurement:
„
Ambient light
„
Physical movement (patient and imposed motion)
„
Diagnostic testing
„
Low perfusion
„
Electromagnetic interference, such as MRI environment
„
Electrosurgical units
„
Dysfunctional haemoglobin, such as carboxyhemoglobin (COHb)and methemoglobin (MetHb)
„
Presence of certain dyes, such as methylene and indigo carmine
„
Inappropriate positioning of the SpO2 sensor, or use of incorrect SpO2
„
Drop of arterial blood flow to immeaurable level caused by shock, anemia, low temperature or vasoconstrictor.
11-5
11.7 Masimo Information
„
Masimo Patents
This device is covered under one or more the following U.S.A. patents: 5,758,644, 6,011,986, 6,699,194, 7,215,986,
7,254,433, 7,530,955 and other applicable patents listed at: www.masimo.com/patents.htm.
„
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with
unauthorized sensors or cables which would, alone, or in combination with this device, fall within the scope of one or
more of the patents relating to this device.
11.8 Nellcor Information
„
Nellcor Patents
This device may be covered by one or more of the following US patents and foreign equivalents: 5,485,847, 5,676,141,
5,743,263, 6,035,223, 6,226,539, 6,411,833, 6,463,310, 6,591,123, 6,708,049, 7,016,715, 7,039,538, 7,120,479, 7,120,480,
7,142,142, 7,162,288, 7,190,985, 7,194,293, 7,209,774, 7,212,847, 7,400,919.
„
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with
unauthorized replacement parts which would, alone, or in combination with this device, fall within the scope of one or
more of the patents relating to this device.
11-6
12 Monitoring NIBP
12.1 Introduction
The patient monitor uses the oscillometric method for measuring the non-invasive blood pressure (NIBP). This
measurement can be used for adults, pediatrics and neonates.
Automatic non-invasive blood pressure monitoring uses the oscillometric method of measurement. To understand how
this method works, we’ll compare it to the auscultative method. With auscultation, the clinician listens to the blood
pressure and determines the systolic and diastolic pressures. The mean pressure can then be calculated with reference
to these pressures as long as the arterial pressure curve is normal.
Since the monitor cannot hear the blood pressure, it measures cuff pressure oscillation amplitudes. Oscillations are
caused by blood pressure pulses against the cuff. The oscillation with the greatest amplitude is the mean pressure. This is
the most accurate parameter measured by the oscillometric method. Once the mean pressure is determined, the systolic
and diastolic pressures are calculated with reference to the mean.
Simply stated, auscultation measures systolic and diastolic pressures and the mean pressure is calculated. The
oscillometric method measures the mean pressure and determines the systolic and diastolic pressures.
As specified by IEC 60601-2-30/EN60601-2-30, NIBP measurement can be performed during electro-surgery and
discharge of defibrillator.
NIBP diagnostic significance must be decided by the doctor who performs the measurement.
NOTE
z
Blood pressure measurements determined with this device are equivalent to those obtained by a trained
observer using the cuff/stethoscope auscultatory method or an intra-arterial blood pressure measurement
device, within the limits prescribed by the American National Standard, Manual, electronic, or automated
sphygmomanometers.
12-1
12.2 Safety
WARNING
z
Be sure to select the correct patient category setting for your patient before measurement. Do not apply
the higher adult settings for pediatric or neonatal patients. Otherwise it may present a safety hazard.
z
Do not measure NIBP on patients with sickle-cell disease or any condition where skin damage has occurred
or is expected.
z
Use clinical judgement to determine whether to perform frequent unattended blood pressure
measurements on patients with severe blood clotting disorders because of the risk of hematoma in the
limb fitted with the cuff.
z
Do not use the NIBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could
cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.
z
If you doubt the NIBP readings, determines the patient’s vital signs by alternative means and then verify
that the monitor is working correctly.
12.3 Measurement Limitations
Measurements are impossible with heart rate extremes of less than 40bpm or greater than 240bpm, or if the patient is
on a heart-lung machine.
The measurement may be inaccurate or impossible:
„
If a regular arterial pressure pulse is hard to detect
„
With excessive and continuous patient movement such as shivering or convulsions
„
With cardiac arrhythmias
„
Rapid blood pressure changes
„
Severe shock or hypothermia that reduces blood flow to the peripheries
„
Obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery
12.4 Measurement Methods
There are three methods of measuring NIBP:
„
Manual: measurement on demand.
„
Auto: continually repeated measurements at set intervals.
„
STAT: continually rapid series of measurements over a five minute period, then return to the previous mode.
12-2
12.5 Setting Up the NIBP Measurement
12.5.1 Preparing to Measure NIBP
1.
Power on the monitor.
2.
Verify that the patient category is correct. Change it if necessary.
3.
Plug the air tubing into the NIBP connector on the patient monitor.
4.
Select a correct sized cuff and then apply it as follows:
‹
Determine the patient’s limb circumference.
‹
Select an appropriate cuff by referring to the limb circumference marked on the cuff. The width of the cuff
should be 40% (50% for neonates) of the limb circumference, or 2/3 of the upper arm’s length. The inflatable part of
the cuff should be long enough to encircle at least 50% to 80% of the limb.
‹
Apply the cuff to an upper arm or leg of the patient and make sure the Φ marking on the cuff matches the
artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the
extremities. Make sure that the cuff edge falls within the marked range. If it does not, use a larger or smaller cuff
that will fit better.
5.
Connect the cuff to the air tubing and make sure that the bladder inside the cover is not folded and twisted.
NOTE
z
The use of the equipment is restricted to one patient at a time.
12.5.2 Starting and Stopping Measurements
Select the [NIBP Measure] QuickKey and you can start the desired measurement from the popup menu. You can
select [Stop All] QuickKey to stop all NIBP measurements. You can also start and stop measurements by using the
hardkey on the monitor’s front panel.
12.5.3 Correcting the Measurement if Limb is not at Heart Level
The cuff should be applied to a limb at the same level as the patient’s heart. If the limb is not at the heart level, to the
displayed value:
„
Add 0.75 mmHg (0.10 kPa) for each centimetre higher, or
„
Deduct 0.75 mmHg (0.10 kPa) for each centimeter lower.
12.5.4 Enabling NIBP Auto Cycling and Setting the Interval
1.
Select the NIBP parameter window to enter the [NIBP Setup] menu.
2.
Select [Interval] and then select a desired time interval. Selecting [Manual] switches to manual mode.
3.
Start a measurement manually. The monitor will then automatically repeat NIBP measurements at the set time
interval.
12-3
12.5.5 Starting a STAT Measurement
1.
Select the NIBP parameter window to enter the [NIBP Setup] menu.
2.
Select [NIBP STAT]. The STAT mode initiates 5 minutes of continuous, sequential, automatic NIBP measurements.
WARNING
z
Continuous non-invasive blood pressure measurements may cause purpura, ischemia and neuropathy in
the limb with the cuff. Inspect the application site regularly to ensure skin quality and inspect the
extremity of the cuffed limb for normal color, warmth and sensitivity. If any abnormity occurs, move the
cuff to another site or stop the blood pressure measurements immediately.
12.6 Understanding the NIBP Numerics
The NIBP display shows numerics only as below. Your display may be configured to look slightly different.
3
1
2
4
5
6
7
8
1.
Time of last measurement
2.
Time remaining to next measurement
3.
Measurement mode
4.
Unit of pressure: mmHg or kPa
5.
Prompt message area: shows NIBP-related prompt messages
6.
Systolic pressure
7.
Diastolic pressure
8.
Mean pressure obtained after the measurement and cuff pressure obtained during the measurement
12.7 Changing NIBP Settings
By selecting the NIBP parameter window, you can enter the [NIBP Setup] menu.
12.7.1 Setting the Initial Cuff Inflation Pressure
You can set the initial cuff inflation pressure manually. In the [NIBP Setup] menu, select [Initial Pressure] and then
select the appropriate setting.
12-4
12.7.2 Setting NIBP Alarm Properties
Select [Alarm Setup >>] from the [NIBP Setup] menu. You can set the alarm properties for this parameter in the
popup menu.
12.7.3 Displaying NIBP List
Select [Screens] QuickKeyė[Screen Setup]. You can set [NIBP List] to be displayed at the bottom area of the
screen. Then, multiple sets of most recent NIBP measurements will be displayed. And PR displayed is derived from NIBP.
You can not display NIBP list in some screens such as the big numerics screen.
12.7.4 Setting the Pressure Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [Press. Unit] and toggle
between [mmHg] and [kPa].
12.8 Assisting Venous Puncture
You can use the NIBP cuff to cause sub-diastolic pressure to block the venous blood vessel and therefore help venous
puncture.
1.
Select [VeniPuncture >>] from the [NIBP Setup] menu. In the popup menu, verify that the [Cuff Press.]
value is appropriate. Change it if necessary.
2.
Select [VeniPuncture].
3.
Puncture vein and draw blood sample.
4.
Select the
hardkey on the monitor’s front, or the [Stop All] QuickKey to deflate the cuff. The cuff deflates
automatically after a set time if you do not deflate it.
During measurement, the NIBP display shows the inflation pressure of the cuff and the remaining time in venous
puncture mode.
12-5
12.9 NIBP Leakage Test
The NIBP leakage test checks the integrity of the system and of the valve. It is required at least once every two years or
when you doubt the measured NIBP. If the test failed, corresponding prompt messages will be given. If no message is
displayed, it means no leakage is detected.
Tools required:
„
An adult cuff
„
An air tubing
„
A correct sized cylinder
Follow this procedure to perform the leakage test:
1.
Set the patient category to [Adu].
2.
Connect the cuff to the NIBP connector on the monitor.
3.
Wrap the cuff around the cylinder as shown below.
Cylinder
Monitor
Connector for
Air tubing
NIBP cuff
4.
Cuff
Select [Main Menu]ė[Maintenance >>]ė[NIBP Leakage Test]. The NIBP display shows [Leakage
Testing…].
5.
After about 20 seconds, the monitor will automatically deflate. This means the test is completed.
6.
If the message [NIBP Pneumatic Leak] is displayed, it indicates that the NIBP airway may have leakages. Check
the tubing and connections for leakages. If you ensure that the tubing and connections are all correct, perform a
leakage test again.
If the problem persists, contact your service personnel.
NOTE
z
The leakage test is intended for use to simply determine whether there are leakages in the NIBP airway. It
is not the same as that specified in the EN 1060-3 standard.
12-6
12.10 NIBP Accuracy Test
The NIBP accuracy test is required at least once every two years or when you doubt the measured NIBP.
Tools required:
„
T-piece connector
„
Approprating tubing
„
Balloon pump
„
Metal Vessel (volume 500±25 ml)
„
Reference manometer (calibrated with accuracy higher than 1 mmHg)
Follow this procedure to perform the accuracy test:
1.
Connect the equipment as shown.
Monitor
Connector for NIBP
Manometer
Tubing
cuff
Balloon pump
2.
Metal vessel
Before inflation, the reading of the manometer should be 0. If not, disconnect the airway and reconnect it until the
readings is 0.
3.
Select [Main Menu]ė[Maintenance >>]ė[NIBP Accuracy Test].
4.
Compare the manometer values with the displayed values. The difference between the manometer and displayed
values should be no greater than 3 mmHg.
5.
Raise the pressure in the metal vessel to 50 mmHg with the balloon pump. Repeat step 3 and 4.
6.
Raise the pressure in the metal vessel to 200 mmHg with the balloon pump. Repeat step 3 and 4.
If the difference between the manometer and displayed values is greater than 3 mmHg, contact your service personnel.
12.11 Calibrating NIBP
NIBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated once every two years by a qualified
service professional. Contact your service personnel when a calibration is necessary.
12-7
FOR YOUR NOTES
12-8
13 Monitoring Temp
13.1 Introduction
You can simultaneously monitor two temperature sites using the patient monitor.
13.2 Safety
WARNING
z
Verify that the probe detection program works correctly before monitoring. Plug out the temperature
probe cable from the T1 or T2 connector, and the monitor can display the message [T1 Sensor Off] or [T2
Sensor Off] and give alarm tones correctly.
13.3 Making a Temp Measurement
1.
Select an appropriate probe for your patient.
2.
If you are using a disposable probe, connect the probe to the temperature cable.
3
Plug the probe or temperature cable to the temperature connector.
4.
Attach the probe to the patient correctly.
5.
Check that the alarm settings are appropriate for this patient.
13.4 Understanding the Temp Display
The temperature monitoring is displayed on the monitor as three numerics: T1, T2 and TD. By selecting this area, you can
enter the [Alarm Setup] menu.
13-1
13.5 Setting the Temperature Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [Temp Unit] and toggle
between [ºC] and [ºF].
.
13-2
14 Monitoring IBP
14.1 Introduction
The iPM 12 patient monitor can monitor up to 4 invasive blood pressures and iPM 10 and iPM 8 patient monitors can
monitor up to 2 invasive blood pressures. The patient monitor can display the systolic, diastolic and mean pressures and
a waveform for each pressure.
14.2 Safety
WARNING
z
Use only pressure transducers specified in this manual. Never reuse disposable pressure transducers.
z
Make sure that the applied parts never contact other conductive parts.
z
To reduce the hazard of burns during high-frequency surgical procedure, ensure that the monitor’s cables
and transducers never come into contact with the high-frequency surgical units.
z
When using accessories, their operating temperature should be taken into consideration. For details, refer
to instructions for use of accessories.
14-1
14.3 Zeroing the Transducer
To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your
hospital policy (at least once per day). Zero whenever:
„
A new transducer or adapter cable is used.
„
You reconnect the transducer cable to the monitor.
„
The monitor restarts.
„
You doubt the readings.
.
Turn off the stopcock to the patient.
Pressure transducer
3-way stopcock
Pressure adapter cable
Monitor
2.
Vent the transducer to the atmospheric pressure by turning on the stopcock to the air.
3.
In the setup menu for the pressure (e.g. Art), select [Art Zero >>]ė[Zero]. During zero calibration, the [Zero]
button appears dimmed. It recovers after the zero calibration is completed. To zero all IBP channels, select [Zero
IBP] hotkey, and then select [Zero All Channels] in the popup menu.
4.
After the zero calibration is completed, close the stopcock to the air and open the stopcock to the patient.
NOTE
z
Your hospital policy may recommend that the ICP transducer is zeroed less frequently than other
transducers.
14-2
14.4 Setting Up the Pressure Measurement
1.
Plug the pressure cable into the IBP connector.
2.
Prepare the flush solution.
3.
Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.
WARNING
z
If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubble
may lead to wrong pressure reading.
4.
Connect the pressure line to the patient catheter.
5.
Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.
6.
Select the appropriate label.
7.
Zero the transducer. After a successful zeroing, turn off the stopcock to the atmosphere and turn on the stopcock
to the patient.
Heparinized
fluid bag
Pressure
transducer
Valve
Stopcock
Flushing set
Adapter cable for using
disposable transducers
Pressure line
Monitor
WARNING
z
If measuring intracranial pressure (ICP) with a sitting patient, level the transducer with the top of the
patient’s ear. Incorrect leveling may give incorrect values.
14-3
14.5 Understanding the IBP Display
The IBP measurement is displayed on the monitor as a waveform and numeric pressures. The figure below shows the
waveform and numerics for the Art pressure. For different pressures, this display may be slightly different.
1
2
1.
Waveform
2.
Pressure unit
3.
Systolic pressure
4.
Mean pressure
5.
Diastolic pressure
3
4
5
For some pressures, the parameter window may show the mean pressure only. For different pressures, their defaults unit
may be different. If the Art and ICP pressures are measured simultaneously, the ICP parameter area will display numeric
CPP, which is obtained by subtracting ICP from the Art mean.
14.6 Changing IBP Settings
14.6.1 Changing a Pressure for Monitoring
1.
Select the pressure you want to change to enter its setup menu. In the menu, there is a figure showing the current
IBP measurement connector.
2.
Select [Label] and then select your desired label from the list. The already displayed labels cannot be selected.
14-4
Label
Description
Label
Description
PA
Pulmonary artery pressure
CVP
Central venous pressure
Ao
Aortic pressure
LAP
Left atrial pressure
UAP
Umbilical arterial pressure
RAP
Right atrial pressure
BAP
Brachial arterial pressure
ICP
Intracranial pressure
FAP
Femoral arterial pressure
UVP
Umbilical venous pressure
Art
Arterial blood pressure
LV
Left ventricular pressure
P1 to P4
Non-specific pressure label
14.6.2 Setting Alarm Properties
Select [Alarm Setup >>] from the parameter setup menu. You can set alarm properties for this parameter in the
popup menu.
14.6.3 Changing Averaging Time
The IBP value displayed on the monitor screen is the average of data collected within a specific time. The shorter the
averaging time is, the quicker the patient monitor responds to changes in the patient’s blood pressure. Contrarily, the
longer the averaging time is, the slower the patient monitor responds to changes in the patient’s blood pressure, but the
measurement accuracy will be improved. For critically ill patients, selecting shorter averaging time will help
understanding the patient’s state.
To set the averaging time, in the parameter setup menu, select [Sensitivity] and toggle between [High], [Med] and
[Low], the corresponding averaging time is about 1 s, 8 s and 12 s respectively.
14.6.4 Setting the Pressure Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [Press. Unit] and toggle
between [mmHg] and [kPa]. Select [CVP Unit] and toggle between [mmHg], [cmH2O] and [kPa].
14.6.5 Setting Up the IBP Wave
In the setup menu for the pressure, you can:
„
„
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the wider the wave is.
Select [Scale] and then select the appropriate setting. If [Auto] is selected, the size of the pressure’s waveform
will be adjusted automatically.
„
Select [Filter] and then select the desired option.
14-5
14.7 Measuring PAWP
Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by fluid status, myocardial
contractility, and valve and pulmonary circulation integrity.
Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the pulmonary artery.
When the catheter is in one of the smaller pulmonary arteries, the inflated balloon occludes the artery allowing the
monitor to record changes in the intrathoracic pressures that occur throughout the respiration cycle.
The pulmonary wedge pressure is the left ventricular end diastolic pressure when the airway pressure and valve function
are normal. The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoracic
pressure is fairly constant and the artifact caused by respiration is minimal.
14.7.1 Preparing to Measure PAWP
1.
Prepare the same accessories as in the C.O. measurement. Connect the parts such as catheter, syringe, etc.
following the C.O. measurement steps and use the balloon inflation port.
2.
Connect the PAWP cable into the IBP connector on the monitor. Since PAWP is measured on PA, selecting [PA] as
the IBP label is recommended.
3.
Select the PA parameter window or waveform area to enter its setup menu. Then, select [PAWP] to enter the
PAWP measurement window. You can also enter the PAWP measurement window from the P1-P4 parameter
window.
NOTE
z
After entering the PAWP measurement window, the monitor will turn off the PA alarm automatically.
14-6
14.7.2 Setting Up the PAWP Measurement
1.
Wedge the flotation catheter into the pulmonary artery. Then inflate the balloon and pay attention to PA waveform
changes on the screen.
2.
After obtaining a stable PAWP waveform, press the [Freeze] key to freeze the waveform and deflate the balloon.
3.
You can adjust the PAWP scale to an appropriate position by adjusting
or
beside the [Adjust] button.
Press the [Confirm] key to save one PAWP measurement.
4.
If you need to start a new measurement, select [Next Measure].
WARNING
z
Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the
minimum time necessary to get an accurate measurement.
z
If the PAWP is greater than the PA (systolic), deflate the balloon and report the incident in accordance with
hospital policy. Because the pulmonary artery could be accidentally ruptured, and the PAWP value derived
will not reflect the patient’s hemodynamic state, but will merely reflect the pressure in the catheter or
balloon.
14.7.3 Understanding the PAWP Setup Menu
Select [Setup] to enter the [PAWP Setup] menu. In this menu, you can:
„
Select a ECG lead wave as the first reference wave.
„
Select a respiration wave as the second reference wave.
„
Select a sweep speed for the displayed waveform.
„
Change the size of the PA waveform by adjusting the scale height.
14-7
FOR YOUR NOTES
14-8
15 Monitoring Cardiac Output
15.1 Introduction
The cardiac output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using
the right heart (atria) thermodilution method. A cold solution of known volume and temperature is injected into the
right atrium through the proximal port of a pulmonary artery (PA) catheter. The cold solution mixes with the blood in the
right ventricle and the change in blood temperature is measured with a thermistor at the distal end of the catheter in
the pulmonary artery. The temperature change is displayed as a curve in the C.O. split screen, and the monitor calculates
the C.O. value from this curve. The C.O. value is inversely proportional to the area under the curve. As cardiac output
varies continuously, a series of measurements must be carried out to achieve a reliable C.O. average value. Always use
the average of multiple thermodilution measurements for therapy decisions. The monitor is capable of storing 6
measurements.
WARNING
z
C.O. monitoring is restricted to adult patients only.
15.2 Understanding the C.O. Display
The C.O. measurement is displayed on the monitor as numeric C.O., C.I. and TB in the C.O. parameter window as shown
below. To enter the [C.O. Setup] menu, select the C.O. parameter window.
2
3
1
4
1.
Cardiac output
2.
Time at which the C.O. average is calculated
3.
Cardiac index
4.
Blood temperature
15-1
15.3 Influencing Factors
The factors that affect cardiac output are:
„
temperature of injectate solution,
„
volume of injectate solution,
„
patient’s baseline blood temperature,
„
patient’s inspiratory/expiratory cycle,
„
placement of catheter with relation to proximity of lung field,
„
the catheter itself,
„
the patient rhythm and hemodynamic status, and
„
any other rapid IV solutions which are infused while the C.O. measurement is being performed.
Followings are some technique suggestions to obtain accurate C.O.:
„
Injectate solution must be cooler than the patient’s blood.
„
Inject solution rapidly and smoothly.
„
Inject at end expiration.
15.4 Setting Up the C.O. Measurement
WARNING
z
Use only accessories specified in this manual. Make sure that the accessories never come into contact with
conductive parts.
1.
Connect the C.O. cable to the C.O. connector on the monitor.
2.
Interconnect the C.O. module, catheter and syringe as shown below. Make sure that:
‹
The module is securely inserted.
‹
The PA catheter is in place in the patient.
‹
The C.O. cable is properly connected to the module.
15-2
Injectate
C.O. module
C.O. cable
Syringe
PA catheter
Stopcock
Hole
In-line probe
Ice water
Balloon inflation port
3.
Select the C.O. parameter window to enter the [C.O. Setup] menu. Check if the height and weight are
appropriate for your patient. Change if necessary.
4.
In the [C.O. Setup] menu:
‹
Check that the correct computation constant is entered. To change the computation constant, select [Comp.
Const] and then enter the correct value. When a new catheter is used, the computation constant should be
adjusted in accordance with the manufacturer’s instructions for use.
‹
Set the [Auto TI] to [Manual] or [Auto]. If you select [Auto], the system automatically detects the injectate
temperature, and the [Manual TI] is disabled. If you select [Manual], you need to enter the injectate
temperature at [Manual TI] manually.
5.
Select [C.O. Measure] to enter the C.O. measurements window.
A
F
B
C
E
D
15-3
A.
Currently measured numeric
B.
Currently measured C.O. curve
C.
Prompt message area
D.
Buttons
E.
Averaged values
F.
Measurement windows
6.
Proceed as follows.
When you see the message [Ready for new measurement], select the [Start] button and then inject the
solution quickly when the message [Inject now!] and prompt tone appear. As shown in the figure above, during
the measurement, the currently measured thermodilution curve and message [Measuring…] are displayed. At
the end of the measurement, the thermodilution curve is transferred to one of the 6 measurement windows and
the monitor prompts you to wait for a certain period of time before starting a new measurement.
A maximum of 6 measurements can be stored. If you perform more than six measurements without rejecting any, the
oldest will automatically be deleted when a seventh curve is stored. Select from the 6 measurement curves and the
system will automatically calculate and display the averaged C.O. and C.I. values. Then select the [Accept Average]
button to accept and store the averaged values.
When injecting, the stopcock to the PA catheter is open and the stopcock to the injectate solution is closed. After the
measurement is completed, turn off the stopcock to the PA catheter and turn on the stopcock to the injectate solution,
and then draw the injectate solution into the injectate syringe.
In the buttons area, you can:
„
Select [Cancel] during a measurement to cancel the measurement. Selecting it after a measurement deletes the
measured results.
„
Select [Record] to print out the curves selected for average calculation, numerics and averaged values by the
recorder.
„
Select [Setup >>] to access the [C.O. Setup] menu.
„
Select [Calc >>]ė[Hemodynamic >>] to access the [Hemodynamic Calculation] menu.
The system can automatically adjust the X-axis scale range to 30 s or 60 s and Y-axis scale range to 0.5ć, 1.0ć, or 2.0ć.
NOTE
z
Starting measuring without blood temperature being stable yet may cause measuring failure.
z
During the cardiac output measurement, blood temperature alarms are inactive.
15-4
15.5 Measuring the Blood Temperature
As shown below, the blood temperature is measured with a temperature sensor at the distal end of the catheter in the
pulmonary artery. During C.O. measurements, blood temperature alarms are suppressed to avoid false alarms. They will
automatically recover as soon as the C.O. measurements are completed.
Pulmonary artery
PA catheter
Balloon
Right atrium
Sensor
Right ventricle
15.6 Changing C.O. Settings
15.6.1 Setting the Temperature Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [Temp Unit] to toggle
between [ć] and [̧].
15.6.2 Setting Alarm Properties
Select [Alarm Setup >>] from the [C.O. Setup] menu. You can set alarm properties for this parameter in the popup
menu.
15-5
FOR YOUR NOTES
15-6
16 Monitoring Carbon Dioxide
16.1 Introduction
CO2 monitoring is a continuous, non-invasive technique for determining the concentration of CO2 in the patient’ airway
by measuring the absorption of infrared (IR) light of specific wavelengths. The CO2 has its own absorption characteristic
and the amount of light passing the gas probe depends on the concentration of the measured CO2. When a specific
band of IR light is passed through respiratory gas samples, some of IR light will be absorbed by the CO2 molecules. The
amount of IR light transmitted after it has been passed through the respiratory gas sample is measured with a
photodetector. From the amount of IR light measured, the concentration of CO2 is calculated.
There are two methods for measuring CO2 in the patient’s airway:
1.
Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patient’s
breathing system.
2.
Sidestream/Microstream measurement samples expired patient gas at a constant sample flow from the patient’s
airway and analyzes it with a CO2 sensor built into the CO2 module.
The measurement provides:
1.
A CO2 waveform
2.
End tidal CO2 value (EtCO2): the CO2 value measured at the end of the expiration phase.
3.
Fraction of inspired CO2 (FiCO2): the smallest CO2 value measured during inspiration.
4.
Airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform.
16-1
16.2 Measuring CO2
16.2.1 Making a Sidestream CO2 Measurement
1.
Attach the watertrap to the module and then connect the CO2 components as shown below.
Watertrap fixer
Sampling line
Watertrap
2.
The CO2 module needs time to warm up to reach the operating temperature. The message [CO2 Sensor
Warmup] is displayed during warm-up. If you perform CO2 measurements during warm-up, the measurement
accuracy may be compromised.
3.
After warm-up is finished, you can perform CO2 measurements.
CAUTION
z
The watertrap collects water drops condensed in the sampling line and therefore prevents them from
entering the module. If the collected water reaches a certain amount , you should drain it to avoid blocking
the airway.
z
The watertrap has a filter preventing bacterium, water and secretions from entering the module. After a
long-term use, dust or other substances may compromise the performance of the filter or even block the
airway. In this case, replace the watertrap. It is recommended to replace the watertrap once every two
months, or when the watertrap is found leaky, damaged or contaminated.
NOTE
z
To extend the lifetime of the watertrap and module, disconnect the watertrap and set the operating mode
to standby mode when CO2 monitoring is not required.
16-2
16.2.2 Making a Microstream CO2 Measurement
Connect the sampling line to the module and then connect the CO2 components as shown below. After warm-up is
finished, you can perform CO2 measurements.
Connector for sampling line
Sampling line
16.2.3 Making a Mainstream CO2 Measurement
1.
Connect the sensor to the module.The message [CO2 Sensor Warmup] appears on the screen when the CO2
module is plugged.
2.
After warm-up is finished, connect the transducer to the airway adapter.
3.
Perform a zero calibration per the Zeroing the Sensor section.
4.
After the zero calibration is finished, connect the airway as shown below.
Connect to monitor
Sensor
Airway adapter
Connect to patient
5.
Make sure there are no leakages in the airway and then start a measurement.
NOTE
z
Always position the sensor with the adapter in an upright position to avoid collection of fluids on the
windows of the adapter. Large concentrations of fluids at this point will obstruct gas analysis.
16-3
16.3 Changing CO2 Settings
16.3.1 Accessing CO2 Menus
By selecting the CO2 parameter window, you can access the [CO2 Setup] menu.
16.3.2 Entering the Standby Mode
The standby mode of the CO2 module relates to the standby mode of the monitor as follows:
„
If the monitor enters the standby mode, the CO2 module will also enter the standby mode.
„
If the monitor exits the standby mode, the CO2 module will also exit the standby mode.
„
If the CO2 module enters or exits the standby mode, it will not affect the monitor.
To enter or exit the standby mode manually, select [Operating Mode] in the [CO2 Setup] menu and then toggle
between [Standby] and [Measure].
When you set the sidestream CO2 module to the strandby mode, the CO2 gas sample intake pump automatically sets the
sample flow rate to zero. When exiting the standby mode, the CO2 module continues to work at the preset sample flow
rate.
For the sidestream CO2 module, you can set the delay time. After the delay time the CO2 module enters the standby
mode if no breath is detected.
For the microstream CO2 module, you can also set a period of time after which the CO2 module enters the standby mode
if no breath is detected since the CO2 module is powered on or the CO2 module switches to the measuring mode or the
automatic standby time is re-set. To set the standby time, in the [CO2 Setup] menu, select [Auto Standby] and then
select the appropriate setting.
16.3.3 Setting the CO2 Unit
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, select [CO2. Unit] and toggle
between [mmHg], [%] and [kPa].
16-4
16.3.4 Setting up Gas Compensations
WARNING
z
Make sure that the appropriate compensations are used. Inappropriate compensations may cause
inaccurate measurement values and result in misdiagnosis.
For the sidestream CO2 module:
1.
Select [CO2 Setup].
2.
According to the actual condition, set the concentration required for the following compensations:
‹
[O2 Compen]
‹
[N2O Compen]
‹
[Des Compen]
For the microstream CO2 module, gas compensations are not required.
For the mainstream CO2 module, in the [CO2 Setup] menu, respectively select:
„
[Balance Gas] and toggle between [Room Air] and [N2O]. Select [Room Air] when air predominates in the
ventilation gas mixture and select [N2O] when N2O predominates in the ventilation gas mixture and select [He]
when He predominates in the ventilation gas mixture.
„
[O2 Compen] and then select [Off] or an appropriate setting according to the amount of O2 in the ventilation
gas mixture. When the amount of O2 is less than 30%, you’d better switch this compensation off.
„
[AG Compen] and enter the concentration of anesthetic gas present in the ventilation gas mixture. This could
compensate for the effect of AG on the readings.
16.3.5 Setting up Humidity Compensation
Sidestream and microstream CO2 modules are configured to compensate CO2 readings for either Body Temperature and
Pressure, Saturated Gas (BTPS), to account for humidity in the patient’s breath, or Ambient Temperature and Pressure,
Dry Gas (ATPD).
Pco 2 (mmHg) CO2 (vol%) u Pamb / 100
1.
ATPD:
2.
BTPS: PCO 2 ( mmHg )
CO2 (vol %) u ( Pamb 47 ) / 100
Where, PCO 2 = partial pressure, vol % = CO2 concentration,
Pamb = ambient pressure, and unit is mmHg.
As the mainstream CO2 module has a built-in heating component to prevent water vapour from condensing, setting
humidity compensation is not needed. For the sidestream and microstream CO2 module, you can set the humidity
compensation on or off according to the actual condition. To set the humidity compensation:
1.
In the [CO2 Setup] menu, select [BTPS Compen].
2.
Select either [On] for BTPS or [Off] for ATPD, depending on which compensation applies.
16-5
16.3.6 Setting the Apnea Alarm Delay
In the [CO2 Setup] menu, select [Apnea Delay] and then select the appropriate setting. The monitor will alarm if the
patient has stopped breathing for longer than the preset apnea time. The [Apnea Delay] of Resp, CO2, and AG module
keeps consistent with each other.
WARNING
z
The respiration measurement does not recognize the cause of apneas. It only indicates an alarm if no
breath is detected when a pre-adjusted time has elapsed since the last detected breath. Therefore, it
cannot be used for diagnostic purpose.
16.3.7 Choosing a Time Interval for Peak-Picking
For microstream and mainstream CO2 modules, you can select a time interval for picking the highest CO2 as the EtCO2
and the lowest as the FiCO2.
In the [CO2 Setup] menu, select [Max Hold] and toggle between [Single Breath], [10 s], [20 s] and [30 s] (for
microstream CO2 module only)..
„
[Single Breath]: EtCO2 and FiCO2 are calculated for every breath.
„
[10 s], [20 s] or [30 s]: EtCO2 and FiCO2 are calculated using 10, 20 or 30 seconds of data.
16.3.8 Setting the Flow Rate
For the sidestream CO2 module, you can change the sampling rate of respiratory gas in the patient’s airway by setting
the flow rate. To set the flow rate, enter the [CO2 Setup] menu and select an appropriate setting from [Flow Rate].
WARNING
z
Please consider the patient’s actual bearing capability and select the appropriate flow rate when setting
the flow rate.
16.3.9 Setting up the CO2 Wave
In the [CO2 Setup] menu, you can:
„
Select [Wave Type] and toggle between [Draw] and [Fill]:
‹
[Draw]: The CO2 wave is displayed as a curved line.
‹
[Fill]: The CO2 wave is displayed as a filled area.
„
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the wider the wave is.
„
Change the size of the CO2 waveform by adjusting the wave [Scale].
16-6
16.4 Setting RR Source
To set RR source:
1.
Enter the [CO2 Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
The [RR Source] settings of Resp, CO2, and AG module are linked. For details, please refer to the section Setting RR
Source of chapter Resp.
16.5 Setting Barometric Pressure Compensation
Both sidestream and microstream CO2 modules have the function of automatic barometric pressure compensation (the
system automatically measures the barometric pressure which the patient monitor is exposed to). However, the
mainstream CO2 module does not have such function. For the mainstream CO2 module, the default barometric pressure
is 760 mmHg. You must modify the barometric pressure based on the actual situation as follows:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required
passwordė[Maintain CO2 >>]ė[Calibrate CO2 >>].
2.
Select [Barometric Pressure] and then enter the value of barometric pressure to which the patient monitor is
exposed to.
WARNING
z
Be sure to set the barometric pressure properly before using the mainstream CO2 module. Improper
settings will result in erroneous CO2 reading.
16.6 Measurement Limitations
The following factors may influence the accuracy of measurement:
„
Leaks or internal venting of sampled gas
„
Mechanical shock
„
Cyclic pressure up to 10 kPa (100 cmH2O)
„
Other sources of interference, if any
16.7 Leakage test
When the sidestream CO2 module needs maintenance, the monitor prompts on the CO2 waveform area: [Need
maintenance. Enter CO2 setup menu.] Then, you can access [CO2 Setup]ė [Maintain CO2], and perform
leakage test according to the prompt messages on the menu.
16-7
16.8 Troubleshooting the Sidestream CO2 Sampling System
When the sampling system of the sidestream CO2 module works incorrectly, check if the sampling line is kinked. If not,
remove it from the watertrap. If the monitor gives a message indicating the airway still works incorrectly, it indicates that
the watertrap must have been blocked, and you should replace with a new one. Otherwise, you can determine that the
sampling line must have been blocked. Replace with a new sampling line.
16.9 Removing Exhaust Gases from the System
WARNING
z
Anesthetics: When using the Sidestream or Microstream CO2 measurement on patients who are receiving
or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia
machine/ventilator, to avoid exposing medical staff to anesthetics.
To remove the sample gas to a scavenging system, connect an exhaust tube to the gas outlet connector of the module.
16.10 Zeroing the Sensor
The zero calibration eliminates the effect of baseline drift during CO2 measurement exerted on the readings and
therefore maintains the accuracy of the CO2 measurements.
16.10.1 For Sidestream and Microstream CO2 Modules
For sidestream and microstream CO2 modules, a zero calibration is carried out automatically when necessary. You can
also start a manual zero calibration if necessary. To manually start a zero calibration, select [Maintain CO2 >>] from
the [User Maintenance] menu. Then select [Calibrate CO2 >>]ė[Start Zero Cal.]. Disconnecting the patient
airway is not required when performing a zero calibration.
16-8
16.10.2 For Mainstream CO2 Modules
For mainstream CO2 modules, zero the sensor whenever:
„
A new adapter is used;
„
You reconnect the sensor to the module;
„
You see the message [CO2 Zero Required]. In this case, check the airway adapter for any blockage, e.g. mucus,
etc. If a blockage is detected, clear or replace the adapter.
To zero the sensor, follow this procedure:
1.
Connect the sensor to the module.
2.
In the [CO2 Setup] menu, set the [Operating Mode] to [Measure]. The message [CO2 Sensor Warmup] is
displayed.
3.
After warm-up is finished, connect the sensor to a clean, dry airway adapter. The adapter should be vented to the
air and isolated from CO2 sources, such as ventilator, the patient’s breathing, your own breathing, etc.
4.
Select [Start Zero Cal.] in the [CO2 Setup] menu. The message [CO2 Zero Running] is displayed.
5.
It takes about 15 to 20 seconds. The message disappears when the zero calibration is completed.
WARNING
z
When perform a zero calibration during the measurement, disconnect the transducer from the patient’s
airway first.
z
Please do not rely on the readings during zeroing.
16.11 Calibrating the Sensor
For sidestream or microstream CO2 modules, a calibration should be performed once every year or when the readings
go far beyond the range. For mainstream CO2 modules, no calibration is required. For details, refer to the chapter 26
Maintenance.
16-9
16.12 Oridion Information
This trademark is registered in Israel, Japan, German and America.
Oridion Patents
The capnography component of this product is covered by one or more of the following US patents: 6,428,483;
6,997,880; 6,437,316; 7,488,229; 7,726,954 and their foreign equivalents. Additional patent applications pending.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with
unauthorized CO2 sampling consumables which would, alone, or in combination with this device, fall within the scope of
one or more of the patents relating to this device and/or CO2 sampling consumable.
16-10
17 Monitoring AG
17.1 Introduction
The anaesthetic gas (AG) module measures the patient’s anesthetic and respiratory gases, and incorporates the features
of the O2 module as well. AG monitoring is for iPM 12 and iPM 10 patient monitors only.
The AG module determines the concentration of certain gases using the infrared (IR) light absorption measurement. The
gases that can be measured by the AG module absorb IR light. Each gas has its own absorption characteristic. The gas is
transported into a sample cell, and an optical IR filter selects a specific band of IR light to pass through the gas. For
multiple gas measurement, there are multiple IR filters. The higher the concentration of gas in a given volume the more
IR light is absorbed. This means that higher concentration of IR absorbing gas cause a lower transmission of IR light. The
amount of IR light transmitted after it has been passed though an IR absorbing gas is measured. From the amount of IR
light measured, the concentration of gas present can be calculated.
Oxygen does not absorb IR light as other breathing gases and is therefore measured relying on its paramagnetic
properties. Inside the O2 sensor are two nitrogen-filled glass spheres mounted on a strong rare metal taut-band
suspension. This assembly is suspended in a symmetrical non-uniform magnetic field. In the presence of paramagnetic
oxygen, the glass spheres are pushed further away from the strongest part of the magnetic field. The strength of the
torque acting on the suspension is proportional to the oxygen concentration. From the strength of the torque, the
concentration of oxygen is calculated.
AG module can identify two anesthetic gases in a mixture automatically and distinguish between them according to
their contributions to the MAC value for display as the primary and secondary anesthetis agent.
NOTE
z
The AG module is configured with automatic barometric pressure compensation function.
17-1
17.2 Understanding the AG Display
The AG module can send waves and numerics for all measured anesthetic gases for display on the monitor, including:
„
CO2, O2, N2O and AA waves
„
awRR: airway respiratory rate
„
MAC: minimum alveolar concentration
„
End tidal (Et) and fraction of inspired (Fi) numerics for CO2, O2, N2O and AA
Where AA represents Des (desflurane), Iso (isoflurane), Enf (enflurane), Sev (sevoflurane), or Hal (halothane).
The AA waveform area displays the primary anesthetic gas’s waveform. When O2 module does not exist, no O2 waveform
will be displayed. When O2 module exists, the O2 waveform will be displayed only when the O2 waveform is currently
switched on.
WARNING
z
To avoid explosion hazard, do not use flammable anesthetic agent such as ether and cyclopropane for this
equipment.
17.3 MAC Values
Minimum alveolar concentration (MAC) is the minimum concentration of the agent in the alveoli. It is a basic index to
indicate the depth of anesthesia. The standard ISO 21647 defines MAC as this: alveolar concentration of an inhaled
anesthetic agent that, in the absence of other anesthetic agents and at equilibrium, prevents 50% of patients from
moving in response to a standard surgical stimulus.
Minimum alveolar concentration (MAC) values are listed below:
Agent
Des
Iso
Enf
Sev
Hal
N2O
1 MAC
7.3%*
1.15%
1.7%
2.1%
0.77%
105%**
* The data is taken from a patient of 25 years old.
** indicates 1 MAC nitrous oxide can only be reached in hyperbaric chamber.
17-2
NOTE
z
The MAC values shown in the table above are those published by the U.S. Food and Drug Administration
for a healthy 40-year-old adult male patient.
z
In actual applications, the MAC value may be affected by age, weight and other factors.
The formula to calculate the MAC value is as follows:
N 1
MAC
EtAgent i
¦ AgentVol
i 0
i
Where N is the number of all agents (including N2O) that the AG module can measure, EtAgenti is the concentration of
each agent and AgentVoli is the concentration of each agent at 1 MAC.
For example, the AG module measures there are 4% of Des, 0.5% of Hal and 50% of N2O in the patient’s end-tidal gas:
MAC
4.0% 0.5% 50%
1.67
7.3% 0.77% 105%
NOTE
z
The formula mentioned above is intended for adult patients only.
17.4 Preparing to Measure AG
1.
Select an appropriate watertrap according to patient category and attach it to the module.
2.
Connect the gas sample line to the connector of the watertrap.
3.
Connect the other end of the gas sampling line to the patient via the airway adapter.
4.
Connect the gas outlet to a scavenging system using an exhaust tube.
AG module
Airway adapter
Exhaust tube
Gas sample line
Connect to the patient
5.
Insert the AG module to the patient monitor and the patient monitor will prompt [AG Startup]. Then the AG
module starts to warmup and at the same time the patient monitor prompts [AG Warmup]. After 45 seconds, the
AG module enters the iso accuracy mode. After 10 minutes, the module enters the full accuracy mode.
17-3
WARNING
z
Make sure that the connections are tight. Any leak in the system can result in erroneous readings due to
ambient air mixing with patient gases.
z
Do not apply adult watertrap to the neonate patient. Otherwise, patient injury could result.
z
Using high-frequency electrosurgical units may increase the risk of skin burn. In this case, do not use
antistatic or conductive respiratory tubing.
CAUTION
z
Position the airway adapter so that the part connecting to the gas sample line is pointing upwards. This
prevents condensed water from passing into the gas sample line and causing an occlusion.
z
The watertrap collects water drops condensed in the sampling line and therefore prevents them from
entering the module. If the collected water reaches to a certain amount, you should drain it to avoid
blocking the airway.
z
The watertrap has a filter preventing bacterium, water and secretions from entering the module. After a
long-term use, dust or other substances may compromise the performance of the filter or even block the
airway. In this case, replace the watertrap. Replacing the watertrap once a month is recommended.
17.5 Changing AG Settings
17.5.1 Setting Gas Unit
For N2O and AA, the unit of the measured gas is fixed to “%”.
Select [Unit Setup >>] from the [User Maintenance] menu. In the popup menu, you can select [CO2 Unit] or [O2
Unit] and toggle between [mmHg], [%] and [kPa].
17.5.2 Setting the Apnea Alarm Delay
In the [AG Setup] menu, select [Apnea Delay] and select the appropriate setting. The monitor will alarm if the
patient has stopped breathing for longer than the preset apnea time.
The [Apnea Delay] of Resp, CO2, AG, and RM module keeps consistent with each other.
WARNING
z
The respiration measurement does not recognize the cause of apneas. It only indicates an alarm if no
breath is detected when a pre-adjusted time has elapsed since the last detected breath. Therefore, it
cannot be used for diagnostic purpose.
17-4
17.5.3 Changing the Sample Flow Rate
In the setup menu for any gas, select [Flow Rate] and then choose either:
„
[High]: 200 ml/min for adult and pediatric patients, and 120 ml/min for neonatal patients.
„
[Med]: 150 ml/min for adult and pediatric patients, and 90 ml/min for neonatal patients.
„
[Low]: 120 ml/min for adult and pediatric patients, and 70 ml/min for neonatal patients.
17.5.4 Setting up the O2 Compensation
If the AG module does not incorporate the O2 module, you need to manually select [O2 Compen] and then select [Off]
or an appropriate setting according to the amount of O2 in the ventilation gas mixture. When the amount of O2 is less
than 30%, you’d better switch this compensation off.
If the AG module incorporates the O2 module, the system will directly use the O2 concentration detected by the O2
module to make compensation. At this time, the [O2 Compen] in the setup menu for any gas is fixed to [Off].
17.5.5 Entering the Standby Mode
For the AG module, the default operating mode is measure. When you set the AG module to the standby mode, the AG
gas sample intake pump automatically sets the sample flow rate to zero. When exiting the standby mode, the AG
module continues to work at preset sample flow rate with no need to warm up again. After nearly 1 minute, the module
enters the full accuracy mode. The standby mode of the AG module relates to the standby mode of the monitor as
follows:
„
If the monitor enters the standby mode, the AG module will also enter the standby mode.
„
If the monitor exits the standby mode, the AG module will also exit the standby mode.
„
If the AG module enters or exits the standby mode, it will not affect the monitor.
To enter or exit the standby mode manually, in the agent’s setup menu, select [Operating Mode] and then toggle
between [Standby] and [Measure]. You can also set a period of time after which the AG module enters the standby
mode automatically if no breath is detected since the last detected breath. To set the standby time, in the agent’s setup
menu, select [Auto Standby (min)] and then select the appropriate setting.
17.5.6 Setting up the AG Wave
In the [AG Setup] menu, you can:
„
Select [CO2 Wave Type] and toggle between [Draw] and [Fill]:
‹
[Draw]: The CO2 wave is displayed as a curved line.
‹
[Fill]: The CO2 wave is displayed as a filled area.
„
Select [Sweep] and then select the appropriate setting. The faster the wave sweeps, the wider the wave is.
„
Change the size of the waveform by adjusting the scale.
17-5
17.5.7 Setting RR Source
To set RR source:
1.
Enter the [AG Setup] menu.
2.
Select [RR Source] and then select a source or [Auto] from the dropdown list.
The [RR Source] settings of Resp, CO2, and AG module are linked. For details, please refer to the section Setting RR
Source of chapter Resp.
17.6 Changing the Anesthetic Agent
When the anesthetic agent used on the patient is changed, the AG module can detect the mixed anesthetic gas during
the transition of two anesthetic agents. The time required for completing the replacement of anesthetic agent depends
on anesthesia type (low flow or high flow) and the characteristics of anesthetic agents (pharmacokinetics). During the
transition of two anesthetic agents, the patient monitor gives no prompt messages and the MAC value displayed may be
inaccurate.
The AG module can identify two anesthetic agents automatically. When the proportion of the primary and secondary
anesthetic agents in the mixture changes, the AG module can distinguish between them according to their
contributions to the MAC value. Then the primary and secondary anesthetic agents will be exchanged for display.
17.7 Measurement Limitations
The following factors may influence the accuracy of measurement:
„
Leaks or internal venting of sampled gas
„
Mechanical shock
„
Cyclic pressure up to 10 kPa (100 cmH2O)
„
Other sources of interference, if any
17.8 Troubleshooting
17.8.1 When the Gas Inlet is Blocked
If the gas inlet (including watertrap, sampling line and airway adapter) is occluded by condensed water, the message
[AG Airway Occluded] will appear.
To remove the occlusion:
„
Check the airway adapter for an occlusion and replace if necessary.
„
Check the sampling line for an occlusion or kinking and replace if necessary.
„
Check the watertrap for a build up of water. Empty the watertrap. If the problem persists, replace the watertrap.
17-6
17.8.2 When an Internal Occlusion Occurs
Condensed water may enter the module and cause contamination and/or internal occlusions. In this case, the message
[AG Airway Occluded] will be displayed.
To remove the occlusion:
„
Check for any occlusion in the gas inlet and/or outlet system.
„
If the problem persists, internal occlusions may exist. Contact your service personnel.
17.9 Removing Exhaust Gases from the System
WARNING
z
Anesthetics: When using the AG measurement on patients who are receiving or have recently received
anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ventilator, to avoid
exposing medical staff to anesthetics.
To remove the sample gas to a scavenging system, connect an exhaust tube to the gas outlet connector of the module.
17-7
FOR YOUR NOTES
17-8
18 Freezing Waveforms
During patient monitoring, the freeze feature allows you to freeze the currently displayed waveforms on the screen so
that you can have a close examination of the patient’s status. Besides, you can select any frozen waveform for recording.
18.1 Freezing Waveforms
1.
To freeze waveforms, select the
hardkey on the monitor’s front.
2.
The system closes the displayed menu (if any), and opens the [Freeze] menu.
3.
All displayed waveforms are frozen, i.e. the waveforms stop being refreshed or scrolling.
The freeze feature exerts no effect on the split-screen view of minitrends, oxyCRG and other patients.
18.2 Viewing Frozen Waveforms
To view the frozen waveforms, you can either:
„
Select the [Scroll] button and then rotate the Knob clockwise or counter-clockwise, or
„
Directly select the
or
beside the [Scroll] button using the touchscreen.
The frozen waveforms will scroll left or right accordingly. And meanwhile, at the lower right corner of the bottommost
waveform, there is an upward arrow. The freeze time is displayed below the arrow and the initial frozen time is [0 s]. With
the waveforms scrolling, the freeze time changes at intervals of 1 second. This change will be applied for all waveforms
on the screen.
18.3 Unfreezing Waveforms
To unfreeze the frozen waveforms, you can either:
„
Select the
button at the upper right corner of the [Freeze] menu,
„
Select the
hardkey on the monitor’s front, or
„
Perform any other action that causes the screen to be readjusted or opens a menu, such as plugging in or out a
module, pressing the
hardkey, etc.
18-1
18.4 Recording Frozen Waveforms
1.
In the [Freeze] menu, select, in turn, [Wave 1], [Wave 2] and [Wave 3] and then select your desired
waveforms.
2.
Select the [Record] button. The selected waveforms and all numerics at the frozen time are printed out by the
recorder.
18-2
19 Review
19.1 Accessing Respective Review Windows
1.
Select the [Review] QuickKey, or [Main Menu]ė[Review >>].
2.
Select [Graphic Trends], [Tabular Trends], [Events], [Full Disclosure] or [12-lead ECG] to access their
respective review windows.
19.2 Reviewing Graphic Trends
In the [Review] menu, select [Graphic Trends] to access the following window.
1
2
3
1.
Event mark area
2.
Time axis
4.
Parameter area
5.
Cursor
3.
Graphic trends area
Events are marked with colors in the event mark area. Red represents high level alarm event. Yellow represents
medium/low level alarm event. Green represents manual event.
In this review window:
„
Select [Trend Group] and you can select a trend group for viewing in the popup menu. If [Custom 1] or
[Custom 2] is selected, you can further select [Define Trend Group]. Then you can select the parameters for
viewing in the popup menu.
„
You can set the time length of the review window by selecting [Zoom].
„
You can set the number of waves displayed in one page by selecting [Waves].
19-1
„
To browse the graphic trends, you can either:
‹
Select
beside [Scroll] to move the cursor one step to the left or right to navigate through the
or
graphic trends, or
‹
Select
or
to move the cursor one page to the left or right to navigate through the graphic
trends.
A time indicating your current position is displayed above the parameter area. Numeric measurement values
corresponding to the cursor location change as the cursor is moved. The measurement value that triggered high
level alarm has red background. The one that triggered medium/low level alarm has yellow background.
„
By selecting
„
By selecting the [Record] button, you can print out the currently displayed graphic trends by the recorder.
„
or
beside [Event], you can position the cursor to different event time.
By selecting the [Print] button, you can set and print out the graphic trends report by the printer. For how to set
the graphic trends report, please refer to the Print chapter.
19.3 Reviewing Tabular Trends
In the [Review] menu, select [Tabular Trends] to access the following window.
Events are marked with colors in window’s top area. Red represents high level alarm event. Yellow represents
medium/low level alarm event. Green represents manual event.
In this review window:
„
Select [Trend Group] and you can select a trend group for viewing in the popup menu. If [Custom 1] or
[Custom 2] is selected, you can further select [Define Trend Group]. Then you can select the parameters for
viewing in the popup menu.
„
You can change the resolution of the trend data by selecting [Interval] and then selecting the appropriate
setting:
‹
[5 s] or [30 s]: select to view up to 4 hours of tabular trends at 5- or 30-second resolution.
19-2
‹
[1 min], [5 min], [10 min], [15 min], [30 min], [1 h], [2 h] or [3 h]: select to view up to 120 hours of
tabular trends at your selected resolution.
‹
„
[NIBP]: select to view the tabular trends when NIBP measurements were acquired.
To browse the tabular trends, you can either:
‹
Select
‹
Select
beside [Scroll] to drag the scrollbar left or right to navigate through the trend database, or
or
or
to scroll left or right to navigate through the trend database.
The measurement value that triggered high level alarm has red background. The one that triggered medium/low level
alarm has yellow background.
„
By selecting
„
or
beside [Event], you can position the cursor to different event time.
By selecting the [Record] button, you can access the [Record Setup] menu and set the start and end
time of the tabular trends you want to record. This feature is not available when reviewing a history patient. By
further selecting [Record], you can print out the currently displayed tabular trends by the recorder.
„
By selecting the [Print] button, you can set and print out the tabular trends report by the printer. For how to set
the tabular trends report, please refer to the Print chapter.
19.4 Events
19.4.1 Marking Events
During patient monitoring, some events may exert effects on the patient and as a result change the waveforms or
numerics displayed on the monitor. To help analysing the waveforms or numerics at that time, you can mark these
events.
Select [Main Menu]ė[Mark Event >>]. In the popup menu, you can select the waves to be stored when a manual
event is triggered. You can select [Trigger Manual Event] from the [Mark Event] menu or the [Manual Event]
QuickKey to trigger a manual event and store it at the same time.
When you are reviewing graphic trends, tabular trends or full-disclosure waveforms, the manual event symbol is
displayed at the time the event is triggered.
19.4.2 Reviewing Events
In the [Review] menu, select [Events] to access the following window.
The events that can be reviewed include parameter alarm events, arrhythmia alarm events and manual events. When an
event occurs, all the measurement numerics at the event trigger time and related waveforms 4 seconds respectively
before and after the event trigger time are stored.
19-3
In this window:
„
You can view the desired events by selecting [Event].
„
You can view the desired events according to the level by selecting [Level].
After selecting the desired event, you can select [Details] to access the following window. In this window, the
waveform area displays the waveforms related to the event, and the parameter area displays the parameter values
happened at the event trigger time.
1. Waveform area
2. Parameter area
19-4
In this window:
„
You can select
or
to navigate through the waveforms.
„
You can select
or
beside the [Event] button to switch between events.
„
You can set the desired [Gain] for ECG waveform.
„
You can set the desired [Sweep].
„
By selecting the [Record] button, you can print out the currently displayed alarm events by the recorder.
„
By selecting the [Print] button, you can print out the currently displayed alarm events by the printer.
„
By selecting the [Events List] button, you can view the events list.
19.5 Reviewing Waveforms
In the [Review] menu, select [Full Disclosure] to access the following window.
In this review window:
„
To review full-disclosure waveforms, you need to save waveforms first. Select [Save Waves >>] and then select
the parameters whose waveforms you want to view. To save full-disclosure waveform, your monitor must be
equipped with a storage card.
„
To view the waveforms, you can either:
‹
Select
beside the [Scroll] button to move the cursor one step left or right to navigate through
or
the waveforms, or
‹
Select
or
to move the cursor one page left or right to navigate through the waveforms.
A time indicating your current position is displayed at the top of the waveform area. Numeric measurement values
corresponding to the cursor location are displayed in the parameter area, and change as the cursor is moved.
„
„
You can change the ECG wave gain by selecting [Gain] and then selecting the appropriate setting.
You can change the waveform sweep speed by selecting [Sweep] and then selecting the appropriate setting.
19-5
„
By selecting the [Record] button, you can print out the first three waveforms and measurement numerics by the
recorder.
„
By selecting
or
beside the [Event] button, you can position the cursor between events.
19-6
20 Calculations
20.1 Introduction
The calculation feature is available with your patient monitor. The calculated values, which are not directly measured,
are computed based on the values you provide.
Your can perform the following calculations:
„
Dose calculations
„
Oxygenation calculations
„
Ventilation calculations
„
Hemodynamic calculations
„
Renal calculations
To perform a calculation, select [Main Menu] ė [Calc >>], or the [Calculations] QuickKey and then select the
calculation you want to perform.
WARNING
z
After the calculation is finished, verify the entered values are correct and the calculated values are
appropriate. We assume no responsibility for any consequences caused by wrong entries and improper
operations.
NOTE
z
The calculation feature is independent of other monitoring functions and can be therefore used for
patients being monitored by other monitors. Any operation in a calculation window does not affect the
patient monitoring by the local patient monitor.
20-1
20.2 Dose Calculations
20.2.1 Performing Calculations
To perform a dose calculation:
1.
Select [Main Menu]ė[Calculations >>]ė[Dose >>], or select [Calculations] QuickKeyė[Dose >>].
2.
Select, in turn, [Patient Cat.] and [Drug Name] and then select the appropriate settings. The dose
calculation program has a library of commonly used drugs, of which Drug A through Drug E are for those not
specified in this library.
3.
‹
Drug A, B, C, D, E
‹
Isuprel
‹
Aminophylline
‹
Lidocaine
‹
Dobutamine
‹
Nipride
‹
Dopamine
‹
NItroglycerin
‹
Epinephrine
‹
Pitocin
‹
Heparin
The system gives a set of default values when the above steps are finished. However, these values cannot be
used as the calculated values. The user must enter values following the doctor’s instructions, and then the
calculated values can only be used
4.
Enter the patient’s weight.
5.
Enter other values.
6.
Verify if the calculated values are correct.
20.2.2 Selecting the Proper Drug Unit
Each drug has its fixed unit or unit series. Among a unit series, one unit may change to another automatically
depending on the entered value.
The units for each drug are as follows:
„
Drug A, B, C, Aminophylline, Dobutamine, Dopamine, Epinephrine, Isuprel, Lidocaine, Nipride and NItroglycerin
use the unit series: g, mg and mcg.
„
Drug D, Heparin and Pitocin use the unit series: Unit, KU (kilo units) and MU (million units).
„
Drug E uses the unit: mEq (milli-equivalents).
You must select the proper drug name (A, B, C, D or E) according to the units when you define a drug not listed in this
library.
NOTE
z
For neonate patients, [Drip Rate] and [Drop Size] are disabled.
20-2
20.2.3 Titration Table
To open the titration table, select [Titration Table >>] in the [Dose Calculation] window after the dose
calculation is finished.
In the titration table, when you change:
„
[Reference]
„
[Interval]
„
[Dose Type]
The titrated values change accordingly.
You can also:
„
Select
„
Select [Record] to print out the currently displayed titrated values by the recorder.
or
, or
or
beside the vertical scrollbar to view more values.
20.3 Oxygenation Calculations
20.3.1 Performing Calculations
To perform an oxygenation calculation:
1.
Select [Main Menu]ė[Calculations >>]ė[Oxygenation >>], or select [Calculations]
QuickKeyė[Oxygenation >>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current settings and displays the
calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow. You can select [Range] to
view its normal range in the unit field.
‹
Invalid values are displayed as [---].
In the [Oxygenation Calculation] window, you can:
„
Change the pressure unit, Hb unit and oxygen content unit by selecting [Press. Unit], [Hb Unit] and
[OxyCont Unit] and then selecting the appropriate settings. The changes take effect automatically.
„
Trigger a recording by selecting the [Record] button. The currently displayed oxygenation calculations are
printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20-3
20.3.2 Entered Parameters
Abbreviation
Unit
Full spelling
C.O.
L/min
cardiac output
FiO2
%
percentage fraction of inspired oxygen
PaO2
mmHg
partial pressure of oxygen in the arteries
PaCO2
mmHg
partial pressure of carbon dioxide in the arteries
SaO2
%
arterial oxygen saturation
PvO2
mmHg
partial pressure of oxygen in venous blood
SvO2
%
venous oxygen saturation
Hb
g/L
hemoglobin
CaO2
ml/L
arterial oxygen content
CvO2
ml/L
venous oxygen content
VO2
ml/min
oxygen consumption
RQ
None
respiratory quotient
ATMP
mmHg
atmospheric pressure
Height
cm
height
Weight
kg
weight
20.3.3 Calculated Parameters
Abbreviation
Unit
Full spelling
BSA
m2
body surface area
VO2 calc
ml/min
oxygen consumption
C(a-v)O2
ml/L
arteriovenous oxygen content difference
O2ER
%
oxygen extraction ratio
DO2
ml/min
oxygen transport
PAO2
mmHg
partial pressure of oxygen in the alveoli
AaDO2
mmHg
alveolar-arterial oxygen difference
CcO2
ml/L
capillary oxygen content
Qs/Qt
%
venous admixture
C.O. calc
L/min
calculated cardiac output
20.4 Ventilation Calculations
20.4.1 Performing Calculations
To perform a ventilation calculation:
1.
Select [Main Menu]ė[Calculations >>]ė[Ventilation >>], or select [Calculations]
QuickKeyė[Ventilation >>].
2.
Enter values for calculation. If the patient monitor is connected to an anesthesia machine or a ventilator, the
system automatically loads the supported parameter values to the [Ventilation Calculation] window.
3.
Select the [Calculate] button. The system performs a calculation per the current settings and displays the
calculated values.
20-4
‹
If a calculated value is outside the range, its background will highlight in yellow. You can select [Range] to
view its normal range in the unit field.
‹
Invalid values are displayed as [---].
In the [Ventilation Calculation] window, you can:
„
Change the pressure unit by selecting [Press. Unit] and then selecting the appropriate setting.
Corresponding pressure values shall convert and update automatically.
„
Trigger a recording by selecting the [Record] button. The currently displayed ventilation calculations are
printed out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20.4.2 Entered Parameters
Abbreviation
Unit
Full spelling
FiO2
%
percentage fraction of inspired oxygen
RR
rpm
respiration rate
PeCO2
mmHg
partial pressure of mixed expiratory CO2
PaCO2
mmHg
partial pressure of carbon dioxide in the arteries
PaO2
mmHg
partial pressure of oxygen in the arteries
TV
ml
tidal volume
RQ
None
respiratory quotient
ATMP
mmHg
atmospheric pressure
20.4.3 Calculated Parameters
Abbreviation
Unit
Full spelling
PAO2
mmHg
partial pressure of oxygen in the alveoli
AaDO2
mmHg
alveolar-arterial oxygen difference
Pa/FiO2
mmHg
oxygenation ratio
a/AO2
%
arterial to alveolar oxygen ratio
MV
L/min
minute volume
Vd
ml
volume of physiological dead space
Vd/Vt
%
physiologic dead space in percent of tidal volume
VA
L/min
alveolar volume
20-5
20.5 Hemodynamic Calculations
20.5.1 Performing Calculations
To perform a hemodynamic calculation:
1.
Select [Main Menu]ė[Calculations >>]ė[Hemodynamic >>], or select [Calculations]
QuickKeyė[Hemodynamic >>].
2.
Enter values for calculation.
‹
For a patient who is being monitored, [HR], [Art mean], [PA mean] and [CVP] are automatically taken
from the currently measured values. If you just have performed C.O. measurements, [C.O.] is the average of
multiple thermodilution measurements. [Height] and [Weight] are the patient’s height and weight you have
entered. If the monitor does not provide these values, their fields appear blank.
‹
3.
For a patient who is not being monitored, confirm the values you have entered.
Select the [Calculate] button. The system performs a calculation per the current settings and displays the
calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow. You can select [Range] to
view its normal range in the unit field.
‹
Invalid values are displayed as [---].
In the [Hemodynamic Calculation] window, you can:
„
Trigger a recording by selecting the [Record] button. The currently displayed renal calculations are printed
out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20.5.2 Entered Parameters
Abbreviation
Unit
Full spelling
C.O.
L/min
cardiac output
HR
bpm
heart rate
PAWP
mmHg
pulmonary artery wedge pressure
Art Mean
mmHg
artery mean pressure
PA Mean
mmHg
pulmonary artery mean pressure
CVP
mmHg
central venous pressure
EDV
ml
end-diastolic volume
Height
cm
height
Weight
kg
weight
20.5.3 Calculated Parameters
Abbreviation
BSA
Unit
Full spelling
2
m
C.I.
L/min/m
SV
ml
body surface area
2
cardiac index
stroke volume
20-6
Abbreviation
Unit
Full spelling
SI
ml/m2
stroke index
SVR
DS/cm5
systemic vascular resistance
2
SVRI
5
DS·m /cm
5
PVR
DS/cm
systemic vascular resistance index
pulmonary vascular resistance
2
5
PVRI
DS·m /cm
pulmonary vascular resistance index
LCW
kg·m
left cardiac work
LCWI
kg·m/m
LVSW
g·m
2
left cardiac work index
left ventricular stroke work
2
LVSWI
g·m/m
RCW
kg·m
left ventricular stroke work index
right cardiac work
RCWI
kg·m/m
RVSW
g·m
2
right cardiac work index
right ventricular stroke work
2
RVSWI
g·m/m
right ventricular stroke work index
EF
%
ejection fraction
20.6 Renal Calculations
20.6.1 Performing Calculations
To perform a renal calculation:
1.
Selecting [Main Menu]ė[Calculations >>]ė[Renal >>], or select [Calculations] QuickKeyė[Renal
>>].
2.
Enter values for calculation.
3.
Select the [Calculate] button. The system performs a calculation per the current settings and displays the
calculated values.
‹
If a calculated value is outside the range, its background will highlight in yellow. You can select [Range] to
view its normal range in the unit field.
‹
Invalid values are displayed as [---].
In the [Renal Calculation] window, you can:
„
Trigger a recording by selecting the [Record] button. The currently displayed renal calculations are printed
out by the recorder.
„
Review the previously performed calculations by selecting [Review].
20-7
20.6.2 Entered Parameters
Abbreviation
Unit
Full spelling
URK
mmol/L
urine pstassium
URNa
mmol/L
urinary sodium
Urine
ml/24h
urine
Posm
mOsm/ kgH2O
plasm osmolality
Uosm
mOsm/ kgH2O
urine osmolality
SerNa
mmol/L
serum sodium
Cr
Pmol/L
creatinine
UCr
Pmol/L
urine creatinine
BUN
mmol/L
blood urea nitrogen
Height
cm
height
Weight
kg
weight
20.6.3 Calculated Parameters
Abbreviation
Unit
Full spelling
URNaEx
mmol/24h
urine sodium excretion
URKEx
mmol/24h
urine potassium excretion
Na/K
%
sodium potassium ratio
CNa
ml/24h
clearance of sodium
Clcr
ml/min
creatinine clearance rate
FENa
%
fractional excretion of sodium
Cosm
ml/min
osmolar clearance
CH2O
ml/h
free water clearance
U/P osm
None
urine to plasma osmolality ratio
BUN/Cr
None*
blood urea nitrogen creatinine ratio
U/Cr
None
urine-serum creatinine ratio
*: BUN/Cr is a ratio under the unit of mol.
20.7 Understanding the Review Window
With the review feature, you can review oxygenation, ventilation, hemodynamic and renal calculations. The review
window for each calculation is similar. Take the hemodynamic calculations review window for example, you can access
it by selecting [Review] in the [Hemodynamic Calculation] window.
In this review window:
„
You can select
„
The values that exceed the range are displayed in yellow background. The [Unit] field displays parameter units.
,
or
to view more values.
If some parameter values are outside of their normal ranges, you can view their normal range in the [Unit] field
by selecting [Range].
„
You can review an individual calculation by selecting its corresponding column and then selecting [Original
Calc]. You can record the currently displayed calculations or perform another calculation is this window.
20-8
21 Recording
21.1 Using a Recorder
The thermal recorder records patient information, measurement numerics, up to three waveforms, etc.
2
1
4
3
5
1.
Start/Stop key: press to start a recording or stop the current recording.
2.
Indicator
‹
On: when the recorder works correctly.
‹
Off: when the monitor is switched off.
‹
Flashes: if an error occurred to the recorder, e.g., the recorder runs out of paper.
3.
Paper outlet
4.
Latch
5.
Recorder door
21.2 Overview of Recording Types
By the way recordings are triggered, the recordings can be classified into the following categories:
„
Manually-triggered realtime recordings.
„
Timed recordings.
„
Alarm recordings triggered by an alarm limit violation or an arrhythmia event.
„
Manually-triggered, task-related recordings.
21-1
The task-related recordings include:
„
Frozen wave recording
„
Graphic trends recording
„
Tabular trends recording
„
Events recording:parameter alarm recording, arrh. alarm recording, manual events recording
„
Wave review recording
„
Titration table recording
„
Hemodynamic calculations recording
„
Oxygenation calculations recording
„
Ventilation calculations recording
„
Renal calculations recording
„
oxyCRG recording
„
C.O. curve recording
„
PAWP recording
„
Respiratory loops recording
„
Monitor information recording
NOTE
z
For details about alarm recording, refer to the chapter 7 Alarms.
z
For details about task-related recordings, refer to respective sections of this manual.
21.3 Starting and Stopping Recordings
To manually start a recording, you can either:
„
Select the
„
Select the [Record] button from the current menu or window.
hardkey on the front of either the patient monitor or the recorder module, or
Automatic recordings will be triggered in the following conditions:
„
Timed recordings will start automatically at preset intervals.
„
If both [Alarm] and [Alm Rec] for a measurement are set on, an alarm recording will be triggered automatically
as alarms occur.
To manually stop a recording, you can either:
„
Select the
„
Select [Clear All Tasks] in the [Record Setup] menu.
hardkey again, or
Recordings stop automatically when:
„
The runtime is over.
„
The recorder runs out of paper.
„
When the recorder has an alarm condition.
21-2
When a recording is stopped, the following markers will be added:
„
Automatically stopped recording: print two columns of ‘*’ at the end of the report.
„
Manually or abnormally stopped recording: print one column of ‘*’ at the end of the report.
21.4 Setting up the Recorder
21.4.1 Accessing the Record Setup Menu
By selecting [Main Menu]ė[Record Setup >>], you can access the [Record Setup] menu.
21.4.2 Selecting Waveforms for Recording
The recorder can record up to 3 waveforms at a time. You can select, in turn, [Waveform 1], [Waveform 2] and
[Waveform 3] in the [Record Setup] menu, and then select the waveforms you want. You can also turn off a
waveform recording by selecting [Off]. These settings are intended for realtime and scheduled recordings.
21.4.3 Setting the Realtime Recording Length
After starting a realtime recording, the recording time depends on your monitor’s settings. In the [Record Setup]
menu, select [Length] and toggle between [8 s] and [Continuous].
„
[8 s]: record 4-second waveforms respectively before and after current moment.
„
[Continuous]: record the waveforms from the current moment until stopped manually.
21.4.4 Setting the Interval between Timed Recordings
Timed recordings start automatically at preset intervals. Each recording lasts 8 seconds. To set the interval between
timed recordings: in the [Record Setup] menu, select [Interval] and then select the appropriate setting.
21.4.5 Changing the Recording Speed
In the [Record Setup] menu, select [Paper Speed] and toggle between [25 mm/s] and [50 mm/s]. This setting is
for all recordings containing waveforms.
21.4.6 Clearing Recording Tasks
In the [Record Setup] menu, select [Clear All Tasks]. All queued recording tasks are cleared and the current
recording is stopped.
21.5 Loading Paper
1.
Use the latch at the upper right of the recorder door to pull the door open.
2.
Insert a new roll into the compartment as shown below.
3.
Close the recorder door.
4.
Check if paper is loaded correctly and the paper end is feeding from the top.
21-3
Paper roll
CAUTION
z
Use only specified thermal paper. Otherwise, it may cause damage to the recorder’s printhead, the
recorder may be unable to print, or poor print quality may result.
z
Never pull the recorder paper with force when a recording is in process. Otherwise, it may cause damage to
the recorder.
z
Do not leave the recorder door open unless you reload paper or remove troubles.
21.6 Removing Paper Jam
If the recorder works incorrectly or produces unusual sounds, check if there is a paper jam first. If a paper jam is detected,
follow this procedure to remove it:
1.
Open the recorder door.
2.
Take out the paper and tear off the draped part.
3.
Reload the paper and close the recorder door.
21.7 Cleaning the Recorder Printhead
If the recorder has been used for a long time, deposits of paper debris may collect on the printhead compromising the
print quality and shortening the lifetime of the roller. Follow this procedure to clean the printhead:
1.
Take measures against the static electricity such as Disposable Wrist Strap for the work.
2.
Open the recorder door and take out the paper.
3.
Gently wipe around the printhead using cotton swabs dampened with alcohol.
4.
After the alcohol has completely been dried, reload the paper and close the recorder door.
CAUTION
z
Do not use anything that may destroy the thermal element.
z
Do not add unnecessary force to the thermal head.
21-4
22 Printing
22.1 Printer
The monitor can output patient reports via a connected printer. So far, the monitor supports the following printer:
„
HP LaserJet 1505n
„
HP LaserJet P2035n
„
HP LaserJet P4015n
„
HP LaserJet 1606dn
The specifications of the reports the monitor prints are:
„
Paper: A4, Letter
„
Resolution: 300 dpi
„
Print on One/Both Sides : printing on one and both sides are supported if the printer supports
For more details about the printer, see the document accompanying the printer. With the upgrading of products, the
monitor will support more printers and no prior notice will be given. If you have any doubt about the printer you have
purchased, contact our company.
22.2 Connecting a printer
To print the reports or the trend data of a patient, you can choose either:
„
the local printer
Connect the printer and the patient monitor directly with a network cable, and then start printing what you want,
or
„
the Central Monitoring System
If your monitor is connected to a central monitoring system, it is recommended to use the central monitoring
system for printing.
22-1
22.3 Setting Up the Printer
To set the printer’s properties, select [Main Menu]ė[Print Setup >>]ė[Printer Setup >>]. In the [Printer
Setup] menu, you can:
„
Select a connected printer
Select [Printer] and then select a connected printer as the monitor’s printer.
„
Search for a printer
If your selected printer is not in the list or a new printer is added into the network, you can select the [Search
Printer] to re-search for all printers in the network.
„
Set up the paper
Select [Paper Size] and toggle between [A4] and [Letter].
„
Print on both sides
By default, the monitor prints out patient reports on one side. If you set [Print On Both Sides] to [On], the
monitor will print out patient reports on both sides.
22.4 Starting Report Printouts
Reports
Contents
Procedures
ECG reports
ECG waveforms and relevant
Select [Main Menu]ė[Print Setup >>]ė[ECG Reports
parameter values
>>]ė[Print]
Depend on the selected parameter
Select [Main Menu]ė[Print Setup >>]ė[Tabular
group, resolution and time period
Trends Reports >>]ė[Print], or select [Main
Menu]ė[Review >>]ė[Tabular
Trends]ė[Print]ė[Print]
Depend on the selected parameter
Select [Main Menu]ė[Print Setup >>]ė[Graphic
group, resolution and time period
Trends Reports >>]ė[Print], or select [Main
Menu]ė[Review >>]ė[Graphic
Trends]ė[Print]ė[Print]
Arrh. alarm
ECG waveforms and relevant
Select [Print] in [Arrh. Events]
review
parameter values
Parameter alarm
Depend on the selected alarms
Select [Main Menu]ė[Review >>]ė[Alarms]ė[Print]
Depend on the selected waveforms
Select [Main Menu]ė[Print Setup >>]ė[Realtime
Tabular trends
Graphic trends
review
Realtime waves
Reports >>]ė[Print]
22-2
22.5 Stopping Reports Printouts
To stop report printouts, select [Main Menu]ė[Print Setup >>]ė[Stop All Reports].
22.6 Setting Up Reports
22.6.1 Setting Up ECG Reports
You can print out ECG reports only under full-screen, half-screen or 12-lead monitoring screen. To set up ECG reports,
select [Main Menu]ė[Print Setup >>]ė[ECG Reports >>].
„
[Amplitude]: set the amplitude of the ECG waveforms.
„
[Sweep]: set the wave print speed.
„
[Auto Interval]: If [Auto Interval] is set to [On], the system will automatically adjust the space between
waveforms to avoid overlapping.
„
[Gridlines]: choose whether to show gridlines.
22.6.2 Setting Up Tabular Trends Reports
To set up tabular trends reports, select [Main Menu]ė[Print Setup >>]ė[Tabular Trends Reports >>].
„
Start time: You can set a time period whose trend data will be printed out by setting [From] and [Back]. For
example, if you set [From] as 2007-4-2 10:00:00 and [Back] as [2 h], the outputted data will be from 2007-4-2
08:00:00 to 2007-4-2 10:00:00. In addition, the [Back] can be set to either:
‹
[Auto]: If [Report Layout] is set to [Time Oriented], the report will be printed by time. If [Report
Layout] is set to [Parameter Oriented], the report will be printed by parameters.
‹
[All]: If you select [All], all trend data will be printed out. In this case, it is no need to set [From].
„
[Interval]: choose the resolution of the tabular trends printed on the report.
„
[Report Layout]: If you select [Time Oriented], the report will be printed by time. If you select [Parameter
Oriented], the report will be printed by parameters.
„
[Select Parameter >>]: from the popup menu, you can:
‹
[Currently Displayed Trended Parameters]: print the parameter trend data selected from the
[Tabular Trends].
‹
[Standard Parameter Group]: select the standard parameter group for printing.
‹
[Custom]: You can define a parameter group for printing from the parameters displayed in the low part of
the menu.
22-3
22.6.3 Setting Up Graphic Trends Reports
To set up graphic trends reports, select [Main Menu]ė[Print Setup >>]ė[Graphic Trends Reports >>]. As
setting up graphic trends reports is similar with tabular trends reports, you can refer to the Setting Up Tabular Trend
Reports section for details.
22.6.4 Setting Up Realtime Reports
To set up realtime reports, select [Main Menu]ė[Print Setup >>]ė[Realtime Reports >>].
„
[Sweep]: set the wave print speed.
„
[Select Wave >>]: from the popup menu, you can:
‹
[Current]: select the currently displayed waves for printing.
‹
[Select Wave]: select the desired waves for printing.
22.7 End Case Reports
ECG reports, tabular trends reports, graphic trends reports, NIBP review reports and realtime reports can be set as end
case reports. When you discharge a patient, the system will automatically print out all contents that are set as end case
reports.
For example, to set ECG report as end case report:
1.
select [Main Menu]ė[Print Setup >>]ė[ECG Report >>].
2.
select [End Case Report]ė[Set as End Case Report] and then select [Ok] from the popup dialog box.
3.
set as described in the 22.6.1 Setting Up ECG Reports.
22.8 Printer Statuses
22.8.1 Printer Out of Paper
When the printer runs out of paper, the print request will not be responded. If there are too many print jobs that are not
responded, a printer error may occur. In these cases, you need to install paper and then re-send the print request. Restart
the printer if necessary.
Therefore, you’d better ensure that there is enough paper in the printer before sending a print request.
22.8.2 Printer Status Messages
If the monitor prompts that selected printer is not available, check that the printer is switched on, correctly connected,
and installed with paper.
22-4
23 Other Functions
23.1 Analog Output
The patient monitor provides analog output signals to accessory equipment via the multifunctional connector on the
rear of the monitor. To obtain analog output signals, connect the accessory equipment such as an oscillograph, etc. to
the monitor.
NOTE
z
The analog output feature is seldom applied in clinical applications. You can contact your service
personnel for more details.
23.2 Transferring Data
You can transfer the patient data saved in the monitor to a PC via a crossover network cable or within a LAN for data
management, review or print.
23.2.1 Data Export System
You must install the data export system on the intended PC before performing the data transfer operation. Refer to the
document accompanying the installation CD-ROM for installation instructions.
The data transfer feature supports patient management, data review, data format conversion, print, etc. in addition to
data transfer. Refer to the help file of the system software for more details.
23.2.2 Transferring Data by Different Means
NOTE
z
Never enter the data transfer mode when the patient monitor is in normal operation or performs
monitoring. You must re-start the patient monitor to exit the data transfer mode.
Transfer data via a crossover network cable
Before transferring data using a crossover network cable, do as follows:
1.
Connect one end of the crossover network cable to the patient monitor and the other end to the PC.
2.
Set the IP address of the PC. This IP address must be in the same network segment with that of the patient monitor.
3.
Make sure that the data export system is active on the PC.
23-1
Then, follow this procedure to transfer data:
1.
Select [Main Menu]ė[Patient Data >>]ė[Transfer Data].
2.
Select [Yes] from the popup message box.
3.
Input the IP address already set on the PC.
4.
Select [Start] to start transferring data.
Transfer data within a LAN
Before transferring data within a LAN, do as follows:
1.
Connect the patient monitor and the intended PC into the same LAN and acquire the PC’s IP address.
2.
Make sure that the data export system is active on the PC.
Follow the same procedure as via a crossover network cable to transfer data.
23.3 Nurse Call
The patient monitor also provides nurse call signals to a nurse call system connected to the monitor via the
multifunctional connector. To obtain nurse call signals, connect a nurse call system to the monitor and then follow this
procedure:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required password.
2.
Select [Others >>] to access the [Others] menu.
3.
Select [Nurse Call Setup >>] to change the nurse call settings as follows:
„
Select [Signal Type] and toggle between [Pulse] and [Continuous].
‹
[Pulse]: the nurse call signals are pulse signals and each pulse lasts 1 second. When multiple alarms occur
simultaneously, only one pulse signal is outputted. If an alarm occurs but the previous one is not cleared yet, a new
pulse signal will also be outputted.
‹
[Continuous]: the nurse call signal lasts until the alarm ends, i.e. the duration of a nurse call signal equals to
that of the alarm condition.
„
Select [Contact Type] and toggle between [Normally Open] and [Normally Closed].
‹
[Normally Open]: select if your hospital’s nurse call relay contact is normally open.
‹
[Normally Closed]: select if your hospital’s nurse call relay contact is normally closed.
„
Select [Alm Lev] and set the alarm level for nurse call-triggering alarms.
„
Select [Alarm Cat.] and then select the category to which the nurse call-triggering alarms belong.
Alarm conditions are indicated to nurses only when:
„
The nurse call system is enabled,
„
An alarm that meets your preset requirements occurs, and
„
The monitor is not in the alarm paused or silence status.
23-2
WARNING
z
Do not rely exclusively on the nurse call system for alarm notification. Remember that the most reliable
alarm notification combines audible and visual alarm indications with the patient’s clinical condition.
NOTE
z
If no setting is selected from [Alm Lev] or [Alarm Cat.], no nurse call signal will be triggered whatever
alarms occur.
23.4 Network Connection
23.4.1 Setting the Network Type
The patient monitor supports both wired and wireless network. To set the network type, you can select [Main Menu]
ė[Maintenance>>]ė[User Maintenance>>]ėenter the required passwordė[Network Setup >>].
23.4.2 Wireless Network
The patient monitors can be connected to a wireless network via a built-in Wi-Fi module. To set the wireless network:
1.
Select [Main Menu]ė[Maintenance>>]ė[User Maintenance>>]ėenter the required passwordė
[Network Setup >>].
2.
Set the [Network Type] to [WLAN].
3.
Select [WLAN Setup >>] to access the [WLAN Setup] menu.
4.
Configure the [Network Name (SSID)], and [Password].
5.
Click [OK] to confirm the setting.
To test the availability of the wireless network, follow this procedure:
1.
Select [WLAN Test >>] in the [WLAN Setup] menu.
2.
Enter the [IP Address] of wireless AP in the [WLAN Test >>] menu.
3.
Click [Connection Test].
The Wi-Fi device used in the monitor is in compliance with IEEE 802.11b/g/n.
23-3
23.4.3 Setting the IP Address, Subnet Mask and Gateway
In the [Network Setup] menu, you can set IP address, subnet mask and gateway. You should not change the patient
monitor’s IP address randomly. If you want to know details about IP address setup, contact the technical personnel in
charge of the CMS.
NOTE
z
The design, installation, restruction and maintenance of the wireless network’s distribution shall be
performed by authorized service personnel of our company.
z
The existence of obstacles (such as wall) will exert impact on data transferring or even cause network
interruption.
z
The Central Monitoring System is capable of connecting up to 32 bedside monitors via the wireless
network.
23-4
24 Batteries
24.1 Overview
This monitor is designed to operate on rechargeable Lithium-ion battery power during intra-hospital patient transfer
or whenever the power supply is interrupted. The battery is charged automatically when the monitor is connected to
AC/DC power, no matter the monitor is powered on or not. Whenever the AC/DC power is interrupted during patient
monitoring, the patient monitor automatically runs power from the internal battery. iPM 12 patieng monitor is
available for up to two batteries. iPM 10 or iPM 8 patient monitor is available for only one battery.
On-screen battery symbols indicate the battery status as follows:
„
Indicates that the battery works correctly. The solid portion represents the current charge level of
the battery in proportion to its maximum charge level.
„
Indicates that the battery has low charge level and needs to be charged. In
monitor provides an alarm message.
„
Indicates that the battery is almost depleted and needs to be charged immediately. Otherwise, the
patient monitor shuts down automatically.
„
this case, the patient
Indicates that no battery is installed.
The capacity of the internal battery is limited. If the battery charge is too low, a technical alarm will be triggered and
the message [Low Battery] or [Battery Depleted] displayed. At this moment, apply AC/DC power to the patient
monitor. Otherwise, the patient monitor will power off automatically before the battery is completely depleted.
24-1
24.2 Replacing a Battery
When the iPM 12 patient monitor uses two battery packs, one battery pack can be easily exchanged while the patient
monitor operates from the other. If the iPM 12 patient monitor uses one battery pack, you should insert a new battery
pack before the old one depletes.
When the iPM 10 or iPM 8 patient monitor operates on battery power, make sure the patient monitor is power off
before replacing a battery.
To replace a battery, follow this procedure:
1.
Open the battery door.
Pull here to open
the battery door
iPM 12
iPM 10/iPM 8
2.
Push aside the latch fixing the battery to be replaced and remove the battery.
3.
Insert a battery into the slot with its contact point inward.
4.
Close the battery door.
24-2
24.3 Battery Guidelines
Life expectancy of a battery depends on how frequent and how long it is used. For a properly maintained and stored
lithium ion battery, its life expectancy is about 3 years. For more aggressive use models, life expectancy can be less.
We recommend replacing lithium ion batteries every 3 years.
To get the most out of the battery, observe the following guidelines:
„
The battery performance test must be performed every two years, before monitor repairs, or whenever the
battery is suspected as being the source of the problems.
„
Condition a battery once when it is used or stored for 3 months, or when its operating time becomes noticeably
shorter.
„
Take out the battery before the monitor is transported or will not be used for more than 3 months.
„
Remove the battery from the monitor if it is not being used regularly. (Leaving the battery in a monitor that is
not in regular use will shorten the life of the battery).
„
The shelf life of a Lithium Ion battery is about 6 months when the battery is stored with the battery power
being 50% of the total power. In 6 months the battery power must be depleted before the Lithium Ion battery
is fully charged. Then run the monitor on this fully charged battery .When its battery power becomes 50% of
the total power, take out the battery from the monitor and store it.
WARNING
z
Keep the battery out of the reach of children.
z
Use only the battery specified by the manufacturer.
z
If the battery shows signs of damage or signs of leakage, replace it immediately. Do not use a faulty
battery in the monitor.
24.4 Battery Maintenance
Conditioning a Battery
A battery should be conditioned before it is used for the first time. A battery conditioning cycle is one uninterrupted
charge of the battery, followed by an uninterrupted battery discharge and charge. . Batteries should be conditioned
regularly to maintain their useful life.
NOTE
z
The actual battery capacity will decrease over time with use of batteries. When a monitor operates on
batteries that have been used before, the full capacity battery symbol does not indicate the capacity and
operating time of this battery can still fulfill battery specifications in the operator’s manual. When
conditioning a battery, please replace the battery if its operating time is significantly lower than the
specified time.
24-3
To condition a battery, follow this procedure:
1.
Disconnect the monitor from the patient and stop all monitoring or measuring.
2.
Insert the battery in need of conditioning in the battery slot of the monitor.
3.
Apply AC/DC power to the monitor and allow the battery to charge uninterrupted for 10 hours.
4.
Remove AC/DC power and allow the monitor to run from the battery until it shuts off.
5.
Apply AC/DC power again to the monitor and allow the battery to charge uninterrupted for 10 hours.
6.
This battery is now conditioned and the monitor can be returned to service.
Checking a Battery
The battery performance test must be performed every two years, before monitor repairs, or whenever the battery is
suspected as being the source of the problems.The performance of a rechargeable battery may deteriorate over time.
To check the performance of a battery, follow this procedure:
1.
Disconnect the monitor from the patient and stop all monitoring or measuring.
2.
Apply AC/DC power to the monitor and allow the battery to charge uninterrupted for 10 hours.
3.
Remove AC/DC power and allow the monitor to run from the battery until it shuts off.
4.
The operating time of battery reflects its performance directly.
Please replace the battery or contact with the maintenance personnel if its operating time is significantly lower than
the specified time.
NOTE
z
The battery might be damaged or malfunctioned if its operating time is too short after being fully charged.
The operating time depends on the configuration and operation. For example, measuring NIBP more
frequently will also shorten the operating time.
z
When a battery has visual signs of damage, or no longer holds a charge, it should be replaced. Remove the
old battery from the monitor and recycle it properly.
24.5 Battery Recycling
When a battery has visual signs of damage, or no longer holds a charge, it should be replaced. Remove the old battery
from the monitor and recycle it properly. To dispose of the batteries, follow local laws for proper disposal.
WARNING
z
Do not disassemble batteries, or dispose of them in fire, or cause them to short circuit. They may ignite,
explode, leak or heat up, causing personal injury.
24-4
25 Care and Cleaning
Use only the substances approved by us and methods listed in this chapter to clean or disinfect your equipment.
Warranty does not cover damage caused by unapproved substances or methods.
We make no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. For the
method to control infection, consult your hospital’s Infection Control Officer or Epidemiologist.
25.1 General Points
Keep you equipment and accessories free of dust and dirt. To avoid damage to the equipment, follow these rules:
„
Always dilute according the manufacturer’s instructions or use lowest possible concentration.
„
Do not immerse part of the equipment into liquid.
„
Do not pour liquid onto the equipment or accessories.
„
Do not allow liquid to enter the case.
„
Never use abrasive materials (such as steel wool or silver polish), or erosive cleaners (such as acetone or
acetone-based cleaners).
WARNING
z
Be sure to shut down the system and disconnect all power cables from the outlets before cleaning the
equipment.
CAUTION
z
If you spill liquid on the equipment or accessories, contact us or your service personnel.
NOTE
z
To clean or disinfect reusable accessories, refer to the instructions delivered with the accessories.
25-1
25.2 Cleaning
Your equipment should be cleaned on a regular basis. If there is heavy pollution or lots of dust and sand in your place,
the equipment should be cleaned more frequently. Before cleaning the equipment, consult your hospital’s regulations
for cleaning the equipment.
Recommended cleaning agents are:
„
Sodium hypochlorite bleach (diluted)
„
Hydrogen peroxide (3%)
„
Ethanol (70%)
„
Isopropanol (70%)
To clean your equipment, follow these rules:
1.
Shut down the patient monitor and disconnect it from the power line.
2.
Clean the display screen using a soft, clean cloth dampened with a glass cleaner.
3.
Clean the exterior surface of the equipment using a soft cloth dampened with the cleaner.
4.
Wipe off all the cleaning solution with a dry cloth after cleaning if necessary.
5.
Dry your equipment in a ventilated, cool place.
25.3 Disinfecting
Disinfection may cause damage to the equipment and is therefore not recommended for this patient monitor unless
otherwise indicated in your hospital’s servicing schedule. Cleaning equipment before disinfecting is recommended.
The recommended disinfectants include: ethanol 70%, isopropanol 70%, Perform® classic concentrate OXY (KHSO4
solution).
.
CAUTION
z
Never use EtO or formaldehyde for disinfection.
25-2
26 Maintenance
WARNING
z
Failure on the part of the responsible individual hospital or institution employing the use of this
equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and
possible health hazards.
z
The safety checks or maintenance involving any disassembly of the equipment should be performed by
professional servicing personnel. Otherwise, undue equipment failure and possible health hazards could
result.
z
If you discover a problem with any of the equipment, contact your service personnel or us.
26.1 Safety Checks
Before every use, after your patient monitor has been used for 6 to 12 months, or whenever your patient monitor is
repaired or upgraded, a thorough inspection should be performed by qualified service personnel to ensure the
reliability.
Follow these guidelines when inspecting the equipment:
„
Make sure that the environment and power supply meet the requirements.
„
Inspect the equipment and its accessories for mechanical damage.
„
Inspect all power cords for damage, and make sure that their insulation is in good condition.
„
Make sure that only specified accessories are applied.
„
Inspect if the alarm system functions correctly.
„
Make sure that the recorder functions correctly and the recorder paper meets the requirements.
„
Make sure that the batteries meet the performance requirements.
„
Make sure that the patient monitor is in good working condition.
„
Make sure that the grounding resistance and leakage current meet the requirement.
In case of any damage or abnormity, do not use the patient monitor. Contact the hospital’s biomedical engineers or your
service personnel immediately.
26-1
26.2 Checking Monitor and Module Information
To view the information about system start time, selftest, etc., select [Main Menu]ė[Maintenance
>>]ė[Monitor Information >>]. You can print out the information for the convenience of troubleshooting. The
information will not be saved during shut down.
You can also view the information about the monitor configuration and system software version by selecting [Main
Menu]ė[Maintenance >>]ė[Software Version >>].
26.3 Calibrating ECG
The ECG signal may be inaccurate due to hardware or software problems. As a result, the ECG wave amplitude becomes
greater or smaller. In that case, you need to calibrate the ECG module.
1.
Select the ECG parameter window or waveform areaė[Filter]ė[Diagnostic].
2.
Select [Main Menu]ė[Maintenance >>]ė[Calibrate ECG]. A square wave appears on the screen and the
message [ECG Calibrating] is displayed.
3.
Compare the amplitude of the square wave with the wave scale. The difference should be within 5%.
4.
After the calibration is completed, select [Stop Calibrating ECG]
You can print out the square wave and wave scale and then measure the difference between them if necessary. If the
difference exceeds 5%, contact your service personnel.
26.4 Calibrating the Touchscreen
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required passwordė[Cal.
Touchscreen].
2.
will, in turn, appear at different positions of the screen.
3.
Select each
4.
After the calibration is completed, the message [Screen Calibration Completed!] is displayed. Select [Ok] to
as it appears on the screen.
confirm the completion of the calibration.
26.5 Calibrating CO2
For sidestream and microstream CO2 modules, a calibration is needed every year or when the measured values have a
great deviation. For maintream CO2 module, no calibration is needed. Calibration for sidestream CO2 module can be
performed only when the sidestream module enters the full accuracy mode.
Tools required:
„
A steel gas cylinder with 6±0.05% CO2 and balance gas N2
26-2
„
T-shape connector
„
Tubing
Follow this procedure to perform a calibration:
1.
Make sure that the sidestream or microstream CO2 module has been warmed up or started up.
2.
Check the airway for leakage and perform a leakage test as well to make sure the airway has no leakage.
3.
Select [Main Menu]ė [Maintenance >>]ė [User Maintenance >>]ė enter the required passwordė
[Maintain CO2 >>]ė [Calibrate CO2 >>].
4.
In the [Calibrate CO2] menu, select [Zero].
5.
After the zero calibration is finished successfully, connect the equipment as follows:
Flowmeter
Tubing
Relief valve
T-shape connector
Monitor
Gas cylinder
6.
Turn on and adjust the relief valve to make the flowmeter reads within 10-50mL/min and keeps stable as well.
7.
In the [Calibrate CO2] menu, enter the vented CO2 concentration in the [CO2] field.
8.
In the [Calibrate CO2] menu, the measured CO2 concentration is displayed. After the measured CO2
concentration becomes stable, select [Calibrate CO2] to calibrate the CO2 module.
9.
If the calibration is finished successfully, the message [Calibration Completed!] is displayed in the [Calibrate
CO2] menu. If the calibration failed, the message [Calibration Failed!] is displayed. In this case, perform another
calibration.
26.6 Calibrating AG
Calibrate the AG module every year or when the measured value has a great deviation.
Tools required:
„
Gas bottle, with a certain standard gas or mixture gas. Gas concentration should meet the following requirements:
AA>1.5%, CO2>1.5%, N2O>40%, O2>40%, of which AA represents an anesthetic agent. a/cİ0.01 (a is the gas
absolute concentration accuracy; c is the gas concentration˅
„
T-shape connector
„
Tubing
26-3
Follow this procedure to perform a calibration:
1.
Select [Main Menu]ė[Maintenance >>]ė[User Maintenance >>]ėenter the required
passwordė[Calibrate AG >>].
2.
Check the airway and make sure that there are no occlusions or leaks.
‹
Vent the tubing to the air and check if the [Current FlowRate] and [Set FlowRate] are approximately the
same. If the deviation is great, it indicates that there is an occlusion in the tubing. Check the tubing for an occlusion.
‹
3.
Perform a leakage test to make sure that the airway has no leakage.
Connect the test system as follows:
Flowmeter
Tubing
Relief valve
T-shape connector
Monitor
Gas cylinder
4.
Open the relief valve and vent a certain standard gas or gas mixture. Adjust the relief valve to make the flowmeter
reads within 10-50mL/min and keeps stable as well.
5.
In the [Calibrate AG] menu, the concentration and flowrate of each measured gas are displayed
‹
If the difference between the measured gas concentration and the actual one is very small, a calibration is not
needed.
‹
If the difference is great, you should perform a calibration. Select [Calibrate >>] to enter the calibrate menu.
6.
Enter the vented gas concentration. If you use only one gas for calibration, set other gases’ concentration to 0.
7.
Select [Calibrate >>] to start calibration.
8.
If the calibration is finished successfully, the message [Calibration Completed!] is displayed. If the calibration
failed, the message [Calibration Failed!] is displayed. Perform another calibration.
CAUTION
z
If the O2 module has been transported for long distance, calibrate it when installing the monitor.
26-4
27 Accessories
The accessories listed in this chapter comply with the requirements of IEC 60601-1-2 when in use with the patient
monitor.
WARNING
z
Use accessories specified in this chapter. Using other accessories may cause damage to the patient
monitor or not meet the claimed specifications.
z
Single-use accessories are not designed to be reused. Reuse may cause a risk of contamination and affect
the measurement accuracy.
z
Check the accessories and their packages for any sign of damage. Do not use them if any damage is
detected.
27.1 ECG Accessories
ECG Electrodes
Model
Quantity
Patient Category
Part No.
31499224
10 pieces
Adult
0010-10-12304
2245
50 pieces
Pediatric
9000-10-07469
2258-3
3 pieces
Neonate
900E-10-04880
12-Pin Integrative Trunk Cables
Leadwire
Compatible
supported
with
5-leadwire
AHA
5-leadwire
IEC
3-leadwire
AHA
3-leadwire
IEC
5-leadwire
AHA
5-leadwire
IEC
3-leadwire
3-leadwire
Type
Patient Category
Model
Part No.
EA6251B
040-000961-00
EA6252B
040-000963-00
EA6231B
040-000965-00
EA6232B
040-000967-00
EA6251A
040-000960-00
EA6252A
040-000962-00
AHA
EA6231A
040-000964-00
IEC
EA6232A
040-000966-00
Snap, Defibrillator-proof
Adult, pediatric
Clip, Defibrillator-proof
27-1
12-Pin Separable Trunk Cables
Leadwire
Compatible with
Type
3-leadwire
AHA, IEC
Defibrillator-proof
3-leadwire
AHA, IEC
ESU-proof
3-leadwire
/
Defibrillator-proof
3/5-leadwire
AHA, IEC
Defibrillator-proof
3/5-leadwire
AHA, IEC
ESU-proof
12-leadwire
AHA
Defibrillator-proof
12-leadwire
IEC
Defibrillator-proof
supported
Patient Category
Part No.
0010-30-42720
Infant, neonate
0010-30-42724
040-000754-00
0010-30-42719
Adult, pediatric
0010-30-42723
0010-30-42721
Adult
0010-30-42722
Cable Sets
3-Electrode Cable Sets
Type
Compatible with
Model
EL6304A
Patient Category
Adult, pediatric
EL6302A
IEC
EL6308A
EL6306A
Pediatric
Infant, neonate
EL6312A
Clip
EL6303A
Adult, pediatric
EL6301A
AHA
EL6307A
EL6305A
Pediatric
Infant, neonate
EL6311A
IEC
Snap
AHA
Part No.
Length
Remark
0010-30-42732
1m
Long
0010-30-42725
0.6m
/
0010-30-42899
0.6m
/
0010-30-42897
1m
Long
040-000149-00
1m
Long
0010-30-42731
1m
Long
0010-30-42726
0.6m
/
0010-30-42898
0.6m
/
0010-30-42896
1m
Long
040-000148-00
1m
Long
EL6302B
Adult, pediatric
0010-30-42733
1m
Long
EL6308B
Pediatric
0010-30-42901
0.6m
/
EL6312B
Infant, neonate
040-000147-00
1m
Long
EL6301B
Adult, pediatric
0010-30-42734
1m
Long
EL6307B
Pediatric
0010-30-42900
0.6m
/
EL6311B
Infant, neonate
040-000146-00
1m
Long
Part No.
Length
Remark
EL6502A
0010-30-42728
0.6m
/
EL6504A
0010-30-42730
1m to 1.4m
Long
EL6501A
0010-30-42727
0.6m
/
EL6503A
0010-30-42729
1m to 1.4m
Long
5-Electrode Cable Sets
Type
Compatible with
IEC
Clip
AHA
Model
Patient Category
1.4m for F
Adult, pediatric
IEC
EL6502B
0010-30-42736
and N; 1m for
Long
others
Snap
1.4m for RL
AHA
EL6501B
0010-30-42735
and LL; 1m
for others
27-2
Long
12-Electrode Cable Sets
Type
Compatible
Patient
Model
with
Part No.
Length
Remark
0010-30-42903
0.8m
Limb
0010-30-42905
0.6m
Chest
EL6801A
0010-30-42902
0.8m
Limb
EL6803A
0010-30-42904
0.6m
Chest
EL6802B
0010-30-42907
0.8m
Limb
0010-30-42909
0.6m
Chest
EL6801B
0010-30-42906
0.8m
Limb
EL6803B
0010-30-42908
0.6m
Chest
Category
EL6802A
IEC
EL6804A
Clip
AHA
IEC
Adult
EL6804B
Snap
AHA
Adult
27.2 SpO2 Accessories
Extension Cable
Module type
Remarks
Part No.
Mindray
/
0010-20-42710
Masimo
8 pins, purple connector
040-000332-00
Nellcor
8 pins
0010-20-42712
SpO2 Sensors
The SpO2 sensor material that patients or other staff will come into contact with have undertaken the
bio-compatibility test and is verified to be in compliance with ISO 10993-1.
Mindray SpO2 Module
Type
Disposable
Single patient use
Reusable
Model
Patient Category
Part No.
MAX-A
Adult (>30Kg)
0010-10-12202
MAX-P
Pediatric (10 to 50Kg)
0010-10-12203
MAX-I
Infant (3 to 20Kg)
0010-10-12204
MAX-N
Neonate (<3Kg), Adult (>40Kg)
0010-10-12205
520A
Adult
520A-30-64101
520P
Pediatric
520P-30-64201
520I
Infant
520I-30-64301
520N
Neonate
520N-30-64401
DS-100A
Adult
9000-10-05161
OXI-P/I
Pediatric, infant
9000-10-07308
OXI-A/N
Adult, neonate
9000-10-07336
ES-3212-9
Adult
0010-10-12392
518B
Neonate (Multi-sites)
518B-30-72107
518C
Neonate (Multi-sites)
040-000330-00
512E
Adult (Finger type)
512F
512G
512E-30-90390
512F-30-28263
Pediatric (Finger type)
512H
512G-30-90607
512H-30-79061
27-3
Masimo SpO2 Module
Type
Disposable
Reusable
Model
Patient Category
Part No.
LNCS NeoPt-L
Pediatric, neonate
0010-10-42626
LNCS Neo-L
Neonate
0010-10-42627
LNCS Inf-L
Infant
0010-10-42628
LNCS Pdtx
Pediatric
0010-10-42629
LNCS Adtx
Adult
0010-10-42630
LNCS DCI
Adult
0010-10-42600
LNCS DCIP
Pediatric
0010-10-42634
LNCS YI
Adult, pediatric, neonate
0010-10-43016
Model
Patient Category
Part No.
MAX-A
Adult (>30Kg)
0010-10-12202
MAX-P
Pediatric (10 to 50Kg)
0010-10-12203
MAX-I
Infant (3 to 20Kg)
0010-10-12204
MAX-N
Neonate (<3Kg), Adult (>40Kg)
0010-10-12205
DS-100A
Adult
9000-10-05161
OXI-P/I
Pediatric, infant
9000-10-07308
OXI-A/N
Adult, neonate
9000-10-07336
D-YS
Adult, pediatric, infant, neonate
0010-10-12476
Nellcor SpO2 Module
Type
Disposable
Reusable
Wavelength emiited by the sensors:
„
520A, 520P, 520I, 520N, 518B, 518C, 512E, 512F, 512G, 512H, and ES-3212-9: red light: 660 nm, infrared light: 905
nm.
„
LNCS NeoPt-L, LNCS Neo-L, LNCS Inf-L, LNCS Pdtx, LNCS Adtx, LNCS DCI, LNCS DCIP, and LNCS YI: red light: 660
nm, infrared light: 940 nm.
„
MAX-A, MAX-P, MAX-I, MAX-N, DS-100A, OXI-P/I, OXI-A/N, and D-YS: red light: 660 nm, infrared light: 890 nm.
The maximum photic output consumption of the sensor is less than 18 mW. The information about the wavelength
range and maximum photic output consumption can be especially useful to clinicians, for example, clinicians
performing photodynamic therapy.
27.3 NIBP Accessories
Tubing
Type
Reusable
Patient Category
Part No.
Adult, pediatric, infant
6200-30-09688
Neonate
6200-30-11560
27-4
Reusable Cuff
Model
Patient
Measurement
Category
Site
Limb Circumference (cm)
Bladder Width
(cm)
Part No.
CM1200
Small infant
7 to 13
5.8
115-002480-00
CM1201
Infant
10 to 19
9.2
0010-30-12157
CM1202
Pediatric
18 to 26
12.2
0010-30-12158
CM1203
Adult
24 to 35
15.1
0010-30-12159
CM1204
Large adult
33 to 47
18.3
0010-30-12160
CM1205
Thigh
46 to 66
22.5
0010-30-12161
CM1300
Small infant
7 to 13
5.8
040-000968-00
CM1301
Infant
10 to 19
9.2
040-000973-00
CM1302
Pediatric
18 to 26
12.2
040-000978-00
CM1303
Adult
24 to 35
15.1
040-000983-00
CM1304
Large adult
33 to 47
18.3
040-000988-00
CM1305
Adult thigh
46 to 66
22.5
040-000993-00
Arm
Thigh
Arm
Thigh
Single-Patient Cuff
Model
Patient
Measurement
Category
Site
Limb Circumference (cm)
Bladder Width
(cm)
Part No.
CM1500A
3.1 to 5.7
2.2
001B-30-70677
CM1500B
4.3 to 8.0
2.9
001B-30-70678
5.8 to 10.9
3.8
001B-30-70679
7.1 to 13.1
4.8
001B-30-70680
8 to 15
/
001B-30-70681
CM1500C
Neonate
CM1500D
Arm
CM1500E
CM1501
Infant
10 to 19
7.2
001B-30-70682
CM1502
Pediatric
18 to 26
9.8
001B-30-70683
CM1503
Adult
25 to 35
13.1
001B-30-70684
CM1504
Large adult
33 to 47
16.5
001B-30-70685
CM1505
Adult
46 to 66
20.5
001B-30-70686
Thigh
27.4 Temp Accessories
Temp Cable
Type
Model
Remark
Part No.
Extension cable (reusable)
MR420B
Applicable to sensor MR411 and MR412
0011-30-37391
MR421
/
0010-30-43056
TEMP adapter cable (2-pin to
audio)
27-5
Temp Probes
Type
Model
Patient Category
MR401B
eusable
Adult
MR403B
MR402B
Pediatric, infant
MR404B
Disposable
MR411
Adult, pediatric, infant
MR412
Measurement Site
Part No.
Esophageal/Rectal
0011-30-37392
Skin
0011-30-37393
Esophageal/Rectal
0011-30-37394
Skin
0011-30-37395
Esophageal/Rectal
0011-30-37398
Skin
0011-30-37397
27.5 IBP/ICP Accessories
Material
Part No.
IBP adapter cable
0010-30-43055
IBP extended cable with dual-receptacle
040-001029-00
Accessories Kit No.
Components
Part No.
IM2201 12Pin IBP Cable
001C-30-70759
6800-30-50876
Disposable Transducer
0010-10-42638
(Hospira)
Steady Rest for IBP Transducer and Clamp
M90-000133---
Steady Rest for IBP Transducer and Clamp
M90-000134---
IM2202 12Pin IBP Cable
001C-30-70757
Disposable Pressure Transducer
6000-10-02107
Transducer/Manifold Mount
0010-10-12156
Model
Material
Part No.
Gaeltec TYPE.S13
12Pin ICP cable
0010-30-42742
Gaeltec ICT/B
Intracranial Pressure Transducer
0010-10-12151
6800-30-50877
(BD)
ICP
It is proved through tests that the following accessories are compatible with the patient monitor. Only the accessories
proceeded by “*” are available from our company. If you want to purchase other accessories, contact respective
manufacturers and make sure if these accessories are approved for sale in local.
Manufacturer
Accessories
MX961Z14 Logical Cable, to be used in connection with the Adapter Cable (0010-20-42795)
MX960 Reusable Transducer Kit
Smith Medical
MX261 Logical Clamp For Transducer Bracket
(Medex)
MX262 Logical Clamp For 2 Transducer Mount Plates
MX960E6441 Logical Transducer Mounting Plate
(More Logical Clamps are available from Medex. For detailed information, contact Medex.)
IBP Reusable Cable (REF: 5203511), to be used in connection with the Adapter Cable (0010-20-42795)
Braun
Combitrans Monitoring Set (contact Braun for detailed information)
Combitrans Attachment Plate Holder (REF:5215800)
Combitrans Attachment Plate (contact Braun for detailed information)
*Truck cable (0010-21-43082)
Memscap
SP844 Physiological Pressure Transducer
844-26 Monitoring Line Set
27-6
84X-49 Mounting Bracket
Reusable Blood Pressure Monitor Interface Cable (REF: 650-206)
Deltran Disposable Pressure Transducer System
Utah
(More Deltran sensors are available from Utah. For detailed information, contact Utah.)
Pole Mount Unit (ERF: 650-150)
Deltran Three Slot Organizer, Attaches to I.V. Pole Mount (REF: 650-100)
Deltran Four Slot Organizer, Attaches to I.V. Pole Mount (REF: 650-105)
* IBP Truwave Reusable Cable (0010-21-12179)
Pressure Monitoring Kit With Truwave Disposable Pressure Transducer.
Edwards
(More Truwave sensors are available from Edwards. For detailed information, contact Edwards.)
DTSC IV Pole Clamp for Model DTH4 Backplate Holder
DTH4 Disposable Holder for DPT
27.6 C.O. Accessories
Model
Material
Part No.
CO7702
12Pin C.O. cable.
0010-30-42743
SP4042
IT Sensor
6000-10-02079
SP5045
IT Sensor Housing
6000-10-02080
MX387
12CC Control Syringe W/1CC Stop W/Rotator
6000-10-02081
27.7 CO2 Accessories
Sidestream CO2 module
Material
Patient Category
Remark
DRYLINE Watertrap
Adult, pediatric
DRYLINE Watertrap
Neonate
9200-10-10574
Sampling Line Adult 2.5m
Adult, pediatric
9200-10-10533
Sampling Line, Neonate, 2.5m
Neonate
9200-10-10555
Adult Nasal CO2 Sample Cannula
Adult
Pediatric Nasal CO2 Sample Cannula
Pediatric
M02A-10-25938
Infant Nasal CO2 Sample Cannula
Neonate
M02B-10-64509
DRYLINE Airway Adapter
/
Reusable
Disposable
Straight,
disposable
27-7
Part No.
9200-10-10530
M02A-10-25937
9000-10-07486
Microstream CO2 Module
Disposable Airway Sampling Line
Model
Patient Category
Remark
Part No.
/
0010-10-42560
Humidified
0010-10-42561
007768
Long
0010-10-42563
007737
Long, humidified
0010-10-42564
Humidified
0010-10-42562
Long, humidified
0010-10-42565
Remark
Part No.
/
0010-10-42566
Plus O2
0010-10-42568
009826
Long, plus O2
0010-10-42570
008174
/
0010-10-42577
Humidified
0010-10-42572
008180
Humidified, plus O2
0010-10-42575
007266
/
0010-10-42567
008175
/
0010-10-42578
Humidified
0010-10-42573
008181
Humidified, plus O2
0010-10-42576
007269
Plus O2
0010-10-42569
007743
Long, plus O2
0010-10-42571
Humidified
0010-10-42574
XS-04620
XS-04624
006324
Adult, pediatric
Infant, Neonate
007738
Disposable Nasal Sampling Line
Model
Patient Category
009818
009822
008177
008178
008179
Adult, intermediate
Adult
Pediatric
Infant, Neonate
Mainstream CO2 Module
Material
Model
Patient Category
6063
6421
Airway adapter
Adult, pediatric
Neonate, pediatric
7053
9960STD
Mask
Part No.
Disposable
0010-10-42662
Disposable, with
mouthpiece
7007
6312
Remark
Adult
9960LGE
0010-10-42663
Reusable
0010-10-42665
Disposable
0010-10-42664
Reusable
0010-10-42666
/
0010-10-42670
Adult large
0010-10-42669
9960PED
Pediatric
/
0010-10-42671
Cable management straps
6934-00
/
/
0010-10-42667
Sensor holding clips
8751
/
/
0010-10-42668
Sensor
1022386
Reusable
6800-30-50760
Adult, pediatric,
neonate
27-8
27.8 AG Accessories
Material
Watertrap
Patient Category
Adult, pediatric
Remark
Part No.
9200-10-10530
Reusable
Neonate
Sampling line
Adult, pediatric
9200-10-10574
9200-10-10533
Disposable
Neonate
Airway adapter
9200-10-10555
Adult, pediatric, neonate
Disposable, straight
9000-10-07486
Adult, pediatric, neonate
Disposable, elbow
9000-10-07487
27.9 Others
Material
Part No.
Lithium battery
022-000008-00
Power cord
509B-10-05996
U.K. power cord
DA8K-10-14453
European power cord
DA8K-10-14454
U.S. power cord
DA8K-10-14452
Brazil power cord (250V, 10A, 3M)
009-001075-00
South Africa Power Cable (250V, 16A, 3M)
009-001791-00
India power cord
0000-10-10903
Grounding cable
1000-21-00122
LCD display, 17"
0000-10-11284
023-000217-00
USB drive, 4G
023-000218-00
Recorder
TR6F-30-67306
Thermal paper
A30-000001---
Wall mount bracket for external display
0010-30-42956
Rolling bracket
045-000670-00
Wall mount
045-000672-00
Bedrail Hook subassembly (iPM 10/iPM 12)
115-012698-00
Bedrail Hook subassembly (iPM 8)
115-012697-00
Transition Plate Kit
115-012695-00
Beneview data output package (CD, Cable, User's Guide)
6800-30-51213
27-9
FOR YOUR NOTES
27-10
A Product Specifications
A.1 Monitor Safety Specifications
A.1.1 Classifications
The patient monitor is classified, according to IEC60601-1:
Type of protection against electrical shock
Degree of protection against electrical shock
Mode of operation
Degree of protection against harmful ingress
of water
Class I, equipment energized from an external and internal electrical
power source.
Type BF defibrillation proof for CO2 and AG monitoring.
Type CF defibrillation proof for ECG, RESP, TEMP, SpO2, NIBP, IBP and C.O..
Continuous
IPX1
A.1.2 Environmental Specifications
Main unit
Item
Operating conditions
Storage conditions
Temperature (ć)
0 to 40
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (kPa)
57.0 to 107.4
16.0 to 107.4
Item
Operating conditions
Storage conditions
Temperature (ć)
0 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (kPa)
57.3 to 105.3
57.3 to 105.3
Item
Operating conditions
Storage conditions
Temperature (ć)
5 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (kPa)
57.3 to 105.3
57.3 to 105.3
Item
Operating conditions
Storage conditions
Temperature (ć)
0 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 90%
10% to 90%
Barometric (kPa)
57.0 to 107.4
53.3 to 107.4
iPM 8: -30 to 70
iPM 12/ iPM 10: -20 to 60
Microstream CO2 module
Sidestream CO2 module
Mainstream CO2 module
A-1
AG module
Item
Operating conditions
Storage conditions
Temperature (ºC)
10 to 40
-20 to 60
Relative humidity (noncondensing)
15% to 95%
10% to 95%
Barometric (kPa)
70 to 107.4
70 to 107.4
NOTE
z
The environmental specifications of unspecified parameters are the same as those of the main unit of iPM
12/iPM 10.
A.2 Power Supply Specifications
AC power
Line voltage
100 to 240 VAC
Current
1.3 to 0.5 A
Frequency
50/60 Hz
DC power (available for iPM 8 only)
Voltage
12 VDC
Current
3.5 A
Battery
Battery Type
Chargeable Lithium-Ion, 11.1DVC, 2.6 Ah
4 hours
when powered by a new fully-charged battery (25ć, SpO2, ECG, disconnected from
iPM 12
Temp cable, Auto NIBP measurements at intervals of 15 minutes)
8 hours
when powered by two new fully-charged batteries (25ć, SpO2, ECG, disconnected from
Temp cable, Auto NIBP measurements at intervals of 15 minutes)
Run time
4 hours
iPM 10
when powered by a new fully-charged battery (25ć, SpO2, ECG, disconnected from
Temp cable, Auto NIBP measurements at intervals of 15 minutes)
6 hours
iPM 8
when powered by a new fully-charged battery (25ć, SpO2, ECG, disconnected from
Temp cable, Auto NIBP measurements at intervals of 15 minutes)
Charge time
Shutdown delay
Less than 3 hours to 90%, and less than 4 hours to 100% when the monitor is off.
Less than 8 hours to 90%, and less than 12 hours to 100% when the monitor is on.
at least 20 min (after a low battery alarm first occurs)
A-2
A.3 Physical Specifications
Model
Size (WidthhHighthThickness)
Weight
Remark
iPM 12
318mmh274mmh128mm
≤4.2 kg
Standard parameters,
iPM 10
282mmh252mmh128mm
≤3.6 kg
including touchscreen and
iPM 8
238mmh225mmh128mm
≤3.2 kg
recorder.
A.4 Hardware Specifications
A.4.1 Display
Host display
Screen Size
(diagonal)
iPM 12
12.1”
iPM 10
10.4”
iPM 8
8.4”
Screen type
Resolution
color LED display
800×600 pixels
External display
Screen type
Medical-grade TFT LCD
Screen Size
15", 17" or above
Resolution
800×600 pixels
EMC
MPR II, CISPR 11B
Third certificate
UL, C-UL, TUV, CE, FCC
A.4.2 Recorder
Method
Thermal dot array
Horizontal resolution
16 dots/mm (25 mm/s paper speed)
Vertical resolution
8 dots/mm
Paper width
50 mm
Paper length
20 m
Paper speed
25 mm/s or 50 mm/s with accuracy within ±5%
Number of waveform channels
1, 2, or 3 (optional)
A.4.3 LEDs
Alarm lamp
1 (two color coded: yellow and red)
Power on LED
1 (green)
AC power LED (iPM 12/ iPM 10)
1 (green)
AC/DC power LED (iPM 8)
1 (green)
Battery LED
1 (green)
A.4.4 Audio Indicator
Speaker
Give alarm tones (45 to 85 dB), key tones, QRS tones; support PITCH TONE and
multi-level tone modulation; alarm tones comply with IEC60601-1-8.
A-3
A.4.5 Monitor Interface Specifications
Power
1 AC power input connector
1 DC power input connector (for iPM 8 only)
Wired network
1 RJ45 connector, 100 Base-TX, IEEE 802.3
USB
2 connectors, USB 2.0
Equipotential Grounding Terminal
1
Multifunctional connector
1
VGA connector
1
A.4.6 Outputs
Analog Output
Standard
Meets the requirements of IEC60601-1 for short-circuit protection and leakage
current
ECG Analog Output
Diagnostic mode:
0.05 to 150 Hz
Bandwidth
Monitor mode:
0.5 to 40 Hz
(-3dB; reference frequency: 10Hz)
Surgical mode:
1 to 20 Hz
ST mode:
0.05 to 40 Hz
Max transmission delay
25 ms (in diagnostic mode, and with Notch off )
Sensitivity
1V/mV ±5%
Pace enhancement
PACE rejection/enhancement
Signal amplitude: Voh≥2.5V
Pulse width: 10ms±5%
Signal rising and falling time: ≤100μs
IBP Analog Output (For iPM 12 only)
Bandwidth (-3dB; reference
frequency:1Hz)
DC to 40 Hz
Max transmission delay
30 ms
Sensitivity
1 V/100 mmHg ±5%
Nurse Call Signal
Output mode
Relay
Electrical requirements
≤60W, ≤2A, ≤36VDC, ≤25VAC
Isolation voltage
1500 VAC
Contact type
Normally open or normally contact (optional)
Defib Sync Pulse
Output impedance
≤100Ω
Max time delay
35 ms (R-wave peak to leading edge of pulse)
Amplitude
High level: 3.5 to 5 V, providing a maximum of 10 mA output current;
Low level: < 0.5 V, receiving a maximum of 5 mA input current.
Pulse width
100 ms ±10%
Rising and falling time
≤1 ms
Alarm output (Network connector)
Alarm delay time from patient monitor
The alarm delay time form the patient monitor to remote equipment is ≤2
to remote equipment
seconds, measured at the patient monitor’s signal output connector.
A-4
A.5 Data Storage
Trends: 120 hours, at 1 min resolution
Trends
Mid-length trends: 4 hours, at 5 s resolution
Minitrends: 1 hour, at 1 s resolution
Parameter alarms
Arrh. events
NIBP measurements
Full-disclosure waveforms
100 alarms and manual events and related parameter waveforms. The waveform
recording length can be 8s, 16s, or 32s.
100 arrhythmia events and relate waveforms and parameters. The waveform
recording length can be 8s, 16s, or 32s.
1000 sets
48 hours at maximum. The specific storage time depends on the waveforms stored
and the number of stored waveforms.
A.6 Wireless Network
Standards
IEEE 802.11b/g, support Wi-Fi
Frequency range
2.400 to 2.4835 GHz
Transmission range
ı50 m (visible range)
A.7 Measurement Specifications
The adjustable range of alarm limits is the same with the measurement range of signals unless otherwise specified.
A.7.1 ECG
ECG
Standards
Meet standards of EC11, EC13, EN60601-2-27/IEC60601-2-27 and IEC60601-2-25
3-lead: I, II, III
Lead set
5-lead: I, II, III, aVR, aVL, aVF, V
12-lead: I, II, III, aVR, aVL, aVF, V1 to V6 (for iPM 12 and iPM 10 only)
ECG standard
Display sensitivity
Sweep speed
Bandwidth (-3dB)
Common mode rejection ratio
Notch
AHA, IEC
1.25 mm/mV (X0.125), 2.5 mm/mV (X0.25), 5 mm/mV (X0.5), 10 mm/mV (X1), 20
mm/mV (X2), 40 mm/mV (X4), Auto
6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s
Diagnostic mode:
0.05 to 150 Hz
Monitor mode:
0.5 to 40 Hz
Surgical mode:
1 to 20 Hz
ST mode:
0.05 to 40 Hz
Diagnostic mode:
>90 dB
Monitor mode:
>105 dB
Surgical mode:
>105 dB
ST mode:
>105 dB
50/60 Hz
Monitor, ST and surgical mode: Notch turns on automatically. Diagnostic mode:
A-5
Notch is turned on/off manually
Differential input impedance
≥5 MΩ
Input signal range
±8 mV (peak-to-peak value)
Accuracy of reappearing input signal
Based on EC11 to determine system total error and frequency response.
Electrode offset potential tolerance
±500 mV
Lead-off detection current
Input offset current
Measuring electrode: <0.1 μA
Drive electrode: <1 μA
Measuring electrode: ≤0.1 μA
Drive electrode: ≤1 μA
Baseline recovery time
<5 s (after defibrillation)
Patient leakage current
<10 uA
Calibration signal
1mV (peak-to-peak value)
Cut mode: 300 W
ESU protection
Coagulate mode: 100 W
Recovery time: ≤10 s
In compliance with the requirements in clause 4.2.9.14 of ANSI/AAMI EC 13:2002
Based on the test method in clause 5.2.9.14 of EC 13, use ECG lead wires which are
ESU noise suppression
in compliance with AAMI. Compared with ECG baseline, the noise of peak to peak
value ≤2 mV.
Pace Pulse
Pace pulses meeting the following conditions are labelled with a PACE marker:
Pace pulse markers
Amplitude:
±2 to ±700 mV
Width:
0.1 to 2 ms
Rise time:
10 to 100 μs
When tested in accordance with the ANSI/AAMI EC13-2002: Sections 4.1.4.1 and
4.1.4.3, the heart rate meter rejects all pulses meeting the following conditions.
Pace pulse rejection
Amplitude:
±2 to ±700 mV
Width:
0.1 to 2 ms
Rise time:
10 to 100 μs
Pacer pulse detector rejection of fast
10V/s RTI when measured in accordance with ANSI/AAMI EC13-2002 Section
ECG signals
4.1.4.3.
Mindray algorithm
HR
Measurement range
Neonate:
15 to 350 bpm
Pediatric:
15 to 350 bpm
Adult:
15 to 300 bpm
Resolution
1 bpm
Accuracy
±1 bpm or ±1%, whichever is greater.
Sensitivity
200μV (lead II)
In compliance with the requirements in Clause 4.1.2.1 d)of ANSI/AAMI EC13-2002,
the following method is used:
HR averaging method
If the last 3 consecutive RR intervals are greater than 1200 ms, the 4 most recent RR
intervals are averaged to compute the HR. Otherwise, heart rate is computed by
subtracting the maximum and minimum ones from the most recent 12 RR intervals
A-6
and then averaging them.
The HR value displayed on the monitor screen is updated every second.
In compliance with the requirements in Clause 4.1.2.1 e)of ANSI/AAMI EC13-2002,
the heart rate after 20 seconds of stabilization is displayed as follows:
Response to irregular rhythm
Ventricular bigeminy (3a):
80±1 bpm
Slow alternating ventricular bigeminy (3b): 60±1 bpm
Rapid alternating ventricular bigeminy (3c): 120±1 bpm
Bidirectional systoles (3d):
90±2 bpm
Meets the requirements of ANSI/AAMI EC13-2002: Section 4.1.2.1 f ).
Response time to heart rate change
From 80 to 120 bpm: less than 11 s
From 80 to 40 bpm: less than 11 s
Meets the requirements of ANSI/AAMI EC13-2002: section 4.1.2.1 g).
Waveform
4ah - range:
11 s
Time to alarm for tachycardia
4a - range:
11 s
(not available in USA)
4ad - range:
11 s
Waveform 4bh - range:
11 s
4b - range:
11 s
4bd - range:
11 s
When the test is performed based on part 4.1.2.1 c)of ANSI/AAMI EC 13-2002, the
heart rate meter will reject all 100 ms QRS complexes with less than 1.2 mV of
Tall T-wave rejection capability
amplitude, and T waves with T-wave interval of 180 ms and those with Q-T interval
of 350 ms.
ST Segment Analysis (Not available in USA)
Measurement range
Accuracy
-2.0 to 2.0 mV
-0.8 to 0.8 mV:
±0.02 mV or ±10%, whichever is greater.
Beyond this range:
Not specified.
Refreshing rate
10 s
Resolution
10 μV
Alarm limit
Range
Step
HR High
(low limit + 2) to 300 bpm
HR Low
15 to (high limit – 2) bpm
ST High
(low limit +0.2) to 2.0 mV
ST Low
-2.0 to (high limit – 0.2) mV
1bpm
0.1mV
Mortara algorithm
Only the differences from the Mindray algorithm are listed.
HR
In compliance with the requirements in Clause 4.1.2.1 d)of ANSI/AAMI EC13-2002,
the following method is used:
HR averaging method
Heart rate is computed by averaging the most recent 16 RR intervals, unless the HR
by averaging the most recent 4 heart beats is less than or equals to 48.
The HR value displayed on the monitor screen is updated every second.
A-7
Meets the requirements of ANSI/AAMI EC13-2002: section 4.1.2.1 g).
Waveform
Time to alarm for tachycardia
Arrhythmia Analysis Classifications
4ah – range:
11 s
4a – range:
11 s
4ad – range:
11 s
4bh – range:
11 s
4b – range:
11 s
4bd – range:
11 s
Asystole, Vfib, Vtac, Vent. Rhythm, Couplet, VT>2, Bigeminy, Trigeminy, R on T,
Multif. PVC, Irr. Rhythm, Tachy, Brady, Missed Beats, PNP, PNC
ST Segment Analysis
Refreshing rate
per 16 heartbeats
A.7.2 Resp
Technique
Trans-thoracic impedance
Lead
Options are lead I and II. The default is lead II.
Respiration excitation waveform
<300 μA RMS, 62.8 kHz (±10%)
Respiration impedance range
0.3 to 5Ω
Baseline impedance range
200 to 2500Ω (using an ECG cable with 1kΩ resistance)
Bandwidth
0.2 to 2.5 Hz (-3 dB)
Sweep speed
6.25 mm/s, 12.5 mm/s or 25 mm/s
Respiration Rate
Measurement range
Resolution
Accuracy
Adult:
0 to 120 rpm
Pediatric, neonate:
0 to 150 rpm
1 rpm
7 to 150 rpm:
±2 rpm or ±2%, whichever is greater
0 to 6 rpm:
Not specified.
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range (rpm)
RR High
RR Low
Step (rpm)
Adult, pediatric:
(low limit + 2) to 100
Neonate:
(low limit + 2) to 150
1
0 to (high limit – 2)
A.7.3 SpO2
Alarm limit
Range (%)
Step (%)
SpO2 High
(low limit + 2) to 100
Mindray, Masimo: Desat to (high limit – 2)
SpO2 Low
Nellcor:
Desat or20 (whichever is greater) to (high limit
– 2)
Desat
Mindray, Masimo:
0 to (high limit – 2)
Nellcor:
0 to (high limit – 2)
A-8
1
Mindray SpO2 Module
Standards
Meet standards of ISO9919
*Measurement accuracy verification: The SpO2 accuracy has been verified in human experiments by comparing with arterial
blood sample reference measured with a CO-oximeter. Pulse oximeter measurement are statistically distributed and about
two-thirds of the measurements are expected to come within the specified accuracy range compared to CO-oximeter
measurements.
Measurement range
0 to 100%
Resolution
1%
70 to 100%: ±2% (measured without motion in adult/pediatric mode)
Accuracy
70 to 100%: ±3% (measured without motion in neonate mode)
70 to 100%: ±3% (measured with motion)
0% to 69%: Not specified.
*Studies were performed to validate the accuracy of Pulse Oximeter with neonatal SpO2 sensors by contrast with a
CO-Oximeter. Some neonates aged from 1 day to 30 days with a gestation age of 22 weeks to full term were involved in this
study. The statistical analysis of data of this study shows the accuracy (Arms) is within the stated accuracy specification. Please
see the following table.
Sensor type
Totally neonates
Data
Arms
518B
97 (51 male & 46 female)
200 pairs
2.38%
520N
122 (65 male & 57 female)
200 pairs
2.88%
The Pulse Oximeter with neonatal SpO2 sensors was also validated on adult subjects.
Refreshing rate
1s
7 s (When the sensitivity is set to High)
SpO2 averaging time
9 s (When the sensitivity is set to Medium)
11 s (When the sensitivity is set to Low)
A-9
Masimo SpO2 Module
Standards
Meet standards of ISO9919
Measurement range
1 to 100%
Resolution
1%
70 to 100%: ±2% (measured without motion in adult/pediatric mode)
Accuracy
70 to 100%: ±3% (measured without motion in neonate mode)
70 to 100%: ±3% (measured with motion)
1% to 69%: Not specified.
Refreshing rate
1s
SpO2 averaging time
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
Low perfusion conditions
Low perfusion SpO2 accuracy
Pulse amplitude: >0.02%
Light penetration: >5%
±2%
Nellcor SpO2 Module
Standards
Meet standards of ISO9919
Measurement range
0 to 100%
Resolution
1%
70 to 100%: ±2% (adult/pediatric)
Accuracy
70 to 100%: ±3% (neonate)
0% to 69%: Not specified.
*: When the SpO2 sensor is applied for neonatal patients as indicated, the specified accuracy range is increased by ±1%, to
compensate for the theoretical effect on oximeter measurements of fetal hemoglobin in neonatal blood.
A.7.4 PR
Alarm limit
Range (bpm)
Step (bpm)
PR High
(low limit +2) to 300
PR Low
15 to (high limit-2)
1
PR from Mindray SpO2 Module
Measurement range
20 to 254 bpm
Resolution
1 bpm
Accuracy
Refreshing rate
±3 bpm (measured without motion)
±5 bpm (measured with motion)
1s
7 s (when sensitivity is set to High)
SpO2 averaging time
9 s (when sensitivity is set to Medium)
11 s (when sensitivity is set to Low)
A-10
PR from Masimo SpO2 Module
Measurement range
25 to 240 bpm
Resolution
1 bpm
Accuracy
±3 bpm (measured without motion)
±5 bpm (measured with motion)
Refreshing rate
1s
SPO2 averaging time
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
Low perfusion conditions
Low perfusion PR accuracy
Pulse amplitude: >0.02%
Light penetration: >5%
±3 bpm
PR from Nellcor SpO2 Module
Measurement range
20 to 300 bpm
Resolution
1 bpm
Accuracy
Refreshing rate
20 to 250 bpm: ±3 bpm
251 to 300 bpm, not specified
1s
PR from NIBP Module
Measurement range
40 to 240 bpm
Resolution
1 bpm
Accuracy
±3bpm or ±3%, whichever is greater
PR from IBP Module
Measurement range
25 to 350 bpm
Resolution
1 bpm
Accuracy
±1 bpm or ±1%, whichever is greater
Refreshing rate
1s
A-11
A.7.5 NIBP
Standards
Meet standards of EN60601-2-30/IEC60601-2-30, EN1060-1, EN1060-3, SP10 and
EN1060-4
Technique
Oscillometry
Mode of operation
Manual, Auto and STAT
Auto mode repetition intervals
1, 2, 2.5, 3, 5, 10, 15, 20, 30, 60, 90, 120, 180, 240 or 480 min
STAT mode cycle time
5 min
Max measurement time
Adult, pediatric:
180 s
Neonate:
90 s
Adult
Pediatric
Neonate
Measurement ranges
Systolic:
40 to 270
40 to 200
40 to 135
(mmHg)
Diastolic:
10 to 210
10 to 150
10 to 100
Mean:
20 to 230
20 to 165
20 to 110
Accuracy
Resolution
Initial cuff inflation pressure range
(mmHg)
Default initial cuff inflation pressure
(mmHg)
Software overpressure protection
Alarm limit
Max mean error: r5 mmHg
Max standard deviation: 8 mmHg
1mmHg
Adult:
80 to 280
Pediatric:
80 to 210
Neonate:
60 to 140
Adult:
160
Pediatric:
140
Neonate:
90
Adult:
297±3 mmHg
Pediatric:
240±3 mmHg
Neonate:
147±3 mmHg
Range (mmHg)
Step (mmHg)
Adult: (low limit+5) to 270
Sys High
Pediatric: (low limit+5) to 200
Neonate: (low limit+5) to 135
Sys Low
40 to (high limit-5)
Adult: (low limit+5) to 230
Mean High
Pediatric: (low limit+5) to 165
Neonate: (low limit+5) to 110
Mean Low
5
20 to (high limit-5)
Adult: (low limit+5) to 210
Dia High
Pediatric: (low limit+5) to 150
Neonate: (low limit+5) to 100
Dia Low
10 to (high limit-5)
**Measurement accuracy verification: In adult and pediatric modes, the blood pressure measurements measured with this
device are in compliance with the American National Standard for Electronic or Automated Sphymomanometers (ANSI/AAMI
SP10-1992) in terms of mean error and stardard deviation by comparing with intra-arterial or auscultatory measurements
(depending on the configuration) in a typical patient population. For auscultatory reference, the 5th Korotkoff sound was
used to determine the diastolic pressure.
In neonatal mode, the blood pressure measurements measured with this device are in compliance with the American
National Standard for Electronic or Automated Sphymomanometers (ANSI/AAMI SP10-1992 and AAMI/ANSI SP10A-1996) in
A-12
terms of mean error and stardard deviation by comparing with intra-arterial measurements (depending on the configuration)
in a typical patient population.
A.7.6 Temp
Standards
Meet standard of EN12470-4
Technique
Thermal resistance
Measurement range
0 to 50 ć (32 to 122 ̧)
Resolution
0.1 ć
Accuracy
±0.1 ć or ±0.2 ̧ (without probe)
Refreshing rate
1s
Minimum time for accurate
Body surface: <100 s
measurement
Body cavity: <80 s
Alarm limit
Range
Step
(low limit +1) to 50 ć
T1/T2 High
(low limit +1.8) to 122 ̧
T1/T2 Low
0 to (high limit -1) ć
0.1 ć
32 to (high limit -1.8) ̧
0.1 ̧
0 to 50 ć
TD High
0 to 90 ̧
A.7.7 IBP
Standards
Meet standard of EN60601-2-34/IEC60601-2-34.
Technique
Direct invasive measurement
IBP
Measurement range
-50 to 300 mmHg
Resolution
1 mmHg
Accuracy
±2% or ±1 mmHg, whichever is greater (without sensor)
Refreshing rate
1s
Pressure transducer
Excitement voltage
5 VDC, ±2%
Sensitivity
5 μV/V/mmHg
Impedance range
300 to 3000Ω
Volume displacement (ABBOTT)
<0.04 mm3 /100 mmHg
Alarm limit
ART
Ao
Range (mmHg)
1
Sys High
Mean High
(low limit + 2) to 300
FAP
BAP
Dia High
UAP
Sys Low
LV
Mean Low
Step (mmHg)
0 to (high limit – 2)
A-13
Alarm limit
Range (mmHg)
Step (mmHg)
Dia Low
PA
Sys High
(low limit + 2) to 120
Mean High
Dia High
1
Sys Low
-6 to (high limit – 2)
Mean Low
Dia Low
CVP, LAP
RAP, ICP
P1 to P4
Mean High
(low limit + 2) to 40
Mean Low
-10 to (high limit – 2)
1
Sys High
(low limit + 2) to 300
Mean High
Dia High
1
Sys Low
-50 to (high limit – 2)
Mean Low
Dia Low
A.7.8 C.O.
Measurement method
Thermodilution method
C.O.:
0.1 to 20 L/min
TB:
23 to 43 ć
TI:
0 to 27 ć
C.O.:
0.1 L/min
TB, TI:
0.1 ć
C.O.:
±5% or ±0.1 L /min, whichever is greater
TB, TI:
±0.1 ć (without sensor)
Repeatability
C.O.:
±2% or ±0.1 L/min, whichever is greater
Alarm range
TB:
23 to 43 ć
Alarm limit
Range
Measurement range
Resolution
Accuracy
TB High
TB Low
Step
(low limit + 1) to 43 ć
(low limit + 1.8) to 109.4 ̧
23 to (high limit - 1) ć
73.4 to (high limit - 1.8) ̧
A-14
0.1 ć
0.1 ̧
A.7.9 CO2
Measurement mode
Sidestream, microstream, mainstream
Technique
Infrared absorption
Sidestream CO2 Module
Standard
Meet standard of ISO 21647
CO2 Measurement range
0 to 99 mmHg
Accuracy*
0 to 40 mmHg:
±2 mmHg
41 to 76 mmHg:
±5% of the reading
77 to 99 mmHg:
±10% of the reading
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Resolution
1 mmHg
Sample flowrate
70 ml/min, 100 ml/min
Sample flowrate tolerance
15% or 15 ml/min, whichever is greater.
Warm-up time
45s, enter the iso accuracy mode
After 10 min, enters the full accuracy mode,
Measured with a neonatal watertrap and a 2.5-meter neonatal sampling line:
<4.5 s @ 100 ml/min
Response time
<5 s @ 70 ml/min
Measured with a neonatal watertrap and a 2.5-meter adult sampling line:
<6 s @ 100 ml/min
<7 s @ 70 ml/min
Measured with a neonatal watertrap and a 2.5-meter neonatal sampling line:
<4 s @ 100 ml/min
Gas sampling delay time
<4.5 s @ 70 ml/min
Measured with a neonatal watertrap and a 2.5-meter adult sampling line:
<5.5 s @ 100 ml/min
<6.5 s @ 70 ml/min
awRR measurement range
0 to 120 rpm
awRR measurement precision
±2 rpm
Apnea time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Effect of interference gases on CO2 measurements
Gas
Concentration (%)
N2O
≤60
Hal
≤4
Sev
≤5
Iso
≤5
Enf
≤5
Des
≤15
Quantitive effect*
±1 mmHg
±2 mmHg
*: means an extra error should be added in case of gas interference when CO2 measurements are performed between
0-40mmHg.
A-15
Alarm limit
Range
EtCO2 High
(low limit + 2) to 99 mmHg
EtCO2 Low
1 to (high limit - 2)mmHg
FiCO2 High
1 to 99 mmHg
awRR High
awRR Low
Step
1 mmHg
Adult, pediatric:
(low limit + 2) to 100 rpm
Neonate:
(low limit + 2) to 150 rpm
1 rpm
0 to (high limit - 2) rpm
* Accuracy applies for the following conditions:
1.
Measurements begin after the CO2 module warms up;
2.
Ambient pressure is from 750 to 760 mmHg, and ambient temperature from 22 to 28ºC;
3.
The measured gas is a dry gas and the balance gas N2;
4.
Gas sample flow rate is 100 ml/min, respiration rate is no greater than 50 rpm with a fluctuation between ±3 rpm,
and I:E is 1:2.
When the operating temperature (near the module detector) is between 5°C and 25°C or between 50°C and 65°C, or the
respiration rate is between 50 rpm and 60 rpm, the measurement accuracy is: ±4 mmHg (0 to 40 mmHg) or 12% of the
reading (41 to 99 mmHg).
Microstream CO2 Module
Standard
Meet standard of ISO 21647
CO2 Measurement range
0 to 99 mmHg
Accuracy*
Accuracy drift
0 to 38 mmHg:
±2 mmHg
39 to 99 mmHg:
±5% of the reading+0.08% of (the reading-38)
Meet the requirement for measurement accuracy within 6 hours
* This accuracy is applied to respiration rate no greater than 80 rpm. For respiration rate greater than 80 rpm and EtCO2 value
greater than 18 mmHg, the accuracy is 4 mmHg or ±12% of the reading, whichever is greater. For respiration rate greater
than 60 rpm, the above accuracy can be achieved by using the CapnoLine H Set for Infant/Neonatal. In the presence of
interfering gases, the accuracy specification deteriorates by 4% of the above accuracy.
Resolution
1 mmHg
Sample flow rate
507.5
15
Initialization time
30 s (typical)
ml/min
2.9 s (typical)
(The response time is the sum of the rise time and the delay time when using a
Response time
FilterLine of standard length)
Rise time: <190 ms (10% to 90%)
Delay time: 2.7 s (typical)
awRR measurement range
awRR measurement accuracy
0 to 150 rpm
0 to 70 rpm:
±1 rpm
71 to 120 rpm:
±2 rpm
121 to 150 rpm:
±3 rpm
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range
Step
A-16
EtCO2 High
(low limit + 2) to 99 mmHg
EtCO2 Low
1 to (high limit – 2)mmHg
FiCO2 High
1 to 99 mmHg
awRR High
awRR Low
1 mmHg
Adult, pediatric:
(low limit + 2) to 100 rpm
Neonate:
(low limit + 2) to 150 rpm
1 rpm
0 to (high limit – 2) rpm
Mainstream CO2 Module
Standard
Meet standard of ISO 21647
CO2 Measurement range
0 to 150 mmHg
Accuracy
0 to 40 mmHg:
±2 mmHg
41 to 70 mmHg:
±5% of the reading
71 to 100 mmHg:
±8% of the reading
101 to 150 mmHg:
±10% of the reading
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Resolution
1 mmHg
Response time
<60 ms
awRR measurement range
0 to 150 rpm
awRR measurement accuracy
f1 rpm
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Alarm limit
Range
EtCO2 High
(low limit + 2) to 99 mmHg
EtCO2 Low
1 to (high limit - 2)mmHg
FiCO2 High
1 to 99 mmHg
awRR High
awRR Low
Step
1 mmHg
Adult, pediatric:
(low limit + 2) to 100 rpm
Neonate:
(low limit + 2) to 150 rpm
1 rpm
0 to (high limit - 2) rpm
A.7.10 AG (For iPM 12/ iPM 10 only)
Standards
Meet standard of ISO 21647
Technique
Infrared absorption
Warm-up time
Sample flow rate
Measurement range
Iso accuracy mode:
45 s
Full accuracy mode:
10 min
Adult, pediatric:
120, 150, 200 ml/min
Neonate:
70, 90, 120 ml/min
Accuracy:
±10 ml/min or ±10%, whichever is greater
CO2:
0 to 30%
O2:
0 to 100%
N2O:
0 to 100%
Des:
0 to 30%
Sev:
0 to 30%
Enf:
0 to 30%
Iso:
0 to 30%
A-17
Resolution
Iso accuracy
Hal:
0 to 30%
awRR:
2 to 100 rpm
CO2:
1 mmHg
awRR:
1 rpm
CO2:
CO2 full accuracy ± 0.3%ABS
N2O:
± (8%REL+2%ABS)
Other anesthetic gases:
Full accuracy of other anesthetic gases ± 8%REL
Gases
Range (%REL)
Accuracy (%ABS)
0 to 1
±0.1
1 to 5
±0.2
5 to 7
±0.3
7 to 10
±0.5
>10
Not specified
0 to 20
±2
20 to 100
±3
0 to 25
±1
25 to 80
±2
80 to 100
±3
0 to 1
±0.15
1 to 5
±0.2
5 to 10
±0.4
10 to 15
±0.6
15 to 18
±1
>18
Not specified
0 to 1
±0.15
1 to 5
±0.2
5 to 8
±0.4
>8
Not specified
0 to 1
±0.15
1 to 5
±0.2
>5
Not specified
2 to 60 rpm
±1 rpm
>60 rpm
Not specified
CO2
N2O
O2
Full accuracy
Des
Sev
Enf, Iso, Hal
awRR
Accuracy drift
Meet the requirement for measurement accuracy within 6 hours
Apnea alarm time
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Refreshing rate
1s
Rise time
gas sample flow rate 120ml/min, using the DRYLINE™ watertrap and neonatal
(10 % ~ 90%)
DRYLINE™ sampling line (2.5m):
CO2
≤250 ms (fall time: ≤200ms)
N2O
≤250 ms
O2
≤600 ms
Hal, Iso, Sev, Des
≤300 ms
Enf
≤350 ms
gas sample flow rate 200ml/min, using the DRYLINE™ water trap and adult DRYLINE™
sampling line (2.5m):
A-18
Delay time
CO2
≤250 ms (fall time: ≤200 ms)
N2O
≤250 ms
O2
≤500 ms
Hal, Iso, Sev, Des
≤300 ms
Enf
≤350 ms
<4 s
Primary anesthetic agent
In full accuracy mode: 0.15%,
In ISO accuracy mode: 0.4%
Anesthetic agent limit
Second anesthetic agent:
In full accuracy mode: 0.3% or 5% REL (10% in ISO accuracy mode) of primary agent if
primary agent is greater than 10%
In ISO accuracy mode: 0.5%
Effect of interference gases on AG measurements
Gas
Concentration(%)
Quantitive effect(%ABS)3)
CO2
N2O
Agent 1)
O2
0.2
CO2
/
/
0.1
0
N2O
/
0.1
/
0.1
5˅
4˅
0.2
Agent 1) 2)
/
0.1
0.1
0.1
Xenon
<100%
0.1
0
0
0.5
Helium
<50%
0.1
0
0
0.5
Ethanol
<0.1%
0
0
0
0.5
Acetone
<1%
0.1
0.1
0
0.5
Methane
<1%
0.1
0.1
0
0.5
Saturated Isopropanol vapour
/
0.1
0
0
0.5
Metered dose inhaler propellants,
/
Unspecified
Unspecified
Unspecified
0.5
1
1) Agent represents one of Des, Iso, Enf, Sev, and Hal.
2) Multiple agent interference on CO2, N2O and O2 is typically the same as single agent interference.
3) For CO2, N2O and Agents, maximum interference from each gas at concentrations within specified accuracy ranges for each
gas. The total interference of all gases is never larger than 5%REL.
4) Applicable to type A AG module, representing the interference effect of secondary anesthetic agents on primary
anesthetic agent.
5) Measurement interference to type M AG module originates from the applied anesthetic agent that is configured manually.
A-19
Alarm limit
Range
EtCO2 High
(low limit + 2) to 99 mmHg
EtCO2 Low
1to (high limit - 2)mmHg
FiCO2 High
1 to 99 mmHg
awRR High
Step
1 mmHg
Adult, pediatric:
(low limit + 2) to 100 rpm
Neonate:
(low limit + 2) to 150 rpm
awRR Low
0 to (high limit - 2)rpm
EtO2 High
(low limit + 2) to 100 %
EtO2 Low
18 to (high limit - 2)%
FiO2 High
(low limit + 2) to 100 %
FiO2 Low
18 to (high limit - 2)%
EtN2O High
(low limit + 2) to 100 %
EtN2O Low
0 to (high limit - 2)%
FiN2O High
(low limit + 2) to 100 %
FiN2O Low
0 to (high limit - 2)%
EtHal/Enf/Iso High
(low limit + 0.2) to 5.0 %
EtHal/Enf/Iso Low
0 to (high limit - 0.2)%
FiHal/Enf/Iso High
(low limit + 0.2) to 5.0 %
FiHal/Enf/Iso Low
0 to (high limit - 0.2)%
EtSev High
(low limit + 0.2) to 8.0 %
EtSev Low
0 to (high limit - 0.2)%
FiSev High
(low limit + 0.2) to 8.0 %
FiSev Low
0 to (high limit - 0.2)%
EtDes High
(low limit + 0.2) to 18.0 %
EtDes Low
0 to (high limit - 0.2)%
FiDes High
(low limit + 0.2) to 18.0 %
FiDes Low
0 to (high limit - 0.2)%
1 rpm
0.1%
1%
0.1%
0.1%
0.1%
A-20
B EMC And Radio Regulatory Compliance
B.1 EMC
The device meets the requirements of IEC 60601-1-2.
Note
z
Using accessories, transducers and cables other than those specified may result in increased
electromagnetic emission or decreased electromagnetic immunity of the patient monitoring equipment.
z
The device or its components should not be used adjacent to or stacked with other equipment. If adjacent
or stacked use is necessary, the device or its components should be observed to verify normal operation in
the configuration in which it will be used.
z
The device needs special precautions regarding EMC and needs to be installed and put into service
according to the EMC information provided below.
z
Other devices may interfere with this monitor even though they meet the requirements of CISPR.
z
When the inputted signal is below the minimum amplitude provided in technical specifications, erroneous
measurements could result.
z
Portable and mobile communication equipment may affect the performance of this monitor.
Guidance and Declaration - Electromagnetic Emissions
The device is intended for use in the electromagnetic environment specified below. The customer or the user of the device
should assure that it is used in such an environment.
Emission tests
Compliance
Electromagnetic environment - guidance
Radio frequency (RF) emissions
Group 1
The device uses RF energy only for its internal function. Therefore, its
CISPR 11
RF emissions are very low and are not likely to cause any interference
in nearby electronic equipment.
RF emissions CISPR 11
Class A
The device is suitable for use in all establishments other than
Harmonic emissions
Class A
domestic and those directly connected to the public low-voltage
power supply network that supplies buildings used for domestic
IEC61000-3-2
Voltage Fluctuations/Flicker
Complies
purposes, provided the following warning is heeled.
Emissions IEC 61000-3-3
WARNING
z
This equipment/system is intended for use by healthcare professionals only. This equipment/ system may
cause radio interference or may disrupt the operation of nearby equipment. It may be necessary to take
mitigation measures, such as re-orienting or relocating the [ME EQUIPMENT or ME SYSTEM] or shielding
the location.
B-1
Guidance and Declaration - Electromagnetic Immunity
The device is intended for use in the electromagnetic environment specified below. The customer or the user of the device
should assure that it is used in such an environment.
Electromagnetic environment -
Immunity test
IEC60601 test level
Compliance level
Electrostatic discharge
±6 kV contact
±6 kV contact
Floors should be wood, concrete or
(ESD) IEC 61000-4-2
±8 kV air
±8 kV air
ceramic tile. If floors are covered
guidance
with synthetic material, the relative
humidity should be at least 30%.
Electrical fast
±2 kV for power supply lines
±2 kV for power supply lines
Mains power quality should be that
transient/burst IEC
±1 kV for input/output lines
±1 kV for input/output lines
of a typical commercial or hospital
61000-4-4
(>3 m)
(>3 m)
environment.
Surge IEC 61000-4-5
±1 kV line(s) to line(s)
±1 kV line(s) to line(s)
±2 kV line(s) to earth
±2 kV line(s) to earth
Voltage dips, short
<5 % UT (>95 % dip in UT) for
<5 % UT (>95 % dip in UT) for
Mains power quality should be that
interruptions and
0.5 cycle
0.5 cycle
of a typical commercial or hospital
environment. If the user of our
voltage variations on
power supply input
40 % UT (60 % dip in UT) for 5
40 % UT (60 % dip in UT) for 5
product requires continued
lines IEC 61000-4-11
cycles
cycles
operation during power mains
interruptions, it is recommended
70 % UT (30 % dip in UT) for
70 % UT (30 % dip in UT) for
that our product be powered from
25 cycles
25 cycles
an uninterruptible power supply or
a battery.
Power frequency
<5 % UT (>95 % dip in UT) for
<5 % UT (>95 % dip in UT) for
5s
5s
3 A/m
3 A/m
Power frequency magnetic fields
(50/60 HZ) magnetic
should be at levels characteristic of
field IEC 61000-4-8
a typical location in a typical
commercial or hospital
environment.
Note: UT is the AC mains voltage prior to application of the test level.
B-2
Guidance and Declaration - Electromagnetic Immunity
The device is intended for use in the specified electromagnetic environment. The customer or the user of the device should
assure that it is used in such an environment as described below.
Immunity test
IEC60601 test
Compliance
level
level
Conduced RF
3 Vrms
3Vrms
IEC61000-4-6
150 kHz to 80 MHz
Electromagnetic environment - guidance
Portable and mobile RF communications equipment should be
used no closer to any part of the system, including cables, than
the recommended separation distance calculated from the
equation appropriate for the frequency of the transmitter.
Recommended separation distances:
d
Radiated RF
3V/m
IEC61000-4-3
80MHz to 2.5GHz
3V/m
1 .2 P
Recommended separation distances:
80 MHz̚800 MHz
d
1 .2 P
800MHz-2.5GHz
d
2 .3
P
Where, P is the maximum output power rating of the
transmitter in watts (W) according to the transmitter
manufacturer and d is the recommended separation distance
in meters (m).b
Field strengths from fixed RF transmitters, as determined by an
electromagnetic site survey c,should be less than the
compliance level in each frequency range d.
Interference may occur in the vicinity of
equipment marked with the following
symbol:
Note 1: At 80 MHz to 800 MHz, the separation distance for the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
reflection from structures, objects and people.
a
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile
radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To
assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be
considered. If the measured field strength in the location in which the [ME EQUIPMENT or ME SYSTEM] is used exceeds
the applicable RF compliance level above, the [ME EQUIPMENT or ME SYSTEM] should be observed to verify normal
operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or
relocating the [ME EQUIPMENT or ME SYSTEM].
b
Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [V1] V/m.
WARNING
z
The monitor is configured with a wireless network connector to receive wireless signal. Other devices may
interfere with this monitor even though they meet the requirements of CISPR.
B-3
Recommended separation distances between portable and mobile RF communications equipment and the device
The device is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The
customer or the user of the device can help prevent electromagnetic interference by maintaining a minimum distance
between portable and mobile RF communications equipment (transmitters) and the device as recommended below,
according to the maximum output power of the communications equipment.
Rated maximum
Separation distance in meters (m) according to frequency of the transmitter
output power of
150 kHz ̚ 80 MHz
80 MHz ̚ 800 MHz
800 MHz ̚ 2.5 GHz
transmitter˄W˅
d
0.01
0.12
0.12
0.23
0.1
0.38
0.38
0.73
1
1.20
1.20
2.30
10
3.80
3.80
7.30
100
12.00
12.00
23.00
1 .2 P
d
1 .2 P
d
2 .3 P
‹ For transmitters rated at a maximum output power not listed above, the recommended separation distance d
in metres (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is
the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.
‹ Note 1: At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
‹ Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by
absorption and reflection from structures, objects and people.
B-4
B.2 Radio Regulatory Compliance
This Wi-Fi device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-001 du Canada.
The patient monitor including Wi-Fi module (US only) complies with part 15 of the FCC Rules. Operation is subject to the
condition that this device does not cause harmful interference.
Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the
Wireless Medical Telemetry Service.
The patient monitor including Wi-Fi module - FCC and Industry Canada Radio Compliance: This device complies with
Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this
device may not cause harmful
interference, and (2) this device must accept any interference received, including interference that may cause undesired
operation. Any changes or modifications to this equipment not expressly approved by Mindray may cause harmful radio
frequency interference and void your authority to operate this equipment.
The maximum antenna gain permitted complies with the e.i.r.p. limits as stated in RSS-210.
The maximum antenna gain permitted complies with the e.i.r.p. limits specified for point-to-point operation, as stated in
RSS-210.
The radio device used in this product is in compliance with the essential requirements and
other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment
Directive). The product is in compliance with ETSI EN 300 328 and ETSI EN 301 489.
WARNING
z
Keep a distance of at least 20cm away from the monitor when Wi-Fi function is in use.
B-5
FOR YOUR NOTES
B-6
C Default Configurations
This chapter lists some of the most important factory default settings for each department in configuration
management. You cannot change the factory default configuration itself. However, you can make changes to the
settings from the factory default configuration and then save the changed configuration as a user configuration. The last
column of the following tables is for your notes and review.
Note: In this chapter, O.M means the monitor’s operating mode. Column C refers to the settings that can be changed in
configuration management. Column M refers to the settings that can be changed in monitoring mode.
C.1 Parameters Configuration
C.1.1 ECG
ECG Setup
O.M
Item Name
C
Lead Set
General
*
Auto
Alm Source
*
*
HR
Alarm
*
*
On
Alm Lev
*
*
Med
Adu
HR/PR High
HR/PR Low
Ped
*
*
NICU
CCU
160
200
Adu
50
*
*
Neo
75
100
Sweep
*
*
25 mm/s
Beat Vol
*
*
2
*
No
Paced
Notch Filter
*
*
On
Gain
*
*
X1
Filter
*
*
Monitor
ECG Display
*
*
Normal
*
60
Pacemaker Rate
ICU
120
Neo
Ped
OR
M
1
Surgery
Monitor
C-1
Diagnostic
User Defaults
ST Analysis
Item Name
O.M
General
C
M
ST Analysis
*
*
Off
Alarm
*
*
Off
Alm Lev
*
*
Med
ST-X High
*
*
ST-X Low
*
*
ISO
OR
ICU
NICU
CCU
User Defaults
On
when ST Unit is mV:
0.20
when ST Unit is mm:
2.0
when ST Unit is mV:
-0.20
when ST Unit is mm:
-2.0
-80 ms
*
J
ST
*
48 ms
J + 60 ms
X represents I, II, III, aVR, aVL, aVF, V, V1, V2, V3, V4, V5 or V6.
Arrh. Analysis
O.M
Item Name
Algorithm
Genral
C
M
*
*
OR
ICU
Arrhythmia Threshold Settings
PVCs High
Tachy
Brady
Asys. Delay
Vtac Rate
Vtac PVCs
Multif. PVC’s
Window
Extreme Tachy
Extreme Brady
Mindray
*
*
*
*
*
*
*
*
*
*
Adu, Ped:
10
Neo:
N/A
Adu:
120
Ped:
160
Neo:
N/A
Adu:
50
Ped:
75
Neo:
N/A
Adu, Ped:
5
Neo:
N/A
Adu, Ped:
130
Neo:
N/A
Adu, Ped:
6
Neo:
N/A
Adu, Ped:
15
Neo:
N/A
Adu:
160
Ped:
180
Neo:
N/A
Adu:
35
Ped:
50
Neo:
N/A
*
*
*
*
*
*
C-2
NICU
CCU
User Defaults
O.M
Item Name
Algorithm
Vbrd Rate
Vbrd PVCs
Genral
C
M
*
*
*
Pause Time
*
PVCs High
*
Asys. Delay
*
Vtac Rate
*
Vtac PVCs
*
OR
ICU
Adu, Ped:
40
Neo:
N/A
Adu, Ped:
5
Neo:
N/A
Ad, Ped:
2
Neo:
N/A
Adu, Ped:
10
Neo:
N/A
Adu, Ped:
4
Neo:
N/A
Adu, Ped:
130
Neo:
N/A
Adu, Ped:
6
Neo:
N/A
Adu, Ped:
15
Neo:
N/A
Adu:
120
Ped:
160
Neo:
N/A
Adu:
50
Ped:
75
Neo:
N/A
NICU
CCU
*
*
*
*
*
*
Mortara
Multif. PVC’s
*
Window
Tachy
*
Brady
*
*
*
*
Arrhythmia Alarm Settings
PVCs/min
Mindray
*
*
Off
On
R on T Alarm
*
*
Off
On
Nonsus. Vtac Alarm
*
*
Off
On
Vent. Rhythm Alarm
*
*
Off
On
Bigeminy Alarm
*
*
Off
On
Trigeminy Alarm
*
*
Off
On
Asystole Alarm
*
*
On
*
*
On
Vtac Alarm
*
*
On
Vent. Brady Alarm
*
*
On
*
*
On
Alarm
VFib/VTac
Alarm
Extreme Tachy
Alarm
C-3
User Defaults
O.M
Item Name
Algorithm
Genral
OR
ICU
NICU
CCU
C
M
*
*
On
X Alarm
*
*
Off
Asystole Alm Lev
*
*
High
*
*
High
Vtac Alm Lev
*
*
High
Vent. Brady Alm Lev
*
*
High
*
*
High
*
*
High
VT>2 Alm Lev
*
*
Low
Pause Alm Lev
*
*
Low
Couplet Alm Lev
*
*
Prompt
PVC Alm Lev
*
*
Prompt
Irr. Rhythm Alm Lev
*
*
Prompt
PNP Alm Lev
*
*
Prompt
PNC Alm Lev
*
*
Prompt
*
*
Prompt
X Alm Lev
*
*
Med
X Alm Rec
*
*
Off
*
*
Off
On
R on T Alarm
*
*
Off
On
Vent. Rhythm Alarm
*
*
Off
On
Bigeminy Alarm
*
*
Off
On
Trigeminy Alarm
*
*
Off
On
Extreme Brady
Alarm
VFib/VTac
Alm Lev
Extreme Tachy Alm
Lev
Extreme Brady Alm
Lev
Missed Beats Alm
Lev
PVCs/min
Mortara
Alarm
Asystole Alarm
On
VFib Alarm
On
VTac Alarm
On
X Alarm
*
*
On
Asystole Alm Lev
*
*
High
VFib Alm Lev
*
*
High
VTac Alm Lev
*
*
High
VT>2 Alm Lev
*
*
Low
C-4
User Defaults
O.M
Item Name
Algorithm
Genral
C
M
Couplet Alm Lev
*
*
Prompt
PVC Alm Lev
*
*
Prompt
Irr. Rhythm Alm Lev
*
*
Prompt
PNP Alm Lev
*
*
Prompt
PNC Alm Lev
*
*
Prompt
*
*
Prompt
X Alm Lev
*
*
Med
X Alm Rec
*
*
Off
Missed Beats Alm
Lev
OR
ICU
NICU
CCU
User Defaults
X represents a certain arrhythmia event. Refer to the Specifications chapter for details. The X in “X Alm Lev” refers to all
arrhythmia events except for those specially marked ones.
C-5
C.1.2 RESP
O.M
Item Name
General
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
Sweep
*
*
6.25 mm/s
Lead
*
*
II
Gain
*
*
X2
RR High
*
*
RR Low
*
*
Apnea Delay
*
*
Detection Mode
*
*
Auto
*
Auto
RR Source
OR
ICU
Adu, Ped:
30
Neo:
100
Adu, Ped:
8
Neo:
30
Adu, Ped:
20
Neo:
15
NICU
CCU
User Defaults
C.1.3 PR
O.M
Item Name
General
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
Adu
HR/PR High Ped
HR/PR Low
ICU
120
*
*
160
Neo
200
Adu
50
Ped
OR
*
*
Neo
75
100
PR Source
*
*
SpO2
Beat Vol
*
*
2
1
C-6
NICU
CCU
User Defaults
C.1.4 SpO2
O.M
Item Name
General
OR
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
SpO2 High
*
*
SpO2 Low
*
*
90
Desat Limit
*
*
80
Sweep
*
*
25 mm/s
*
Off
NIBP Simul
ICU
NICU
Adu, Ped:
100
Neo:
95
Sensivity˄Mindray˅
*
*
Med
Sensivity˄Masimo˅
*
*
Normal
Averaging˄Masimo˅
*
*
8s
Sat-Seconds˄Nellcor˅
*
*
0s
CCU
User Defaults
C.1.5 Temp
O.M
Item Name
General
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
T1/T2 High˄ºC˅
*
*
38.0
T1/T2 Low˄ºC˅
*
*
35.0
TD High˄ºC˅
*
*
2.0
OR
ICU
NICU
CCU
User Defaults
C.1.6 NIBP
O.M
Item Name
General
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
Interval
*
*
15 min
Adu
Cuff Press.
˄mmHg˅
Ped
˄mmHg˅
*
*
Adu
160
Neo
NICU
CCU
5 min
15 min
30 min
15 min
60
40
Ped
ICU
80
Neo
Initial Pressure
OR
*
140
90
C-7
User Defaults
Alarm Limits
Adu
NIBP-S High
˄mmHg˅
Ped
*
*
90
Adu
90
Ped
*
*
Neo
Ped
90
Adu
60
Ped
*
*
50
Neo
25
Adu
90
Ped
*
*
70
Neo
60
Adu
50
NIBP-D Low
˄mmHg˅
*
70
NIBP-D High
˄mmHg˅
110
*
Neo
NIBP-M Low
˄mmHg˅
70
40
Adu
NIBP-M High
˄mmHg˅
120
Neo
NIBP-S Low
˄mmHg˅
160
Ped
*
*
Neo
40
20
C.1.7 IBP
Alarm
O.M
C M
* *
On
Alm Lev
*
*
Med
P1 Measure
*
*
All
P2 Measure
*
*
All
P3 Measure
*
*
Mean
P4 Measure
*
*
Mean
Sensitivity
*
*
Med
Sweep
*
*
25 mm/s
Filter
*
Item Name
General
OR
ICU
12.5 Hz
Art, Ao, UAP, BAP, FAP, LV, P1-P2 Arterial Pressure Alarm Limits
Adu
IBP-S High
˄mmHg˅
Ped
IBP-M Low
*
120
90
Adu
90
Ped
*
*
70
Neo
55
Adu
110
IBP-M High
˄mmHg˅
*
Neo
IBP-S Low
˄mmHg˅
160
Ped
*
*
Neo
Adu
90
70
*
*
70
C-8
NICU
CCU
User Defaults
O.M
C M
Item Name
˄mmHg˅
Ped
50
Neo
35
Adu
90
IBP-D High
˄mmHg˅
Ped
*
*
60
Adu
50
Ped
*
*
OR
ICU
70
Neo
IBP-D Low
˄mmHg˅
General
40
Neo
20
Adu
35
PA Alarm Limits
PA-S High
˄mmHg˅
Ped
Adu
10
*
24
24
Adu
20
Ped
*
*
26
Neo
26
Adu
0
Ped
*
*
12
Neo
12
Adu
16
PA-D High
Ped
*
*
4
Neo
4
Adu
0
PA-D Low
˄mmHg˅
*
Neo
PA-M Low
˄mmHg˅
60
60
PA-M High
˄mmHg˅
*
Neo
PA-S Low˄mmHg˅ Ped
˄mmHg˅
*
Ped
*
*
Neo
-4
-4
CVP, LAP, RAP, ICP, UVP, P3-P4 Venous Pressure Alarm Limits
Adu
IBP-M High
˄mmHg˅
Ped
*
*
4
Neo
4
Adu
0
IBP-M Low
˄mmHg˅
10
Ped
*
*
Neo
0
0
Art, Ao, BAP, FAP, LV, P1-P2 Arterial Pressure Scale
Scale˄mmHg˅
*
*
0-160
*
*
0-30
*
0-20
PA Scale
Scale˄mmHg˅
CVP, LAP, RAP, ICP, UVP Scale
Scale˄mmHg˅
*
UAP, P3-P4 Venous Pressure Scale
Scale˄mmHg˅
*
*
0-80
C-9
NICU
CCU
User Defaults
C.1.8 C.O.
O.M
Item Name
General
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
TB High˄ºC˅
*
*
39.0
TB Low˄ºC˅
*
*
36.0
Comp. Const
*
*
0.542
Auto TI
*
*
Auto
Manual TI˄ºC˅
*
*
2.0
Measuring mode
*
*
Manual
OR
ICU
NICU
CCU
User Defaults
C.1.9 CO2
Item Name
O.M
General
OR
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
Operating Mode
*
*
Measure
Sweep
*
*
6.25 mm/s
Scale˄mmHg˅
*
*
50
Apnea Delay
*
*
RR Source
*
ICU
Adu, Ped:
20
Neo:
15
NICU
Auto
Sidestream CO2 Setup
Adu, Ped:
100 ml/min
Neo:
70 ml/min
Flow Rate
*
*
BTPS Compen
*
*
Off
N2O Compen
*
*
0
O2 Compen
*
*
21
Des Compen
*
*
0
50
21
Microstream CO2 Setup
BTPS Compen
*
Off
Max Hold
*
*
20 s
Auto Standby (min)
*
*
0
Max Hold
*
*
10 s
O2 Compen
*
*
Off
Balance Gas
*
*
Room Air
AG Compen
*
*
0
Mainstream CO2 Setup
C-10
CCU
User Defaults
Alarm Limits
EtCO2 High˄mmHg˅
*
*
EtCO2 Low˄mmHg˅
*
*
FiCO2 High˄mmHg˅
*
*
RR High
*
*
RR Low
*
*
Adu, Ped:
50
Neo:
45
Adu, Ped:
25
Neo:
30
Adu, Ped, Neo:
4
Adu, Ped:
30
Neo:
100
Adu, Ped:
8
Neo:
30
C.1.10 AG
Item Name
O.M
General
C
M
Alarm
*
*
On
Alm Lev
*
*
Med
Sweep
*
*
6.25 mm/s
O2 Compen
*
*
Off
Operating Mode
*
*
Measure
Flow Rate
*
*
Auto Standby
*
*
Off
Apnea Time
*
*
20 s
*
Auto
Draw
RR Source
OR
ICU
On
Off
Adu, Ped:
120 ml/min
Neo:
70 ml/min
CO2 Setup
Wave Type
*
*
Scale
*
*
EtCO2 High˄mmHg˅
*
*
EtCO2 Low˄mmHg˅
*
*
FiCO2 High˄mmHg˅
*
*
RR High
*
*
RR Low
*
*
Agent
*
*
AA
N2O Scale
*
*
50
O2 Scale
*
*
AA Scale
*
*
9.0
Hal/Enf/Iso Scale
*
*
2.5
when unit is mmHg:
50
when unit is %
7.0
or KPa:
Adu, Ped:
50
Neo:
45
Adu, Ped:
25
Neo:
30
4
Adu, Ped:
30
Neo:
100
Adu, Ped:
8
Neo:
30
Gas Setup
when unit is mmHg:
400
when unit is %
50
or KPa:
C-11
NICU
CCU
User Defaults
Item Name
O.M
General
C
M
Des Scale
*
*
9.0
Sev Scale
*
*
4.0
EtO2 High
*
*
88
EtO2 Low
*
*
18
FiO2 High
*
*
FiO2 Low
*
*
18
EtN2O High
*
*
55
EtN2O Low
*
*
0
FiN2O High
*
*
53
FiN2O Low
*
*
0
EtHal/Enf/Iso High
*
*
3.0
EtHal/Enf/Iso Low
*
*
0.0
FiHal/Enf/Iso High
*
*
2.0
FiHal/Enf/Iso Low
*
*
0.0
EtSev High
*
*
6.0
EtSev Low
*
*
0.0
FiSev High
*
*
5.0
FiSev Low
*
*
0.0
EtDes High
*
*
8.0
EtDes Low
*
*
0.0
FiDes High
*
*
6.0
FiDes Low
*
*
0.0
OR
Adu, Ped:
100
Neo:
90
ICU
NICU
CCU
User Defaults
CCU
User Defaults
C.2 Routine Configuration
C.2.1 Alarm
Item Name
O.M
General
OR
ICU
*
2
1
2
*
*
Low
Recording Length
*
*
16 s
Apnea Delay
*
*
Alarm Delay
*
*
6s
ST Alarm Delay
*
*
30 s
C
M
Alm Volume
*
Reminder Vol
Adu, Ped: 20 s
Neo: 15 s
C-12
NICU
C.2.2 Screens
O.M
Item Name
General
OR
C
M
Choose Screen
*
*
Normal Screen
Display the ST segments on ECG screen
*
*
Unselected
Select QuickKeys
*
NICU
CCU
User
Defaults
NIBP MeasureėStop AllėReviewėStandby
1
ECG1
2
ECG2
3
SpO2+PR
Select Wave Sequence
for Normal Screen
ICU
*
4
*
Any IBP
5
Any IBP
6
CO2
7
Resp
Parameter 1
ECG
Select Parameters for
Parameter 2
Big Numerics Screen
Parameter 3
Resp
Parameter 4
NIBP
*
*
SpO2+PR
C.2.3 Waveform
O.M
Item Name
C
General
OR
M
Parameter/
ECG
Wave Colour
NIBP
White
SpO2
Cyan
PR
Cyan
TEMP
White
*
Green
Art/Ao/UAP/FAP
/BAP/LV/P1~P4
Red
(arterial pressure)
PA
CVP/ICP/P1~P4
(venous pressure)
Yellow
Blue
LAP
Purple
RAP
Orange
UVP
Cyan
CO2
Yellow
RESP
Yellow
AA
Yellow
N2O
Blue
O2
Green
Hal
Red
Enf
Orange
Iso
Purple
Des
Cyan
C-13
ICU
NICU
CCU
User Defaults
Sev
Yellow
C.O.
White
X represents a waveform label, such as ECG, RESP, CO2 and so forth. The ECG waveform cannot be set off.
C.2.4 Review
O.M
Item Name
Tabular Trends
Graphic Trends
General
OR
ICU
*
30 min
5min
30 min
*
*
Standard
*
*
Standard
*
2h
*
Save ECG1 by default.
C
M
Interval
*
Trend Group
Trend Group
Minitrend Length
Full Disclosure
Save Waves
*
NICU
CCU
User Defaults
C.2.5 Event
O.M
Item Name
C
General
OR
ICU
NICU
CCU
User Defaults
M
Waveform 1
*
II
Waveform 2
*
I
Pleth
I
Waveform 3
*
Pleth
Resp
Pleth
NICU
CCU
C.2.6 Record
O.M
Item Name
C
General
Length
*
8s
Interval
*
Off
Paper Speed
*
25 mm/s
*
Off
Alm Rec
X
OR
ICU
M
X represents a parameter label.
C-14
User Defaults
C.2.7 Print
O.M
Item Name
C
Paper Size
General
OR
ICU
*
A4
Amplitude
*
10 mm/mV
Sweep
*
25 mm/s
Auto Interval
*
Off
12-Lead Format
*
12X1
Set as End Case Report
*
Unselected
Back
*
Auto
Spacing
*
Auto
Tabular Trends
Report Layout
*
Parameter Oriented
Reports
Currently Displayed Trended
*
Selected
Standard Parameter Group
*
Unselected
Custom
*
Unselected
Set as End Case Report
*
Unselected
Back
*
Auto
Zoom
*
Auto
Set as End Case Report
*
Unselected
Sweep
*
Auto
Select Wave
*
Current
ECG Reports
Parameters
NICU
CCU
User Defaults
M
Graphic Trends
Reports
Realtime Report
C.2.8 Others
O.M
Item Name
C
General
Brightness
*
5
Key Volume
*
2
*
On
View Other
Patient
Auto Alarm
OR
ICU
NICU
CCU
User Defaults
M
C.3 User Maintenance Items
Item Name
O.M
C
General
OR
M
Changing Bed No.
*
Protected
Atmospheric Pressure
*
760 mmHg
Height Unit
*
cm
Weight Unit
*
kg
ST Unit
*
mV
Press. Unit
*
mmHg
CVP Unit
*
cmH2O
C-15
ICU
NICU
CCU
User Defaults
O.M
Item Name
C
General
OR
ICU
1
2
CO2 Unit
*
mmHg
O2 Unit
*
%
Temp Unit
*
ć
Network Type
*
LAN
Latching Alarms
*
*
No
Alarm Pause Time
*
*
2 min
Minimum Alarm Volume
*
*
2
Reminder Tone
*
Off
Reminder Interval
*
1 min
ECGLeadOff Lev.
*
Low
SpO2SensorOff Lev.
*
Low
Alarm Tone Interval
*
Lethal Arrh. OFF
*
Disable
Silence Other Bed
*
On
Extended Arrh.
*
Enable
Wave Line
*
Mediate
ECG Standard
*
AHA
Notch Freq.
*
50 Hz
Data Transfer Method
*
Module
Transferred Data Length
*
4h
Data Transfer Strategy
*
Always Ask
SpO2 Tone
*
Mode 1
Signal Type
*
Continuous
Contact Type
*
Normally Closed
Signal Type
**
Continuous
Contact Type
*
Normally Closed
Nurse Call
NICU
M
High Level Alarm:
10 s
Med/Low Level Alarm:
20 s
Alm Lev
*
*
High, Med, Low
Alarm Cat.
*
*
Phys., Tech.
C-16
CCU
User Defaults
D Alarm Messages
This chapter lists only the most important physiological and technical alarm messages. Some messages appearing on
your monitor may not be included.
In this chapter:
The “I” field indicates how alarm indications are cleared: “A” means all alarm indications are cleared after the
hardkey
is pressed, “B” indicates alarm lamp flashing and alarm tones are cleared and the alarm messages change to prompt
messages after the
hardkey is pressed, and “C” indicates alarm lamp flashing and alarm tones are cleared and Ĝ
appears before the alarm message after the
hardkey is pressed.
The “L” field indicates the alarm level: H means high, M means medium and L means low. “*” means the alarm level is
user-adjustable.
XX represents a measurement or parameter label, such as ECG, NIBP, HR, ST-I, PVCs, RR, SpO2, PR, etc.
In the “Cause and Solution” column, corresponding solutions are given instructing you to troubleshoot problems. If the
problem persists, contact your service personnel.
D.1 Physiological Alarm Messages
Measurement
Alarm messages
L
Cause and solution
XX Too High
M*
XX value has risen above the high alarm limit or fallen below the low
XX Too Low
M*
ECG Weak Signal
H
Asystole
H
Arrhythmia has occurred to the patient. Check the patient’s condition
VFib/VTac
H
and the ECG connections.
Vtac
H
Vent. Brady
H
Extreme Tachy
H
Extreme Brady
H
R on T
M*
VT>2
M*
Couplet
M*
PVCs/min
M*
Bigeminy
M*
Trigeminy
M*
XX
ECG
alarm limit. Check the patient’s condition and check if the patient
category and alarm limit settings are correct.
The ECG signal is so weak that the monitor can’t perform ECG
analysis. Check the patient’s condition and the ECG connections.
D-1
Measurement
Alarm messages
L
Tachy
M*
Brady
M*
Missed Beats
M*
Irr. Rhythm
M*
Vent. Rhythm
M*
Multif. PVC
M*
Nonsus. Vtac
M*
Pause
M*
PNP
M*
PNC
M*
Cause and solution
The pacer appears abnormal. Check the pacer.
The respiration signal was so weak that the monitor cannot perform
Resp Apnea
H
respiration analysis. Check the patient’s condition and the Resp
Resp
connections.
Resp Artifact
The patient’s heartbeat has interfered with his respiration. Check the
H
patient’s condition and the Resp connections.
The SpO2 value has fallen below the desaturation alarm limit. Check
SpO2 Desat
H
the patient’s condition and check if the alarm limit settings are
correct.
SpO2
The pulse signal was so weak that the monitor cannot perform pulse
No Pulse
H
analysis. Check the patient’s condition, SpO2 sensor and
measurement site.
CO2
CO2 Apnea
H
AG Apnea
H
FiO2 Too Low
H
The patient stops breathing, or the respiration signal was so weak
that the monitor cannot perform respiration analysis. Check the
patient’s condition and the RM connections.
AG
Check the patient’s condition, the ventilated O2 content and the AG
connections.
D.2 Technical Alarm Messages
Measurement
Alarm message
L
I
Cause and solution
XX SelfTest Err
H
C
XX Init Err
H
A
An error occurred to the XX module, or there is a problem
XX Init Err N
H
A
with the communications between the module and the
monitor. Re-plug the module and restart the monitor, or
N is within 1 to 8
XX
ECG
plug the module into another monitor.
XX Comm Err
H
A
XX Comm Stop
H
C
XX Limit Err
L
C
XX Overrange
L
C
ECG Lead Off
L*
B
The electrode has become detached from the patient or
ECG YY Lead Off
L*
B
the lead wire has become disconnected from the adapter
D-2
XX parameter limit is accidentally changed. Contact your
service personnel.
The measured XX value is not within the specified range
for XX measurement. Contact your service personnel.
Measurement
Alarm message
L
I
Cause and solution
Note: YY represents the leadwires, V (V1, V2,
cable. Check the connections of the electrodes and
V3, V4, V5, V6,), LL, LA, RA, as per AHA
leadwires.
standard, or C (C1, C2, C3, C4, C5, C6), F, L
and R as per IEC standard.
The ECG signal is noisy. Check for any possible sources of
ECG Noisy
L
A
signal noise around the cable and electrode, and check the
patient for great motion.
Artifacts are detected on the ECG analysis lead and as a
result heart rate cannot be calculated and Asystole, Vfib
and Vtac cannot be analyzed. Check the connections of
ECG Artifact
L
A
the electrodes and leadwires and check for any possible
source of interference around the cable and electrode.
Check the patient’s condition and check the patient for
great motion.
High frequency signals are detected on the ECG analysis
ECG High Freq. Noise
L
A
lead. Check for any possible source of interference around
the cable and electrode.
Low frequency signals are detected on the ECG analysis
ECG Low Freq. Noise
L
A
lead. Check for any possible source of interference around
the cable and electrode.
The ECG amplitude didn’t reach the detected threshold.
ECG Amplitude Too Small
L
C
Check for any possible source of interference around the
cable and electrode.
ECG configuration is wrongly downloaded. Check the
ECG Config. Err
L
C
downloaded configuration and re-download the correct
configuration.
Resp
Temp
SpO2
Resp Disturbed
L
A
The respiration circuit is disturbed. Restart the monitor.
Temp Cal. Err
H
C
A calibration failed. Restart the monitor.
T1 Sensor Off
L
A
The Temp sensor has become detached from the patient or
T2 Sensor Off
L
A
the module. Check the sensor connections.
SpO2 Sensor Off
L*
B
The SpO2 sensor has become detached from the patient or
SpO2 Sensor Fault
L
C
the module, or there is a fault with the SpO2 sensor, or an
SpO2 No Sensor
L
B
unspecified SpO2 sensor has been used. Check the sensor
SpO2 Unknown Sensor
L
C
application site and the sensor type, and make sure if the
SpO2 Sensor Incompatible
L
C
sensor is damaged. Reconnect the sensor or use a new
sensor.
There is too much light on the SpO2 sensor. Move the
SpO2 Too Much Light
L
C
sensor to a place with lower level of ambient light or cover
the sensor to minimize the ambient light.
SpO2 Low Signal
L
C
SpO2 Weak Signal
L
C
condition and change the sensor application site. If the
SpO2 Weak Pulse
L
C
error persists, replace the sensor.
The SpO2 signal is too low or too weak. Check the patient’s
D-3
Measurement
Alarm message
L
I
Cause and solution
The SpO2 signal has been interfered. Check for any
SpO2 Interference
L
C
possible sources of signal noise around the sensor and
check the patient for great motion.
There is a problem with the SpO2 measurement board. Do
SpO2 Board Fault
L
C
NIBP Loose Cuff
L
A
The NIBP cuff is not properly connected, or there is a leak
NIBP Air Leak
L
A
in the airway.
NIBP Pneumatic Leak
L
A
Check the NIBP cuff and pump for leakages.
NIBP Cuff Type Wrong
L
A
not use the module and contact your service personnel.
The cuff type applied mismatches the patient category.
Verify the patient category and replace the cuff.
An error occurred to the air pressure. Verify that the
NIBP Air Pressure Err
L
A
monitor application site meets the environmental
requirements and check if there is any source that affects
the air pressure.
The patient’s pulse is weak or the cuff is loose. Check the
NIBP Weak Signal
L
A
patient’s condition and change the cuff application site. If
the error persists, replace the cuff.
NIBP
The NIBP signal is saturated due to excess motion or other
NIBP Signal Saturated
L
A
NIBP Overrange
L
A
NIBP Excessive Motion
L
A
NIBP Cuff Overpress.
L
A
NIBP Equip Err
H
A
An error occurred during NIBP measurement and therefore
NIBP Timeout
L
A
the monitor cannot perform analysis correctly. Check the
NIBP Measure Failed
L
A
NIBP Illegally Reset
L
A
sources.
The measured NIBP value is not within the specified range.
Check the patient’s condition and reduce the patient
motion.
The NIBP airway may be occluded. Check the airway and
measure again.
patient’s condition and NIBP connections, or replace the
YY Sensor Off
IBP
YY Non-Pulsatile
cuff.
An illegal reset occurred during NIBP measurement. Check
if the airway is occluded.
Check the sensor connection and reconnect the sensor.
L
A
The catheter may be occluded. Please flush the catheter.
YY represents an IBP label.
C.O.
TB Sensor Off
L
A
Check the sensor connection and reconnect the sensor.
CO2
CO2 Sensor High Temp
L
C
Check, stop using or replace the sensor.
CO2 Sensor Low Temp
L
C
Check, stop using or replace the sensor.
The operating temperature of the CO2 module goes
CO2 Temp Overrange
L
C
beyond the specified range. After it restores within the
specified range, the module will restart automatically.
CO2 Airway High Press.
L
C
CO2 Airway Low Press.
L
C
CO2 High Barometric Press.
L
C
An error occurred in the airway pressure. Check the patient
connection and patient circuit, and then restart the
D-4
monitor.
Check the CO2 connections, make sure that the monitor
Measurement
Alarm message
L
I
Cause and solution
application site meets the requirements, and check for
CO2 Low Barometric Press.
L
C
special sources that affect the ambient pressure. Restart
the monitor.
CO2 FilterLine Occluded
L
C
The airway or watertrap was occluded. Check the airway
and remove the occlusion.
CO2 No Watertrap
L
B
Check the watertrap connections.
CO2 Check Adapter
L
A
CO2 FilterLine Err
L
C
CO2 Zero Failed
L
A
CO2 System Err
L
A
Re-plug the module or restart the monitor.
CO2 Check Cal.
L
C
Perform a calibration.
CO2 Check Airway
L
C
An error occurred to the airway.
CO2 No Filterline
L
A
Make sure that the filterline is connected.
CO2 No Sensor
L
A
Make sure that the sensor is connected.
CO2 Main Board Err
H
C
CO2 Checking Sensor
L
C
CO2 Replace Scrubber&Pump
L
C
CO2 15V Overrange
H
C
CO2 Hardware Err
H
C
AG No Watertrap
L
B
Check the connections of the watertrap and re-connect it.
AG Change Watertrap
L
A
Wait until the change is completed.
AG Watertrap Type Wrong
L
A
Make sure that a correct watertrap has been used.
O2 Accuracy Unspecified
L
A
N2O Accuracy Unspecified
L
A
CO2 Accuracy Unspecified
L
A
Enf Accuracy Unspecified
L
A
Iso Accuracy Unspecified
L
A
Sev Accuracy Unspecified
L
A
Hal Accuracy Unspecified
L
A
Des Accuracy Unspecified
L
A
awRR Accuracy Unspecified
L
A
AG Hardware Err
H
A
AG Airway Occluded
L
A
AG Zero Failed
L
A
12V Too High
H
C
There is a problem with the system power supply. Restart
12V Too Low
H
C
the monitor.
5V Too High
H
C
5V Too Low
H
C
There is a problem with the airway adapter. Check, clean or
replace the adapter.
Check if there is a leak in the CO2 sample line or the CO2
sample line has been occluded.
Check the CO2 connections. After the sensor’s temperature
becomes stabilized, perform a zero calibration again.
There is a problem with the CO2 module. Re-plug the
module or restart the monitor.
The measured value has exceeded the specified accuracy
AG
Power
D-5
range.
Remove the AG module. Stop using the module and
contact your service personnel.
Check the airway and remove the occlusion.
Re-plug the module or restart the monitor, and then
perform a zero calibration again.
Measurement
Alarm message
L
I
Cause and solution
3.3V Too High
H
C
3.3V Too Low
H
C
Battery Too Low
H
C
Different Battery Voltages
M
C
Connect the monitor to an AC power source and allow the
batteries to charge.
The two batteries have different charge capacity, or the
batteries unspecified have been used, or there is a
problem with the batteries. Make sure that correct
batteries are used and the batteries are not damaged, or
replace the batteries.
The power consumption of the equipment is too high.
Battery Power Overload
H
C
RT Clock Not Exist
H
C
Recorder Init Err N
L
A
Recorder SelfTest Err
L
A
Recorder Comm Err
L
A
Recorder S. Comm Err
L
A
Recorder Unavailable
L
A
Recorder Vlt High
L
C
An error occurred to the system power supply. Restart the
Recorder Vlt Low
L
C
monitor.
Power the monitor using an AC power source.
Contact your service personnel.
Restart the monitor.
N is within 1 to 8.
Recorder
Stop the recording and restart the monitor.
The recorder has been working for too long time. Stop the
Recorder Head Hot
L
C
recording and resume the recording till the recorder’s
printhead cools down.
System
Rec Paper Wrong Pos.
L
A
System Watchdog Err
H
C
System Software Err
H
C
System CMOS Full
H
C
System CMOS Err
H
C
System FPGA Err
H
C
System Err N
H
C
N is within 2 to 12.
D-6
Re-load the recorder paper.
An error occurred to the system. Restart the monitor.
E Symbols and Abbreviations
E.1 Symbols
μA
microampere
μV
microvolt
μs
Microsecond
A
ampere
Ah
ampere hour
bpm
beat per minute
bps
bit per second
ºC
centigrade
cc
cubic centimeter
cm
centimeter
dB
decibel
DS
dyne second
ºF
fahrenheit
g
gram
GHz
gigahertz
GTT
gutta
h
hour
Hz
hertz
in
inch
kg
kilogram
kPa
kilopascal
L
litre
lb
pound
m
meter
mAh
milliampere hour
Mb
mega byte
mcg
microgram
mEq
milli-equivalents
mg
milligram
min
minute
ml
milliliter
mm
millimeter
mmHg
millimeters of mercury
cmH2O
centimeters of water
ms
millisecond
mV
millivolt
mW
milliwatt
MΩ
megaohm
E-1
nm
nanometer
rpm
breath per minute
s
second
V
volt
VA
volt ampere
Ω
ohm
W
watt
–
minus, negative
%
percent
/
per; divide; or
+
plus
=
equal to
<
less than
>
greater than
≤
less than or equal to
≥
greater than or equal to
±
plus or minus
×
multiply
E.2 Abbreviations
AaDO2
alveolar-arterial oxygen gradient
AAMI
Association for Advancement of Medical Instrumentation
AC
alternating current
ACI
acceleration index
Adu
adult
AG
anaesthesia gas
AHA
American Heart Association
ANSI
American National Standard Institute
Ao
aortic pressure
Art
arterial
aVF
left foot augmented lead
aVL
left arm augmented lead
aVR
right arm augmented lead
awRR
airway respiratory rate
BAP
brachial arterial pressure
BIS
bispectral index
BP
blood pressure
BPSK
binary phase shift keying
BSA
body surface area
BT
blood temperature
BTPS
body temperature and pressure, saturated
C.I.
cardiac index
CCI
Continuous Cardiac Index
E-2
C.O.
cardiac output
CCO
Continuous Cardiac Output
CaO2
arterial oxygen content
CCU
cardiac (coronary) care unit
CE
Conformité Européenne
CFI
cardiac function index
CIS
Clinical Information System
CISPR
International Special Committee on Radio Interference
CMOS
complementary metal oxide semiconductor
CMS
central monitoring system
CO2
carbon dioxide
COHb
carboxyhemoglobin
CP
cardiopulmonary
CPI
cardiac power index
CPO
Cardiac Power Output
CVP
central venous pressure
DC
direct current
Des
desflurane
Dia
diastolic
DPI
dot per inch
dPmx
left ventricular contractility
DVI
digital video interface
DO2
oxygen delivery
DO2I
oxygen delivery index
ECG
electrocardiograph
EDV
end-diastolic volume
EEC
European Economic Community
EEG
electroencephalogram
EMC
electromagnetic compatibility
EMG
electromyography
EMI
electromagnetic interference
Enf
enflurane
ESU
electrosurgical unit
Et
end-tidal
EtCO2
end-tidal carbon dioxide
EtN2O
end-tidal nitrous oxide
EtO
ethylene oxide
EtO2
end-tidal oxygen
EVLW
extravascular lung water
ELWI
extravascular lung water index
FAP
femoral arterial pressure
FCC
Federal Communication Commission
FDA
Food and Drug Administration
FEV1.0%
first second forced expiratory volume ratio
Fi
fraction of inspired
FiCO2
fraction of inspired carbon dioxide
E-3
FiN2O
fraction of inspired nitrous oxide
FiO2
fraction of inspired oxygen
FPGA
field programmable gate array
FV
flow-volume
GEDV
global end diastolic volume
GEDI
global end diastolic volume index
GEF
global ejection fraction
Hal
halothane
Hct
haematocrit
Hb
hemoglobin
Hb-CO
carbon mono-oxide hemoglobin
HbO2
oxyhemoglobin
HR
heart rate
I:E
inspiratory-expiratory ratio
IBP
invasive brood pressure
ICG
impedance cardiography
ICP
intracranial pressure
ICT/B
intracranial catheter tip pressure transducer
ICU
intensive care unit
ID
identification
IEC
International Electrotechnical Commission
IEEE
Institute of Electrical and Electronic Engineers
Ins
inspired minimum
IP
internet protocol
Iso
isoflurane
IT
injectate temperature
ITBI
Intrathoracic Blood Volume Index
ITBV
Intrathoracic Blood Volume
LA
left arm
LAP
left atrial pressure
Lat
lateral
LCD
liquid crystal display
LCW
left cardiac work
LCWI
left cardiac work index
LED
light emitting diode
LL
left leg
LVD
low voltage directive
LVDS
low voltage differential signal
LVET
left ventricular ejection time
LVSW
left ventricular stroke work
LVSWI
left ventricular stroke work index
MAC
minimum alveolar concentration
Art mean
mean arterial pressure
MDD
Medical Device Directive
MetHb
methemoglobin
MRI
magnetic resonance imaging
E-4
MVe
expiratory minute volume
MVi
inspiratory minute volume
N/A
not applied
N2
nitrogen
N2O
nitrous oxide
Neo
neonate
NIBP
noninvasive blood pressure
O2
oxygen
O2CI
oxygen consumption index
O2R
oxygen extraction ratio
OR
operating room
oxyCRG
oxygen cardio-respirogram
PA
pulmonary artery
pArt-D
diastolic artery pressure
pArt-M
mean artery pressure
pArt-S
systolic artery pressure
Paw
airway pressure
PAWP
pulmonary artery wedge pressure
PD
photodetector
Ped
pediatric
PEEP
positive end expiratory pressure
PEF
peak expiratory flow
PEP
pre-ejection period
PIF
peak inspiratory flow
PIP
peak inspiratory pressure
Pleth
plethysmogram
Pmean
mean pressure
Pplat
plateau pressure
PPV
Pulse Pressure Variation
PR
pulse rate
PVC
premature ventricular contraction
PVR
pulmonary vascular resistance
PVRI
pulmonary vascular resistance index
PVPI
pulmonary vascular permeability index
PPV
pulse pressure variation
pArt
artery pressure
pCVP
central venous pressure
R
right
RA
right arm
RAM
random access memory
RAP
right atrial pressure
Rec
record, recording
Resp
respiration
RHb
reduced hemoglobin
RL
right leg
RM
respiratory mechanics
E-5
RR
respiration rate
RSBI
rapid shallow breathing index
SaO2
arterial oxygen saturation
SEF
spectral edge frequency
Sev
sevoflurane
SFM
self-maintenance
SI
stroke index
SMR
satellite module rack
SpO2
arterial oxygen saturation from pulse oximetry
SQI
signal quality index
SR
suppression ratio
STR
systolic time ratio
SV
stroke volume
SVI
Stroke Volume Index
SVR
systemic vascular resistance
SVRI
systemic vascular resistance index
SVV
stroke volume variation
SvO2
mixed venous oxygen saturation
ScvO2
central venous oxygen saturation
Sync
synchronization
Sys
systolic pressure
Taxil
axillary temperature
TB
Blood Temperature
TD
temperature difference
Temp
temperature
TFC
thoracic fluid content
TFI
thoracic fluid index
TFT
thin-film technology
Toral
oral temperature
TP
total power
Trect
rectal temperature
TVe
expiratory tidal volume
TVi
inspiratory tidal volume
UAP
umbilical arterial pressure
UPS
uninterruptible power supply
USB
universal serial bus
UVP
umbilical venous pressure
VAC
volts alternating current
VEPT
volume of electrically participating tissue
VI
velocity index
VO2
oxygen consumption
VO2I
oxygen consumption index
WLAN
wireless local area network
E-6
P/N: -002382-00 (2.0)
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