GE Medical Systems MAC 500 electrocardiograph Operator's Manual

MAC  500
Version 2.2
Operator's Manual
2003361-004 USA
Revision B
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it is using the names only for editorial purposes and to the benefit of the trademark owner with no intention of
improperly using the trademark.
900 SC, ACCUSKETCH, AccuVision, APEX , AQUA-KNOT, ARCHIVIST, Autoseq, BABY MAC, C Qwik Connect, CardioServ,
CardioSmart, CardioSys, CardioWindow, CASE, CD TELEMETRY, CENTRA, CHART GUARD, CINE 35, COROLAN, CORO,
COROMETRICS, Corometrics Sensor Tip, CRG PLUS, DASH, Digistore, Digital DATAQ, E for M, EAGLE, Event-Link, FMS
101B, FMS 111, HELLIGE, IMAGE STORE, INTELLIMOTION, IQA, LASER SXP, MAC, MAC-LAB, MACTRODE, MARQUETTE, MARQUETTE MAC, MARQUETTE MEDICAL SYSTEMS, MARQUETTE UNITY NETWORK, MARS, MAX,
MEDITEL, MEI, MEI in the circle logo, MEMOPORT, MEMOPORT C, MINISTORE, MINNOWS, Monarch 8000, MULTI-LINK,
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KNOB, Trimline, UNION, STATION, UNITY logo, UNITY NETWORK, Vari-X, Vari-X Cardiomatic, VariCath, VARIDEX, VAS,
and Vision Care Filter are trademarks of GE Medical Systems Information Technologies, Inc., registered in the United States Patent
and Trademark Office.
12SL, 15SL, Access, AccuSpeak, ADVANTAGE, BAM, BODYTRODE, Cardiomatic, CardioSpeak, CD TELEMETRY®-LAN,
CENTRALSCOPE, Corolation, Dash Port Docking Station, Dash Responder, EK-Pro, EDIC, Event-Link Cumulus, Event-Link Cirrus,
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Information Technologies, Inc.
GE Medical Systems
Information Technologies, Inc.
8200 West Tower Avenue
Milwaukee, WI 53223 USA
Tel:
+1.414.355.5000
800.558.5120 (US only)
Fax: +1.414.355.3790
GE Medical Systems Information
Technologies GmbH
Postfach 60 02 65
D-79032 Freiburg, Germany
Tel:
+49.761.45.43.0
Fax: +49.761.45.43.233
© GE Medical Systems Information Technologies, Inc., 2001, All rights reserved.
Revision History
This manual is subject to the GE Medical Systems Information Technologies (GEMS IT) change order service. The
revision code, a letter that follows the document part number, changes with every update of the manual.
Part No./ Revision
Date
Comment
2003361-004-A
2000-04
Initial Release / ECO 064 204
2003361-004-B
2001-06
ECO 067 433
2
MAC® 500
2003361-004-B
How To Reach Us
How To Reach Us
Service Calls and Product Support
To open a service call or obtain product support call
the numbers below:
800.558.7044
561.575.5000
Have the following information available before
calling:
(US & Canada)
(outside US)
–
part number of the defective part, or
–
model and serial number of the equipment,
–
or contact your representative or distributor.
For other product information please contact one of
the offices listed on the next page.
–
–
Ordering Supplies & Service Parts
Order supplies (leadwires, electrode paste, thermal
paper, etc.) or service parts (manuals, circuit boards,
cables, software, etc.) from:
Accessories
part number/name of the assembly where the
item is used,
item name, and
where applicable, reference designation (e.g.,
R13, S12, U32).
Ordering Manuals
When ordering additional operator manuals, be sure
to include the software version of the product.
GE Medical Systems Accessories
and Supplies
2607 North Grandview Blvd.
Mail Code: SN-471
Waukesha, WI 53188
Telephone: 800.558.5102 (US only)
262.521.6856 (outside US)
Fax: 800.232.2599 (US only)
262.521.6855 (outside US)
Service parts
GE Clinical Services
P.O. Box 9100, 100 Marquette Drive
Jupiter, FL 33468-9100
Telephone:
800.558.7044 (US only)
561.575.5000 (outside US)
Fax:
800.421.6841 (US only)
561.575.5050 (outside US)
2003361-004-B
MAC® 500
3
How To Reach Us
Other Questions or Problems
For additional information contact one of the offices
listed below or see our website at
www.gemedicalsystems.com.
Japan
GE Medical Systems, Japan
67-4 Takakura-cho
Headquarters
Hachiojii-shi, Tokyo 192-003, Japan
GE Medical Systems Information Technologies
8200 West Tower Avenue
Telephone:
+81.42.648.2944
+0120-055-919 (toll free inside Japan only)
Milwaukee, WI 53223 USA
Fax:
Telephone:
414.355.5000 or
800.558.5120 (US only)
Hong Kong
Fax:
414.355.3790
GE Medical Systems Hong Kong Limited
+81.42.648.2902
11th Floor, The Lee Gardens
Europe
33 Hysan Avenue
GE Medical Systems Information Technologies
Causeway Bay, Hong Kong
Postfach 60 02 65
Telephone:
+852.2100.6300
D-79032 Freiburg Germany
Fax:
+852.2100.6292
Telephone:
+49.761.4543.0
Fax:
+49.761.4543.233
Southeast Asia
GE Pacific
Australia
298 Tion Bahru Road #15-01/06
GE Medical Systems (Australia) Pty Ltd.
Central Plaza, Singapore 168730
13 South Street
Telephone:
+65.277.7620
Rydalmere NSW 2116
Fax:
+65.277.7600
Australia
Telephone:
+61.2.9975.5501
Fax:
+61.2.9975.5503
4
MAC® 500
2003361-004-B
General Information
General Information
• Standards compliance:
European Council Directive 93/42/EEC
IEC60601-1-2/EN 60601-1-2 "Electromagnetic Compatibility - Medical Electrical Equipment"
CISPR11 / EN 55011 "Radio interference emission"
IEC 60601, protection class I
MDD class IIb
• The symbol
means: Consult accompanying
documents. It indicates points which are of particular
importance in the operation of the device.
• The warranty does not cover damage resulting from the
use of unsuitable accessories and consumables from
other manufacturers.
• On request GEMS IT will provide a service manual.
• The GEMS IT quality management system complies with
the standards EN ISO 9001 and EN 46001.
2003361-004-B
MAC® 500
5
For your notes
For your notes
6
MAC® 500
2003361-004-B
Contents
1 INTRODUCTION TO THE MAC® 500 SYSTEM
9
2 CONTROLS AND INDICATORS
10
3 SAFETY INFORMATION, STARTUP AND PERFORMANCE TEST
12
4 PREPARATIONS FOR ECG RECORDING
20
5 12 LEAD MODE
23
6 3 LEAD MODE
32
7 AUTO RHYTHM MODE
35
8 HEART-RATE CONTROL
39
9 ECG RECORDING DURING DEFIBRILLATION / ECGS OF PACEMAKER PATIENTS
40
10 LOADING WRITER PAPER
41
11 THE SETUP MENU
43
12 CLEANING, DISINFECTION AND MAINTENANCE
46
13 TROUBLESHOOTING
47
14 TECHNICAL SPECIFICATIONS
48
INDEX
52
2003361-004-B
MAC® 500
7
For your notes
For your notes
8
MAC® 500
2003361-004-B
®
Introduction to the MAC 500 System
1 Introduction to the MAC® 500 System
The MAC® 500 is a compact 3-channel electrocardiograph for battery and line-power operation.
The MAC® 500 has three operating modes: 12 Lead,
3 Lead and Auto Rhythm, and meets all demands on
modern electrocardiographs.
In the 12 Lead Mode the MAC® 500 simultaneously
acquires 12 leads of ECG for a period of 10 seconds
and then prints them out. You can choose between
simultaneous and sequential recordings.
In simultaneous recordings all leads represent the
same period of time (either 10 seconds = long
format, or 3 seconds = short format).
1.5 times the RR interval averaged over the 4
preceding QRS complexes.
The MAC® 500 continues recording until the
triggering event ceases. The first 30 seconds are
recorded at the selected speed, then the recorder
switches to a paper speed of 5 mm/s.
Numerous device settings can be customized to meet
each user's special requirements.
The device is not intended for intracardial use.
The device is not intended for use as a vital-signs
physiological monitor.
For sequential recordings the 10-second signal
acquisition period is divided into 4 segments of 2.5
seconds each. The first 3 recorded leads represent
the first segment (0-2.5 seconds), the second group
of 3 leads represents the second segment (2.5 to 5
seconds), etc.
Caution
Patient Hazard  Medical technical equipment
such as the MAC® 500 must only be used by qualified and trained personnel.
You can choose between the standard lead sequence
and the CABRERA sequence for the recording.
One version of the MAC® 500 comes with an ECG
measurement program which, in the 12 Lead Mode,
provides a patient data sheet with ECG measurement
results (Figure 5-3).
powe
on/of
r
f
sta
sto
stan
db
y
bat
te
lowry
rt
copy
p
setu
In the 3 Lead Mode the MAC® 500 records 3 leads
of continuous ECG data (or 1 lead, if the default
setting is changed in the setup menu).
pro
g
mm
12
p
50
3
Hz
/s
mm
With the Interpretation option activated, this version
of the MAC® 500 will also print the interpretative
statements after the measurement results (Figure 58).
/m
V
Hz
20
25
HR ∆
10
5
20/35
filter
5
Figure 1-1. The MAC® 500 system
In the Auto Rhythm Mode the MAC® 500 will
analyze the ECG and automatically starts recording
− when the heart rate exceeds the set upper or
lower limit
− when QRS complexes are detected whose RR
interval is shorter than 0.8 times or greater than
2003361-004-B
MAC® 500
9
Controls and Indicators
2 Controls and Indicators
1
2
3
pow
on/o
er
ff
star
t
stop
copy
pro
setu
p
g
mm
/s
12
mm
/m
50
3
Hz
V
Hz
20
25
HR ∆
20
filte/35
r
10
5
4
5
5
6
7
Hz
standby
battery
low
prog
power
on/off
12
copy
3
setup
mm/s
mm/mV
50
20
25
10
5
5
10
9
Hz
20/35
filter
8
start
HR∆
stop
19 18
17 16 15
14
13 12 11
Figure 2-1. Controls and Indicators
10
MAC® 500
2003361-004-B
Controls and Indicators
Explanation of the signs and symbols used on the
device
1
Cover of paper compartment
2
Spring lock to open the paper compartment
3
Power connector
Observe the operator's manual
4
Patient cable connector (type CF, highly
insulated, defibrillation-proof)
Type CF signal input, highly insulated,
5
"battery low" indicator (yellow): when it
lights up, the battery needs to be charged
6
defibrillation-proof
Start
"standby" indicator (green): when it lights up,
the MAC® 500 is connected to the mains and
operates on line power
ECG lead
7
2-line character display
Lead-fail indicator
8
Enables/disables muscle filter (20/35 Hz)
9
Gain selection keys - 5, 10, 20 mm/mV
10
Paper speed selection keys - 5, 25, 50 mm/s
(5 mm/s only in 3 Lead and Auto Rhythm
Modes)
Stop
heart rate (BPM)
11
Mode selection keys
12
Prints additional report copies (e.g. after
change of lead sequence) and the 10-second
ECG in Auto Rhythm Mode
13
Displays the setup menu
14
ECG lead selection in 3 Lead and Auto
Rhythm Modes, cursor control keys for navigating in the setup menu
15
Enables/disables QRS beep, silences audio
signals
16
Power switch (ON/OFF)
17
Starts and stops the recorder in the selected
mode
18
Yellow indicator is lit when selected mode is
disabled
19
Green indicator is lit when selected mode is
enabled
2003361-004-B
QRS beep/audio signals
Cursor control, lead selection
12
12 Lead Mode
3
3 Lead Mode
HR∆
Auto Rhythm Mode
MAC® 500
11
Safety Information, Startup and Performance Test
3 Safety Information, Startup and Performance Test
3.1 Safety Information
• This manual is an integral part of the device. It
should always be kept near the device. Close
observance of the information given in the manual is a prerequisite for proper device performance and correct operation and ensures patient
and operator safety. Please note that information pertinent to several chapters is given only
once. Therefore, carefully read the manual
once in its entirety.
Caution
indicates a potentially hazardous situation which, if
not avoided, may result in minor or moderate injury
or product/property damage.
• GEMS IT is responsible for the effects on safety,
reliability, and performance of the device, only if
− assembly operations, extensions, readjustments, modifications, or repairs are carried
out by persons authorized by GEMS IT,
• To ensure patient safety, the specified measuring
accuracy, and interference-free operation, we
recommend to use only original GEMS IT components. The user is responsible for application
of unsuitable accessories from other manufacturers.
• This manual is in conformity with the device
specifications and standards on safety of electromedical equipment valid at the time of printing.
All rights are reserved for devices, circuits, techniques, software programs, and names appearing in
this manual.
• The terms danger, warning, and caution are used
throughout this manual to point out hazards and
to designate a degree or level of seriousness.
Hazard is defined as a source of potential injury
to a person.
− the electrical installation of the relevant room
complies with the requirements of the appropriate regulations, and
− the device is used in accordance with the
instructions for use.
The safety statements presented in this chapter refer
to the equipment in general and, in most cases, apply
to all aspects of the device. There are additional
safety statements in the other chapters which are
specific to the topic described. The order in which
safety statements are presented in no way implies
order of importance.
DANGERS
EXPLOSION HAZARD — Do not use this
equipment in the presence of flammable anesthetics,
vapors or liquids.
Danger
indicates an imminently hazardous situation which,
if not avoided WILL result in death or serious
injury.
Warning
indicates a potentially hazardous situation which, if
not avoided, COULD result in death or serious
injury.
12
MAC® 500
2003361-004-B
Safety Information, Startup and Performance Test
WARNINGS
ACCESSORIES (SUPPLIES) — Use only the
original GEMS IT cables. Do not connect other
signal sources to the cables. The user is responsible
for the use of accessories from other manufacturers.
ACCIDENTAL SPILLS — To avoid electric shock
or device malfunction liquids must not be allowed to
enter the device. If liquids have entered a device,
take it out of service and have it checked by a
service technician before it is used again.
BEFORE USE — Before putting the system into
operation visually inspect all connecting cables for
signs of damage. Damaged cables and connectors
must be replaced immediately.
BEFORE USE — Before using the device, the
operator must verify that it is in correct working
order and operating condition. For instructions, refer
to section 3.3 “Testing the Performance” in this
chapter.
CONDUCTIVE CONNECTIONS — Do not allow
electrodes to come into contact with conductive
parts. The neutral electrode, in particular, must not
be connected to earth.
MPSO—The use of a multiple portable socket outlet
(MPSO) for a system will result in an enclosure
leakage current equal to the sum of all individual
earth leakage currents of the system if there is an
interruption of the MPSO protective earth conductor. Do not use an additional extension cable with
the MPSO as it will increase the chance of the single
protective earth conductor interruption.
OPERATOR — The user must have received
adequate training in the use of the MAC® 500 and
must be capable of applying it properly.
POWER SUPPLY — The device 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
the monitor from the power line and operate it on
battery power, if possible.
If the installation of this equipment in the USA will
use 240V rather than 120V, the source must be a
center-tapped, 240V, single phase circuit.
DISCONNECTION FROM MAINS — When
disconnecting the system from the power line,
remove the plug from the wall outlet first. Then you
may disconnect the power cord from the device.
MOISTURE CONDENSATION — Devices
intended for emergency application must not be
stored or transported at temperatures which cause
moisture condensation at the application site. Wait
until all moisture condensation has evaporated
before using the device.
2003361-004-B
MAC® 500
13
Safety Information, Startup and Performance Test
CAUTIONS
MAINTENANCE — Regular preventive maintenance should be carried out annually, inspections of
equipment with measuring functions should be done
every two years (refer to chapter 12 “Cleaning,
Disinfection and Maintenance”).
PERFORMANCE CHECKS — Check the device
performance once a month, strictly following the
instructions outlined in section 3.3 “Testing the
Performance”.
POWER REQUIREMENTS — Before connecting
the device to the power line, check that the voltage
and frequency ratings of the power line are the same
as those indicated on the unit’s label. If this is not
the case, do not connect the system to the power line
until you adjust the unit to match the power source.
VENTILATION REQUIREMENTS — Set up the
device in a location which affords sufficient
ventilation. The ventilation openings of the device
must not be obstructed. The ambient conditions
specified in the technical specifications must be
ensured at all times.
EMC — Magnetic and electrical fields are capable
of interfering with the proper performance of the
device. For this reason make sure that all external
devices operated in the vicinity of the monitor
comply with the relevant EMC requirements. X-ray
equipment or MRI devices are a possible source of
interference as they may emit higher levels of
electromagnetic radiation.
INTERFACING OTHER EQUIPMENT — Devices
may only be interconnected with each other or to
parts of the system when it has been determined by
qualified biomedical engineering personnel that
there is no danger to the patient, the operator, or the
environment as a result. In those instances where
there is any element of doubt concerning the safety
of connected devices, the user must contact the
manufacturers concerned (or other informed experts)
for proper use. In all cases, safe and proper operation
should be verified with the applicable manufacturer’s instructions for use, and system standards
IEC 60601-1-1/EN 60601-1-1 must be complied
with.
DEFIBRILLATOR PRECAUTIONS — Patient
signal inputs labeled with the CF and BF symbols
with paddles are protected against damage resulting
from defibrillation voltages To ensure proper
defibrillator protection, use only the recommended
cables and leadwires. Proper placement of defibrillator paddles in relation to the electrodes is required to
ensure successful defibrillation.
DISPOSAL — Dispose of the packaging material,
observing the applicable waste control regulations
and keeping it out of children’s reach.
ELECTROCAUTERY PRECAUTIONS — To
prevent unwanted skin burns, apply electrocautery
electrodes as far as possible from all other electrodes, a distance of at least 15 cm/ 6 in. is recommended.
14
MAC® 500
2003361-004-B
Safety Information, Startup and Performance Test
NOTES
Literature
®
- The MAC 500 is designed to comply with IEC
60601/ EN 60601 requirements. It is Class I
equipment/equipment with a built-in rechargeable
electrical power source. The device is not suitable for intracardiac use. The device is suitable
for continuous operation.
- Choose a location which affords an unobstructed
view of the monitor’s screen and easy access to
the operating controls.
- The MAC® 500 has no additional protection
against ingress of water.
- Medical technical equipment such as the MAC®
500 must only be used by persons who have
received adequate training in the use of such
equipment and who are capable of applying it
properly.
Medical Device Directive 93/42/EEC
EN 60601-1/1990 + A1: 1993 + A2: 1995: Medical
electrical equipment. General requirements for
safety
EN 60601-1-1/9.1994 + A1 12.95: General
requirements for safety. Requirements for the safety
of medical electrical systems. Requirements for the
safety of medical electrical systems.
EN 60601-2-25/1993: Medical electrical equipment.
Part 2: Special requirements for the safety of
electrocardiographs.
IEC Publication 513/1994: Fundamental aspects of
safety standards for medical equipment.
- At the end of its service life; the MAC® 500 and
its accessories must be disposed of in compliance
with the special waste control regulations for
electronic parts. If you have any questions in this
matter, please contact GEMS IT Medical Systems.
2003361-004-B
MAC® 500
15
Safety Information, Startup and Performance Test
®
3.2 Starting Up the MAC 500
5
6
Power Supply
Hz
standby
battery
low
prog
copy
setup
12
3
HR∆
mm/s
mm/mV
50
20
25
10
5
5
Hz
20/35
filter
− The MAC® 500 operates on line power or on
power from the rechargeable battery.
− The battery is automatically charged when the
device is connected to the power line (indicator 6
(Figure 3-1) is lit when the battery is charging). It
is not necessary to turn the device on for charging. In order to have the battery fully charged at
all times, leave the MAC® 500 connected to the
power line. A depleted battery needs 6 hours to
recharge.
− Indicator (5) lights up when the battery needs
charging.
− A new, fully charged battery provides power to
record at least 50 12 Lead ECGs. Have the battery replaced by a service technician when the
capacity drops to about 25 recordings.
Figure 3-1. Indicators
Starting Up and Connecting the MAC® 500
− The MAC® 500 must not be used or stored in
moist and/or dusty rooms. Further, it must not be
exposed to direct sunlight or other sources of
heat.
− Figure 3-2 shows a practical arrangement
between patient and recorder. For interferencefree operation, it is important that the patient
cable and the power cord do not run parallel.
Figure 3-2. Arranging the MAC® 500 and examination couch
•
Use the power cord to connect the recorder to the
power line (Figure 3-3). Use only the original
power cord or an equivalent cable.
The MAC® 500 is shipped with a fully charged
battery. Please note that the battery needs to be
charged when the battery indicator (5) lights up.
•
Insert writer paper as described in chapter 10.
MAC® 500
2003361-004-B
Figure 3-3. Power input
16
Safety Information, Startup and Performance Test
3.3 Testing the Performance
•
standby
18 16
On power up the device runs an automatic self-test.
It defaults to the 12 Lead Mode (Figure 3-5), unless
a malfunction is identified. If a malfunction is
detected, the system will display an error message.
Contact GEMS IT Service for further information.
battery
low
power
on/off
Using the power switch (16), turn on the MAC®
500. The yellow indicator (18) lights up.
copy
setup
When a patient cable is not connected, two ^^
symbols appear on the display in place of the leadfail indicator. Also, the MAC® 500 will emit an
audio signal to inform you that the cable is missing.
start
stop
The ^^ symbols on the display disappear as soon as
you connect the cable. At the same time the lead-fail
Figure 3-4. Operating controls and indicators
detection function is enabled. The MAC® 500 will
again emit an audio signal and alert you to one of the
missing electrodes, until a patient is connected. The
audio signal can be silenced with
Hz
.
After application of all required electrodes, the
MAC® 500 automatically enables the HR indication
function (chapter 8 "Heart-Rate Control").
prog
mm/s
mm/mV
Hz
Figure 3-5. Display after successful MAC® 500 selftest
2003361-004-B
MAC® 500
17
Safety Information, Startup and Performance Test
3.4 Selecting the Language,
Customizing the Recorder
Selecting the Language
For the displayed texts and reports you can choose
among various languages.
standby
•
battery
low
12
copy
setup
to display the language selection menu:
Figure 3-7 will appear.
prog
power
on/off
Press
•
Use the cursor keys
to select the
language and confirm your selection with
.
3
setup
start
•
Exit the menu with
setup
.
HR∆
stop
Figure 3-6. Controls required for language
selection
Hz
prog
mm/s
mm/mV
Hz
Figure 3-7. Selected language
18
MAC® 500
2003361-004-B
Safety Information, Startup and Performance Test
Customizing the Device Settings
Parameter
Default
Options
Language
[English]
further languages
Notation
[AAMI]
IEC
Leads
[Standard]
Cabrera
Report format
[Sequential]
Simultaneous
- when choosing
"sequential"
Rhythm lead
- when choosing
"simultaneous"
[Yes]
No
[Short]
Long
Override Mode
[On]
Off
Patient Data sheet*
[No]
Yes
Leads
[3]
1
Speed
[25]
50
Sensitivity
[10]
5, 20
AC Filter
[60]
50, off
Muscle Filter
[On]
Off
Muscle Filter
[35]
20
The MAC® 500 allows you to customize numerous
settings to suit your personal needs and preferences.
The MAC® 500 will save these settings as the user
defaults and will activate them each time it is turned
on. Figure 3-8 lists all settings that can be customized, the middle column shows the factory defaults.
Please refer to chapter 11 "The Setup Menu" for a
detailed explanation of how to customize the device
settings.
ADS (cubic spline)
[On]
Off
HR Control
[On]
Off
HR-Control
[45], [130]
30 to 120, 80 to 240
Cut-off Frequency
[0.08]
0.04; 0.16
Contrast
QRS Beep
< reduce,
> increase
[2] (medium)
0 (off), 1 (low), 3
(loud)
Date
Time
Option no.**
for "Interpretation" option
Factory Defaults
[No]
Yes
Print
[No]
Yes (printout of all
settings)
Figure 3-8. The MAC® 500 setup menu (on the
display the active selections are shown
in angular brackets [ ])
*
not part of MAC® 500 with measurement program
**
only for MAC® 500 with measurement program
2003361-004-B
MAC® 500
19
Preparations for ECG Recording
4 Preparations for ECG Recording
4.1 Connecting the Patient Cable
The 10-lead cable is used for acquisition of the
standard ECG leads (Standard, Augmented, Chest).
•
Warning
Shock Hazard  For reasons of safety, use only the
original GEMS IT patient cables. Do not connect other
signal sources to the cable.
Connect the patient cable to the ECG signal input
(4, Figure 4-1).
When a patient cable is not connected, two ^^
symbols appear on the display in place of the leadfail indicator. Also, the MAC® 500 will emit an
audio signal to inform you of the missing cable.
The ^^ symbols disappear as soon as you connect
Note
The signal input is highly insulated and defibrilla-
the cable. At the same time the lead-fail detection
tion-proof (only if the original GEMS IT patient
function is enabled. The MAC® 500 will again emit
cables are used). These patient cables ensure patient
an audio signal and alert you to one of the missing
safety and protect the device during defibrillation
electrode, until a patient is connected. The audio
and electrosurgery.
signal can be silenced with
. After application of
all required electrodes, the MAC® 500 automatically
enables the HR indication function (chapter 8
"Heart-Rate Control").
4
Figure 4-1. ECG signal input (type CF, highly
insulated, defibrillation proof)
20
MAC® 500
2003361-004-B
Preparations for ECG Recording
4.2 Applying the Electrodes
Note
Applying Electrodes (Limb Leads)
Use silver-silver chloride electrodes when recording
lated. (Refer to chapter 9 "ECG Recording During
Careful application of the electrodes is the key to an
interference-free ECG.
Defibrillation" for details.)
Refer to the illustration shown in Figure 4-2.
the ECG of a patient who may have to be defibril-
RA (white)
LA (black)
LL (red)
RL (green)
V
RA
Applying Suction Electrodes (Thorax)
LA
•
RL
LL
V2
V3
V5
V4
Shave and clean application points, if necessary.
Application Points for Standard Leads
(I, II, III, aVR, aVL, aVF, V1 to V6)
Figure 4-2. Applying limb-lead electrodes
V1
electrode on right arm
electrode on left arm
electrode on left leg
electrode on right leg
Four limb and six chest electrodes must be applied
for the acquisition of the standard leads. Attach the
limb electrodes above the wrists and ankles. Figure
4-3 shows the chest lead application points.
V1 in the 4th intercostal space at the right sternal
edge
V6
V2 in the 4th intercostal space at the left sternal
edge
V6
V1 V2 V3 V4
V3 on the level of the 5th rib midway between
between V2 and V4
V5
Figure 4-3. Chest electrode application points
RL green
RA white
V4 in the 5th intercostal space on the left midclavicular line
V5 on the left anterior axillary line between V4 and
V6
right leg
right arm
V1 brown
V1
V2 brown
V3 brown
V2
V3
V5
V6 on the mid-axillary line at the level of V4
V6
V4
Connect the 10-wire patient cable as shown in
Figure 4-4.
V4 brown
V5 brown
V6 brown
LA black
left arm
LL red
V6
left leg
V1 V2 V3 V4
Shock Hazard  Avoid contact between electrodes
and conductive parts The neutral electrode, in
V5
Figure 4-4. Connecting the patient cable (10-lead
cable, standard leads)
2003361-004-B
Warning
MAC® 500
particular, must not come into contact with ground.
21
Preparations for ECG Recording
Artifact Due to Poor Electrode Application
This device is equipped with state-of-the-art
electronic utilities to insure artifact-free recording.
Among these are the automatic baseline adjustment and the anti-drift system (ADS). At the
beginning of the recording the automatic baseline
adjustment verifies the incoming signal and adjusts
the baseline position accordingly. During recording
the anti-drift system continuously checks the
baseline position and returns the baseline to its
normal level if it wanders (Figure 4-5).
When electrodes are not properly applied, these
measures may not fully compensate for artifact.
High polarization voltages induced by electrodes
applied without conductive gel may cause the
amplifier to overrange, so that a straight line will be
recorded instead of the ECG (see Figure 4-5). ADS
will return this line to its normal position, and a
baseline ensues for approx. 1 second. Blocking can
be initiated manually by disconnecting the RA
electrode.
Remedy
•
•
•
•
•
Apply the electrodes according to instructions.
Do not apply the electrodes on top of clothing.
Use a contact agent (moist electrode paper,
electrode cream, spray, etc.).
Wait approx. 10 seconds before initiating a
recording. After the 10-second period the polarization voltages have stabilized, provided the
electrodes are properly applied. If this is not the
case, the electrode concerned is indicated on the
display (RL, RA, LA, LL, V1 to V6).
If it becomes necessary to verify the raw ECG
signal, switch off the ADS function and all filters
(35 Hz/20 Hz muscle filter, AC filter).
approx.1 s
Figure 4-5. Sample recording
22
MAC® 500
2003361-004-B
12 Lead Mode
5 12 Lead Mode
5.1 The Basics
Note
− With the factory defaults unchanged, the HR
indication function is active in all operating
modes. The HR limit values are 45 BPM and
130 BPM. These limits can be changed from
the setup menu. Further details on this subject can be found in chapter 8 "Heart-Rate
Control" and chapter 11 "The Setup Menu".
− At least 4 QRS complexes are required for
correct determination of the heart rate.
− In the presence of lead failure the MAC 500
will operate in the 12 Lead Mode only if
"Override" is enabled in the setup menu
(chapter 11 "The Setup Menu").
®
Warning
Patient Hazard  The MAC 500 is not
intended for use as a vital signs physiological
®
monitor.
2003361-004-B
In the 12 Lead Mode the MAC® 500 simultaneously acquires 12 leads of ECG for a period of
10 seconds. When initiated with the
key,
the recording proceeds automatically. Furthermore it measures the ECG and documents the
results on the ECG report.
You can choose between sequential and
simultaneous recordings.
For sequential recordings the 10-second signal
acquisition period is divided into 4 segments of
2.5 seconds each. The first 3 recorded leads
represent the first segment (0-2.5 seconds), the
second group of 3 leads represents the second
segment (2.5 to 5 seconds), etc.
In simultaneous recordings all leads represent the
same period of time (either 10 seconds = long
format, or 3 seconds = short format).
You can choose between the standard and the
CABRERA lead sequences for recording (chapter
11 "The Setup Menu").
With the factory defaults unchanged, the MAC®
500 will write a sequential 12 lead ECG
followed by a rhythm strip (leads II, aVF, V5).
The MAC® 500 with the optional measurement
program will also print a patient data sheet
including measurement results.
MAC® 500
23
12 Lead Mode
5.2 Recording
a
b
c
d
e
Hz
prog
mm/s
j
i
mm/mV
Hz
g
f
h
Figure 5-1. 12 Lead mode display
a Lead sequence (Stnd = standard, Cab1 = CABRERA)
b Lead-fail indication
c QRS indicator
d Heart rate
e AC line filter (60 Hz) enabled
f Muscle filter (35 Hz) enabled
g Gain
h "Collecting Data" indicator
i Paper speed
j Operating mode
Upon power up, the MAC® 500 defaults to the
12 Lead Mode.
− Having first applied the electrodes, please
wait about 10 seconds for the signal to stabilize (see "Artifact Due to Poor Electrode
Application" in section 4.2).
With the factory defaults unchanged, the MAC®
500 selects the following functions and settings
after power up (the most important settings are
indicated on the display, Figure 5-1):
− the "Standard" lead sequence (I, II, III, aVR,
aVL, aVF, V1 to V6; Stnd = Standard, Cab1
= CABRERA) - a
− a gain of 10 mm/mV - g
− a paper speed of 25 mm/s - i
− the AC line filter (60 Hz) is active - e
− the muscle filter (35 Hz) is active - f
− the anti-drift system (cubic spline) is enabled
− the report format is sequential and includes
the rhythm leads (and patient data sheet –
MAC® 500 with optional measurement program)
− pressing
copy
initiates repeated printouts of the
ECG
*RA* right arm electrode disconnected
*V2* chest electrode V2 disconnected
− Before starting the recording with
,
check that there is no lead-fail indication on
the display - b, Figure 5-1. If the lead-fail
message persists after you have checked the
electrode connections, there could be a break
in the patient cable and the cable should be
replaced. Also check the paper supply.
*V3* chest electrode V3 disconnected
− Press
*LA* left arm electrode disconnected
*LL* left leg electrode disconnected
*RL* right leg electrode disconnected
*V1* chest electrode V1 disconnected
to initiate the recording.
*V4* chest electrode V4 disconnected
*V5* chest electrode V5 disconnected
*V6* chest electrode V6 disconnected
Messages indicating disconnected electrodes
24
MAC® 500
2003361-004-B
12 Lead Mode
1
MAC 500
V2.2
GEMS IT
I
aVR
II
aVL
III
aVF
2
Jan.14 2000 01:55pm
12Ld
25mm/s
10mm/mV
ADS
60Hz
0.08-35Hz
60BPM
3
4
5
6
7
8
9
Figure 5-2. ECG recording (12 Lead Mode, factory defaults)
1 Date/time
2 Calibration pulse
3 Operating mode
4 Paper speed
5 Gain
6 ADS enabled
7 AC filter enabled (60 Hz)
8 Signal transmission range (low cut-off frequency at 0.08 Hz - adjustable, high cut-off
frequency at 35 Hz - muscle filter enabled)
9 Heart rate
2003361-004-B
MAC® 500
25
12 Lead Mode
At the end of the data collection period, the MAC®
500 will record the ECG (Figure 5-2).
Note
The following parameters cannot be changed before
printing out additional report copies
− AC line filter
− muscle filter
− The ECG recording can be stopped at any time
.
with
− Copies of the same ECG can be printed out with
copy
− ADS.
. Before printing a copy you can
– change the gain with mm/mV,
– change the paper speed with mm/s,
– change the sequence of recorded leads (
). The display indicates the leads recorded
a
b
c
d
e
Hz
prog
mm/s
j
i
mm/mV
Hz
g
f
h
Figure 5-1. 12 Lead mode display (repeated)
a Lead sequence (Stnd = standard, Cab1 = CABRERA)
b Lead-fail indication
c QRS indicator
d Heart rate
e AC line filter (60 Hz) enabled
f Muscle filter (35 Hz) enabled
g Gain
h "Collecting Data" indicator
i Paper speed
j Operating mode
26
first - a, Figure 5-1.
The normal lead sequence is "Standard"
Stnd = standard
Aug = augmented
V1-V3 = V1, V2, V3
V4-V6 = V4, V5, V6
or CABRERA
Cab1 = aVL, I, -aVR
Cab2 = II, aVF, III
V1-V3 = V1, V2, V3
V4-V6 = V4, V5, V6
When starting with the augmented leads, the
recording sequence is
Aug
V1-V3
V4-V6
Stnd
MAC® 500
=
=
=
=
augmented
V1, V2, V3
V4, V5, V6
standard
2003361-004-B
12 Lead Mode
5.3 Report Documents
The length and scope of the reports depends on the
selected lead sequence and on the selected report
format (chapter 11 "The Setup Menu"). The
illustrations below show examples of the default
formats.
Sequential Recordings
In sequential recordings the standard leads are
followed by the rhythm leads and, if you are using
the MAC® 500 with the optional measurement
program, the patient data sheet which includes the
measurement results (Figure 5-3). Instead of the
standard leads, the CABRERA lead sequence can be
recorded (aVL, I, -aVR, II, aVF, III).
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
II
II
II
aVF
aVF
aVF
V5
V5
V5
GEMS IT
Serial No
:
Jan. 14 00 02:21pm
Last Name
First Name
Date of Birth
Sex
:
:
:
:
Measurement Results:
QRS
QT/QTC
PR
P
RR/PP
P/QRS/T
MAC 500
:
:
:
:
:
:
108ms
366 / 427ms
170ms
162ms
724 / 146ms
67/ 66/ 65Degrees
V2.2
12SL V 13
Figure 5-3. Lead sequence
standard
Report format
sequential
(rhythm leads default — can be disabled; measurement results only with the MAC® 500 with
optional measurement program)
2003361-004-B
MAC® 500
27
12 Lead Mode
Simultaneous Recordings
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Figure 5-4. Lead sequence standard
Report format simultaneous, short (3 seconds)
aVL
II
V1
V4
I
aVF
V2
V5
-aVR
III
V3
V6
Figure 5-5. Lead sequence CABRERA
Report format simultaneous, short (3 seconds)
28
MAC® 500
2003361-004-B
12 Lead Mode
I
I
I
II
II
II
III
III
III
aVR
aVR
aVR
aVL
aVL
aVL
aVF
aVF
aVF
V1
V1
V1
V2
V2
V2
V3
V3
V3
V4
V4
V4
V5
V5
V5
V6
V6
V6
Figure 5-6. Lead sequence standard
Report format simultaneous, long (10 seconds)
2003361-004-B
MAC® 500
29
12 Lead Mode
aVL
aVL
aVL
I
I
I
-aVR
-aVR
-aVR
II
II
II
aVF
aVF
aVF
III
III
III
V1
V1
V1
V2
V2
V2
V3
V3
V3
V4
V4
V4
V5
V5
V5
V6
V6
V6
Figure 5-7. Lead sequence CABRERA
Report format simultaneous, long (10 seconds)
30
MAC® 500
2003361-004-B
12 Lead Mode
Recording of the Interpretative Statements
(Option)
5.4 Brief Operating Instructions
(12 Lead Mode)
With the Interpretation option activated, the MAC®
500 will print the interpretative statements after the
measurement results. Since it is not possible to enter
the patient's age, the MAC® 500 always interprets
data as an adult ECG.
For a detailed description of the ECG measurement
and interpretation program, refer to our publication
GE Marquette 12SL Physician's Guide (part no.
000-90160-010). In chapter 11 "The Setup Menu"
you will find detailed information on activating the
interpretation option.
•
•
GEMS IT
Jan.11 00
02:21pm
Interpretation:
•
Switch on device and wait for self-test to end
Apply electrodes to the patient, connect patient
cable to device
Check device settings
− lead sequence
− report format
Modify device settings, if required, using the
appropriate function key or
setup
•
Wait for patient to lie motionless
•
Start signal acquisition and recording with
Unusual P axis, possible ectopic
atrial tachycardia
Left axis deviation
Left ventricular hypertrophy with
QRS widening and repolarization
abnormality
Inferior infarct, age undetermined
Abnormal ECG
MAC 500
V2.2
12SL V 13
Figure 5-8. Interpretation
2003361-004-B
MAC® 500
31
3 Lead Mode
6 3 Lead Mode
6.1 The Basics
In the 3 Lead Mode the MAC® 500 simultaneously
Note
records 3 leads of ECG in real-time (factory default,
With the factory defaults unchanged, the HR
the device can also be set up to record one ECG
indication function is active in all operating modes.
lead). The recording is started and stopped with the
The HR limit values are 45 BPM and 130 BPM.
key.
These limits can be changed from the setup menu.
Further details on this subject can be found in
chapter 8 "Heart-Rate Control" and chapter 11
"The Setup Menu".
Some of the device settings can be customized,
either directly with the appropriate key or from the
setup menu (chapter 11 "The Setup Menu").
6.2 Recording
Warning
Patient Hazard  The device is not intended for
use as a vital-signs physiological monitor.
a
b c d
e
Hz
Switch on the MAC® 500 and select the 3 Lead
Mode with
3
.
With the factory defaults unchanged, the MAC® 500
selects the following functions and settings (the most
important settings are indicated on the display,
Figure 6-1):
− the "Standard" lead sequence (I, II, III, aVR,
aVL, aVF, V1 to V6; Stnd = Standard, Cab1 =
CABRERA) - a
prog
mm/s
i
h
mm/mV
g
Hz
f
Figure 6-1. 3 Lead mode display
a Lead sequence
b Lead-fail indication
c QRS indicator
d Heart rate
e AC line filter (60 Hz) enabled
f Muscle filter (35 Hz) enabled
g Gain
h Paper speed
i Operating mode
32
− a gain of 10 mm/mV - g, the setting can be
changed any time with the gain keys - 9, Figure
6-2
− a paper speed of 25 mm/s - h, the paper speed can
be changed any time with the speed keys - 10,
Figure 6-2
− the AC line filter (60 Hz) is active - e
− the muscle filter (35 Hz) is active - f, it can be
disabled any time with the muscle filter key - 8,
Figure 6-2
− the anti-drift system (cubic spline) is enabled
MAC® 500
2003361-004-B
3 Lead Mode
Hz
− Before starting the recording with
, check
that there is no lead-fail indication on the display
standby
- b, Figure 6-1. If the lead-fail message persists
battery
low
prog
mm/s
mm/mV
after you have checked the electrode connections,
Hz
there could be a break in the patient cable and the
copy
12
50
20
25
10
20/35
filter
cable should be replaced. Also check the paper
supply.
setup
3
HR∆
5
•
Press
to initiate the recording. You can
stop the recording by pressing the same key
5
again.
10
9
Figure 6-2. Controls and indicators
*RA* right arm electrode disconnected
8
− If you change the paper speed, gain, the lead
group or the filter settings during a recording, the
MAC® 500 briefly interrupts the recording,
advances the paper and then resumes recording
with the new settings.
− The arrow keys
*RL* right leg electrode disconnected
*V1* chest electrode V1 disconnected
*V2* chest electrode V2 disconnected
can be used to
switch to the next 3 leads of the selected se-
*LA* left arm electrode disconnected
*LL* left leg electrode disconnected
and
quence.
− If the Anti-Drift System (ADS) is enabled, there
will be a short delay before recording starts. The
system needs this time to activate the ADS function.
*V3* chest electrode V3 disconnected
*V4* chest electrode V4 disconnected
*V5* chest electrode V5 disconnected
*V6* chest electrode V6 disconnected
Messages indicating disconnected electrodes
2003361-004-B
MAC® 500
33
3 Lead Mode
6.3 Brief Operating Instructions
(3 Lead Mode)
•
•
Switch on device and wait for self-test to end
Apply electrodes to the patient, connect patient
cable to device
•
Select 3 Lead Mode
•
Check device settings
3
− lead sequence ( setup )
− speed (50, 25, 5 mm/s)
− gain (20, 10, 5 mm/mV)
Modify device settings, if required, using the
appropriate function key or
34
setup
.
•
Start recording with
•
Select next lead group with
•
Enable/disable muscle filter with
MAC® 500
20/35
filter
2003361-004-B
Auto Rhythm Mode
7 Auto Rhythm Mode
7.1 The Basics
Warning
Patient Hazard  The MAC 500 is not intended for
®
use as a vital signs physiological monitor.
In the Auto Rhythm Mode the MAC® 500 continuously scans the ECG and initiates a recording, if it
detects specific conditions. The event that triggers
the recording is always documented with "context",
since the MAC® 500 also records the 5-second
segment preceding the event. The recording
continues as long as the condition exists. The first 30
seconds are recorded at the selected paper speed,
then the recorder selects a speed of 5mm/s.
Conditions that initiate a recording are
− a heart rate exceeding one of the set limit values
− QRS complexes with an RR interval shorter than
0.8 times or greater than 1.5 times the RR interval averaged over the 4 preceding RR intervals.
The default heart-rate limits are 45 BPM and 130
BPM. These limits can be changed from the setup
menu. Further details on this subject can be found in
chapter 11 "The Setup Menu". The heart-rate
indication function can be disabled from the setup
menu, but this would only affect the 12 Lead and 3
Lead Modes. The function cannot be disabled for the
Auto Rhythm Mode.
The audio signal that the MAC® 500 emits when the
heart rate exceeds either limit can be silenced with
(chapter 8 "Heart-Rate Control").
2003361-004-B
MAC® 500
35
Auto Rhythm Mode
a
b
c
d
7.2 Recording
e
•
Hz
prog
mm/s
i
h
mm/mV
Rhythm Mode with
copy
setup
3
HR∆
50
20
25
10
5
5
10
.
− the "Standard" lead sequence (I, II, III, aVR,
aVL, aVF, V1 to V6 — as selected; Stnd =
Standard, Cab1 = CABRERA) - a
f
Figure 7-1. Auto Rhythm mode display
a Lead sequence
b Lead-fail indication
c QRS indicator
d Heart rate
e AC line filter (60 Hz) enabled
f Muscle filter (35 Hz) enabled
g Gain
h Paper speed
i Operating mode
12
HR∆
With the factory defaults unchanged, the MAC® 500
selects the following functions and settings (the most
important settings are indicated on the display,
Figure 7-1):
Hz
g
Switch on the MAC® 500 and select the Auto
20/35
filter
− a gain of 10 mm/mV - g, the setting can be
changed any time with the gain keys - 9, Figure
7-2)
− a paper speed of 25 mm/s - h, the paper speed can
be changed any time with the speed keys - 10,
Figure 7-2
− the AC line filter (60 Hz) is active - e
O
9
Figure 7-2. Controls and indicators
− the muscle filter (35 Hz) is active - f, it can be
disabled any time with the muscle filter key - 8,
Figure 7-2
− the anti-drift system (cubic spline) is enabled
, check
− Before starting the recording with
that there is no lead-fail indication on the display
- b. If the lead-fail message persists after you
have checked the electrode connections, there
could be a break in the patient cable and the cable
should be replaced. Also check the paper supply.
•
*RA* right arm electrode disconnected
*LA* left arm electrode disconnected
Press
to initiate the recording. You can
stop the recording by pressing the same key
again.
*LL* left leg electrode disconnected
*RL* right leg electrode disconnected
*V1* chest electrode V1 disconnected
*V2* chest electrode V2 disconnected
*V3* chest electrode V3 disconnected
*V4* chest electrode V4 disconnected
*V5* chest electrode V5 disconnected
*V6* chest electrode V6 disconnected
Messages indicating disconnected electrodes
36
MAC® 500
2003361-004-B
Auto Rhythm Mode
Name:................................
I
GEMS IT
Jan.11 00
09:21am
1
II
II
III
2
II
III
III
HR^
25mm/s
10mm/mV
Name:...................
I
I
ADS
60Hz
Figure 7-3. Auto Rhythm-recording
1 History
2 Triggering event
0.08-35Hz
117BPM
HR^
25mm/s
10mm/mV
Upon program start, the MAC® 500 writes a 7-inch
strip of the selected lead group. Then the recorder
stops and starts analyzing the ECG. If the analysis
algorithm detects one of the conditions described
above, this event is recorded with a history of
5 seconds (Figure 7-3). The recording continues as
long as the condition exists. The first 30 seconds are
recorded at the selected paper speed, then the
recorder selects a speed of 5 mm/s.
The recording can be stopped any time with the
key. When there is no paper left in the
recorder, the program stops automatically and the
recorder will beep at 10-second intervals to alert the
user to this condition.
Note
The recording can be stopped any time with the
key.
Between events, a 10-second recording of the
Warning
selected lead group can be initiated with
copy
.
Patient Hazard  When there is no paper in the
recorder, the program stops automatically and the
If the heart rate exceeds one of the set limit values,
recorder will beep at 10-second intervals.
the MAC® 500 emits an audio signal. This signal can
be silenced with
Note
Information may be lost due to the pause following a
change of the device settings.
.
− If you change the paper speed, gain or the filter
settings during a recording, the MAC® 500
briefly interrupts the recording, advances the
paper and then resumes recording with the new
settings.
− If the Anti-Drift System (ADS) is enabled, there
will be a short delay before recording starts.
2003361-004-B
MAC® 500
37
Auto Rhythm Mode
7.3 Brief Operating Instructions
(Auto Rhythm Mode)
•
•
Switch on device and wait for self-test to end
Apply electrodes to the patient, connect patient
cable to device
•
Select Auto Rhythm Mode -
•
Check device settings
– lead sequence -
HR∆
setup
– speed (50, 25, 5 mm/s)
– gain (20, 10, 5 mm/mV)
Modify device settings, if required, using the
appropriate function key or
38
setup
•
Start program with
•
Select lead group with
•
Enable/disable muscle filter with
MAC® 500
20/35
filter
2003361-004-B
Heart-Rate Control
8 Heart-Rate Control
The Basics
Warning
Patient Hazard  The MAC 500 is not intended
®
for use as a vital signs physiological monitor.
The MAC® 500 will control the heart rate in all
operating modes, even when not recording. This
automatic control function can be disabled from the
setup menu (chapter 11 "The Setup Menu"). It is
also possible to modify the heart-rate limits. The
factory defaults are 45 and 130 BPM.
If the heart rate exceeds one of the set limit values,
the MAC® 500 will emit an audio signal (alternating
beep).
This audio signal will cease
− automatically when the heart rate returns to the
permitted range
− when you press the
key.
The audio signal will not recur if it was silenced
with
. Only when the heart rate exceeds one of
the limit values anew, will the audio signal recur.
Selecting HR Limit Values
•
Press
setup
.
Figure 8-1 will appear.
Hz
•
Keep pressing
until the display shown in
Figure 8-2 appears.
The cursor flashes on the low limit value. Using the
cursor keys
prog
mm/s
mm/mV
Hz
Hz
prog
mm/s
Figure 8-2. HR limit menu
2003361-004-B
mm/mV
steps of 5 BPM between 30 and 120 BPM.
•
Figure 8-1. Language selection menu
Hz
, you can change this value in
Press
to confirm your selection, or to
skip this menu option.
•
Adjust the high limit value in the same way
(between 80 and 240 BPM).
•
Again, confirm the entry with
•
Press
MAC® 500
setup
.
to exit the menu.
39
ECG Recording During Defibrillation / ECGs of Pacemaker Patients
9 ECG Recording During Defibrillation / ECGs of Pacemaker Patients
ECG Recording During Defibrillation
ECGs of Pacemaker Patients
The patient signal input is defibrillation-proof.
Therefore it is not necessary to remove the patient
cable during defibrillation.
Due to the slow paper speed it is not possible to
display pacing pulses directly on the ECG recording.
At a paper speed of 50 mm/s and a pulse duration of
just 0.5 ms, the width of the recorded pacing pulse
would be a mere 0.025 mm.
When using stainless steel or silver electrodes,
however, the defibrillator discharge current may
cause complete polarization at the electrode/skin
interface. This will block acquisition of the ECG
signal for several minutes. You can avoid this effect
by using silver/silver-chloride electrodes.
Select the 3 Lead Mode, if defibrillation is carried
out during ECG recording and disable the anti-drift
system as it causes a signal delay of approx. 4
seconds (chapter 11 "The Setup Menu").
If electrodes made of other materials are used, we
recommend disconnecting the patient cable from the
recorder while the shock is delivered.
For this reason the MAC® 500 adapts the pulse
amplitude and pulse width for recording, so that the
pacing pulse is easier to identify. The MAC® 500
records the pulse with the correct polarity and a
width of 5 ms. The pulse amplitude is the same in all
leads (depending on the polarity of the pacing pulse
in leads I and II, the pacing pulse in lead III may be
suppressed). The charge reversal waveform may
differ slightly between leads. Figure 9-1 shows an
ECG recording with pacing pulses.
Warning
Warning
− Shock Hazard  For safety reasons, use only the
original GEMS IT patient cables. Before connecting the cable to the device, check it for signs
of mechanical damage. Do not use a damaged
cable.
− Shock Hazard  Observe the safety information
given in the operator manual of the defibrillator
used.
− Shock Hazard  During defibrillation, do not
touch the patient, the electrodes or the leadwires.
Patient Hazard  If several adverse conditions exist
at once, the possibility that the pacer pulses are
interpreted (and counted) as QRS complexes should
be considered. At the same time, however, QRS
complexes might be suppressed in certain situations.
Therefore, pacemaker patients should always be
watched closely.
Caution
Patient Hazard, Equipment Damage  The patient
signal input of the device is protected against
damage from defibrillation voltages. Nevertheless,
caution is advised when using defibrillators at the
same time as other equipment connected to the
Figure 9-1. ECG recording with pacing pulses
patient.
40
MAC® 500
2003361-004-B
Loading Writer Paper
10 Loading Writer Paper
•
•
Note
Use only the original GEMS IT writer paper.
This paper is specifically designed to prevent
•
electrostatic build up and debris collection on the
thermal array printhead. Using other papers may
result in recordings of poor quality and/or premature wear of the printhead. Use of other paper may
•
void the warranty.
•
Caution
Risk of Skin Burns  Take care not to touch the
Switch on the device.
Press on the spring lock of the paper compartment to open the door (Figure 10-1).
Remove the sleeve of the previous paper roll and
the plastic axle.
Slide new roll on axle and insert as shown in
Figure 10-2.
Unroll a length of paper and close the door
(Figure 10-3), taking care that the paper is exactly positioned on the pressure roller and that
the door locks into place on both sides.
thermal printhead when inserting the paper. After
prolonged periods of recording there is a risk of skin
burns.
standby
battery
low
Power
on/off
copy
Figure 10-1. Opening the paper compartment
standby
standby
battery
low
Power
on/off
Figure 10-2. Inserting the new pad
2003361-004-B
battery
low
copy
Power
on/off
copy
Figure 10-3. Closing the paper compartment
MAC® 500
41
Loading Writer Paper
Error Message
End-of-Paper Indication
The last 10 feet of the paper roll are marked.
When the message "Paper Problem" appears
− press
Aging Stability
The standard ECG writer paper CONTRAST is
designed to guarantee full contrast for a period
between 3 and 5 years if it is handled as described
below before and after recording:
•
•
to clear the message
− verify the paper supply and check that the paper
compartment is correctly closed
Store the paper in suitable rooms at a temperature
between 18 °C and 24 °C/65 °F and 75 °F and a
relative humidity between 40 % and 60 %.
Avoid direct contact of the paper with
− carbon and carbonless forms
− chart papers and adhesives containing tributyl
phosphate, dibutyl phthalate, or any other organic solvents
− document protectors, envelopes, and sheet
separators containing plasticizers.
Caution: The above components may also be
found in recycled papers.
− solvents or solvent-based products containing
alcohols, ketones, esters, or other substances
from this chemical group.
•
•
42
We recommend archiving ECG recordings on our
ECG filing cards only (P/N 217 043 03).
If longer storage periods are required, we suggest
using our ARCHIVIST 30 writer paper (image
legibility up to 30 years) or other image storage
technologies.
MAC® 500
2003361-004-B
The Setup Menu
Parameter
Default
Options
Language
[English]
further languages
Notation
[AAMI]
IEC
Leads
[Standard]
Cabrera
Report format
[Sequential]
Simultaneous
- when choosing
"sequential"
Rhythm lead
- when choosing
"simultaneous"
[Yes]
No
[Short]
Long
Override Mode
[On]
Off
Patient Data sheet*
[No]
Yes
Leads
[3]
1
Speed
[25]
50
Sensitivity
[10]
5, 20
AC Filter
[60]
50, off
Muscle Filter
[On]
Off
Muscle Filter
[35]
20
ADS (cubic spline)
[On]
Off
HR Control
[On]
Off
HR-Control
[45], [130]
30 to 120, 80 to 240
Cut-off Frequency
[0.08]
0.04; 0.16
Contrast
11 The Setup Menu
From the setup menu many of the MAC® 500
settings can be customized. The MAC® 500 will
save these settings as the user defaults and will
activate them each time it is switched on. Angular
brackets [ ] mark the selected option on the display.
Figure 11-1 lists all settings that can be customized
and the available options.
•
[2] (medium)
setup
to display the setup menu.
The first menu item is the language (Figure 11-2).
Selection of a setting is always done in the same
way:
•
use the cursor keys
•
confirm your selection with
item. You can also press
Factory Defaults
[No]
Yes
Print
[No]
Yes (printout of all
settings)
Figure 11-1. The setup menu and menu options
setup
.
Language
lets you select the language
Notation (Electrode Designation)
AAMI: RA, LA, RL, LL, V1 to V6
IEC: R, L, F, N, C1 to C6
Leads
standard (10-lead cable):
Hz
CABRERA (10-lead cable):
mm/mV
to skip a menu
item. You can exit the setup menu with
0 (off), 1 (low), 3
(loud)
for "Interpretation" option
mm/s
.
The cursor moves automatically to the next menu
Date
Time
Option no.**
prog
to move the cursor to
the desired setting and
< reduce,
> increase
QRS Beep
Press
I, II, III, aVR, aVL,
aVF, V1 to V6
aVL, I, -aVR, II, aVF,
III, V1 to V6
Hz
Figure 11-2. Language selection menu
*
not part of MAC® 500 with measurement program
**
only for MAC® 500 with measurement program
2003361-004-B
MAC® 500
43
The Setup Menu
standby
battery
low
prog
power
on/off
copy
setup
12
3
start
HR∆
stop
Figure 11-3. Recorder setup keys
Report Format
The MAC® 500 collects the 12 standard leads for 10
seconds and saves them. Then the leads are recorded
in 4 groups of 3 leads each. For the simultaneous
report format, all recorded leads reflect the same
period of time: long format = 10 seconds, short
format = 3seconds. On the sequential reports, the 10second period is divided into 4 segments of 2.5
seconds each: the first 3 leads reflect the first quarter
of the 10-second period, the second group of 3 leads,
the second quarter and so on. The sequential report
is followed by the rhythm leads (II, aVF, V5) and by
the patient data sheet which includes the measurement results.
Override
After actication of the START key, the MAC® 500
will record a resting ECG, even if one or more ECG
leads are impaired by lead failure. Lead failure may
be caused by disconnected electrodes or inadequate
electrode application. When the system detects lead
failure, a message informing the user of poor signal
quality will be annotated on the recording. Furthermore, system with interpretation capability will print
a message indicating that the measuring results and
interpretation may be incorrect.
Patient Data Sheet
In the 12 Lead Mode, a patient data sheet which is
without measurement results can be added to the
report. You can measure the ECG manually and
annotate the measuring values on the patient data
sheet.
Leads
Number of leads recorded in 3 Lead Mode: 1 or 3
Speed
Paper speed 25 or 50 mm/s
Sensitivity (gain)
5, 10 or 20 mm/mV
44
MAC® 500
2003361-004-B
The Setup Menu
AC Filter
Suppression of AC line interference:
50 Hz = AC line filter Europe
60 Hz = AC line filter USA
Date
Adjust date with
, confirm with
Time
Adjust time with
Muscle Filter
Suppression of muscle artifact: filter on or off
, confirm with
Option no.
In order to activate the optional "Interpretation"
function, enter the option code shown on the option
code sheet. Do not enter any blanks. If the number is
correct the option will be activated and the menu
item will not appear any more.
Muscle Filter
Selection of the muscle filter frequency:
20 Hz or 35 Hz
Note
Please note that filters may suppress diagnostically
relevant portions of the signal. Filters should
therefore only be enabled if necessary.
ADS (anti-drift system – cubic spline)
In case of wandering baselines the anti-drift system
restores the baseline to its original position. ADS
causes a signal delay of 4 seconds.
Factory Defaults
Allows you to restore the factory default settings
(Yes)
Print
To obtain a printout of all device settings (Yes)
HR-Control
Enables/disables the HR indication function. When
the function is disabled, the MAC® 500 switches off
automatically when no key is activated for 5
minutes.
HR-Control
For selection of the heart-rate limit values (in steps
of 5 BPM).
reduces the value,
increases it.
Adjustment ranges: 30 to 120 BPM and 80 to
240 BPM.
Cut-off Frequency
For selection of the lower cut-off frequency of the
signal transmission range: 0.04, 0.08 or 0.16 Hz.
Contrast
: increases contrast
: reduces contrast
2003361-004-B
MAC® 500
45
Cleaning, Disinfection and Maintenance
12 Cleaning, Disinfection and Maintenance
Cleaning and Disinfecting the Recorder Housing
Maintenance
Checks before each use
Warning
Shock Hazard — Disconnect the device from the
Before each use, visually inspect the device, the
leads and electrodes for signs of mechanical damage.
power line before cleaning or disinfecting its
surface.
If you detect damages or impaired functions that
may adversely affect the safety of the patient or user,
do not use the device before it has been repaired.
Caution
Equipment Damage — Liquids must not be allowed
Technical Inspections
to enter the device. Devices into which liquids have
entered must be immediately cleaned and checked by
a service technician, before they can be reused.
Equipment Damage — The MAC® 500 has no
additional protection against ingress of water.
•
Wipe the monitor clean with a moist cloth. Do
not let liquid enter the monitor. All cleaning
agents and disinfectants that contain alcohol and
are commonly used in hospitals are suitable
(exception: disinfectants on a phenol base or
peroxide compounds).
For safety, the devices require regular maintenance.
To ensure functional and operational safety of the
MAC® 500 units, Technical Inspections should be
carried out on an annual basis.
These checks should be performed by persons with
adequate training and experience.
The checks can be carried out by GEMS IT within
the framework of a service agreement. The inspections include the following checks:
•
Cleaning and Disinfecting the Patient Cable
•
•
Disconnect the cable from the recorder before
cleaning or disinfecting it. When disconnecting
the cable, be sure to pull on the connector, not on
the cable.
Clean the cable by rubbing it down with a cloth
moistened with soap water. Use a disinfectant for
disinfection. Do not immerse the cable in liquid.
46
•
•
Check that all device labeling relevant for safety
is legible.
Run a performance test as described in the
operator's manual.
Measure the resistance of the non-fused, earthed
conductor and the equivalent leakage current as
per local regulations.
The device does not require any other maintenance.
Handling Electrodes
•
•
Visually inspect the device and the accessories
for signs of mechanical damage that may impair
the device functions.
Discard disposable electrodes immediately after
use to prevent that they are reused.
MAC® 500
2003361-004-B
Troubleshooting
13 Troubleshooting
Symptom
Cause
Remedy
Periodic superimposition of AC
line interference (60 Hz) (Figure
13-1)
Superimposition of irregular
interference signals (Figure 132)
Interference from the power line
Ground bed, verify position of the
leadwires, switch on AC line filter
Muscle artifact caused by
patient movements, hiccup,
coughing
The patient should be warm enough
and resting comfortably (place
cushions under arms and knees).
Comfort or distract patient, enable
muscle filter (20 Hz / 35 Hz), if
necessary.
The printed date and time are
incorrect
Built-in lithium battery is
depleted. The battery has a life
of approx. 5 years.
Notify service to check and/or replace
battery
The green "standby" indicator 6
does not light up, although the
recorder is connected to the
power line
Defective AC power adapter or
fuse
Notify service to check and/or replace
fuse
The recorder does not write over Paper compartment not properly Paper door must lock into place on
the entire paper width
closed
both sides
No paper transport after
activation of an operating mode
or the recorder does not stop and
continues to feed paper
The writer paper was inserted
the wrong way round, so that
the queue mark cannot be
identified.
Insert the paper as instructed (chapter
10).
Message "Paper Problem"
The MAC® 500 is out of paper Check paper supply
Paper jam
Remove jammed paper
Paper compartment not properly Close paper compartment correctly
closed
Acknowledge message with
Figure 13-2. Irregular interference signals
Figure 13-1. Regular AC interference
Note
In the presence of very strong AC line interference
in all leads, the thermal printhead may interrupt the
recording. Activate the AC line filter in these
situations.
2003361-004-B
MAC® 500
47
Technical Specifications
14 Technical Specifications
Recording
Direct recording of waveforms and alphanumeric
characters with rectangular coordinates by means of
thermal-array printhead printing on thermosensitive
paper.
•
•
•
•
•
•
recording channels: 3, in manual mode 1 or 3,
overlapping is possible
Indicators (LEDs)
For mains supply, battery charge level and start/stop
function
Automatic functions
Assisting and facilitating device operation:
baseline pitch: 25 mm with 3 leads (manual)
writing width: 80 mm maximum
annotation of device settings, date and time in the
margin of recording strip
documentation of analysis results on separate
page
resolution of the recording:
vertically
Display
Alphanumeric LCD, 2 x 16 characters, contrast
adjustable
8 dots/mm
•
•
•
•
•
horizontally 25 µm at 25 mm/s
•
•
To prevent debris from collecting on the printhead,
use the original writer paper only!
when supply of writer paper is depleted, recorder
switches off and sounds an audible indicator;
end-of-paper indication by red stripe in upper
paper margin
Membrane keypad
Membrane keys with tactile feedback
48
report formatting
automatic baseline adjustment
anti-drift system compensating for polarization
voltage fluctuation (cubic spline)
function keys for all important routine operations
pulse amplitude between ±5 mV and ±700 mV
marks with correct pulse polarity in all leads
Heart-rate display
Derivation of the heart rate from all ECG signals
•
•
Chart transport
• paper speed
5-25-50 mm/s (key-selectable)
error limit: typically ±1%, max. ±10%
•
automatic lead sequencing, paper feed, calibration
Detection of pacing pulses
• pulse duration between 0.1 and 2 ms
Writer paper
CONTRAST thermal roll paper
paper width
90 mm/0.35 inches
length
35 m/115 feet
•
automatic amplifier blocking
display range 30 to 300 BPM ±1BPM
display update with every heart beat, maximum
every 2 seconds
Signal inputs
Isolated patient signal input, type CF according to
IEC, high-voltage protection for all lead connections
and neutral electrode RL (only in conjunction with the
original GEMS IT patient cables), interference
compensation via neutral electrode (RL), monitoring
for detection of open leads
•
MAC® 500
electrode connections for RA, LA, LL, RL, V1 to
V6
2003361-004-B
Technical Specifications
•
•
•
•
•
•
•
•
•
input impedance for differential signals applied
between any two electrode connections
>10 MOhms for 10 Hz
for all channels; digital output of processed signals
via thermal-array printhead
•
input impedance for common-mode signals
referred to RL >50 MOhms for up to 60 Hz
dynamic range for differential signals between
any two electrode connections for AC voltage
±10 mV, for superimposed DC voltage (polarization voltage) ±600mV
dynamic range for common-mode signals referred
to RL±1V, referred to chassis 263 V AC voltage
(rms)
quiescent input current via any electrode
connection for 1-kOhm termination referred to
RL <50 nA
patient leakage current (rms values) according to
IEC class CF: under normal conditions <10 µA,
in single-fault condition (e.g., patient in contact
with line voltage) <20 µA
non-destructive range for lead-electrode
connections and the RL-connection referred to
RL ±50 V, referred to chassis ±1500 V
•
•
•
•
•
•
•
•
•
pulse voltage resistance of all lead-electrode
connections and of the N-connection referred to
chassis (e.g., defibrillation) 5000 V
•
monitoring of each electrode for disconnection:
RA, LA, LL, RL, V1 to V6
audible indicator signal upon detection of disconnected leads
•
Signal transmission
Patient signal input to recording
After lead formation and digitization simultaneous
transmission of all electrode signals to the digital
processing system; muscle filter, AC filter, pacing
pulse identification, automatic or manual gain
adjustment, automatic baseline adjustment and drift
compensation by means of the anti-drift system
(A.D.S.) can be enabled or disabled simultaneously
2003361-004-B
•
low cut-off frequency (-3-dB limits) 0.04 Hz,
0.08 Hz or 0.16 Hz
equivalent to a time constant of 4 s, 2s or 1 s
high cut-off frequency (-3-dB limit) 150 Hz
(IEC/AHA)
signal sampling rate 1000 Hz
resolution, referred to the input, 5 µV
output rate to recorder 1000/s
for all leads gain adjustment in three steps:
20 - 10 -5mm/mV, max. error limits ±5%
with muscle filter (low-pass characteristic)
switched on, 3-dB drop of the amplitude frequency response at approx. 35 Hz or 20 Hz
with AC filter switched on, identification and
compensation of periodic 50 or 60-Hz frequency
components: attenuation > 40 dB
non-linear distortion below values specified in
IEC and AHA recommendations
coincidence error limits between any two
channels ±0.5mm
identification of pacing pulses in V2 or other Vleads and marking in all channels for signals
referred to patient input: duration ≥ 0.1 ms,
amplitude > 5 mV
noise in the signal-transmission path below
values specified in IEC and AHA recommendations: ≤ 2,5 µV rms
common-mode rejection for 50 or 60-Hz signals
(depending on recorder model) with AC filter
switched on > 140 dB
ECG calibration
Automatic recording of a defined voltage step, valid
for all channels
•
MAC® 500
calibration voltage of 1 mV ± 1%, referred to
ECG signal input
49
Technical Specifications
calibration pulse width approx. 200 ms, irrespective of paper speed
Baseline
Automatic adjustment of the baseline to the optimal
recording range, in dependence of the signal
amplitude
Anti-Drift System (A.D.S) — Cubic Spline
Automatic compensation of baseline fluctuations
caused by polarization voltage fluctuations at the
lead electrodes (recording delayed 4.2 s)
Blocking
Rapid charge reversal of the coupling capacitors in
the preamplifiers after electrode application
Lead-fail indication
Audible and visual indication on the LCD of
disconnected electrodes or line break; each single
electrode is monitored
Copy function
In 12 Lead Mode, after ECG recording, additional
copies of the ECG can be printed from memory
Test
Automatic performance test upon power up,
including verification of the signal path starting at
the signal input
Power
From the power line or from a built-in rechargeable
battery, automatic switchover; automatic battery
charging via built-in charger during line-power
operation
Line-power operation
• instrument design in protection class I according
to IEC60601-1
•
•
•
50
rated voltage range
100 to 240 V
•
typical power consumption:
during battery charging
13 W
device turned on + battery charging 17 W
recording + battery charging
22 W
Battery-power operation
battery type: lead-acid
•
•
•
•
•
•
•
•
•
rated battery voltage
12 V
rated battery capacity
1.2 Ah
fully charged battery sufficient for up to 50
"automatic" ECGs, if device is switched on only
for recording
operating time without recording:
approx. 4. hours
battery charge time
approx. 6 hours (100%)
approx. 4 hours (90%)
min. charge time for one 12-Lead ECG
20 minutes
battery service life approx. 3 years, replacement
only by GEMS IT service
Lithium battery for built-in clock: battery service
life approx. 5 years, replacement only by GEMS
IT service
Automatic Switch-Off
Device switches off automatically when the battery
voltage drops below a given level.
Device switches off automatically when no controls
are activated for 5 minutes (if HR control is set to
"OFF")
Operational readiness
After successful self-test within 5 seconds of powerup
Operating position
Horizontal
operating voltage range 90 to 264 V;
49 to 65 Hz
rated current
0.12 to 0.3 A
MAC® 500
2003361-004-B
Technical Specifications
Environment
Operation
• ambient temperature between +10 and +40 °C/50
and 104 °F
•
•
rel. humidity between 25 and 95% (no condensation)
atmospheric pressure between 700 and 1060 hPa
Case dimensions
• width
•
•
290 mm/11.4 in.
height
80 mm/3.1 in.
depth
200 mm/7.8 in.
Weight
MAC® 500 with battery approx. 2.2 kg/4.84 lbs
Storage and transport
• ambient temperature
between -20 and +60 °C/-4 and 140 °F (without
battery)
between -15 and +50 °C/5 and 122 °F (with
battery)
•
•
rel. humidity between 20 and 95% (no condensation)
atmospheric pressure between 500 and 1060 hPa
2003361-004-B
MAC® 500
51
Index
Index
A
AC line filter
AC line interference
Addresses, how to reach us
Aging stability (recordings)
Anti-drift system
Auto Rhythm recording
Auto Rhythm recording (Example)
Automatic baseline adjustment
H
45
47
3
42
22
35
37
22
B
Battery operation
Brief operating instructions, 12 Lead Mode
Brief operating instructions, 3 Lead Mode
Brief operating instructions, Auto Rhythm Mode
16
31
34
38
12
40
46
45
10
45
12
45
46
15
E
ECG recording during defibrillation
ECGs of pacemaker patients
Electrode application points
40
40
21
F
Factory defaults, 12 Lead Mode
Factory defaults, 3 Lead Mode
Factory defaults, Auto Rhythm Mode
Factory defaults, restore
Functional description
Functional test
Indication of the heart rate
Installation
Intended use
Interpretation
Introduction
39
16
9
31
9
L
18, 43
17
47
M
Maintenance
Measurement results
Muscle filter
46
31
45
O
D
Danger, definition
Date
Disinfection
Disposal of device
39
45
39
3
I
Language selection
Lead-fail detection function
Lithium battery
C
Caution, definition
Charge reversal waveform
Cleaning
Contrast, adjust
Controls and indicators
Cut-off frequency
Heart rate indication
Heart rate indication, enable/disable
Heart rate limits, select
How to reach us (addresses)
24
32
36
45
9
17
Operating controls
Operating mode "12 Lead"
Operating mode "3 Lead"
Operating mode "Auto Rhythm"
Options, activate
Override function
10
23
32
35
45
44
P
Pacemaker patients, ECG recording
Paper speed, adjust
Patient cable, connection
Patient data sheet
Performance test
Power line, connection to
Power supply
Problems during recording
Putting into service
40
44
20
44
17
16
16
22
16
G
General information
52
5
MAC® 500
2003361-004-B
Index
R
Recording in 12 Lead Mode
Report document "Interpretation"
Report document "Sequential recording"
Report document "Simultaneous recording"
Report format, select
Revision code
Revision history
T
23
31
28
27
44
2
2
S
Safety information
Self-test
Sequential recording
Service requests, where to call
Simultaneous recording
Specifications
Suction electrodes
Symbols, explanation
12
17
28
3
27
48
21
11
2003361-004-B
MAC® 500
Technical data
Technical inspections
Technical support
Time
Troubleshooting
48
46
3
45
47
W
Warning, definition
Warranty
Writer paper, load
12
5
41
53
gemedicalsystems.com
European Headquarters
GE Medical Systems
Information Technologies GmbH
Postfach 60 02 65
D-79032 Freiburg • Germany
Tel. +49 761 45 43 - 0
Fax +49 761 45 43 - 233
World Headquarters
GE Medical Systems
Information Technologies, Inc.
8200 West Tower Avenue
Milwaukee, WI 53223 • USA
Tel. +1 414 355 5000
Fax +1 414 355 3790
Asia Pacific
GE Medical Systems Hong Kong Ltd.
11th Floor, The Lee Gardens
33 Hysan Avenue
Causeway Bay Hong Kong
Tel:
+852.2100.6300
Fax:
+852.2100.6292