NICaS Operational Manual

NICaS Operational Manual
USER MANUAL
USER MANUAL
FOR
FOR (2011) MODEL
NEW NI MEDICAL
NEW NI MEDICAL (2011) LTD’s
MODEL
NICaS
TM
CS
With Software version 3.58
With Software
versionMEASURING
3.58
BIOIMPEDANCE
CARDIAC
and ANALYZING SYSTEM
BIOIMPEDANCE CARDIAC MEASURING
and
SYSTEM
Caution: Federal
LawANALYZING
restricts this device
for sale, distribution
and use by or on the order of a physician.
Caution: Federal Law restricts this device for sale, distribution
and use by or on the order of a physician.
0473
0473
Catalogue No.
1 NI5.0001.01
Catalogue No. NI5.0001.01
TABLE OF CONTENTS
1. INTRODUCTION …………………………………………………………………..
4
2. SAFEGUARDS & STANDARD CLASSIFICATION ………………………
6
2.1
CLASSIFICATION ………………………………………………………….. 6
2.2
SIGNS ………………………………………………………………………….. 6
2.3
CAUTION …………………………………………………………………….. 6
2.4
WARNING…………………………………………………………………….. 7
3. TECHNICAL SPECIFICATIONS …………………………………………………. 8
4. TAKING CARE OF YOUR SYSTEM ……………………………………………. 9
4.1
ROUTINE CARE ……………………………………………………………. 9
4.2
MAINTENANCE ……………………………………………………………. 9
4.3
CLEANING ……………………………………………………………………. 9
4.4
ORDERING INFORMATION …………………………………………… 9
5. COMPONENTS ……………………………………………………………………….. 10
6. UNIT SETUP ……………………………………………………………………………. 11
7. PATIENT HOOKUP ………………………………………………………………….. 12
7.1
CONNECTING THE ICG SENSORS ………………………………….. 12
7.2
CONNECTING THE ECG SEMSORS ………………………………… 13
8. GETTING STARTED …………………………………………………………………. 15
8.1
TYPICAL OPERATING SEQUENCE NICaS ………………………… 15
8.2
FUNCTIONALITIES DURING MONITORING ……………………. 17
8.3
TABLE OF PARAMETERS …………………………………………….… 18
8.4
GGI – Granov Goor Index …………………………………………….. 19
9. FUNCTIONAL DESCRIPTION ……………………………………………………. 20
10. COMPARATIVE SCREEN ………………………………………………………….. 36
2
1. IN
11. NICaS REPORTING SYSTEM …………………………………………………….. 38
11.1 PATIENT SINGLE MEASUREMENT REPORT …………………… 39
11.2 PATIENT STATUS REPORT ……………………………………………. 41
11.3 PATIENT HISTORY REPORTS ………………………………………… 43
11.4 NICaS HEMODYNAMIC NAVIGATOR REPORT ………………. 45
11.5 REPORT OPTIONS ………………………………………………………… 47
12. ALARMS ……………………………………………………………….………………… 48
13. INTENDED PATIENT POPULATION ………………………………………….. 50
14. TROUBLESHOOTING ………………………………………………………………. 51
15. SERVICE …………………………………………………………………………………. 52
16. ORDERING INFORMATION …………………………………………………….. 53
APPENDIX A: KIMITED ONE-YEAR WARRANTY ………………………………. 54
The N
focus
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by a m
param
given
param
heart
histor
The
transf
variou
and it
contr
Imped
place
contr
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This t
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than
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meas
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on th
3
2. SAFEGUARDS
& STANDARD CLASSIFICATION
1. INTRODUCTION
NICaS (Non-Invasive Cardiac System) is a bioimpedance system
2.1.The
CLASSIFICATION
focusing on noninvasive assessment and monitoring of cardiovascular,
2.1.1. Equipment Classification according to IEC 601-1
respiratory, and fluid parameters. The system provides real-time data on
various parameters
of a patient's
cardiac vascular
functions. The data from
 CLASS II EQUIPMENT
according
to the type
any given ofreading
session
is
displayed
on
the
screen
according to the
protection against electrical shock;
different parameters, patient reports can be issued and saved, trends in the
EQUIPMENT
notcan
suitable
for useand
in the
patient's heart
condition
be viewed
monitored, and the system
presence
of
a
FLAMMABLE
ANAESTHETIC
also provides historical data and comparative reports.
MIXTURE, with air or with oxygen or with
The NICaSnitrous
device
replaces the CD drive in any laptop computer,
oxide;
transforming it into a medical instrument for non-invasive measuring of
 CONTINUOUS
according toinclude
the the cardiac output
various cardiac
functions.OPERATION
These measurements
mode of operation.
and its derivatives,
as well as an assessment of the left ventricular cardiac
contractility.
The NICaS
is also unique
in that
is the only
method of
2.1.2. Equipment
Classification
According
to EUit Medical
Device
Impedance Cardiography (ICG) which utilizes dual impedance electrodes,
Directive DEGREE OF PROTECTION against electric shock is
placed on two limbs, preferably one on the wrist and the other on the
type BF. ankle. This type of electrical surveillance is called Regional
contra-lateral
or RIC.
2.2.ICG,
SIGNS
This technology is based on two independent principles:
Class II double isolated device
The first is the fact that the electrical conductance of the blood is higher
than that of the surrounding tissue structures. Consequently, with each
sign (pulsation), an increase in the electrical
arterial General
systolicwarning
expansion
conductance (or reduction in the electrical resistance) of the body is
measured.
This(body-protected
change in systolic
resistance
(impedance) is marked ΔR,
BF-type
floating)
symbol
and the baseline body resistance is R (measured in ohms Ω).
2.3. CAUTION: NOT FOR INTRACARDIAC USE. The instrument does not
The
second
principle, which
is called
the Granov
Goor Index is(GGI),
utilize
a protective
(earth)
ground.
The instrument
not is based
on
the
systolic
time
intervals
(STI)
which,
similarly
to
Left
Ventricle
Ejection
protected against ingress of liquid or against explosive hazards.
DEGREE OF MOBILITY: Portable.
4
Fraction (LVEF), can assess cardiac function i.e., as indicated by LVEF
measurement, the lower the GGI the graver the condition).
REPORTING
SYSTEM
……………………………………………………..
38
The NICaS 11.
is a NICaS
tetrapolar
apparatus
which
operates by an alternating
current of 1.4 mA11.1
and 32PATIENT
kHZ. TheSINGLE
analogMEASUREMENT
resistance signals
are
received
by
REPORT …………………… 39
the device, where
they are
amplified
andREPORT
filtered.…………………………………………….
These signals are then
11.2
PATIENT
STATUS
41
transmitted to a 11.3
microprocessor,
where
they
are
digitized
and
analyzed
via
PATIENT HISTORY REPORTS ………………………………………… 43
mathematical algorithms.
11.4 NICaS HEMODYNAMIC NAVIGATOR REPORT ………………. 45
ECG resistance and
respiratory
waveforms
as well as numerical patterns are
11.5
REPORT
OPTIONS …………………………………………………………
47
displayed on12.
theALARMS
screen ……………………………………………………………….………………… 48
The collected
can be easily
printed
or viewed…………………………………………..
through several easy to
13.data
INTENDED
PATIENT
POPULATION
50
define reports.
14. TROUBLESHOOTING ………………………………………………………………. 51
15. SERVICE …………………………………………………………………………………. 52
16. ORDERING INFORMATION …………………………………………………….. 53
APPENDIX A: KIMITED ONE-YEAR WARRANTY ………………………………. 54
5
2. SAFEGUARDS & STANDARD CLASSIFICATION
2.1. CLASSIFICATION
2.1.1. Equipment Classification according to IEC 601-1
 CLASS II EQUIPMENT according to the type
of protection against electrical shock;
 EQUIPMENT not suitable for use in the
presence of a FLAMMABLE ANAESTHETIC
MIXTURE, with air or with oxygen or with
nitrous oxide;
 CONTINUOUS OPERATION according to the
mode of operation.
2.1.2. Equipment Classification According to EU Medical Device
Directive DEGREE OF PROTECTION against electric shock is
type BF.
2.2. SIGNS
Class II double isolated device
General warning sign
BF-type (body-protected floating) symbol
2.3. CAUTION
NOT FOR INTRACARDIAC USE. The instrument does not utilize a
protective (earth) ground.
6
The instrument is not protected
INPUT PROTECTION: The device is not protected against
defibrillation.
Therefore, before the patient undergoes
defibrillation, all five electrodes (3 ECG and 2 dual impedance)
must be disconnected from the patient. This can be achieved by
pulling the two main cable plugs from the NICaS box.
2.4. WARNINGS
DO NOT USE ANY ELECTRODE PASTE, WHICH WILL REDUCE
ELECTRICAL CONDUCTION.
DO NOT REMOVE COVERS OR PANELS. REFER TO QUALIFIED
SERVICE PERSONNEL.
NO MODIFICATION OF THIS EQUIPMENT IS ALLOWED
3.
NICa
Weig
Pow
Tem
Meth
Lead
Wav
Swee
Impe
ΔR R
ΔR Si
Accu
Samp
Injec
7
5. COMPONENTS
3. TECHNICAL SPECIFICATIONS
The package includes the following components (See Figure 1):
NICaS Dimensions:
Weight:
5.1 One NICaS CS device
Power:
Temperature:
(L)12.8 x (W)13.1 x (H)1.3 cm (5.0 x 5.2 x 0.5 inch)
150 gm (5 oz)
USB: 5v/15]0mA DC
10C,50F to 32C to 90F for operation and sensor
transport and storage
5.2 One laptop computer is required for
system:
ICG
regional impedance
1 lead (I, V+, V-,
5.3 ICG Cable
I_GND)
Waveform
single channel
Sweep speed
25 mm/s
Impedance range:
200-500 Ω
ΔR Range
to 1Ω
5.4 ECG Cable
ΔR Signal Bandwidth 0.3Hz to 12 Hz
Accuracy
±5%
Sample Rate
200 Hz
Injection Current
1.35 +/- 0.1mA RMS
5.5 NICaS CS USB cable
at 32.5 +/-0.5kHz
(purchase from NI Medical is optional)
Method:
Lead mode:
Lead mode
Waveform:
ECG
3 lead (RA,LA,LL)
single channel
Gain
Sweep speed
Heart Rate range
HR Accuracy
x1,x2,x4
25mm/s
30-240bpm
±1bpm
5.6 NICaS CS Sensor Kit, pack of 20
applications (may be sold separately)
Figure 1: NICaS Components
Note:
Please inspect the device to verify that no parts are missing, and that no
8
4. TAKING CARE OF YOUR SYSTEM
4.1 ROUTINE CARE
The following rules should be applied in everyday work to allow
the NICaS CS extended durability:

Keep the NICaS CS dry.

Do not expose the NICaS CS to extreme temperatures.

Keep the NICaS CS away from dust and any kind of dirt (pay
particular attention to the electrode connectors).
4.2 MAINTENANCE
All repairs are to be performed only by New NI Medical (2011) Ltd.
service personnel or, alternatively, by authorized distributor
personnel.
4.3 CLEANING
ECG and BIP cables and lead wires must be cleaned with soap and
water before each application to a new patient.
4.4 ORDERING INFORMATION
See Section 16.
9
7. PATIENT HOOKUP
Five sensors
connect to the patient: two (2) are paired ICG sensors and
5. COMPONENTS
three (3) are ECG sensors.
The package includes the following components (See Figure 1):
7.1. CONNECTING THE ICG SENSORS
One NICaS
device
ICD Cable5.1
is connected
byCS
a blue
plug to the ICG slot of the NICaS. The
ICG Cable is split into two branches labeled 1 (Red) and 2 (Blue), each
have 1 double connector and one single connector.
Connect the
sensors
the patient
as followsfor
(see Figure 3):
5.2 ICG
One
laptoptocomputer
is required
1 (Red) branch:
system:
(purchase
Medical is optional)
Single connector – left from
wristNIproximal;
Double connector – left wrist distal;
5.3 ICG Cable
2 (Blue) branch:
Single connector – right ankle proximal;
Double connector – right ankle distal;
5.4 ECG Cable
5.5 NICaS CS USB cable
5.6 NICaS CS Sensor Kit, pack of 20
applications (may be sold separately)
Figure 1: NICaS Components
Note:
Figure 3: ICG Sensors locations and connection to ICG Cable
Please inspect the device to verify that no parts are missing, and that no
visible damage has occurred during shipment.
10
visible damage has occurred during shipment.
6. UNIT SETUP
According to IEC 601-1-1, if the computer (or any other attached device) is
connected to an external power source (the power supply should be listed
to UL 60950) it must be kept at least 1.5m (60 inches) away from the
patient. When the laptop, connected to the NICaS , is operated on a
battery, no distance limitations exist. The lifespan of a fully charged battery
is approximately one hour.
6.1 CONNECTING TO A POWER OUTLET
Connect the power cord to the NICaS CS back panel and to a laptop USB
slot. The AC power connects to a power supply that supplies DC power
to the computer, and simultaneously recharges its battery.
6.2 CONNECTING THE LEAD WIRES TO THE CONNECTORS PANEL
Connect the lead wire plugs as shown below in Figure 2.



Plug ECG connector into designated slot (No. 2 in Fig. 2).
Plug Impedance Cardiography (ICG) connector into designated
slot (No.1 in Fig. 2).
Connect power/data cable to the laptop USB port (No. 3 in Fig. 2).
1.ICG connector
3.USB connector
2.ECG connector
Figure 2: NICas Device Connectors
11
7. Make
sure the
area where sensors are to be placed on patient’s
PATIENT
HOOKUP
arm and leg is clean, free of perfumes/colognes and lotions and
Five
sensors
to the patient: two (2) are paired ICG sensors and
the
skin is connect
not damaged.
three
(3)
are
ECG
sensors.
 Patient’s limbs should not be cold, and pulse should be palpated.
 Patient’s limbs should be placed so that electrodes do not touch
7.1. CONNECTING THE ICG SENSORS
each other.
ICD Cable
connected
a blue
plug of
to patient’s
the ICG slot
of the NICaS. The
 There
shouldisbe
no metal by
in the
vicinity
limbs.
 Place
a
new
set
of
disposable
electrodes
onto
patient’s
skin2 (Blue), each
ICG Cable is split into two branches labeled 1 (Red) and
before
measurement.
have each
1 double
connector and one single connector.
 To prevent the sensors from drying out, do not open until
Connect the
ICG sensors
immediately
before
use. to the patient as follows (see Figure 3):
1 (Red) branch:
Caution:Single
Do not
use sensors
after
specified
shelf life has expired.
connector
– left
wrist
proximal;
Double connector – left wrist distal;
2 (Blue) branch:
Single connector – right ankle proximal;
Double connector – right ankle distal;
Figure 3: ICG Sensors locations and connection to ICG Cable
12
7.2. CONNECTING THE ECG SENSORS
Place the ECG sensors onto the patient as described in Figure 4.
 The White ECG lead wire is attached to the Right Arm.
 The Black ECG lead wire is attached to the Left Arm.
 The Red ECG lead wire (ground) is attached to the patient's lower
abdomen or leg.
White ECG Clip
Black ECG Clip
RED ECG Clip
Figure 4: Connecting the ECG sensors
NICaS CS is optimized for the wrist-ankle (WA) connection which allows
to estimate the SV based on both upper and lower peripheral flow. In
case that pulse can be palpated the signal is strong enough for the
NICaS to correctly estimate the SV.
Note: Do not place the connector on a limb with the following
abnormalities, and choose a different limb:
• Peripheral Arterial Disease (PAD)
• Significant Edema
• Damaged skin
Note: Do not use any sensor paste, as this will reduce the electrical
conduction.
13
s
 Make
sure the area where sensors are to be placed on patient’s
begin.
arm and leg is clean, free of perfumes/colognes and lotions and
c. Press
Start’ button
. The
the
skin isthe
not ‘Measurement
damaged.
following
window
 Patient’s
limbs
shouldwill
notopen:
be cold, and pulse should be palpated.
 Patient’s limbs should be placed so that electrodes do not touch
each other.
 There should be no metal in the vicinity of patient’s limbs.
 Place a new set of disposable electrodes onto patient’s skin
before each measurement.
 To prevent the sensors from drying out, do not open until
Figure 5: Patient Reminder
immediately before use.
Select
‘Enter
Patient'
the window
with
allexpired.
the
Caution:
Do not
useNew
sensors
afterand
specified
shelf life
has
details required for the patient will open.
8.1.3.2. To start the measurement of an existing
patient select one of the following 2 options:
a. Press 'Patient Button'
and select ‘Find’.
b. Press ‘Measurement Start' button
. The 'Patient
Reminder' window opens (see above):
i. If the name in the field following 'current patient'
is correct - select ‘Continue’.
ii. If the name in the field following 'current patient
is' incorrect or blank - select ‘Find Existing
Patient’. A ‘Patient List’ window will open, in
which you can seek the relevant patient (see a
more detailed explanation in the Functional
Description below).
14
8. GETTING STARTED
8.1. TYPICAL OPERATING SEQUENCE NICAS
The following paragraphs describe a typical operating sequence
with the NICaS CS monitor
8.1.1. Power Up NICaS CS
Ensure the laptop is on and running and that the NICaS CS is
connected to its USB connector. Double-click the NICaS
icon. The start-up process might take a few minutes to
complete.
8.1.2. Connecting Lead Wires to a Patient
See explanation in section of Patient Hookup.
8.1.3. Measurement Start-Up
To start the monitoring process, select either ‘New Patient’
or ‘Existing Patient’.
8.1.3.1. To begin measurement of a new patient
select one of the following 3 options:
a. Press ‘Patient’ button and select ‘New’
b. Press the first icon on the toolbar
After selecting one of these two options, a window
with all the details relevant to the patient will open.
Fill in details and click
. The measurement will
15
begin.
8.3. TABLE OF PARAMETERS
Parameter
Heart Rate
Stroke Volume
Stroke index
Cardiac Output
Cardiac Index
Cardiac Power
Index
Granov Goor
Index
Total
Peripheral
Resistance
Total
Peripheral
Resistance
Index
c. Press the ‘Measurement
Start’Normal
buttonRange
. The
Abb.
Definition
following
window
open:
Number
of heartwill
beats
each 58 - 86 bpm (beats
HR
minute
per minute)
Number of heart beats each
SV
60 - 130 milliliter
minute
Stroke volume normalized
35 - 65
SI
2
for body surface area
milliliter/beat/m
Amount of blood pumped by
CO
4.5 – 8.5 liter/min
the
left ventricle
minute
Figure
5: Patientper
Reminder
Cardiac Output normalized
2.5 - 4.7
CI
2
Selectfor
‘Enter
Patient'
window with
all the
bodyNew
surface
area and theliter/min/m
details required for the patient will open.
An indicator of myocardial
2
CPI
0.45 - 1.0ofwatt/m
8.1.3.2.
To start the measurement
an existing
contractility
patientofselect
An indicator
Left one of the following 2 options:
> 10.0 (equals an
Ventricular Function, which
a. Press 'Patient Button'
andEjection
select ‘Find’.
GGI
Fraction
is strongly related to
> 55%)
Ejection
Fraction
b. Press
‘Measurement
Start' button
. The 'Patient
The
resistance
to
the
flow
of
Reminder' window opens (see above):
blood in the arterial system
770 - 1500
patient'
TPR i. If the name in the field following 'current
-5
(often
referred
to
as
dynes·sec·cm
is correct - select ‘Continue’.
ii. “Afterload”)
If the name in the field following 'current patient
The resistance to the flow of
is' incorrect or blank - select
‘Find
Existing
1540
- 3000
blood in the arterial system
-5
TPRI
dynes·sec·cm
/ in
Patient’.
A
‘Patient
List’
window
will
open,
normalized for body surface
2
m
which you can seek the relevant patient (see a
area
more detailed explanation in the Functional
Total Body
Water
TBW
Respiration
rate
RR
The amount of extracellular
Description below).
fluid in % or kilograms
40.0 – 63.0%
Number of breaths each
minute
8 – 24 breaths /
minute
16
8.2. FUNCTIONALITIES DURING MONITORING
8.2.1. Alarms – NICaS has a built-in alarm system that alerts the
user of a technical failure. This alarm may sound while
monitoring a patient however it indicates a technical failure
only. In the event of a technical failure the system sounds
an audio notification and the status line at the bottom of
the screen will display the cause of the alarm.
Note: See Alarms (Section 11) for a more detailed
explanation.
8.2.2. Review Collected Data – ‘Review Mode’ enables the review
of previously measured data. This mode can be accessed by
directly pressing the ‘Review’ button on the main menu or
by pressing
.
17
8.3. TABLE OF PARAMETERS
Parameter
Abb.
Heart Rate
HR
Stroke Volume
SV
Stroke index
SI
Cardiac Output
CO
Cardiac Index
CI
Cardiac Power
Index
CPI
Granov Goor
Index
GGI
Total
Peripheral
Resistance
TPR
Total
Peripheral
Resistance
Index
TPRI
Total Body
Water
TBW
Respiration
rate
RR
Definition
Normal Range
Number of heart beats each
minute
Number of heart beats each
minute
Stroke volume normalized
for body surface area
Amount of blood pumped by
the left ventricle per minute
58 - 86 bpm (beats
per minute)
Cardiac Output normalized
for body surface area
2.5 - 4.7
2
liter/min/m
An indicator of myocardial
contractility
0.45 - 1.0 watt/m
60 - 130 milliliter
35 - 65
2
milliliter/beat/m
4.5 – 8.5 liter/min
An indicator of Left
Ventricular Function, which
is strongly related to
Ejection Fraction
The resistance to the flow of
blood in the arterial system
(often referred to as
“Afterload”)
The resistance to the flow of
blood in the arterial system
normalized for body surface
area
770 - 1500
-5
dynes·sec·cm
The amount of extracellular
fluid in % or kilograms
40.0 – 63.0%
Number of breaths each
minute
8 – 24 breaths /
minute
18
> 10.0 (equals an
Ejection Fraction
> 55%)
1540 - 3000
-5
dynes·sec·cm /
2
m
2
8.4. GGI – Granov Goor Index - is a ratio that assesses Left Ventricular
Systolic Function similarly to LVEF. Higher GGI readings indicate a
better Left Ventricular Systolic Function. Below is the Correlation
graph of GGI vs LVEF (GGI < 10 is associated with LVEF of < 55).
The graph represents Blinded comparison of EF and GGI in 60
patients presenting at a cardiology clinic asymptomatic of
ischemic heart disease and, selected to undergo
echocardiography, and selected in accordance with device
exclusion criteria. Data is not from an unselected population.
Figure 6: Granov Goor Index
19
9.
9. FUNCTIONAL
DESCRIPTION
Right pane
display:
The right pane displays 10 parameters that provide data on the current
9.1. Main Screen
measurements. These parameters display the real time values of the
measurement
the selected
The normal
Theformain
screen isparameters.
used to navigate
andmeasurement
operate the system and
range for each
parameter
is
displayed
below
the
measured
value.
present the different views of the measurement
data (see Figure 7
below).
The color display
is to enhance distinction between the parameters in
real-time and
does not
qualify
theAt
measurement
in any
way.there are 2 navigation
Toolbars
and
menus:
the top of the
screen
toolbars.
They
functionally
– of
theParameters
top one is textual and
For parameters
glossary
of are
abbreviations
seeidentical
the Table
the
bottom
one
has
icon
representations.
in the section Getting Started.
screen
is divided
into 3 main sections as follows:
Bottom leftThe
pane
– Trends
display:
pane
is divided
horizontally
The
This area isLeft
divided
intodisplay
3 graphs.
The trends
are choseninto
fromthree
a list sections.
of
sections
display
waveforms
representing
real
time
ECG,
∆R
and
14 parameters in the Options window (see Figure 12 below), whereas,
of thetrends
presentdisplayed.
measurement.
HR, SV andRespiratory
CO are therate
default
Each point on the
screen represents
thedisplays
measured
and pre-selected
computed result
of a single
Right pane
10 user
parameters
(from a total of
measurement.
The
sequence
of
points
displays
the
TREND
for
14). The values of the parameters are preprogrammedthat
to be updated
parameter at
during
measurement
at 10,a measurement.
20 or 30 seconds
10, 20the
or specific
30 seconds
intervals during
preset intervals. The latest measurement point is located furthest to
the right. Bottom left pane, below the wavelength, displays the trends of three
of the parameters selected from the vertical right side readings (HR, SV
and CO) during a measurement.
9.3. Toolbar menus
The main screen offers 2 options for navigating through the NICaS
system: the top is a text menu and the bottom is a graphic tool bar
(see Figure 8).
Figure 8: Main screen navigating menu
20
I
II
III
Figure 7: Main Screen
9.2. THE DISPLAY
Left pane screen – waveform display (refer to Figure 7 above):
I. GREEN waveform represents the ECG.
II. RED waveform represents the bioimpedance ΔR.
III WHITE waveform represents the respiration.
The waveforms progress from left to right along a horizontal axis
drawing the vertical values (of the ECG, ICG and respiratory
measurements). The Horizontal axis is marked by 1 second interval
indicators
21
Rightsee
pane
display:
For example
Patient
3 in Figure 9.
The right pane displays 10 parameters that provide data on the current
Clicking measurements.
the button "Enter/Update
patientdisplay
data"the real time values
on theof the
These parameters
upper right
corner
opens
‘New
Patient’
window
were
patient
data
measurement for the selected parameters. The normal measurement
need torange
be filled
in.
In
the
event
of
an
existing
patient,
just
update
data
for each parameter is displayed below the measured value.
that were changed from previous measurement (see Figure 10).
The color display is to enhance distinction between the parameters in
real-time and does not qualify the measurement in any way.
For parameters glossary of abbreviations see the Table of Parameters
in the section Getting Started.
Bottom left pane – Trends display:
This area is divided into 3 graphs. The trends are chosen from a list of
14 parameters in the Options window (see Figure 12 below), whereas,
HR, SV and CO are the default trends displayed. Each point on the
screen represents the measured and computed result of a single
measurement. The sequence of points displays the TREND for that
parameter during the specific measurement at 10, 20 or 30 seconds
preset intervals. The latest measurement point is located furthest to
the right.
9.3. Toolbar menus
Figure 10: New Patient
The main screen offers 2 options for navigating through the NICaS
The following
Patient
data
in full:
system:
the top
is menu
a textshould
menu be
andcompleted
the bottom
is a graphic tool bar
 (see
TypeFigure
in full 8).
name and ID number
 Click on the icon to indicate sex M/F
 Choose from scroll menu date of birth mm/dd/yy
 Enter the data for the Height, Weight, Hematocrit; Sodium;
Systolic Blood Pressure,
Diastolic
Blood
Pressure.
Figure 8: Main
screen
navigating
menu
22
Patient
- Patient Management window
Before entering a new patient you may want to check if he/she is
already registered in the system: use this option to add a new patient,
find an existing one, or to edit data of an existing patient (See Figure
9).
Figure 9: Patient Management
The window displays the list of patients already registered in the
system. To enter a new patient or to search for an existing patient,
enter the patient's Last Name, First Name or ID in one of the top 3
boxes.
If the patient exists, click on the selected patient in the list of patients.
Patient First Name, Last Name and ID will appear in the top 3 boxes.
23
Clicking the button "Enter/Update patient data"
on the
upper right corner opens ‘New Patient’ window were patient data
need to be filled in. In the event of an existing patient, just update data
that were changed from previous measurement (see Figure 10).
Figure 10: New Patient
The following Patient data menu should be completed in full:
 Type in full name and ID number
 Click on the icon to indicate sex M/F
 Choose from scroll menu date of birth mm/dd/yy
 Enter the data for the Height, Weight, Hematocrit; Sodium;
Systolic Blood Pressure, Diastolic Blood Pressure.
o Note: If no updated data on Hematocrit and Sodium for
24
o


Note:
If no updated
data
on Hematocrit
and Sodium for
Patient
- Patient
Management
window
patient the system enters a default measurement.
Before entering a new patient you may want to check if he is already
o The numbers on the right indicate the accepted range for
registered in the system: use this option to add a new patient, find an
each of the data entered.
existing one, or to edit data of an existing patient (See Figure 9).
Connecting the sensors: choose 2 options - left and right wrists
(RW/LW) and left and right ankles (RA/LA).
o Clicking on your choice of icons will change the "not set" to
indicate the selected placement: i.e. RW+ LA
Choose one of the three positions of the patient during the
measurement: supine, sitting or standing.

Click
to save and measure

Click
to save and exit

Click
to cancel
Patient measurements file display
Click on a selected patient from the left pane list will display
his/her measurements file in the right pane. The name of the
patient appears at the top of the
right
pane. Management
Selecting the
Figure
9: Patient
relevant patient’s name displays the measurement data on a 3
The window displays the list of patients already registered in the
level hierarchy.
system. To enter a new patient or to search for an existing patient,
Example Figure
9 –the
leftpatient's
pane Patient
3 is selected;
Right
enter
Last Name,
First Name
or pane
ID in one of the top 3
boxes. 3 measurement library. Click on Patient
shows the Patient
number to open
all patient
files. exists, click on the selected patient in the list of patients.
If the
Patient First Name, Last Name and ID will appear in the top 3 boxes.
P – Patient name
or number
For example
see(Patient
Patient3)
3 in Figure 9.
25
S
w
M
(
T
t
p
were taken
Eachopens
Series when
has several
measurements.
Patient Reminder
– A(23-Sep-12).
window that
the program
is
reopened. The
includes the name
of the
current
patient, and
4
M –window
Listed Measurements
stating
by the
measurement
number
options: (M #17) and hour 10:34:34).
The Patient Management window has additional 6 function buttons at
the bottom of the window for accessing, managing and retrieving
patient data and issuing reports.
a.
o
- enable changing the following parameters of
Figure
10: Patient
Reminder
existing
series:
Systolic
Blood Pressure, Diastolic Blood
Pressure,
Sensors Location,
Patient Position.
Continue
– Choosing
this option
continues the
measurement of the current patient.
b. New Patient – Opens
- Opens
a window
entering
o Enter
a window
thatfor
includes
allfree
the text
comments
relevant
to
the
patient,
the
specific
measurement
or
data necessary for a new patient (see above).
other
data
entered.
These
comments
will
appear
at
the
bottom
o Find Existing Patient – Opens the ‘Patient List’ window,
of the
series
reports
(see can
Figure
To write
a comment,
from which
the
relevant
patient
be 11).
selected
by marking
position
cursor
in
the
right
box,
type-in
the
comment,
and press
his/her name in the left screen.
the
arrow
to
transfer
the
comment
into
the
highlighted
series
o Cancel – Closes this window.
at the left box. The left box shows all the comments that were
Measurement Pause
- Stops
the measurement.
To dates.
continue,
written for the
selected
patient, and their
select ‘Measurement
Continue’are displayed
. The measurement
continues
All comments
in the patient report,
with the date
the sequence fromand
where
it
was
stopped,
without
losing
the
data
time of entry.
already accumulated for this series i.e. trends and last results of all
parameters.
When Pause is activated, 4 menus can be opened: 1) Report – for a
single measurement; 2) Settings – ‘options’ are available, the number
and/or types of trends displayed on the screen can be changed; 3)
Comments; and 4) Help.
Stop
- Stops the measurement. When restarting, the
measurement continues the sequential numbering from the last
measurement (without retaining comparative data).
26
patient the system enters a default measurement.
The numbers on the right indicate the accepted range for
each of the data entered.
Connecting the sensors: choose 2 options - left and right wrists
(RW/LW) and left and right ankles (RA/LA).
o Clicking on your choice of icons will change the "not set" to
indicate the selected placement: i.e. RW+ LA
Choose one of the three positions of the patient during the
measurement: supine, sitting or standing.
o



Click
to save and measure
Figure 9: Add Comments

c.
Click
to save and exit
– Opens a window with the option to view the
 Click
to cancel
data through
four types
of reports: Measurement Report,
Series Report, History Report (in ascending order) and
Hemodynamic Navigator.
Patient measurements file display
d.
- Exportpatient
data of
specific
patient
all displays
data his
Click on a selected
from
the left
paneor
listofwill
basemeasurements
to Excel.
file in the right pane. The name of the patient
appears at the top of the right pane. Selecting the relevant
e.
Use thisthe
option
to reviewdata
a selected
patient’s name- displays
measurement
on a 3 level
measurement.
hierarchy.
f.
Example Figure
9 – left
Patient
3 is selected;
Right pane
- Use
this pane
option
to start
an additional
measurement
an existing
patient. Afterlibrary.
patientClick
has on
beenPatient
shows theofPatient
3 measurement
selected,
clicking
‘Continue’
will
start
a
measurement.
number to open all files.
Measurement Start
- Starts the measurement. Clicking this
P – Patient
name or number
(Patient 3)
button changes
it to ‘Measurement
Pause'
S - Measurement Series (S #4) followed by the date the series
27


A window
opensgain
when
the program is
Patient
Reminder
ECG zoom
– Choose– one
of three that
amplitude
options
reopened.
The
window
includes
the
name
of
the
current
patient, and 4
for the ECG: 1, 2 or 4. Gain 2 is default.
options:
Measurement duration – Offers the option to choose the
rate of updating the data during the measurement: 10,
20, or 30 seconds intervals (default is 20 seconds).

Trends - Lists the parameters that can be selected to be
displayed in the trends charts at the bottom left of the
main screen (see Figure 11). Choose 3 of the 11 options
Figure 10: Patient
Reminder
for display per measurement
by ticking
the relevant
checkbox.
o Continue
Choosingthatthis
option
the

Parameters
- Lists the –parameters
can be
selectedcontinues
to
measurement
of
the
current
patient.
be displayed in the Parameters pane to the right of the
o Enter
Patient
– Opens10a of
window
includes all the
the 14that
options
main screen
(seeNew
Figure
11). Choose
for a new
for displaydata
pernecessary
measurement
by patient
ticking (see
theabove).
relevant
o
Find
Existing
Patient
–
Opens
the
‘Patient List’ window,
checkbox.
from which
the relevant patient
can be

Trends Speed
- Determines
the rate
at selected
which by marking
his/her
in displayed
the left screen.
measurement
dataname
will be
on the chart to
o
Cancel
–
Closes
this
create the trend graph. Choosewindow.
from 1, 3, 5 or 10 minute
intervals.
- Stops the measurement. To continue,
Measurement
Pause
select ‘Measurement Continue’
. The measurement continues
Settings/Techniques
is
available
when
measurement
is paused
the sequence from where it was stopped, without
losing the data
or stopped.already
It can accumulated
be accessed for
only
by
authorized
personal
withresults of all
this series i.e. trends and last
validated password.
The advance setting enables the Algorithm
parameters.
Selection (See
Figure
12).
When Pause is activated, 4 menus can be opened: 1) Report – for a
single measurement; 2) Settings – ‘options’ are available, the number
and/or types of trends displayed on the screen can be changed; 3)
Comments; and 4) Help.
Stop
- Stops the measurement. When restarting, the
measurement continues the sequential numbering from the last
measurement (without retaining comparative data).
28
Review
- Opens a window with a 4 graphs display: ECG, dR, dR/dt
and respiration, and the calculated results of the patient’s last
measurement. This option is available only when the patient is no
longer connected to the NICaS system. In addition, any other
measurement can be selected from the 'Patient List' window, and by
clicking this 'Review' button in the 'Patient List', the review of the
selected measurement will appear. To stop the measurement review,
press the 'Stop' button.
Setting/Options
- Use this window to select your default or premeasurement settings. Click on 'Settings' or the icon to open a window
menu that displays all the system parameters and check boxes (see
Figure 11).
Figure 11: Setting/Options
29





ECG zoom – Choose one of three amplitude gain options
for the ECG: 1, 2 or 4. Gain 2 is default.
Measurement duration – Offers the option to choose the
rate of updating the data during the measurement: 10,
20, or 30 seconds intervals (default is 20 seconds).
Trends - Lists the parameters that can be selected to be
displayed in the trends charts at the bottom left of the
main screen (see Figure 11). Choose 3 of the 11 options
for display per measurement by ticking the relevant
checkbox.
Parameters - Lists the parameters that can be selected to
be displayed in the Parameters pane to the right of the
main screen (see Figure 11). Choose 10 of the 14 options
for display per measurement by ticking the relevant
checkbox.
Trends Speed - Determines the rate at which
measurement data will be displayed on the chart to
create the trend graph. Choose from 1, 3, 5 or 10 minute
intervals.
Settings/Techniques
- is available when measurement is paused
or stopped. It can be accessed only by authorized personal with
validated password. The advance setting enables the Algorithm
Selection (See Figure 12).
30
Figure 12: Advance Settings Authorization
Algorithm selection:
The default setting is for volumetric measurement and should
be the standard mode of measurement. This option is for use
by advance settings and should be changed only by an
authorized technician (see Figure 13).
Figure 13: Advance Settings Authorization
There are two options for measuring the CO:
A) The standard Volumetric method, where the SV is
calculated by Frinerman’s (ΔR) algorithm.
B) The alternative Velocimetric method, where the SV is
calculated by the first derivative of ΔR.
31
The velocimetric
option
should algorithm
be used only when
Correlation
with Thermodilution
of volumetric
25 post operative
patients
patient’sinadmitting
diagnosis
is “acute heart failure”.
8
Enclosed is a graph showing correlations with range lines of
the results from acute heart failure and another graph for all
other patients. The data from which these two graphs were
constructed were published in Cotter’s paper (Physio
Measures 2006; 27:817-27).
7
NICAS CO (lit/min)
the
6
5
4
Correlation with Thermodilution of Volumetric vs.
Velocimetric Algorithm in post operative patients
3
13.0
2
3 11.0
2
4
5
6
7
8
Thermodilution CO (lit/min)
9.0
NICaS (lit/min)
Figure 16: Correlation of Volumetric Algorithm to TD in
7.0
Post-Operative Patients
Velocimetric
Volumetric
*Range lines in the plot represent +/- 0.8 L/min for TD CO values <= 4
5.0
L/min, +/- 20%
for TD CO values > 4 L/min.
3.0
Print Screen
- is a function that enables converting the data on
the screen into a PDF format and Thermodilution
then save
or send it to a mail
(lit/min)
recipient.
Figure 14: Correlation with TD in P Operative Patients
1.0
1.0
Help
3.0
5.0
7.0
9.0
11.0
13.0
– Click
to access
user
*Range
lines inthe
the electronic
plot represent
+/-guide.
0.8 L/min for TD CO values <= 4
L/min, +/- 20% for TD CO values > 4 L/min.
Your NICaS version
currently installed.
– provides information regarding the version
Exit – To close the program click on the
main screen.
32
at the top right of the
Correlation with Thermodilution of Volumetric vs.
Velocimetric Algorithm in Acute Heart failure patients
8
7
NICaS (lit/min)
6
5
Velocimetric
4
Volumetric
3
2
1
1
2
3
4
5
6
7
8
Thermodilution (lit/min)
Figure 15: Correlation with TD in Acute Heart Failure Patients
*Range lines in the plot represent +/- 0.8 L/min for TD CO values <= 4
L/min, +/- 20% for TD CO values > 4 L/min.
As one can see in the acute heart failure group, the lower the cardiac
output (below 4.0 lit/min) the higher the accuracy of the velocimetric
results, and the higher the cardiac output, the better the volumetric
results.
Results of an additional group of patients measured with the
Volumetric algorithm – (see Figure 18) below.
33
Correlation with Thermodilution of volumetric algorithm
in 25 post operative patients
8
NICAS CO (lit/min)
7
6
5
4
3
2
2
3
4
5
6
7
8
Thermodilution CO (lit/min)
Figure 16: Correlation of Volumetric Algorithm to TD in
Post-Operative Patients
*Range lines in the plot represent +/- 0.8 L/min for TD CO values <= 4
L/min, +/- 20% for TD CO values > 4 L/min.
Print Screen
- is a function that enables converting the data on
the screen into a PDF format and then save or send it to a mail
recipient.
Help
– Click to access the electronic user guide.
Your NICaS version
currently installed.
– provides information regarding the version
Exit – To close the program click on the
main screen.
34
at the top right of the
Shut Down
Pressing the laptop’s Power button
willwith
begin
the shutting
down sequence.
Correlation
Thermodilution
of Volumetric
vs.
Velocimetric
Algorithm
in
Acute
Heart
Note: If you wish to continue using your laptop, simplyfailure
exit patients
the NICaS
8
application by clicking on
the X at the top right of the screen
7
1
T
(
C
u
p
NICaS (lit/min)
6
5
Velocimetric
4
Volumetric
3
2
1
1
2
3
4
5
6
7
8
Thermodilution (lit/min)
Figure 15: Correlation with TD in Acute Heart Failure Patients
*Range lines in the plot represent +/- 0.8 L/min for TD CO values <= 4
L/min, +/- 20% for TD CO values > 4 L/min.
As one can see in the acute heart failure group, the lower the cardiac
output (below 4.0 lit/min) the higher the accuracy of the velocimetric
results, and the higher the cardiac output, the better the volumetric
results.
Results of an additional group of patients measured with the
C
Volumetric algorithm – (see Figure 18) below.
T
N
m
35
e.
CaS
10. COMPARATIVE SCREEN
The NICaS system offers users a shift between the regular measurement
(Figure 7: Main screen) screen to a comparative screen (Figure 17:
Comparative Screen). The comparative screen is designed to enable users
to perform a set of comparative measurements according to different
parameters.
Figure 17: Comparative Screen
Click on
to shift from the regular to the comparative screen.
The top screen display is of the ECG (green) and ∆R (red) waveforms.
Note: Enter the comparative parameters of your choice for each
measurement/series in Parameters 1/Parameter 2. These parameters can
36
be customized through the 'Setting/Options' menu.
Click
to open the Comparative Measurement Options and edit
Parameters 1 and 2 according to your comparative parameters. Before
starting a new measurement the system will open a dialog box reminding
the user to change the comparative parameters for that measurement.
The right pane displays the data for each series – in descending sequential
order; the current or last measurement appears at the bottom. The
numerical data in the right pane columns displays and updates the values
per series with reference to the comparative parameters 1 and 2.
The left pane displays 4 trends representing the series graphically and
numerically (each dot is a measurement in a series). The numeric data
displays current vs. average values. When the measurement is stopped, a
click on any of the dots changes the top ECG/∆R waveforms to that of the
specific measurement. Placing the cursor on the dot and right click on the
mouse neutralizes it from the average calculation for that trend (displayed
numerically at the side).
The bottom right continues the numerical comparison between the current
and average values for the other parameters
When opening the Patient Management window from this screen the
patient file also displays the date of each of the series.
37
11
he
ld.
ox
hat
tial
he
ues
nd
ata
,a
he
he
ed
ent
11. NICAS REPORTING SYSTEM
There are 3 types of reports:
Patient Measurement report – report of 1 measurement obtained
by clicking on the required measurement (e.g. M #12 in Figure 20).
Patient Series report – report of average of a few measurements
obtained by clicking on the required series (e.g. S #3 in Figure 20).
Patient History report – report of all historical series obtained by
clicking on the patient name (e.g. Patient 1 in Figure 20).
After required report has been selected press ‘View Report’
to generate a PDF report.
Hemodynamic Navigator - provides Cardiovascular and Cardiac
Function graphs for on-line drug titration – double mouse click on
Patient name.
he
Figure 20: Selecting reports
38
All reports display the patient's identification data as entered during
registration: Name, ID number, sex, date of birth, and height.
All other data and display varies according to the selected event and
type of report.
11.1. PATIENT SINGLE MEASUREMENT REPORT
The report heading states the number of the selected measurement
for the report (see Figure 21: M13). Top of the page shows patient’s
permanent data and identifies the date and time of the measurement
and the recording intervals (20 seconds).
This is followed by a tabular display of all the measurement
parameters and their results. The table states the name and
abbreviation of each parameter, the measurement unit and the actual
reading. The last column displays a scale with the low to high values
for each parameter. The measurement reading is indicated on the
scale: Green = in norm; Red = out of norm.
The table is followed by 2 graphs representing a sample of ECG and ∆R
waveform of the measurement.
39
Figure 21: Measurement Report
40
11.2. PATIENT STATUS REPORT
The Series Report is similar in form to a Measurement Report with
certain additional data. The tabular data displays the average of the
series' measurements results per parameter.
The scale displays the readings per series within the high/low range for
each parameter. The continuous colored section on the scale indicates
the values for the current series measurement.
In addition, Patient Series report compares the current series
measurements with those of the last series taken on the sequential
date prior to the current one (see Figure 22: M3). The earlier series is
marked with a dot before the date (column heading).
The dot indicating the values of earlier measurement - it can be within
the colored range (lower) or out of the colored range (higher) than the
current value/reading.
The graphic data displays the ECG and ΔR waveform.
The report displays 3 measurement trends chosen for that series. Each
dot on the trend display represents a single measurement.
Example: HR, SV, CO
The bottom of the page displays all the comments entered by the
physician.
41
Figure 18: Status Report
42
11.3. PATIENT HISTORY REPORTS
The top of the page shows patient’s permanent data.
A Hemodynamic Patient Report provides a tabular summary of a
patient's previous measurements in ascending order of occurrence.
Additionally, the values of three user-selected parameters are plotted
to display the trend with relation to its time sequence.
All the physician's comments are displayed at the bottom of the page.
43
Figure 19: Patient History Report
44
11.4. NICAS HEMODYNAMIC NAVIGATOR REPORT
Provides Cardiovascular and Cardiac Function graphs for on-line
drug titration – double mouse click on Patient name.
Figure 20: Hemodynamic Navigator
45
11.4.1. Cardiovascular Status Graph
This graph displays Blood Pressure vs. Cardiac Index and
helps understand the vascular status. To the left and right
of the graph are the measurement scales for MAP, SBP and
DBP – each with a graphic representation (MAP – black dot;
SBP red triangle; DBP blue square). The normal range is
indicated by a green hexagon. Measurement values within
the hexagon boundaries are within norm. Below the graph
is a tabular display of the values for the two measurements
parameters.
11.4.2. Cardiac Function
This graph display of Stroke Index (SI) vs. Heart Rate (HR).
Each series is represented by a blue dot on the graph. The
arrow indicated the sequence, earlier measurement to
later. The Green graphic form indicates the norm.
Measurement values within the graphic boundaries are
within norm. Below the graph is a tabular display of the
values for the two measurements parameters.
46
11.5. REPORT OPTIONS
12
11.5.1. Quick Report
Pointing the mouse to a measurement (M) or to a series (S)
in the right-hand pane will open a small window with the
results of 5 parameters (HR, SV, CO, CI, TPR) either for the
specific measurement or the average for the series.
11.5.2. Omitting a measurement/s from a report
Selecting a measurement or several measurements with
the right mouse button excludes these measurements from
statistics and from calculated averages in reports (see
Figure 25: M#8).
Figure 21: Patient Management Windows
47
As
al
Te
Te
W
is
th
(S)
he
he
th
om
ee
12. ALARMS
As mentioned in the previous section, the system can set-off one type of
alarm while monitoring a patient.
Technical Alarm
Technical alarms are activated as a result of a technical or software failure.
When a technical alarm sounds, a unique technical-alarm audio notification
is heard, and the status line in bottom of the screen displays the cause of
the alarm. Figure 23 demonstrates a technical alarm scenario.
Figure 22: Technical Alarm
48
Possible Technical Alarms are:
A) Communication port problem- there is no data received from the
unit
Root cause:
 Communication cable is not properly connected.
 Hardware defect on the cable, or port of NICaS or PC.
B) Bad electrodes - No data from electrodes.
Root Cause
 Electrodes are not attached properly
 Hardware defect on electrodes
C) Cannot calculate results - Bad data from electrodes
Root Cause
 Electrodes are not attached properly
 Electrodes are dry
13
Th
pa
ind
Ind
ne
Ex
Fo
be
At
no
rec
49
he
13. INTENDED PATIENT POPULATION
The NICaS CS is intended to monitor and display patients hemodynamic
parameters (including stroke volume, stroke index, heart rate, cardiac
index, cardiac output, total peripheral resistance, and the Granov-Goor
Index), in males and females with known or suspected cardiac disorders
needing cardiac assessment.
Exclusion Criteria
For proper use of the RIC technology, the following exclusion criteria must
be strictly adhered to:
 Aortic valve insufficiency
 Significant aortic valve stenosis
 Severe mitral valve insufficiency
 The following aortic conditions:
a) aneurysm; b) coarctation; c) obstruction (bifurcation)
 Peripheral vascular disease with feeble or absent peripheral pulses
 Restlessness and/or chaotic breathing
 Congenital cardiac malformations
 Extra-cardiac shunts
 During renal dialysis
 Adiposity – 50% or more than normal
 Height under 1.50 m and above 2.00 m.
Attention: For optimal results, the patient must be motionless except for
normal breathing. If the patient cannot be immobile, sedation is
recommended.
50
14. TROUBLESHOOTING
1
When problems arise, a message will be displayed at the top of the screen
referring the user to the following chart:
S
c
A
PROBLEM
9.1 MESSAGE: “Check
Connectors”
9.2 MESSAGE: “Bad
Electrodes”
ACTION
- Check if power connection and the RS232 plug
are properly plugged in.
- If problem persists, contact manufacturer’s local
Service Department.
- Check ECG and impedance electrodes for dirt or
broken parts.
- Unplug sensors, clean connectors with a clean
cloth and 90% alcohol.
- If unsuccessful, replace with new set of
electrodes.
in
o
t
N
3
K
T
F
In case of a general problem, refer to the following chart for further details:
PROBLEM
RESOLUTION
E
N
L
T
E
N
T
F
E
N
51
:
15. SERVICE
Should service be required during or after the warranty period, please
contact New NI Medical representative as per list below (please visit our
website www.ni-medical.com for an update distributor list) to obtain a
Return Authorization Number. Please repackage the device carefully in its
original box or in a sturdy carton to prevent damage. Include a note
describing the nature of the problem and your return address. We also
suggest that you insure the package. Send the medical device to:
Main Office
New NI Medical (2011) Ltd.
3 En Hay St.
Kfar Mallal 4592000, Israel
Tel.: +972 9 7407031
Fax: +972 9 7401030
Email: sales@nimedical.co.il
www.ni-medical.com
EU Official representative
New NI Medical (2011) UK
TEL: +44-(0)758-049-8397
E-mail: sales@nimedical.co.uk
www.ni-medical.com
USA
New NI Medical (2011) USA
500 Market St. Suite205
Chapel Hill, NC 27516 USA
Tel.: +1-800-979-2904
Fax: +1-888-724-2926
E-mail: sales@ni-medical.com
www.ni-medical.com
52
NI Medical will provide service and support for the product for at least
seven years from the day of manufacture.
16. ORDERING INFORMATION
If for any reason you wish to order one of the following items, please write
to us or to your supplier, and remember to enter part number and
description, as specified below:
Part No.
NI2.0001.01
NI2.0005.01
NI2.0006.01
NI2.0009.04
Description
NICaS CS Module, Integrated ECG
NICaS CS ICG Cable
NICaS CS ECG Cable
NICaS CS Sensor Kit, ICG only, box of 100 applications
N
fr
e
to
M
fa
c
n
L
a
w
m
e
T
re
a
g
w
in
53
st
e
s
APPENDIX A: LIMITED ONE-YEAR WARRANTY
1. Warranty
N.I. Medical Ltd. warrants that for a period of twelve (12) months
from installation of equipment at a customer’s premises, such
equipment (excluding consumable component) will materially conform
to its published specifications under normal use and service. New NI
Medical Ltd.'s sole obligation and customer's sole remedy, for any
failure of an equipment to perform as warranted above, is, the
correction or replacement, at New NI Medical Ltd.'s option, of the
non-conforming equipment, provided, however, that New NI Medical
Ltd. has been notified by customer or New NI Medical Ltd.'s
authorized distributor of the non-conformity prior to expiration of the
warranty period set forth above; replacement of equipment shall be
made by New NI Medical Ltd. only against receipt of the defective
equipment unless otherwise agreed between the parties.
2. Warranty Exceptions
The warranty set forth herein will not apply, and, customer will
reimburse New NI Medical Ltd. or its authorized distributor, as
applicable, for any costs and expenses incurred in connection with
goods or services provided in the event:
a)
the equipment has been used other than in accordance
with this User Manual, its documentation or other written operating
instructions or has been subject to negligence or accident by anyone
54
other than New NI Medical Ltd. or its authorized distributor;
b)
use of the equipment in excess of the maximum period
determined by New NI Medical Ltd. or its authorized distributor;
c)
products or parts identification labels are removed or
altered from the equipment;
d)
the equipment has been modified, repaired, serviced,
maintained or altered by anyone other than New NI Medical Ltd. or its
authorized distributor;
e)
the equipment has been combined with software,
hardware or other equipment not supplied by New NI Medical Ltd. or
its authorized distributor;
f)
if at any time the power supplied to any part of the
equipments exceeds the rated tolerance design parameters or
applicable local regulations;
g)
the equipment has been installed not in accordance with
the written installation instructions provided by New NI Medical Ltd. or
by its authorized distributor;
h)
the equipment has been damaged by causes beyond the
control of New NI Medical Ltd.;
i)
the equipment has been modified without New NI Medical
Ltd.'s written consent; or
j)
if any time the serial number plate is removed or defaced.
55
3
E
E
O
I
M
P
A
D
O
S
E
I
S
T
4
Customer will reimburse New NI Medical Ltd. for all expenses
and costs involved in New NI Medical Ltd.'s efforts in the event
the problem for which service sought is not covered by the
above warranty.
3. Limited Warranty.
EXCEPT FROM THE WARRANTY SPECIFIED ABOVE THE
EQUIPMENT IS PROVIDED “AS IS” AND THERE ARE NO
OTHER WARRANTIES EXPRESSED OR IMPLIED, IN LAW OR
IN FACT, INCLUDING THE IMPLIED WARRANTIES OF
MERCHANTABILITY AND FITNESS FOR A PARTICULAR
PURPOSE TO CUSTOMER HEREUNDER. CUSTOMER
ACKNOWLEDGES THAT THE EQUIPMENT IS NOT A
DIAGNOSTIC OR THERAPEUTIC DEVICE AND MAY BE USED
ONLY FOR THE PURPOSES APPROVED BY THE FDA AS
SPECIFIED BELOW. CUSTOMER ACKNOWLEDGES THAT
EQUIPMENT MAY BE USED ONLY ON PERSONS WHICH ARE
INCLUDED IN THE "INTENDED PATIENT POPULATION"
SPECIFIED ABOVE AND THAT DO NOT FALL WITHIN ANY OF
THE EXCLUSION CRITERIA SPECIFIED THEREIN.
4. Limitation of Liability.
N.I. MEDICAL LTD. IS NOT LIABLE TO CUSTOMER FOR
INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL
DAMAGES RESULTING FROM ANY BREACH OF WARRANTY
OR BREACH OF THIS AGREEMENT OR UNDER ANY OTHER
56
LEGAL THEORY INCLUDING, BUT NOT LIMITED TO, LOST
PROFITS, DOWNTIME, GOODWILL, DAMAGE TO OR
REPLACEMENT OF EQUIPMENT AND PROPERTY, AND ANY
COSTS
OF
RECOVERING,
REPROGRAMMING,
OR
REPRODUCING ANY PROGRAM OR DATA STORED IN OR
USED WITH AN EQUIPMENT EVEN IF N.I. MEDICAL LTD.
HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH
DAMAGES OR LOSSES. IN NO EVENT SHALL N.I. MEDICAL
LTD. BE LIABLE FOR THE CUSTOMER'S COSTS OF
PROCURING SUBSTITUTE PRODUCTS OR COMPONENTS.
IN NO EVENT SHALL N.I. MEDICAL LTD. BE LIABLE FOR
ANY THIRD PARTY PRODUCTS (SUCH US COMPUTERS)
THAT ARE USED TOGETHER WITH THE EQUIPMENT EVEN
IF THEY WERE PURCHASED VIA N.I. MEDICAL LTD. OR ITS
AUTHORIZED DISTRIBUTORS.
THE AMOUNT OF LIABILITY OF N.I. MEDICAL LTD. FOR ANY
CLAIM ARISING UNDER CUSTOMER'S USE OR INABILITY TO
USE THE EQUIPMENT, WHETHER BASED ON BREACH OF
CONTRACT, BREACH OF WARRANTY, NEGLIGENCE,
STRICT LIABILITY OR OTHERWISE WILL NOT EXCEED THE
AMOUNT PAID BY CUSTOMER. THESE LIMITATIONS APPLY
TO ALL CAUSES OF ACTION IN THE AGGREGATE.
SOME OF THESE LIMITATIONS MAY NOT BE FULLY
APPLICABLE IN CERTAIN JURISDICTIONS.
57
58
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