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BeneVision N22/BeneVision N19
BeneVision N17/BeneVision N15/BeneVision N12
Patient Monitor
Operator’s Manual
© Copyright 2017-202
2
Shenzhen Mindray Bio-Medical Electronics Co., Ltd. All rights reserved.
Release time:
April
202
2
Revision: 1
7
.0
WARNING
•
Federal Law (USA) restricts this device to sale by or on the order of a physician or other practitioner licensed by U.S. state law to use or order the use of this device.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual I
II
Intellectual Property Statement
SHENZHEN MINDRAY BIO-MEDICAL ELECTRONICS CO., LTD. (hereinafter called Mindray) owns the intellectual property rights to this Mindray product and this manual. This manual may refer to information protected by copyright or patents and does not convey any license under the patent rights or copyright of Mindray, or of others.
Mindray intends to maintain the contents of this manual as confidential information. Disclosure of the information in this manual in any manner whatsoever without the written permission of Mindray is strictly forbidden.
Release, amendment, reproduction, distribution, rental, adaptation, translation or any other derivative work of this manual in any manner whatsoever without the written permission of Mindray is strictly forbidden.
is the trademark, registered or otherwise, of Mindray in China and other countries. All other trademarks that appear in this manual are used only for informational or editorial purposes. They are the property of their respective owners.
This posting serves as notice under 35 U.S.C.§287(a) for Mindray patents: http://www.mindrayna.com/patents.
Manufacturer’s Responsibility
Contents of this manual are subject to changes without prior notice.
Mindray is responsible for the effects on safety, reliability and performance of this product, only if:
■
■
■ all installation operations, expansions, changes, modifications and repairs of this product are conducted by
Mindray authorized personnel; the electrical installation of the relevant room complies with the applicable national and local requirements; the product is used in accordance with the instructions for use.
WARNING
•
Only skilled/trained clinical professionals should operate this equipment.
•
It is important for the hospital or organization that uses this equipment to perform a recommended service/maintenance plan. Neglect of this may result in machine breakdown or personal injury.
Service
Mindray maintains a network of service representatives and factory-trained distributors. Prior to requesting service, perform a complete operational check of the instrument to verify proper control settings. If operational problems continue to exist, contact Mindray service.
In North America contact the Service Department at (800) 288-2121, ext: 8116 for Technical Support or (201)
995-8000 for assistance in determining the nearest field service location.
Please include the instrument model number, the serial number, and a description of the problem with all requests for service.
Any questions regarding the warranty should be directed to the local sales or service representative.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Company Contact
Manufacturer:
Address:
Website:
E-mail Address:
Tel:
Fax:
Distributor:
Address:
Tel:
Website:
Shenzhen Mindray Bio-Medical Electronics Co., Ltd.
Mindray Building, Keji 12th Road South, High-tech Industrial Park, Nanshan,
Shenzhen 518057, P.R.China
www.mindray.com
+86 755 81888998
+86 755 26582680
Mindray DS USA, Inc.
800 MacArthur Boulevard, Mahwah, New Jersey, 07430 USA
1.800.288.2121, 1.201.995.8000
www.mindray.com
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual III
Preface
Manual Purpose
This manual contains the instructions necessary to operate the product safely and in accordance with its function and intended use. Observance of this manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety.
This manual is based on the maximum configuration and therefore some contents may not apply to the product.
If you have any question, please contact Mindray.
This manual is an integral part of the product. It should always be kept close to the equipment so that it can be obtained conveniently when needed.
Intended Audience
This manual is geared for clinical professionals who are expected to have a working knowledge of medical procedures, practices and terminology as required for monitoring of patients.
Illustrations
All illustrations in this manual serve as examples only. They may not necessarily reflect the setup or data displayed on the patient monitor.
Conventions
■
■
■
Italic text is used in this manual to quote the referenced manuals, chapters, sections and formulas.
Bold text is used to indicate the screen texts and names of hard keys.
→ is used to indicate operational procedures.
IV BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Contents
Main Unit .........................................................................................................................................................................2 - 2
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 1
2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 3
Parameters from External Devices ....................................................................................................................................6 - 4
Data from External Devices on the Main Screen ............................................................................................6 - 5
4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 5
12 Monitoring Pulse Oxygen Saturation (SpO
2
) ..............................................................................................................12 - 1
Introduction ..................................................................................................................................................................................... 12 - 1
Safety Information ......................................................................................................................................................................... 12 - 2
Measurement Limitations ........................................................................................................................................................... 12 - 3
Display ................................................................................................................................................................................................ 12 - 4
6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Monitoring ............................................................................................................................................................. 12 - 4
2
Settings .................................................................................................................................................................. 12 - 5
Alarm Settings ....................................................................................................................................... 12 - 5
TM
Alarm Management ....................................................................................................................... 12 - 5
Sensitivity (for Masimo SpO
2
) ....................................................................................................................... 12 - 6
12.6.4 Enabling FastSAT (for Masimo SpO
2
) .................................................................................................................................... 12 - 7
12.6.5 Displaying SIQ (for Masimo SpO
2
) ......................................................................................................................................... 12 - 7
12.6.6 Changing Averaging Time (for Masimo SpO
) .................................................................................................................. 12 - 7
and NIBP Simultaneously ....................................................................................................................... 12 - 8
2
Troubleshooting ............................................................................................................................................................................. 12 - 9
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 7
8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
17 Monitoring Central Venous Oxygen Saturation (ScvO
) ............................................................................................17 - 1
Introduction .................................................................................................................................................................................... 17 - 1
Safety Information ........................................................................................................................................................................ 17 - 1
Display .............................................................................................................................................................................................. 17 - 1
17.4 Accessing the On-screen ScvO
Guide ............................................................................................................................................... 17 - 2
Equipment to Patient Connection .......................................................................................................................................... 17 - 2
2 ..........................................................................................................................................................................................................................................17 - 2
Calibration ....................................................................................................................................................................................... 17 - 3
Settings ........................................................................................................................................................................ 17 - 3
2
Alarm Settings ............................................................................................................................................. 17 - 3
Value .......................................................................................................................................................... 17 - 4
2
Introduction ............................................................................................................................................................................ 18 - 1
2
Safety Information ............................................................................................................................................................... 18 - 2
/ScvO
2
Settings ............................................................................................................................................................ 18 - 7
/ScvO
2
Alarm Settings ......................................................................................................................... 18 - 7
2
/ScvO
2
Analog Output Signal ................................................................................................................. 18 - 8
2
Troubleshooting ................................................................................................................................................................... 18 - 9
19 Monitoring Carbon Dioxide (CO
) ................................................................................................................................19 - 1
2
Introduction ........................................................................................................................................................................................ 19 - 1
Modules ......................................................................................................................................................................... 19 - 1
2
Safety Information ............................................................................................................................................................................ 19 - 2
2
Measurement Limitations .............................................................................................................................................................. 19 - 2
2
Display .................................................................................................................................................................................................. 19 - 2
Using the Sidestream/Microstream CO
2
Module ........................................................................................... 19 - 3
19.6.1 Preparing to Measure CO
Using the Sidestream CO
2
Module .................................................................................. 19 - 3
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 9
19.6.2 Preparing to Measure CO
2
Using the Microstream CO
2
Module ............................................................................... 19 - 4
19.6.3 Zeroing the Sidestream/Microstream CO
2
Module ........................................................................................................ 19 - 5
19.7 Changing Settings for All CO
Modules ............................................................................................................................................ 19 - 5
Alarm Settings ................................................................................................................................................ 19 - 5
Waveform ....................................................................................................................................................... 19 - 5
2
Calibration ........................................................................................................................................................................................ 19 - 8
2
Troubleshooting ............................................................................................................................................................................. 19 - 8
19.13.1 Troubleshooting the Sidestream/Microstream CO
Module .................................................................................... 19 - 9
Compensation ................................................................................................................................................. 20 - 6
10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 11
24 Monitoring Regional Oxygen Saturation (rSO
2
) .........................................................................................................24 - 1
2
Introduction ...................................................................................................................................................................................... 24 - 1
2 Safety Information .......................................................................................................................................................................... 24 - 2
2
Measurement Limitations ............................................................................................................................................................ 24 - 2
2
Display ................................................................................................................................................................................................. 24 - 2
24.5 Accessing the On-screen rSO
2
Guide ................................................................................................................................................. 24 - 3
2
Monitoring ............................................................................................................................................................. 24 - 3
Sensor Site Selection ........................................................................................................................................................ 24 - 3
Sensor ......................................................................................................................................................... 24 - 4
Parts ....................................................................................................................................................... 24 - 4
2
Settings .......................................................................................................................................................................... 24 - 5
Alarm Settings ............................................................................................................................................... 24 - 5
Auto Low Limit Switch ............................................................................................................................ 24 - 5
Label ............................................................................................................................................................... 24 - 5
12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2
Parameters for Display ................................................................................................................................. 24 - 6
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 13
27.2 Calculation Safety Information ............................................................................................................................................................. 27 - 1
27.3 Drug Calculations ...................................................................................................................................................................................... 27 - 1
27.3.1 Performing Drug Calculations ................................................................................................................................................ 27 - 1
28.1 Recorder ........................................................................................................................................................................................................ 28 - 1
28.2 Starting Recordings .................................................................................................................................................................................. 28 - 1
28.2.1 Manually Starting Recordings ................................................................................................................................................. 28 - 1
28.2.2 Automatic Recordings ............................................................................................................................................................... 28 - 1
14 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 15
32.5.5 Manually Zeroing the CO
Module ..................................................................................................................................... 32 - 15
32.5.6 Hiding the Invalid Display after Zeroing the CO
Module ..........................................................................................32 - 15
32.5.11 Setting Flow Rate (For Sidestream CO
Module Without O
2
) .................................................................................32 - 16
16 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 17
2
Tone Mode .............................................................................................................................................. 32 - 28
18 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2
Accessories ........................................................................................................................................................................................ 36 - 4
RD Set Sensors Available for Purchase .................................................................................................... 36 - 5
LNCS Sensors Also Compatible .................................................................................................................. 36 - 5
2
Sensors Also Compatible ................................................................................................................................ 36 - 5
2
Accessories .......................................................................................................................................................................................... 36 - 9
Accessories Available for Purchase ....................................................................................................... 36 - 9
2
Accessories Also Compatible ............................................................................................................... 36 - 9
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 19
2
Accessories ....................................................................................................................................................................................36 - 11
Accessories Available for Purchase ........................................................................................................................ 36 - 11
Accessories Also Compatible ................................................................................................................................... 36 - 11
20 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Specifications ....................................................................................................................................................................A - 13
Specifications ................................................................................................................................................................A - 20
2
Specifications ....................................................................................................................................................................A - 20
2
Specifications ...................................................................................................................................................................A - 27
2
/SpO
2 b Default Settings .................................................................................................................................................................... C - 5
Default Settings ...............................................................................................................................................................................C - 12
/SvO
2
Default Settings(Vigilance II/Vigileo/EV1000/HemoSphere) ............................................................................C - 12
2
Default Settings .................................................................................................................................................................................C - 13
Default Settings ...............................................................................................................................................................................C - 17
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 21
2
Physiological Alarm Messages ........................................................................................................................................ D - 2
Physiological Alarm Messages ............................................................................................................................................. D - 2
Physiological Alarm Messages .......................................................................................................................................... D - 3
2
Technical Alarm Messages ................................................................................................................................................ D - 4
2
Technical Alarm Messages .............................................................................................................................................. D - 7
Technical Alarm Messages ............................................................................................................................................... D - 7
2
Technical Alarm Messages ............................................................................................................................................D - 11
Technical Alarm Messages ..........................................................................................................................D - 11
Sensor Accuracy ....................................................................................................................................................... E - 1
E.1 The Accuracy of Masimo SpO
Sensors ................................................................................................................................................... E - 1
E.2 The Accuracy of Nellcor SpO
2
Sensors .................................................................................................................................................... E - 3
22 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1
Safety
1.1
1.1.1
Safety Information
WARNING
•
Indicates a potential hazard or unsafe practice that, if not avoided, could result in death or serious injury.
CAUTION
•
Indicates a potential hazard or unsafe practice that, if not avoided, could result in minor personal injury or product/property damage.
NOTE
•
Provides application tips or other useful information that does not involve patient or user risk.
Warnings
WARNING
•
Patient with a pacemaker – on ventricular paced patients, episodes of Ventricular Tachycardia may not always be detected. Do not rely entirely upon the system’s automated arrhythmia detection algorithm. Keep pacemaker patients under close surveillance.
•
This equipment is used for a single patient at a time.
•
To avoid explosion hazards, do not use the equipment in the presence of oxygen-rich atmospheres, flammable anesthetics, or other flammable agents.
•
Do not touch the equipment’s metal parts or connectors when in contact with the patient; otherwise patient injury may result.
•
Never mix patient electrode types or brands. Dissimilar metals or other incompatibilities may cause considerable baseline drift and may increase trace recovery time after defibrillation.
•
To reduce the hazard of burns during high-frequency surgical procedure, ensure that the monitor’s cables and transducers never come into contact with the electro-surgery unit (ESU).
•
The neutral electrode of the electro-surgery unit (ESU) shall properly contact the patient. Otherwise, burns may result.
•
MR unsafe: the N Series monitor is not intended to be used within the Magnetic Resonance (MR) environment.
•
Before connecting the equipment to the mains power, ensure that the voltage and frequency ratings of the power line are the same as those indicated on the equipment’s label or in this manual.
•
Before putting the system into operation, the operator must verify that the equipment, connecting cables, and accessories are in correct working order and operating condition.
•
To avoid risk of electric shock, the equipment must only be connected to mains power with protective earth, or operated on battery power.
•
Do not touch the patient and live parts simultaneously. Otherwise patient injury may result.
•
Do not touch the patient or metal parts in contact with the patient during defibrillation. Otherwise serious injury or death could result.
•
Do not open the equipment housings. All servicing and future upgrades must be carried out by trained and authorized personnel.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 1 - 1
•
Do not rely exclusively on the audible alarm system for patient monitoring. Turning the alarm volume to a low level or off may result in a hazard to the patient. Always keep the patient under close surveillance.
•
Alarm settings should be customized according to patient situations.
•
Do not place the equipment or accessories in any position that might cause it to fall on the patient.
•
Do not start or operate the equipment unless the setup was verified to be correct.
•
To avoid inadvertent disconnection, route all cables in a way to prevent a stumbling hazard. Wrap and secure excess cabling to reduce risk of entanglement by patients or personnel.
•
The physiological data and alarm messages displayed on the equipment are for reference only and cannot be directly used for diagnostic interpretation. The equipment should not be used as the sole basis for medical decisions. It must be used in conjunction with clinical signs and symptom. If any measurement seems questionable, first check the patient’s vital signs by alternate means and then check the equipment for proper functioning.
1.1.2
Cautions
CAUTION
•
Use only parts and accessories specified in this manual.
•
Disposable accessories are not designed to be reused. Reuse may cause a risk of contamination and affect the measurement accuracy.
•
Ensure that the equipment is supplied with continuous electric power during operation from the mains power or batteries. Sudden power failure may cause data loss.
•
When no battery is installed, ensure that the monitor is supplied with continuous electric power during operation. Sudden power failure may lead to data loss.
•
Store and use the equipment in specified environmental condition. The monitor and accessories may not meet the performance specification due to aging, stored or used outside the specified temperature and humidity range.
•
Magnetic and electrical fields are capable of interfering with the proper performance of the equipment. For this reason make sure that all external devices operated in the vicinity of the equipment comply with the relevant EMC requirements. Mobile phones, X-ray equipment, and MRI devices are possible sources of interference as they may emit higher levels of electromagnetic radiation.
•
Always install or carry the equipment properly to avoid damage caused by drops, impacts, strong vibrations or other mechanical forces.
•
Dry the equipment immediately in case of rain or water spray.
•
Some settings are password protected and can only be changed by authorized personnel. Contact your department manager or biomedical engineering department for the passwords used at your facility.
•
Do not loop the patient cabling into a tight coil or wrap around the device, as this can damage the patient cabling.
•
Dispose of the package material as per the applicable waste control regulations. Keep it out of children’s reach.
•
At the end of its service life, the equipment, as well as its accessories, must be disposed of in compliance with the guidelines regulating the disposal of such products. If you have any questions concerning disposal of the equipment, please contact Mindray.
1.1.3
Notes
NOTE
•
The equipment software copyright is solely owned by Mindray. No organization or individual shall resort to modifying, copying, or exchanging it or to any other infringement on it in any form or by any means without due permission.
•
Put the equipment in a location where it can be easily viewed and operated.
1 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1.2
•
The equipment uses a mains plug as isolation means to the mains power. Do not locate the equipment in a place difficult to access the mains plug.
•
During normal use, the operator is expected to face the front of the equipment.
•
Remove the battery before shipping the monitor or if it will not be used for an extended period of time.
•
Remove the battery before transporting the equipment or if the equipment will not be used for a long time.
•
The software was developed in compliance with IEC62304, to minimize the possibility of hazards arising from software errors.
•
This manual is based on the maximum configuration and therefore some contents may not apply to the product. If you have any question, please contact Mindray.
•
Observance of this manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety.
•
Keep this manual in the vicinity of the equipment so that it can be referenced when needed.
Equipment Symbols
Symbol Description
General warning sign
Symbol Description
Refer to instruction manual/booklet
Serial number
Date of manufacture
USB connector
Battery indicator
Equipotentiality
Catalogue number
Manufacturer
Protected against vertically falling water drops per IEC 60529
Computer network
Alternating current
Defibrillation-proof type CF applied part
Stop USB
Input/output
Defibrillation-proof type BF applied part
Output
IBP zero key
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 1 - 3
Symbol Description
NIBP start/stop
Start
Set baseline
Stand-by
Check sensor
Gas outlet
Pushing prohibited (wheels locked, no pushing)
Video output
Dispose of in accordance to local requirements
Symbol Description
Calibration
Stop
Batch code
Menu
Graphical record
Gas inlet
Unlocking
Non-ionizing electromagnetic radiation
Plastic identification symbol
Conforms to ANSI Std. ES60601-1, IEC Std. 60601-1-8, IEC Std. 60601-2-25, IEC Std. 60601-2-26, IEC Std. 60601-
2-27, IEC Std. 80601-2-30, IEC Std. 60601-2-34, IEC Std. 60601-2-49, ISO Std. 0601-2-55, ISO Std. 80601-2-56, and ISO Std. 80601-2-61
1 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2
Equipment Introduction
2.1
2.2
Indications for Use
The BeneVision N12/N15/N17/N19/N22 patient monitors are intended for monitoring, displaying, reviewing, storing, alarming, and transferring of multiple physiological parameters including ECG (3-lead, 5-lead, 6-lead or
12-lead selectable, Arrhythmia Detection, ST Segment Analysis, QT Analysis, and Heart Rate (HR)), Respiration
Rate (Resp), Temperature (Temp), Pulse Oxygen Saturation (SpO
2
), Pulse Rate (PR), Non-invasive Blood Pressure
(NIBP), Invasive Blood Pressure (IBP), Pulmonary Artery Wedge Pressure (PAWP), Cardiac Output (C.O.),
Continuous Cardiac Output (CCO), Mixed/Central Venous Oxygen Saturation (SvO
2
/ScvO
2
), Carbon Dioxide
(CO
2
), Oxygen (O
2
), Anesthetic Gas (AG), Impedance Cardiograph (ICG), BispectralIndex (BIS), Respiration
Mechanics (RM), Neuromuscular Transmission Monitoring (NMT), Electroencephalograph (EEG), and Regional
Oxygen Saturation (rSO
2
). The system also provides an interpretation of resting 12-lead ECG.
All the parameters can be monitored on single adult, pediatric, and neonatal patients except for the following:
■ The BIS, RM, CCO, SvO
2
/ScvO
2
, PAWP, NMT monitoring, PNP, and PNC are intended for adult and pediatric patients only.
C.O. monitoring and A-Fib are intended for adult patients only. ■
■ ICG monitoring is intended for only adult patients who meet the following requirements: height: 122 to
229cm, weight: 30 to 155kg.
■ rSO
2
monitoring is intended for use in individuals greater than 2.5 kg.
The monitors are to be used in healthcare facilities by clinical professionals or under their guidance. They should only be used by persons who have received adequate training in their use. The BeneVision N12/N15/N17/N19/
N22 monitors are not intended for helicopter transport, hospital ambulance, or home use.
NOTE
•
This manual is based on the maximum configuration and therefore some contents may not apply to the product. If you have any question, please contact Mindray.
Applied Parts
The applied parts of the monitor are:
■
■
■
■
■
■
■
■
■
■
■
■
■
■
ECG electrode and leadwire
SpO
2
sensor
Temp probe
NIBP cuff
IBP transducer
C.O. sensor
CCO sensor
ScvO
2
sensor
CO
2
sampling line/nasal sampling cannula, water trap, and mask
AG sampling line, water trap, airway adapter, and mask
EEG electrode
BIS sensor
NMT sensor and electrode rSO
2
sensor
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 2 - 1
2.3
System Components
The N22 and N19 monitors consist of the main unit, primary display, secondary displays, external modules, satellite module rack (SMR), input devices, and output devices.
The N17, N15, N12 monitors consist of the main unit, external display, external modules, input devices, and output devices. The N17 and N15 can also configured with the satellite module rack (SMR).
NOTE
•
The monitor may not include all these components. Contact the local service personnel for available components.
2.3.1
N22, N19 Main Unit
The main unit processes data from modules and sends information to displays and, optionally, among networked devices.
2.3.1.1
N22, N19 Main Unit for Integrated Installation
If the main unit and the primary display are installed together. It provides the following connectors:
(1) (2) (3) (4)
(10)
(5) (6) (7) (8) (9)
N22, N19 Main Unit Bottom View
(11)
13
2 - 2
12
(1) Cable retainer
N22, N19 Main Unit Side View
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(2)
(3)
(4)
AC Power input
Nurse call connector (NC)
It is a BNC connector. It connects the monitor to the hospital’s nurse call system through the nurse call cable (PN:
8000-21-10361). Alarms from the monitor are sent to the nurse station through the nurse call system, if configured to do so.
Satellite module rack connector (SMR1, 2, 3): connects the SMR and N1/T1 docking station.
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
When using the monitor together with other devices, connect their equipotential grounding terminals together to eliminate the potential difference between them.
Video output connector (VP1): connects the secondary display.
Network Connector (LAN1)
It is a standard RJ45 connector which connects the monitor to the central monitoring system (CMS) or other network devices.
Network Connector (LAN 2)
Reserved for future use.
Serial bus connectors (MSB1, 2, 3): connect approved USB devices, for example the keyboard, mouse, and barcode reader. If an independent secondary display is connected, the MSB1 connector is connected to the SBH connector at the rear of the secondary display to activate the MSB connector connecting the keyboard and mouse for the independent secondary display.
Network Connector (LAN3)
It is a standard RJ45 connector which connects the iView system to the external network.
Video output connector (VP2): connects the iView display.
USB connectors: available only when iView module is configured. They connect approved USB devices to the iView, for example keyboard and mouse.
UDI label
CAUTION
•
Main unit installation and troubleshooting should be executed by Mindray service personnel or authorized technicians.
NOTE
•
The UDI label on the main unit should be consistent with that on the display.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 2 - 3
2.3.1.2
N22, N19 Main Unit for Separate Installation
N19 Main Unit for Integrated Installation , the main unit also provides connectors at the rear.
(1) (2) (3)
(4)
2.3.2
(1) Video output connector (VP3): connects the VP connector on the separated primary display.
(2) Serial bus connector (MSB4): connects the serial bus hub connector (SBH) on the separated primary display.
(3) Signal input/output connector (SIG): connects the SIG1 connector on the separated primary display.
(4) DC-output connector: connects the DC-in connector on the separated primary display.
N22, N19 Displays
The displays are used to display system information, alarm messages, parameter numerics, waveforms, and so on. The displays integrate audible and visual alarms and provide USB connectivity. There are two display sizes available: the 22-inch display and the 19-inch display. The monitor supports a primary display, a secondary display, and a iView display.
2 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.3.2.1
N22, N19 Integrated Primary Display
The primary display can be attached to or separately from the main unit, either horizontally or vertically.
The following picture shows the indicators and connectors on the primary display when it is installed with the main unit.
(1)
(5)
(4)
(2)(3)
(1)
(6)
(7)
(5)
(6)
(7)
(3)
(2)
(4)
(5)
(1) Alarm lamp:
When a physiological alarm or technical alarm occurs, this lamp lights and flashes corresponding with the alarm priority:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 2 - 5
◆
High priority alarms: the lamp quickly flashes red.
◆
Medium priority alarms: the lamp slowly flashes yellow.
◆
Low priority alarms: the lamp lights in cyan without flashing.
(2) Battery indicator:
◆
Yellow: the battery is being charged.
◆
Green: the battery is fully charged.
◆
Flashing green: the monitor operates on battery power.
◆
Off: no battery is installed, or the battery is malfunctioning, or the monitor is powered off and no AC power is connected.
(3) AC power indicator
◆
On: when AC power is connected.
◆
Off: when AC power is not connected.
(4) Power switch
◆
Pressing this switch turns on the monitor.
◆
When the monitor is on, pressing and holding this switch turns off the monitor.
(5) Serial bus connectors (MSB): connect approved USB devices, for example keyboard, mouse, and barcode reader.
Note that every connector may not be visible if the handle (7) is installed.
(6) Navigation knob
(7) Handle
2.3.2.2
N22, N19 Separated Primary Display and Secondary Display
Besides the indicators and connectors, which are the same as those of the integrated primary display, the separated primary display and the secondary display have connectors at the rear.
(6)
(1) (2) (3) (4) (5)
2 - 6
(1) Serial bus connector (MSB1, MSB2): connect approved USB devices, for example keyboard, mouse, and barcode reader.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(2)
(3)
(4)
(5)
Signal input/output connector (SIG1): for the separate primary display, it connects the SIG connector at the rear of the main unit; for the secondary display, it is reserved for future use.
Serial bus hub connector (SBH): connects the MSB1 connector at the bottom of the main unit to activate MSB connectors for the independent secondary display.
DC-in connector: connects the DC adapter to run the secondary display.
Video connector (VP): connects only to the VP3 connector on the back of the main unit when used as a separate primary display.
UDI label (6)
NOTE
•
The UDI label on the main unit must be consistent with that on the display
•
VP of the primary display must connect to VP3 on the main unit to have a supported configuration.
2.3.3
N17, N15, N12 Main Unit
The main unit processes and displays data from modules, and optionally, among networked devices.
2.3.3.1
N17, N15, N12 Front View
(1)
(2)
(3)
(1)
(2)
(5) (4)
Alarm lamp:
When a physiological alarm or technical alarm occurs, this lamp lights and flashes corresponding with the alarm priority:
◆ High priority alarms: the lamp quickly flashes red.
◆ Medium priority alarms: the lamp slowly flashes yellow.
◆ Low priority alarms: the lamp lights in cyan without flashing.
Display
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 2 - 7
(3) AC power indicator
◆ On: when AC power is connected.
◆ Off: when AC power is not connected.
◆ Yellow: the battery is being charged.
◆ Green: the battery is fully charged.
◆
Flashing green: the monitor operates on battery power.
◆ Off: no battery is installed, or the monitor is powered off and no AC power is connected.
◆
Pressing this switch turns on the monitor.
◆ When the monitor is on, pressing and holding this switch turns off the monitor.
2.3.3.2
N17, N15, N12 Left View
(1)
(1)
(2)
(2)
(2)
(2)
N17/N15
(1) Handle
(2) Module racks
N12
2 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.3.3.3 N17, N15, N12 Right View
(1)
(2)
(1) Handle
(2) Recorder
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2.3.3.4 N15, N12 Rear View
(1)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(1)
(2)
(3)
(4)
(5)
(6)
USB connectors
Connect approved USB devices, for example the keyboard, mouse, and barcode reader.
Equipotential Grounding Terminal
When using the monitor together with other devices, connect their equipotential grounding terminals together to eliminate the potential difference between them.
AC Power input
Satellite module rack connector
For N15, connects the SMR and N1/ T1 docking station.
For N12, connects the N1/ T1 docking station.
Nurse call connector
It is a BNC connector. It connects the monitor to the hospital’s nurse call system through the nurse call cable (PN:
8000-21-10361). Alarms from the monitor are sent to the nurse station through the nurse call system, if configured to do so.
Digital video connector: connects external display.
It is a standard RJ45 connector which connects the monitor to the central monitoring system (CMS) or other network devices.
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2.3.3.5
N17 Rear View
(1) (3) (4)
(5)
(9)
(10)
(6)
(2)
(3)
(4)
(5)
(6)
(1)
(2) (7) (8)
Equipotential Grounding Terminal
When using the monitor together with other devices, connect their equipotential grounding terminals together to eliminate the potential difference between them.
AC Power input
USB connectors
Connect approved USB devices, for example the keyboard, mouse, and barcode reader.
USB connectors: available only when iView module is configured. They connect approved USB devices to the iView system, for example keyboard and mouse.
Digital video connector: connects a mirrored external display.
Digital video connector:
Connects the iView display if the iView module is configured.
Connects an independent external display if the N17 does not have an iView.
(8)
(9)
(10)
It is a standard RJ45 connector which connects the monitor to the central monitoring system (CMS) or other network devices.
Network Connector: available only when iView module is configured. It is a standard RJ45 connector which connects the iView system to an external network.
Satellite module rack (SMR) connector: connects the SMR or N1/T1 docking station.
Nurse call connector
It is a BNC connector. It connects the monitor to the hospital’s nurse call system through the nurse call cable (PN:
8000-21-10361). Alarms from the monitor are sent to the nurse station through the nurse call system, if configured to do so.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 2 - 11
2.3.4
Satellite Module Rack (SMR)
The SMR provides an interface between the monitor and external modules. The SMR has eight module slots. It is connected to the main unit through the SMR connector.
The following pictures show the indicator and connectors on the SMR.
(1)
(2) (3)
(1) SMR status indicator: illuminates when the SMR is powered on.
(2) Monitor connector: connects to the Passport 17m/12m monitor.
(3) Monitor connector: connects to the BeneVision monitor.
2.3.5
External Modules
■
■
■
The external modules are used to monitor the patient’s physiological parameters, record patient information and data, and connect external devices. The monitor provides the following modules:
Parameter modules: acquires and processes the patient’s data and sends the data to the main unit.
Recorder module: prints patient information, parameter measurements and waveforms.
BeneLink module: connects external devices. The monitor outputs data from external devices through the
BeneLink module.
2.3.5.1
Available Modules
Refer to 36.16 External Modules for available modules.
The monitor can simultaneously use maximum of three IBP modules and three Temp modules (besides the
Temp and IBP of the MPM module), and two rSO
2 modules. The other modules can only be used one at a time.
Otherwise, the monitor will issue a module conflict prompt. Using MPM module, T1, or N1 at the same time will also result in module conflict.
For example, if a CO
2 module is already loaded and then another CO
2
module is inserted, the monitor will then prompt module conflict. To solve the problem of module conflict, just remove a module.
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2.3.5.2
Example Module
The parameter modules have similar structure:
■
■
■
The parameter label is marked at the upper left corner.
Hard keys are located on the upper part.
Patient cable connectors are located at the lower part.
Take the MPM module as an example:
(1) (2) (3)
(5)
(9)
(4)
(5)
(6)
(7)
(8)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
NIBP Start/Stop key: starts/stops NIBP measurement.
Zero hard key: enters the Zero IBP dialog.
Analog out connector: outputs defibrillation synchronization pulse, ECG, and IBP analog signal.
Module status indicator
◆
On: the module works properly.
◆
Flashing: the module is initializing.
◆
Off: the module is not connected or the module fails.
Connector for IBP cable
Connector for Temp probe
Connector for NIBP cuff
Connector for SpO
2
cable
Connector for ECG cable
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2.3.5.3
BeneVision N1
The BeneVision N1 is used as an MPM module when being connected to the monitor through the module rack
(for N17, N15, N12), SMR or through the Dock.
(1) (2) (3)
(4)
(3)
(9)
(8)
(5)
(6)
(7)
(1) Power switch
(2) Sample line connector for sidestream
CO
2
(3) Temperature probe connector
(4) Gas outlet
(5) ECG cable connector
(6) SpO
2
sensor connector
(7) NIBP cuff connector
(8) Multifunctional connector: outputs analog ECG, IBP and defib synchronization signals.
(9) IBP cable connector
2.3.5.4
T1
The T1 is used as an MPM module when being connected to the monitor through the module rack (for N17, N15,
N12), SMR or through the T1 docking station.
(1) (1)
(6)
(5)
(2)
(3)
(4)
(1)
(2)
(3)
(4)
(5)
(6)
Temperature probe connector
NIBP cuff connector
ECG cable connector
SpO
2
sensor connector
Multifunctional connector: outputs analog
ECG, IBP, and defibrillation synchronization signals.
IBP cable connector
2 - 14 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.3.6
Cable Management Kit
The cable management kit is installed at the bottom of the SMR.
(1)
(2)
2.3.7
(1) Handle: can hold the NIBP cuff
(2) Cable hooks: can hold the cables and leadwires
Input Devices
The monitor allows data entry through touchscreen, keyboard, mouse, navigation knob, remote controller, and barcode reader.
Only Mindray specified input devices should be used. For N22 and N19, the primary display and the secondary display can have independent mice and keyboards. When the secondary display is used as an extended display, one mouse and one keyboard can control both the primary display and the secondary display.
For N22 and N19, you can use the navigation knob to operate some features of the monitor, such as scrolling through lists. The navigation knob is installed at the bottom of the display. The primary display and the secondary display can have independent navigation knobs. When the secondary display is configured as an extended display, you can use one navigation knob to control both the primary display and the secondary display.
(1) (2)
(3)
(1)
(2)
(3)
(4)
(5)
(5) (4)
Alarm Reset hard key: resets the alarm system
Main Menu hard key: enters the main menu.
Navigation knob
NIBP Start/Stop hard key: starts an NIBP measurement or stops the current NIBP measurement
Alarm Pause hard key: pauses physiological alarm system
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2.3.8
Printing Devices
The monitor can use Mindray specified printer and/or recorder to output patient information and data.
N17, N15, N12 can be configured with a built-in recorder. If the built-in recorder is not available, an optional external recorder module is available.
For N22 and N19, to use the recorder, insert the recorder module into the SMR.
The printer can be connected to the monitor through the network to output patient reports.
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3
Getting Started
3.1
3.2
Equipment Preparation Safety Information
WARNING
•
Use only installation accessories specified by Mindray.
•
Connect only approved devices to this equipment. Devices connected to the equipment must meet the requirements of the applicable IEC standards (e.g. IEC 60950 safety standards for information technology equipment and IEC 60601-1 safety standards for medical electrical equipment). The system configuration must meet the requirements of the IEC 60601-1 medical electrical systems standard. Any personnel who connect devices to the equipment’s signal input/output port are responsible for providing evidence that the safety certification of the devices has been performed in accordance to the IEC 60601-1. If you have any questions, please contact Mindray.
•
The monitor and parameter monitoring accessories are suitable for use within the patient environment. For other equipment and accessories connected to the monitor, consult corresponding manufacturers for the suitability within the patient environment.
•
If it is not evident from the equipment specifications whether a particular combination with other devices is hazardous, for example, due to summation of leakage currents, please consult the manufacturer or an expert in the field. A determination must be made that the proposed combination will not negatively affect the devices themselves or the patient's safety.
CAUTION
•
The equipment should be installed by Mindray authorized personnel.
•
When disposing of the packaging material, be sure to observe the applicable waste control regulations and keep it out of children’s reach.
•
Before use, verify whether the packages are intact, especially the packages of single use accessories.
In case of any damage, do not apply it to the patient.
•
Make sure that the equipment operating environment meets the specific requirements. Otherwise unexpected consequences, e.g. damage to the equipment, could result.
•
Avoid rough handling during transport.
NOTE
•
This manual is based on the maximum configuration and therefore some contents may not apply to the product. If you have any question, please contact Mindray.
•
Put the equipment in a location where it can be easily viewed and operated.
•
Keep this manual in the vicinity of the equipment so that it can be referenced when needed.
•
Save the packing case and packaging material as they can be used if the equipment must be reshipped.
•
Many settings in the patient monitor are password protected. It is recommended to change the default passwords and keep the passwords safe. Passwords should only be changed by authorized personnel. Contact the department manager or biomedical engineering department for the passwords used at the facility.
Monitor Installation
The monitor can be installed in various ways as required.
■
■
Wall mount
Installed on the medical supply unit
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 3 - 1
3.2.1
3.2.2
■ Installed on the anesthesia machine
Unpacking and Checking
Before unpacking, examine the packaging carefully for signs of damage. If any damage is detected, contact the carrier, distributor, or Mindray.
If the packing case is intact, open the package and remove the equipment and accessories carefully. Check all materials against the packing list and check for any mechanical damage. Contact Mindray in case of any problems.
Environmental Requirements
The operating environment of the equipment must meet the requirements specified in this manual.
The environment where the equipment is used shall be reasonably free from noises, vibration, dust, corrosive, flammable and explosive substances. Moreover, to maintain good ventilation, the equipment shall be at least 2 inches (5cm) away from around the cabinet.
When the equipment is moved from one place to another, condensation may occur as a result of temperature or humidity difference. In this case, never start the system before the condensation evaporates.
CAUTION
•
Make sure that the equipment operating environment meets the specific requirements. Otherwise unexpected consequences, e.g. damage to the equipment, could result.
3.3
3.3.1
Setting Up the Equipment
Observance of this manual is a prerequisite for proper product performance and correct operation. It ensures patient and operator safety.
Connecting the AC Mains
The monitor is powered by an AC power supply. Before connecting the equipment to the AC mains, check that the voltage and frequency ratings of the power line are the same as those indicated beside the AC power input.
To use the AC power source, follow this procedure:
1.
Connect the female end of the power cord with the AC power input.
2.
Connect the male end of the power cord with a wall AC outlet.
3.
Check that the AC indicator is on.
The AC indicator is off if the AC mains is not connected. When AC mains is connected, the AC indicator is illuminated in green.
WARNING
•
Operate the equipment on battery power if the integrity of the protective earth conductor or the protective earthing system in the installation is in doubt.
CAUTION
•
Always use the accompanying power cord delivered with the monitor.
•
Before connecting the equipment to the AC mains, ensure that the voltage and frequency ratings of the power line are the same as those indicated beside the AC power input.
NOTE
•
Use the cable retainer to secure the power cord to prevent it from falling off.
3 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
3.3.2
3.3.3
3.3.4
Connecting the Input Devices
Connect the mouse, keyboard, navigation knob, and/or barcode reader to the USB ports if necessary.
Connecting the SMR
To connect the SMR, use the SMR cable (PN: 009-005121-00 or 009-005122-00) to connect the monitor connector on the rear of SMR to the SMR connector on the main unit.
Connecting Modules to the SMR
3.3.5
To connect a module to the SMR, follow this procedure:
1.
With the module properly oriented, align the module insertion guide slot with the SMR insertion guide.
Push the module into the SMR until there is a click.
2.
Push the lock at the bottom of the module inwards to lock the module.
Removing Modules from the SMR
To remove a module from the SMR, follow this procedure:
1.
Pull outwards on the lock at the bottom of the module to release the module.
2.
Lift the latches at the bottom of the module and slide the module out of the SMR. Hold on the module securely to make sure it does not drop when it comes out.
(1)
(2)
(1)
(2)
Latch
Lock
CAUTION
•
When removing modules, be careful not to drop them. Modules may be heavier than expected, so securely supporting a module with two hands during removal is recommended.
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3.4
Turning on the Monitor
Before beginning measurements, turn on the monitor, perform the following inspections:
1.
Check the monitor, SMR and modules for any mechanical damage. Make sure that all external cables, plugins and accessories are properly connected.
2.
Connect the power cord to the AC power source.
3.
Press the power switch to turn on the monitor. Secondary displays must be turned on separately.
When the monitor is turned on, the alarms are paused for two minutes. Then the alarm system is activated.
CAUTION
•
Check that visual and auditory alarm signals are presented correctly when the equipment is powered on.
•
Do not use the monitor for any monitoring procedure on a patient if you suspect it is not working properly, or if it is mechanically damaged. Contact the service personnel or Mindray.
3.5
3.5.1
Operation and Navigation
Everything needed to operate the monitor is on its screen. Almost every element on the screen is interactive.
Screen elements include parameter values, waveforms, quick keys, information fields, alarms fields, dialogs, and menus. Often you can access the same element in different ways. For example, you can access a parameter dialog by selecting the corresponding numeric area or waveform area, through the Menu hard key on the parameter module, or through the Parameters Setup quick key.
Using the Touchscreen
You can use the touchscreen to select a screen element by pressing directly on the monitor’s screen.
3.5.1.1
Tapping or Swiping across the Screen
■ Tapping the screen
◆
To select an item from menus or lists or select a quick key, tap on it with your finger.
◆
To enter a parameter menu, tap the corresponding numeric area or waveform area. For example, select the ECG numeric area or waveform area to enter the ECG menu.
■
■
Swiping the screen with a single finger
◆ To scroll through a list or a menu, swipe up or down.
◆ To show or expand the Minitrends screen or the EWS screen, swipe right across the corresponding screen.
◆
To contract or hide the Minitrends screen or the EWS screen, swipe left across the corresponding screen.
Swiping across the screen with two fingers
◆ To switch to another screen, swipe left or right across the screen. For example, on the Normal screen, swipe with two fingers from left to right to switch to the Minitrends screen.
◆
To discharge a patient, swipe from top to bottom.
3.5.1.2
Locking the Touchscreen
To avoid accidental use, you can temporarily disable the touchscreen by holding and pressing the Main Menu quick key and sliding as directed by the arrow. A padlock symbol key if the touchscreen is disabled.
displays at the top of the main menu quick
The touchscreen lock period is configurable. To do so, follow this procedure:
1.
Access Display in either of the following ways:
◆ Select the Screen Setup quick key → select the Display tab.
◆ Select the Main Menu quick key → from the Display column select Display .
2.
Set Screen Lock Duration .
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The touchscreen is enabled when the preset time is reached. To manually enable the touchsceen, hold and press the Main Menu quick key and slide as directed by the arrow.
CAUTION
•
Check that the touchscreen is not damaged.broken, or loose. If there is any sign of damage, stop using the monitor and contact the service personnel.
3.5.2
3.5.3
3.5.4
Using the On-Screen Keyboard
The on-screen keyboard enables information entry:
■
■
■
■
Enter the information by selecting one character after another.
Select the Backspace key
Select the Caps Lock key
Select the Enter key
to delete single characters or select
to access uppercase letters.
to delete the entire entry.
to confirm the entry and close the on-screen keyboard.
If a conventional keyboard is connected to the monitor, you can use it instead of, or in combination with, the onscreen keyboard.
Using the Navigation Knob (for N22/N19)
You can use the navigation knob and associated buttons to access the main menu, pause alarms, reset alarms, and start/stop NIBP measurements.
Using the Barcode Reader
The monitor supports both a linear (1D) barcode reader and two-dimensional (2D) barcode reader. The barcode reader is connected to the monitor’s MSB connector (for N22/N19) or the USB connector (N17/N15/N12).
NOTE
•
Use the Mindray custom barcode reader to obtain all the available patient information from both the 2D and 1D barcodes. Using other barcode readers can only output the patient’s medical record number (MRN) and visit number.
3.5.4.1
Clearing Old Data Formats (for the Mindray Custom 2D Barcode Reader)
If you are using the Mindray custom 2D barcode reader (Model HS-1R or HS-1M), before using the it for the first time, clear old data formats and configure the barcode reader. To do so, follow this procedure:
1.
Scan the engineering barcode to clear the previous data format.
2.
Scan the 2D engineering barcode which contains the hospital’s data format.
NOTE
•
Contact the scanner manufacturer or Mindray to obtain the barcodes for clearing data formats and programming the hospital’s data format.
3.5.5
3.6
Using the Remote Controller
The remote controller can control the monitor by connecting the receiver of the remote controller to the monitor’s MSB connector (for N22/N19) or the USB connector (N17/N15/N12). For more information on how to use the remote controller, see the Instructions for Use delivered with the remote controller.
Screen Display
The following figure shows the normal screen:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 3 - 5
(1) (2) (3) (4) (5)
(6)
(7)
(8)
3.6.1
(9)
(1) Patient information area: displays patient information, including patient category, gender, department, room number, bed number, and so on. The displayed patient information is configurable. Selecting this area enters the
Patient Management dialog. For more information, see
5.2.1 Entering the Patient Management Dialog .
(2) The current configuration: displays the name of the configuration that can be loaded from the main menu.
(3) Technical alarm information area: displays prompt messages at the top; displays technical alarm messages at the bottom.
(4) Physiological alarm information area: displays high priority physiological alarms at the top; displays medium and low priority physiological alarms at the bottom.
(5) System status information area: displays alarm symbol, battery status, network status, currently connected CMS,
storage device status, and system time. For more information, see 3.6.1 On-screen Symbols .
(6) Parameter waveform area: displays parameter waveforms, measurement ranges, and magnification. Selecting a waveform enters the corresponding parameter dialog.
(7) Parameter numerics area: displays parameter values, alarm limits, and alarm status. This area can also display the parameter list. For more information, see
3.9.3 Displaying the Parameter List
. Selecting a parameter numeric block enters the corresponding parameter dialog. Selecting the parameter list enters Tabular Trends review.
(8) Parameter waveform/numerics area: unique area of the screen that can be configured to display either parameter numerics or parameter waveforms. Depending on the configuration, the tiles take on the characteristics of either area (6) or area (7).
(9) Quick key area: displays quick keys.
On-screen Symbols
The following table lists the on-screen symbols displayed on the system status information area:
Symbol Description
Adult, male
Symbol Description
Adult, female
Pediatric, male Pediatric, female
3 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Symbol Description
Neonate, male
Wireless network is connected. The solid part indicates network signal strength.
Wired network is connected.
Symbol Description
Neonate, female
Wireless network is not connected.
Wired network is not connected.
All the alarms are paused.
Audible alarm tones are paused.
The alarm system is reset.
The battery has low power and needs to be charged.
The battery is being charged.
Individual physiological alarms are turned off or the monitor is in the alarm off status.
Audible alarm tones are turned off.
The battery is working correctly. The green portion represents the remaining charge.
The battery has critically low charge and needs to be charged immediately. Otherwise, the monitor will automatically shut down soon.
No battery is installed.
3.6.2
Dialogs
All dialogs have similar style and structure, see the figure below:
(1)
(2)
(2)
(4)
(5)
(6)
(3)
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 3 - 7
(4) Exit button: closes the current dialog.
(5) Main body area: includes dialog items and options.
(6) Switch:
◆
Green: the switch is on.
◆
Gray: the switch is off.
3.6.3
Quick Keys
The monitor provides quick keys for you to quickly access some functions. The quick key area is located at the bottom of the screen. Normally the quick key area displays 14 quick keys (12 quicks keys for N12). The Main
Menu key is permanently located the right, and the More key is permanently located at the left. Selecting the
More quick key shows more quick keys. The quick keys displayed on the screen are configurable.
3.6.3.1
Available Quick Keys
The following table shows available quick keys.
Symbol Label
Main Menu
Function
Enters the main menu.
Symbol Label
Alarm Reset
Function
Resets the alarm system.
Alarm Pause
Screen Setup
Pauses the physiological alarm system (Availability depends on configuration of Pause in Maintenance
→ Alarm → Pause/Reset dialog).
Enters the Screen Setup dialog.
Manual Event Manually saves an event into the Events list.
NIBP Start/
Stop
NIBP STAT
Alarm Setup
Starts an NIBP measurement or stops the current NIBP measurement.
Starts a five-minute continuous NIBP measurement.
Enters the Alarm dialog.
Zero IBP Enters the Zero IBP dialog.
Audio Pause Pauses alarm tone
(Availability depends on configuration of Pause in
Maintenance → Alarm →
Pause/Reset dialog).
Standby Enters the standby mode.
Print Starts printing a real-time report.
NIBP Measure Opens the NIBP Measure interval options.
NIBP Stop All Stops all NIBP measurements.
More Shows more quick keys.
C.O. Measure Opens the C.O.
Measure screen.
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Symbol Label
PAWP
Function
Opens the PAWP screen.
Symbol Label
Loops
Venipuncture Inflates the NIBP cuff to help venous puncture.
Parameters
Setup
Enters the Parameters
Setup dialog.
Review
OxyCRG
Enters the Review dialog to review historical data.
Opens the OxyCRG screen.
Function
Opens the Loops screen.
Start TOF Starts/stops TOF measurement.
Remote View Opens the Remote View screen to view other patients.
Minitrends Opens the Minitrends screen.
ECG Full-
Screen
Opens the ECG full screen.
Night Mode Enters the night mode.
Privacy Mode Enters the privacy mode.
CPB Mode Enters the CPB mode.
Volume Enters dialog.
Intubation
Mode
Enters the intubation mode.
Freeze Freezes waveforms.
Calculations Enters the Calculations dialog.
Patient
Management
Enters the Patient
Management dialog.
Integrated
Devices
Opens the Integrated
Devices screen
ECG Lead/Gain Enters the ECG Lead/Gain dialog.
HemoSight Enters the HemoSight dialog.
GCS Enters the GCS dialog.
Load Config Enters the Load Config dialog.
Record Starts/Stops a recording.
Rotate Screen
(N22 and N19 only)
Changes the screen orientation.
Call Help Sends the Call Help signal over the network.
EWS Opens the EWS screen.
SepsisSight Enters the SepsisSight dialog.
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Symbol Label
Discharge
Patient
ECG 24h Sum
Function
Enters the Discharge
Patient dialog to discharge the patient and restore pre-configured default settings.
Views the 24-hour ECG summary.
Symbol Label
Discharged
Patients
End Case
Report
Function
Enters the Discharged
Patients dialog and displays previously discharged patients.
Prints the selected end case reports
Bedside
Devices
Enters the Bedside
Devices dialog.
Targeted Goal Opens the Targeted Goal screen.
3.6.3.2
Configuring the Displayed Quick Keys
To select the quick keys for display, follow this procedure:
1.
Access Quick Keys in either of the following ways:
◆
Select the Screen Setup quick key
→ the Select Quick Keys tab.
◆
Select the Main Menu quick key
→ from the Display column select Quick Keys .
2.
Select the Current tab to configure the quick keys for display on the screen: From the top of this page, select a block location to show a certain quick key, and then select the quick key from the quick key list. For example, to show the Screen Setup quick key at the first block, select the first block, and then select
Screen Setup from the list.
3.
Select the More tab to configure the quick keys for display when the More quick key is selected.
3.7
Operating Modes
The monitor provides different operating modes. This section describes the different monitoring modes and standby modes.
3.7.1
Monitoring Mode
The monitoring mode is the most frequently used clinical mode for patient monitoring. When the monitor is turned on, it automatically enters the monitoring mode.
3.7.2
Privacy Mode
The privacy mode is a special clinical monitoring mode. In the privacy mode, the monitor does not display patient information and monitoring data. This provides controlled access to patient data and ensures confidentiality.
The privacy mode is only available when the patient admitted by the monitor is also monitored by the CMS. The monitor continues monitoring the patient, but patient data is only visible at the CMS.
3.7.2.1
Entering the Privacy Mode
To enter the privacy mode, choose either of the following ways:
■
■
Select the Privacy Mode quick key
→
select Ok .
Select the Main Menu quick key
→
from the Display column select Privacy Mode
→
select Ok .
The monitor has the following features after entering the privacy mode:
■ The screen turns blank.
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■
■
Except for the low battery alarm, the monitor inactivates alarm tones and alarm lights for all other alarms.
The monitor suppresses all system sounds, including heart beat tone, pulse tone, and prompt tone.
WARNING
. •
In the privacy mode, all audible alarms are suppressed and the alarm light is deactivated at the monitor. Alarms are presented only at the CMS. Pay attention to potential risk.
NOTE
•
The privacy mode is not available if the Department is set to OR.
•
You cannot enter the privacy mode if a low battery alarm is active.
3.7.2.2
Exiting the Privacy Mode
The monitor automatically exit the privacy mode in any of the following situations:
■
■
The monitor disconnects from the CMS.
The low battery alarm occurs.
You can also operate the touchscreen, mouse, or keyboard to manually exit the privacy mode.
3.7.3
Night Mode
The night mode is a special clinical monitoring mode. The night mode reduces screen brightness, sound volumes, and pauses NIBP measurements. To avoid disturbing the patient, you can use the night mode.
3.7.3.1
Entering the Night Mode
To enter the night mode, follow this procedure:
1.
Select the Night Mode quick key, or select the Main Menu quick key → from the Display column select
Night Mode .
2.
Change the night mode settings if necessary.
3.
Select Enter Night Mode .
The night mode settings are as follows by default:
■
■
■
■
■
■
Brightness
Alarm Volume
QRS Volume
Key Volume
NIBP End Tone
Stop NIBP :
: 1
:
:
0
1
Off
:
:
2
Off
CAUTION
•
Verify the night mode settings before entering the night mode. Pay attention to the potential risk if the setting value is low.
3.7.3.2
Exiting the Night Mode
To cancel the night mode, follow this procedure:
1.
Select the Night Mode quick key, or select the Main Menu quick key
→
from the Display column select
Exit Night Mode .
2.
Select Ok .
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NOTE
•
If the monitor is connected to the CMS, it automatically exits the night mode if disconnected from the CMS.
•
The monitor resumes the previous settings after exiting the night mode.
3.7.4
Standby Mode
You can temperately stops patient monitoring without switching off the monitor by entering the standby mode.
3.7.4.1
Entering the Standby Mode
1.
Select the Standby quick key, or select the Main Menu quick key → from the Patient Management column select Standby .
2.
Define where the patient is by selecting a location in the drop down list when the monitor enters the standby mode.
3.
Select Ok .
The monitor behaves as follows after entering the standby mode:
■
■
■
Stops all parameter measurements.
Disables all the alarms and prompt messages, except for the battery low alarm.
Turns screen brightness to the dimmest after entering the standby mode for 30 seconds.
WARNING
•
Pay attention to the potential risk of placing the monitor to standby. In the standby mode, the monitor stops all parameter measurements and disable all the alarm indications, except for the battery low alarm.
3.7.4.2
Changing the Patient Location at Standby
To change the patient’s location, select patient location from the Standby screen.
3.7.4.3
Exiting the Standby Mode
To exit the standby mode, choose any of the following ways:
■
■
Select
Select
Resume Monitor to exit the standby mode and resume monitoring the current patient.
Discharge Patient to discharge the current patient.
If the monitor automatically enters the standby mode after a patient is discharged, choose any of the following ways to exit the standby mode:
■
■
Select
Select
Monitor to exit the standby mode and admit a new patient.
Patient Management to enter the patient information for preparing to admit a new patient.
When the monitor exits Standby mode and resumes monitoring, the alarms are paused for two minutes, after which the alarm system is activated.
3.7.5
3.8
Discharge Mode
The discharge mode is a special standby mode after a patient is discharged.
Configuring the Monitor
Configure the monitor before putting it in use.
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3.8.1
3.8.2
3.8.3
3.8.4
Setting the Screen Orientation (for N22 and N19)
Both the primary display and the secondary display can be installed vertically or horizontally. Set the screen orientation accordingly. To do so, follow this procedure:
1.
Access Display in either of the following ways:
◆ Select the Screen Setup quick key → select the Display tab.
◆ Select the Main Menu quick key → from the Display column select Display .
2.
Select Screen Orientation to set the screen orientation of the corresponding display.
◆ Portrait : if the display is vertically installed, set Screen Orientation to Portrait .
◆ Landscape : if the display is horizontally installed, set Screen Orientation to Landscape .
You can select the Rotate Screen quick key to quickly switch the screen orientation.
Setting the Date and Time
To set the system time, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Time .
2.
Set Date and Time .
3.
Set Date Format .
4.
If you want to use the 12-hour mode, switch off 24 Hour Time .
5.
If you want to use daylight saving time, switch on Daylight Saving Time . You can manually switch on or off the daylight saving time only when the auto daylight saving time function is disabled. For more
information, see 32.8.2 Enabling Auto Daylight Savings Time for details.
If the monitor is connected to a central monitoring system (CMS) or hospital clinical system (HIS), the date and time are automatically taken from the CMS. In this case, you cannot change the date and time on the monitor.
CAUTION
•
Changing the date and time affects the storage of trends and events and may result in loss of data.
Adjusting the Screen Brightness
To adjust the screen brightness, follow this procedure:
1.
Access Display in either of the following ways:
◆ Select the Screen Setup quick key → select the Display tab.
◆ Select the Main Menu quick key → from the Display column select Display .
2.
Set Brightness . If Brightness is set to Auto , the monitor automatically adjust the screen brightness according to the ambient light.
NOTE
•
The brightness of the primary screen and secondary screen can be adjusted separately.
Adjusting the Volume
■ Set Alarm Volume in either of the following ways:
■
◆ Select the Volume quick key.
◆ Select the Main Menu quick key → from the Alarm column select Setup .
Set Reminder Volume by selecting the Main Menu quick key → from the Alarm column select Setup .
■ Set QRS Volume in any of the following ways:
◆ Select the Volume quick key.
◆ From the ECG dialog select Setup .
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3.9
3.9.1
■
◆ From the SpO
2
dialog select PR Setup .
Select the Volume quick key to set Key Volume .
General Operation
This section describes the operations that are generally used when monitoring a patient.
Switching On or Off a Parameter
You can manually switch on or off a parameter when its module is connected. If setting parameter switches is not password protected, follow this procedure to set parameter switches:
1.
Access Parameters On/Off in either of the following ways:
◆ Select the Screen Setup quick key
→ select the Parameters On/Off tab.
◆ Select the Main Menu quick key
→
from the Parameters column select Parameters On/Off .
2.
Switch on or off desired parameters.
When a parameter is switched off, the monitor stops data acquisition and alarming for this measurement.
NOTE
•
When a parameter is manually switched off, you cannot monitor this parameter even if corresponding parameter module is plugged in and related accessories of this parameter are connected.
3.9.2
3.9.3
3.9.4
Displaying Parameter Numerics and Waveforms
You can configure the parameter numerics, waveforms, and their sequence displayed on the normal screen. To do so, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆ Select the Screen Setup quick key
→
select the Tile Layout tab.
◆ Select the Main Menu quick key
→ from the Display column select Tile Layout .
2.
Select a parameter numeric area or waveform area, and then from the popup list select an element you want to display in this area. The parameters and waveforms you did not select will not displayed.
If you are using the independent secondary display, you can select parameter and waveform locations on the secondary display.
Displaying the Parameter List
You can display the trends of HR, SpO
2
, RR, and NIBP/IBP in the parameter numerics area. To do so, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆ Select the Screen Setup quick key → select the Tile Layout tab.
◆ Select the Main Menu quick key → from the Display column select Tile Layout .
2.
Select the parameter numerics area where you want to display the parameter list, and then from the popup list select Parameter List .
Accessing Parameter Setup Dialogs
Each parameter has a setup dialog in which you can adjust the alarm and parameter settings. You can enter a parameter setup dialog by using any of the following methods:
■
■
■
Select the parameter numeric area or waveform area.
Press the setup hard key
Select the Parameters Setup
on the module front.
quick key , and then select the desired parameter .
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■ Select the Main Menu quick key → from the Parameters column select Setup → select the desired parameter .
NOTE
•
In this manual, we always use the first method to enter the setup dialog. But you can use any method you prefer.
3.9.5
Changing Measurement Colors
You can set the color of measurement values and waveforms for each parameter. To do so, follow this procedure:
1.
Select Main Menu quick key
→ from the Parameters column select Parameter Color .
2.
Select the Current tab and set the colors of the currently monitoring measurement values and waveforms.
3.
Select the All tab and set the colors of measurement values and waveforms for all parameters.
3.10
Initiating a Manual Event
To save a manual event, follow this procedure:
1.
Select the Manual Event quick key to enter the Manual Event menu.
2.
Select a name for this event, for example Intubated , or input a name.
3.
Select OK .
To edit the name of preset event names, select to enter the Manual Event Setup menu.
Selecting or editing manual event name functionality is available only if the Manual Event Edit switch is turned
on. For more information, see 32.16.3 Setting the Manual Event Edit Switch .
You can review the manual events. For more information, see 25.2.7 Events Review Page .
3.11
Freezing Waveforms
During patient monitoring, the freeze feature allows you to freeze the currently displayed waveforms on the screen so that you can have a close examination of the patient’s status. Additionally, you can select any frozen waveform for recording.
3.11.1
Freezing Waveforms
To freeze waveforms, select the Freeze quick key. Except waveforms of the following screens, all displayed waveforms stop refreshing and scrolling after you select the Freeze quick key:
■
■
■
■
Minitrends
OxyCRG
EWS screen screen screen
Remote View screen
3.11.2
Viewing Frozen Waveforms
To view the frozen waveforms, follow this procedure:
■
■
Select the or button in the Freeze screen.
Slide the frozen waveform leftward or rightward.
At the lower right corner of the bottom-most waveform displays the freeze time. The initial frozen time is 0 s .
With the waveforms scrolling, the freeze time changes at an interval of 1 second. For example, -2 s means two seconds before the frozen time. This change will be applied for all waveforms on the screen.
NOTE
•
You can view the frozen waveforms of up to 120 seconds.
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3.11.3
Unfreezing Waveforms
To unfreeze the frozen waveforms, select the
Numerics.
button at the upper right corner of the Freeze Big
3.11.4
Printing Frozen Waveforms
To print the frozen waveforms, select the button at the upper left corner of the Freeze Big Numerics.
3.12
N22 and N19 Secondary Display
The secondary display of N22/N19 has the following features:
■
■
Be able to connect independent input devices.
Provides visual and audible alarm indications.
The secondary display runs on independent AC mains through a DC adapter. To use the secondary display, turn it on and verify that it is connected before turning on the monitor. The secondary display does not support hot swapping. If the secondary display is disconnected from the main unit, the primary display will announce an alarm.
3.12.1
Connecting the Secondary Display Power Supply (for N22/N19)
You need a power adapter to convert the AC mains to DC so as to power the secondary display. Before connecting the power adapter, check that the power adapter meets the specification.
To connect the power supply, follow this procedure:
1.
Connect one end of the power adapter to the DC-IN connector on the secondary display.
2.
Connect the other end of the power adapter to the AC mains.
3.
Check that the AC indicator on the secondary display is on.
CAUTION
•
Use only Mindray-specified power adapters for powering Mindray displays.
3.12.1.1
Setting Secondary Display Orientation (for N22/N19)
If the secondary display is an independent display or an extended display, you can set its orientation if necessary.
See
3.8.1 Setting the Screen Orientation (for N22 and N19) for details.
NOTE
•
If the secondary display is a mirror display, its orientation is the same with the primary display and cannot be set separately.
3.12.1.2
Setting Secondary Display Brightness (for N22/N19)
See
3.8.3 Adjusting the Screen Brightness for details.
3.12.2
Setting the ECG Waveform Size for the Independent External Display (for N17/
N15/N12)
For N17/N15/N12 monitors, if the independent external display is connected, you can set the speed and amplitude scales of the ECG waveforms for displays of different dimensions to achieve the best display effect. To do so, follow this procedure:
1.
From the independent external display screen, select the Main Menu quick key
→
from the System column select Maintenance → input the required password → select .
2.
Select Display → select the Screen Size tab.
3.
Select the screen size.
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4.
Adjust the speed and amplitude of the ECG waveform by setting the scale so that 1 cm on the scale is actually equal to one centimeter.
5.
Restart the monitor.
(2)
(1)
(1) Adjust the amplitude of the ECG waveform
(2) Adjust the speed of the ECG waveform
NOTE
•
The setting of Screen Size for the independent external display takes effect only after the monitor restarts.
3.13
Using the iView System
The iView system provides a means of running clinical applications on a monitor for obtaining other patient data. The application data from the iView can show on the monitor’s display or on the iView display.
For more information on iView, see iView System Operator’s Manual (PN: 046-012637-00).
WARNING
•
Some clinical applications may show data from another patient. Be aware that some of the data on the patient monitor display may not always be from a single patient.
•
Applications running on the iView cannot act as a primary alarming device and cannot be relied upon for alarm notification. There may be no audible or visible indications apart from what is shown on the screen, and any data shown may be delayed.
CAUTION
•
Always use AC mains to run the monitor if iView is in use.
•
Ensure that any software installed on the iView complies with all relevant local regulations.
• iView is an independent PC platform that enables running third-party applications. The monitor runs independently of the iView, and vice versa.It is the user's responsibility to maintain iView security patches in compliance with hospital PC policy. The user’s IT administrator should determine what security patches and policies needed after third-party applications are installed.
•
Contact Microsoft service personnel if iView Windows problems occur.
3.14
Capturing the Screen
The monitor provides the function of screen capture. To capture the current screen display, follow this procedure:
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1.
Connect the USB drive to the monitor’s MSB connector (for N22/N19) or the USB connector (N17/N15/N12).
2.
Press and hold the More quick key. Wait until it turns from blue to grey.
The captured pictures are automatically saved in the USB drive.
The screen capture function is disabled by default. If you need this function, contact the service personnel.
3.15
Connecting the CMS
■
■
You can connect the monitor to the BeneVision CMS through wired LAN or wireless LAN. When connected to the
CMS, the system provides the following function.
■
■
■
The monitor can transmit parameter values, waveforms, alarms, and events to the CMS. From the CMS, you can check the patient’s monitoring data and alarms.
The monitor can transmit parameter values and alarms from the connected external devices to the CMS.
From the CMS you can check the patient’s monitoring data and alarms obtained from the connected external devices.
Patient information, alarm settings, and alarm status can be synchronized between the monitor and the
CMS.
You can start or stop NIBP measurements from the CMS.
In case of network disconnection, the monitor can transmit the offline data to the CMS when the network is reconnected.
For more information on the CMS, see the operator’s manual of corresponding central monitoring system.
To select a CMS, select the system status information area at the top right corner of the main screen. Select the desired CMS from the popup CMS list.
NOTE
•
You can select CMS only when the Select CMS switch is on. For more information, see
32.13.6 Enabling Selecting a CMS
.
3.16
Connecting the eGateway
■
■
You can connect the monitor to the eGateway through wired LAN or wireless LAN to implement interaction between the monitor and external devices. When connected to the eGateway, the system provides the following functions:
■
The monitor can transmit parameter values, waveforms, alarm settings, and events to the eGateway.
The monitor can transmit parameter values and alarm settings received from the BeneLink-connected external devices to the eGateway.
Clock can be synchronized between the monitor and the eGateway.
3.17
Connecting the Wireless Network
You can add up to five wireless networks for the monitor. For more information, see
.
If connecting the current wireless network fails, the monitor automatically connects other wireless networks in the order when they were added.
To manually switch the wireless network, from the system status information area on the top right conner of the screen select , and select the desired wireless network.
3.18
Disconnecting the Wireless Network
To disconnect the wireless network manually, follow this procedure:
1.
Swipe the screen from top down with a single finger.
2.
Select .
To reconnect the wireless network after it is disconnected manually, follow this procedure:
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1.
Swipe the screen from top down with a single finger.
2.
Select .
3.19
Turning Off the Monitor
Before turning off the monitor, perform the following check:
1.
Ensure that monitoring of the patient has been completed.
2.
Disconnect the cables and sensors from the patient.
3.
Save or clear the patient data as required.
To turn off the monitor, press and hold the power switch for 3 seconds.
CAUTION
•
Press and hold the power switch for 15 seconds (for N22/N19) or 10 seconds (for N17/N15/N12) to forcibly shut down the monitor if it could not be shut down normally. This may cause loss of patient data.
NOTE
•
Turning off the monitor does not disconnect the monitor from the AC mains. To completely disconnect the power supply, unplug the power cord.
•
If a monitor is on during a power loss, then the monitor is automatically switched on when the power is restored.
•
In case of a temporary power failure, if the power is restored within 30 minutes, monitoring will resume with all active settings unchanged. If the monitor is without power for more than 30 minutes, it behaves the same as if it were normally turned off.
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4
User Screens
4.1
4.2
4.2.1
4.2.2
4.3
4.3.1
The monitor provides different user screens to facilitate patient monitoring in different departments and clinical applications.
Choosing a Screen
The monitor enters the normal screen after it is powered on. The normal screen is most frequently used for patient monitoring. To select other screens, follow this procedure:
1.
Access the Choose Screen tab in either of the following ways:
◆
Select the Screen Setup quick key.
◆
Select the Main Menu quick key
→ from the Display column select Choose screen .
2.
Select the desired screen.
Normal Screen
The normal screen is most frequently used for patient monitoring. For general department, ICU, and CCU, normal screen is used by default.
■
■
■
Entering the Normal Screen
To enter the normal screen, choose any of the following ways:
Swipe left or right on the touchscreen with two fingers to switch to the normal screen.
Select the Screen Setup quick key
→
select the Choose Screen tab
→
select Normal Screen .
Select the Main Menu quick key
→
from the Display column select Choose Screen
→
select Normal
Screen .
Configuring the Normal Screen
You can configure the parameter numerics, waveforms, and their sequence displayed on the normal screen. To do so, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆
Select the Screen Setup quick key.
◆
Select the Main Menu quick key
→ from the Display column select Tile Layout .
2.
Select a parameter numeric area or waveform area, and then from the popup list select an element you want to display in this area. The parameters and waveforms you did not select will not displayed.
The Big Numerics Screen
The Big Numerics screen displays parameter numerics in big font size. The Big Numerics screen displays measurement values and waveforms of up to six parameters. You can configure the parameters and their layout on the big numeric screen.
Entering the Big Numerics Screen
■
■
■
To enter the big numerics screen, choose any of the following ways:
Swipe left or right on the touchscreen with two fingers to switch to the big numerics screen.
Select the Screen Setup quick key → select the Choose Screen tab → select Big Numerics .
Select the Main Menu quick key → from the Display column select Choose Screen → select Big
Numerics .
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4.3.2
4.4
4.4.1
Configuring the Big Numerics Screen
To configure the big numerics screen, follow this procedure:
1.
Access Choose Screen in either of the following ways:
◆ Select the Screen Setup quick key .
◆
Select the Main Menu quick key
→ from the Display column select Choose Screen .
2.
Select the Big Numerics tab
3.
Select a parameter numeric area or waveform area, and then from the popup list select an element to display in this area.
■
Minitrends Screen
The Minitrends screen shows the recent graphic trends of parameters.
Entering the Minitrends Screen
■
■
■
Choose one of the following methods to enter the Minitrends screen:
■
■
■
■
Swipe left or right on the touchscreen with two fingers to switch among the Minitrends screen, normal screen, and the big numerics screen.
Select the
Select the
Select the
Minitrends quick key.
Screen Setup
Main Menu quick key
quick key
→
→
Select the from the
Choose Screen
Display
tab
column select
For adult and pediatric patients, when the Minitrends screen is hidden as following methods to quickly enter the Minitrends screen.
→
Choose Screen
, select Minitrends
→
.
select Minitrends you can also choose one of the
.
Swipe left or right across the touchscreen with two fingers until you switch to the Minitrends screen.
Swipe right across the touchscreen with a single finger.
Select the button .
4 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
4.4.2
The Display of Minitrends Screen
The following figure shows the minitrends screen. Your display may be configured to look slightly different.
(3)
(1)
(4)
4.4.3
4.4.4
4.4.5
(6)
(2)
(1)
(2)
(3)
(4)
(5)
(6)
Scale
Routine Vital button. If the department is set to OR , then the Baseline button is displayed.
Routine Vital/Baseline
Select this button to view the long trends, or contract the long trends screen to the Minitrends screen.
Time line
Alarm statistic area
Viewing the Long Trends
To expand the Minitrends screen to view the long trends, choose either of the following ways:
■
■
Select the button.
Swipe right across the Minitrends screen with a finger.
Setting Minitrends Parameters
To set parameters, follow this procedure:
1.
Enter the Minitrends screen.
2.
Select the Setup button.
3.
Set parameters. If you want to use the default parameters, select Default Parameter .
Setting the Minitrend Length
To set the Minitrend length, follow this procedure:
1.
Enter the Minitrends screen.
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(5)
4 - 3
4.4.6
4.4.7
2.
Select the Setup button.
3.
Set the Minitrend Length .
Setting the Alarm Statistics Switch
The Minitrends screen can be configured to display the statistic number of physiological alarms in its lower half screen. To set the alarm statistics switch, follow this procedure:
1.
Enter the Minitrends screen.
2.
Select the Setup button.
3.
Switch on or off the Alarm Statistics switch.
Setting the Alarm Statistics Duration
The time length within which the alarms statistics are made is configurable. To set the alarm statistics length, follow this procedure:
1.
Enter the Minitrends screen.
2.
Select the Setup button.
3.
Set Alarm Statistics Duration .
4.4.8
Routine Vital/Baseline
The Routine vital/Baseline function is used for marking the parameter measurements of certain moment for later reference. If the department is set to OR , then the Baseline button is available. For other departments, the
Routine Vital button is available.
4.4.8.1
Manually Marking the Routine Vital/Baseline
To manually mark the Routine Vital/Baseline, follow this procedure:
1.
Enter the Minitrends screen.
2.
Select the Routine Vital button or Baseline button.
NOTE
•
If you do not see the Baseline button or Routine Vital button in the Minitrends screen, you can select the Setup button and switch on the Baseline switch, or set the Routine Vital to Manual or Auto.
4.4.8.2
Configuring Automatic Routine Vital Settings
The monitor can automatically mark the routine vital sign values. To enable this function, follow this procedure:
1.
Enter the Minitrends screen.
2.
Select the Setup button.
3.
Select Auto from the dropdown list of Routine Vital .
4.
Select Time to set the time for marking the first routine vital sign values.
5.
Select Interval to set the interval for marking the routine vital sign values.
4.5
4.5.1
The OxyCRG Screen
The monitor displays the OxyCRG screen by default when the neonatology department is selected. The OxyCRG screen is available in any department setting, but only when the patient size is set to Neo . This screen displays 6minute HR, SpO
2
trends, CO
2
/Resp compressed waveform, ABD parameters, and the latest ABD events.
The OxyCRG function is intended for neonatal patents only.
Entering the OxyCRG Screen
To enter the OxyCRG screen, choose any of the following ways:
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4.5.2
■
■
■
■
Swipe left or right on the touchscreen with two fingers to switch to the OxyCRG screen.
Select the OxyCRG quick key.
Select the Screen Setup quick key → select the Choose Screen tab → select OxyCRG .
Select the Main Menu quick key → from the Display column select Choose Screen → select OxyCRG .
The Display of the OxyCRG Screen
The following figure shows the OxyCRG screen. Your display may be configured to look slightly different.
(8) (7)
(1)
(6)
(2)
4.5.3
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(3) (4) (5)
HR, SpO
2
/SpO
2 b trend
Resp/CO
2
compressed waveform
Event time
Event type
Parameter values of ABD events
ABD event list: displays the latest red ABD events. Selecting the ABD event list area enters the OxyCRG review page.
Mark button: opens the Mark dialog to edit the events.
ABD event prompt area: displays parameter values of currently active OxyCRG events.
OxyCRG Events
The following table lists the ABD events and their criteria:
B
D
BD
AB
AD
ABD
Event type Description
A Apnea event: the apnea duration exceeds the threshold.
• A20: the apnea duration is greater or equal to 20 seconds.
• A15: the apnea duration is between 15 to 20 seconds (excluding 20 seconds).
• A10: the apnea duration is between 10 to 15 seconds (excluding 15 seconds).
Low Heart Rate event: the duration of low heart rate exceeds the threshold.
Low SpO2 event: the duration of SpO2 Desat exceeds the threshold.
Low Heart Rate and low SpO2 happen at the same time.
Apnea and Low Heart Rate happens at the same time.
Apnea and low SpO2 happen at the same time.
Apnea, Low Heart Rate, and low SpO2 happen at the same time.
Remarks
A20 is a red event
/
/
/
Red event
Red event
Red event
NOTE
•
The monitor records all ABD events for OxyCRG review, but only red events displays in the ABD list of the OxyCRG screen.
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4.5.4
4.5.5
4.5.6
4.5.7
4.6
4.6.1
4.6.2
The Display of the ABD Event Area
The ABD event area displays parameter values of currently active OxyCRG events and lists the latest red ABD events.
Setting OxyCRG Parameters
Select parameter trends or compressed waveform to set parameters and the compressed waveform you want to display. The selected parameters will be used for ABD event calculation.
Setting the Threshold of ABD Events
Select any parameter trend or the compressed waveform to perform the following setup:
■ Set the threshold of ABD events.
■ Set Event Storage Format :
◆ 1 min+3 min : stores data one minute before and three minutes after the event.
◆ 3 min+1 min : stores data three minutes before and one minute after the event.
◆ 2 min+2 min : stores data two minutes before and two minutes after the event.
The stored data includes the trends of the OxyCRG parameters, compressed waveform, alarm thresholds, NIBP, and Temp measurements.
Editing ABD Events
To edit ABD events, follow this procedure:
1.
Select the Mark button to enter the Mark dialog box.
2.
Drag the event list upwards and downwards to select the desired event.
3.
Select the patient’s status when the event happened.
4.
Select Save .
The Targeted Goal Screen
If you are concerned with specific parameters and their trends, you can use the Targeted Goal screen. The
Targeted Goal screen focuses on the target parameter and displays parameter measurements in big numerics.
You can easily identify whether parameter target is reached via a dashboard and review the statistics of the target parameter by sections.
The Targeted Goal screen displays parameter measurements and waveforms of ECG, SpO
2
, IBP, PI, PR, CO
2
, Resp,
NIBP, and Temp. You can define the target parameter and secondary parameters. The measurements of these parameters displays in big numerics.
Entering the Targeted Goal Screen
To enter the Targeted Goal screen, choose any of the following ways:
■
■
Select the Screen Setup quick key
→
select the Choose Screen tab
→
select Targeted Goal screen.
Select the Main Menu quick key
→
from the Display column select Choose Screen
→
select Targeted
Goal Screen.
■ If the Patient Category is set to Neo , swipe left or right on the touchscreen with two fingers to switch to the Targeted Goal screen.
The Display of the Targeted Goal Screen
The following figure shows the Targeted Goal screen. Your display may be configured to look slightly different.
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(5)
(1)
(6)
4.6.3
(2)
(3)
(4)
(7)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Parameter trends area: displays trends of the target parameter and secondary parameters. If the target parameter is Art, this area only lists the trend of arterial pressure. Selecting this area enters the Tabular Trends review page.
Target parameter statistics area: displays the statistics of the target parameter by sections.
Target parameter trends area: displays the graphic trends of the target parameter. If this area is not configured to display the trends of the target area, other selected parameter is displayed.
Other parameter area: displays parameter measurements and alarm limits of parameters other than the target parameter and secondary parameters.
Target parameter area: displays the measurement of the target parameter in big numerics, as well as its target range, and alarm limits.
• If the target parameter is Resp or PR, parameter source is also displayed.
• The dashboard shows the target range in green.
• The
△ pointer below the dashboard indicates the current measurement value.
• Selecting this area enters the corresponding parameter setup menu.
Secondary parameters area: displays parameter measurement of secondary parameters in big numerics, as well as waveforms and alarm limits. If secondary parameters are Resp and PR, parameter sources are also displayed.
Target parameter waveform area: displays the waveform of the target parameter.
• If the target parameter is Resp or PR, the waveform of the source parameter is displayed.
• If the target parameter is ECG, the fist ECG waveform is displayed by default.
Configuring the Targeted Goal Screen Layout
To configure the parameter numerics, waveforms, and their sequence displayed on the Targeted Goal screen, follow this procedure:
1.
Access the Targeted Goal screen in either of the following ways:
◆ Select the Screen Setup quick key → select the Choose Screen tab → select Targeted Goal screen.
◆ Select the Main Menu quick key → from the Display column select Choose Screen → select
Targeted Goal Screen.
2.
Select a parameter numeric area or waveform area, and then from the popup list select an element to display in this area. The parameters and waveforms not selected will not displayed.
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(6)
(1)
4.6.4
(2)
(5)
(3)
(4)
(1) Select this area to define items to be displayed for the target area:
Statistics: this area displays the statistics of the target parameter by sections.
Statistics & Trend: this area displays the statistics of the target parameter by sections and the area below displays the graphic trends of the target parameter.
(2) If the graphic trends of the target parameter is not displayed, select this area to define other parameter to be displayed.
(3) Select this area to define other parameter (other than the target parameter and the secondary parameter) to be displayed.
(4) Select this area to define the target parameter.
(5) Select this area to define the secondary parameter.
(6) Select this area to define the secondary parameter.
Setting Parameter Statistics
You can show the statistics of the target parameter for a defined period of time. To do so, follow this procedure:
1.
Select from the target parameter statistics area to enter the parameter statistics menu.
2.
Select the range of each section: from the To column select the SpO2 value at which corresponding section ends.
3.
From the Target column select the target section. The target section is highlighted in green in the SpO
2 statistics area.
4.
From the target parameter statistics area, select the duration to redefine the statistics duration.
The following figure shows the target parameter statistics area when SpO
2 is set as the target parameter:
1
2
3
4
(1) Statistics duration
(2) Statistics setup icon
(3) Statistics results
(4) Sections for statistics
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4.6.5
4.6.6
4.7
Selecting the Range of each Parameter Section and the Target Section
For the target parameter, to define the range of each section, follow this procedure:
1.
Select from the target parameter statistics area.
2.
From the To column select the parameter value at which corresponding section ends.
3.
From the Target column select the target section. The target section is highlighted in green in the statistics area.
Selecting the Statistics Duration of the Target Parameter
The statistics duration of the target parameter is configurable. From the target parameter statistics area, select the duration to redefine its duration.
Remote View
On the monitor, you can observe alarm conditions and view real time physiological data from patients on other compatible remote networked monitoring devices, such as a bedside monitor or a telemetry device.
A device from a remote site is called a remote device or bed. N22/N19/N17 can simultaneously watch up to 18 remote devices. N15/N12 can simultaneously watch up to 12 remote devices. The monitor can show waveforms of one remote device.
■
■
You can watch the remote devices in the Remote View screen, or the alarm watch tiles on the main screen.
From the Remote View screen you can watch the following information:
■
■
The alarm status and alarm messages of up to 18 remote devices for N22/N19/N17 or 12 remote devices for
N15/N12.
The realtime parameter values and waveforms from the main bed.
If an anesthesia system or ventilator is connected to the main bed, you can watch realtime parameter values and waveforms from the anesthesia system or the ventilator.
If pumps are connected to the main bed, you can view the pump alarm status.
NOTE
•
A particular monitor (for example Monitor #1) can be viewed by at most 32 remote devices at the same time, of which eight of those remote devices can watch Monitor #1’s waveforms.
4.7.1
4.7.2
■
■
Entering the Remote View Screen
To enter the Remote View screen, choose one of the following ways:
■
Select the Remote View quick key.
Alarm Watch Tile on the Main Screen .
Select the Screen Setup quick key → select the Choose Screen tab → select Remote View .
About the Remote View
The Remote View screen displays parameter measurements and waveforms of the remote device. If an anesthesia system is connected to the main bed, swipe left or right on the screen to view more information, including parameters and waveforms from the anesthesia system.
The following figure shows the Remote View screen.
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(1)
(2)
(3)
(1)
(2)
(3)
Alarm watch area
Displays all the monitored remote beds. Each bed displays the room number, bed number, connection status and alarm status. The background color indicates the alarm status on the corresponding bed.
Background Color Description
Green
Red
Yellow
Cyan
Grey
Main area
No alarm is occurring at the bed.
The remote device is disconnected or a high priority alarm is currently the highest alarm level on the bed. If the remote device is disconnected, the icon is displayed.
The medium priority alarm is currently the highest alarm level on the bed.
The low priority alarm is currently the highest alarm level on the bed.
The bed is in the standby mode.
Displays the patient’s information, alarm status and messages, waveforms, measurements, etc. of the selected bed.
This bed is called main bed. Scrolling up and down can view more parameters and waveforms. If anesthesia system is connected to the main bed, swipe left and right on the screen to view parameters and waveforms from the anesthesia system.
Remote View setup button: select it to enter the Remote View setup menu.
WARNING
•
The data presented in the Remote View screen has a delay. Do not rely on this screen for real time data.
4.7.3
Adding a Bed
After adding the desired remote devices, then the alarms from these devices can be viewed on the monitor. To add a remote device, follow this procedure:
1.
Enter the Select Bed dialog. To do so, choose either of the following ways:
◆ In the Remote View screen, select Select Bed . For more information, see
.
◆ Select the icon at the alarm watch tile if the tile is configured to display on the main screen.
2.
In the Select Bed dialog, select a desired department. All the beds under this department will be listed.
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4.7.4
4.7.5
4.7.6
4.7.7
4.7.8
4.7.9
3.
Select a desired tile at the A-W1, A-W2 or A-W3 areas and then select a bed from the bed list. The selected bed will appear in the tile.
NOTE
•
The added bed is indicated by a check mark (√) at the left of the bed list.
Removing a Bed
To remove a remote device from remote monitoring, follow this procedure:
1.
Enter the Select Bed dialog. Choose either of the following ways:
◆
In the Remote View screen, select Select Bed
. For more information, see 4.7.1 Entering the Remote
.
◆ Select the icon in the alarm watch tile if the tile is configured to display on the main screen.
2.
In the Select Bed dialog, select a bed at the A-W1, A-W2 or A-W3 areas, and then select Clear Bed . If you want remove all beds, select Clear All Beds .
Displaying the Main Bed
In the Remote View screen, you can select a bed in the alarm watch area, then the main body of the Remote
View screen will display the real time monitoring screen of the device.
Saving a Manual Event
You can initiate a manual event on the remote monitor by selecting Manual Event in the Remote View screen.
Managing Alarms from Remote Devices
You can view and manage the alarms coming from remote devices.
If the monitor and remote devices have alarms at the same time, the monitor presents alarms according to the following rules:
■
■
If the alarm tone pattern for the monitor is same as that for the remote devices, the monitor prioritizes all the alarms and sounds the highest alarm tone.
If the alarm tone pattern for the monitor is different from that for the remote devices, the monitor sounds the alarms in their corresponding tone.
The monitor provides the same alarm tone pattern for the remote device alarms as those for the monitor alarms by default. You can change the alarm tone pattern of the remote monitor; see
32.3.5.5 Setting the Tone Pattern for
.
Resetting Alarms for Remote Devices
You can reset the alarms on the remote devices by selecting Alarm Reset in the Remote View screen. This
Selecting Beds By Care Group
If configured, the monitor automatically selects beds in the same care group during the shift of care groups in the CMS. To enable this function, follow this procedure:
1.
Enter the Select Bed window. Choose either of the following ways:
◆ In the Remote View window, select Select Bed . For more information, see
for entering the Remote View window.
◆
Select the icon in the alarm watch tile if the tile is configured to display on the main screen.
2.
In lower left corner of the Select Bed window, select Select Beds By Care Group .
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4.7.10
Alarm Watch
The alarm watch function provides the alarm notification by color and sound.
■
■
The monitor sounds the highest priority alarm tone from all the monitored remote devices.
The monitor displays the highest priority alarm in corresponding background color for each bed at the following areas:
◆ At the top of the Remote View . For more information, see
for details.
◆ On the main screen. For more information, see
4.7.10.1 About Alarm Watch Tile for details.
4.7.10.1
About Alarm Watch Tile
The main screen can display up to three alarm watch tiles, namely A-W1, A-W2 and A-W3. Each tile can accommodate up to six beds.
The following figure shows the alarm watch tiles.
(1) (2)
(5) (4) (3)
(1)
(2)
(3)
(4)
Alarm watch tile label
Disconnection icon: when the remote device is disconnected, this icon displays at the tile, and the tile background color is red.
Bed area (multiple beds): if more than one bed is assigned to an alarm watch tile, each bed cyclically displays the bed number, room number, and the alarm of the highest priority. The background color of each bed indicated the status of this bed.
Bed area (one bed): if only one bed is assigned to an alarm watch area, this area displays the bed number, room number, parameter value, and alarm message from this bed, etc.
Select bed icon: select it to enter the Select Bed dialog.
(5)
The alarm watch tile in the main screen is similar to the alarm watch area in the Remote View.
For more
information, see 4.7.2 About the Remote View .
4.7.10.2
Displaying the Alarm Watch Tile on the Main Screen
To configure the alarm watch tile to be displayed on the monitor’s main screen, follow this procedure:
1.
Select the Main Menu quick key
→
from the Display column select Choose Screen to enter the Screen
Setup dialog.
2.
Select the Tile Layout tab.
3.
Select the numeric area where you want to display the alarm watch tile, and then in the drop-down list, select Alarm Watch
→
A-W1, A-W2 , or A-W3 .
4.7.11
Auto Displaying the Alarm Bed
The monitor provides the function of automatically displaying the remote alarm bed. If this function is enabled, when a remote bed issues an alarm, the monitor automatically displays this bed as the main bed on the Remote
View screen.
If multiple remote beds issue alarms, the monitor cyclically displays the alarm beds as per the preset interval and in the order of alarm time.
The auto displaying alarm bed function is disabled by default. To enable this function, follow this procedure:
1.
From the Remote View screen, select to enter the Remote View setup menu.
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2.
Switch on Rollup Alarm Beds .
3.
Set Rollup Interval :
◆ Off : do not cyclically display the remote alarm beds. Once a new alarm is issued, the monitor automatically switches to the new alarm bed.
◆ 10 sec , 20 sec , or 30 sec : If multiple remote beds issue alarms, the monitor cyclically displays the alarm beds as per the preset interval and alarm priority in the order of alarm time.
4.
Set Alarm Priority:
◆ High Only: Only when a high priority alarm is issued, the monitor automatically switches to the alarm bed.
◆
High & Med: If Rollup Interval is set to Off and when a high priority alarm or medium priority alarm is issued, the monitor automatically switches to the alarm bed. If Rollup Interval is set to 10 sec , 20 sec , or 30 sec and multiple remote beds issue alarms, the monitor cyclically displays the alarm beds with higher priority in the order of alarm time. For example, if both high priority alarms or medium priority alarm are issued, only beds with high priority alarms are cyclically displayed.
5.
Set Switch Bed Prompt Voice. If this function is enabled, the monitor issues a reminder sound each time the main bed switches.
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5
Managing Patients
5.1
5.2
Starting Monitoring a Patient
After turning on the monitor, follow this procedure to monitor a patient:
1.
Admit the patient.
2.
Check patient settings. Make sure that alarm limits, patient category and paced status, and so on, are appropriate for the patient. Change them if necessary.
3.
Perform desired measurements. For more information, see corresponding measurement chapters.
Admitting a Patient
The monitor admits a new patient in the following situations:
■
■
■
After a patient is manually discharged, the monitor automatically admits a new patient.
After being switched off for the selected time period, the monitor automatically discharges the previous patient and admits a new patient at startup.
If the monitor has not detected certain patient vital signs (ECG, SpO
2
, PR, RR, NIBP) for 30 minutes, it will prompt whether to start monitoring a new patient if any of the above vital signs are detected again.
Always input patient information as soon as the patient is admitted. For more information, see
Patient Information for details.
WARNING
•
The default Patient Category setting is Adult, and Paced setting is Unspecified. Set Paced and check if the Patient Category setting is correct for the patient.
•
For paced patients, set Paced to Yes. If it is incorrectly set to No, the monitor could mistake a pace pulse for a QRS and fail to alarm when the ECG signal is too weak.
•
For non-paced patients, set Paced to No.
5.2.1
5.2.2
■
■
■
Entering the Patient Management Dialog
Use any of the following methods to enter the Patient Management dialog:
Select the patient information area at the top left corner of the screen.
Select the Patient Management quick key.
Select the Main Menu quick key
→
from the Patient Management column select Patient Management .
Editing Patient Information
Edit patient information after a patient has been admitted, or when patient information is incomplete, or when it is necessary to change patient information:
To edit patient information, follow this procedure:
1.
Enter the Patient Management
dialog. For more information, see 5.2.1 Entering the Patient Management
2.
Edit patient information as required.
If a barcode reader is connected to the monitor, scanning the patient’s barcode will enter the patient’s information.
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5.2.3
5.2.4
NOTE
•
The monitor will reload the configuration if you change the patient category.
Loading Patient Information from the CMS
If the monitor is connected to the central monitoring system (CMS). You can load patient information from the
CMS to the monitor. To do so, follow this procedure:
1.
Enter the Find Patient dialog in either of the following ways:
◆ Select the Main Menu quick key → from the Patient Management column select Find Patient .
◆ From the Patient Management dialog select Find Patient .
2.
Input query criteria.
3.
Select Search . Then a list pops up, including all the patients that meet the query criteria.
4.
Select a patient from the patient list, and then select Admit . Corresponding patient information in the monitor will be updated.
.
NOTE
•
If ADT Query is switched on, input query criteria from the Discharged Patients page.
Loading Patient Information from the ADT Server
If the monitor is connected with the Admit-Discharge-Transfer (ADT) server through the eGateway. You can load patient information from ADT server to the monitor.
To do so, follow this procedure:
1.
Enter the Find Patient dialog in either of the following ways:
◆ Select the Main Menu quick key → from the Patient Management column select Find Patient .
◆ Select Find Patient from the Patient Management dialog.
2.
Input query criteria.
3.
Select Search . Then a list pops up, including all the patients that meet the query criteria.
4.
Select a patient from the patient list, and then select Admit . Corresponding patient information in the monitor will be updated.
The patient where you can search is configurable. For more information, see
32.2.2 Setting the Range of Finding
NOTE
•
You can load patient information from the ADT server only when ADT Query is enabled. For more
information, see 32.13.11 Using the ADT Gateway .
•
The monitor can automatically upload the patient information from the ADT server when:
◆
The configured keywords of the monitor and the eGateway are the same.
◆
The IP address of the monitor is added to the eGateway configuration dialog.
•
Loading patient information from the ADT server updates only patient information in the monitor.
The patient’s monitoring data is not changed and the patient is not discharged.
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5.3
Transferring Patient
Patient settings and data can be transferred from a T1, BeneVision N1, or MPM module into this monitor. The patient settings and data includes patient information, trend data, alarm events, and parameter alarm limits. The
N1 also allows transfer of full disclosure data.
The MPM allows transfer of patient information, such as patient ID, height, and weight, etc.
WARNING
•
Do not discharge a patient on the bedside monitor before patient information is completely transferred. Discharging the patient during transfer will result in incomplete patient information.
NOTE
•
The system automatically switches on the HR/PR (high, low) alarms and lethal arrhythmia alarms after transferring the patient data.
5.3.1
Data Storage Introduction
Familiarizing with the data respectively stored in the patient monitor, T1, N1, or MPM helps you understand the effects incurred by transferring patients with an T1, N1, or MPM.
Type of storage
Data
Settings
Patient demographics
Trend data
Calculation data
Event data
Full disclosure waveforms
Monitor settings
(Alarm pause, alarm volume, etc.)
Parameter settings
(Alarm limits, measurement setting, etc.)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Can be stored in the monitor?
Can be transferred via MPM?
Can be transferred via T1?
Yes
Yes
No
No
No
No
Yes
Yes
No
Yes
No
No
Can be transferred via N1
Yes
Yes
Yes
Yes
Yes
No
Yes Yes Yes
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5.3.2
Transferring Patient Data
To transfer the patient data via N1/ T1/MPM, insert it into the SMR.
■
■
If the patient demographics in the monitor are consistent with those of in the N1/T1/MPM, N1/T1/MPM automatically uploads the data to the monitor.
If the patient demographics in the monitor are not consistent with those of in the N1/T1/MPM, and Data
Transfer Strategy is set to Always Ask (for more information, see
32.2.4 Setting the Strategy of Transferring
Patient Information ), the monitor prompts the
Select Patient dialog automatically. In this case, you need to select an operation (see the following table) according to the actual situation. If the Data Transfer Strategy is not set to Always Ask then the monitor will follow the strategy setting without prompting the user.
5.4
5.5
Operations
Continue Patient in Monitor
Continue Patient in Module
New Patient
Same Patient
Operation Description Examples of applications
Continue to use the patient data in the monitor. This deletes all patient data in the
N1/T1/MPM and copies all data in the monitor to the N1/T1/MPM.
Continue to use the patient data in N1/T1/
MPM. The monitor discharges the patient, and automatically admits a new patient and copies all data from N1/T1/MPM.
Select this option if you will use neither the information in the monitor nor that in the
N1/T1/MPM. This deletes all data in the monitor and N1/T1/MPM and lets you admit a new patient on the monitor. In this case, you need to re-enter the patient demographics. The monitor will restore the settings according to the patient category.
Select this option if the patient information in the monitor and N1/T1/MPM are different but you are sure that it is the same patient. This merges the patient’s trend data in the monitor and N1/T1/MPM and copies the settings in N1/T1/MPM to the monitor as well.
1. Replace N1/T1/MPM during patient monitoring.
2. After the patient is admitted, connect the
N1/T1/MPM.
You are monitoring a patient using N1/T1/
MPM, and you need to transfer the patient, e.g. from a ward (original monitor) to the operating room (destination monitor).
Connect the N1/T1/MPM before admitting a new patient. However, the monitor and/ or N1/T1/MPM have stored the previous patient’s data and settings.
A patient monitored with the N1/T1/MPM is moved to another department and again moved back.
However, the patient information stored in the N1/T1/MPM was altered before connected to the original monitor.
NOTE
•
Selecting Apply Module Settings will transfer the N1/T1/MPM settings to the monitor along with the patient data.
Exporting Patient Data
You can export the demographic information and monitoring data of the current and discharged patients via a
USB drive. For more information, see 32.6.3 Exporting Patient Data .
Deleting Patient Data
To delete the data of discharged patients, follow this procedure:
1.
Access the Discharged Patients dialog box by either of the following ways:
◆ Select the Discharged Patients quick key.
◆ Select the Main Menu quick key
→ from the Patient Management column select Discharged
Patients .
2.
From the patient list select desired patients.
3.
Select Delete .
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5.6
5.7
Stopping a Parameter Measurement
To stop monitoring a parameter, follow this procedure:
1.
Remove corresponding sensor from the patient.
2.
Disconnect the sensor from the patient cable.
3.
Disconnect the patient cable from the parameter module.
Discharging a Patient
Before monitoring a new patient, discharge the previous patient. The technical alarms are reset, and monitor
settings return to their defaults. For more information, see 31.3 Setting Default Patient Category
.
After a patient is discharged, the monitor automatically admits a new patient.
WARNING
•
Always discharge the previous patient before starting to monitor a new patient. Failure to do so can lead to data being associated with the wrong patient.
To manually discharge a patient, use any of the following methods to access the Discharge Patient dialog:
■
■
■
■
■
Swipe down the touchscreen with two fingers.
Select the Discharge Patient quick key.
Select the patient information area at the top left corner of the screen → Discharge Patient .
Select the Patient Management quick key
→
Discharge Patient .
Select the Main Menu quick key → from the Patient Management column select Discharge .
■
■
Select a button in the Discharge Patient dialog:
Print End Case Report : prints the end case report when the patient is discharged.
■
Discharge : clears the waveform data of the current patient. The monitor loads the default configuration and goes to the standby mode. The current patient becomes a discharged patient.
Clear Patient Data : discharges the current patient and clears the waveform data. The monitor loads the default configuration and does not go to the standby mode. The current patient becomes a discharged patient.
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6
Interfacing with External Devices
6.1
BeneLink Introduction
BeneLink module is intended for connecting external devices, such as ventilators and anesthesia machines, to the monitor. It allows information (patient data, alarms, etc.) from external devices to be displayed, saved, recorded, or printed through the monitor. If the monitor is connected with the CMS or eGateway, information from external devices can also be transmitted to the CMS or eGateway.
For more information on connecting external devices via the BeneLink module, see BeneLink Module Operator’s
Manual (PN: 046-011948-00).
6.2
BeneLink Safety Information
WARNING
•
Devices of the same category cannot be connected to the BeneLink module simultaneously.
•
The parameter labels used on the patient monitor may be different from those used on the external device.
•
The alarms from external devices may be delayed before transmission to the patient monitor.
•
There can be differences between the alarm priorities displayed on the monitors and the priorities displayed on external devices interfaced through BeneLink.
CAUTION
•
Check the compatibility of the external devices and ID adapters before connection. Otherwise, unpredictable system failure may result.
NOTE
•
The alarm messages from external devices are derived from the open protocol of the corresponding external device. For more information about these alarms, please see the operator’s manual for the corresponding devices.
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6.3
6.4
Differences in Displayed Values
In certain cases, there may be differences between the numerics displayed on the monitor and those on external devices. The table below lists some situations and possible reasons.
Situation
Some parameter values are displayed as invalid values on the monitor.
The monitor and external device display parameter values with different numbers of places of decimals.
Non-continuously measured values and continuously measured values have the same displaying mode in the patient monitor.
Parameter values displayed on the patient monitor and those displayed in the external device are slightly different.
Possible Reasons
The patient monitor and the external device may have different parameter configuration or displaying range of values. If the patient monitor displays a parameter not configured in the external device, or a parameter value from the external device exceeds the displaying range of the monitor, then the corresponding parameter value is displayed on the monitor as an invalid value.
The monitor displays parameter values from the external device based on the monitor displaying rules. Same parameter value is displayed differently when the monitor and the external device display numbers with different precision.
For non-continuously measured values, the monitor displays the latest measured values until a new measurement is transmitted by the external device.
Some parameter values are converted to different units when transmitted to the monitor. Sometimes, values from the external device may be delayed before transmission to the patient monitor.
NOTE
•
When the pressure units are converted among cmH
2
O, hPa and mbar, the parameter values remain unchanged, for example, 1cmH
2
O=1hPa=1mbar, which may differ from some external devices.
Connecting an External Device
An external device is connected to the BeneLink module through an ID adapter. The ID adapter supports only its matching device.
(4)
(1)
(2)
(3)
(5)
6 - 2
(1) BeneLink Module
(3) RJ45 connecting cable
(5) External device
(6)
(2) Label
(4) ID Adapter
(6) Serial port adapting cable (optional)
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6.5
To connect an external device, follow this procedure:
1.
Insert the BeneLink module into the SMR.
2.
Connect the ID adapter that matches the external device to the BeneLink module with an RJ45 connecting cable.
3.
Plug the ID adapter into the RS232 port on the external device. Some external devices may have ports incompatible with the ID adapter. In this case, a serial port adapting cable is required.
4.
Stick a device name label to the RJ45 connecting cable at the end close to the BeneLink module. When the
BeneLink module is connected to several external devices, you can tell devices easily with these labels.
Switch on the external device.
After the external device is connected to the monitor, the indicators on both the ID adapter and the BeneLink module illuminate to show that the monitor successfully communicates with the external device.
CAUTION
•
First installation and debugging should be executed by Mindray service personnel or an authorized technician.
•
Please check the compatibility of the external device and the ID adapter before connection.
Otherwise, unpredictable system failure may result.
•
Ports on the BeneLink module are not conventional network connectors. They are intended for connecting with the serial port of designated devices only. Do not connect them to network interfaces.
Accessing the Integrated Devices Screen
■
■
■
You can view the information of external devices in the Integrated Devices screen of the monitor. The
Integrated Devices screen provides information of both individual device and multi devices. To access the
Integrated Devices screen, follow this procedure:
■
Select the Integrated Devices quick key.
Select the Screen Setup quick key → select Integrated Devices .
Select the Main Menu quick key → from the Display column select Choose Screen → select Integrated
Devices .
Select the numeric area or waveform area of any parameter from the external device
→ select Integrated
Devices button.
The Integrated Devices screen has the following features:
■
■
For the parameters measured by the external device, the measurements display directly after the parameter labels.
For the parameters input on the external device, the settings are enclosed in parenthesis after parameter labels.
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6.6
■ For the measured parameters and input parameters that have the same label, parameter measurements and settings are displayed after parameter labels with the settings are enclosed in parenthesis. For example, PEEP 18 (20), in which PEEP is parameter label, 18 is the measurement, and (20) is the setting.
NOTE
•
Parameters in the Integrated Devices screen are displayed in the order as shown in the selection dialog. If the screen cannot display all the selected parameters, the parameter with higher positions
(from top to bottom and from left to right) in the Select Parameter dialogue are displayed.
Displaying Parameters from External Devices
■
■
■
This monitor can display parameters from external devices in the main screen:
Display waveforms from external devices in the waveform area.
Display labels and measurements of parameters from external devices in the numeric area.
Display respiratory loops of parameters from external deivices in the Loops screen.
The following is an example of parameters (from TOF-Watch SX monitor) displayed in the numeric area of the main screen.
(8) (7)
(6)
(1)
(5)
(2) (3) (4)
(1) Parameter unit
(3) Parameter measurement
(5) Skin temperature
(7) Measurement countdown
(2) Parameter label
(4) Response amplitude of stimulation
(6) Measurement interval
(8) Time of last measurement
NOTE
•
When displayed in the monitor main screen, parameter labels of external devices are prefixed with the plug sign “+”. For example, if SpO
2
is from an external device, its label is displayed as “+SpO
2
”, and its waveform label is displayed as “+Pleth”.
•
If a parameter can be obtained either from the monitor or an external device, the measured value, waveform or loops coming from the monitor will be displayed preferentially.
6.6.1
Setting Waveform Properties for Parameters from External Devices
To set the waveform properties for parameters from external devices, follow this procedure:
1.
Access the parameter setup dialog by selecting its waveform area or numeric area.
2.
Set Speed or Scale .
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6.6.2
6.6.3
6.6.4
Setting Alarms from External Devices
To enable or disable the storage, display, and sound of the external device alarms of a certain priority and category, follow this procedure:
1.
From the Integrated Devices screen select Setup .
2.
Set switches as desired.
If the storage, display, or audio settings of a specific alarm are different from its category or priority, set them individually by adding the Alarm ID to the alarm list. To do so, follow this procedure:
1.
From the Integrated Devices screen select Setup .
2.
Input the Alarm ID for this alarm, and select Add .
To delete a specific external device alarm, select the desired Alarm ID, and select Delete .
Refer to the BeneLink Module Operator’s Manual (PN: 046-011948-00) for the list of supported alarms and
Alarm IDs.
Setting Parameters from External Devices for Display
To select parameters displayed in the Integrated Devices screen, follow this procedure:
1.
From the Integrated Devices screen select Select Parameter .
2.
Select desired parameters.
Displaying Data from External Devices on the Main Screen
This monitor can display data from external devices on the main screen:
■
■
■
■
Display waveforms from external devices in the waveform area.
Display labels and measurements of parameters from external devices in the numeric area.
If an anesthesia system is connected, display its set parameters (+Anes set) in the numeric area
If pumps are connected, display their alarm status in the numeric area
To display data from external devices on the main screen, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆
Select the Screen Setup quick key
→
select the Tile Layout tab.
◆
Select the Main Menu quick key
→ from the Display column select Tile Layout .
2.
Select a parameter numeric area or waveform area, then select the BeneLink element, and then from the popup list select the external device element you want to display in this area.
6.6.4.1
Setting Waveform Properties for Parameters from External Devices
To set the waveform properties for parameters from external devices, follow this procedure:
1.
On the main screen, select the waveform area or numeric area for the external device to enter the parameter setup menu.
2.
Set Speed or Scale .
6.6.4.2
Selecting Measured Parameters from the Anesthesia System for Display
On the main screen, the numeric area of some parameters from an external device, for example the +Paw parameter, can display multiple parameters. To select parameters for display, follow this procedure:
1.
On the main screen select the numeric area of the parameter from the anesthesia system.
2.
Select the Select Parameter tab.
3.
Select a parameter tile, and then select a parameter to display from the popup parameter.
4.
Repeat Step 3 to select additional desired parameters.
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6.6.5
6.6.6
Setting Units for Parameters from External Devices
To set units for parameters from external devices, follow this procedure:
1.
Select the numeric area or waveform area of any parameter from the external device.
2.
Select the Unit tab.
3.
Set the unit for O2 , CO2 , Pressure or Temp .
Accessing the Loops Screen
■
■
■
To enter the Loops screen, choose any of the following ways:
■
Select the Loops quick key.
Select the Screen Setup quick key → Select the Choose Screen tab → select Respiratory Loops .
Select the Main Menu quick key → from the Display column select Choose Screen → select Respiratory
Loops .
From the main screen, select the numeric area for the anesthesia system or ventilator, select Loops .
NOTE
•
The monitor only displays real-time loops of the external device, and these loops cannot be displayed or saved as reference loops.
6.7
6.8
6.9
Viewing Alarms from External Devices
If the patient monitor is configured to do so, the monitor displays alarms from external devices in the physiological and technical alarm information areas. A plus sign “+” is added before each alarm message from external devices.
Viewing Parameter Trends from External Devices
If the patient monitor is configured to do so, the monitor saves parameters trends and alarm events from external devices. You can review these data in the Tabular Trends , Graphic Trends , Events and Full Disclosure pages in the Review screen.The monitor adds a “+” before the parameter label of external devices.
For more information, see
.
NOTE
•
Parameters from external devices are saved and displayed according to the time on the monitor.
Recording and Printing Parameter Trends from External Devices
You can record or print parameter trends from external devices. For more information, see
,
.
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7
Using with the Telemetry Monitor
7.1
Introduction
You can connect a TM80 or TM70 telemetry monitor (hereinafter called the telemetry) with the N Series monitor
(hereinafter called the monitor) to measure the ECG, Resp, and SpO
2
of ambulatory adult and pediatric patients.
If the telemetry is connected to the BP10 NIBP module, the NIBP measurements can also be transferred to the N
Series monitor via the telemetry.
The telemetry is connected with the monitor via the wireless network. The process of connecting the telemetry and the monitor is called "pairing”. After the telemetry is paired with the monitor, you can view the measurement data from the telemetry on the monitor’s screen.
NOTE
•
To connect to the TM70 telemetry monitor, N Series monitor system software V01.11.00 and above is required.
7.1.1
Pairing Procedure
Before pairing the telemetry and the monitor, verify the network settings of both the telemetry and the monitor.
Ensure that the telemetry and the monitor are in the same network.
To pair the telemetry with the monitor, follow this procedure:
1.
Access the Bedside Devices dialog in either of the following ways:
◆
Select the Bedside Devices quick key.
◆
Select the Main Menu quick key
→ from the Parameters column select Bedside Devices .
2.
Select + to enter the Add Device dialog. Select Refresh if you want to refresh the unpaired telemetries list.
◆
From the All Unpaired tab or the Unpaired in Current Dept. tab, select the telemetry you want to pair.
◆ In the search box, input the device name, the patient’s MRN, department, or bed number, and then select Search . Select the desired telemetry from the search results.
3.
Select Pair and follow the on-screen instructions: a Select Confirm to start pairing the selected telemetry with the monitor.
b Select patient.
◆
Use Patient in Monitor : uses the patient data in the monitor and deletes patient data in the telemetry.
◆ Use Patient in Telemetry : uses the patient data in the telemetry and deletes patient data in the monitor.
◆
New Patient : discharges the current patient and admits a new patient. The new patient will be monitored.
c Check that the message “This telemetry is pairing with patient monitor XX, are you sure?” is displayed on the desired telemetry. Select Yes .
4.
At the completion of pairing, the message “Paired successfully” is displayed on the monitor. Close the
Pairing and the Bedside Devices dialogs.
After pairing with the telemetry, on the monitor, labels of parameters from the telemetry are followed by “-T”, for example ECG-T, indicating that these parameters come from the telemetry.
CAUTION
•
Make sure that correct telemetry is selected for pairing with the monitor.
•
If the wireless network signal is poor, the monitor may have the risk of data loss.
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7.2
NOTE
•
The telemetry is not intended for monitoring neonatal patients.
•
By default the device name of the telemetry is its serial number. If you need to change the name of the telemetry, refer to the operator’s manual of the corresponding telemetry.
Binding the Telemetry with the Monitor
After the telemetry is paired with the monitor, discharging the patient from either device automatically unpairs the telemetry and the monitor. If you need the monitor and the telemetry to remain paired after the patient is discharged, bind the two devices. To do so, enter the Bedside Devices dialog and select the unlock symbol on the top left corner. After the two devices are bound together, the lock symbol turns to be locked .
To release the binding of the monitor and the telemetry, select the lock symbol . Then the two devices are unbound and the lock symbol changes to be unlocked .
7.3
7.3.1
7.3.2
Unpairing the Telemetry and the Monitor
If you do not need to connect the monitor and the telemetry to monitor the patient, you can unpair them. After the monitor and the telemetry are unpaired, the CMS receives patient data from the monitor or the telemetry if connected.
Unpairing the Telemetry and the Monitor via the Monitor
To unpair the telemetry from the monitor, follow this procedure:
1.
Access the Bedside Devices dialog in either of the following ways:
◆ Select the Bedside Devices quick key.
◆ Select the Main Menu quick key → from the Parameters column select Bedside Devices .
2.
Select Unpair .
3.
Select which device is used to continue monitoring the patient.
◆ Monitor : the monitor is used to continue monitoring the patient.The telemetry enters standby.
◆ Telemetry : the telemetry is used to continue monitoring the patient. The monitor enters standby.
4.
Close the Unpair and the Bedside Devices dialogs.
Unpairing the Telemetry and the Monitor via the telemetry
To unpair the monitor from the telemetry, follow this procedure:
1.
Press the main menu button on the front panel of the telemetry.
2.
If prompted, input the password for the screen lock dialog. When Screen Lock is set to Off , skip this step.
3.
Select Unpair .
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7.4
4.
Select which device is used to continue monitoring the patient.
◆ Telemetry : the telemetry is used to continue monitoring the patient. The monitor enters standby.
◆ Monitor : the monitor is used to continue monitoring the patient. The telemetry enters standby.
◆ Cancel : do not unpair the telemetry and the monitor.
Troubleshooting
Problem Possible Cause
Telemetry Disconnected The telemetry is out of the wireless network coverage area.
The telemetry is powered off.
The monitor is not connected to the network or network settings are incorrect.
The telemetry is not connected to the wireless network or wireless network settings are incorrect.
The exchanger network connected by the telemetry and the monitor does not support multicast data transfer.
Wireless signal interference exists.
After the telemetry is paired with the monitor, ECG and
Pleth waveforms from the telemetry are not properly displayed on the monitor screen.
Wireless signals are weak.
Corrective Action
Put the telemetry in the Wi-Fi coverage area.
Power on the telemetry.
Verify that the monitor’s network settings are correct and the monitor is connected to the network.
Verify that the telemetry’s network settings are correct and the telemetry is connected to the wireless network.
Contact the service personnel.
■
■
■
■
Put the telemetry in the wireless coverage area.
Check the interference source and reduce or eliminate interference.
Put the telemetry in the wireless network coverage area with strong signals.
Remove any metallic obstructions that stand between the telemetry and the monitor.
Contact the service personnel.
The telemetry occasionally goes offline.
Insufficient network bandwidth or greater network delay leads to data transfer delay.
Wireless signal interference exists.
Wireless signals are weak.
■
■
■
■
Put the telemetry in the wireless network coverage area.
Check the interference source and reduce or eliminate interference.
Put the telemetry in the wireless network coverage area with strong signals strength.
Remove any metallic obstructions between the telemetry and the monitor.
Contact the service personnel.
Telemetry Low Battery or
Telemetry Battery Depleted
Insufficient network bandwidth or greater network delay leads to data transfer delay.
The telemetry battery charge is low or depleted.
Replace the battery with a known good one.
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8
Alarms
8.1
8.2
Alarm Introduction
This chapter describes alarm functions and alarm settings.
Alarm Safety Information
WARNING
•
A potential hazard can exist if different alarm presets and default configuration settings are used for the same or similar equipment in the same care area, for example an intensive care unit or cardiac operating room.
•
If the monitor is connected to the central monitoring system (CMS) or other monitors, alarms can be presented and controlled remotely. Remote suspension, inhibition, or reset of monitor alarms via the CMS or other monitors may cause a potential hazard. For more information, see the operator’s manuals for the CMS and the other monitors.
•
The monitors in the care area may each have different alarm settings to suit different patients.
Always check that the alarm settings are appropriate for the patient before starting the monitoring.
Always make sure that necessary alarm limits are active and set according to the patient's clinical condition.
•
Setting alarm limits to extreme values may cause the alarm system to become ineffective. For example, setting the SpO
2
high alarm limit to 100%, is equivalent to switching the alarm off.
•
When the alarm sound is switched off, the monitor gives no alarm tones even if a new alarm occurs.
Be careful when considering to switch off the alarm sound. When the alarms are off or while alarm audio is paused either temporarily or indefinitely, observe the patient frequently.
•
When monitoring patients that are not continuously attended by a clinical operator, properly configure the alarm system and adjust alarm settings as per the patient's condition.
•
Do not rely exclusively on the audible alarm system for monitoring. Adjustment of alarm volume to a low level may result in a hazard to the patient.
8.3
8.3.1
8.3.2
Understanding the Alarms
Alarm Categories
The monitor has two different types of alarms: physiological alarms and technical alarms.
■
■
Physiological alarms are triggered by patient measurement exceeding the parameter limits, or by an abnormal patient conditions.
Technical alarms are triggered by an electrical, mechanical, connectivity, or other monitor abnormal operation, or by failure of a sensor or component. Technical alarm conditions may also be caused when an algorithm cannot classify or interpret the available data.
Apart from the physiological and technical alarms, the monitor can also prompt with some messages describing the system status or patient status.
Alarm Priorities
By severity, the alarms are classified into the following priority levels:
■
■
High priority alarms: indicate a life threatening situation or a severe device malfunction. High priority alarms require an immediate response.
Medium priority alarms: indicate abnormal vital signs or a device malfunction. Medium priority alarms require a timely response.
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8.3.3
■
■
Low priority alarms: indicate a discomfort condition, a device malfunction, or an improper operation. Low priority alarms require you to be aware of this condition.
Messages: provides additional information on the patient or the equipment.
Alarm Indicators
When an alarm occurs, the monitor indicates it through visual or audible alarm indications. For more information, see the following table.
Alarm Indicator High Priority
Alarm
Alarm lamp
Audible tone pattern
Red
Flashing frequency: 1.4 -
2.8 Hz
Duty cycle: 20 -
60% on
ISO Repeat pattern of triple + double + triple
+ double beeps
Mode 1 Repeat pattern of high-pitched single beep
Mode 2 Repeat pattern of high-pitched triple beeps
Alarm message White text inside a red box
Medium
Priority Alarm
Yellow
Flashing frequency: 0.4 -
0.8 Hz
Duty cycle: 20 -
60% on
Repeat pattern of triple beeps
Repeat pattern of double beeps
Repeat pattern of double beeps
Black text inside a yellow box
Low Priority
Alarm
Cy a n
No flashing
Duty cycle:
100% on
Single beep
Low-pitched single beep
Low-pitched single beep
Black text inside a cyan box
Message Comments
None
None
None
None
White text
None
None
Alarm priority indicator
Parameter value
*** ** * None
Alarm messages are displayed in the alarm information area at the top of the screen. You can select the alarm messages to show the alarm list.
The indicator appears in front of the corresponding alarm message.
None White text inside a flashing red box
Black text inside a flashing yellow box
Black text inside a flashing cyan box
None
NOTE
•
When multiple alarms of different priority levels occur simultaneously, the monitor selects the highest priority alarm to light the alarm lamp and issue the alarm tone.
•
When multiple alarms of different priority levels occur simultaneously and should be displayed in the same area, the monitor only displays the messages from the highest priority alarm.
•
When multiple alarms of the same priority levels occur simultaneously alarm messages are displayed cyclically.
•
Some physiological alarms, such as Asystole, are exclusive. They have identical alarm tones and alarm lights with normal high level physiological alarms, but their alarm messages are displayed exclusively. That is, when an exclusive physiological alarm and a normal high level physiological alarm are triggered simultaneously, only exclusive physiological alarm message will be displayed.
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8.3.4
Alarm Status Symbols
to indicate the alarm status:
Alarm pause: indicates that all the alarms are paused.
Alarm off: indicates that individual measurement alarms are turned off or the system is in the alarm off status.
Audio pause: indicates that audible alarm tones are paused.
Audio off: indicates that audible alarm tones are turned off.
Alarm reset: indicates that the alarm system is reset.
8.4
Accessing On-screen Help for Technical Alarms (AlarmSight)
In the technical alarm list, alarm messages followed by Detail include help messages or pictures to help you identify the problem. This function is called AlarmSight. To access AlarmSight, follow this procedure:
1.
Select an alarm displaying in the technical alarm information area to enter the Alarms dialog.
2.
From the alarm list select the desired alarm.
NOTE
•
If there are no displayed alarms, then selecting the technical alarm area will not open any dialogs.
8.5
8.6
8.6.1
Checking the Physiological Alarms List
If the patient monitor has more than one physiological alarm, you can see the physiological alarm list by selecting the physiological alarm information area to enter the Alarms dialog. If there is only one physiological alarm, selecting the physiological alarm information area enters the Review dialog for the event created by this alarm.
Changing Alarm Settings
Alarms settings can be changed by selecting Main Menu and choosing from the list in the Alarm column.
Setting Parameter Alarm Properties
To set parameter alarm properties, follow this procedure:
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1.
Access the Limits page in either of the following WAYS:
◆ Select the Alarm Setup quick key.
◆
Select the Main Menu quick key
→
from the Alarm column select Limits.
2.
Enter the password if required.
3.
Select a parameter tab and set alarm properties as desired.
You can also change the alarm properties of individual parameter from the corresponding parameter dialog.
8.6.2
NOTE
•
The monitor can be configured to require an password or login to change alarm settings. For more
information, refer to 32.14.3 Selecting Password for User Authentication
.
Changing the Alarm Volume
To change the alarm volume, follow this procedure:
1.
Access the Setup page in either of the following ways:
◆ Select the Alarm Setup quick key → select the Setup tab.
◆ Select the Main Menu quick key → from the Alarm column select Setup.
2.
Set Alarm Volume . The alarm volume can be set from X to 10, in which X is the minimum volume allowed by your department, and 10 is the maximum volume.
3.
Select High Alarm Volume to set the volume of the high priority alarm.
4.
Select Reminder Volume to set the volume of the reminder tone.
NOTE
•
Alarm volume can only be set to 0 if the monitor is connected to a Central Monitoring System.
•
When the alarm volume is set to 0, the alarm sound is turned off and the audio off symbol appears on the screen.
•
You cannot set the volume of high priority alarms if Alarm Volume is set to 0.
•
You can set the Alarm Volume to 0 only when your monitor is connected to the CMS. If your monitor is not connected to the CMS, the lowest setting of Alarm Volume is 1.
•
When the monitor is connected to the CMS and Alarm Volume is set to 0, Alarm Volume automatically changes to 2 if the CMS is disconnected.
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8.6.3
Setting the Auto Limits for New Patient Switch
If the Auto Limits for New Patient function is enabled, a dialog box can pop up to ask you whether to set alarm limits based on the latest parameter measurements for a newly admitted patient. To set the Auto Limits for New
Patient switch, follow this procedure:
■
■
■
■
■
■
■
■
1.
Enter the alarm setup page in any of the following ways:
◆
Select the Alarm Setup quick key
→
select the Setup tab.
◆ Select the Main Menu quick key
→
from the Alarm column select Setup .
2.
Set the Auto Limits for New Patient switch.
When Auto Limits for New Patient is switched on, the confirmation dialog box pops up if all of the following requirements are met:
Within 10 minutes after the patient is admitted.
Continuous measurements are stable.
An NIBP measurement has been taken.
HR alarm switch is on.
No lethal alarms are triggered.
The patient is not in poor perfusion condition.
Alarm limits of no parameters were manually changed.
The monitor is not in intubation mode, private mode, or CPB mode.
NOTE
•
The Auto Limits for New Patient function is intended for newly admitted patients only.
•
The automatically set alarm limits take effect only after being confirmed.
8.6.4
Initiating Auto Alarm Limits
The monitor provides the auto alarm limits function to automatically adjust alarm limits according to the patient’s vital signs. When auto limits are selected, the monitor calculates safe auto limits based on the latest measured values. To get accurate auto alarm limits, collect a set of measured vital signs as a baseline.
To initiate auto alarm limits, follow this procedure:
1.
Access the Limits page in either of the following ways:
◆ Select the Alarm Setup quick key.
◆ Select the Main Menu quick key → from the Alarm column select Limits.
2.
From the Limits page, select Auto Limits at the left bottom.
3.
Select Ok from the popup dialog box.
Then the monitor will automatically calculate alarm limits based on the latest measured values. Before applying these automatically created alarm limits, confirm if they are appropriate for the patient from the Limits dialog. If not, you can adjust them manually. These alarm limits will remain unchanged until you select auto limits again or adjust them manually.
The monitor calculates auto limits based on the following rules:
Module
ECG
Parameter Lower Limit
HR/PR
(bpm)
Upper Limit Auto Limit Range
Adult/ pediatric
Neonate Adult/ pediatric
HR × 0.8 or 40
(whichever is greater)
(HR - 30) or 90
(whichever is greater)
HR × 1.25 or
240
(whichever is smaller)
Neonate
(HR + 40) or
200
(whichever is smaller)
Adult/pediatric: 35 to 240
Neonate: 55 to 225
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8 - 6
Module
Resp
SpO
NIBP
2
Temp
(xx refers to temperat ure site)
IBP: ART/
Ao/UAP/
BAP/FAP/
LV/P1-P4
(Arterial pressure)
Txx (°C)
ΔT (°C)
IBP-S
(mmHg)
IBP-D
(mmHg
IBP: PA
Parameter Lower Limit
RR (rpm)
SpO
2
(%)
NIBP-S
(mmHg)
NIBP-D
(mmHg)
NIBP-M
(mmHg)
Upper Limit Auto Limit Range
Adult/ pediatric
RR × 0.5 or 6
(whichever is greater)
Same as the default alarm limit
(SYS × 0.68 +
10)
(Dia × 0.68 +
6)
(Mean × 0.68
+ 8)
(Txx - 0.5)
Same as the default alarm limit
Neonate Adult/ pediatric
Neonate
(RR - 10) or 30
(whichever is greater)
Same as the default alarm limit
(SYS - 15) or
45 (whichever is greater)
(Dia - 15) or
20 (whichever is greater)
(Mean - 15) or
35 (whichever is greater)
(Txx - 0.5)
Same as the default alarm limit
(RR × 1.5) or
30 (whichever is smaller)
Same as the default alarm limit
(SYS × 0.86 +
38)
(Dia × 0.86 +
32)
(RR + 25) or
85 (whichever is smaller)
Same as the default alarm limit
(SYS + 15) or
105
(whichever is smaller)
(Dia + 15) or
80 (whichever is smaller)
(Mean × 0.86
+ 35)
(Txx + 0.5)
Same as the default alarm limit
Adult/pediatric: 6 to 55
Neonate: 10 to 90
Same as the measurement range
Adult: 45 to 270
Pediatric: 45 to 185
Neonate: 35 to 115
(Mean + 15 or
95)
(whichever is smaller)
(Txx + 0.5)
Same as the default alarm limit
Adult: 25 to 225
Pediatric: 25 to 150
Neonate: 20 to 90
Adult: 30 to 245
Pediatric: 30 to 180
Neonate: 25 to105
1 to 49
Same as the measurement range
IBP-M
(mmHg)
SYS × 0.68 +
10
(Dia × 0.68 +
6)
Mean × 0.68 +
8
SYS × 0.75
(SYS - 15) or
45 (whichever is greater)
(Dia - 15) or
20 (whichever is greater)
(Mean - 15) or
35
(whichever is greater)
SYS × 0.75
SYS × 0.86 +
38
(Dia × 0.86 +
32)
Mean × 0.86 +
35
SYS × 1.25
(SYS + 15) or
105
(whichever is smaller)
(Dia + 15) or
80 (whichever is smaller)
(Mean + 15) or 95
(whichever is smaller)
SYS × 1.25
Adult: 45 to 270
Pediatric: 45 to 185
Neonate: 35 to 115
Adult: 25 to 225
Pediatric: 25 to 150
Neonate: 20 to 90
Adult: 30 to 245
Pediatric: 30 to180
Neonate: 25 to 105
3 to 120
IBP: CPP
IBP-S
(mmHg)
IBP-D
(mmHg
IBP-M
(mmHg)
CPP
(mmHg)
Dia × 0.75
Mean × 0.75
Dia × 0.75
Mean × 0.75
CPP × 0.68 + 8 (CPP-15) or
Mean × 0.75
35,
(whichever is greater)
Mean × 0.75
Dia × 1.25
Mean × 1.25
CPP × 0.86 +
35
Mean × 1.25
Dia × 1.25
Mean × 1.25
3 to 120
3 to 120
IBP: CVP/
LAP/
RAP/
UVP/P1-
P4
(Venous pressure)
IBP-M
(mmHg)
(CPP+15) or
95,
(whichever is smaller)
Mean × 1.25
Adult: 20 to 235
Pediatric: 25 to175
Neonate: 25 to 100
3 to 40
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Module
CO
AG
C.O.
SvO rSO
2
2
2
Parameter Lower Limit
EtCO
(mmHg)
FiCO
FiO
2
/EtO
ScvO rSO
2
2 awRR
(rpm)
EtCO
FiCO
2 awRR
(rpm)
FiAA/EtAA
FiN
EtN
TB (°C)
C.I.
TFC
SvO
2
2
O/
2
2
2
O
(%)
2
2
(%)
Upper Limit Auto Limit Range
Adult/ pediatric
0 to 32: remains the same
33 to 35: 29
Neonate
0 to 32: remains the same
33 to 35: 29 awRR × 0.5 or
6 (whichever is greater)
(awRR - 10) or
30 (whichever is greater)
Adult/ pediatric
0 to 32: remains the same
33 to 35: 41
Neonate
0 to 32: remains the same
33 to 35: 41
Same as the measurement range
36 to 45:
(etCO
2
- 6)
46 to 48: 39
>48: remains the same
None
36 to 45:
(etCO
2
- 6)
46 to 48: 39
>48: remains the same
None
36 to 45:
(etCO
2 limit
+ 6)
46 to 48: 51
>48: remains the same
Same as the default alarm awRR × 1.5 or
30 (whichever is smaller)
36 to 45:
(etCO
2
+ 6)
46 to 48: 51
>48: remains the same
Same as the default alarm limit
(awRR+25) or
85 rpm
(whichever is smaller)
Same as the measurement range
Same as the measurement range
Same as the measurement range
Same as the measurement range
Same as the measurement range
Adult/pediatric: 6 to 55
Neonate: 10 to 90
Same as the CO
2
module
Same as the CO
2
module awRR × 0.5 or
6 (whichever is greater)
(awRR - 10) or
30 (whichever is greater)
Same as the default alarm limit
Same as the default alarm limit
Same as the default alarm limit
Same as the default alarm limit
Same as the default alarm limit
Adult: (TB - 1)
Pediatric: N/A
N/A
N/A
SvO
2
- 5
Same as the default alarm limit
N/A
N/A
N/A
N/A awRR × 1.5 or
30 (whichever is smaller)
Same as the default alarm limit
Same as the default alarm limit
Same as the default alarm limit
Adult: (TB + 1)
Pediatric: N/A
N/A
N/A
SvO
2
+ 5
N/A
N/A
N/A
ScvO
2
- 5 N/A ScvO
2
+ 5 awRR+25 or
85 (whichever is smaller)
Same as the default alarm limit
Same as the default alarm limit
Same as the default alarm limit
N/A
Adult/pediatric: 6 to 55
Neonate: 10 to 90
Same as the measurement range
Same as the measurement range
Same as the measurement range
Same as the measurement range
N/A
N/A
N/A
Same as the measurement range
Same as the measurement range
15 to 95 Same as the default alarm limit
Manual mode: same as the default alarm limit
Auto mode: remains unchanged
Same as the default alarm limit
Manual mode: same as the default alarm limit
Auto mode: remains unchanged
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8.6.5
8.6.6
8.6.7
Setting the Apnea Delay Time
To set the apnea delay time, follow this procedure:
1.
Access the Setup page in either of the following ways:
◆ Select the Alarm Setup quick key → select the Setup tab.
◆ Select the Main Menu quick key → from the Alarm column select Setup.
2.
Select Apnea Delay to set the apnea delay time.
Switching On or Off V-Tach Latching
When V-Tach Latching Lock is switched on, you can switch on or off V-Tach Latching . To do so, follow this procedure:
1.
Access the Setup page in either of the following ways in either of the following ways:
◆ Select the Alarm Setup quick key → select the Setup tab.
◆ Select the Main Menu quick key → from the Alarm column select Setup.
2.
Switching on or off V-Tach Latching .
For information on the V-Tach Latching function, see 32.3.4 Latching Physiological Alarms
.
Restoring the Default Alarm Settings
To reset all alarm settings to the defaults, follow this procedure:
1.
Access the Alarm page in either of the following ways:
◆ Select the Alarm Setup quick key.
◆ Select the Main Menu quick key → from the Alarm column select Limits.
2.
On the Limits page, select Defaults at the bottom.
8.6.8
Setting the Length of Printed Waveforms
You can define the length of printed waveforms when an alarm is triggered. To do so, follow this procedure:
1.
Access the Setup page in either of the following ways:
◆ Select the Alarm Setup quick key
→
select the Setup tab.
◆ Select the Main Menu quick key
→
from the Alarm column select Setup.
2.
Set Printing Duration On Alarm .
8.7
Pausing Alarms/Pausing Alarm Tones
You can either pause alarms or pause alarm tones. This depends on the pause setting. To set the pause function, refer to
32.3.3 Defining the Pause Function
.
8.7.1
Pausing Alarms
If the Pause function is configured to alarm pause, pressing the Alarm Pause quick key can temporarily disable alarm indicators. For the configuration of the pause function, see
32.3.3 Defining the Pause Function
. When alarms are paused, the following rules are followed:
■
■
■
■
No physiological alarm will be presented.
Except battery-related technical alarms, sounds of other technical alarms are paused, but alarm lamps and alarm messages continue to be presented.
The remaining alarm pause time is displayed in the physiological alarm information area.
The alarm pause symbol is displayed in the system information area.
When the alarm pause time expires, the alarm paused state is automatically deactivated. You can also cancel the alarm paused state by pressing the Alarm Pause quick key again.
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8.7.1.1
Prolonging the Alarm Pause Time
If enabled, you can temporarily prolong the alarm pause time after the monitor enters the alarm paused state.
This capability is disabled by default. To prolong the alarm pause time, follow this procedure:
1.
In the physiological alarm information area, select the alarm pause countdown.
2.
Select Pause 5 min, Pause 10 min , or Pause 15 min .
NOTE
•
Prolonging alarm pause time does not affect the setting of alarm pause time.
8.7.1.2
Switching Off All Alarms
■
■
■
■
If Pause Time is set to Permanent
(see section 32.3.3.1 Setting the Alarm Pause Time/Alarm Tone Pause Time
), pressing the Alarm Pause quick key permanently switches off all alarms. The alarm off state has the following features:
Physiological alarms are switched off. The alarm lamp does not flash and alarm sound is not issued.
Alarm sound of technical alarms is switched off, but alarm lamp flashes and alarm messages are presented.
The message Alarm Off with red background is displayed in the physiological alarm information area.
The alarm off symbol is displayed in the system status information area.
To exit the alarm off state, press the Alarm Pause quick key again.
WARNING
•
Pausing or switching off alarms may result in a hazard to the patient.
8.7.2
Pausing Alarm Sound
■
■
■
If the Pause function is configured to Audio Pause, pressing the Audio Pause quick key pauses alarm tone and
. When alarm tones are paused, the following rules are followed:
The sound of all physiological alarms and technical alarms are switched off.
The remaining audio pause time is displayed in the physiological alarm information area.
The audio pause symbol is displayed in the system information area.
When the audio pause time expires, the audio paused state is automatically deactivated. You can also cancel the audio paused state by pressing the highlighted Audio Pause quick key again.
8.7.2.1
Prolonging the Alarm Tone Pause Time
If enabled, you can temporarily prolong the alarm tone pause time after the monitor enters the alarm tone paused state. This capability is disable by default. To prolong the audio pause time, follow this procedure:
1.
In the physiological alarm information area, select the alarm pause countdown.
2.
Select the alarm tone pause time. Options may include Pause 5 min, Pause 10 min , or Pause 15 min .
NOTE
•
Prolonging alarm pause time does not affect the setting of alarm tone pause time.
8.7.2.2
Switching Off Alarm Sound
■
■
If Pause Time is set to Permanent
(see section 32.3.3.1 Setting the Alarm Pause Time/Alarm Tone Pause Time
), pressing the Audio Pause quick key permanently switches off all alarm sound. The audio off state has the following features:
Alarm sound of both physiological alarms and technical alarms is switched off.
The audio off symbol is displayed in the system information area.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 8 - 9
To exit the audio off state, press the Audio Pause quick key again.
WARNING
•
Pausing or switching off alarm sound may result in a hazard to the patient.
8.8
Resetting Alarms
Press the Alarm Reset quick key to reset the alarm system. When the alarm system is reset, the alarm reset symbol displays in the system status information area for alarm symbols.
NOTE
•
If a new alarm is triggered after the alarm system is reset, the alarm reset icon will disappear and the alarm light and alarm tone will be reactivated.
8.8.1
8.8.2
8.9
■
■
■
Resetting Physiological Alarms
For physiological alarms, when the alarm system is reset, the following occur:
The alarm sound is silenced.
A √ appears before the alarm message.
The color of the parameter numeric background corresponds with the alarm priority, but the parameter numeric does not flash.
Resetting Technical Alarms
For technical alarms, when the alarm system is reset, the following occur:
■
■
■
Some technical alarms are cleared. The monitor gives no alarm indications.
Some technical alarms are changed to prompt messages.
For some technical alarms, the alarm is silenced and a √ appears before the alarm message.
For details about the indications of technical alarms when the alarm system is reset, see
.
Latching Alarms
The latching setting for physiological alarms defines how alarm indicators behave if you do not reset the alarms.
■
■
If you do not “latch” physiological alarms, their alarm indications disappear when the alarm condition ends.
If you “latch” physiological alarms, all visual and audible alarm indications remain (if configured) until the alarms are reset. For latched alarms the time when the alarm is last triggered is displayed behind the alarm message.
The monitor can be set to separately latch visual indications or simultaneously latch the visual and the audible indications.
■
■
When visual indications are latched, visual indications, including alarm lamp, alarm message and its background remain when the alarm condition ends and the time when the alarm last triggered is displayed behind the alarm message.
When audible indications are latched, the monitor continues to issues alarm sounds when the alarm condition ends.
NOTE
•
Changing alarm priority may affect the latching status of the corresponding alarm. Determine if you need to adjust the latching status for the specific alarm when you have changed its alarm priority.
•
When the alarm system is reset, latched physiological alarms are cleared.
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8.10
Nurse Call
■
■
■
The monitor provides a nurse call connector to output a nurse call signal when a user-defined alarm occurs. To obtain a nurse call signal, use the nurse call cable to connect the hospital nurse call system with the monitor’s nurse call connector.
Alarms are indicated on the nurse call device only when the following conditions are met:
The nurse call system is enabled.
A user-defined alarm occurs.
Alarms are not paused or reset.
WARNING
•
Do not rely exclusively on the nurse call system for alarm notification. Remember that the most reliable alarm notification combines audible and visual alarm indications with the patient’s clinical condition.
8.11
Calling for Help
This monitor can be configured to call monitors in the same department so that nearby doctors and nurses can come to help.
8.11.1
Issuing the Call Help Signal
To call help, select the Call Help quick key and select Ok from the popup dialog box. If Ok is not selected within 5 seconds then the monitor will automatically send out the call help signal.
After the call help signal is sent out, the Call Help quick key flashes in red. Select the Call Help quick key again to stop the call help signal.
Monitors receiving the call help signal issue a sound and a dialog box pops up indicating which monitor is calling.
Select Ok to acknowledge the call and stop the sound at this monitor.
NOTE
•
The call help function works only when the monitor is connected to the network.
•
The call help sound may disturb patients in the same department.
8.12
CPB Mode
The CPB (Cardiopulmonary Bypass) mode is activated only if you set the department to OR .
In the CPB mode, except for EEG, NMT, tcGas, and rSO
2
related alarms, all the physiological alarms and technical alarms are switched off. So when performing CPB, you can put the monitor in the CPB mode to inactivate unnecessary alarms.
8.12.1
Entering the CPB Mode
To enter the CPB mode, choose either of the following ways:
■
■
Select the CPB Mode quick key.
Select the Main Menu quick key
→
from the Alarm column select CPB Mode .
In the CPB mode, CPB Mode is displayed in the physiological alarm area with a red background color.
NOTE
•
When the CPB mode is entered, the monitor stops all NIBP measurements. You can restart NIBP measurements after entering the CPB mode.
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8.12.2
Exiting the CPB Mode
To exit the CPB mode, choose either of the following ways:
■
■
Select the CPB Mode quick key.
Select the Main Menu quick key
→
from the Alarm column select Exit CPB Mode .
8.13
Intubation Mode
Intubation mode is available for Resp, CO
2
, and AG monitoring. When performing intubation during general anesthesia, you can put the monitor in the intubation mode in order to inactivate unnecessary alarms.
In the intubation mode, Resp, CO
2
, and AG related physiological alarms are switched off.
8.13.1
Entering the Intubation Mode
To enter the intubation mode, choose either of the following ways:
■
■
■
Select the Intubation Mode quick key.
From the bottom of the Resp , CO2 , or AG dialog, select Intubation Mode .
Select the Main Menu quick key
→ from the Alarm column select Intubation Mode .
8.13.2
Exiting the Intubation Mode
To exit the intubation mode, choose either of the following ways:
■
■
■
Select the Intubation Mode quick key.
From the bottom of the Resp , CO2 , or AG dialog, select Exit Intubation Mode .
Select the Main Menu quick key from the Alarm column
→ select Exit Intubation Mode .
8.14
Testing Alarms
The monitor automatically performs a selftest at startup. Check that an alarm tone is heard, the alarm lamp illuminates, one after the other, in red, yellow, and cyan. This indicates that the visible and audible alarm indicators function correctly.
To further test individual measurement alarms, perform measurements on yourself or using a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.
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9
Monitoring ECG, Arrhythmia, ST and QT
9.1
ECG Introduction
The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as waveforms and numerics. ECG monitoring provides 3-, 5-, 6-, and 12-lead ECG monitoring, ST-segment analysis, arrhythmia analysis, QT/QTc measurements, and optional 12-lead resting analysis via the Glasgow algorithm.
The associated module incorporating ST analysis has the ST label.
The associated module incorporating 12-lead has the 12-lead label.
(3)
(1)
(4)
(1)
(2)
(1)
9.2
(1) ECG cable connector (2) ST label (3) 12-lead label (4) Glasgow label
ECG Safety Information
WARNING
•
This equipment is not intended for direct cardiac application.
•
Ensure that the conductive parts of ECG electrodes and associated connectors, including the neutral electrode, do not come into contact with any other conductive parts including earth.
•
Always use defibrillation-proof ECG cables during defibrillation.
•
Do not touch the patient, or metal devices connected to the patient, during defibrillation.
•
To minimize the hazard of burns during high-frequency surgical procedures, ensure that the monitor’s cables and transducers never come into contact with the electrosurgery unit (ESU).
•
To minimize the hazard of burns during use of high-frequency surgical unit (ESU), the ECG electrodes should not be located between the surgical site and the ESU return electrode.
CAUTION
•
Only use parts and accessories specified in this manual. Follow the instructions for use and adhere to all warnings and cautions.
•
Periodically inspect the electrode application sites to ensure skin integrity. If the skin quality changes, replace the electrodes or change the application site.
•
Interference from an ungrounded instrument near the patient or electrosurgery usage can induce noise and artifact into the waveforms.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 9 - 1
9.3
ECG Display
The following figures show the ECG waveform and numeric areas. The display may be configured to look slightly different.
(1) (2) (3) (4) (5) (6) (7)
(1) ECG lead label of the displayed waveform
(3) ECG filter mode
(2) ECG waveform gain
(4) Notch filter status
(5) Paced status: If Paced is set to Yes , is displayed. If Paced is set to No , is displayed.
(6) Pace pulse marker: If Paced is set to Yes , pace pulse markers “|” are displayed corresponding to detected pacer for each beat.
(7) HR/PR alarm message
(1)
(2)
(4)
(3)
9.4
9.4.1
9.4.2
(1) Parameter label
(3) HR alarm limits
(2) HR measurement unit
(4) HR value
Preparing for ECG Monitoring
Preparing the Patient Skin
Proper skin preparation is necessary to ensure good signal quality at the electrode sites, as the skin is a poor conductor of electricity. To properly prepare the skin, choose flat areas and then follow this procedure:
1.
Shave hair from skin at chosen electrode sites.
2.
Gently rub skin surface at sites to remove dead skin cells.
3.
Thoroughly cleanse the site with a mild soap and water solution. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.
4.
Dry the skin completely before applying electrodes.
Applying Electrodes and Connecting the Patient
To connect ECG cables, follow this procedure:
1.
Check that electrode packages are intact and the electrodes are not past the expiry date. Ensure the electrode gel is moist. If you are using snap electrodes, attach the snaps to the electrodes before placing electrodes on the patient.
2.
Place the electrodes on the prepared sites. Ensure that all electrodes have good skin contact.
9 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
3.
Connect the leadwires to the patient cable if not already connected.
4.
Plug the patient cable into the ECG connector.
CAUTION
•
Never mix patient electrode types or brands. This may lead to impedance mismatches issues.
NOTE
•
When applying the electrodes, avoid bony area, obvious layers of fat, and major muscles. Muscle movement can result in electrical interference. Applying electrodes on major muscles, for example on muscles of the thorax, may lead to erroneous arrhythmia alarms due to excessive muscle movement.
9.4.3
Lead Wire Color Code
The following table lists the color coding of leadwires for AHA standards:
Lead
Right arm
Left arm
Right leg (neutral)
Left leg
Chest 1
Chest 2
Chest 3
Chest 4
Chest 5
Chest 6
Label
V1
V2
V3
V4
RA
LA
RL
LL
V5
V6
Color
White
Black
Green
Red
Brown/Red
Brown/Yellow
Brown/Green
Brown/Blue
Brown/Orange
Brown/Violet
9.4.4
ECG Electrode Placements
In this section, electrode placement is illustrated using the AHA naming convention.
9.4.4.1
3-leadwire Electrode Placement
The following is the electrode configuration when a 3-leadwire cable is used:
■
■
■
RA placement: directly below the clavicle and near the right shoulder.
LA placement: directly below the clavicle and near the left shoulder.
LL placement: on the left lower abdomen.
RA LA
LL
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9.4.4.2
■
■
■
5-leadwire and 6-leadwire Electrode Placement
The following is the electrode configuration for a 5-leadwires cables:
■
■
RA placement: directly below the clavicle and near the right shoulder.
LA placement: directly below the clavicle and near the left shoulder.
RL placement: on the right lower abdomen.
LL placement: on the left lower abdomen.
V placement: on the chest in any of the V1 to V6 positions.
For 6-leadwire placement, you can use the position for the 5 leadwire placement but with two chest leads. The two chest leads (Va and Vb) can be positioned at any two of the V1 to V6 positions. For more information, see
9.4.4.3 Chest Electrode Placement
. The Va and
Vb lead positions are configurable. For more information, see
9.5.3.3 Changing Va and Vb Labels
.
V
RL
RA LA
9.4.4.3
■
■
Chest Electrode Placement
The chest electrode can be placed at the following positions:
■
■
■
■
■
V1 placement: on the fourth intercostal space to the right of the sternum.
V2 placement: on the fourth intercostal space to the left of the sternum.
V3 placement: midway between the V2 and V4 electrode positions.
V4 placement: on the fifth intercostal space at the left midclavicular line.
V5 placement: on the left anterior axillary line, horizontal with the V4 electrode position.
V1
VE V2 V3
V6 placement: on the left midaxillary line, horizontal with the V4 electrode position.
V3R-V6R placement: on the right side of the chest in positions corresponding to those on the left.
V6
V5
V4
NOTE
•
For the 5-leadwire and 6-leadwire placement, place the precordial electrode according to the physician's preference.
LL
9 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
9.4.4.4
10-leadwire Electrode Placement
12-lead ECG uses 10 electrodes, which are placed on the patient’s four limbs and chest. The limb electrodes should be placed on the limb extremities and the chest electrodes placed according to the physician’s preference. The figure at right illustrates the conventional 10-leadwire electrode placement.
9.4.4.5
Lead Placement for Pacemaker Patients
The recommended lead placement for monitoring a pacemaker patient is as follows.
RA
Pacemaker
LA
LL
RA
V1
RL
Pacemaker
LA
LL
3-leadwire Electrode Placement 5-leadwire Electrode Placement
A pacemaker patient usually requires a different electrode patch placement configuration than a nonpacemaker patient.
Do not place an ECG electrode directly over the pacemaker generator. Place the electrode patches 2 to 3 inches away from the pacemaker generator area. For example, if the pacemaker generator is located in the left subclavian area, relocate the Left Arm electrode closer in towards the center of the chest.
9.4.4.6
Lead Placement for Surgical Patients
The surgical site should be taken into consideration when placing electrodes on a surgical patient. For example, for open-chest surgery, the chest electrodes can be placed on the lateral chest or back. To reduce artifacts and interference from electrosurgical units, you can place the limb electrodes close to the shoulders and lower abdomen and the chest electrodes on the left side of the mid-chest. Do not place the electrodes on the upper arm. Otherwise, the ECG waveform will be very small.
WARNING
•
To reduce the hazard of burns during use of electrosurgical units (ESU), the ECG electrodes should not be located between the surgical site and the ESU return electrode.
•
Never entangle the ESU cable and the ECG cable together.
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•
When using ESU, never place ECG electrodes near the grounding plate of the ESU, as this can cause a lot of interference on the ECG signal.
•
When using ESU, ensure proper contact of the ESU return electrode to the patient to avoid burns at monitor measurement sites. Also ensure that the ESU return electrode is near the operating area.
9.4.5
9.4.6
Choosing the ECG Lead Type
To choose ECG lead type, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set Lead Set according to the lead type you are going to use. The default lead type is Auto . In this case, the monitor automatically detects the lead type.
Checking Paced Status
It is important to correctly set the patient’s paced status before you start monitoring ECG. The paced symbol is displayed when Paced is set to Yes . Pace pulse markers “|” are displayed on each ECG waveform whenever a pacer signal is detected. If Paced is set to No or unspecified, the symbol will be shown in the ECG waveform area.
To change the paced status, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Pacer tab.
3.
Set Paced to Yes or No .
You can also change the patient’s paced status from the Patient Management dialog. For more information, see
5.2.1 Entering the Patient Management Dialog
.
If you did not set the paced status, the monitor issues a prompt tone when pace pulse is detected. At the same time, the paced symbol flashes and the message Please check if the patient has a pacemaker?
appears in the ECG waveform area. Check and set the patient’s paced status.
WARNING
•
For paced patients, you must set Paced to Yes. If it is incorrectly set to No, the monitor could mistake a pace pulse for a QRS complex and fail to alarm when the ECG signal is too weak. On ventricular paced patients, episodes of ventricular tachycardia may not always be detected. Do not rely entirely upon the system’s automated arrhythmia detection algorithm.
•
False low heart rate or false asystole alarms may result with certain pacemakers because of pacemaker artifacts, such as electrical overshoot of the pacemaker overlapping the true QRS complexes.
•
Do not rely entirely on rate meter alarms when monitoring patients with pacemakers. Always keep these patients under close surveillance.
•
The auto pacer recognition function is not applicable to pediatric patients, neonatal patients, and patients with NMT monitoring.
9.4.7
Enabling Pacer Rejection
To eliminate the pacing pulse from the ECG waveform of paced patients, it is recommended to enable the pace pulse rejection function. The pace pulse rejection function is disabled by default. To enable this function, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Pacer tab.
3.
Switch on Pacer Reject .
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NOTE
•
When pace pulses are detected, the pace pulse markers “|” are shown on the ECG waveforms. Pacer
Rejection setting has no impact on the display of pace pulse markers “|”.
•
You can switch on pacer rejection only when Paced is set to Yes. If Paced is set to no, the Pacer Reject function is disabled.
9.5
Changing ECG Settings
9.5.1
9.5.2
Choosing an ECG Screen
When monitoring ECG, several display options are available.
■
■
■
■
For 3-lead ECG monitoring, only normal screen is available.
For 5-lead ECG monitoring, besides the normal screen, you can also choose Full-screen (7-lead) or Half
Screen (7-lead).
For 6-lead ECG monitoring, besides the normal screen, you can also choose Full-screen (8-lead) or Half
Screen (8-lead).
For 12-lead ECG monitoring, besides the normal screen, you can also choose Full-screen (7-lead), Half
Screen (7-lead), or 12-Lead (12-lead analysis).
To choose the desired screen configuration, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select Full-Screen , Half-Screen , or 12-Lead .
To return to the normal screen, press the highlighted button to unselect that screen.
Alternately you can choose the desired screen configuration as follows:
1.
Select the Screen Setup quick key
→
Choose Screen or select the Main Menu quick key
→ from the
Display column select Choose Screen .
2.
Select ECG Full-Screen , ECG Half-Screen , or ECG 12-Lead .
Setting ECG Alarm Properties
To select the desired ECG alarm options, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Alarm tab.
3.
Select the desired alarm options.
9.5.3
Changing ECG Wave Settings
9.5.3.1
Selecting the Leads of Displayed ECG Waveforms
To select the desired ECG waveforms to be displayed, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Select ECG to set the lead of each displayed ECG waveform.
4.
If more than three ECG waveforms are to be displayed, select the More Leads tab, and then select ECG to set leads of other ECG waveforms.
■
■
■
For optimal ECG analysis, select leads with the following characteristics:
The QRS complex should be either completely above or below the baseline and it should not be biphasic.
The QRS complex should be tall and narrow.
The P waves and T waves should be less than 0.2mV.
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CAUTION
•
Ensure that you have selected the optimal leads with the best waveform amplitude and the highest signal-to-noise ratio. Selecting the optimal leads is important for detecting beats, classifying beats, and detecting ventricular fibrillation.
9.5.3.2
Changing ECG Waveform Size
If the ECG waveform is too small or clipped, you can change its size by selecting the appropriate Gain setting. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Select ECG Gain to set the size of each ECG waveform.
4.
If more than three ECG waveforms are displayed, select the More Leads tab, and then select ECG Gain to change the sizes of other ECG waveforms. If you select Auto , the monitor automatically adjusts the size of the ECG waveforms for all the leads.
9.5.3.3
Changing Va and Vb Labels
When monitoring ECG with 6-leadwire. You can change the labels of Va and Vb leads. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set Va and Vb according to the locations of the Va and Vb electrode sites. Default settings are Va and Vb .
9.5.3.4
Changing ECG Waveform Speed
To change ECG waveform speed, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set the desired Speed .
9.5.3.5
Setting the ECG Filter
To set the appropriate ECG waveform filter mode, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set Filter .
◆ Diagnostic : use when diagnostic quality ECG is required. The unfiltered ECG waveform is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segment are visible.
◆ Monitor : use under normal monitoring conditions.
◆ Surgery : use when the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular.
Low frequency interference usually leads to wandering or rough baseline. The surgery filter reduces artifacts and interference from electrosurgical units. Under normal measurement conditions, selecting Surgery may suppress certain features or details of the QRS complexes.
◆ ST : recommended for ST monitoring.
9.5.3.6
Switching On or Off the Notch Filter
The notch filter removes the line frequency interference. To switch on or off the notch filter, follow this procedure:
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1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Switch on or off Notch Filter .
NOTE
•
The notch filter can only be switched on or off when ECG Filter is set to Diagnostic. In other filter modes, the notch filter is always on.
9.5.4
9.5.5
9.5.6
Disabling the Smart Lead Off Function
The monitor provides the smart lead off function. When the lead corresponding to the first ECG wave gets detached but another lead is available, the monitor automatically switches to the available lead to recalculate heart rate, and to analyze and detect arrhythmias. When you reconnect the detached leads, the monitor automatically switches back to the original lead.
The smart lead off function is enabled by default. To disable this function, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Switch off Smart Lead .
Adjusting the QRS Volume
To adjust the QRS volume, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set QRS Volume .
When valid SpO
2
measurements are available, the monitor adjusts the pitch of QRS tone based on the SpO
2 value.
Adjusting the Minimum QRS Detection Threshold
To avoid false asystole alarm due to low R wave amplitude, and to avoid tall T waves and P waves being mistaken for QRS complexes, the monitor provides a means to manually adjust the minimum QRS detection threshold.
To adjust the minimum QRS detection threshold, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab and set Filter to Monitor .
3.
Select the QRS Threshold tab.
4.
Select up or down arrow buttons to adjust the minimum threshold for QRS detection. Selecting Default resets the QRS threshold to the default value (0.16 mV).
CAUTION
•
The setting of the QRS detection threshold can affect the sensitivity for arrhythmia, ST, QT/QTc detection, and heart rate calculation.
•
If the QRS amplitude is low, the monitor might not be able to detect the beats and false asystole calls may occur.
NOTE
•
The minimum QRS detection threshold can only be adjusted when the ECG filter is set to Monitor.
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9.6
9.6.1
Monitoring Arrhythmia
Arrhythmia monitoring is intended for adult, pediatric, and neonatal patients.
Arrhythmia Safety Information
WARNING
•
Heart rate reading may be affected by cardiac arrhythmias. Do not rely entirely on heart rate alarms when monitoring patients with arrhythmias. Always keep these patients under close surveillance.
•
The arrhythmia analysis program may incorrectly identify the presence or absence of an arrhythmia.
Therefore, a physician must analyze the arrhythmia information with other clinical findings.
•
Pacer not Capture and Pacer not Pacing detection funcitons are not intended for neonatal patients.
CAUTION
Atrial fibrillation (A-Fib) detection function is not intended for pediatric and neonatal patients.
•
Since the arrhythmia detection algorithm sensitivity and specificity are less than 100%, it is possible for false arrhythmias to be detected and true arrhythmia events to not be detected. The possibility increases when the signal is noisy.
•
The ECG size and minimum QRS detection threshold settings affect arrhythmia detection and heart rate calculation sensitivity.
•
If QRS amplitude is low, the monitor might be unable to calculate heart rate and thus create false asystole calls. During the learning phase of the algorithm, arrhythmia detection may not be available. It is recommended to closely monitor patient condition during, and for several minutes after, the learning phase to allow the algorithm to reach optimal detection performance.
9.6.2
Arrhythmia Events
This section lists all arrhythmia events and their criteria.
9.6.2.1
Lethal Arrhythmia Events
Arrhythmia message
Asystole
V-Fib/V-Tach
V-Tach
Description
No QRS complex detected within the set time interval in the absence of ventricular fibrillation or chaotic signal.
A fibrillatory wave for 6 consecutive seconds.
A dominant rhythm of adjacent PVCs and the ventricular rate is greater than the V-tach rate limit.
The number of consecutive PVCs is greater than or equal to the V-Tach PVCs limit, and the ventricular rate is greater than or equal to the V-Tach rate limit.
9.6.2.2
Nonlethal Arrhythmia Events
Arrhythmia message
Vent Brady
Extreme Tachy
Extreme Brady
R on T
Run PVCs
Couplet
Description
The number of consecutive PVCs is greater than or equal to V brady PVC limit and the ventricular rate is less than the V-Brady Rate limit.
The heart rate is greater than the extreme tachycardia limit.
The heart rate is less than the extreme bradycardia limit.
R on T PVC is detected.
More than two consecutive PVCs, but lower than the V-Brady PVCs limit, and the ventricular rate is lower than the V-Tach rate limit.
A Pair of PVCs detected in between normal beats.
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9.6.3
Arrhythmia message
Multiform PVC
PVC
Bigeminy
Trigeminy
Tachy
Brady
Pacer Not Capture
Pacer Not Pacing
Missed Beat
Nonsus V-Tach
Vent Rhythm
Pause
Irr Rhythm
A-Fib (for adult only)
PVCs/min
Pauses/min
Irr Rhythm End
A-Fib End (for adult only)
*N: normal beat; V: ventricular beat
Description
Multiform PVCs detected in Multif. PVC's Window (which is adjustable).
One PVC detected in between normal beats.
A dominant rhythm of N, V, N, V, N, V * .
A dominant rhythm of N, N, V,N, N, V, N, N, V * .
The heart rate is greater than the tachycardia limit.
The heart rate is lower than the bradycardia limit.
No QRS complex detected for 300 ms following a pace pulse (for paced patients only).
No pace pulse detected for 1.75 x average R-to-R intervals following a QRS complex (for paced patients only).
At least 3 consecutive Ns * , and
The current RR interval is greater than 1.5 x previous RR interval, and
The next RR interval is lower than 1.5 x average RR interval, and
HR lower than 100 and the current RR interval is greater than 1.75 x average RR interval , or
HR is greater than or equal to 100 and the current RR interval is greater than 1000 ms.
The number of consecutive PVCs is lower than the V-Tach PVCs limit but greater than 2, and the ventricular rate is greater than or equal to the V-Tach Rate limit.
The number of consecutive PVCs is greater than or equal to the V-Brady PVCs limit, and ventricular rate is greater than or equal to the V-Brady Rate limit but lower than V-Tach Rate limit.
No QRS complex is detected within the set pause time threshold.
Consistently irregular rhythm (N * , irregular RR interval change is greater than 12.5%)
P wave is absent and normal beat RR intervals are irregular.
PVCs/min exceeds high limit.
Pauses/min exceeds high limit.
Irregular rhythm no longer detected for the irregular rhythm end delay time.
Atrial fibrillation no longer detected for the A-Fib end delay time.
Displaying Arrhythmia Information
You can display the arrhythmia information in the numeric area. To do so, follow this procedure:
1.
Access Tile Layout using either of the following ways:
◆ Select the Screen Setup quick key → select the Tile Layout tab.
◆ Select Main Menu quick key → from the Display column select Tile Layout .
2.
Click the numeric area where you want to display the arrhythmia information, and then select ECG →
Arrhythmia .
9.6.4
Changing Arrhythmia Settings
9.6.4.1
Changing Arrhythmia Alarm Settings
To set the arrhythmia alarm properties, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Arrhythmia tab
→
Alarm tab.
3.
Set alarm properties as desired.
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NOTE
•
You can switch off lethal arrhythmia alarms only when the monitor is set to enableLethal Arrh
Alarms Off. For more information, see 32.3.10.1 Setting the Lethal Arrhythmia Alarms Switch
.
•
The priority of lethal arrhythmia alarms is always high. It cannot be altered.
9.6.4.2
Changing Arrhythmia Alarm Threshold Settings
You can change threshold settings for certain arrhythmia alarms. When an arrhythmia exceeds its threshold, an alarm will be triggered. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Arrhythmia tab
→
select the Threshold tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set the threshold for the desired arrhythmia alarms.
NOTE
•
The asystole delay time relates to ECG relearning. When heart rate is less than 30 bpm, it is recommended to set Asystole Delay to 10 sec.
9.6.4.3
Arrhythmia Threshold Range
Arrhythmia
Asystole Delay
Tachy (HR High)
Brady (HR Low)
Extreme Tachy
Extreme Brady
Multif PVCs Window
V-Tach Rate
V-Brady Rate
V-Tach PVCs
V-Brady PVCs
PVCs/min
Pauses/min
Pause Threshold
AF/Irr Rhy End Time
Threshold Range
3 sec to 10 sec
60 bpm to 295 bpm
16 bpm to 120 bpm
65 bpm to 300 bpm
15 bpm to 115 bpm
3 beats to 31 beats
100 bpm to 200 bpm
15 bpm to 60 bpm
3 beats to 99 beats
3 beats to 99 beats
1 to 100
1 to 15
1.5 sec, 2.0 sec, 2.5 sec, 3.0 sec
0 min, 1 min, 2 min, 3 min, 4 min, 5 min, 10 min, 15 min, 30 min
9.6.4.4
Setting Thresholds for PVC-Related Alarms
PVC-related alarms are detected on the basis of the current PVC rate and the number of consecutive PVCs.
To set the required thresholds for PVC-related alarms, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Arrhythmia tab → select the More Threshold tab.
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3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
Adjust V-Tach PVCs , V-Tach Rate , V-Brady PVCs , and V-Brady Rate as necessary to set the thresholds for the desired PVC-related alarms.
The following figure illustrates the conditions under which PVC alarms will be generated if V-Tach PVCs is set to
6, V-Tach Rate is set to 130, V-Brady PVCs is set to 5, and V-Brady Rate is set to 40.
9.6.5
■
■
■
■
■
If the number of consecutive PVCs is greater than or equal to the V-Tach PVCs limit (6), and the ventricular rate (Vent Rate) is greater than or equal to the V-Tach Rate limit (130), a V-Tach alarm is generated.
If the number of consecutive PVCs is lower than the V-Tach PVCs limit (6) but greater than 2, and the ventricular rate is greater than or equal to the V-Tach Rate limit (130), a Nonsus V-Tach alarm is generated.
If the number of consecutive PVCs is greater than or equal to the V-Brady PVCs limit (5), and the ventricular rate is lower than the V-Tach Rate limit (130) but greater than or equal to the V Brady Rate limit (40), a Vent
Rhythm alarm is generated.
If the number of consecutive PVCs is lower than the V-Brady PVCs limit (5) but greater than 2, and the ventricular rate is lower than the V-Tach Rate limit (130), a Run PVCs alarm is generated.
If the number of consecutive PVCs is greater than or equal to the V-Brady PVCs limit (5), and the ventricular rate is lower than the V Brady Rate limit (40), a Vent Brady alarm is generated.
Intelligent Arrhythmia Alarm
Normally, an arrhythmia alarm is presented when an alarm condition is detected. However, there are certain situations that can inhibit audible and visible alarm indications even though an alarm condition was detected.
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9.6.5.1
Arrhythmia Alarm Chains
If multiple alarms overlap, announcing all of the detected alarm conditions would be confusing, and a more serious condition might be overlooked. So arrhythmia alarms are prioritized by alarm "chains".
Asystole
V Ͳ Fib/V Ͳ Tach
V Ͳ Tach / Vent Brady
PVC Alarm Chain
Nonsus V Ͳ Tach /
Vent Rhythm
Run PVCs
Extreme Tachy/
Extreme Brady
Beat Detection
Alarm Chain
Pauses/min
Rate Alarm Chain
Tachy/Brady
Pause
HR High /
HR Low
Couplet
Pacer not Capture /
Pacer not Pacing /
Missed Beat
R on T
A Ͳ Fib Alarm Chain
A Ͳ Fib/
A Ͳ Fib End
Irr. Rhythm/
Irr.Rhythm End
Bigeminy
Trigeminy
PVCs/min
Multiform PVC
PVC
9.6.5.2
Arrhythmia Alarm Shielding Rules
The following table explains how audible and visual alarms are indicated during arrhythmia alarm shielding period .
Previous alarm
Alarm in high priority chain
Alarm in medium priority chain
Current alarm
Alarm in high priority chain
Alarm in medium priority chain
Alarm indication
Alarm light and alarm tone
During the shielding period, alarm light and alarm tone are disabled. When the shielding period is reached, alarm light and alarm tone are reactivated.
Alarm light and alarm tone
Alarm light and alarm tone
Alarm in high priority chain
Alarm in the same medium priority chain, but with higher priority
The same alarm reoccurs
Alarm in the same medium priority chain, but with lower priority
Alarm in other medium priority chain
During the shielding period, alarm light and alarm tone are disabled. When the shielding period is reached, alarm light and alarm tone are reactivated.
During the shielding period, alarm light and alarm tone are disabled. When the shielding period is reached, alarm light and alarm tone are reactivated.
Alarm light and alarm tone
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9.6.5.3
Arrhythmia Alarm Refractory Period
■
■
■
■
■
■
■
■
For the following eight alarms in medium priority chain, there is a 30-second refractory period. That is to say, if the same alarm is not presented within 30 seconds after the previous alarm disappears.
Couplet
R on T
PVCs/min High
Multiform PVCs
PVC
Missed Beat
Pacer not Capture
Pacer not Pacing
9.7
ST Segment Monitoring
ST segment analysis is intended for adult, pediatric and neonatal patients. To use this feature, the MPM must be labeled to support ST analysis, see
9.7.1
ST Safety Information
WARNING
•
ST segment deviation values may be affected by such factors as certain drugs or metabolic and conduction disturbances.
•
ST deviation is often calculated at a fixed offset from the J point. Changes in heart rate may affect ST.
•
The significance of ST segment changes needs to be determined by a physician.
•
This monitor provides information regarding changes in ST deviation levels. The clinical significance of the ST level change information should be determined by a physician.
9.7.2
9.7.3
Enabling ST Monitoring
The ST monitoring function is disabled by default. Before you start ST monitoring, enable the ST function. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab → select the Setup tab.
3.
Switch on ST Analysis .
Reliable ST monitoring cannot be ensured under the following situations:
■
■
■
■
You are unable to get a lead that is not noisy.
Arrhythmias, such as atrial fibrillation or atrial flutter, which may cause an irregular baseline.
The patient is continuously ventricularly paced.
The patient has left bundle branch block.
In these cases, you may consider switching off ST monitoring.
Displaying ST Deviation Numerics
To display ST numerics, follow this procedure:
1.
Access Tile Layout by either of the following ways:
◆ Select the Screen Setup quick key → select the Tile Layout tab.
◆ Select Main Menu quick key → from the Display column select Tile Layout .
2.
Click the numeric area where you want to display the ST numerics, and then select ECG → ST .
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The ST parameter display area is configured differently according to the ECG cable used:
■
■
■
■
When you are using the 3-lead ECG leadwires, a separate ST numeric area does not appear on the display.
The ST deviation value displays in the ECG numeric area.
When you are using the 5-lead ECG leadwires, the ST numeric area displays 7 ST deviation values: ST-I, ST-II,
ST-III, ST-aVR, ST-aVL, ST-aVF, ST-V.
When you are using the 6-lead ECG leadwires, the ST numeric area displays 8 ST deviation values: ST-I, ST-II,
ST-III, ST-aVR, ST-aVL, ST-aVF, ST-Va, ST-Vb.
When you are using the 12-lead ECG leadwires, the ST numeric area displays12 ST deviation values: ST-I, ST-
II, ST-III, ST-aVR, ST-aVL, ST-aVF, ST-V1, ST-V2, ST-V3, ST-V4, ST-V5, ST-V6.
This example shows the ST numeric area when 5-lead ECG cable is used. The monitor screen may look slightly different:
(4) (5)
(1)
(2)
(3 )
9.7.4
(1) Parameter label
(3) ST alarm off symbol
(2) ST measurement unit
(4) Lead labels
(5) ST numerics: a positive value indicates ST segment elevation, and a negative value indicates ST segment depression.
Displaying ST Segments in the Waveform Area
You can display ST segments in the waveform area. To do so, follow this procedure:
1.
Access Tile Layout by either of the following ways:
◆ Select the Screen Setup quick key → select the Tile Layout tab.
◆ Select Main Menu quick key → from the Display column select Tile Layout .
2.
Select the waveform area where you want to display the ST segments, and then select ECG → ST .
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ST segment shows a QRS complex segment for each measured ST lead. The current ST segment is drawn in the same color as the ECG wave, usually green, superimposed over the stored reference segment, drawn in a different color. The information is updated once every ten seconds.
(1) (2)
(3 )
9.7.5
9.7.6
(1) ST lead
(3) Baseline ST deviation value
(4) (5)
(2) Current ST deviation value
(4) 1 mV scale
(5) Current ST segment (green) and baseline ST segment (white)
Entering the ST View
In ST View mode a complete QRS segment for each ST lead is displayed. The color of the current ST segments and ST deviation values is consistent with the color of the ECG waveforms, normally green. The color of the baseline ST segments and ST deviation values is white.
To enter the ST View, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab.
3.
From the bottom of the dialog, select ST View .
Saving the Current ST Deviation and Segment as Baseline
ST deviation is typically monitored as a relative change from a baseline value. Set an ST baseline when ST deviation values become stable. If you did not set the ST baseline, the monitor automatically saves the baseline when valid ST deviation values appear for 5 minutes. To set the ST baseline, follow this procedure:
1.
From the ST View , select Set Baseline .
2.
From the pop-up dialog box, select Ok to set the current ST segments and values as the baseline.
From the ST View , you can also perform the following operations:
■
■
Display or hide ST baseline by selecting Display Baseline or Hide Baseline
Display or hide the position of ISO point, J point and ST point by selecting
.
Display Marker or Hide Marker .
CAUTION
•
Updating ST baseline affects ST alarms.
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9.7.7
Entering the ST Graphic
To display ST Graphic , follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab.
3.
Select ST Graphic .
The following figure shows the ST Graphic when ST Alarm Mode is set to Absolute . The height of the bar indicates the ST deviation value of corresponding ST lead. The color of the bar indicates ST alarm status: green indicates that corresponding ST deviation value is within alarm limits; cyan, yellow and red indicate that the ST deviation value exceeds the alarm limits. The color matches ST alarm priority.
The following figure shows the ST Graphic when ST Alarm Mode is set to Relative . The height of grey bar indicates the baseline ST deviation value and the green bar (cyan, yellow or red if an alarm occurs) indicates relative ST from that baseline.
9.7.8
Changing ST Settings
9.7.8.1
Setting ST Alarm Properties
To set ST alarm properties, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab → Alarm tab.
3.
Set ST Alarm Mode to Absolute or Relative .
◆ Absolute : you can separately set the alarm properties for each ST alarm for each lead.
◆ Relative : you can set the alarm properties for ST Single and ST Dual alarms.
4.
Set ST alarm properties.
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9.7.8.2
Changing Leads for ST Display
The monitor automatically selects the three most deviated leads for ST display. You can also manually select the leads. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab → select the Setup tab.
3.
Set ST Segment . You can select up to 3 leads.
9.7.8.3
Showing ISO Point, J Point, and ST Point Markers
In the waveform area, the ISO point, J point, and ST point marker do not display on the ST segments by default.
To display these markers, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab
→
select the Setup tab.
3.
Switch on Show Markers .
9.7.9
Adjusting ST Measurement Points
9.7.9.1
About ST Point, ISO Point, and J Point
The ST deviation value for each beat is the potential difference between the isoelectric (ISO) point and the ST point. The ISO point provides the baseline. The ST point is located between the J point and the start of the Twave. The J point is the end of the QRS complex. As the ST point is at a fixed distance away from the J point (40,
60, 80 etc msec), manually adjusting the J point helps you correctly position the ST point.
R
P
(1) (2) (3) T (4)
Q
(1) ISO point (2) J point
S
(3) ST point (4) ST deviation
9.7.9.2
Setting ST Point, ISO Point, and J Point
CAUTION
•
If Auto Adjust is Off, or if the patient's heart rate or ECG morphology changes significantly, the ISO and ST points need to be occasionally adjusted because this may affect the QT interval and thus the location of the ST point. False ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set.
•
Always ensure that the locations of ST points are appropriate for the patient.
To set the ST point, ISO point, and J point, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the ST tab → select the Adjust tab.
3.
Set ST Point .
The setting for Auto Adjust defines the method of adjusting the ISO and J point locations. Auto Adjust is enabled by default. In this case, the locations of the ISO point and J point are automatically determined by the
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9.8
9.8.1
9.8.2
algorithm. When Auto Adjust is disabled, you need to manually adjust the position of the ISO point and J point using the arrows at the right sides of ISO and J .
■
■
■
The ISO point (isoelectric) location shown is relative to the R-wave peak. Position the ISO point in the middle of the flattest part of the waveform (between the P and Q waves).
The J point location is indicated relative to the R-wave peak. Position the J point at the end of the QRS complex and the beginning of the ST segment.
The ST point is positioned a fixed distance from the J point. Position the ST point relative to the J point at
J+60/80ms , J+40ms , J+60ms or J+80ms . When J+60/80ms is selected, the ST point will be positioned 80 ms (heart rate 120 bpm or less) or 60 ms (heart rate more than 120 bpm) from the J point.
QT/QTc Interval Monitoring
The QT interval is the time between the beginning of the Q-wave and the end of the T-wave. It represents the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricles. QT interval monitoring can assist in the detection of long QT syndrome.
The QT interval has an inverse relationship to heart rate. Faster heart rates shorten QT interval and slower heart rates prolong QT interval. Therefore, several formulas are commonly used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc.
QT/QTc interval monitoring is intended for adult, pediatric, and neonatal patients.
QT/QTc Monitoring Limitations
Some conditions may make it difficult to achieve reliable QT/QTc monitoring, for example:
■
■
■
■
■
■
■
■
R-wave amplitudes are too low
The presence of frequent ventricular ectopic beats
RR intervals are unstable
P-waves tending to encroach on the end of the previous T-wave at high heart rates
The T-wave is very flat or T-wave are not well defined
The end of the T-wave is difficult to delineate because of the presence of U-waves
QTc measurements are not stable
In the presence of noise, asystole, ventricular fibrillation, atrial fibrillation, or ECG lead off
For reliable QT/QTc monitoring, choose lead with good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave.
Some conditions such as left or right bundle branch block or ventricular hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.
Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm.
If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates), QT will not be measured. When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable QTc calculation it is important to avoid measurements when the heart rate is changing.
Enabling QT/QTc Monitoring
The QT monitoring function is disabled by default. Before you start QT monitoring, enable the QT function. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the QT tab → select the Setup tab.
3.
Switch on QT Analysis .
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9.8.3
9.8.4
Displaying QT Numerics and Segments
To display QT numerics and Segments, follow this procedure:
1.
Access Tile Layout by either of the following ways:
◆ Select the Screen Setup quick key
→
select the Tile Layout tab.
◆
Select Main Menu quick key
→ from the Display column select Tile Layout .
2.
Click the parameter numeric area where you want to display the QT numerics, and then select ECG
→
QT/
QTc .
NOTE
•
QTc values are calculated based on the QT-HR, not the ECG HR. To view the QT-HR, open the QT View.
For more information, see
The following picture shows the QT numeric area. The monitor screen may look slightly different:
(3)
(2)
(4)
(5)
(1 )
(6)
(1) QTc alarm limit (if QTc alarm is off, the alarm off symbol is displayed)
(2) Parameter label (3) QTc value
(4) ΔQTc value (the difference between the current and baseline QTc values)
(5) QT value (6) QT-HR value
Entering
the
QT View
QT View shows the current and baseline QT parameter values and waveforms. To enter QT View, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the QT tab.
3.
Select QT View .
The following picture shows a typical QT view.
■
■
The current waveform is shown in the upper half in green.
The baseline waveform is shown below in white.
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9.8.5
■
■
■ The waveform of selected lead is highlighted, while the waveforms of other leads are in light green or light gray.
The start of the QRS complex and the end of the T wave are marked with a vertical line.
In some conditions, no QT measurement can be made. Then the cause of failed QT measurement is shown at the bottom of the QT numerics area and the message “Cannot Analyze QT” is shown in the technical alarm area.
Select the left or right arrow to switch leads, and the corresponding waveform will be highlighted.
Saving the Current QTc as Baseline
In order to quantify changes in the QTc value, you can set a QTc baseline. If no baseline has been set for this patient within the first five minutes after getting valid QT values, the monitor will automatically set a baseline. To set the current values as baseline, follow this procedure:
1.
From the QT View , select Set Baseline .
2.
From the pop-up dialog box, select Ok . This baseline will then be used to calculate ΔQTc.
If you set a new baseline the previous baseline is discarded.
From the QT View , you can also perform the following operations:
■ Select the left or right arrow to select a lead label to highlight corresponding waveform.
■ Select Display Baseline or Hide Baseline to display or hide the baseline waveform.
CAUTION
•
Updating QTc baseline affects the ΔQTc value and alarm.
9.8.6
Changing QT Settings
9.8.6.1
Setting QT Alarm Properties
To set QT alarm properties, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the QT tab
→
select the Alarm tab.
3.
Set QTc and ΔQTc alarm properties.
9.8.6.2
Selecting Leads for QT Calculation
You can select one lead or all leads for QT calculation. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the QT tab → select the Setup tab.
3.
Set QT Leads . All is selected by default. This means all leads are used for QT calculation.
9.9
9.9.1
ECG Relearning
Changes in ECG beat morphology could result in incorrect arrhythmia alarms and/or inaccurate heart rate. ECG relearning allows the monitor to learn the new dominant beat morphology and thus reduce false arrhythmia alarms and inaccurate HR values. Once learning is complete, the dominant QRS complex is stored as a reference template. The reference template is used as the normal morphology of that patient and it is compared with incoming beats to identify possible arrhythmias.
Auto ECG Relearning
Auto arrhythmia relearning happens in the following situation:
■ The ECG lead type or lead label is changed.
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9.9.2
■
■
ECG leads are off and are not reconnected within 60 seconds.
The patient‘s paced status is changed.
Initiating an ECG Relearning Manually
If you suspect that false arrhythmia alarms are presented, you may need to manually initiate an ECG relearn. To do so, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select Relearn .
CAUTION
•
Initiate ECG relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free. If ECG learning takes place during arrhythmias, the ectopic beats may be incorrectly learned as normal QRS complexes. This may result in missed detection of subsequent arrhythmia events.
9.10
Defibrillation Synchronization Pulse Output
The 12-lead MPM module provides an analog out connector to output synchronization pulses for defibrillators. If a defibrillator is connected, it receives a synchronization pulse (100 ms, +5 V) through the analog out connector each time an R-wave is detected. The 3/5/6 lead MPM module does not offer this output.
WARNING
•
According to IEC 60601-2-4: 2010, the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output (sync pulse) on the monitor is delayed by maximum of 30 ms. the biomedical engineer should verify that the ECG/
Defibrillator combination does not exceed recommended maximum delay of 60 ms.
•
Before defibrillation, ensure that both defibrillator and monitor have passed the system test and can be safely used together.
9.11
ECG Troubleshooting
This section lists some of the problems that might be encountered during ECG monitoring. If you encounter problems when using the monitor or accessories, check the table below before requesting for services. If the problem persists after you have taken corrective actions, contact the service personnel.
NOTE
•
For the physiological and technical alarm messages, see
.
Problem
Noisy ECG traces
Excessive electrosurgical Interference
Muscle Noise
Corrective Actions
1. Check that the electrodes are not detached or dry. Replace with fresh and moist electrodes if necessary.
2. Check that leadwires are not defective. Replace leadwires if necessary.
3. Check that the patient cable or leadwires are not routed too close to other electrical devices. Move the patient cable or leadwires away from electrical devices and their cables if necessary.
Use ESU-proof ECG cables.
For more information, see
Inadequate skin preparation, tremors, tense subject, and/or poor electrode placement.
1. Perform skin preparation again and re-place the electrodes. For more
.
2. Apply fresh, moist electrodes. Avoid muscular areas.
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Problem
Intermittent Signal
Excessive alarms: heart rate, lead fault
Low Amplitude ECG Signal
No ECG Waveform
Base Line Wander
Corrective Actions
1. Check that cables are properly connected.
2. Check that electrodes are not detached or dry. Perform skin preparation again as described in
9.4.1 Preparing the Patient Skin
and apply fresh and moist electrodes.
3. Check that the patient cable or leadwires are not damaged. Change them if necessary.
1. Check that electrodes are not dry. Perform skin preparation again and re-place the electrodes. For more information, see
Patient Skin and 9.4.2 Applying Electrodes and Connecting the Patient
.
2. Check for excessive patient movement or muscle tremor. Reposition the electrodes. Replace with fresh and moist electrodes if necessary.
1. Check that the ECG gain is not set too low. Adjust the gain as required.
For more information, see 9.5.3.2 Changing ECG Waveform Size .
2. Perform skin preparation again and re-place the electrodes. For more information, see
9.4.1 Preparing the Patient Skin
and
Electrodes and Connecting the Patient
.
3. Check electrode application sites. Avoid bone or muscular area.
4. Check that electrodes are not dry or used for a prolonged time. Replace with fresh and moist electrodes if necessary.
1. Check that the ECG gain is not set too low. Adjust the gain as required.
For more information, see 9.5.3 Changing ECG Wave Settings .
2. Check that the leadwires and patient cables are properly connected.
3. Change cable and lead wires if necessary.
4. Check that the patient cable or leadwires are not damaged. Change them if necessary.
1. Check for excessive patient movement or muscle tremor. Secure leadwires and cable.
2. Check that electrodes are not detached or dry and replace with fresh and
.
3. Check for ECG filter setting. Set ECG Filter mode to Monitor to reduce baseline wander on the display.
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10
Resting 12-Lead ECG Analysis
10.1
Resting 12-Lead ECG Analysis Introduction
The monitor can be configured with the Glasgow 12-lead resting ECG analysis algorithm. The MPM module or N1 incorporating the Glasgow algorithm is labelled with the logo of Glasgow as shown in
The Glasgow algorithm is intended for adult, pediatric, and neonatal patients.
10.2
Entering the 12-Lead Screen
To enter the 12-Lead screen, follow this procedure:
1.
Select the ECG numeric area or waveform area to enter the ECG dialog.
2.
From the bottom of the ECG dialog, select 12-Lead .
You can also enter the 12-Lead screen by following this procedure:
■
■
Select the Screen Setup quick key
→
select the Choose Screen tab
→
select ECG 12-Lead .
Select Main Menu quick key
→ from the Display column select Choose Screen
→
select ECG 12-Lead .
NOTE
•
The ECG 12-Lead screen is available only when the Glasgow algorithm is configured (associated module has the Glasgow label) and Lead Set is set to Auto or 12-Lead.
10.3
Initiating Resting 12-Lead ECG Analysis
Before initiating 12-lead ECG analysis, check that all electrodes are correctly connected to the lead wires and the
ECG trunk cable is properly connected. Check that patient information is correct. Keep the patient still.
To initiate 12-Lead ECG analysis, select Analyze from the bottom left of the 12-Lead screen.
10.4
Changing 12-Lead ECG Analysis Settings
On the ECG 12-Lead screen, you can set the high frequency filter, baseline drift removal (BDR) filter, and the waveform layout.
10.4.1
Setting the High Frequency Filter
The high frequency filter attenuates muscle artifact by restricting the included frequencies. The setting of the high frequency filter is 35 Hz by default. To change the setting, follow this procedure:
1.
On the ECG 12-Lead screen, select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set High-Freq Cut-off .
The high frequency filter is a low-pass filter. That is to say, signal frequencies higher than the set frequency are filtered out. For example, if you set High-freq Cutoff to 35 Hz , then signal below 35 Hz is kept in the signal and signal exceeding 35 Hz is attenuated.
10.4.2
Setting the Baseline Drift Removal Filter
The baseline drift removal (BDR) filter suppresses most baseline drift interference and also is able to preserve the fidelity of the ST-segment level. BDR is switched on by default. To set the BDR, follow this procedure:
1.
On the ECG 12-Lead screen, select the ECG numeric area or waveform area to enter the ECG dialog.
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2.
Select the Setup tab.
3.
Switch on or off Baseline Drift Removal as desired. If BDR is switched off, the 0.05 Hz high pass filter is used.
NOTE
•
BDR introduces around 1-second delay. Using BDR is recommended except when the delay is unacceptable.
10.4.3
Setting the 12-Lead Waveform Layout
To set the 12-lead waveform layout, follow this procedure:
1.
On the ECG 12-Lead screen, select the ECG numeric area or waveform area to enter the ECG dialog.
2.
Select the Setup tab.
3.
Set Waveform Layout .
◆ Standard : the waveform sequence is I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6.
◆ Cabrera : the waveform sequence is aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6.
For the Glasgow algorithm, the sequence of the chest leads depends on the setting of V3 Placement . If V3 placement is set to V4R , the sequence of chest leads is V4R, V1, V2, V4, V5, V6.
10.4.4
Editing Patient Information
Some patient information may directly affect ECG analysis. Complete and correct patient information is helpful for accurate diagnosis and treatment of the patient. Enter patient information before starting a resting ECG analysis.
To enter patient information, follow this procedure:
1.
On the ECG 12-Lead screen, select Setup to enter the 12-Lead Setup dialog.
2.
On the Patient Demographics page, input or edit patient information.
NOTE
•
Saving information will also save the information as though it was entered in the Patient
Management dialog.
•
Changes are not saved until you press Save. So changing to another tab without saving and then pressing the exit button “X” will lose any changes.
•
Check that patient information is correct before starting a resting 12-lead analysis.
•
Using pediatric lead placement V4R, V1, V2, V4 - V6 is recommended if the patient is under 16 years of age. Please record V4R using the V3 electrode. Also set V3 Electrode to V4R. This is a normal practice for a patient of this age.
10.4.5
Setting Tachycardia and Bradycardia Thresholds
To set tachycardia and bradycardia thresholds, follow this procedure:
1.
On the ECG 12-Lead screen, select Setup to enter the 12-Lead Setup dialog.
2.
Select the Setup tab.
3.
Set Tachy and Brady .
NOTE
•
The tachycardia threshold only applies to patients whose age exceeds 180 days.
•
The bradycardia threshold only applies to patients whose age exceeds 2191 days (6 years).
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10.4.6
Setting the 12-Lead Interpretation Report
To set the 12-lead interpretation report, follow this procedure:
1.
On the ECG 12-Lead screen, select Setup to enter the 12-Lead Setup dialog.
2.
Select the Report tab.
3.
Set the format and items included in the 12-lead interpretation report.
10.5
Saving the 12-Lead Interpretation Report
At the completion of 12-lead ECG interpretation, select Save to save the report. You can review the saved 12-
lead interpretation reports. For more information, see 25.2.11 12-Lead ECG Review Page .
10.6
Printing the 12-Lead Interpretation Report
At the completion of 12-lead ECG interpretation, select Print or Record to output the report via the printer or recorder.
10.7
Exiting the ECG 12-Lead Screen
To exit the ECG 12-Lead screen, select Exit on the ECG 12-Lead screen.
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11
Monitoring Impedance Respiration (Resp)
11.1
Resp Introduction
Impedance respiration is measured across the thorax. When the patient is breathing or ventilated, the volume of air changes in the lungs, resulting in impedance changes between the electrodes. Impedance respiration rate
(RR) is calculated from the signal representing these impedance changes, and a respiration waveform is displayed on the patient monitor screen.
Impedance respiration monitoring is intended for adult, pediatric and neonatal patients.
and 20 Monitoring Anesthetic Gas (AG) for respiration information specific to those modules.
11.2
Impedance Resp Safety Information
WARNING
•
When monitoring the patient’s impedance respiration, do not use ESU-proof ECG cables. The monitor cannot measure impedance respiration with ESU-proof ECG cables.
•
If you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect zero respiration rate. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in case of zero respiration rate.
•
The respiration measurement does not recognize the cause of zero respiration rates. It only indicates an alarm if a pre-adjusted time has elapsed without a breath being detected since the last detected breath. Therefore, it cannot be used for diagnostic purpose.
•
If operating under conditions according to the EMC Standard IEC 60601-1-2 (Radiated Immunity 3V/ m), field strengths above 3V/m may cause erroneous measurements at various frequencies.
Therefore, it is recommended to avoid the use of electrically radiating equipment in close proximity to the impedance respiration measurement unit.
•
The current used to measure impedance respiration may cause rate changes in Minute Ventilation
Rate Responsive Pacemakers. If you suspect the patient monitor is affecting the pacemaker rate then replace the ECG cable with an ECG cable that contains ESU filters.
CAUTION
•
Only use parts and accessories specified in this manual.
•
Impedance respiration monitoring is not for use on patients while they are active, as this can cause false alarms.
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11.3
Resp Display
(1) (2) (3) (4) (5)
(1) Resp waveform gain
(4) Respiration rate (RR)
(2) Resp lead label
(5) RR source
(3) Alarm limits
NOTE
•
If ESU-proof ECG cables are used, the Resp waveform area will display the message “Check Leads”.
Replace the ECG cable if necessary.
11.4
Preparing for Impedance Resp Monitoring
11.4.1
Preparing the Patient
Follow this procedure to prepare the patient:
1.
Shave hair from skin at chosen sites.
2.
Gently rub skin surface at sites to remove dead skin cells.
3.
Thoroughly cleanse the site with a mild soap and water solution.
4.
Dry the skin completely before applying the electrodes.
CAUTION
•
Proper skin preparation is necessary for good signal quality at the electrode site, as the skin is a poor conductor of electricity.
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11.4.2
Placing the Electrodes
Impedance respiration is acquired using standard ECG electrodes and cables. Either lead I (RA-LA) or lead II (RA-
LL) can be used.
For more information, see 9.4.4 ECG Electrode Placements .
(1) (2)
(1) Lead I (2) Lead II
CAUTION
•
Correct electrode placement can help to reduce interference from cardiac related impedance changes: avoid including the liver area and the ventricles of the heart between the respiratory electrodes. This is particularly important for neonates.
•
Some patients with restricted movements breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory waveform.
•
Some patients (especially neonates) expand their chests laterally, causing a negative intrathoracic pressure. In these cases, it is better to place the two respiration electrodes in the right midaxillary and the left lateral chest areas at the patient’s maximum point of the breathing movement to optimize the impedance respiration waveform.
•
To optimize the impedance respiration waveform, place the RA and LA electrodes horizontally when monitoring respiration with ECG Lead I; place the RA and LL electrodes diagonally when monitoring respiration with ECG Lead II.
•
Periodically inspect electrode application sites to ensure skin integrity. If the skin quality changes, replace the electrodes or change the application site.
NOTE
•
Store the electrodes at room temperature. Open the electrode package immediately prior to use.
•
Check that the electrode packages are intact and that the electrodes are not past the expiration date. Ensure the electrode gel is moist.
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11.5
Changing Resp Settings
11.5.1
Setting the Resp Alarm Properties
To set the Resp alarm properties, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to
32.14.3 Selecting Password for User Authentication .
4.
Set alarm properties as desired.
11.5.2
Setting the RR Source
To set RR source, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Setup tab.
3.
Choose RR Source from the dropdown list.
When you select Auto , the monitor automatically selects the RR source following order of priority: first CO2 , and then ECG . When the manually selected RR source is not available, the monitor automatically switches the RR
Source to Auto .
11.5.3
Choosing the Respiration Lead
To set the respiration lead, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Setup tab.
3.
Set Resp Lead .
If you cannot get an acceptable impedance Resp waveform or you suspect the veracity of the Resp value after choosing the Resp lead, you may need to adjust the electrode placement.
11.5.4
Setting the Resp Waveform Size
To set the Resp waveform size, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Setup tab.
3.
Set Gain .
11.5.5
Setting the Resp Waveform Speed
To set the Resp waveform speed, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Setup tab.
3.
Set Speed .
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11.5.6
Setting the Auto Detection Switch
To set the auto detection switch, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Setup tab.
3.
Switch on or off Auto Threshold Detection .
◆ If Auto Threshold Detection is switched on, the monitor automatically adjusts the Resp waveform detection level, or threshold.
◆ If Auto Threshold Detection is switched off, you have to manually adjust the Resp waveform threshold. For more information, see
11.5.7 Adjusting the Resp Waveform Detection Threshold .
In the auto threshold detection mode, if you are monitoring Resp and the ECG parameter is switched off, the monitor cannot compare the heart rate and Resp rates to detect cardiovascular artifact. The respiration detection level is automatically set higher to prevent the detection of cardiovascular artifact as respiration.
In the manual detection mode (where auto threshold detection is off ), cardiovascular artifact can, in certain situations, trigger the respiration rate counter. This may lead to a false indication of a high respiration or an undetected zero respiration rate condition. If you suspect that cardiovascular artifact is being registered as respiratory activity, raise the detection level above the zone of cardiovascular artifact. If the Resp wave is so small that raising the detection level is not possible, you may need to optimize the electrode placement.
11.5.7
Adjusting the Resp Waveform Detection Threshold
■
■
■
Use the manual detection mode (where auto threshold detection is off ) in the following situations:
The respiration rate and the heart rate are close.
Patients have intermittent mandatory ventilation.
Respiration is weak. Try repositioning the electrodes to improve the signal.
To set the Resp waveform threshold to the desired level, follow this procedure:
1.
Select the Resp numeric area or waveform area to enter the Resp dialog.
2.
Select the Threshold tab.
3.
Select the up and down arrows below Upper Line and Lower Line to define the Resp waveform threshold.
Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.
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12
Monitoring Pulse Oxygen Saturation (SpO
2
)
12.1
SpO
2
Introduction
Pulse Oxygen Saturation (SpO
2
) monitoring is a non-invasive technique used to measure the amount of oxygenated hemoglobin and pulse rate by measuring the absorption of selected wavelengths of light. The light generated in the emitter side of the probe is partly absorbed when it passes through the monitored tissue. The amount of transmitted light is detected in the detector side of the probe. When the pulsative part of the light signal is examined, the amount of light absorbed by the hemoglobin is measured and the pulse oxygen saturation can be calculated. This device is calibrated to display functional oxygen saturation.
SpO
2
monitoring is intended for adult, pediatric and neonatal patients.
You can simultaneously measure SpO
2
from two different measurement sources: the MPM module and the SpO
2 module. The measurement from the MPM module is labelled as SpO
2
and the measurement from the SpO
2 module is labelled as SpO
2 b.
The monitor can be configured with Masimo SpO
2 or Nellcor SpO
2
:
■
■
Masimo SpO
2
: the connector is purple and the logo of Masimo SET is on the module’s front panel.
Nellcor SpO
2
: the connector is grey and the logo of Nellcor is on the module’s front panel.
Platinum MP1 Platinum MP1
ECG
T1
T2
SpO
2
IBP2
NIBP
ECG
T1
T2
SpO
2
IBP2
NIBP
(1) (2)
(1) Connector of Masimo SpO
2
(2) Connector of Nellcor SpO
2
NOTE
•
If you need to measure SpO
2
by both the MPM module and the SpO
2
module, select the same type of
SpO
2
. Otherwise, the SpO
2
module will be disabled. For example, if an MPM module configured with the Nellcor SpO
2
and an SpO
2
module configured with the Masimo SpO
2
are simultaneously applied, the SpO
2
module will be automatically disabled.
•
The SpO
2
extension cable used must be compatible with the SpO
2 sensor connectors used. For example, only the Masimo SpO
2
extension cable can be connected to the Masimo SpO
2
sensor connectors.
•
Measurement accuracy verification: The SpO
2
accuracy has been verified in human experiments by comparing with arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurement are statistically distributed and about two-thirds of the measurements are expected to come within the specified accuracy range compared to CO-oximeter measurements.
•
A functional tester or SpO
•
A functional tester or SpO
2
simulator can be used to determine the pulse rate accuracy.
2
simulator cannot be used to assess the SpO
2
accuracy.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 12 - 1
12.2
SpO
2
Safety Information
WARNING
•
When a trend toward patient deoxygenation is indicated, analyze the blood samples with a laboratory co-oximeter to completely understand the patient’s condition.
•
Do not use SpO
2
sensors during magnetic resonance imaging (MRI). Induced current could potentially causes burns. The sensor may affect the MRI image, and the MRI unit may affect the accuracy of the oximetry measurements.
•
Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics, such as irritation, reddening, blistering or burns. Inspect the sensor site every two hours and move the sensor if the skin quality changes. Change the application site every four hours.
For neonates, or patients with poor peripheral blood circulation or sensitive skin, inspect the sensor site more frequently.
•
If the sensor is too tight because the application site is too large or becomes too large due to edema, excessive pressure for prolonged periods may result in venous congestion distal from the application site, leading to interstitial edema and tissue ischemia.
•
When patients are undergoing photodynamic therapy they may be sensitive to light sources. Pulse oximetry may be used only under careful clinical supervision for short time periods to minimize interference with photodynamic therapy.
•
Setting alarm limits to extreme values may cause the alarm system to become ineffective. For example, high oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration, do not set the high alarm limit to 100%, which is equivalent to switching off the alarm.
•
SpO
2
is empirically calibrated in healthy adult volunteers with normal levels of carboxyhemoglobin
(COHb) and methemoglobin (MetHb).
•
To protect from electric shock, always remove the sensor before bathing the patient.
•
The pulse oximetry function of the bedside monitor should not be used for apnea monitoring.
•
The pulse oximetry function of the bedside monitor should not be used for arrhythmia analysis.
CAUTION
•
Change the application site or replace the sensor and/or patient cable when a persistent SpO2 Low
Signal Quality message is displayed on the equipment. These messages may indicate that patient monitoring time is exhausted on the patient cable or sensor.
•
Replace the cable or sensor when a “SpO2 Sensor Off”, “SpO2 No Sensor”, or “SpO2 Low Signal
Quality” message is consistently displayed while monitoring consecutive patients after completing troubleshooting steps listed in this manual.
•
Variation in measurements may be profound and may be affected by sampling technique as well as the patient's physiological conditions. Any results exhibiting inconsistency with the patient’s clinical status should be repeated and/or supplemented with additional test data. Blood samples should be analyzed by laboratory instruments prior to clinical decision making to completely understand the patient’s condition.
•
Use only SpO
2
sensors specified in this manual. Follow the SpO
2
sensor’s instructions for use and adhere to all warnings and cautions.
•
Do not place the patient monitor where the controls can be changed by the patient.
•
If using pulse oximetry during full body irradiation, keep the sensor out of the radiation field. If the sensor is exposed to the radiation, the reading might be inaccurate or the device might read zero for the duration of the active irradiation period.
NOTE
•
Additional information specific to the Masimo sensors compatible with the equipment, including information about parameter/measurement performance during motion and low perfusion, may be found in the sensor's directions for use (DFU).
12 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
•
Masimo cables and sensors are provided with X-Cal™ technology to minimize the risk of inaccurate readings and unanticipated loss of patient monitoring. Refer to the Cable or Sensor DFU for the specified duration of the patient monitoring time.
12.3
SpO
2
Measurement Limitations
The following factors may influence the accuracy of SpO
2
measurement:
■ Patient physiological characteristics:
◆ Cardiac arrest
◆ Hypotension
◆ Darkly pigmented skin
◆ Shock
◆ Severe vasoconstriction
◆ Hypothermia
◆ Severe anemia
◆ Ventricular septal defects (VSDs)
◆ Venous pulsations
◆ Poor perfusion
◆ Dysfunctional hemoglobin, such as carboxyhemoglobin (COHb) and methemoglobin (MetHb)
◆ Elevated levels of bilirubin
◆ Vasospastic disease, such as Raynaud’s, and peripheral vascular disease
◆ Hemoglobinopathies and synthesis disorders such as thalassemias, Hb s, Hb c, sickle cell, etc.
◆ Hypocapnic or hypercapnic conditions
◆ Birthmark(s), tattoos, skin discolorations, moisture on skin, deformed or abnormal fingers. etc.
■
■
Interfering substances:
◆ Intravascular dyes (such as indocyanine green, methylene blue, indigo carmine, etc.)
◆
Dyes in the measure site, such as nail polish
Environmental conditions:
■
◆ Excessive ambient light
◆
Electrosurgery equipment
◆ Defibrillation (may cause inaccurate reading for a short amount of time)
◆ Excessive patient/sensor motion
◆
Electromagnetic field
◆ Arterial catheters and intra-aortic balloon
Others
◆
Inappropriate positioning of the SpO
2
sensor, or use of incorrect SpO
2
sensor
◆ Cuff or arterial blood pressure measurement device on the same limb as the SpO
2
sensor
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 12 - 3
12.4
SpO
2
Display
(1) (2) (3)
(1) (2) (3)
(1) Pleth waveform (Pleth/Plethb): visual indication of patient’s pulse. The waveform is not normalized.
(2) Oxygen saturation of arterial blood (SpO
2
/SpO
2 b): percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin.
(3) Perfusion indicator: the pulsatile portion of the measured signal caused by arterial pulsation.
(4)
(5)
(6)
Perfusion index (PI): gives the numerical value for the pulsatile portion of the measured signal caused by arterial pulsation. PI is an indicator of the pulsatile strength. You can also use it to assess the SpO
2
signal strength.
Pulse rate (derived from the pleth wave): detected pulsations per minute.
SpO
2 difference ( ∆ SpO
2
):
SpO
2
= SpO
2
– SpO
2 b
NOTE
•
PI is displayed for Masimo SpO
2
.
12.5
Preparing for SpO
2
Monitoring
To prepare to monitor SpO
2
, follow this procedure:
1.
Select an appropriate sensor according to the module type, patient category and weight.
2.
Clean the contact surface of the reusable sensor.
3.
Remove colored nail polish from the application site.
4.
Apply the sensor to the patient according to the instruction for use of the sensor.
5.
Select an appropriate extension cable according to the connector type and plug the cable into the SpO
2 connector.
6.
Connect the sensor to the extension cable.
CAUTION
•
Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.
•
At elevated ambient temperatures, be careful with measurement sites that are not well perfused, because this can cause burns after prolonged application.
•
Avoid placing the sensor on extremities with an arterial catheter, an NIBP cuff or an intravascular venous infusion line.
•
For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.
(4)
(5)
(4)
(6)
12 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
NOTE
•
Up to two measurement sites are available simultaneously.
12.6
Changing the SpO
2
Settings
NOTE
•
The settings of in the SpO
2
module and SpO
2 b module are linked.
12.6.1
Changing the SpO
2
Alarm Settings
To change the SpO
2
alarm settings, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set the alarm properties as desired.
For SpO
2 b, you can also set alarm properties for
∆
SpO
2
.
NOTE
•
The desat alarm is a high level alarm notifying you of potentially life threatening drops in oxygen saturation. When the SpO
2
value is below the desat alarm limit and desat alarm switch is set on, the message “SpO2 Desat” is displayed.
•
You can switch off the SpO
2
Desat alarm only when the SpO
2
Desat Alarm Off is enabled. For more information, see section
32.3.7.7 Setting the Switch of the SpO
.
12.6.2
Nellcor SatSeconds
TM
Alarm Management
With traditional alarm management, high and low alarm limits are set for monitoring oxygen saturation. During monitoring, once an alarm limit is violated, an audible alarm immediately sounds. When the patient SpO
2 fluctuates near an alarm limit, the alarm sounds each time the limit is violated. Such frequent alarms can be distracting. Nellcor’s SatSeconds alarm management technique is used to reduce these nuisance alarms.
The SatSeconds feature is available with the Nellcor SpO
2
to decrease the likelihood of false alarms caused by motion artifacts. With SatSeconds alarm management, high and low alarm limits are set in the same way as those with traditional alarm management. A SatSeconds limit is also set. The SatSeconds limit controls the amount of time that SpO
2
saturation may be outside the set limits before an alarm sounds.
The method of calculation is as follows: the percentage points of the SpO
2
saturation falling outside the alarm limit is multiplied by the number of seconds remaining outside the limit. This can be stated as the equation:
SatSeconds = Points × Seconds
Only when the SatSeconds limit is reached, the monitor gives a SatSeconds alarm. For example, the figure below demonstrates the alarm response time with a SatSeconds limit set at 50 and a low SpO
2
limit set at 90%. In this example, the patient SpO
2
drops to 88% (2 points) and remains there for 2 seconds. Then it drops to 86% (4 points) for 3 seconds, and then to 84% (6 points) for 6 seconds. The resulting SatSeconds are:
% SpO
2
2×
4×
6×
Total SatSeconds=
Seconds
2=
3=
6=
SatSeconds
4
12
36
52
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 12 - 5
After approximately 11 seconds, a Sat-Second alarm would sound, because the limit of 50 SatSeconds would have been exceeded.
%SpO
2
Seconds
Saturation levels may fluctuate rather than remaining steady for a period of several seconds. Often, the patient
SpO
2
may fluctuate above and below an alarm limit, re-entering the non-alarm range several times. During such fluctuation, the monitor integrates the number of SpO
2
points, both positive and negative, until either the
SatSeconds limit is reached, or the patient SpO
2
re-enters the non-alarm range and remains there.
NOTE
•
The SpO
2
Too Low or SpO
2
Too High alarm is presented in the case that SpO
2
value violates the alarm limits 3 times within one minute even if the setting of SatSeconds is not reached.
To set the SatSeconds, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the Alarm tab.
3.
Set Sat-Seconds .
12.6.3
Setting SpO
2
Sensitivity (for Masimo SpO
2
)
For Masimo SpO
2
, selects the Sensitivity as per signal quality and patient motion.
Normal sensitivity is the recommended for patients who are experiencing some compromise in blood flow or perfusion. It is advisable for care areas where patients are observed frequently, such as the intensive care unit
(ICU).
Adaptive Probe Off Detection (APOD) sensitivity is the recommended sensitivity mode where there is a high probability of the sensor becoming detached. It is also the suggested mode for care areas where patients are not visually monitored continuously. This mode delivers enhanced protection against erroneous pulse rate and arterial oxygen saturation readings when a sensor becomes inadvertently detached from a patient due to excessive movement.
Maximum sensitivity is recommended for use on patients with weak signals (e.g. high ambient noise and/or patients with very low perfusion) and for use during procedures or when clinician and patient contact is continuous such as in higher acuity settings.
To set SpO
2
sensitivity, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the Setup tab.
3.
Set Sensitivity to Maximum, Normal, or APOD .
12 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
CAUTION
•
When using the Maximum Sensitivity setting, performance of "Sensor Off" detection may be compromised. If the equipment and the sensor becomes detached from the patient, the potential for false readings may occur due to environmental noise such as light, and vibration.
•
Configuring the monitor to “Load Latest Configuration” as the default configuration may result in
Masimo SpO
2
being set to Maximum sensitivity mode on power up or after admitting a new patient.
Maximum sensitivity is recommended for use during procedures or when clinician and patient contact is continuous, such as in higher acuity settings. Maximum sensitivity is not recommended for care areas where patients are not monitored visually as “Sensor Off” detection may be compromised. Refer to
Section 31.4 Setting Default Configuration for managing configuration.
12.6.4
Enabling FastSAT (for Masimo SpO
2
)
FastSAT enables rapid tracking of arterial oxygen saturation changes as may be required in urgent situations.
When FastSAT is switched on, the averaging algorithm evaluates all the SpO
2
values and provides an averaged
SpO
2
value that is a better representation of the patient’s current oxygen saturation status.
The reliability of FastSAT is dependent on the setting for the averaging time and the input signal. FastSAT is disabled by default. To enable FastSAT, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 menu.
2.
Select the Setup tab.
3.
Switch on FastSAT .
12.6.5
Displaying SIQ (for Masimo SpO
2
)
The signal quality indicator (SIQ) displays below the Pleth waveform. The SIQ is conveyed by vertical bars. The height of the bar provides an assessment of the confidence in the displayed SpO
2
value. The SpO
2
SIQ can also be used to identify the occurrence of a patient ‘s pulse.
The following picture shows the SpO
2
SIQ:
(1)
(1) Signal quality indicator (SIQ)
To show SpO
2
SIQ, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 menu.
2.
Select the Setup tab.
3.
Switch on Display SIQ .
NOTE
•
If the monitor connects to the TM70 telemetry monitor for SpO2 monitoring, the SIQ does not display.
12.6.6
Changing Averaging Time (for Masimo SpO
2
)
The SpO
2
value displayed on the monitor screen is the average of data collected within a specific time. The shorter the averaging time is, the quicker the monitor responds to changes in the patient’s oxygen saturation level. Contrarily, the longer the averaging time is, the slower the monitor responds to changes in the patient’s oxygen saturation level, but the SpO
2
measurement is more stable. For critically ill patients, selecting a shorter averaging time will help with understanding the patient’s state.
To set the averaging time, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the Setup tab.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 12 - 7
3.
Set Averaging .
12.6.7
Monitoring SpO
2
and NIBP Simultaneously
When monitoring SpO
2
SpO
2
and NIBP on the same limb simultaneously, you can switch on NIBP Simul to lock the
alarm status until the NIBP measurement ends. If you switch off NIBP Simul , low perfusion caused by NIBP measurement may lead to inaccurate SpO
2
readings and therefore cause false physiological alarms.
To set the NIBP Simul , follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the Alarm tab.
3.
Set NIBP Simul .
12.6.8
Changing the Sweep Speed of the Pleth Waveform
To set the sweep speed of Pleth waveform, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the Setup tab.
3.
Set Speed .
12.7
Changing the PR Settings
12.7.1
Changing the PR Alarm Settings
To change the PR alarm settings, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the PR tab.
3.
Enter the password if required. For more information refer to 32.14.3 Selecting Password for User
.
4.
Set the alarm properties as desired.
12.7.2
Changing the QRS Volume
If the Alarm Source is set to PR , the QRS tone is derived from PR measurements. To set the QRS volume, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the PR tab.
3.
Select the Setup tab.
4.
Set QRS Volume .
If the SpO
2
value is valid, the monitor also adjusts the QRS tone (pitch tone) according to the SpO
2
value. For
information, see 32.16.4 Setting the SpO
NOTE
•
Changing the QRS volume settings in the PR Setup page also changes the QRS volume settings in the
Setup page of the ECG dialog.
12.7.3
Setting the PR Source
Current pulse source is displayed in the PR numeric area if current PR source is not SpO
2
. The PR from current pulse source has the following characteristics:
■ PR is stored in the monitor’s database and can be reviewed in the graphic and tabular trends.In graphic trends, as the PR curve has the same color as that of current PR source.
12 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■ PR is sent via the network to the CMS, if available.
To set which parameter is used as a PR source, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 dialog.
2.
Select the PR tab.
3.
Select the Setup tab.
4.
Set PR Source .
The dropdown list of the PR Source displays the currently available PR sources from top to bottom by priority.
When you select Auto , the system will automatically select the first option as the PR source. If the current PR source is unavailable, the system will automatically switch PR Source to Auto . When you select IBP , the system will automatically select the first pressure label as the PR source.
12.7.4
Showing/Hiding PR
You can set whether to display the PR value in the SpO
2
parameter area. To do so, follow this procedure:
1.
Select the SpO
2
numeric area or waveform area to enter the SpO2 menu.
2.
Select the PR tab.
3.
Select the Setup tab.
4.
Switch on or off Display PR.
12.8
SpO
2
Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting service. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix D Alarm Messages .
Problem
Do not see SpO
2
numeric area or waveform area on the main screen
Dashes “- -” display in place of numerics
Low amplitude SpO
2
signal
SpO
2
value is inaccurate
Solution
1. Check that the SpO
2 is set to display in the Screen Setup
→
Tile
Layout page. For more information, see
.
2. Check that the SpO
SpO
2
.
2 parameter switch is enabled. If not, enable the
measurement .
For more information, see
3. Check that the cable connections of the SpO
2
sensor and the extension cable are tight. Replace the SpO
2
sensor or the extension cable if needed.
1. Check that the cable connections of SpO
2 extension cable are tight. Replace the SpO
2 sensor and the
sensor or the extension cable if needed.
2. Reconnect the SpO
2
sensor if the alarm SpO2 Sensor Off appears.
3. Check the PI value. If the PI value is too low, adjust the SpO
2 or apply the sensor to a site with better perfusion.
sensor,
4. Move the sensor to a place with weaker ambient light, or cover the sensor to minimize the ambient light if the alarm SpO2 Too Much
Light appears.
1. The SpO
2
sensor and NIBP cuff are placed on the same limb.
Change the monitoring site if necessary.
2. Check the PI value. If the PI value is too low. Adjust the SpO
2 or apply the sensor to a site with better perfusion.
sensor,
1. Check the patient’s vital signs.
2. Check for conditions that may cause inaccurate SpO
2
readings. For more information, see
3. Check the monitor, the SpO
2 functioning.
module or the MPM for proper
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 12 - 9
12.9
Nellcor Information
Nellcor Patents
This posting serves as notice under 35 U.S.C.§287(a) for Covidien patents: http://www.covidien.com/patents.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized replacement parts which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.
12.10
Masimo Information
Masimo Patents
This posting serves as notice under 35 U.S.C.§287(a) for Masimo patents: http://www.masimo.com/patents.htm.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized sensors or cables which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.
12.11
Masimo End-User License Agreement
THIS DOCUMENT IS A LEGAL AGREEMENT BETWEEN YOU (“PURCHASER”) AND SHENZHEN MINDRAY. IF YOU DO
NOT AGREE TO THE TERMS OF THIS AGREEMENT, PROMPTLY RETURN THE ENTIRE PACKAGE, INCLUDING ALL
ACCESSORIES, IN THEIR ORIGINAL PACKAGE, WITH YOUR SALES RECEIPT TO SHENZHEN MINDRAY FOR A FULL
REFUND.
1.
Grant of License. In consideration of payment of the license fee, which is part of the price paid for this product, Shenzhen Mindray grants to Purchaser a nonexclusive, nontransferable license, without right to sublicense, to use the copy of the incorporated software/firmware, and documentation in connection with
Purchaser's use of the Masimo Products for their labeled purpose. Shenzhen Mindray reserves all rights not expressly granted to Purchaser.
2.
Ownership of Software/Firmware. Title to, ownership of, and all rights and interests in, any Masimo software and/or firmware and the documentation, and all copies thereof, remain at all times vested in
Masimo Corporation, licensor to Shenzhen Mindray, and they do not pass to Purchaser.
3.
Assignment. Purchaser shall not assign or transfer this License, in whole or in part, by operation of law or otherwise, without Shenzhen Mindray's prior written consent; any attempt without such consent, to assign any rights, duties or obligations arising hereunder shall be void.
4.
Copy Restrictions. The software/firmware, mask works, circuit board layouts, and accompanying written materials are copyrighted. Unauthorized copying of the software, including software that has been modified, merged, or included with other software, or other written materials is expressly forbidden. You may be held legally responsible for any copyright infringement that is cause or incurred by your failure to abide by the terms of this license. Nothing in this license provides any rights beyond those provided by 17
U.S.C. §117.
5.
Use Restriction. As the Purchaser, you may physically transfer the products from one location to another provided that the software/firmware is not copied. You may not electronically transfer the software/ firmware from the products to any other device. You may not disclose, publish, translate, release distribute copies of, modify, adapt, translate, reverse engineer, decompile, disassemble, or create derivative works based on the Masimo Product, the software/firmware, or the written materials without the prior written consent of Masimo. Masimo Sensors that are designated for single use are licensed under Masimo patents for use on a single patient only, and are not sold. There is no license, implied or otherwise, that would allow use of single use Masimo Sensors beyond their intended single use. After use of single use Masimo Sensors, there is no further license granted by Masimo to use the sensors and they must be discarded.
12 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
6.
Transfer Restrictions. The software/firmware is licensed to the Purchaser, and may not be transferred to anyone, except other end-users, without the prior written consent of Shenzhen Mindray. In no event may you transfer, assign, rent, lease, sell, or otherwise dispose of the software/firmware or the products on a temporary basis.
7.
Beneficiary. Masimo Corporation is a Beneficiary of this Agreement and has the right to enforce its provisions.
U.S. Government Rights: If you are acquiring software (including the related documentation) on behalf of any part of the United States Government, the following provisions apply: the software is deemed to be “commercial software” and “commercial computer software documentation,” respectively pursuant to DFAR Section 227.7202
FAR 12.212, as applicable. Any use, modification, reproduction, release, performance, display or disclosure of the software (including the related documentation) by the U.S. Government or any of its agencies shall be governed solely by the terms of this Agreement and shall be prohibited except to the extent expressly permitted by the terms of this agreement.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 12 - 11
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12 - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
13
Monitoring Temperature (Temp)
13.1
Temperature Introduction
The monitor can continuously monitor the patient’s skin temperature and core temperature by the MPM module and the Temp modules. Thermally sensitive resistors (thermistors) are used, and are based on the principle that electrical resistance of the thermistor changes as temperature changes. The resistance change of the thermistors is used to calculate the temperature.
You can connect an MPM module and up to three Temp modules. Up to eight temperature sites can be monitored simultaneously and the difference between two measured sites is calculated.
.
Temperature monitoring is intended for adult, pediatric and neonatal patients.
Platinum MP1
(2) (2)
IBP2 T1
T2
SpO
2
(1)
(1)
ECG NIBP
(1)
(1)
(1) Temperature probe connector (2) Temp dialog hard key
13.2
Temperature Safety Information
CAUTION
•
Verify that the probe detection program works correctly before monitoring. Remove the temperature probe cable from the temperature probe connector, and check that the monitor can display the alarm messages and give alarm tones correctly.
13.3
Temperature Display
The following figure shows the Temp numeric area for temperature monitoring with the MPM module or Temp module. Your display may be configured to look different.
(3)
(1)
(2)
(1)
(2) (4)
(1) Temperature site
(3)
( 2 ) Temperature alarm limits (3) Temperature value
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(4) Temperature difference ( ∆ T): Difference between two temperature sites. It displays only when ∆ T is switched on.
13.4
Preparing for Temperature Monitoring
To prepare temperature monitoring, follow this procedure:
1.
Select an appropriate probe for your patient according to patient category and measured site.
2.
Plug the probe or temperature cable to the temperature connector. If using a disposable probe, connect the probe to the temperature cable.
3.
Follow the probe manufacturer’s instructions to connect the probe to the patient.
13.5
Changing Temperature Settings
13.5.1
Setting the Temperature Alarm Properties
To set the temperature alarm properties, follow this procedure:
1.
Select the temperature numeric area to enter the Temp dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set the alarm properties as desired.
13.5.2
Selecting the Temperature Label
Select the temperature label according to the measurement site. To do so, follow this procedure:
1.
Select the temperature numeric area to enter the Temp dialog.
2.
Select the Setup tab.
3.
Set the temperature label.
Label
T1
T2
T skin
T core
T axil
T naso
T eso
T rect
Description
Temperature of application site 1
Temperature of application site 2
Skin temperature
Core temperature
Axillary temperature
Nasopharyngeal temperature
Esophageal temperature
Rectal temperature
Label
T amb
T airw
T vesic
T blood
T myo
T tymp
T cereb
Description
Ambient temperature
Airway temperature
Vesical temperature
Blood temperature
Myocardial temperature
Tympanic temperature
Cerebral temperature
13.5.3
Displaying the Temperature Difference
To display the temperature difference between two measurement sites monitored by the same temperature module, switch on
∆
T. To do so, follow this procedure:
1.
Select the temperature numeric area to enter the Temp dialog.
2.
Select the Setup tab.
3.
Switch on ∆ T .
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13.6
Temperature Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting service. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix D Alarm Messages .
Problem
Do not see Temp numeric area on the main screen
Measurement fails/’--’ is displayed in the Temp numeric area
Solution
1. Check that if the Temp parameter switch is enabled. If not, enable
the Temp measurement. For more information, see 3.9.1 Switching
.
2. Check that the connections of the temperature probe and the temperature cable are tight.
1. If using a disposable probe, check the connection between the probe and the temperature cable.
2. Try using a known good probe in case the sensor is damaged.
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14
Monitoring Noninvasive Blood Pressure (NIBP)
14.1
NIBP Introduction
The monitor uses the oscillometric method for measuring Non-Invasive Blood Pressure (NIBP). NIBP measurement is based on the principle that pulsatile blood flow through an artery creates oscillations of the arterial wall. The oscillometric device uses a blood pressure cuff to sense these oscillations that appear as tiny pulsations in cuff pressure. The oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish. The oscillometric method measures the mean pressure and determines the systolic and diastolic pressures.
The NIBP module is integrated into the MPM module. NIBP monitoring is intended for adult, pediatric, and neonatal patients.
MP1 Platinum
ECG
T1
T2
SpO
2
IBP2
NIBP
(1)
(1) NIBP cuff connector
NOTE
•
Blood pressure measurements determined with this device are equivalent to those obtained by a trained observer using the cuff/stethoscope auscultatory method or an intra-arterial blood pressure measurement device, within the limits prescribed by the American National Standard: manual, electronic, or automated sphygmomanometers.
•
NIBP measurement can be performed during electro-surgery and discharge of a defibrillator.
14.2
NIBP Safety Information
WARNING
•
Be sure to select the correct patient category setting for your patient before NIBP measurement. Do not apply the higher adult settings for pediatric or neonatal patients. Otherwise, it may present a safety hazard.
•
Do not measure NIBP on patients with sickle-cell disease or on the limb where skin damage has occurred or is expected.
•
Use clinical judgment to determine whether to perform frequent unattended blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff.
•
Do not use the NIBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.
•
Do not apply cuff on the arm on the side of a mastectomy or lymph node clearance.
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•
Continuous cuff pressure due to connection tubing kinking may cause blood flow interference and result in harmful injury to the patient.
•
NIBP reading can be affected by the measurement site, the position of the patient, exercise, or the patient's physiologic condition. If you doubt the NIBP measurements, determine the patient’s vital signs by alternative means, and then verify that the monitor is working correctly.
•
Devices that exert pressure on tissue have been associated with purpura, ischemia, and neuropathy.
Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or STAT measurements. Auto NIBP measurements with one and two minute intervals are not recommended for extended periods of time.
•
Do not modify or replace connectors of the NIBP air hose except with mindray-approved connectors.
Use neonatal and infant cuffs with CM1901 hoses only. Use pediatric/adult cuffs with CM1903 hoses only.
•
Never connect intra-arterial or intra-venous lines, or any other incompatible connectors to the NIBP hose. This can cause serious injury or death.
•
NIBP diagnostic significance must be decided by the hospital’s clinician staff.
CAUTION
•
Measuring NIBP on patients connected to an Intra Aortic Balloon Pump (IABP) machine may result in the NIBP measurement, including PR, to be inaccurate or fail.
•
Only use parts and accessories specified in this manual. Follow the instructions for use and adhere to all warnings and cautions.
•
Using IABP may cause NIBP, including PR, measurements inaccurate or failed.
•
Accuracy of NIBP measurement depends on using a cuff of proper size. It is essential to measure limb circumference and choose a cuff with proper size.
14.3
NIBP Measurement Limitations
■
■
■
■
■
■
■
Measurements are impossible with heart rate extremes of less than 30 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine. The measurement may be inaccurate or impossible in the following situations:
Regular arterial pressure pulses are hard to detect
Excessive and continuous patient movement such as shivering or convulsions
Cardiac arrhythmias
Rapid blood pressure changes
Severe shock or hypothermia that reduces blood flow to the peripheries
On an edematous extremity
Obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery
NOTE
•
The effectiveness of this sphygmomanometer has not been established in pregnant women, including pre-eclamptic patients.
14.4
■
■
■
■
Measurement Modes
The monitor provides the following NIBP measurement modes:
Manual: measurement on demand.
Auto: repeated measurements at set interval.
STAT: continual rapid series of measurements over a five-minute period.
Sequence: continually automatic measurement at set durations and intervals.
14 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
14.5
NIBP Display
The NIBP display shows only numerics.
(3) (4) (5)
(2)
(1)
(6)
(7)
(8)
(11) (10) (9)
(1) Systolic pressure alarm limits
(2) NIBP unit: mmHg or kPa
(3) The last NIBP measurement time
(4) Time to the next measurement (for Auto mode and Sequence mode)
(5) Measurement mode: for Auto NIBP, interval is displayed; for Sequence mode, the current phase and interval are displayed
(6) Diastolic pressure
(7) Diastolic pressure alarm limits
(8) Mean pressure alarm limits
(9) Mean pressure (displayed after measurement completed) or cuff pressure (displayed during the measurement)
(10) Systolic pressure
(11) Pulse Rate
NOTE
•
If NIBP measurement fails, “XX” is displayed; if NIBP measurement is not taken or NIBP measurement exceeds its measurement ranges, “--” is displayed.
•
NIBP numerics in black color with a light outline indicate that the measurement is old and exceeds the configured NIBP Measurement Timeout time (see section
Measurement Timeout ). These NIBP values are not recommended for reference.
14.6
Preparing for NIBP Measurements
14.6.1
Preparing the Patient for NIBP Measurements
■
■
■
■
In normal use, perform NIBP measurement on a patient who is in the following position:
Comfortably seated
Legs uncrossed
Feet flat on the floor
Back, arm and feet supported
NOTE
•
It is recommended that the patient remains calm and relaxes as much as possible before performing the measurement and that the patient does not talk during the measurement.
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•
Other factors that have been shown to result in an overestimation of blood pressure are labored breathing, full bladder, pain etc.
14.6.2
Placing the NIBP Cuff
To place the NIBP cuff, follow this procedure:
1.
Verify that the patient category setting is correct.
2.
Connect the air tubing to the NIBP connector.
3.
Select an appropriately sized cuff for the patient, and then wrap it around the limb directly over the patient’s skin as follows: a Determine the patient
’ s limb circumference.
b Select an appropriate cuff by referring to the limb circumference marked on the cuff. The width of the cuff should be 40% (50% for neonates) of the limb circumference, or 2/3 of the length of the upper arm or the thigh. The inflatable part of the cuff should be long enough to encircle to overlap at least
50% to 80% of the limb. c Apply the cuff to the patient ’ s upper arm or leg and make sure the Φ marking on the cuff matches the artery location. The cuff should fit snugly, but with enough room for two fingers to be placed between the cuff and the patient ’ s arm (on adults), and loosely on neonates with little or no air present within the cuff. Otherwise it may cause discoloration and ischemia of the extremities. Make sure that the cuff index line falls within the range markings on the cuff. If it does not, use a cuff that fits better.
d Middle of the cuff should be at the level of the right atrium of the heart. If it is not, use the measurement correction formula to correct the measurement. For more information, see
14.8.7 Setting the NIBP Display Format
.
4.
Connect the cuff to the air tubing. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing.
CAUTION
•
Do not touch or apply external pressure against the cuff and air tubing during NIBP measurement.
This may cause inaccurate blood pressure values.
•
Use care when placing the cuff on an extremity used for monitoring other patient parameters.
14.7
Starting and Stopping NIBP Measurements
Start and stop NIBP measurement by selecting the NIBP quick keys or from the NIBP dialog.
Task
Start a manual measurement
Start auto NIBP series
Start NIBP sequence measurement
Start STAT measurement
Stop the current NIBP measurements
By Quick Key
NIBP Start/Stop quick key
NIBP Start/Stop quick key
NIBP Measure quick key
Interval
NIBP Measure quick key
Sequence
NIBP STAT quick key
→
→ select
NIBP Measure quick key
NIBP Start/Stop quick key
→
STAT
From NIBP dialog
Start NIBP button
Setup tab
→
set Interval
→
Start NIBP button
Sequence tab → set NIBP sequence
→ Start NIBP button
STAT button
Stop NIBP button
14 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Task
End auto NIBP series or NIBP
Sequence
Stop STAT measurement and end series
By Quick Key
NIBP Stop All quick key
NIBP Start/Stop quick key
NIBP STAT quick key
From NIBP dialog
NIBP Stop All button
Stop NIBP or NIBP Stop All button
14.8
Changing NIBP Settings
14.8.1
Setting the NIBP Alarm Properties
To set the NIBP alarm properties, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set the alarm properties as desired.
14.8.2
Setting the Initial Cuff Inflation Pressure
To set initial cuff inflation pressure, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP dialog.
2.
Select Initial Pressure , and then select the appropriate setting.
NOTE
•
For known hypertensive patients, you need to set initial cuff pressure to a higher value to reduce the measurement time.
14.8.3
Setting the NIBP Interval
For auto NIBP measurement, you need to set the interval between two NIBP measurements. To set the NIBP interval, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP dialog.
2.
Set Interval . Selecting Manual switches to manual mode.
NOTE
•
NIBP Measure dialog gives quick access to starting and setting the interval. Selecting an option from the NIBP Measure dialog will change the NIBP interval to that selection and start the NIBP measurement.
14.8.4
Selecting NIBP Start Mode
Start mode defines how future NIBP measurements are initiated with automatic measurement mode. To set the start mode, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP dialog.
2.
Select Start Mode .
◆ Clock : after the first measurement, the monitor automatically synchronizes NIBP automatic measurements with the real time clock. For example, if Interval is set to 20 min , and NIBP auto measurement is started at 14:03, the next measurement will be taken at 14:20, and then at 14:40,
15:00, and so on.
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◆ Interval : after the first measurement, the monitor automatically repeats measurements at set interval. For example, if Interval is set to 20 min , and NIBP auto measurement is started at 14:03, the next measurement will be taken at 14:23, and then at 14:43, 15:03, and so on.
14.8.5
Enabling the NIBP End Tone
The monitor can issue a reminder tone at the completion of NIBP measurement. The NIBP End Tone is off by default. To switch on the NIBP end tone, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP dialog.
2.
Switch on NIBP End Tone .
14.8.6
Setting NIBP Sequence
NIBP sequence measurement can have up to five phases: A, B, C, D, and E. The duration and interval of each phase can be set individually.
To set NIBP sequence, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP dialog.
2.
Select the Sequence tab.
3.
Set Duration and Interval of each phase.
14.8.7
Setting the NIBP Display Format
To set the NIBP display format, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP menu.
2.
Select the Setup tab.
3.
Set Display Format .
14.8.8
Setting the NIBP Alarm Limits Display Switch
To set whether to display the alarm limits of diastolic NIBP and mean NIBP, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP menu.
2.
Select the Setup tab.
3.
Switch on or off Display Alarm Limits.
14.8.9
Showing/Hiding PR
You can set whether to display the PR value in the NIBP parameter area. To do so, follow this procedure:
1.
Select the NIBP numeric area to enter the NIBP menu..
2.
Select the Setup tab.
3.
Switch on or off Display PR.
14.8.10
Correcting the NIBP Measurements
The middle of the cuff should be at the level of right atrium. If the limb is not at the heart level, the measurement should be corrected as follows:
■
■
Add 0.75 mmHg (0.10 kPa) to the displayed value for each centimetre higher.
Deduct 0.75 mmHg (0.10 kPa) to the displayed value for each centimeter lower.
14.9
Assisting Venous Puncture
You can use the NIBP cuff to cause sub-diastolic pressure to block the venous blood vessel and therefore help venous puncture. To assist venous puncture, follow this procedure:
1.
Select the Venipuncture quick key or select the NIBP numeric area → Setup tab.
14 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.
Set Venipuncture Pressure .
3.
Select Venipuncture at the bottom of the dialog.
4.
Puncture vein and draw blood sample.
5.
Select the NIBP Start/Stop quick key to deflate the cuff. If the cuff is not manually deflated, the cuff automatically deflates after a fixed period of time (170 seconds for adult and pediatric patient, 85 seconds for neonatal patient).
During venous puncture, pay attention to the cuff pressure and the remaining time displayed in the NIBP numerics area.
14.10
NIBP Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting for services. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix D Alarm Messages .
Problem
Cannot see NIBP numeric area on the main screen
Solution
1. Check that the NIBP is set to display in the Screen Setup
→
Tile Layout page. For more information, see.
3.9.2 Displaying Parameter Numerics and
Waveforms
2. Check that if the NIBP parameter switch is enabled. If not, enable the NIBP measurement. For more information, see
.
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14 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
15
Monitoring Invasive Blood Pressure (IBP)
15.1
IBP Introduction
You can measure invasive blood pressure (IBP) using the MPM, or the IBP module. This patient monitor can monitor up to 8 invasive blood pressures and displays the systolic, diastolic and mean pressures and a waveform for each pressure.
IBP monitoring is intended for adult, pediatric, and neonatal patients. PAWP monitoring is only intended for adult and pediatric patients.
(1) (3) (1)
Platinum MP1
(2)
ECG
T1
T2
SpO
2
IBP2
NIBP
(2)
(2)
(1) Zero IBP hard key (2) IBP cable connector (3) IBP dialog hard key
15.2
IBP Safety Information
WARNING
•
Use only pressure transducers specified in this manual. Never reuse disposable pressure transducers. See chapter
36 Accessories for specified pressure transducers.
•
Make sure that the applied parts never contact other conductive parts.
•
To reduce the hazard of burns during high-frequency surgical procedures, ensure that the monitor’s cables and transducers never come into contact with the high-frequency surgical units.
•
When using accessories, their operating temperature should be taken into consideration. For more information, see instructions for use of accessories.
•
All invasive procedures involve risks to the patient. Use aseptic technique. Follow catheter manufacturer's instructions.
•
Mechanical shock to the invasive blood pressure transducer may cause severe shifts in zero balance and calibration, and cause erroneous readings.
•
The neutral electrode of the electro-surgery unit (ESU) shall properly contact the patient. Otherwise, burns may result.
CAUTION
•
Measuring IBP on patients connected to an Intra Aortic Balloon Pump (IABP) machine may result in the IBP measurement, including PR, to be inaccurate or fail.
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15.3
Preparing for IBP Monitoring
15.3.1
IBP Equipment to Patient Connection
(1) mmHg
(4)
(5)
(3)
(2)
(5)
(1) Pressure bag
(3) IBP cable
(5) Three-way valve
(2) IBP connector
(4) IBP transducer
15.3.2
Measuring an Invasive Blood Pressure
To monitor IBP, follow this procedure:
1.
Connect one end of the IBP cable to the IBP cable connector, and the other end to the IBP transducer.
2.
Flush the IBP transducer system to exhaust all air from the tubing according to the manufacturer’s instructions. Ensure that the system is free of air bubbles.
3.
Connect the IBP transducer to the patient, making sure that the transducer is at the same horizontal level as the heart.
4.
Select the proper pressure label for currently measured pressure. For more information, see
15.6.2 Changing the Pressure Label .
5.
Zero the IBP transducer. For more information, see.
15.3.3 Zeroing the IBP transducer . After a successful
zeroing, turn off the three-way valve to the air and turn on the three-way valve to the patient.
CAUTION
•
Make sure that all the transducers are zeroed correctly before making IBP measurements.
•
Make sure that all air bubbles have been flushed from the IBP transducer system before making IBP measurements.
•
If measuring intracranial pressure (ICP) with a sitting patient, level the transducer with the top of the patient’s ear. Incorrect leveling may give incorrect values (not applicable if measuring ICP with the
Codman ICP transducer).
15 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
15.3.3
Zeroing the IBP transducer
■
■
■
■
To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy. The IBP transducer should be zeroed in the following conditions:
The IBP transducer, adapter cable or module is reconnected.
The monitor restarts.
The readings are in doubt.
The monitor displays the prompt message Zero Required .
To zero the transducer, follow this procedure:
1.
Connect the IBP transducer, the IBP adapter cable and the module.
2.
Turn off the three-way valve (the one near the transducer) to the patient, in order to vent the transducer to the atmospheric pressure.
3.
Zero the transducer by one of the following methods:
◆ Press the Zero hard key on the module. In the Zero IBP dialog, select to zero an IBP, or select to zero all IBP.
◆ Select the numeric area (such as the Art numeric area), and then select Zero button.
◆ Select the Zero IBP quick key. In the Zero IBP dialog, select to zero an IBP, or select to zero all IBP.
4.
After the zero calibration is completed, close the three-way valve to the air and open the three-way valve to the patient.
15.4
Zero calibration may fail in case of pressure fluctuation or pressure exceeding the calibration range. If zero calibration fails, follow this procedure:
1.
Check that the three-way valve (the one near the transducer) is open to the air.
2.
Perform zero calibration again. Do not sway the IBP transducer and tubing during zero calibration.
Measuring ICP Using the Codman ICP Transducer
15.4.1
Zeroing the Codman ICP transducer
The Codman ICP transducer (Model: 82-6653) must be zeroed before use. To zero the ICP transducer, follow this procedure:
1.
Before unpacking the ICP transducer, check that the monitor supports the Codman ICP transducer. a Select the Main Menu quick key → from the Parameters column select Setup → select ICP (If the
ICP button is not in the Parameter Setup dialog, select any IBP button to enter corresponding IBP dialog, and then change the IBP label to ICP ) → select the Zero tab.
b Check that the following icon is displayed in the Zero page. The monitor supports the Codman ICP transducer if the following icon is displayed in the Zero page.
2.
Connect the ICP transducer, the ICP adapter cable and the module.
3.
Follow the manufacturer’s instructions to prepare the ICP transducer.
4.
Zero the ICP transducer: when the message Zero Reference is displayed in the ICP numeric area, select the
ICP waveform area or numeric area to enter the ICP dialog
→
select the Zero tab
→ select the Zero button.
5.
Record the zero reference value on the blank area of the ICP transducer for reference.
If the ICP transducer zero calibration failed or the zero reference value is in doubt, perform the zero calibration again.
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15.4.2
Measuring ICP
To perform the ICP measurement, follow this procedure:
1.
.
2.
Disconnect the ICP transducer and ICP adapter cable. Follow the manufacturer’s instructions to apply the
ICP transducer to the patient.
3.
Reconnect the ICP transducer and ICP adapter cable.
4.
Check that the zero reference value displayed on the monitor is consistent with that recorded on the ICP transducer.
◆ Consistent: select Accept .
◆ Inconsistent: input the zero reference value recorded on the ICP transducer, and select Accept .
If the patient being monitored for ICP must be transported, check that the target monitor supports the Codman
ICP transducer. For more information, see 15.4.1 Zeroing the Codman ICP transducer
. If the target monitor does not support the Codman ICP transducer, do not use it for ICP monitoring.
If the target monitor supports the Codman ICP transducer, follow this procedure to transport the patient:
1.
Disconnect the ICP adapter cable from the measurement module, or remove the module from the monitor.
2.
Connect the ICP adapter cable, measurement module, and the transport monitor, or insert the measurement module into the transport monitor.
3.
Check that the zero reference value displayed on the monitor is consistent with that recorded on the ICP transducer.
◆ Consistent: select Accept .
◆ Inconsistent: input the zero reference value recorded on the ICP transducer, and select Accept .
CAUTION
•
If monitors of different brands are used to zero the Codman ICP transducer, the zero reference values can be different. Use a Mindray monitor to Zero the Codman ICP transducer if you will take
ICP measurement using a Mindray monitor. Otherwise the ICP measurement could be inaccurate.
15.5
IBP Display
The IBP measurement is displayed on the monitor as a waveform and numeric pressures. For arterial pressure, the IBP numeric area displays systolic pressure, diastolic pressure and mean pressure. For venous pressure, the
IBP numeric area displays only the mean pressure. The figure below shows the waveform and numerics for the
Art pressure.
(1) (2) (3) (4) (5)
15 - 4
(7) (6)
(1) Pressure label
(3) Pressure Unit
(5) Diastolic pressure
(7) PPV measurement
(2) Waveform
(4) Systolic pressure
(6) Mean pressure
For some pressures, the parameter window may show the mean pressure only. For different pressures, their defaults unit may be different. If the Art and ICP pressures are measured simultaneously, the ICP parameter area will display numeric CPP, which is obtained by subtracting ICP from the Art mean.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
15.5.1
Overlapping IBP Waveforms
The IBP waveforms can be displayed together. To combine IBP waveforms, follow this procedure:
1.
Access Tile Layout by either of the following ways:
◆ Select the Screen Setup quick key
→
select the Tile Layout tab.
◆
Select Main Menu quick key
→ from the Display column select Tile Layout .
2.
Select the waveform area where you want to display the overlapped IBP waveforms, and then select the IBP waves to be overlapped on the left side of the same line.
3.
Repeat step 2 in another waveform area if needed.
4.
Select to save the setting and exit the screen. The main screen will display the overlapped IBP waves.
■
■
Selecting the overlapped IBP waveforms on the main screen opens the Overlapping Waveform Setup dialog, where you can make the following settings:
■ Scale
◆
Set Left Scale for the arterial pressure.
◆ Set Right Scale for the venous pressure.
◆ Set CVP Scale individually if the CVP waveform is combined and CVP unit is different from IBP unit.
◆
Set ICP Scale individually if the ICP waveform is combined and ICP unit is different from IBP unit.
◆ Set PA Scale individually if the PA waveform is combined.
Switch on or off Gridlines to show or hide gridlines in the overlapped waveform area.
Set Speed for the overlapped waveforms.
NOTE
•
The unit of CVP scale is consistent with the CVP parameter unit.
15.6
Changing IBP Settings
15.6.1
Changing the IBP Alarm Settings
To change the IBP alarm settings, follow this procedure:
1.
Select the IBP numeric area or waveform area to enter the corresponding pressure dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set the alarm properties of pressure.
15.6.2
Changing the Pressure Label
The pressure label is a unique identifier for each type of pressure. Therefore, it is recommended to select the proper pressure label for the source of the pressure being monitored.
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To select the pressure label, follow this procedure:
1.
Select the IBP numeric area or waveform area to enter the corresponding pressure dialog.
2.
Select the Setup tab.
3.
Set IBP1 Label or IBP2 Label .
Label
Art
Ao
BAP
CVP
RAP
UVP
P1 to P4
Description
Arterial blood pressure
Aortic pressure
Brachial arterial pressure
Central venous pressure
Right atrial pressure
Umbilical venous pressure
Non-specific pressure label
Label
PA
UAP
FAP
LAP
ICP
LV
Description
Pulmonary artery pressure
Umbilical arterial pressure
Femoral arterial pressure
Left atrial pressure
Intracranial pressure
Left ventricular pressure
NOTE
•
The same label cannot be selected for different pressures. When two pressures are detected having the same label, the monitor automatically changes one pressure label to a currently unused one.
15.6.3
Setting the Pressure Type for Display
For the non-specific pressure (P1, P2, P3 or P4), the displayed pressure type is configurable. To set the displayed pressure type, follow this procedure:
1.
Select the numeric area or waveform area of the non-specific pressure to enter the corresponding pressure dialog.
2.
Select the Setup tab.
3.
Set Measure :
◆
If this non-specific pressure is arterial pressure, set the Measure to All . In this case, its corresponding numeric area displays systolic pressure, diastolic pressure and mean pressure.
◆ If this non-specific pressure is venous pressure, set the Measure to Mean Only . In this case, its corresponding numeric area displays only the mean pressure.
15.6.4
Changing the Sensitivity
The IBP value displayed on the monitor screen is the average of data collected within a specific time. The shorter the averaging time is, the quicker the monitor responds to changes in the patient’s blood pressure, and the higher the sensitivity. Contrarily, the longer the averaging time is, the slower the monitor responds to changes in the patient’s blood pressure, the lower the sensitivity, but the measurement accuracy will be improved. For critically ill patients, selecting higher sensitivity will help with understanding the patient’s state.
To set the sensitivity, follow this procedure:
1.
Select the IBP numeric area or waveform area to enter the corresponding pressure dialog.
2.
Select the Setup tab.
3.
Set Sensitivity .
15.6.5
Setting the IBP Waveform
To set the IBP waveform, follow this procedure:
1.
Select the IBP numeric area or waveform area to enter the corresponding pressure dialog.
2.
Select the Setup tab.
3.
Set the following properties of the IBP waveform:
15 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
◆ Speed
◆ Scale : if Auto is selected, the size of the pressure’s waveform will be adjusted automatically.
15.6.6
Setting the Display Format of Artery Pressure
To set the display format of the artery pressure, follow this procedure:
1.
Select the numeric area or waveform area of any arterial pressure to enter the corresponding menu.
2.
Select the Setup tab.
3.
Set Display Format .
15.6.7
Showing/Hiding the Alarm Limits of Artery Pressure
To set whether to display the alarm limits of the arterial pressure, follow this procedure:
1.
Select the numeric area or waveform area of any arterial pressure to enter the corresponding menu.
2.
Select the Setup tab.
3.
Switch on or off Display Alarm Limits.
15.6.8
Setting the Use PA-D as PAWP Switch
The PA-D value can be configured to replace the PAWP value for hemodynamic calculation. To do so, follow this procedure:
1.
Select the PA numeric area or waveform area to enter the PA dialog.
2.
Select the Setup tab.
3.
Switch on or off Use PA-D as PAWP .
For more information on hemodynamic calculation, see 27.4 Hemodynamic Calculations
.
15.6.9
Enabling PPV Measurement
PPV indicates pulse pressure variation. When measuring the arterial pressure (except PA), the PPV measurement is available. To enable the PPV measurement, follow this procedure:
1.
Select the IBP numeric area or waveform area to enter the corresponding pressure dialog.
2.
Select the PPV Setup tab.
3.
Switch on PPV Measure .
You can select PPV source after enabling the PPV measurement.
WARNING
•
This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician.
•
The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.
•
PPV calculation may lead to inaccurate values in the following situations:
◆ at respiration rates below 8 rpm
◆ during ventilation with tidal volumes lower than 8 ml/kg
◆ for patients with acute right ventricular dysfunction (cor pulmonale).
•
The PPV measurement has been validated only for adult patients.
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15.7
PAWP
Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by fluid status, myocardial contractility, and valve and pulmonary circulation integrity.
Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the inflated balloon occludes the artery allowing the monitor to record changes in the intrathoracic pressures that occur throughout the respiration cycle.
The pulmonary wedge pressure is the left ventricular end diastolic pressure when the airway pressure and valve function are normal. The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoracic pressure is fairly constant and the artifact caused by respiration is minimal.
WARNING
•
PAWP monitoring is not intended for neonatal patients.
15.7.1
PAWP Equipment to Patient Connection
(2)
(1)
(3)
(4)
(6)
(7)
(8)
(5)
(1) IBP connector
(3) IBP transducer
(5) PA distal port
(7) Thermodilution catheter
15.7.2
Preparing to Measure PAWP
To prepare to monitor PAWP, follow this procedure:
(2) Flush bag
(4) Three-way valve
(6) Balloon inflation syringe
(8) Balloon
15 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1.
Connect one end of the IBP cable to the IBP cable connector, and the other end to the IBP transducer. For more information, see
15.3.2 Measuring an Invasive Blood Pressure
.
2.
Follow the manufacturer’s instructions to connect the PA port of the thermodilution catheter and the patient end of the IBP transducer.
3.
Zero the IBP transducer. For more information, see
15.3.3 Zeroing the IBP transducer
.
4.
Set the IBP label to PA
since the PAWP is measured on PA. For more information, see 15.6.2 Changing the
15.7.3
Measuring PAWP
To measure the PAWP, follow this procedure:
1.
Select the PA numeric area or waveform area to enter the PA dialog, and then select PAWP .
2.
Wedge the flotation catheter into the pulmonary artery by observing the PA waveform changes on the screen, referring to the following figure.
3.
Select Start .
4.
Inflate the balloon and pay attention to PA waveform changes on the screen when the prompt message
Ready For Balloon Deflation appears.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 15 - 9
5.
Deflate the balloon when the prompt message Ready For Balloon Deflation appears. If the PA waveform is stable, but the monitor is still not showing the prompt message Ready For Balloon Deflation , select
Freeze to freeze the waveform, and deflate the balloon.
6.
Select Accept to save the PAWP value.
7.
If you need to start a new measurement, repeat step 3 to step 6.
■
■
■
If the measurement fails or you need to adjust the PAWP value, you can use the following buttons to adjust the
PAWP waveform and measurement.
Select the up or down arrow button to adjust the PAWP value.
Select the left or right arrow button to view the frozen waveforms of 40 seconds.
Select Accept to save the PAWP value.
WARNING
•
Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the minimum time necessary to get an accurate measurement.
•
If the PAWP is greater than the PA (systolic), deflate the balloon and report the incident in accordance with hospital policy. Because the pulmonary artery could be accidentally ruptured, and the PAWP value derived will not reflect the patient’s hemodynamic state, but will merely reflect the pressure in the catheter or balloon.
•
If the flotation/thermodilution catheter drifts into the wedge position without inflation of the balloon, the PA waveform assumes a wedged appearance. Take appropriate action, in accordance with standard procedures, to correct the situation.
NOTE
•
The PA alarm is turned off automatically when the monitor enters the PAWP screen.
15.7.4
Setting the Waveforms of the PAWP Screen
On the PAWP screen, select Setup to enter the PAWP Setup dialog. In the PAWP Setup dialog, you can make the following settings:
■
■
■
■
Select
Select
Select
Select
Reference Waveform 1
Reference Waveform 2
Speed
Scale to set an ECG lead wave as the first reference wave.
to set a respiration wave as the second reference wave.
to set a sweep speed for the displayed waveforms on the
to set the size of the PA waveform on the PAWP screen.
PAWP screen.
15.7.5
Performing Hemodynamic Calculation
On the PAWP screen, select Hemo Calcs to enter the Calculations dialog. For more information, see
27.4 Hemodynamic Calculations .
15.8
Connecting a Camino Device
The IBP module can interface with the Camino multi-parameter monitor (Model: MPM-1) to measure intracranial pressure (ICP).
To connect the Camino, follow this procedure:
1.
Plug the IBP module into the module rack.
2.
Connect the Camino ICP cable to the IBP module.’
3.
Connect the Camino ICP cable to the ICP adapter.
4.
Connect the ICP connector to the ICP adapter.
5.
Connect the Camino cable to the Camino monitor.
15 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(1)
(2) (3) (4) (5)
(6)
(1) IBP module
(3) ICP adapter
(5) Camino cable
(2) Camino ICP cable
(4) ICP connector
(6) Camino monitor
WARNING
•
Refer to the Camino Operator’s Manual to adjust settings and connect the monitor with the patient.
•
ICP alarm settings on the Mindray patient monitor are independent of the Camino monitor alarm settings, and thus may be different. Please pay special attention to the alarms on the Camino monitor.
15.9
IBP Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting service. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix D Alarm Messages .
Problem
Cannot see IBP numeric area or waveform area on the main screen
Cannot see systolic pressure and diastolic pressure for P1/P2/P3/P4
IBP readings seem unstable
Solution
1. Check that the IBP is set to display in the Screen Setup dialog. For more information, see.
3.9.2 Displaying Parameter Numerics and Waveforms .
2. Check that if the IBP parameter switch is enabled. If not, enable the IBP measurement. For more information, see
.
3. Check the connection of IBP cable, IBP transducer and monitor.
4. Check that the three-way valve is turned to the correct position.
5. Check that the IBP transducer has been zeroed. For more information, see
15.3.3 Zeroing the IBP transducer .
Set Measure to All in the P1/P2/P3/P4 setup page. For more information, see
15.6.3 Setting the Pressure Type for Display .
1. Make sure there are no air bubbles in the transducer systems.
2. Check that the transducer is properly fixed.
3. Zero the transducer again.
4. Replace the transducer.
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Problem
Zeroing of IBP channel(s) fails.
Solution
1. Ensure that the channels are open to air.
2. Perform zero calibration again.
Do not sway the IBP transducer and tubing during zero calibration.
For more information, see
15.3.3 Zeroing the IBP transducer .
3. If zero calibration still fails, replace the transducer.
15 - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
16
Monitoring Cardiac Output (C.O.)
16.1
C.O. Introduction
The cardiac output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using the right heart (atria) thermodilution method. A cold solution of known volume and temperature is injected into the right atrium through the proximal port of a pulmonary artery (PA) catheter. The cold solution mixes with the blood in the right ventricle and the change in blood temperature is measured with a thermistor at the distal end of the catheter in the pulmonary artery. The temperature change is displayed as a curve on the
C.O. split screen, and the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to the area under the curve. As cardiac output varies continuously, a series of measurements must be carried out to achieve a reliable C.O. average value. Always use the average of multiple thermodilution measurements for therapy decisions. The monitor is capable of storing 6 measurements.
C.O. monitoring is intended for adult patients only.
(1) (2)
(3)
(1) C.O. dialog hard key (2) C.O. measure dialog hard key (3) C.O. cable connector
16.2
C.O. Safety Information
WARNING
•
The C.O. measurement results may be erroneous during electrosurgery.
•
All invasive procedures involve risks to the patient. Use aseptic technique and follow catheter manufacturer's instructions.
•
Use only accessories specified in this manual. Make sure that the accessories never come into contact with conductive parts.
•
C.O. monitoring is not intended for pediatric and neonatal patients.
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16.3
C.O. Measurement Limitations
■
■
■
■
■
■
■
■
The following factors may influence the accuracy of C.O. measurement: temperature of injectate solution volume of injectate solution baseline of patient’s blood temperature patient’s inspiratory/expiratory cycle placement of catheter with relation to proximity of lung field the catheter itself patient’s heart rate and hemodynamic status any solution infused with intravenous injection during the C.O. measurement
To obtain accurate C.O. measurements, follow these recommendations:
■
■
■
■
Temperature of injectate solution must be at least 10 ºC cooler than that of the patient’s blood.
Inject solution at end of expiration.
Inject solution rapidly and smoothly.
Finish injection within four to five seconds.
16.4
C.O. Display
The C.O. display shows only C.O., C.I. (cardiac index), and TB (blood temperature) in the C.O. numeric area.
(1)
(2)
(3)
(1) C.O. label
(3) Labels and values for primary parameters
(4)
(2) Primary parameter unit
(4) Labels and values for secondary parameters
NOTE
•
The C.O. value is invalid if it is displayed in outline font.
16 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
16.5
C.O. Equipment to Patient Connection
(1) C.O. module
(4) In-line probe
(7) Three-way valve
(10) Thermistor connector
(13) Thermistor
(2) 12-pin C.O. cable (Model: CO7702)
(5) Injectate solution
(8) Proximal injectate port
(11) PA distal port
(3) TI cable connector
(6) Injectate syringe
(9) Balloon inflation valve
(12) Thermodilution catheter
16.6
Performing C.O. Measurement
16.6.1
Preparing for C.O. Measurement
1.
Connect the C.O. cable to the C.O. module and thermistor connector, making sure the C.O. numeric area is displayed on the monitor’s main screen.
2.
Follow the hospital’s policy and procedures to prepare the patient for the C.O. measurement.
3.
Follow the manufacturer’s instructions to set up the catheter and other accessories.
4.
Check that all the accessories are properly connected.
•
For an in-line probe setup, make sure the in-line sensor is securely connected to the tubing. For the bath probe setup, make sure the bath probe is correctly sensing the injectate temperature.
16.6.2
Setting C.O. Measurement
Before performing the C.O. measurement, follow this procedure:
1.
Select the C.O. numeric area to enter the C.O.
Measure dialog.
2.
Select the Setup .
3.
Perform the following check or setup:
◆
Check if the height and weight are appropriate for your patient. Change if necessary. The patient's height and weight values are required for determining cardiac index (C.I.).
◆ Check that the correct computation constant is entered. The computation constant has a close relationship with the entered injectate volume, injectate probe type (in-line probe or bath probe) and temperature. See the Instructions for Use of the pulmonary artery catheter to determine correctness.
To change the computation constant, select Comp Const and then input the correct value. When a
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 16 - 3
new catheter is used, the computation constant should be adjusted in accordance with the manufacturer’s instructions for use.
◆
Switch on or off Auto TI . If Auto TI is switched on, the system automatically detects the injectate temperature, and TI setting is disabled. If Auto TI is switched off, you need to input the injectate temperature at TI .
◆ Switch on or off Auto Start . If Auto Start is switched on, the monitor automatically takes the C.O. measurement after establishing a baseline of blood temperature. If Auto Start is switched off, you need to click the Start button in the C.O. Measure dialog for a new measurement.
16.6.3
Performing C.O. Measurement
To perform the C.O. measurement, follow this procedure:
1.
Select the C.O. numeric area to enter the C.O. Measure dialog.
(1)
(2)
16 - 4
(3)
(4)
(5)
(6)
(1) Average values
(3) Current measurement values
(5) Prompt message area
(2) Historical measurement dialogs
(4) Current C.O. curve
(6) Buttons
2.
Proceed as follows to perform the C.O. measure:
◆ If Auto Start is switched off, select the Start button, and then inject the solution quickly when you see the message Please Wait . As shown in the figure above, during the measurement, the currently measured thermodilution curve is displayed. At the end of the measurement, the thermodilution curve is transferred to one of the 6 measurement areas and the monitor prompts you to wait for a certain period of time before starting a new measurement.
◆ If Auto Start is switched on, inject the solution quickly when you see the message Ready For New
Set Of Measurement . The monitor consecutively takes C.O. measurements automatically without the need for pressing the Start button between two measurements. A new thermodilution measurement is possible as soon as the message Inject Now!
is displayed on the screen. The monitor automatically detects further thermodilution measurements.
3.
Acquire the average value of C.O. and C.I. A maximum of 6 measurements can be stored. If you perform more than six measurements without rejecting any, the oldest will automatically be deleted when a seventh curve is stored. Select from the 6 measurement curves and the system will automatically calculate and display the averaged C.O. and C.I. values. Then select the Accept Average button to accept and store the averaged values.
When injecting, the stopcock to the thermodilution catheter is open and the stopcock to the injectate solution is closed. After completing the measurement, turn off the stopcock to the thermodilution catheter and turn on the stopcock to the injectate solution, and then draw the injectate solution into the injectate syringe.
The button area also provides you with the following functions:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■
■
Select Stop to stop the current measurement. Select Setup to enter the C.O.
dialog.
Select Hemo Calcs to enter the Calculations dialog.
NOTE
•
Starting a measurement without blood temperature being stable may cause measurement failure.
•
The TB alarms are inactivated during a C.O. measurement, and will be reactivated automatically after the completion of C.O. measurement.
•
Please see the Instructions for Use of thermodilution catheter to determine the Comp Const and the volume of injectate solution.
16.7
Changing C.O. Settings
16.7.1
Setting C.O. Alarm Properties
To set the C.O. alarm properties, follow this procedure:
1.
Select the C.O. numeric area to enter the C.O.
Measure dialog.
2.
Select Setup to enter the C.O.
dialog.
3.
Select the Alarm tab.
4.
Enter the password if required. For more information, refer to 32.14.3Selecting Password for User
.
5.
Set the alarm properties as desired.
16.8
C.O. Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, the table below may help with troubleshooting before requesting a service personnel visit. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix DAlarm Messages .
Problem
Do not see C.O. numeric area on the main screen
C.O. value is inaccurate
Solution
1. Check that the C.O. is set to display in the Screen Setup dialog. For
more information, see 3.9.2Displaying Parameter Numerics and
2. Check that if the C.O. parameter switch is enabled. If not, enable the
C.O. measurement. For more information, see
3.Check that the patient type is adult.
4. Check the connection of C.O. cable, thermodilution catheter and TI sensor.
1. Check that the thermodilution catheter is positioned properly.
2. Check that the computational constant is proper for current injectate temperature, injectate volume and injectate probe type.
3. Inject solution rapidly and smoothly.
4. Finish injection within four to five seconds.
5. Inject more volume, or inject colder solution.
6. Check that the height and weight of patient is properly configured.
7. If Auto TI is switched off, check that the entered temperature is correct.
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Problem
C.O. measurement fails
Solution
1. Inject more volume, or inject colder solution. Make sure that the injectate temperature is at least 10°C colder than the patient blood temperature.
2. Finish injection within four to five seconds.
3. Check the connection of C.O. cable, thermodilution catheter and TI sensor.
16 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
17
Monitoring Central Venous Oxygen Saturation
(ScvO
2
)
17.1
ScvO
2
Introduction
Central venous oxygen saturation (ScvO
2
) is measured across spectrophotometry. Spectrophotometry involves the use of light emitting diodes (LED) that produce light of various wavelengths in red and infrared spectra. The light is transmitted to the blood through a fiberoptic in the probe, reflected off the red blood cells and transmitted back through a separate fiberoptic to an optical module. The central venous oxygen saturation is calculated through the analysis of the reflected spectra.
ScvO
2
monitoring is intended for adult and pediatric patients.
(1)
(1) Calibration hard key (2) CeVOX cable connector
17.2
ScvO
2
Safety Information
WARNING
•
ScvO
2
monitoring is not intended for neonatal patients.
17.3
ScvO
2
Display
(2)
(2)
(1)
(1) ScvO
2
value
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(2) SQI bar graph
17 - 1
17.4
Accessing the On-screen ScvO
2
Guide
The monitor provides the on-screen ScvO
2
guide to help you understand ScvO
2
monitoring principles, functions, and operating procedure. To access the on-screen ScvO
2
guide, follow this procedure:
1.
Select the ScvO
2
numeric area to enter the ScvO2 dialog.
2.
Select the Introduction tab.
3.
Select the desired tab of Summary , Target Patients , Points To Note , or Operation Guides .
17.5
ScvO
2
Equipment to Patient Connection
(1) ScvO
2
module
(3) CeVOX fiberoptic probe
(2) CeVOX optical module
(4) Central venous catheter
17.6
Measuring ScvO
2
To perform the ScvO
2
measurements, follow this procedure:
1.
Apply the central venous catheter.
2.
Place one end of the fiberoptic probe into the central venous catheter through the distal lumina, and connect the other end to the CeVOX optical module.
3.
Plug the CeVOX cable into the ScvO
2
module.
4.
If you see the message Calibration Required , calibrate the ScvO
2
before performing the measurements.
For more information, see 17.7 ScvO
.
5.
Check the reading in the ScvO
2
numeric area.
WARNING
•
To avoid application failure, ensure that the proper fiberoptic probe is selected.
•
The monitor may only be regarded as a device providing early warning. If there is an indication of a trend towards de-oxygenation of the patient, blood samples must be taken and tested on a laboratory oximeter in order to arrive at a decision concerning the condition of the patient.
•
Incorrect placement of the fiberoptic probe can lead to vessel perforation. Therefore, check the correct position of the probe as indicated in the probe’s instructions for use.
17 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
17.7
ScvO
2
Calibration
Regular in vivo calibration is required using blood gas analysis of a central venous blood sample to ensure accurate measurement of continuous ScvO
2
. For optimal accuracy, it is recommended that an in vivo calibration be performed at least every 24 hours or if hemoglobin is changing (for more details, check the notes below).
To perform calibration, follow this procedure:
1.
Check the central venous catheter and CeVOX probe for proper placement.
2.
Check the quality of the signal. The Signal Quality Indicator (SQI) is used for assessing the quality of fiberoptical signals during probe placement, calibration and measurement. The signal quality is indicated by bars of different height levels. Generally, the higher the level, the better the signal.
3.
Withdraw a sufficient amount of central venous blood from the side port of the CeVOX probe to avoid intermixture of infusion/injection with the withdrawn blood.
4.
Slowly withdraw 2ml blood from the side port of the CeVOX probe. Do not pull too strongly in order to avoid a hemolysis.
5.
Immediately confirm by selecting Sample Drawn in the Calibration page of the ScvO2 dialog.
6.
If necessary put blood sample on ice and perform an analysis by a blood gas analysis device or a laboratory oximeter.
7.
Input lab values for Hb, Hct, and ScvO
2
and select Calibrate to confirm.
NOTE
•
The SQI signal can be affected by the presence of electrosurgical units. Keep electrocautery equipment and cables away from the monitor and use separate power socket if possible.
•
To achieve optimal accuracy, it is recommended that the entered hemoglobin and hematocrit values are updated when there is a change of 6% or more in hematocrit, or of 1.8 g/dl (1.1 mmol/l) or more in hemoglobin. A change in hemoglobin may also affect SQI.
•
Dye (e.g. Indocyanine Green) or other substances, containing dyes which usually modify the light absorption capacities, can lead to faulty measurement values of the oxygen saturation.
17.8
Accessing the HemoSight Dialog
To accessing the HemoSight dialog, follow this procedure:
1.
Select the ScvO
2
numeric area to enter the ScvO2 dialog.
2.
Select the HemoSight
button. For information on HemoSight, see 26.6 HemoSight
.
17.9
Changing ScvO
2
Settings
17.9.1
Changing ScvO
2
Alarm Settings
To change the ScvO
2
alarm settings, follow this procedure:
1.
Select the ScvO
2
numeric area to enter the ScvO2 dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set the alarm properties as desired.
17.9.2
Setting Hb or Hct
To set the Hb or Hct, follow this procedure:
1.
Select the ScvO
2
numeric area to enter the ScvO2 dialog.
2.
Select the Calibration tab.
3.
Set Hb or Hct .
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17.9.3
Inputting the SaO
2
Value
The monitor computes the DO
2
and VO
2
using the SaO
2
value. To input the SaO
2 value, follow this procedure:
1.
Select the ScvO
2
numeric area to enter the ScvO2 dialog.
2.
Select the Setup tab.
3.
Input the SaO2 value.
17 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
18
Monitoring CCO/SvO
2
18.1
CCO/SvO
2
Introduction
The Edwards Lifesciences Vigilance II monitor, Vigileo monitor, EV1000 monitor, and HemoSphere monitor, measure continuous cardiac output (CCO), mixed venous oxygen saturation (SvO
2
), central venous oxygen saturation (ScvO
2
) etc. They also calculate hemodynamic and oxygenation parameters. The N Series monitors can be connected to the Vigilance II/Vigileo/EV1000/HemoSphere monitors and can display, store, and review the measured and calculated parameter values from these monitors. The N Series monitors can also give alarms of these measured parameters; however, you must set alarm on/off, alarm limits, alarm priority, and alarm record separately on the N Series monitors. The alarm is On by default.
The CCO/SvO
2
module is only intended for adult and pediatric patients.
(1) (2)
(3)
(4)
(1) CCO/SvO2 dialog hard key
(2) Calibration key (for Vigilance II and Vigileo monitor )
(3) Module status indicator (4) CCO/SvO
2
cable connector
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 18 - 1
18.2
CCO/SvO
2
Safety Information
WARNING
•
Because the alarm limits of the relevant measured parameters can be set on the N Series monitors, the alarms of these parameters may be different from those on the Vigilance II/Vigileo/EV1000/
HemoSphere monitors. Please pay special attention to the alarms on the Vigilance II/Vigileo/
EV1000/HemoSphere monitors.
•
The CCO/SvO
2 monitoring is not intended for neonatal patients.
CAUTION
•
Observe the operator’s manuals of Vigilance II/Vigileo/EV1000/HemoSphere monitor to configure settings and to connect the monitor to the patient.
•
The N Series monitors give disconnection alarms when being disconnected from the Vigilance II/
Vigileo/EV1000/HemoSphere monitors. These alarms may be delayed.
NOTE
•
The Vigilance II monitor, Vigileo monitor, EV1000 monitor, and HemoSphere monitor are manufactured and trademarked by Edwards Lifesciences, and they provide the technology for measuring and calculating the relevant parameters. Mindray only provides a connection and interface to display the parameters from the Vigilance II/Vigileo/EV1000/HemoSphere monitor on the N Series monitors. If you have any doubts about the operation and maintenance of the Vigilance
II/Vigileo/EV1000/HemoSphere monitors, read the operator’s manuals of the corresponding monitor, or contact Edwards Lifesciences (www.edwards.com) directly.
18.3
Connecting the Device
The CCO/SvO
2
cable is used to connect this monitor to the Vigilance II/Vigileo/EV1000/HemoSphere monitor.
18.3.1
CCO/SvO2 Cable
The following figure shows the CCO/SvO
2
cable.
18.3.2
Connecting to the Vigilance II Monitor
The following figure shows the rear housing connectors of the Vigilance II monitor.
18 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
100-240V-
50/60Hz ， 1.0A
T1AL 250V
1
2
ECG
1 2 3
(1) (2) (3)
(1) Serial ports (2) ECG signal input port (3) Analog signal input ports
To connect the Vigilance II monitor, follow this procedure:
1.
Insert the end of the CCO/SvO
2
cable marked CN1 to the Mindray CCO/SvO
2
module.
2.
Insert the ECG signal end of the CCO/SvO
2
cable into the ECG signal input port marked on the rear housing of the Vigilance II monitor.
3.
Insert the MAP signal end of the CCO/SvO
2
cable into the analog signal input port 1 marked , the CVP signal end into port 2 marked , and SpO
2
signal end into port 3 marked respectively on the rear housing of the Vigilance II monitor.
4.
Insert UART end of the CCO/SvO
2
cable into either of the serial ports (marked housing of the Vigilance II monitor.
or ) on the rear
5.
Enter the Serial Port Setup menu of the Vigilance II monitor, and make the following settings:
◆ Device : IFMout
◆ Baud Rate : 19200
◆ Parity : None
◆ Stop Bits : 1
◆ Data Bits : 8
◆ Flow Control : 2 seconds
6.
Enter the Analog Input Setup menu of the Vigilance II monitor, and set port 1, port 2 and port 3 as follows:
Setting Port 1 Port 2 Port 3
Parameter
Voltage Range
MAP
0-5 V
CVP
0-5 V
SaO
2
0-10 V
Full Scale Range 500 mmHg (66.7 kPa) 100 mmHg (13.3 kPa) 100%
Simulated High Value 500 mmHg (66.7 kPa) 100 mmHg (13.3 kPa) 100%
Simulated Low Value 0 mmHg (0.0 kPa) 0 mmHg (0.0 kPa) 0%
For more information, see the Vigilance II operator’s manual for the operation of the monitor.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 18 - 3
WARNING
•
Calibrate the Vigilance II monitor before monitoring. For more information, see the Vigilance II operator’s manual for the calibration instructions.
18.3.3
Connecting to the Vigileo Monitor
The following figure shows the rear housing connectors of the Vigileo monitor.
(1)
(2)
OM
(3)
(4)
18 - 4
(1) Patient Optical Module (OM)
(3) Analog Input
(2) Analog Input
(4) Serial Port
To connect the Vigileo monitor, follow this procedure:
1.
Insert the end of the CCO/SvO
2
cable marked CN1 to the Mindray CCO/SvO
2
module.
2.
Insert the CVP signal end of the CCO/SvO
2
cable into the analog signal input port(2) on the rear housing of the Vigileo monitor.
3.
Insert UART end of the CCO/SvO
2
cable into the serial port on the rear housing(4) of the Vigileo monitor.
4.
Enter the Serial Port Setup menu of the Vigileo monitor, and make the following settings:
◆ Device : IFMout
◆ Baud Rate : 19200
◆ Parity : None
◆ Stop Bits : 1
◆ Data Bits : 8
◆ Flow Control : 2 seconds
5.
Enter the Analog Input Port Setup menu of the Vigileo monitor, and set the CVP as follows:
◆ Parameter : CVP
◆ Voltage Range : 0-5 v
◆ Full Scale Range : 100 mmHg (13.3 kPa)
◆ Simulated High Value : 100 mmHg (13.3 kPa)
◆ Simulated Low Value : 0 mmHg (0.0 kPa)
For more information, see the Vigileo operator’s manual for the operation of the monitor.
WARNING
•
Calibrate the Vigileo monitor before monitoring. See the Vigileo operator’s manual for the calibration instructions.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
18.3.4
Connecting the EV1000 Monitor
The following figure shows the rear housing of the EV1000 monitor.
(1)
LAN1 LAN2
- +
DC24V
(1) serial port
To connect the EV1000 monitor, follow this procedure:
1.
Insert the end of the CCO/SvO2 cable marked CN1 to the Mindray CCO/SvO2 module.
2.
Insert UART into the serial port(1) on the rear housing of the EV1000 monitor.
3.
Enter the Serial Port Setup menu of the EV1000 monitor, and make the following settings:
◆
Device : IFMout
◆
Baud Rate : 19200
◆
Parity : None
◆
Stop Bits : 1
◆
Data Bits : 8
◆
Flow Control : 2 seconds
For more information, see the EV1000 operator’s manual for the operation of the monitor.
WARNING
•
Calibrate the EV1000 monitor before monitoring. Refer to the EV1000 Operator’s Manual for the calibration instructions.
18.3.5
Connecting the HemoSphere Monitor
The following figure shows the rear housing of the HemoSphere monitor.
.*3/
(2)
(3)
+)-
(4)
(1)
(1) COM1 Serial Port
(3) Analog Input
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(2) Analog Input
(4) ECG Input
18 - 5
To connect the HemoSphere monitor, follow this procedure:
1.
Connect CN1 with the CCO/SvO2 cable connector of the CCO/SvO2 module.
2.
Insert the UART signal end of the CCO/SvO
2
cable into the COM1 serial port on the rear housing of the
HemoSphere monitor.
3.
Insert the CVP and MAP signal ends of the CCO/SvO
2
cable into the Analog Inputs on the rear housing of the HemoSphere monitor.
4.
Insert ECG signal end of the CCO/SvO
2
cable into the ECG Input on the rear housing of the HemoSphere monitor.
5.
Enter the Serial Port Setup menu of the HemoSphere monitor, and make the following settings:
◆ Device : IFMout
◆ Baud Rate : 19200
◆ Parity : None
◆ Stop Bits : 1
◆ Data Bits : 8
◆ Flow Control : 2 seconds
6.
Enter the Analog Input Setup menu of the HemoSphere monitor, and set as follows:
Parameter
Voltage Range
Full Scale Range
Simulated High Value
Simulated Low Value
MAP
0-5 v
500 mmHg (66.7 kPa)
500 mmHg (66.7 kPa)
0 mmHg (0.0 kPa)
CVP
0-5 v
100 mmHg (13.3 kPa)
100 mmHg (13.3 kPa)
0 mmHg (0.0 kPa)
For more information, see the HemoSphere operator’s manual for the operation of the monitor.
WARNING
•
Calibrate the HemoSphere monitor before monitoring. Refer to the HemoSphere Operator’s Manual for the calibration instructions.
18.4
Accessing the HemoSight dialog
To access the HemoSight dialog, follow this procedure:
1.
Select the CCO numeric area to enter the CCO dialog.
2.
Select the HemoSight button. For more information, see
18.5
Changing CCO Settings
18.5.1
Changing the CCO Alarm Settings
To change the CCO alarm settings, follow this procedure:
1.
Select the CCO numeric area to enter the CCO dialog.
2.
Select the Alarm tab.
3.
Set the alarm properties of CCO and CCI.
18.5.2
Setting Parameters for Display
To set the parameters for display, follow this procedure:
18 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1.
Select the CCO numeric area to enter the CCO dialog.
2.
Select the Select Parameter tab.
3.
Select the primary and secondary parameters for display.
18.5.3
Setting the CCO Analog Output Signal
To set the CCO output signal, follow this procedure:
1.
Select the CCO numeric area to enter the CCO dialog.
2.
Select the Signal Output Setup tab.
3.
Set the output signal as follows:
◆
This monitor can output the analog signals of ECG waveform, MAP value, SpO
2
value and CVP value to the Vigilance II monitor. If a signal has several sources, you can select a source.
◆ This monitor can output the CVP analog signal to the Vigileo monitor. If the CVP signal has several sources, you can select a source.
◆ This monitor can output ECG waveform, MAP value, and CVP value to the HemoSphere monitor. If a signal has several sources, you can select a source.
◆ Select Simulated High Value to output the simulated high value calibration signals to Vigilance II,
Vigileo, or HemoSphere monitor. To stop outputting the simulated high value signal, select Stop Cal
Signal Output where the Simulated High Value button was previously.
◆ Select Simulated Low Value to output the simulated low value calibration signals to Vigilance II,
Vigileo, or EV1000 monitor. To stop outputting the simulated low value signal, select Stop Cal Signal
Output where the Simulated Low Value button was previously.
The following table shows values and voltages of the high and low value calibration signals.
Parameter Values Output Voltage Parameters
High Value Calibration Signals
MAP
SpO
2
CVP
Low Value Calibration Signals
MAP
SpO
2
CVP
500 mmHg
100%
100 mmHg
0 mmHg
0%
0 mmHg
0V
0V
0V
5V
10V
5V
CAUTION
•
The calibration voltage of Vigilance II, Vigileo, EV1000, and HemoSphere monitor should be the same as the output voltage of this monitor. Otherwise, some parameter values may be incorrectly calculated.
NOTE
•
See the operator’s manuals of Vigilance II, Vigileo, EV1000, and HemoSphere monitors for the calibration instructions.
18.6
Changing SvO
2
/ScvO
2
Settings
18.6.1
Changing the SvO
2
/ScvO
2
Alarm Settings
To change the SvO
2
/ScvO
2
alarm settings, follow this procedure:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 18 - 7
1.
Select the SvO
2
/ScvO
2
numeric area to enter the SvO2 or ScvO2 dialog.
2.
Select the Alarm tab.
3.
Set the alarm properties of SvO
2
/ScvO
2
.
18.6.2
Setting the SvO
2
/ScvO
2
Analog Output Signal
This monitor can output the analog signals to the Vigilance II/Vigileo/EV1000/HemoSphere monitor. To set the
SvO
2
/ScvO
2
analog output signal, follow this procedure:
1.
Select the SvO
2
numeric area to enter the SvO2 dialog; or select the ScvO
2
numeric area to enter the
ScvO2 dialog.
2.
Select the Signal Output Setup tab.
3.
Set the output signal as follows:
◆ This monitor can output the analog signals of ECG waveform, MAP value, SpO
2
value and CVP value to the Vigilance II monitor. If a signal has several sources, you can select a source.
◆ This monitor can output the CVP analog signal to the Vigileo monitor. If the CVP signal has several sources, you can select a source.
◆ This monitor can output ECG waveform, MAP value, and CVP value to the HemoSphere monitor. If a signal has several sources, you can select a source.
◆ Select Simulated High Value to output the simulated high value calibration signals to Vigilance II,
Vigileo, or HemoSphere monitor. To stop output the simulated high value signal, select Simulated
High Value again.
◆ Select Simulated Low Value to output the simulated low value calibration signals to Vigilance II,
Vigileo, or HemoSphere monitor. To stop output the simulated low value signal, select Simulated
Low Value again.
The following table shows values and voltages of the high and low value calibration signals.
Parameter Values Output Voltage Parameters
High Value Calibration Signals
MAP
SpO
2
CVP
Low Value Calibration Signals
MAP
SpO
2
CVP
500 mmHg
100%
100 mmHg
0 mmHg
0%
0 mmHg
0V
0V
0V
5V
10V
5V
CAUTION
•
The calibration voltage of Vigilance II, Vigileo, EV1000, and HemoSphere monitor should be the same as the output voltage of this monitor. Otherwise, some parameter values may be incorrectly calculated.
NOTE
•
See the operator’s manuals of Vigilance II, Vigileo, EV1000, and HemoSphere monitors for the calibration instructions.
18 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
18.7
CCO/SvO
2
Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting for services. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix D Alarm Messages .
Problem
The numeric area does not display CCO values when the Vigilance II, Vigileo, EV1000, or
HemoSphere monitor is connected.
Do not see ScvO
2
or SvO
2
numeric area on the main screen
Solution
1. Check that the CCO is set to display in the Screen Setup
→
Tile
Layout
page. For more information, see 3.9.2 Displaying Parameter
.
2. Check that if the CCO parameter switch is enabled. If not, enable the
CCO measurement. For more information, see
3.Check that the Vigilance II, Vigileo, EV1000, or HemoSphere monitor is set properly as described in
4. Check the connection of CCO/SvO
2
cable. For more information, see
.
1. Check that the ScvO
2
or SvO
2
is set to display in the Screen Setup
→
Tile Layout page. For more information, see
.
2. Check that if the ScvO
2
/SvO
2
parameter switch is enabled. If not, enable the ScvO
2
/SvO
2
measurement. For more information, see
3.9.1 Switching On or Off a Parameter .
3.Check that the Vigilance II , Vigileo, EV1000, or HemoSphere monitor is set properly as described in
4. Check the connection of CCO/SvO
2
cable. For more information, see
.
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18 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
19
Monitoring Carbon Dioxide (CO
2
)
19.1
CO
2
Introduction
CO
2
monitoring is a continuous, non-invasive technique for determining the concentration of CO
2
in the patient’s airway by measuring the absorption of infrared (IR) light of specific wavelengths. CO
2
has its own absorption characteristic and the amount of light passing the gas probe depends on the concentration of the measured CO
2
. When a specific band of IR light passes through respiratory gas samples, some of IR light will be absorbed by the CO
2
molecules. The amount of IR light transmitted after it has been passed through the respiratory gas sample is measured with a photodetector. From the amount of IR light measured, the concentration of CO
2
is calculated.
CO
2
measurement is used to monitor the patient’s respiratory status. The sidestream/Microstream CO
2 measurement takes a sample of the respiratory gas with a constant sample flow from the patient's airway and analyzes it with a remote CO
2
sensor built into the Sidestream or Microstream CO
2
module.
The sidestream and microstream CO
2
measurement can be used, with specified accessories, with intubated and non-intubated adult, pediatric, and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patient's breathing circuit through an airway adapter and a gas sampling line. With nonintubated patients, the gas sample is drawn through a nasal cannula.
Both sidestream and microstream CO
2
modules have the function of automatic barometric pressure compensation (the system automatically measures the barometric pressure to which the patient monitor is exposed).
CO
2
monitoring is intended for adult, pediatric and neonatal patients.
19.2
Identifying CO
2
Modules
The following figures show the controls and connectors of different CO
2
module.
(1) (2) (1) (2)
(4)
(3)
(5)
(4)
Sidestream CO
2
module Microstream CO
2
module
(1) CO
2
dialog hard key
(3) CO
2
watertrap seat
(5) Sample line connector
(2) CO
2
Measure/standby hard key
(4) Gas outlet
To measure CO
2
using the AG module, see
20 Monitoring Anesthetic Gas (AG)
.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 19 - 1
19.3
CO
2
Safety Information
WARNING
•
Route all tubing away from the patient’s throat to avoid strangulation.
CAUTION
•
Remove the airway sample line from the patient’s airway while nebulized medications are being delivered. Measuring CO
2
during nebulization may lead to inaccurate CO
2
readings.
•
EtCO
2
values measured from the CO
2
module may differ from those from the blood gas analysis.
•
Avoid mechanical shock to the sidestream CO
2
module.
•
Shaking the CO2 module during O2 measurement may lead to a distorted O2 waveform or inaccurate O2 measurement
NOTE
•
The CO
2
module automatically suppresses physiological alarms until breathing waves have been detected. Ensure that the patient is properly connected when using the CO
2
module.
19.4
CO
2
Measurement Limitations
The following factors may influence the measurement accuracy:
■
■
■
■
Leaks or internal venting of sampled gas
Mechanical shock
Cyclic pressure up to 10 kPa (100 cmH
2
Other sources of interference, if any
O)
For more information, see
.
CAUTION
•
Measurement accuracy of the sidestream CO
2
module may be affected by the breath rate and inspiration/expiration (I/E) ratio.
•
Measurement accuracy of the microstream CO
2
module may be affected by the breath rate.
19.5
CO
2
Display
The CO
2
numeric and waveform areas provide FiCO
2
measurement, EtCO
2
measurement, awRR measurement, and a CO
2
waveform.
19 - 2
(1)
(1) CO
2
waveform
(3) End tidal CO
2
value (EtCO
2
)
(2) (3) (4)
(2) Fraction of inspired CO
2
(FiCO
2
)
(4) Airway respiration rate (awRR)
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
19.6
Measuring CO
2
Using the Sidestream/Microstream CO
2
Module
19.6.1
Preparing to Measure CO
2
Using the Sidestream CO
2
Module
To prepare the CO
2
measurement, follow this procedure:
1.
Select the appropriate gas sample line and watertrap according to the patient category.
2.
Connect the watertrap to the CO
2
module, and connect the gas sample line to the watertrap.
(1)
(2)
(3)
(1) Watertrap receptacle
(3) Gas sample line
(2) DRYLINE II watertrap
3.
Connect the other end of the gas sample line to the patient.
◆ For intubated patients requiring an airway adapter, install the airway adapter between the patient circuit and the ventilator Y-piece.
(1)
(2)
(3)
(4)
(1) Sample line
(3) Airway adapter
(2) Connection to the ventilator
(4) Connection to the patient
◆
For non-intubated patients, place the nasal cannula onto the patient.
4.
Connect the gas outlet to the scavenging system using an exhaust tube.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 19 - 3
After the CO
2
module is connected, it enters measure mode by default and the monitor displays CO2 Starting .
CO
2
can be measured after the start-up sequence is complete.
WARNING
•
Do not use the adult or pediatric watertrap with a neonate patient. Otherwise, patient injury could result.
•
Connect the gas outlet to the scavenging system when measuring CO
2
using the sidestream CO
2 module.
CAUTION
•
Leakage in the breathing or sampling system may cause the displayed EtCO
2
values to be significantly low. Always make sure that all components are securely connected.
•
Inspect the airway adapter for a tight connection and proper operation before attaching it to the patient.
•
Squeezing or bending the sample line during sidestream or microstream CO
2
measurement may cause inaccurate CO
2
readings or no reading.
•
To avoid blocking the airway, empty the DRYLINE II watertrap container whenever half full.
Replacing the DRYLINE II watertrap once a month is recommended. Dispose of accumulated fluids in accordance with hospital policy or your local regulations.
•
The DRYLINE II watertrap has a filter preventing bacterium, water and secretions from entering the module. Extended use could destroy the filter in watertrap and fail to stop the bacterium, water and secretions entering the module, result in damaging the gas module and having infection risk.
NOTE
•
To extend the lifetime of the watertrap and module, disconnect the watertrap from the module and set the operating mode to Standby mode when CO
2
monitoring is not required.
•
The sample rates are different when different types of watertraps are used.
•
The emptying interval of the DRYLINE II adult/pediatric watertrap is 26 hours @ 120 ml/min, sample gas of 37 °C, room temperature of 23 °C, and 100% RH.
•
The emptying interval of the DRYLINE II neonatal watertrap is 35 hours @ 90 ml/min, sample gas of
37 °C, room temperature of 23 °C, and 100% RH.
19.6.2
Preparing to Measure CO
2
Using the Microstream CO
2
Module
To prepare the CO
2
module for measurement, follow this procedure:
1.
Connect one end of the sample line to the microstream CO
2
module.
(1)
19 - 4
(2)
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(1) Sample line connector (2) Sample line
2.
Connect the other end of the sample line to the patient.
◆ For intubated patient requiring an airway adapter, install the airway adapter between the patient circuit and the ventilator Y-piece.
◆
For non-intubated patient, place the nasal cannula onto the patient.
◆ For patient prone to mouth breathing, place the oral-nasal cannula onto the patient.
3.
Connect the gas outlet to the a scavenging system using an exhaust tube.
After the CO
2
module is connected, it enters measure mode by default and the monitor displays CO2 Sensor
Warmup . CO
2
can be measured after the start-up sequence is complete.
WARNING
•
Connect the gas outlet to the scavenging system when measuring CO
2
using the microstream CO
2 module.
NOTE
•
Disconnect the sample line from the module when CO
2
monitoring is not required.
19.6.3
Zeroing the Sidestream/Microstream CO
2
Module
The sidestream and microstream CO
2
modules perform a zero calibration automatically when needed. Once the zero calibration is started, the CO
2
module stops measuring and “ Zeroing ” is displayed in the CO
2
numeric area.
After the zero calibration is completed, the CO
2
module reacquires the CO
2
readings. During the reacquisition period, “ Zero Recovering ” is displayed in the CO
2
numeric area. Valid data will reappear 30 seconds after the zero calibration is started. You can hide the display of the “ Zero Recovering ” message, but values displayed
The automatic zero calibration will not start under the following conditions:
■
■
■
Physiological alarms related to CO
An apnea alarm is active.
2
or AG are active.
No breath has been detected for over 30 seconds.
19.7
Changing Settings for All CO
2
Modules
19.7.1
Changing CO
2
Alarm Settings
To change the CO
2
alarm settings, follow this procedure:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set alarm properties as desired.
19.7.2
Setting the CO
2
Waveform
To set the CO
2
waveform, follow this procedure:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 19 - 5
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set Waveform Type , Speed, Scale , or CO2 Scale of the CO
2
waveform.
19.7.3
Setting the RR Source
To set the respiration rate (RR) source, follow this procedure:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set RR Source .
When you select Auto , the system automatically selects the RR source according to the priority. The priority of
RR source is first CO
2
, and then ECG. When the current RR source does not have valid measurement, the system automatically switches the RR Source to Auto .
19.7.4
Entering the Standby Mode
Set the CO
2
module to one of the following modes according to the module status:
■
■
Select Measure mode when using the CO
2
module for monitoring.
Select Standby mode to prolong the CO
2
module service life when not using the CO
2
module.
The default operating mode is Measure . When not using the CO
2
module, proceed as follows to enter the
Standby mode:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set Operating Mode to Standby .
19.7.5
Entering the Intubation Mode
When performing intubation during general anesthesia, enter the intubation mode to reduce unnecessary alarms. To enter the intubation mode, follow this procedure:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select Intubation Mode .
■
■
To exit the intubation mode, choose either of the following ways:
From the bottom of the CO2 dialog, select Exit Intubation Mode .
Select the Main Menu quick key → from the Alarm column select Exit Intubation Mode .
For the details of the intubation mode, see
.
NOTE
•
When the configured intubation period is over, the monitor automatically exits the intubation mode and gives two alert sounds.
19.7.6
Setting the Auto Standby
The monitor enters standby mode automatically if no breath is detected after the configured period of time. To set the auto standby, follow this procedure:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set Auto Standby .
19 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
19.7.7
Setting Humidity Compensation
Sidestream and microstream CO
2
modules are configured to compensate CO
2
readings for either Body
Temperature and Pressure, Saturated Gas (BTPS), to account for humidity in the patient’s breath, or Ambient
Temperature and Pressure, Dry Gas (ATPD).
■
■
■
ATPD: P
CO2
(mmHg)=CO
2
(vol%) x P amb
/100
BTPS (sidestream): P
CO2
(mmHg)=CO
2
(vol%) x (P amb
- 47)/100
BTPS (microstream): P
CO2
(mmHg)=CO
2
(vol%) x (1- 0.03)x P amb
/100
Where, P
CO2
(mmHg)= partial pressure, vol%=CO
2
concentration, P amb
=ambient pressure, and unit is mmHg.
For the sidestream and microstream CO
2
module, set the humidity compensation on or off according to the actual condition.
To set the humidity compensation, follow this procedure:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set BTPS Compensation .
◆ Switch on for BTPS.
◆ Switch off for ATPD.
19.8
Setting the Gas Compensation
The presence of interfering gas affects the CO
2
measurement. To get the best possible measurement result, it is recommended to set the gas compensation. The configured concentration of the interfering gas should be in accordance with its actual proportion.
For the microstream CO
2
module, gas compensations are not required.
CAUTION
•
Make sure to use the appropriate compensations. Inappropriate compensations may cause inaccurate measurement values and result in misdiagnosis.
For the sidestream CO
2
module, follow this procedure to set the gas compensation:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set the compensation according to the actual condition.
19.9
Choosing a Time Interval for Peak-Picking
For microstream CO
2
modules, select a time interval for picking the highest CO
2
as the EtCO
2
and the lowest as the FiCO
2
.
To set the time interval, follow this procedure:
1.
Select the CO
2
numeric area or waveform area to enter the CO2 dialog.
2.
Select the Setup tab.
3.
Set Maximum Hold .
4.
Toggle between Single Breath , 10 s and 20 s .
◆
Single Breath : EtCO
2
and FiCO
2
are calculated for every breath.
◆
10 s and 20 s : EtCO
2
and FiCO
2
are calculated using 10 or 20 seconds of data.
19.10
Performing the Leakage Test
When measuring CO
2
using the sidestream CO
2
module, the leakage test is required every time before the CO
2 measurement. To perform the CO
2
leakage test, follow this procedure:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 19 - 7
1.
Connect the measuring accessories as per section
19.6.1 Preparing to Measure CO
.
2.
Wait until the startup finishes. Completely block the gas inlet on the sidestream CO
2
module. The alarm message “ CO2 Airway Occluded ” will appear on the screen.
3.
Continue to block the gas inlet for another one minute.
4.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
5.
Select the Module tab
→
CO2 tab.
6.
Check that the current flow rate is less than 10ml/min, and the alarm message “ CO2 Airway Occluded ” does not disappear.
This indicates that the module does not leak. If the alarm message disappears, or the flow rate is equal to
10ml/min or greater, it indicates that the module leaks. Perform the leakage test again. If the problem remains, contact your service personnel for help.
19.11
CO
2
Calibration
For sidestream and microstream CO
2
modules, a calibration is needed every year or when the measured values have a great deviation.
To calibrate the CO
2
module, contact your service personnel.
CAUTION
•
Connect the gas outlet to the scavenging system when calibrating the CO
2
module.
19.12
Test Method Used to Determine the Respiration Rate Measuring
Range
To determine the RR measurement range, follow this procedure:
1.
Connect the 5% CO
2
+ N monitor.
2
(BAL) gas cylinder, reduction valve, rhythm generator and gas sampling path of a
2.
Respectively set the rhythm generator to generate a respiration rate of 0 rpm, 6 rpm, 20 rpm, 60 rpm,
120rpm, and 150 rpm.
3.
Verify that it meets the specifications.
NOTE
•
The rhythm generator mentioned above is a sensor/sampling site in Figure 201.101 – Test apparatus for the TOTAL SYSTEM RESPONE TIME of an RGM of ISO 80601-2-55.
19.13
CO
2
Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting service. If the problem persists, contact your service personnel.
NOTE
•
For the physiological and technical alarm messages, see Appendix D Alarm Messages
.
19 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
19.13.1
Troubleshooting the Sidestream/Microstream CO
2
Module
Problem
EtCO
2
measurements too low
Solution
1. Check the patient status.
2. Check the sample line and connectors for leakage.
3. Ventilate the room if the environmental CO
2
concentration is too high.
19.14
Oridion Information
Oridion Patents
This posting serves as notice under 35 U.S.C.§287(a) for Covidien patents: http://www.covidien.com/patents.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized CO
2 sampling consumables which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device and/or CO2 sampling consumable.
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20
Monitoring Anesthetic Gas (AG)
20.1
AG Introduction
The anesthetic gas (AG) module measures the patient’s anesthetic and respiratory gases by connecting to the airway of intubated patients or collecting the gases with specified accessories. It also incorporates the features of the O
2
module and BIS module.
The AG module determines the concentration of certain gases using the infrared (IR) light absorption measurement. The gases that can be measured by the AG module absorbing IR light. Each gas has its own absorption characteristic. The gas is transported into a sample cell, and an optical IR filter selects a specific band of IR light to pass through the gas. For multiple gas measurements, there are multiple IR filters. The higher the concentration of gas in a given volume, the more IR light is absorbed. This means that higher concentration of IR absorbing gas causes a lower transmission of IR light. The amount of IR light transmitted after it has been passed through an IR absorbing gas is measured. From the amount of IR light measured, the concentration of gas present can be calculated.
Oxygen does not absorb IR light as other breathing gases and is therefore measured relying on its paramagnetic properties. Inside the O
2
sensor are two nitrogen-filled glass spheres mounted on a strong rare metal taut-band suspension. This assembly is suspended in a symmetrical non-uniform magnetic field. In the presence of paramagnetic oxygen, the glass spheres are pushed further away from the strongest part of the magnetic field.
The strength of the torque acting on the suspension is proportional to the oxygen concentration. From the strength of the torque, the concentration of oxygen is calculated.
AG monitoring is intended for adult, pediatric and neonatal patients.
(1)
(2)
(3)
(4)
(5)
(1) AG dialog hard key
(3) AG Measure/standby hard key
(5) BIS cable connector
(2) Gas outlet
(4) Watertrap seat
NOTE
•
The AG module is configured with automatic barometric pressure compensation function.
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20.2
AG Safety Information
WARNING
•
To avoid explosion hazard, do not use flammable anesthetic agent such as ether and cyclopropane for this equipment.
•
The presence of other substances in the patient’s breathing circuit, such as ethanol, acetone, methanol, isopropanol, freon, asthma medication carrier gases, and other infrared absorbing gases, can influence the anesthesia agent identification and lead to incorrect measurements and identification.
•
Using high-frequency electrosurgical units may increase the risk of skin burn. In this case, do not use antistatic or conductive respiratory tubing.
•
Route all tubing away from the patient’s throat to avoid strangulation.
CAUTION
•
Perform the measurement in a well-ventilated environment.
•
EtCO
2
values measured from the AG module may differ from that of from the blood gas analysis.
NOTE
•
The AG module automatically suppresses physiological alarms until breathing waves have been detected. Make sure that a patient is properly connected when monitoring with the AG module
20.3
AG Measurement Limitations
The following factors may influence the measurement accuracy:
■
■
■
■
Leaks or internal venting of sampled gas
Mechanical shock
Cyclic pressure up to 10 kPa (100 cmH
2
Other sources of interference, if any
O)
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20.4
AG Display
The AG module can send waves and numerics for all measured anesthetic gases for display on the monitor, including:
■
■
■
■
CO
2
, O
2
, N
2
O and AA waves awRR: airway respiratory rate
MAC: minimum alveolar concentration
End tidal (Et) and fraction of inspired (Fi) numerics for CO
2
, O
2
, N
2
O and AA
AA represents one of the following agents: Des (desflurane), Iso (isoflurane), Enf (enflurane), Sev (sevoflurane), or
Hal (halothane).
If only one anesthetic agent is used, the AA waveform area displays the waveform of this anesthetic agent. If several anesthetic agents are used, the AA waveform area displays the waveform of the primary anesthetic agent.
20.5
AG Equipment to Patient Connection
(5)
(4)
( )
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 20 - 3
(1) AG module
(3) Watertrap
(5) Airway adapter (connected to patient)
(2) Gas outlet
(4) Gas sample line
(6) Y-piece (connected to the anesthesia machine)
20.6
Preparing for AG Monitoring
To prepare to monitor AG, follow this procedure:
1.
Select the appropriate gas sample line and watertrap according to the patient category.
2.
Connect the watertrap to the AG module, and connect the gas sample line to the watertrap.
3.
Connect the other end of the gas sample line to the patient via the airway adapter.
4.
Connect the gas outlet to a scavenging system or the patient respiration circuit using an exhaust tube.
5.
Check that the connections are tight.
After the AG module is connected to the SMR, the AG module enters the measurement mode by default and the monitor prompts AG Starting . AG measurement is available after the start-up is completed.
WARNING
•
When using the AG module, connect the gas outlet to the scavenging system or the patient respiration circuit when in use with the Mindray A7 anesthesia machine.
•
If the sampled gas is returned to the breathing system, there may be a risk of patient crossinfection.
•
If the sampled gas is returned to the breathing system, install a breathing system filter compliant with the ISO 23328-1 and ISO 23328-2 standards on the patient end.
•
Make sure that the connections are tight. Any leak in the system can result in erroneous readings due to ambient air mixing with patient gases.
•
Always inspect the airway adapter for a tight connection and proper operation before attaching it to the patient.
•
Squeezing or bending the gas sample line during AG measurement may cause erroneous readings or no readings.
CAUTION
•
Position the airway adapter so that the part connecting to the gas sample line is pointing upwards.
This prevents condensed water from passing into the gas sample line and causing an occlusion.
•
The watertrap collects water drops condensed in the sample line and therefore prevents them from entering the module. To avoid blocking the airway, empty the watertrap container whenever half full.
•
The watertrap has a filter preventing bacterium, water and secretions from entering the module.
After long-term use, dust or other substances may compromise the performance of the filter or even block the airway. In this case, replace the watertrap. Replacing the watertrap once a month is recommended.
NOTE
•
Do not apply adult watertrap to the neonatal patient. Otherwise, patient injury could result.
•
To extend the lifetime of the watertrap and module, disconnect the watertrap from the module and set the operating mode to Standby when AG monitoring is not required.
20.7
Zeroing the AG Module
The AG module performs a zero calibration automatically when needed. Once the zero calibration is started, the
AG module stops measuring and “ Zeroing ” is displayed in the AG numeric area.
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After the zero calibration is completed, the AG module reacquires the AG readings. During the reacquisition period, “ Zero Recovering ” is displayed in the AG numeric area. Valid data will reappear 30 seconds after the zero calibration is started. You can hide the display of the “ Zero Recovering ” message, but values displayed during
more information.
The automatic zero calibration will not start under the following conditions:
■
■
■
Physiological alarms related to CO
2
An apnea alarm is active.
or AG are active.
No breath has been detected for over 30 seconds.
20.8
MAC Values
Minimum alveolar concentration (MAC) is the minimum concentration of the agent in the alveoli. It is a basic index to indicate the depth of anesthesia. The standard ISO 80601-2-55 defines MAC as this: alveolar concentration of an inhaled anesthetic agent that, in the absence of other anesthetic agents and at equilibrium, prevents 50% of patients from moving in response to a standard surgical stimulus.
MAC values are listed below:
Agent Des Iso Enf Sev
1 MAC 6% 1.15% 1.7% 2.1%
* indicates 1 MAC nitrous oxide can only be reached in hyperbaric chamber.
Hal
0.77%
N
2
O
105%*
NOTE
•
The types of gases used for calculating the MAC value can be selected. For more information, see
32.5.5 Manually Zeroing the CO
•
The MAC values shown in the table above are those published by the U.S. Food and Drug
Administration for a healthy 40-year-old adult male patient.
•
In actual applications, the MAC value may be affected by age, weight and other factors.
The formula to calculate the MAC value is as follows:
MAC = i = 0
AgentVol age i
Where N is the number of all agents (including N
2
O) that the AG module can measure, EtAgent i
is the concentration of each agent, and AgentVol age i is the concentration of each agent at 1 MAC with age correction.
The formula for calculating age correction of 1 MAC is:
MAC age
= MAC
40
10
– 0.00269
age 40
For example, the Des concentration at 1 MAC of a 60-year old patient is .
6% 10
– 0.00269
60 40
=
The AG module measures 4% of Des, 0.5% of Hal and 50% of N
2
O in the patient’s end-tidal gas:
MAC = + + = 2.04
NOTE
•
The formula above is only suitable for patients who are older than one year. If the patient is less than one year, the system uses one year old to do age correction.
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20.9
Changing AG Settings
20.9.1
Changing AG Alarm Settings
To change the AG alarm settings, follow this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the desired gas tab.
3.
Select the Alarm tab.
4.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
5.
Set alarm properties as desired.
20.9.2
Setting the O
2
Compensation
If the AG module does not incorporate the O
2
module, you need to set the amount of O
2
in the ventilation gas mixture. To set the O
2
compensation, follow this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the Setup tab.
3.
Set O2 Compensation :
◆ Select Off when the amount of O
2
is less than 30%.
◆ Select the other options in accordance with the O
2
concentration in the gas mixture.
The O2 Compensation setting is available only when the AG module does not incorporate the O
2
module. If the
AG module incorporates the O
2
module, the system directly uses the O module to make compensation.
2
concentration detected by the O
2
20.9.3
Entering the Standby Mode
Set the AG module to one of the following modes according to the module status:
■
■
Select
Select
Measure
Standby
mode when using the AG module for monitoring.
mode when not using the AG module.
The default operating mode is Measure . If not using the AG module, follow this procedure to enter the Standby mode:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the desired gas tab.
3.
Select the Setup tab.
4.
Set Operating Mode to Standby .
20.9.4
Setting Auto Standby
The monitor enters the standby mode automatically after the configured period of time if no breath is detected since the last detected breath. To set the auto standby, follow this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the desired gas tab.
3.
Select the Setup tab.
4.
Set Auto Standby .
20 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
20.9.5
Setting the Gas Waveform
To set the gas waveform, follow this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the desired gas tab.
3.
Select the Setup tab.
4.
Set the speed and scale of gas waveforms. For CO
2
, set Waveform Type .
20.9.6
Setting the RR Source
To set the RR (respiration rate) source, follow this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the desired gas tab.
3.
Select the Setup tab.
4.
Set RR Source .
When the current RR source does not have valid measurement, the system will automatically switch RR Source to
Auto .
20.9.7
Entering the Intubation Mode
When performing intubation during general anesthesia, enter the intubation mode to reduce unnecessary alarms. To enter the intubation mode, follow this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select Intubation Mode from the bottom of the dialog.
For the details of the intubation mode, see
20.9.8
Enabling or Disabling MAC Display
Set whether MAC value is displayed in the AG numeric area by following this procedure:
1.
Select the AG numeric area or waveform area to enter the Gas dialog.
2.
Select the desired anesthetic agent tab.
3.
Switch on or off MAC .
20.10
Changing the Anesthetic Agent
When the anesthetic agent used on the patient is changed, the AG module detects the mixed anesthetic gas during the transition of two anesthetic agents. The time required for completing the replacement of anesthetic agent depends on anesthesia type (low flow or high flow) and the characteristics of anesthetic agents
(pharmacokinetics). During the transition of two anesthetic agents, the monitor gives no prompt messages and the MAC value displayed may be inaccurate.
The AG module can identify two anesthetic agents automatically. When the proportion of primary and secondary anesthetic agents in the mixture changes, the AG module can distinguish between them according to their contributions to the MAC value. Then primary and secondary anesthetic agents will be exchanged for display.
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20.11
Performing AG Leakage Test
The AG leakage test is required every time before the AG measurement. To perform the AG leakage test, follow this procedure:
1.
Plug the AG module into the module rack.
2.
Wait for about one minute until the AG module warms up. Completely block the gas inlet of the AG module.
Then the alarm message “ AG Airway Occluded ” will appear on the screen.
3.
Block the gas inlet for another one minute.
4.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
5.
Select the Module tab
→
AG tab.
6.
Check that the current flow rate is less than 10 ml/min, and the alarm message “ AG Airway Occluded ” does not disappear.
This indicates that the module does not leak. If the alarm message disappears, or the flow rate is equal to
10ml/min or greater, it indicates that the module leaks. Perform the leakage test again. If the problem remains, contact your service personnel for help.
20.12
Calibrating the AG Module
Calibrate the AG module every year or when the measured value is outside the specification. To calibrate the AG module, contact the service personnel.
CAUTION
•
Connect the gas outlet to the scavenging system when calibrating the AG module.
20.13
AG Troubleshooting
If the AG airway is occluded, the message AG Airway Occluded appears. In this case, check for the follows until the message disappears:
1.
Check the airway adapter for occlusion and replace if necessary.
2.
Check the sample line for occlusion or kinking and replace if necessary.
3.
Check the watertrap for water or occlusion. Empty the watertrap, or replace the watertrap if necessary.
4.
Check the gas outlet and the exhaust tube for any occlusion.
If the message does not disappear, it is probably the module fault. Contact the service personnel in this case.
NOTE
•
For the physiological and technical alarm messages, see Appendix
.
20 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
21
Monitoring Electroencephalogram (EEG)
21.1
EEG Introduction
The Electroencephalograph (EEG) module monitors the patient's cerebral function by measuring the electrical activity of the brain.
The EEG module can continuously monitor EEG signal from up to four channels. It can also display Density
Spectral Arrays (DSA) and Compressed Spectral Arrays (CSA).
EEG monitoring is intended for adult, pediatric, and neonatal patients.
(1) (2)
(3)
(4)
(1) EEG dialog hard key
(3) Module status indicator
(2) Sensor check hard key
(4) EEG cable connector
21.2
EEG Safety Information
WARNING
: •
The conductive parts of electrodes and connectors should not contact other conductive parts, including electrically grounded parts.
•
To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the EEG sensor should not be located between the surgical site and the electrosurgical unit return electrode.
•
To avoid burns at the application site, do not use needle electrodes to perform EEG monitoring if electrosurgical unit (ESU) is in use. In case that needle electrodes are used, disconnect the EEG cable from the monitor and move the EEG cable away from the ESU cable before starting the ESU.
•
The EEG electrode must not be located between defibrillator pads when a defibrillator is used on a patient under monitoring.
•
To ensure proper defibrillator protection, use only recommended cables and leadwires.
•
EEG is a complex monitoring technology intended for use only as an adjunct to clinical judgment and training.
CAUTION
•
Only use parts and accessories specified in this manual. Follow the instructions for use and adhere to all warnings and cautions.
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•
Implanted devices (for example cardiac pacemakers), other patient connected equipment, and other equipment near the patient (for example high-frequency surgical units) can cause interference on the waveform, numerics, and the CSA presentation.
•
External radiating devices may disturb the measurement. It is recommended to avoid the use of electrical radiating equipment in close proximity to the monitor.
•
Interference from ECG can be eliminated by adjusting the filter settings.
NOTE
•
The EEG accessories are purchased from EB Neuro S.p.A. Please contact EB Neuro or visit its website
(www.ebneuro.com) for more information.
•
In the event of electrode connection issues, the monitor provides an error indication only when it performs an auto sensor check according to the time interval that is set by the user. It is recommended to start a manual sensor check if an abnormal waveform or high noise is observed.
21.3
EEG Parameters
EEG monitoring provides nine parameters: SEF, MF, PPF, TP, SR, Delta, Theta, Alpha, and Beta. The numerics area of each EEG channel can display up to six parameters.
Parameter Label
SEF
(Spectrum Edge Frequency)
MF
(Median Frequency)
PPF
(Peak Power Frequency)
TP
(Total Power)
SR
(Suppression Ratio)
Delta%, Theta%, Alpha%, Beta%
(Frequency band ratio)
Description
The frequency at which 95% of the total power lies below it and 5% lies above it. Its range is from 0.5 to 30.0 Hz.
The frequency at which 50% of the total power lies below it and 50% lies above it. Its range is from 0.5 to 30.0Hz.
The PPF is the frequency with the highest measured amplitude range from 0.5 to 30 Hz.
TP numeric is a measure of the absolute total power in the frequency band from 0.5 to 30.0 Hz. The useful range is from 40 to 100 dB, where 0 dB = 0.0001uV2..
SR numeric is the percentage of time in the past 60 seconds in which the EEG signal is considered suppressed.
EEG is traditionally divided into four frequency bands: delta, theta, alpha and beta. Frequency band ratio is the percentage of total power falling in corresponding band. For example, Delta % = Power in delta band/Total power.
Alpha waves: 8 to 13 Hz
Beta waves: 13 to 30 Hz
Theta waves: 4 to 8 Hz
Delta waves: 0.5 to 4 Hz
21.4
EEG Display
(1) (2) (3) (4)
21 - 2
(1) Lead label
(2) EEG waveform scale. For more information, see
21.8.1 Changing the EEG Scale .
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(3)
(4)
EEG waveform
You can configure the displayed EEG waveforms. A maximum of four EEG waveforms can be displayed.
EEG parameters
You can configure the displayed EEG parameters. A maximum of six EEG parameters can be displayed. For more
information, see 21.8.5 Changing Displayed EEG Parameters .
21.5
Accessing the On-screen EEG Guide
The monitor provides the on-screen EEG guide to help you understand EEG monitoring functions and operating procedure.
To access the on-screen EEG guide, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select the Introduction tab.
3.
Select a tab as required.
◆ Select the Summary tab to view the EEG monitoring principles, and work modes.
◆ Select the Target Patients tab to view the applicable patients for EEG monitoring.
◆ Select the Operation Guides tab to view the EEG monitoring procedure.
◆ Select the CSA and DSA tab to understand the CSA and DSA expand views.
21.6
Prepare for EEG Monitoring
To monitor EEG, follow this procedure:
1.
Connect EEG module, patient cable and lead wires. For more information, see 21.6.1 EEG Equipment to
2.
Select Montage. You can select a predefined montage and you can also customize a montage. See
21.6.2.3 Customizing an Electrode Montage
.
3.
Mark the electrode sites on the patient’s head according to the montage you have chosen.
4.
Prepare the skin of the electrode application sites.
5.
Apply the electrodes. For more information, see 21.6.3 Attaching EEG Electrodes
.
6.
Perform sensor check and observe the results.
21.6.1
EEG Equipment to Patient Connection
The following picture illustrates the connection between the EEG module and accessories.
(1) (2)
(1) EEG module (2) EEG patient cable (3) Lead wires
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(3)
21 - 3
21.6.2
EEG Electrode Montages
Both bipolar mode and referential mode have four predefined montages. The following table shows electrode locations of each predefined montage in the bipolar mode:
Electrode
Positive (+)
EEG1 (A) Negtive (-)
Label
Positive (+)
EEG2 (B) Negtive (-)
Label
Positive (+)
EEG3 (C) Negtive (-)
Label
Positive (+)
EEG4 (D) Negtive (-)
Label
Montage 1
Fp1
T3
Fp1-T3
Fp2
T4
Fp2-T4
C3
O1
C3-O1
C4
O2
C4-O2
Montage 2
F3
C3
F3-C3
C3
P3
C3-P3
F4
C4
F4-C4
C4
P4
C4-P4
Montage 3
P3
P4
P3-P4
X
X
X-X
X
X
X-X
X
X
X-X
X
X-X
X
X
X-X
Note: X indicates to no electrode is applied in this site.
The following table shows electrode locations of each predefined montage in the referential mode:
Montage 4
P3
C3
P3-C3
P4
C4
P4-C4
X
Electrode
Positive (+)
EEG1 (A) Negtive (-)
Label
Positive (+)
EEG2 (B) Negtive (-)
Label
Positive (+)
EEG3 (C) Negtive (-)
Label
Positive (+)
EEG4 (D) Negtive (-)
Label
Montage 1
Fp1
Ne
Fp1-Ne
Fp2
Ne
Fp2 -Ne
C3
Ne
C3 -Ne
C4
Ne
C4 -Ne
Montage 2
F3
Ne
F3 -Ne
C3
Ne
C3 -Ne
F4
Ne
F4
C4
Ne
C4
-Ne
-Ne
Montage 3
F3
Ne
F3 -Ne
F4
Ne
F4 -Ne
P3
Ne
P3
P4
Ne
P4
-Ne
-Ne
Ne
O1 -Ne
O2
Ne
O2 -Ne
Montage 4
Fp1
Ne
Fp1 -Ne
Fp2
Ne
Fp2 -Ne
O1
You can modify the predefined montage and rename it as a customized montage. For more information, see
21.6.2.3 Customizing an Electrode Montage
.
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21.6.2.1
EEG Electrode Locations
The following pictures shows the electrode locations. The electrode locations are labeled according to the international 10-20 electrode placement system. The numbers and letters refer to electrode locations:
21.6.2.2
■
■
■
Odd numbered electrodes: placed on the left
Even numbered electrodes: placed on the right
Letters: F = frontal, T = temporal, C = central, P = parietal, O = occipital, Z = midline electrodes
Bipolar Mode and Referential Mode
Measurement can be referential or bipolar.
■
■
In bipolar mode, each channel (EEG1, EEG2, EEG3 and EE4) uses two electrodes, a positive and a negative, to measure the potential difference between each pair.
In referential mode, all channels use the same referential electrode (Ne), and only use one electrode
(positive) to measure the potential difference.
21.6.2.3
Customizing an Electrode Montage
To modify a predefined montage and save it as customized montage, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select the Montage Setup tab.
3.
Select the Montage Type to set the work mode.
4.
Select a montage (for example Montage 1 ).
5.
Modify the electrode locations: select an electrode position from the channel area on the left, and then select the electrode position from the electrode map on the right. Repeat this operation until you have defined all the electrode positions as desired.
6.
Select Save As and input a new name for this montage, and then select OK to confirm the changes.
You can define up to three customized montages. Selecting Delete can delete a customized montage.
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21.6.3
Attaching EEG Electrodes
CAUTION
•
Keep the mental part of the EEG electrodes from being contacted. Otherwise impedance results of the sensor check may be inaccurate.
NOTE
•
Use only one type of electrode in the whole montage.
•
Make sure that you have attached the ground electrode.
•
The neutral electrode is usually more prone to artifact.
•
For best results, use Ag/AgCl electrodes for the EEG measurement.
21.6.3.1
Attaching Cup Electrodes
To attach the cup electrodes, follow this procedure:
1.
Mark the electrode sites on the patient’s head according to the montage you have chosen.
2.
Comb or cut the hair away from the spots and rub the skin with the abrasive paste to remove oil and grease.
3.
Apply the conductive paste on the inside of each electrode and then press the electrodes on the spots.
NOTE
•
Preferably use cup electrodes if montage includes placements within hair area.
21.6.3.2
Attaching Needle Electrodes
To attach the needle electrodes, follow this procedure:
1.
Clean the skin with alcohol.
2.
Insert the needle into the subcutaneous area.
3.
Secure the needles to prevent excess movement or detachment. You may also use a small amount of paste to attach the cable to the patient's hair. This prevents the cables from pulling the needles out of the skin.
WARNING
•
Check that the package of needle electrodes is intact before use. Do not use the electrodes if the package is damaged.
•
Do not open the electrode package until immediately before use.
•
Needle electrodes are disposable. Do not reuse needle electrodes.
•
Replace any needle electrodes that are found to be bent. Using needles that have been previously bent may cause damage to the attachment site or inaccurate measurement.
21.7
Performing EEG Sensor Check
The monitor has an EEG sensor check function. The Sensor Check dialog displays the status of each electrode and the result of sensor check.
21.7.1
Setting the Interval of Auto Sensor Check
The sensor check is automatically initiated in the following situations:
■
■
The EEG module is connected.
The patient cable is connected.
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■
■
The Electrode montage is changed.
The Sensor Check dialog is entered.
You can set the interval of performing the auto sensor check. To do so, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select the Sensor Check tab.
3.
Select an appropriate setting from Interval list.
21.7.2
Displaying/Hiding Impedance Value
To display the impedance value of each electrode on the electrode map, select Display Imped Values(KΩ) .
Selecting Hide Imped Values(KΩ) displays the sensor check result instead of the impedance value.
21.7.3
Manually Starting a Sensor Check
To manually start sensor check, choose either of the following way:
1.
Select the EEG numerics area or waveform area to enter the EEG menu.
2.
Select the Sensor Check tab.
3.
Verify that the Montage Type setting and Montage setting are correct.
4.
Select Start Sensor Check .
You can also press the sensor check hardkey on the EEG module to start the sensor check.
21.7.4
EEG Electrode Status
EEG electrode status is color coded. The following table lists all electrode status options and actions to be taken.
Color
Red
Grey
Yellow
Status
Off
Noise
High
Description Action
Electrode falls off and has no skin contact. In the Bipolar mode, reconnect the electrode indicated as red, and PGND electrode.
In the Referential mode, reconnect the electrode indicated as red, NE and PGND electrodes.
The EEG signal is too noisy. Impedance cannot be measured.
The impedance is above the need.
The impedance is within the need.
Check the sensor-to-skin contact. If necessary, reconnect the electrodes.
Check the sensor-to-skin contact. If necessary, reconnect the electrodes.
No action is necessary.
Green Pass
For each EEG channel, to get reliable results all electrodes for this channel should be in Pass status (green).
21.7.5
Stopping Sensor Check
Sensor check automatically stops if all the electrodes pass the impedance check. You can also manually stop the sensor check.
To stop sensor check, choose either of the following ways:
■
■
Press the sensor check hardkey on the EEG module.
Select Stop Sensor Check from the Sensor Check dialog.
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21.8
Changing EEG Settings
21.8.1
Changing the EEG Scale
To set EEG waveform scale, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select an appropriate setting from the Scale list.
21.8.2
Changing the EEG Sweep Speed
To set EEG sweep speed, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select an appropriate setting from the Speed list.
21.8.3
Changing the High/Low Filter
The low and high filters can screen out undesirable interference which may come from respiration, movement, etc. The current EEG high and low filter settings are shown at the top of DSA and CSA view.
To change the filter settings, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select an appropriate setting from the Low Freq Cut-off and High Freq Cut-off list.
21.8.4
Switching Off the Notch Filter
The notch filter can screen out 50Hz/60Hz power line noise. The notch filter is enabled by default. To disable the notch filter, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Set Notch Filter to Off .
21.8.5
Changing Displayed EEG Parameters
You can choose the displayed parameters. To do so, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
Select the Select Parameter tab.
3.
Select the parameters you want to display.
You can select at most six parameters. The selected parameters are applied to all EEG channels.
21.9
Displaying the EEG Expand View
To display the EEG expand view, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
From the bottom of the EEG dialog, select EEG Expand .
3.
Select the desired tab to enter corresponding view:
◆ Select the EEG tab, and then select EEG Channels , Scale , and Speed to view corresponding EEG waveforms.
◆ Select the Parameters tab to view parameter values of each EEG channel.
◆ Select the Trends tab, and then select EEG Channels , Parameters , and Trend Length to view the trends of corresponding EEG channels and parameters.
◆ Select the CSA
tab to enter the CSA view. For more information, see 21.9.1 CSA View
.
◆ Select the DSA tab to enter the DSA view. For more information, see
.
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21.9.1
CSA View
The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA).
The CSA View provides an overview of the patient's EEG values over time.
To display the CSA View, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
From the bottom of the EEG dialog, select EEG Expand .
3.
Select the CSA tab.
The CSA View provides up to CSA of four EEG channels. It provides the following information:
Displayed item
Status bar
Frequency scale
Spectral lines
Trendlines
Description
The first line displays the current montage, filter setting, notch frequency, SEF percentage (95%), and trendline labels and color codes.
The second line displays the EEC channel labels and lead labels.
It is the horizontal axis. The scale range depends on the filter settings ( Low Freq Cut-off and
High Freq Cut-off settings. The maximum displayed frequency is 30 Hz, so if you set High Freq
Cut-off to 50 or 70, the upper scale remains 30.
The energy at each frequency is computed and displayed as a spectral line.
EEG values are sampled at configured time intervals and displayed as color-coded trendlines.
Trendlines are available for up to three frequency numerics (SEF, MF, and PPF). SEF trendline is white, MF trendline is purple, and PPF trendline is green.
Appears when artifact is detected, electrodes are off or disconnected, or montage is changed.
“?” mark
From the CSA view you can select the following items:
■
■
■
EEG Channels
Parameters
Trend Length
To change Power Scale and CSA Clipping setting, select CSA Setup .
■
■
Changing Power Scale can adjust the amplitude of spectral lines. The wider the power scale range, the greater amplitude of the spectral lines is.
If CSA Clipping is switched on, the latest spectral line displays in a normal shape, in which area other gothrough spectral lines will be cut out. If the CSA Clipping is switched off, all the spectral lines display normally.
21.9.2
DSA View
The Density Spectral Array (DSA) is to show changes in the power spectrum distribution over time.
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To display the DSA View, follow this procedure:
1.
Select the EEG numerics area or waveform area to enter the EEG dialog.
2.
From the bottom of the EEG dialog, select EEG Expand .
3.
Select the DSA tab.
The DSA View displays DSA for up to four EEG channels. It provides the following information:
Displayed item
Color bar
Status bar
Frequency scale
Trendlines
“?” mark
Description
It is located at the right of the DSA view. The color bar color codes the power.
You can change the setting of Power Scale to adjust the color of corresponding power.
Displays the current montage, filter setting, notch frequency, SEF percentage
(95%), and trendline labels and color codes.
It is the vertical axis. The scale range depends on the filter settings ( Low Freq
Cut-off and High Freq Cut-off setting. The maximum displayed frequency is
30 Hz, so if you set High Freq Cut-off to 50 or 70, the upper scale remains 30.
EEG values are sampled at configured time intervals and displayed as colorcoded trendlines. Trendlines are available for up to three frequency numerics
(SEF, MF, and PPF). SEF trendline is white, MF trendline is purple, and PPF trendline is green.
Appears when high electrode impedance or artifact is detected, electrodes are off or disconnected is changed.
From the DSA view you can select the following items:
■
■
■
■
EEG Channels
Parameters
Trend Length
Power Scale
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21.10
EEG Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting for services. If the problem persists after corrective actions have been taken, contact the service personnel.
Problem
EEG signal is noisy
EEG cable and electrodes properly connected, but no EEG waveforms.
The EEG numerics area displays ”- -”.
EEG waveform baseline fluctuates.
The electrode impedances show “- -” and there is a message prompting to check the ground electrode?
Solution
1. Check that the electrodes are properly connected and not dried out.
2. Check that the electrodes properly contact with skin.
3. Perform electrode impedance check.
4. Calm the patient since frontal muscle activity can cause artifact.
5. Remove sources of external electrical noise (for example, the lamps) from the vicinity of the patient’s head.
6. ECG monitoring may cause artifact; change electrode positioning.
7. Possible mains power noise. Check that the monitor and other medical devices connected to the patient are properly connected to earth ground. If the noise persists, consider stopping EEG monitoring.
1. The number of channels in the montage is smaller than the number of channels connected to the patient. Check the number of channels.
2. Select the Screen Setup quick key → Parameters On/Off. Make sure that EEG parameter is turned on.
The patient has high muscle activity in the head area, or noise from some interfering equipment is coupling to electrode cables. Relax the patient and remove the source of noise.
1. Sweating may cause variations in the electrode impedance. Check the patient.
2. If the fluctuation is disturbing, prepare the skin and replace the electrodes.
The ground electrode is poorly connected to the patient. Check the electrode and cable. If the impedance of the electrode is too high, the measurement fails even if the electrode is properly attached. Use better electrodes or prepare the skin better.
NOTE
•
For the list of physiological and technical alarm messages, see
.
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22
Monitoring Bispectral Index (BIS)
22.1
BIS Introduction
Bispectral Index (BIS) monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in OR and ICU. It is designed to monitor the hypnotic state of the brain based on acquisition and processing of EEG signals. Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall during general anesthesia or sedation.
There are two BIS solutions available for use with the BIS module: the BISx or the BISx4. The BISx is for single side
BIS monitoring, and the BISx4 is for both single side and bilateral BIS monitoring. The BISx4 provides bilateral BIS monitoring only when the BIS Bilateral Sensor is connected.
BIS monitoring is intended for adult and pediatric patients.
(1) (2)
(3) (5)
(6) (7)
(4)
(1) BIS dialog hard key
(3) Module status indicator
(5) BIS module
(7) Patient cable
(2) Sensor check hard key
(4) BIS cable connector
(6) BISx or BISx4
(8) BIS sensor
(8)
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22.2
BIS Safety Information
WARNING
•
BIS monitoring is not intended for neonatal patients.
•
The BIS technology used with this monitor is purchased from Covidien. It is important to recognize this index is derived using solely that company's proprietary technology. Therefore, it is recommended that clinicians have reviewed applicable information on its utility and/or risks in published articles and literature/web site information from Covidien, or contact Covidien at www.covidien.com for clinical-based BIS questions. Failure to do so could potentially result in the incorrect administration of anesthetic agents and/or other potential complications of anesthesia or sedation. It is recommend that clinicians also review the following practice advisory (that includes a section on BIS monitoring): The American Society of Anesthesiologists, Practice Advisory for
Intraoperative Awareness and Brain Function Monitoring (Anesthesiology 2006;104:847-64).
Clinicians are also recommended to maintain current knowledge of FDA or other federal-based regulatory, practice or research information on BIS and related topics.
•
The conductive parts of sensors and connectors should not come into contact with other conductive parts, including earth conductors.
•
To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the BIS sensor should not be located between the surgical site and the electrosurgical unit return electrode.
•
To reduce the hazard of burns during use of brain-stimulating devices (e.g. transcranial electrical motor evoked potential), place stimulating electrodes as far as possible from the BIS sensor and make certain that sensor is placed according to package instructions.
•
The BIS sensor must not be located between defibrillator pads when a defibrillator is used on a patient connected to the monitor.
•
The clinical utility, risk/benefit and application of the BIS component have not undergone full evaluation in the pediatric population.
•
Due to limited clinical experience for patients with neurological disorders, patients taking psychoactive medication, and children under one year old, BIS values from these patients should be interpreted cautiously.
•
The BIS monitoring is a complex technology, intended for use only as an adjunct to clinical judgment and training. Clinical judgment should always be used when interpreting BIS in conjunction with other available clinical signs. Reliance on BIS alone for intraoperative anesthetic management is not recommended.
•
Misinterpretation of BIS can result in incorrect administration of anesthetic agents and/or other potential complications of anesthesia or sedation.
•
BIS values should be interpreted cautiously with certain anesthetic combinations, such as those relying primarily on either ketamine or nitrous oxide/narcotics to produce unconsciousness.
CAUTION
•
Ensure that the BISx or BISx4 does not come into prolonged contact with the patient's skin, as it may generate heat and cause discomfort.
•
Do not use the BIS sensor if the sensor gel is dry. To avoid dryout, do not open the pack until you are ready to use the sensor.
•
When using electro-convulsive therapy (ECT) equipment during BIS monitoring, place ECT electrodes as far as possible from the BIS sensor to minimize the effect of interference. Certain ECT equipment may interfere with the proper function of the BIS monitoring system. Check for compatibility of equipment during patient setup.
•
The BIS measurement based on measuring the EEG signal is inherently very sensitive. Do not use electrical radiating equipment close to the BISx or BISx4.
•
Artifact may lead to inappropriate BIS values. Potential artifact may be caused by unusual or excessive electrical interference or high EMG activity like shivering, muscle activity or rigidity, sustained eye movements, head and body motion. Also, improper sensor placement and poor skin contact (high impedance) may cause artifact and interfere with the measurement.
•
External radiating devices may disturb the measurement.
•
Poor signal quality may lead to inappropriate BIS values.
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22.3
BIS Parameters
Single side BIS monitoring provides the following parameters:
Parameter Description
BIS
(Bispectral Index)
SQI
(Signal Quality Index)
EMG
(Electromyography)
The BIS numeric reflects the patient’s level of consciousness. It ranges from 100 for wide awake to 0 in the absence of brain activity.
100: the patient is wide awake.
70: the patient is underdosed but still unlikely to become aware.
60: the patient is under general anesthesia and loses consciousness.
40: the patient is overdosed and in deep hypnosis.
0: the EEG is a flat line. The patient has no electrical brain activity.
The SQI numeric reflects signal quality and provides information about the reliability of the BIS, SEF, TP, and SR numerics during the last minute. The greater the SQI value, the better signal quality.
EMG bar graph reflects the electrical power of muscle activity and high frequency artifacts. Low EMG indicates that EMG activity is low. BIS monitoring conditions are optimal when the bar is empty.
SR numeric is the percentage of time over the last 63-second period during which the
EEG is considered to be in a suppressed state.
SR
(Suppression Ratio)
SEF
(Spectral Edge Frequency)
TP
(Total Power)
BC
(Burst Count)
The SEF is a frequency below which 95% of the total power is measured.
TP numeric is a measure of the absolute total power in the frequency ranging from 0.5 to
30.0 Hz. The useful range is from 40 to 100 db.
A burst means a period (at least 0.5 second) of EEG activity followed and preceded by inactivity. The BC numeric helps you quantify suppression by measuring the number of
EEG bursts per minute. For single side BIS monitoring, this parameter is intended for the
BIS module with the Extend sensor only. BC numeric is valid only when SQI≥15% and
SR≥5%.
Bilateral BIS monitoring simultaneously monitors both cerebral hemispheres. When bilateral BIS is monitored, an "L" or "R" will be added to each of the numeric identifiers except ASYM. In addition to the above parameters, it also provides the following parameters:
Parameter sBIS
(BIS Variability Index) sEMG
(EMG Variability Index)
ASYM
(Asymmetry)
Description sBIS numeric represents the standard deviation of the BIS variable over the last three minutes. sEMG numeric represents the standard deviation of the EMG value over the last three minutes.
ASYM is a processed variable indicating the percentage of EEG power presented in the left or right hemisphere with respect to total (left and right) EEG power.
Designation ‘L’ of the asymmetry data indicates asymmetry to the left side.
Designation ‘R’ of the asymmetry data indicates asymmetry to the right side.
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22.4
BIS Display
(1) (2)
The display of BIS waveform area depends on the setting of Display from the BIS dialog. For more information, see
22.7.3 Setting the Display of BIS Waveform Area
.
(3) SQI indicator
◆
Empty: SQI < 15%, unable to calculate BIS and secondary parameter values. BIS and secondary parameter values are displayed as “---”.
◆
1 to 2 bars: SQI 15% - 49%, parameter values are unreliable.
◆
3 to 5 bars: SQI 50% - 100%, parameter values are reliable.
(4) EMG indicator
◆
Empty: EMG < 30 dB. BIS monitoring conditions are optimal.
◆
1 to 4 bars: EMG 30 - 55 dB. BIS monitoring conditions are acceptable.
◆
5 bars: EMG > 55 dB. BIS monitoring conditions are unacceptable.
(5) Secondary parameters
.
22.5
Accessing the On-screen BIS Guide
The monitor provides the on-screen BIS guide to help you understand BIS monitoring functions and operating procedure.
To access the on-screen BIS guide, follow this procedure:
1.
Select the BIS numerics area or waveform area to enter the BIS dialog.
2.
Select the Introduction tab.
3.
Select a tab as required.
◆ Select the Summary tab to view the BIS monitoring principles.
◆ Select the Target Patients tab to view the applicable patients for BIS monitoring.
◆ Select the Operation Guides tab to view the BIS monitoring procedure.
(3)
(4)
(5)
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22.6
Preparing for BIS Monitoring
(1)
(2)
(3)
(4)
(1) BIS module
(3) Patient cable
(2) BISx or BISx4
(4) BIS sensor
To perform BIS monitoring, follow this procedure:
1.
Connect the BISx or BISx4 to the BIS module.
2.
Use the attachment clip to secure the BISx or BISx4 to a convenient location near the patient’s head.
3.
Connect the patient cable to the BISx or BISx4.
4.
Attach the BIS sensor to the patient following the instructions supplied with the sensor.
5.
Insert the BIS sensor into the patient cable connector until it is fully engaged.
6.
Observe the results of the automatic sensor check in the numeric area.
Sensor Check is initiated automatically when the BIS sensor and the patient cable are connected to the BISx or
BISx4. The measurement starts automatically after the sensor has passed the check.
WARNING
•
To minimize the risk of patient strangulation, the patient cable must be carefully placed and secured.
CAUTION
•
Make sure the patient’s skin is dry. A wet sensor or a salt bridge could result in erroneous BIS and impedance values.
•
Do not use if sensor gel is dry. To avoid dry out, do not open pack until ready for use.
•
Due to intimate skin contact, reuse may pose risk of infection. If skin rash or other unusual symptoms develop, stop using and remove.
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22.7
Changing BIS Settings
22.7.1
Setting BIS Alarm Properties
To set the BIS alarm properties, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
In the BIS dialog, select the Alarm tab.
3.
Enter the password if required. For more information, refer to
32.14.3 Selecting Password for User Authentication .
4.
Set alarm properties as desired.
22.7.2
Choosing the BIS Smoothing Rate
The smoothing rate defines how the monitor averages the BIS value. With the smoothing rate becoming smaller, the monitor provides increased response to changes in the patient’s state. Contrarily, the monitor provides a smoother BIS trend with decreased variability and sensitivity to artifacts.
To change the smoothing rate, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
In the BIS dialog, select the Setup tab.
3.
Set Smoothing Rate to 10 sec , 15 sec , or 30 sec .
22.7.3
Setting the Display of BIS Waveform Area
To set the display of BIS waveform, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
In the BIS dialog, select the Setup tab.
3.
Set Display .
◆ If you set Display to EEG waveforms, set Scale and Speed for EEG waveforms.
◆ If you set Display to BIS parameter trends, set Trend Length .
22.7.4
Switching the Filter On or Off
The filter can remove undesired interference from the raw EEG wave display. It is switched on by default.
To enable/disable the filter, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
In the BIS dialog, select the Setup tab.
3.
Switch on/off Filter .
22.7.5
Setting the Displayed BIS Parameters
Besides the BIS value, you can also display up to four secondary parameters in the BIS numeric area. To select the displayed parameters, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
In the BIS dialog, select the Select Parameter tab.
3.
From the BIS Tile area, select a secondary parameter block, and then select a secondary parameter from the Parameters area.
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22.8
Sensor Check
22.8.1
Automatic Sensor Check
Once the BIS sensor is connected, an automatic sensor check starts to check the sensor type, status, and impedance of all the electrodes, including the signal electrodes, the reference electrode and the ground electrode. During the sensor check, the message “Sensor Check In Progress” displays in the information area. If this message continuously displays, enter the Sensor Check dialog and check if the impedance of each electrode is acceptable.
After the initial sensor check, the monitor performs automatic checks during BIS monitoring. Automatic sensor checks includes the following items:
■
■
The combined impedance of the signal electrodes plus the reference electrode. This is done automatically and continuously and does not affect the EEG waveform. As long as the impedances are within the valid range, there is no prompt message of this check or its results.
The impedance of the ground electrode. This is done every ten minutes and takes approximately four seconds. It causes artifact in the EEG waveform, and the message BIS: Checking Ground is displayed on the monitor during the check. If the ground electrode does not pass this check, re-apply the electrode.
Then another check will automatically initiate.
The monitor continually checks impedance levels during a procedure by generating a 128 Hz test signal.
Occasionally this signal may interfere with other equipment. If this becomes a problem, you may need to disable the auto checking. Impedance levels will still be tested at startup, but once they pass, they will not be tested again until a new case is begun.
NOTE
•
Automatic sensor check may need to be disabled if the 1nA 128 Hz impedance check signal interferes with other equipment.
22.8.2
Disabling automatic sensor check
To disable automatic sensor check, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
Select the Setup tab.
3.
Switch off Auto Check .
CAUTION
•
Switching the auto impedance check off will disable automatic prompt to the user of impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done if the check interferes with or disturbs other measurements.
22.8.3
Manual Sensor Check
To manually start a sensor check, use either of the following methods:
■
■
Press the sensor check hard key
Select the Sensor Check tab from the
on the BIS module.
BIS dialog.
The monitor enters the Sensor Check dialog after you start the sensor check. The Sensor Check dialog displays the following items:
■
■
■
Sensor Type
The status of each electrode
Expiration time or usable cycles
NOTE
•
For different types of sensors the Sensor Check dialog may be different.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 22 - 7
22.8.4
BIS Sensor Status
The color of each electrode indicates its status:
Color
Red
Grey
Yellow
Status
Lead off
Noise
High
Description Action
Electrode has fallen off and has no skin contact.
The EEG signal is too noisy. Impedance cannot be measured.
The impedance is above the limit.
The impedance is within valid range.
Press the sensor more firmly to skin to ensure good sensor-to-skin contact. If necessary, remove the sensor, and then clean and dry the skin. Reapply the senor or replace the sensor.
Press the sensor more firmly to skin to ensure good sensor-to-skin contact.
Press the sensor more firmly to skin to ensure good sensor-to-skin contact.
No action necessary.
Green Pass
Although BIS may still be measured when the electrode status is Noise or High , for best performance, all electrodes should be in the Pass status.
■
■
■
■
The sensor check may fail for the following reasons:
■
■
■
■
Impedance too high
Incorrect sensor application
Poor sensor connection
Defective patient interface cable or sensor
To correct the situation:
Recheck the sensor
Reapply the sensor according to instructions
Check sensor connection
Replace patient interface cable or sensor
22.9
Monitoring Bilateral BIS
By using BISx4 and the Bilateral sensor you can perform bilateral BIS monitoring. You can display the BIS expand view during bilateral BIS monitoring.
From the BIS expand view you can monitor 4-channel EEG and the density spectral array (DSA) which shows the degree of asymmetry in EEG power between the left and right hemispheres. The BIS expand view also provides
BIS trend.
22.9.1
Entering the BIS Expand View
To enter the BIS expanded view, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
Select BIS Expand at the bottom left corner to enter the BIS Expand View.
22.9.2
Selecting BIS Expand View Display
To configure what is displayed in the BIS Expand View screen, follow this procedure:
1.
Select the BIS numeric area or waveform area to enter the BIS dialog.
2.
Select BIS Expand at the bottom left corner to enter the BIS Expand View.
3.
Select the EEG , BIS Trend or DSA tab.
22.9.2.1
Displaying the EEG waveforms
The EEG tab of the BIS Expand view shows the selected EEG waveforms. You can configure the EEG waveforms:
■ Select EEG Waveforms to set which EEG waveforms you want to display.
22 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■
■
Select Scale to set EEG waveform scale.
Select Speed to set EEG waveform speed.
22.9.2.2
Displaying the BIS Trend
The BIS Trend tab of the BIS Expand view shows the trend of selected parameters. You can configure the BIS trend:
■
■
Select Parameter 1 and Parameter 2 to set the parameters whose trend you want to display.
Set Trend Length .
22.9.2.3
Displaying BIS DSA
The Density Spectral Array (DSA) shows changes in the power spectrum distribution over a certain period of time.
■
■
DSA view shows the following information:
■
■
■
■ y-axis: time scale x-axis: signal frequency scale from 0 to 30 Hz
Color bar: shows range of power. Red indicates maximum power and blue indicates minimum power.
Spectral edge frequency (SEF) trend: It is the white Spectral Edge line superimposed on the graph where
95% of the total power lies on one side of the line (toward the inside of the graph) and 5% lies on the other.
The current SEF value: displays above the graph.
ASYM graph: displays in the center of the DSA view. It shows the degree of asymmetry in EEG power between the left and right hemispheres. The ASYM scale begins at 20% at the center line and runs left or right to 100%. Asymmetry data less than 20% are not displayed on the graph, but are available in the tabular trends.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 22 - 9
22.10
BIS Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting for services. If the problem persists after corrective actions have been taken, contact the service personnel.
Problem
Measurement does not start
Solution
1. Check the sensor attachment to the patient and the sensor placement. Check the sensor contact with skin.
2. Check the sensor type.
3. Check all connections and the patient cable.
NOTE
•
For a comprehensive list of physiological and technical alarm messages, see
22.11
Covidien Information
Covidien Patents
This posting serves as notice under 35 U.S.C.§287(a) for Covidien patents: http://www.covidien.com/patents.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized replacement parts or consumables which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.
22 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
23
Monitoring Neuromuscular Transmission (NMT)
23.1
NMT Introduction
The neuromuscular transmission (NMT) module evaluates muscle relaxation of patients under neuromuscular block by measuring the strength of muscle reaction after electrically stimulating the dedicated motor nerve.
Two electrodes are placed on the patient’s skin over dedicated nerve. A controllable current source delivers stimulation pulses to the two electrodes, and the acceleration of muscle contractions is measured with a 3-axis accelerometer.
NMT monitoring is intended for adult and pediatric patients.
(1)
(2)
(3)
(4)
(1) Calibration hard key
(3) Module status indicator
(2) Start/stop key
(4) NMT patient cable connector
23.2
NMT Safety Information
WARNING
•
The NMT measurement is not intended for neonatal patients.
•
The NMT stimulation should not be applied across or through the head, directly on the eyes, covering the mouth, on the front of the neck, especially the carotid sinus, or from electrodes placed on the chest and the upper back or cross over the heart.
•
Application of electrodes near the thorax may increase the risk of cardiac fibrillation.
•
Never apply electrodes to patients in areas where inflammation or injury is evident.
•
When you are connecting the electrodes or the patient cable, make sure that the connectors do not touch any electrically conductive material including earth conductors.
•
Patients with nerve damage or other neuromuscular problems may not respond properly to stimulation. The NMT measurement may show unusual patterns when monitoring muscle paralysis in these patients.
•
NMT stimulation current pulses may interfere with other sensitive equipment, for example, implanted cardiac pacemakers. Do not use the NMT measurement on patients with implanted electronic devices unless so directed by a medical specialist.
•
Simultaneous use of the NMT with high frequency electrosurgical equipment (ESU) may result in burns at the stimulation site and can also adversely affect measurement accuracy. Make sure the
ESU return electrode is properly applied to the patient.
•
Do not use the NMT in close proximity to shortwave or microtherapy devices, there is a risk of adversely affecting the NMT measurement.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 23 - 1
•
Never touch the electrodes unless the stimulation has been stopped.
•
Check each time before use that the material insulating the NMT sensor and the stimulation cable is intact and does not show signs of wear and tear.
CAUTION
•
NMT monitoring is intended as an adjunct in patient assessment and must be used in conjunction with observation of clinical signs and symptoms.
•
NMT stimulation can be painful to a non-sedated patient. It is recommended not to stimulate before the patient is adequately sedated.
•
Use only electrodes suitable for nerve stimulation deemed appropriate by the attending physician.
•
Pay special attention to current densities exceeding 2 mA r.m.s/cm
2
for any electrodes.
23.3
Stimulation Modes
The NMT module provides the following stimulation modes. Some stimulation modes require a minimum neurophysiological recovery time and during this recovery phase no new stimulation can be started. So you cannot start a measurement or calibration.
23.3.1
Train-Of-Four (TOF)
TOF mode is recommended for most cases.
In TOF mode, four stimulation pulses are generated at 0.5 second intervals. Each stimulation of the train causes the muscle to contract. The fade in the individual response to each single stimulation provides a basis for evaluation. The response is measured after each stimulus and the ratio of the fourth to the first response of the
TOF sequence is calculated resulting in TOF-Ratio (TOF%).
When relaxation deepens, the TOF% declines until the fourth response disappears and no TOF% is calculated.
Low response to the first stimulus (T1) also results in TOF% unavailable. When no TOF% is available, the degree of neuromuscular block is estimated from the number of responses or TOF counts. The fewer the response count is detected, the deeper is the relaxation.
If NMT calibration establishes the reference response amplitude, response to T1 as percentage of the reference value is calculated resulting in T1%.
In TOF mode, the minimum neurophysiological recovery time is 10 seconds. If NMT measurement or calibration is initiated during this period, it will be automatically delayed.
23.3.2
Single Twitch (ST)
In single twitch (ST) stimulation, the module delivers a single electrical pulse and measures the strength of the resulting twitch, the module then calculates the ratio of measured response to the reference twitch resulting in
ST-Ratio.
ST mode is practical when using depolarizing relaxants since TOF% does not give any additional information about the patient status. Additionally, when the change of patient’s relaxation level is considered, ST stimulation at a frequency of 1 Hz can indicate the relaxation change in a more real-time way.
23.3.3
Post-Tetanic Count (PTC)
When neuromuscular block deepens, different parameters are needed to measure the response. At first, when the response to the fourth TOF stimulation pulse disappears or the first twitch is very weak, the TOF% is not available and only the number of detected counts can be observed. When stimulation pulses no longer give any stimulation response, you do not get the TOF count either. To monitor the relaxation level, you can start tetanic stimulation and estimate the relaxation level from the Post Tetanic Count (PTC).
PTC stimulation mode starts with a sequence of four current pulses delivered at 2 Hz. If a muscle response is detected, the PTC sequence is stopped and the TOF result is reported. If there is no muscle response, the sequence continues with a five seconds long tetanic stimulation delivered at 50 Hz, followed by a pause of 3 seconds, followed by 20 single current pulses delivered at 1 Hz. The number of detected responses is counted and expressed as PTC. The fewer responses are detected, the deeper the relaxation is.
23 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
After tetanic stimulation, NMT measurements and calibration are disabled for 20 seconds and PTC is disabled for
2 minutes.
23.3.4
Double Burst Stimulation (DBS)
Double Burst Stimulation (DBS) enables better visual observing of the fading in the responses. DBS consists of two separate bursts at an interval of 750 ms, where each burst consists of certain pulses directly after each other at a frequency of 50 Hz. The response ratio of the second to the first burst is calculated resulting in DBS-Ratio, while the number of responses is detected and expressed as DBS Count.
The module supports DBS3.2 and DBS3.3.
■ For DBS3.2 mode, the first burst consists of 3 consecutive pulses, and the second burst consists of 2 consecutive pulses.
For DBS3.3 mode, both bursts consist of 3 consecutive pulses.
■
In DBS mode, the minimum neurophysiological recovery time is 15 seconds. If NMT measurement or calibration is initiated during this period, it will be automatically delayed.
23.4
NMT Parameters
The following table lists the NMT parameters in different stimulation modes.
Stimulation Mode
TOF
ST
PTC
DBS
Parameter Label
TOF-ratio
TOF-count
T1%
ST-ratio
ST-count
PTC
DBS ratio
DBS count
Unit
%
/
/
/
/
%
%
/
Number of Bars
2
2
1
/
/
1
4
4
23.5
NMT Display
(10) (9)
(1)
(2)
(8)
(7)
(6)
(5) (3) (4)
(1) Parameter unit
(2) Parameter value
(3) Parameter label
(4) Stimulation current
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 23 - 3
(5) T1%: responses to the first stimulus as percentage of the reference amplitude in TOF mode. This value is not shown if calibration fails.
(6) Bar graph: indicates the amplitude of response to the stimulation. The maximum height of the bar graph displayed is
120%. Bar graph is not shown if calibration is not completed successfully.
(7) Scale: indicates the amplitude of response to stimulation.
(8) Measurement interval: Manual is displayed if Interval is set to Manual .
(9) Measurement countdown: time to the next measurement. The measurement countdown is not shown if Interval is set to Manual .
(10) The last measurement time .
NOTE
•
The NMT parameter values become outline font 15 minutes after the NMT measurement is taken.
•
The PTC value is shown on the display for 20 seconds after which the NMT module returns to the preset stimulation mode.
23.6
Accessing the On-screen NMT Guide
The monitor provides the on-screen NMT guide to help you understand NMT monitoring functions and operating procedure.
To access the on-screen NMT guide, follow this procedure:
1.
Select the NMT numerics area or waveform area to enter the NMT menu.
2.
Select the Introduction tab.
3.
Select a tab as required.
◆
Select the Summary tab to view the NMT monitoring principles.
◆
Select the Target Patients tab to view the applicable patients for NMT monitoring.
◆
Select the Points To Note tab to view the precautions before NMT monitoring.
◆
Select the Operation Guides tab to view the NMT monitoring procedure.
23.7
Preparing for NMT Monitoring
23.7.1
NMT Equipment to Patient Connection
The following picture shows NMT cable and patient connection .
(5)
(6)
(3)
(7)
(1)
(1) NMT module
(3) NMT stimulation cable
(5) Proximal electrode (red)
(7) NMT sensor
(2) (4)
(2) NMT patient cable
(4) NMT sensor cable
(6) Distal electrode (black)
23 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
23.7.2
Preparing the Skin
Good electrode-to-skin contact is important for good signal quality. Before applying the electrodes, clean the application site of oil and dirt and avoid placing the electrodes over excessive body hair or lesions. Insufficient cleaning of the skin can cause high skin impedance which could cause the stimulation to stop.
To properly prepare the skin, follow this procedure:
1.
Select sites with intact skin, without lesion of any kind.
2.
Shave hair from skin at chosen sites.
3.
Gently rub skin surface at sites to remove dead skin cells.
4.
Thoroughly cleanse the site with a mild soap and water solution.
5.
Dry the skin completely before applying the electrodes.
23.7.3
Placing the Electrodes and Sensor
Stimulation of the ulnar nerve in the wrist and acceleration measurements at the adductor pollicis are preferred for routine monitoring. When monitoring neuromuscular transmission, round surface electrodes with snap connection are a must. Small (pediatric or neonatal) electrodes are advisable to obtain a sufficient current density. In order to ensure a steady signal quality, be sure only to use CE marked electrodes.
Ensure that the thumb can move freely before applying NMT electrodes and sensor. Follow this procedure to place the electrodes and sensor:
1.
Place the distal electrode near the wrist.
2.
Place the proximal electrode 2 to 3 cm proximal of the distal electrode.
3.
Attach the red clamp to the proximal electrode.
4.
Attach the black clamp to the distal electrode.
5.
Affix the sensor with its large flat side against the palmar side of the thumb with a piece of tape. The cable should be attached in such a way that it does not 'pull' at the sensor and that movement of the thumb is not obstructed.
CAUTION
•
When placing the electrodes, make sure that they do not touch each other.
•
If the electrodes are placed incorrectly, wrong nerves are stimulated and this causes wrong muscle response.
•
When multiple nerves are stimulated, the measured response may be affected by activity of other muscles.
•
If the stimulation electrodes are placed very close to the palm of the hand, the muscles are stimulated directly by the stimulation pulses.
•
If the current is too strong, it may stimulate the muscles too much.
•
Moving or touching the patient during measurement may cause incorrect results.
•
Make sure that the NMT cables does not contact external pacemaker or catheter wires.
•
To avoid unintentional electrical shocks always make sure that the NMT stimulation has been stopped before touching the electrodes.
•
Take care to handle the NMT sensor, avoiding forcefully striking the sensor.
•
After repositioning the patient, check the NMT sensor application site and ensure that the sensor is still properly applied and the thumb can move freely.
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CAUTION
•
Correct positioning of the electrodes is important. Small displacements may result in considerable changes in stimulation current requirements. Furthermore, the electrodes must be positioned in such a way to avoid direct stimulation of the muscle.
•
The electrodes should be applied properly to the patient skin. It has been found that slight pressure on the electrodes may improve the stimulation considerably. Therefore, taping the electrodes to the skin may be advisable.
•
The more distal the sensor is placed on the thumb, the stronger the acceleration signal. This effect can be used to adjust the signal strength.
•
During NMT measurement, the arm applied with NMT electrodes and sensor should be kept immobile during the whole procedure.
23.8
Calibrating the NMT Measurement
The size of the sensor signal varies from patient to patient. NMT calibration determines supramaximal stimulation current and the reference response amplitude. The reference response amplitude is the twitch at the supramaximal stimulation current when the patient is not paralyzed. The calibration must be done prior to administration of a muscle relaxant drug.
CAUTION
•
Start calibration before the administration of a muscle relaxant drug (but after the induction of sleep in general anesthesia) to prevent voluntary muscle contraction and tension from interfering with the reference search.
23.8.1
Setting the Calibration Current
If you set Stimulation Current to Supra (60 mA) , the module automatically searches for supramaximal current to determine the reference response amplitude. If you select a value between 0 and 60 mA, the reference response amplitude is determined using the selected stimulation current. For adults, the supramaximal current is usually between 35 and 55 mA. For more information, see
23.11.2 Changing the Stimulation Current
.
23.8.2
Starting NMT Calibration
To Start NMT calibration, follow this procedure:
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Setup tab.
3.
Verify that the settings of Stimulation Current and Pulse Width .
4.
Press the calibration hard key on the NMT module or select Calibrate at the bottom of the NMT menu to start calibration.
If calibration succeeds, the message Calibration Completed displays on the NMT menu. If calibration failed, the
NMT module automatically uses the default value as the reference amplitude.
NOTE
•
It is recommended that the patient be anesthetized before setting up the calibration twitch as nerve stimulation can be painful.
•
Changing the stimulation current or pulse width after calibration invalidates the stored reference data, and therefore recalibration is required.
23 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
23.9
Starting NMT Measurements
■
■
At the completion of NMT calibration, the monitor automatically starts a TOF mode measurement.
You can also choose either of the following ways to start NMT measurements:
Press the Start/stop key on the NMT module.
From the Measure tab of the NMT menu, select a measurement mode, set Interval , and select Start (XX) to start NMT measurement at corresponding mode.
NOTE
•
Stop NMT measurements if you need to change the NMT settings.
•
Take care when removing the sensor from the patient. Do not pull on the cable.
23.10
Stopping NMT Measurements
Choose either of the following ways to stop an on-going NMT measurement.
■
■
Press the
Select
Start/stop
Stop All
key on the NMT module.
at the bottom of the NMT menu.
23.11
Changing NMT Measurement Settings
23.11.1
Selecting the NMT Measurement Mode
To select the NMT measurement mode, follow this procedure:
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Measure tab.
3.
Select the desired stimulation mode.
4.
If you select TOF Mode , ST Mode , or DBS mode, select Interval to set the time interval between two measurements.
23.11.2
Changing the Stimulation Current
Before calibration and NMT measurement, confirm that the desired stimulus current is selected. To set the simulation current, follow this procedure:
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Setup tab.
3.
Set Stimulation Current .
◆
When Stimulation Current is set to Supra , the module automatically searches for supramaximal current to determine the reference response amplitude. For adults, the supramaximal current is usually between 35 and 55 mA. Smaller currents may be desirable for children.
◆
If Stimulation Current is set to a value between 0 and 60 mA, the reference response amplitude is determined using the selected stimulation current.
NOTE
•
Stimulation current is adjusted in increments of 5 mA.
23.11.3
Changing the Pulse Width
You can increase the pulse width to increase the effect of the stimulation to help finding the supramaximal current. To set the pulse width, follow this procedure:
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 23 - 7
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Setup tab.
3.
Set Pulse Width .
23.11.4
Enabling Block Recovery Notification
A message “NMT Block Recovery” is displayed in the technical alarm information area to notify you when the set block recover limit is reached. This indicates that the patient is responding more clearly to the stimuli and the neuromuscular block is decreasing. This notification can be used, for example, to help maintain a certain relaxation level.
To enable the block recovery notation and set the limit for activating the note, follow this procedure:
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Setup tab.
3.
Set Block Recovery . If Block Recovery is set to Off , the monitor will not give a note.
23.11.5
Adjusting NMT Stimulation Beep Volume
The monitor gives a beep at the selected volume at each stimulation pulse if the setting is not zero. To adjust the volume of NMT stimulation beep, follow this procedure:
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Setup tab.
3.
Set Stimulation Beep Volume .
23.12
Recalling Calibration Information
In the situation that the NMT module is power down, or you want move the NMT module to another monitor along with the patient and you want to continue with the already determined calibration information, including stimulation current, pulse width, and reference response amplitude, you can use the recall function.
To recall the calibration information, follow this procedure:
1.
Select the NMT numeric area to enter the NMT menu.
2.
Select the Recall Reference tab.
3.
Select Recall Reference .
23.13
NMT Troubleshooting
This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting for services. If the problem persists, contact the service personnel.
Problem
NMT calibration and measurement fails.
NMT measurement is disturbed.
Supramaximal current cannot be found.
Solution
1. Check that the electrodes are properly applied.
2. Replacing the electrodes.
1. Do not touch the arm where electrodes are applied.
2. Check that the electrodes and NMT sensor are properly applied.
Check that the electrodes are properly applied. Also, supramaximal current may not be found if the patient is already relaxed.
NOTE
•
For a comprehensive list of physiological and technical alarm messages, see
23 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
24
Monitoring Regional Oxygen Saturation (rSO
2
)
24.1
rSO
2
Introduction
The rSO
2
(Regional Oxygen Saturation) monitoring provides noninvasive and continuous information of changes in regional oxygen saturation of blood. The measurement takes place in real time, providing an immediate indication of a change in the critical balance of regional oxygen delivery and oxygen consumption.
The harmless, near-infrared wavelengths generated by the INVOS System’s light-emitting diodes pass through scalp and bone tissue beneath the sensor. Once in vivo they are either absorbed or scattered back up to the sensor’s shallow and deep detectors. Red-colored hemoglobin molecules within red blood cells have the highest light absorption of the wavelengths used, and the exact shade of red of each hemoglobin molecule indicates the amount of oxygen it is carrying. The type and quantity of absorption data returned to the detectors reflects deoxyhemoglobin and total hemoglobin, from which a regional oxygen saturation (% rSO
2
) value unique to the specific area under the sensor is calculated.
(1)
(2)
(3)
(1)
(2)
(
(3)
(1) Light source
(4)
(2) Shallow detector (3) Deep detector
(5)
(6)
(4) rSO
2
dialog hard key
(6) Module status indicator
(7)
(5) Set the baseline for all rSO
2
channels
(7) rSO
2
cable connector
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 24 - 1
24.2
rSO
2
Safety Information
CAUTION
• rSO
2
monitoring is intended for use in individuals greater than 2.5 kg at risk for reduced-flow or noflow ischemic states.
•
Do not use the rSO
2 value as the sole basis for making decisions regarding diagnosis or therapy because the rSO
2
values represent a small volume of tissue beneath the sensor and may not reflect oxygenation disturbances that occur elsewhere.
•
Use only recommended or provided accessories. Using any other sensor will compromise accuracy.
•
Use of an electrosurgical instrument in the vicinity of the monitor may interfere with the signal and result in inaccurate rSO
2
measurement.
NOTE
•
Environments with excessive ambient light such as bright sunlight or strong operating room lighting may require loosely covering the area of the sensor with an opaque drape.
24.3
rSO
2
Measurement Limitations
If present, the following may cause inaccurate readings:
■
■
■
■
■
Cardiogreen, indigo carmine or other intravascular dyes
Carboxyhemoglobin or other dyshemoglobins
Hemoglobinopathies
Conjugated hyperbilirubinemia (direct)
Myoglobin (Mb) in muscle tissues
24.4
rSO
2
Display
rSO
2
-1 and rSO
2
-2 are from the first inserted rSO
2
module. rSO
2
-1' and rSO
2
-2' are from the second inserted rSO module. Each rSO
2
numeric area displays one rSO
2
channel, which is shown as below:
2
(2) (3)
(1)
(4)
(7)
(6) (5)
(8)
(9)
(1) rSO
2
label
(3) Baseline (BL)
(2) Channel indicator
(4) Signal Strength Indicator (SSI)
24 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(5) Change percentage of the rSO
2
realtime value and baseline (If the rSO
2
value is greater than or equal to the baseline, the arrowhead is upward; If the rSO
2
value is smaller than the baseline, the arrowhead is downward)
(6) Realtime rSO
(8)rSO
2
2
value
rolling average of latest 60 minutes
(7) Upper and lower rSO
2
alarm limits
(9) Area Under the Curve (AUC)
24.5
Accessing the On-screen rSO
2
Guide
The monitor provides the on-screen rSO
2
guide to help you understand rSO
2
monitoring principles, functions, and operating procedure. To access the on-screen rSO
2
guide, follow this procedure:
1.
Select the rSO
2
numeric area to enter the rSO
2
dialog.
2.
Select the Introduction tab.
3.
Select the desired tab of Summary Target Patients , Points To Note , or Operation Guides .
24.6
Preparing for rSO
2
Monitoring
1.
Select the site for sensor placement. For more information, see 24.6.1 rSO
2.
Prepare the patient skin. For more information, see
.
3.
Apply the rSO
2
sensor. For more information, see
.
4.
Connect the rSO
2
parts. For more information, see 24.6.4 Connecting the rSO
24.6.1
rSO
2
Sensor Site Selection
The rSO
2
sensor can be placed on the proper cerebral or somatic site.
■ Cerebral site selection: select sensor site on the right and/or left side of forehead. Placement of the sensor in other cerebral locations, or over hair, may cause inaccurate readings.
■ Somatic site selection: select sensor site over tissue area of interest (site selection will determine which body region is monitored)
CAUTION
•
For cerebral site selection, do not place the sensor over nevi, sinus cavities, the superior sagittal sinus, subdural or epidural hematomas, injured skin or other anomalies such as arteriovenous malformations, as this may cause readings that are not reflective of brain tissue or no readings at all.
•
For somatic site selection, avoid placing the sensor over thick fatty deposits, hair or bony protuberances. Do not place the sensor over nevi, hematomas or broken skin, as this may cause readings that are not reflective of somatic tissue or no readings at all.
NOTE
•
For the somatic site selection, see the instruction for use of corresponding sensor for detailed information.
24.6.2
Preparing the Skin
To achieve the optimal measurement result, the sensor application site should be clean and dry. To properly prepare the skin, follow this procedure:
1.
Shave hair from skin at chosen sites.
2.
Gently rub skin surface at sites to remove dead skin cells.
3.
Thoroughly cleanse the site with a mild soap and water solution.
4.
Dry the skin completely before applying the sensors.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 24 - 3
24.6.3
Applying the rSO
2
Sensor
Follow this procedure to apply the rSO
2
sensor to patient:
1.
Remove the protective backing label from the adhesive side of the sensor and apply the sensor to the skin.
2.
Continue applying the sensor by smoothing it to the skin from the center outward. Ensure edges of the sensor are sealed to prevent light from entering.
CAUTION
•
The sensor is designed for single use only and can not be reused. Reuse may cause inaccurate readings, erratic readings, or no readings at all. Also, reuse may cause an increased risk of crosscontamination among patients.
•
The sensor is designed for external use only as described in the instructions. Do not use the sensor internally for any reason.
•
Do not place the sensor on regions with severe tissue edema to reduce the possibility of skin lesions.
•
Do not autoclave or gas sterilize the sensor.
NOTE
•
Use care when placing orremoving sensor. Do not place on broken or undeveloped skin.
•
For extended monitoring, it is recommended to use a new sensor every 24 hours or if adhesive is inadequate to seal the sensor to the skin.
•
To avoid pressure sores do not apply external pressure (e.g. headbands, wraps, or tape) to sensor.
24.6.4
Connecting the rSO
2
Parts
1.
Connect Preamplifier(s) to the rSO
2
module. Align red dot on the silvery connector of the Preamplifier with red dot on rSO
2
cable connector.
2.
Connect the following devices as per patient category:
◆
For neonatal patients, connect the neonatal sensor directly to the Preamplifier.
◆
For pediatric or adult patients, a reusable sensor cable is needed for the connection of the
Preamplifier and the sensor. Use color-coding when connecting the Preamplifier and the reusable sensor cable.
(2)
(3)
24 - 4
(1)
(1) rSO
2 module (2) Preamplifier (3) Reusable sensor cable
NOTE
•
Different sensors (adult, pediatric and infant/neonatal) cannot be used simultaneously on the same monitor. Cerebral sensors can be used with somatic sensors on the same monitor.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
24.7
Changing rSO
2
Settings
24.7.1
Changing rSO
2
Alarm Settings
To change the rSO
2
alarm settings, follow this procedure:
1.
Select the rSO
2
numeric area to enter the rSO2 dialog.
2.
Select the Alarm tab.
3.
Enter the password if required. For more information, refer to 32.14.3 Selecting Password for User
.
4.
Set alarm properties as desired.
24.7.2
Setting the rSO
2
Auto Low Limit Switch
To set the rSO
2
auto low alarm limit, follow this procedure:
1.
Select the rSO
2
numeric area to enter the rSO2 dialog.
2.
Select the Alarm tab.
3.
Set Auto Low Limit switch.
◆ If Auto Low Limit is switched on, rSO2-1 Variance and rSO2-2 Variance are activated to allow you to set the percentage of rSO
2
low limits below the baseline. Then the monitor calculates the rSO
2
low limits automatically based on the setting.
◆ If Auto Low Limit is switched off, the rSO
2
low limits should be set manually.
24.7.3
Setting the rSO
2
Label
To set the rSO
2
label, follow this procedure:
1.
Select the rSO
2 numeric area to enter the rSO2 dialog.
2.
Select the Setup tab.
3.
Set rSO2-1 Label and rSO2-2 Label .
24.7.4
Setting the AUC Mode
To set the AUC mode, follow this procedure:
1.
Select the rSO
2
numeric area to enter the rSO2 dialog.
2.
Select the Setup tab.
3.
Set AUC Mode .
◆
Select Fixed to activate the item Fixed Threshold . In this case, AUC is calculated according to the configured fixed threshold.
◆ Select Below Base Percentage to activate the item Percentage Below Baseline . In this case, AUC is calculated according to the configured percentage below baseline.
24.7.5
Setting the Baseline
To set the rSO
2
baseline for the respective channel, follow this procedure:
1.
Select the rSO
2
numeric area to enter the rSO2 dialog.
2.
Select the Baseline tab.
3.
Select Set Baseline . The monitor automatically sets the current rSO
2
value as the baseline.
You can also set the baselines for all rSO
2
channels by the following two methods:
■
■
Select Set Baseline s in the lower left corner of the rSO
2
dialog.
Press the hard key at the upper right of the rSO
2
module.
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Then the monitor set the baselines for all rSO
2
channels according to their respective current rSO
2
values.
NOTE
•
Set the rSO
2
value measured when patient is sober and eupraxic as baseline. The baseline will be set automatically if it is not set within 5 to 6 minutes and current rSO
2
value is effective.
24.7.6
Selecting rSO
2
Parameters for Display
In the rSO
2
numeric area, rSO
2
and SSI are permanently displayed parameters, and other parameters are selectable. To select the parameters for display, follow this procedure:
1.
Select the rSO
2
numeric area to enter the rSO2 dialog.
2.
Select the Select Parameter tab.
3.
Select the parameters for display.
24.8
Covidien Information
Covidien Patents
This posting serves as notice under 35 U.S.C.§287(a) for Covidien patents: http://www.covidien.com/patents.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized replacement parts or consumables which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.
24 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
25
Review
25.1
Review Overview
Trends are patient data collected over time and displayed in graphic, tabular, or other forms to give you a picture of how the patient's condition is developing. The Review dialog also enables access to review the events, 12lead ECG analysis results and waveforms, full disclosure waveforms, and so on.
25.2
Review Dialog
The Review dialog contains tabs to display trend data in tabular, graphic, or other forms.
25.2.1
Accessing the Review Dialog
Choose one of the following methods to enter the review dialog:
■
■
Select the Review quick key. If reviewing patient data is password protected, input the monitor's clinical password (local password).
Select the Main Menu quick key → from the Review column select the desired option. If reviewing patient data is password protected, input the monitor's clinical password (local password).
25.2.2
Example Review Dialog
The review pages have a common structure. The graphic trends review page is taken as an example:
(1)
(2)
(5)
(3)
(4)
(1)
(2)
(3)
(4)
■
■
■
Event type indicator: different color blocks match different types of events:
■ Red: high priority alarm event
■ Yellow: medium priority alarm event
Cyan: low priority alarm event
Green: manual event
White: operation-related event
Current screen time line: indicates the time length of the current screen.
Waveform area: displays trend curves. The color of trend curves is consistent with the color of parameter labels.
Time line: indicates the entire time length.
■ : indicates the time length of trend data.
■ : indicates the time length of no trend data.
can be moved within this time length.
cannot be moved within this time length.
■ Different color blocks along the time line indicate events of different types. See the color definition for the event type indicator.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 25 - 1
(6)
(7)
(8)
(9)
(5)
(6)
(7)
(8)
(9)
Event area: displays the event of the cursor time. Selecting the event accesses the event list. If there is no event at the cursor time, the cursor time is displayed.
Numeric area: displays numeric values at the cursor indicated time. The background color of numeric values matches the alarm priority.
Cursor: this is adjusted by touching different locations. Adjusting this changes the data displayed in the Event area and Numeric area.
Slider: indicates the position of current screen time in the entire time length. Dragging this button left or right enables you to locate the trend data at a specific time and also refreshes trend data in current screen accordingly.
Button area.
25.2.3
Symbols on Review Pages
The following table lists the symbols on review pages.
Symbol
or
or
Description
Slider: indicates the position of current screen time in the entire time length. Dragging the slider left or right enables you to locate the trend data at a specific time and also refreshes data in current screen accordingly.
Goes to the previous or next event.
Event list: displays events in a chronological order. The most recent event is displayed at the top. The number of asterisk symbols before an event indicates alarm priority.
Selecting this symbol displays two review pages simultaneously.
+
Record button: select it to output patient information and data through the recorder.
Print button: select it to output patient information and data through the printer.
Indicates that the followed parameter is from an external device connected to the monitor via the BeneLink module.
25.2.4
Common Operations
This section describes common operations for all review pages.
25.2.4.1
Browsing Trend Data
Browse trend data in one of the following ways:
■
■
■
Move the cursor.
Move the slider .
Slide your finger on the screen.
25.2.4.2
Viewing Events
■
■
■
You can view the following types of events:
Manually triggered events
Parameter-related operation events and alarm-related events, such as starting NIBP measurement
Operation events not related to parameters, such as system time change
■
■
View events in either of the following ways:
Select and select the desired event.
Select or to jump to the previous event or next event.
Events are displayed in a chronological order. The most recent event is displayed at the top. The number of asterisk symbols before an event indicates alarm priority as follows:
25 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■
■
■
***: high priority alarm
**: medium priority alarm
*: low priority alarm
25.2.4.3
Displaying Two Review Pages Simultaneously
For N22/N19, you can display two review pages simultaneously. To do so, follow this procedure:
1.
Enter the desired review page by one of the following methods:
◆ Select the Review quick key → select the desired tab.
◆ Select the Main Menu quick key → from the Review column select the desired item.
2.
Select (for landscape display) or navigated independently.
(for portrait display) to open a duplicate view that can be
25.2.5
Tabular Trends Review Page
The tabular trends review page displays trend data in a tabular form.
25.2.5.1
Entering the Tabular Trends Review Page
Choose one of the following methods to enter the tabular trends review page:
■
■
Select the Review quick key
→ select the Tabular Trends tab.
Select the Main Menu quick key
→
from the Review column select Tabular Trends .
25.2.5.2
Changing the Tabular Trend Group
To change the tabular trend group, follow this procedure:
1.
Enter the tabular trends review page.
2.
Set Trend Group .
25.2.5.3
Editing the Tabular Trend Group
The setting of the Trend Group defines the contents of displayed trends. It is possible to edit any trend group except for the All and Standard trend groups. To do so, follow this procedure:
1.
Enter the tabular trends review page:
2.
Select Group Setup
→ select the desired tab.
◆ Rename the trend group (optional): select the desired name.
symbol at the upper left corner and input the
◆ Add parameters: select desired parameters from the Choices column, and then select Add . Selecting
Add All adds all parameters (up to the maximum of 83).
◆ Delete parameters: select desired parameters from the Selected column, and then select Delete .
Selecting Delete All deletes all parameters except for HR.
◆ Move the position of parameters displayed on the trend page: select desired parameters from the
Selected column, and then select Move up , Move Down , Move to Top , or Move to Bottom .
◆ Display two parameters side by side: select two parameters from the Selected column, and then select Overlap . Then, the symbol appears at the right of the overlapped parameters. The overlapped parameters will be displayed side by side in one numerics area and waveform area.
◆ Unoverlap two parameters: select the overlapped parameters from the Selected column, and then select Unoverlap .
Selecting Default will restore the trend group settings to factory defaults.
NOTE
•
Trend groups labeled All or Standard cannot be edited.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 25 - 3
•
The HR parameter and waveform are always displayed in the first row on the trend page. It cannot be deleted or moved.
25.2.5.4
Changing the Resolution of Tabular Trend Data
The interval of tabular trends defines the interval of displaying trend data. A short interval is especially suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer interval may be more informative.
To change the interval of trend data, follow this procedure:
1.
Enter the tabular trends review page.
2.
Select Interval .
◆ 5 sec or 30 sec : select to view up to 4 hours of tabular trends at an interval of 5 seconds or 30 seconds.
◆ 1 min, 5 min, 10 min, 15 min, 30 min, 1 hr, 2 hrs, or 3 hrs : select to view up to 120 hours of tabular trends at selected interval.
◆
Select parameters, such as NIBP, or GCS, to view the tabular trends when these parameter measurements are acquired.
NOTE
•
Changing between intervals does not typically change the position of the slider or cursor except to round it to the nearest interval, however changing intervals to be 30 seconds or less will move any cursor position more than 4 hours ago to the oldest data less than 4 hours ago.
25.2.5.5
Printing a Tabular Trends Report
To print a tabular trends report, follow this procedure:
1.
Enter the tabular trends review page.
2.
Select to enter the Print Setup dialog.
3.
Set the tabular trends report as described in 29.6.3 Configuring Tabular Trends Reports .
4.
Select Print or Print (All) .
◆ Print : the trend data before the above set Time , for the above set Period , and at the above set
Interval will be printed.
◆ Print (All) : all the stored trend data will be printed at the review interval.
25.2.5.6
Recording Tabular Trends
To print tabular trends with the recorder, follow this procedure:
1.
Enter the tabular trends review page.
2.
Select to enter the Record Setup dialog.
3.
Respectively set Start Time and End Time of the tabular trends data.
4.
Select Record or Record (All) .
◆ Record : the trend data between the Start Time and End Time will be recorded.
◆ Record (All) : all the stored trend data at the review interval will be recorded.
25.2.6
Graphics Trends Review Page
The graphic trends review page displays trend data in a visual format.
25.2.6.1
Entering the Graphic Trends Review Page
Choose one of the following methods to enter the graphic trends review page:
■
■
Select the Review quick key → select the Graphic Trends tab.
Select the Main Menu quick key → from the Review column select Graphic Trends .
25 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
25.2.6.2
Changing the Graphic Trend Group
To change the graphic trend group, follow this procedure:
1.
Enter the graphic trends review page.
2.
Set Trend Group .
25.2.6.3
Editing the Graphic Trend Group
1.
Enter the graphic trends review page.
2.
Select Group Setup .
25.2.6.4
Changing the Resolution of Trend Data
To change the length of trend data displayed on the current screen, follow this procedure:
1.
Enter the graphic trends review page.
2.
Select Zoom .
◆
8 min: the screen displays eight minutes of trend data. You can view the most recent one hour of data.
◆ 30 min, 1 hr, 2 hrs, 4 hrs : the screen displays 30 minutes, one hour, two hours, or four hours of trend data. You can view the most recent four hours of data.
◆
8 hrs, 12 hrs, 24 hrs, 48 hrs : the screen displays 8 hours, 12 hours, 24 hours, or 48 hours of trend data.
You can view the most recent 120 hours of data.
25.2.6.5
Changing the Number of Waveforms
To change the number of waveforms displayed on the trend review page, follow this procedure:
1.
Enter the graphic trends review page.
2.
Select Trends .
25.2.6.6
Printing a Graphic Trends Report
To print a graphic trends report, follow this procedure:
1.
Enter the graphic trends review page.
2.
Select to enter the Print Setup dialog.
3.
Set the graphic trends report as described in
29.6.4 Configuring Graphic Trends Reports
.
4.
Select Print to print the graphic trend data before the above set Time and for the above set Period .
25.2.7
Events Review Page
The monitor stores events in real time, including technical alarm events, physiological alarm events, manual events, and operational events. When an event occurs, all the measurement numerics and three event-related waveforms 16 seconds before and after the event are stored.
NOTE
•
Alarms are saved as events and will be maintained if the equipment is powered down. The time of equipment power down is not recorded as an event and cannot be reviewed.
•
Earlier events will be overwritten by later ones if the storage capacity is reached.
•
A total loss of power does not affect the events already stored.
25.2.7.1
Entering the Events Review Page
Choose one of the following methods to enter the events review page:
■ Select the Review quick key → select the Events tab.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 25 - 5
■ Select the Main Menu quick key → from the Review column select Events .
The Event page displays the event list. Events are displayed in descending chronological order, with the most recent displayed at the top. The number of asterisk symbols before an event indicate alarm priority as described
.
Different color blocks are displayed on the left of each event to indicate different event types.
■
■
■
■
■
Red: high priority alarm event
Yellow: medium priority alarm event
Cyan: low priority alarm event
Green: manual event
White: operation-related event
The number of currently selected events and the total number of events are displayed at the top right corner of the event list. For example, 2/4 indicates that the selected event is the second event in the filtered events and the total number of filtered events is 4. Total indicates the total number of events. For example: Total : 28 means that there are a total of 28 events.
25.2.7.2
Configuring the Filter
You can filter events to facilitate event review. To configure the filter, follow this procedure:
1.
Enter the Events page.
2.
Select Filter . From the drop-down list, select the desired filter item.
You can create up to two sets of custom filter. To do so, follow this procedure:
1.
From the Filter drop-down list, select Custom 1 or Custom 2 to enter the Filter Setup menu.
2.
Select the Name field to edit the name of the custom filter criterion.
3.
Select the desired items.
If you want to review events which happened around certain time, select the button → set the time → select Ok
.
The cursor then jumps to the event happened closest to the time entered.
25.2.7.3
Editing Events
To edit events, follow this procedure:
1.
Enter the Events page and tick off the desired events.
2.
Select to edit the selected events.
◆ Lock : manually lock the event. Locked events cannot be deleted.
◆ Note : enter comments for the event.
◆ Rename : allow renaming an event name. Only manual events and arrhythmia events can be renamed if enabled by the hospital’s settings. For more information, see
.
25.2.7.4
Viewing Event Details
To view waveforms and parameter values at the event time, follow this procedure:
■
■
■
■
■
■
1.
Enter the Events page.
2.
Select Detail .
To display beat labels on the first ECG waveform, switch on Beat Anno . The white beat labels indicate heart beats classification and may explain suspected, missed, or false arrhythmia calls. Heart beats are classified as follows:
N = Normal
V = Ventricular ectopic
S = Supraventricular premature
P = Paced
L = Learning
? = Insufficient information to classify beat
25 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■
■
I = Inoperative (for example, Lead Off )
M = Missed beat
If you switch on Beat Anno on the Events page, beat labels will also be displayed on the Full Disclosure page, and vise versa. Beat labels can be printed out.
25.2.7.5
Printing Event Reports
To print event reports via a printer, follow this procedure:
1.
Enter the events review page.
2.
Select to enter the Print Setup dialog.
3.
Select the desired options.
◆ Print All Event List : print the entire event list.
◆ Print List of Selected Events : print the list of selected events.
◆ Print Detail of Selected Events : print the details of selected events.
◆ Print Displayed Event Detail : print the waveforms and parameters of the currently displayed event.
4.
Select Print .
25.2.7.6
Recording Event Details
To print events details via a recorder, follow this procedure:
1.
Enter the events review page.
2.
Select the Detail button.
3.
Select to print the details of the event.
NOTE
•
When a parameter label is prefixed with the plus sign (+) on a printout, it indicates that the data is from an external device.
25.2.8
Full Disclosure Review Page
You can review up to 48 hours of waveform data on the full disclosure review page. You can view both the compressed waveforms and numeric values.
25.2.8.1
Entering the Full Disclosure Review Page
Choose one of the following methods to enter the full disclosure review page:
■
■
Select the Review quick key → select the Full Disclosure tab.
Select the Main Menu quick key → from the Review column select Full Disclosure .
25.2.8.2
Selecting Waveforms
You can select the waveforms to be displayed and stored. Up to 48 hours of waveforms for all parameters can be stored. When closing the Select Waveform dialog, a prompt will inform you of the duration of waveforms that can be saved if the amount is less than 48 hours. To save and display the desired waveforms, follow this procedure:
1.
Enter the full disclosure review page.
2.
Select Setup to enter the Select Waveform page.
3.
Select the Storage tab and set the desired waveforms to be stored in the monitor. Select the Display
(Maximum: 3) tab and set the desired waveforms to be displayed on the Full Disclosure page.
NOTE
•
Storing more waveforms may shorten the storage time to less than 48 hours. Please adjust the waveforms stored with this consideration.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 25 - 7
•
Parameter labels from external devices are prefixed with the plus sign (+).
In case of alarms, the background of the compressed waveform is highlighted with a colored block during the alarm time:
■
■
■
Red: high alarm priority
Yellow: medium alarm priority
Cyan: low alarm priority
25.2.8.3
Setting the Scale and Duration
To set the length and size of displayed compressed waveforms, follow this procedure:
1.
Enter the full disclosure review page.
2.
Set the waveforms scale in either of the following ways:
◆
Select the Scale button. If you do not see Scale , select the
◆
Select the waveform label.
3.
Select Duration to set the length of displayed waveforms.
button to show it.
4.
Select the parameter label beside the waveforms to set scale for each parameter.
25.2.8.4
Viewing Details of Compressed Waveforms
To view the full waveforms and numeric values, follow this procedure:
1.
Enter the full disclosure review page.
2.
Select Detail .
■
■
You can perform the following operations on the this page:
■
Switch on Beat Anno . For more information, see
25.2.7.4 Viewing Event Details
.
Select Speed , ECG Gain , or Save As Event . If you do not see an option, then select the show it.
Select Overview to switch to the compressed waveform view.
button to
25.2.8.5
Printing the Full Disclosure Waveform Report
To print a compressed waveform report, follow this procedure:
1.
Enter the full disclosure review page.
2.
Select to enter the Print Setup dialog.
3.
Select waveform type you want to print:
◆
Print Waveform Overview : compressed waveform of selected period will be printed. This option is only available when printing from the Overview or compressed waveform view.
◆ Print Displayed Waveform Detail : parameter values and all stored waveforms around the cursor time will be printed. This option is only available when printing from the Detail view.
4.
Select Print .
NOTE
•
When a parameter label is prefixed with the plus sign (+) on a printout, it indicates that the data is from an external device.
25.2.8.6
Recording the Details of the Compressed Waveform
To record a Full Disclosure Detail Record Report, follow this procedure:
1.
Enter the Full Disclosure page.
2.
Select Detail .
25 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
3.
Select .
NOTE
•
When a parameter label is prefixed with the plus sign (+) on a printout, it indicates that the data is from an external device.
25.2.9
Arrhy Statistics Review Page
The Arrhy Statistics review page shows arrhythmia events happened over the lastest 24 hours. This page is only available with the ECG 24h Summary option.
To enter the Arrhy Statistics review page, choose one of the following methods:
■
■
Select the Review quick key
→ select the Arrhy Statistics tab.
Select the Main Menu quick key
→
from the Review column select Arrhy Statistics .
Selecting each type of arrhythmia statistics bar shows compressed waveforms, the time and duration of each arrhythmia event. Selecting the compression waveform shows the event details.
25.2.10
OxyCRG Review Page
You can review up to 48 hours worth of 4 minute trend curves on the OxyCRG review page. The OxyCRG review functionality is available for neonatal monitoring only.
NOTE
•
OxyCRG Review Page is available only when Patient Category is set to Neo.
25.2.10.1 Entering the OxyCRG Review Page
■
■
■
Choose one of the following methods to enter the OxyCRG review page:
From the OxyCRG screen, select the ABD events list area.
Select the Review quick key
→ select the OxyCRG tab.
Select the Main Menu quick key
→
from the Review column select OxyCRG .
25.2.10.2 The Display of the OxyCRG Review Page
The following figure shows the OxyCRG screen:
(1)
(2) (2)
(4)
(3)
(1) Event title area: displays information of the selected event, such as the event type and time.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 25 - 9
(2) Event detail area: displays 4 minutes of parameter trends and compressed waveform, and parameter values of the selected event.
(3) Event summary area: displays ABD events within the Zoom period. The selected event is enclosed in a white frame.
(4) Event statistics area: displays the total number of ABD events and the numbers of each event within the Zoom period.
25.2.10.3 Changing the Resolution of Trend Curves
To set the resolution of trend curves, follow this procedure:
1.
Enter the OxyCRG review page.
2.
Set Zoom .
NOTE
•
If the Zoom is set for a large duration (for example, 8 hrs), the screen may show "No Patient Data" for the first several minutes of data collection (for example, 6 minutes), but data will be shown after enough data has been collected.
25.2.10.4 Printing an OxyCRG Review Report
To print an OxyCRG review report, follow this procedure:
1.
Enter the OxyCRG review page.
2.
Select to enter the Print Setup dialog.
3.
Select Print . The report duration corresponds to the duration of data shown on the screen.
25.2.11
12-Lead ECG Review Page
When 12-lead ECG analysis is performed, you can review the most recent 20 events of 12-lead analysis. For more
information, see 10 Resting 12-Lead ECG Analysis
.
25.2.11.1 Entering the 12-Lead Review Page
Choose one of the following methods to enter the 12-lead ECG review page:
■
■
■
Upon completion of 12-lead ECG analysis, select Review from the 12-Lead Interpretation page. For more
information, see 10 Resting 12-Lead ECG Analysis
.
Select the Review quick key → select 12-Lead ECG .
Select the Main Menu quick key → from the Review column select 12-Lead ECG .
25.2.11.2 Switching to Median Complex (for Glasgow Algorithm Only)
The median complex template displays 12-lead ECG waveforms on one page in 4 columns, with 3 lines in each column, and one rhythm lead waveform at the bottom. Additionally, a short vertical bar appears above each waveform, marking the start and end positions of the P-wave and the QRS-wave and the end position of T-wave.
To view Median Complex, follow this procedure:
1.
Enter the 12-lead review page.
2.
Select Median Complex .
Selecting Waveform can return to the 12-lead ECG waveform page.
25.2.11.3 Setting 12-Lead ECG Waveforms
To set the 12-lead ECG waveforms on the review page, follow this procedure:
1.
Enter the 12-lead review page.
25 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.
Set Speed , Gain , and Layout .
25.2.11.4 Printing the 12-Lead ECG Report
To print the 12-Lead ECG report, follow this procedure:
1.
Enter the 12-lead review page.
2.
Select .
3.
Configure the 12-lead ECG report.
4.
Select Print .
25.2.11.5 Recording the 12-Lead ECG Report
To print the 12-Lead ECG report via the recorder, follow this procedure:
1.
Enter the 12-lead review page.
2.
Select .
25.2.12
ST Review Page
When ST analysis is enabled, the monitor saves ST segments and values at an interval of one minute. You can review the latest 120 hours of ST data.
25.2.12.1 Entering the ST Review Page
Choose either of the following methods to enter the ST review page:
■
■
Select the Review quick key
→ select the ST tab.
Select the Main Menu quick key → from the Review column select ST .
25.2.12.2 Setting the ST Reference
You can set the currently displayed ST as reference. To do so, follow this procedure:
1.
Enter the ST review page.
2.
Select Set Reference .
NOTE
•
The ST baseline is used as ST reference by default.
25.2.12.3 Displaying/Hiding the ST Reference
To display or hide ST reference, follow this procedure:
1.
Enter the ST review page.
2.
Select Display Reference or Hide Reference .
25.2.12.4 Displaying/Hiding Markers
To display or hide markers, follow this procedure:
1.
Enter the ST review page.
2.
Select Display Marker or Hide Marker .
25.2.12.5 Printing ST Data
To print ST data, follow this procedure:
1.
Enter the ST review page.
2.
Select .
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25.3
Reviewing Discharged Patients
For discharged patients, you can review the trend data in the review page. You can also review the events and
12-lead ECG analysis results.
Access the Discharged Patients dialog box by either of the following ways:
◆ Select the Discharged Patients quick key. If viewing discharged patients is password protected, input the user name and password (the user name and password saved in the MLDAP server).
◆ Select the Main Menu quick key
→ from the Patient Management column select Discharged
Patients .
If viewing discharged patients is password protected, input the user name and password (the user name and password saved in the MLDAP server).
25.3.1
Checking the Data of a Discharged Patient
1.
Access the data of the discharged patient as described in
25.3 Reviewing Discharged Patients .
2.
From the patient list select the desired patient.
3.
Select Detail .
25.3.2
Checking the Information of a Discharged Patient
1.
Access the data of the discharged patient as described in
25.3 Reviewing Discharged Patients .
2.
Select the icon to enter the Patient Management dialog box.
3.
Select Ok to exit the Patient Management dialog box.
25 - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
26
Clinical Assistive Applications (CAA)
The Clinical Assistive Applications (CAA) function integrates some commonly used clinical guidelines and tools into the monitor. It puts the currently monitoring parameter measurements together and provides comprehensive analysis results.
CAA can improve the clinician’s working efficiency. However, it is not directly used for diagnosis and cannot not replace the clinician’s judgement.
26.1
Checking Software Licenses
Licenses are required to run the following CAA functions in the monitor:
■
■
■
■
HemoSight
Early Warning Score (EWS)
SepsisSight
ECG 24h Summary
To check the licenses, select the Main Menu quick key → select License → Local .
To install the licenses, follow this procedure:
1.
For N17/N15/N12, connect the USB drive with the licenses in to the monitor’s USB connector. For N22/N19. connect the USB drive to the monitor’s MSB connector.
2.
Select the Main Menu quick key
→ select License
→ select External .
3.
Select Install .
26.2
Early Warning Score (EWS)
The Early Warning Scores (EWS) can help you recognize the early sign of deterioration in patients based on vital signs and clinical observations. It is based on the “Royal College of Physicians (2015) National Early Warning
Score (NEWS2): Standardizing the assessment of acute illness severity in the NHS, Report of a Working Party. RCP,
London. Depending on the score calculated, appropriate recommendations are displayed.
The monitor supports the following scores:
■
■
■
■
MEWS (Modified Early Warning Score)
NEWS (National Early Warning Score)
NEWS2 (National Early Warning Score 2)
Custom Score
A subscore is given for each parameter based on the measured or entered value. When all the required parameters are entered or measured, the subscores are added together to calculate the total early warning score. Each subscore has a color coding to indicate associated level of risk. When the total score is outside of the thresholds, actions are recommended. MEWS, NEWS and NEWS2 can give total scores.
Custom Score is based on user-defined parameters.
MEWS, NEWS and NEWS2 are intended for adult patients only. The patient category applied to the Custom Score is defined by the Mindray Clinical Score Configuration Tool. For more information, see Mindray Clinical Scoring
Config Tool Instruction for Use (P/N: 046-012986-00).
WARNING
•
EWS is not intended for pediatric and neonatal patients.
•
The EWS scores and recommended actions are for reference only and cannot be directly used for diagnostic interpretation.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 26 - 1
•
EWS cannot be used as an prognosis index. It is not a clinical judgement tool. Clinicians must use their clinical judgement in conjunction with the EWS tool at all times.
•
MEWS and NEWS are intended for adult patients only. NEWS is not applicable to pregnant woman and COPD (Chronic Obstructive Pulmonary Disease) patients.
NOTE
•
The EWS scores does not trigger any alarms and cannot used for continuous monitoring.
26.2.1
Displaying the EWS Numerics Area
To display the EWS numerics area, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆ Select the Screen Setup quick key → select the Tile Layout tab.
◆ Select the Main Menu quick key → from the Display column select Tile Layout .
2.
Select the parameter area where you want to display the EWS score, and then from the popup list select
EWS .
(2)
(1)
(3)
(8)
(4)
(5)
(6)
(5)
(6)
(7)
(8)
(1)
(2)
(3)
(4)
(7)
EWS protocol label
Scoring countdown: time to the next scoring.
Scoring interval
The scoring time
Single parameter whose score reaches 3
Risk level indicator. The level of risk increases from top down. The current level is enclosed by a white square frame.
History total score. The rightmost one is the latest history score.
Total score. The color of the circle indicates the level of risk.
26.2.2
Accessing the EWS Screen
Access the EWS window in any of the following ways:
■
■
■
■
Select the EWS parameter area
Select the EWS quick key.
Select the Screen Setup quick key → select the Choose Screen tab → select EWS .
Select the Main Menu quick key → from the CAA column select EWS .
When the EWS screen is hidden as
EWS screen.
, you can also choose one of the following methods to quickly enter the
■
■
Swipe left or right across the touchscreen with two fingers until you switch to the EWS screen.
Swipe right across the touchscreen with a single finger ,
26 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■ Select the button ,
Take NEWS2 as an example, the EWS screen is shown as follows. Your screen may be slightly different due to the configuration.
(12) (11) (10) (9)
(1)
(2)
(8)
(7)
(6)
(3)
(4)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(5)
Total score. The color of the circle indicates the level of risk.
Risk level indicator. The level of risk increases from top down. The current level is enclosed by a white frame.
Parameter area: display the subscore and parameter value of each parameter. The keyboard symbol indicates that the parameter value is manually entered.
History total scores area: selecting this area or swiping up with one finger can review the trends of total score and each subscore
Selecting this button expands the History Total Scores area where your can review the trends of the total score and each subscore.
Selecting this button or swiping right across the screen with one finger displays the trends of total score and parameter values for scoring.
Clinician ID (displays only when the Clinician ID is enabled): allows inputing the Clinician ID to associate with the
EWS score. For more information, see
32.4.1 Enabling Inputing the Clinician ID .
Select this button to see the clinical response to the current score
Scoring interval
EWS protocol label
Scoring countdown: time to the next scoring.
The scoring time
26.2.3
Performing EWS Scoring
CAUTION
•
The decision to use Scale 2 of the SpO2 Scale should be made by a competent clinical decision maker and should be recorded in the patient’s clinical notes.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 26 - 3
NOTE
•
Before calculating the score, select Reset to clear the previous score.
•
The keyboard symbol at the right of the parameter value indicates that the value is manually entered.
•
You can get the score only when all required parameters have been measured or entered.
•
When a patient is discharged, or the monitor is turned off, the clinician ID is cleared
To perform scoring, follow this procedure:
1.
Select Reset to clear the previous score and update values of currently monitored parameters and relevant subscores.
2.
For NEWS2, set the SpO2 Scale .
◆
Scale 1 : for patient without hypercapnic respiratory failure.
◆
Scale 2 : f or patients with a prescribed oxygen saturation requirement of 88–92% (for example, in patients with hypercapnic respiratory failure).
3.
Measure or manually enter other required parameters and observations.
4.
If the clinician ID is enabled, input the clinician information by selecting and manually entering the information, or by scanning the clinician’s barcode.
5.
Select Calculate to get the total score.
6.
If Score Confirmation is enabled, select Confirm to save current scoring, or select Cancel to give up
26.2.4
Changing EWS Settings
26.2.4.1
Changing the Scoring Protocol
The monitor is configured with a default scoring protocol. To change the scoring protocol, follow this procedure:
1.
From the EWS page select Setup .
2.
Set Score .
26.2.4.2
Setting the Scoring Confirmation Switch
To select if confirmation is required before saving score, follow this procedure:
1.
From the EWS page select Setup .
2.
Set Score Confirmation switch.
◆
Off: the monitor automatically saves the scoring result after the scoring is completed.
◆
On: you need to confirm that whether the scoring result is saved or not after the scoring is completed.
26.2.4.3
Setting the Manual Data Timeout
The manually input parameter data can be configured to become invalid after a preset time. To set the timeout period for the input data, follow this procedure:
1.
From the EWS screen select Setup .
2.
From the Manual Data Timeout area, select a desired parameter and set its timeout period.
NOTE
•
If the data is expired and not updated, the monitor displays the corresponding parameter score in outline font, and gives a timeout alarm.
26.2.4.4
Setting Auto Scoring
The monitor automatically starts scoring at the preset interval. To set auto scoring, follow this procedure:
1.
From the EWS page select Setup .
26 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.
Set Auto Scoring :
◆ Interval : the monitor automatically starts scoring at the preset interval.
◆ NIBP : the monitor automatically starts scoring at the completion of each NIBP measurement.
◆ Alarm : the monitor automatically starts scoring when an alarm occurs to the parameter for scoring.
◆ If no option is selected, the monitor does not initiate auto scoring.
26.2.4.5
Setting Auto Scoring Interval
1.
From the EWS page select Setup .
2.
Set Interval :
◆ By Score : the monitor automatically starts scoring as per the interval selected for corresponding total score.
◆
5 min - 24 h : If Auto Scoring is set to Interval , the monitor automatically starts scoring as per the selected interval. If Auto Scoring is not set to Interval , the countdown timer of manual scoring is selected.
26.2.5
Viewing Historical Scores
■
■
From the EWS screen, you can view the total score or subscores of the past 24 hours. To do so, choose either of the following ways:
Select the history total score area.
From the history total score area, swipe up with a finger.
To return to the EWS screen, select
from the top of the historical score screen. Refer to 26.2.2 Accessing the
EWS Screen for the position of the history total score area.
26.2.6
Viewing Parameter Trends
From the EWS screen, you can view the 24-hour graphic trends of each parameter used for scoring. To do so, choose either of the following ways:
■
■
Select the button.
Swipe right across the EWS screen with a finger.
From the screen of parameter trends, selecting the button or swiping left across the screen with a finger can return to the EWS screen.
Refer to 26.2.2 Accessing the EWS Screen for the position of the
button.
26.3
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) function is based on Teasdale’s Assessment of Coma and Impaired Consciousness-A
Practical Scale (Lancet, 1974) . Three aspects of behavior are independently measured: eye opening, verbal response, and motor response. The scores are added together to indicate that patient’s level of consciousness.
GCS is intended for adults and pediatric patients.
CAUTION
•
GCS is intended as an adjunct in patient assessment and must be used in conjunction with observation of clinical signs and symptoms.
•
GCS is not applied to patients that are sedated, muscularly relaxed, with artificial airway, drunk, hypothermia or in status epilepsies.
•
Please refer to hospital policy regarding acceptable use of GCS.
•
When applied to children younger than five years old or to the elderly, the GCS score may not reflect actual function.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 26 - 5
26.3.1
Displaying the GCS Parameter Area
To display the GCS parameter area, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆ Select the Screen Setup quick key
→
select the Tile Layout tab.
◆
Select the Main Menu quick key
→ from the Display column select Tile Layout .
2.
Select the parameter area where you want to display the GCS score, and then from the popup list select
GCS .
The following figure shows the GCS parameter area. The display may be configured to look slightly different.
(4)
(1)
(5)
(2)
(3)
(1)
(2)
(3)
(4)
(5)
(6)
GCS label
Total score and level of consciousness. The color of the circle indicates the level of risk.
Scoring time
Scoring countdown: time to the next scoring
Scoring interval
Subscores
◆
E: eye opening
◆ V: verbal response
◆
M: motor response
(6)
26.3.2
Accessing the GCS Dialog
Enter the GCS dialog in any of the following ways:
■
■
■
Select the GCS parameter area.
Select the GCS quick key.
Select the Main Menu quick key
→ from the CAA column select GCS .
26 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
(1)
(2)
(1) Subscore (2) Total score
26.3.3
Performing GCS Scoring
To perform scoring, follow this procedure:
1.
From the Eye Opening area, Verbal Response area, and Motor Response area, respectively select an item that represents the patient’s status.
2.
Select Ok to accept the total score.
The following table lists the default score range and color of relevant consciousness level.
Level
Mild damage
Moderate damage
Severe damage
Range
13-15
9 - 12
3 - 8
Color
White
Yellow
Red
NOTE
•
The GCS score range is adjustable. Refer to
32.4.4 Setting GCS Threshold for Each Consciousness Level
for the method of changing the high limit and low limit of each consciousness level.
26.3.4
Setting GCS Scoring Interval
From the GCS dialog, select Interval to set GCS scoring interval. When the scoring interval is reached and you do not perform another scoring, the score will be invalidated and displayed as outline fonts.
26.3.5
Reviewing GCS Trend Data
From the GCS dialog, select Review to enter the Review dialog and view the GCS trend data from the Tabular
Trends .
26.4
SepsisSight
TM
The SepsisSight
TM
function is based on Third International Consensus Definitions for Sepsis and Septic Shock
(Sepsis-3) and Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock:
2012 and 2016 (SSC Guideline 2016). It assists you in recognizing the early signs and symptoms of sepsis by comparing the state of the patient to the defined criteria and then guides you through the recommended treatment protocol.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 26 - 7
CAUTION
•
SepsisSight is not a diagnostic or therapeutic tool and is not intended to replace the competent judgment of a clinician.
•
SepsisSight should not be used with intravenous immunoglobulins in adult patients with severe sepsis or septic shock.
•
SepsisSight should not be used with intravenous selenium for the treatment of severe sepsis.
•
SepsisSight should not be used with sodium bicarbonate therapy for the purpose of improving hemodynamics or reducing vasopressor requirements in patients with hypoperfusion-induced lactic acidemia with pH ≥7.15.
NOTE
•
SepsisSight is intended to perform routine screening of potentially infected seriously ill patients for severe sepsis to allow earlier implementation of therapy.
•
SepsisSight is intended to be followed by application of hospital–based performance improvement efforts in severe sepsis.
•
The Surviving Sepsis Campaign recommends to discuss goals of care and prognosis with patients and families.
•
The Surviving Sepsis Campaign recommends to incorporate goals of care into treatment and end-oflife care planning, utilizing palliative care principles where appropriate.
•
The SepsisSight goals of care are intended to be applied in a time defined by the SSC guidelines.
•
Due to space limitations on the screen, the recommendations cannot always be reproduced in the full detail available in the printed and on-line guidelines.
•
SepsisSight is intended for adult patients suffering from sepsis or suspicion of sepsis.
26.4.1
Accessing the SepsisSight Dialog
■
■
Enter the SepsisSight dialog in any of the following ways:
Select the SepsisSight quick key.
Select the Main Menu quick key → from the CAA column select SepsisSight .
26.4.2
Screening
As per Sepsis-3, SepsisSight supports quick Sepsis-Related Organ Failure Assessment (qSOFA, or quick SOFA) and
Sepsis-Related Organ Failure Assessment (SOFA). SOFA is the default assessment tool for ICU, while qSOFA is the default for other departments.
26.4.2.1
Performing qSOFA qSOFA evaluates the patient’s respiration rate, systolic blood pressure and altered mental status.
RR and BP-S being monitored are automatically obtained. You can also manually enter these values by selecting the symbol. Select whether the patient’s mental status is altered. Then qSOFA score is calculated.
Select Confirm to record the calculation time.
If the qSOFA score is greater than or equal to 2, or sepsis is suspected, select SOFA>> to perform SOFA.
To clear the score, select Reset .
NOTE
•
The keyboard symbol indicates that the parameter value is manually entered.
•
The question mark (?) in the score circle indicates that more parameter values are required before a score can be calculated.
26 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
26.4.2.2
Performing SOFA
SOFA score is used to identify organ function or the rate of sepsis-related organ failure.
To perform SOFA, enter the value or select a range for each item, SOFA score will be automatically calculated.
To clear the score, select Reset .
If Sepsis criteria is met, make a comprehensive judgement on the clinical features.
26.4.2.3
Changing Screening Settings
■
■
From the Screening page select Setup . You can change the following settings:
In the Screening area, set RR (rpm) high limit and BP-S (mmHg) low limit for qSOFA scoring.
In the Unit area, set the unit of Bilirubin and Creatinine .
26.4.3
Recommendations
The SSC Bundles page lists goals and treatments to be completed in the defined time. Pages Treatment I and
Treatment II list graded recommendations as per the SSC Guidelines 2016,
You can define the time and goals for initial resuscitation, as well as treatments to be completed in one hour, 3
hours, and 6 hours. For more information, see 32.4.5 Changing SepsisSight Settings
.
26.4.3.1
Viewing Detailed Recommendations
On the Pages Treatment I and Treatment II select the arrow symbol at the right side of each item to view detailed recommendations of SSC Guideline 2016. The star symbol
★
indicates the grade of recommendation:
■
■
★★
: strong recommendation
★
: weak recommendation
■ No star symbol: best practice statement
To hide the detailed recommendations, select the arrow symbol .
26.4.3.2
Marking Implemented Items
Check off implemented items. Then the time and date are automatically recorded and displayed.
■
■
You can select the symbol to change the date and time.
Select Reset to clear the current results.
26.4.4
Reviewing SepsisSight Trend Data
Select the Graphic Trends tab to view the trend of parameters of resuscitation.
When a recommended treatment is checked off on pages Treatment I and Treatment II , relevant event is marked in the tabular trend. Vertical lines of different colors indicate the event type:
■
■
■
■
White: inspection performed
Blue: medication
Green: goal achieved
Purple: other treatment
26.5
ECG 24h Summary
■
■
The ECG 24h Summary provides ECG statistics of the current patient over the latest 24 hours. You can view the following information through the ECG 24h Summary:
Heart rate statistics
Arrhythmia event statistics
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 26 - 9
■
■
■
■
QT/QTc measurement statistics
Maximum and minimum ST statistics of each lead
Pacer statistics
Typical ECG strips
NOTE
•
The ECG 24h Summary is intended for the current patient. It is not intended for discharged patients.
•
Pacer statistics is intended for paced patients.
•
Patient data is saved, collected and displayed together in the ECG 24h Summary. Data displayed in the ECG 24h Summary is not recalculated.
•
If BeneView T1 is used to monitor a patient, when BeneView T1 is connected with the host monitor, data sent to the host monitor is not included in the ECG 24h Summary.
•
A license is required for the ECG 24h Summary function.
26.5.1
Viewing the ECG 24h Summary
■
■
To view the ECG 24h Summary, choose either of the following ways:
Select the ECG 24h Sum quick key.
Select the Main Menu quick key
→
from the CAA column select ECG 24h Summary
.
26.5.2
Selecting Typical ECG Strips
The Typical Strips area displays ECG strips of the following situations:
■
■
■
Maximum heart rate
Minimum heart rate
Four arrhythmia events
You can select a typical ECG strip of each situation. For example, to select the typical ECG strip of asystole, follow this procedure:
1.
Select the currently displayed asystole strip.
2.
From the popup strips, select the desired strip as the typical strip of asystole.
26.5.3
Reviewing ECG Summary
From the ECG 24h Summary dialog, you can review corresponding trends and events.
■
■
■
■
■
■
Select the Heart Rate area to review HR graphic trends.
Select the Max ST/Min ST area to review the current ST reference and ST graphic trends.
Select the Pace area to review historic pace events.
Select the QT area to review QT/QTc graphic trends.
Select the Arrhythmia area to review arrhythmia statistics. For more information, refer to
Select Full Disclosure to review ECG full disclosure waveforms. For more information, refer to
.
26.6
HemoSight
TM
■
■
This monitor provides the HemoSight TM function. You can easily view and review hemodynamic parameters through the HemoSight dialog.
The HemoSight dialog is available when you are using the following modules:
C.O. module
ScvO
2
module
26 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■ CCO/SvO
2
module (measured from the Vigilance II, Vigileo, HemoSphere, and EV1000 monitor)
For detailed information on monitoring and setting hemodynamic-related parameters, see
17 Monitoring Central Venous Oxygen Saturation (ScvO
. This chapter only introduces functions operated through the
HemoSight dialog.
26.6.1
Accessing the HemoSight Dialog
■
■
Access the HemoSight dialog by either of the following ways:
■
Select the HemoSight quick key.
Select the CCO numeric area, ScvO2 numeric area, or SvO2 numeric area → from the bottom of the dialog select HemoSight .
Select the Main Menu quick key
→ from the CAA column select HemoSight .
26.6.2
Viewing Hemodynamic Parameters
To view hemodynamic parameters, select the desired tab on the Diagnosis page of the HemoSight dialog:
◆ Select All to view all hemodynamic parameters. For more information, see 32.2.1 Hemodynamic
Parameters .
◆ Select Physiology Graphics to view dynamic graphics for parameters’ changes. For more
information, see 26.6.3 Physiology Graphics
.
◆ Select Physiology Relationship to view the realtime relationship of parameters. For more
information, see 26.6.4 Physiology Relationship .
■
■
■
■
The symbols beside the hemodynamic parameters have the following meanings:
*: indicates an intermittent parameter.
**: indicates an oxygenation parameter.
*Measure Time: refers to the measurement time of the intermittent parameter.
↑ or ↓ : indicates that a parameter value exceeds its upper or lower limit. For setting the upper and lower limits of the hemodynamic parameters, see section
26.6.8 Setting Hemodynamic Parameter Ranges
.
26.6.2.1
Hemodynamic Parameters from ScvO
2
module
The following table lists the hemodynamic parameters from the ScvO
2
module.
Oxygenation
Parameters
Abbreviation
ScvO
2
Hb
Hct
DO
2
DO
2
I
VO
2
VO
2
I
SaO
2
Full Spelling
Central Venous Oxygen Saturation
Hemoglobin
Haematocrit
Oxygen Delivery
Oxygen Delivery Index
Oxygen Consumption
Oxygen Consumption Index
Arterial Oxygen Saturation
Unit
% g/L, g/dl, mmol/L
% ml/min ml/min/m
2 ml/min ml/min/m
2
%
26.6.2.2
Hemodynamic Parameters from CCO/SvO
2
module
The following table lists the hemodynamic parameters from the Vigilance II, Vigileo, HemoSphere, and EV1000 monitors.
Output
Abbreviation
CCO
Full Spelling
Continuous Cardiac Output
Unit
L/min
Applicable Device
All
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26 - 12
Contractility
Preload
Volume
Afterload
SVR
SVRI eArt-S eArt-M eArt-D
Oxygenation
Parameters
SaO
2
ScvO
2
EDV
EDVI
SVV
GEDV
GEDI
ITBV
ITBI
PPV
MAP
PR
ESV
ESVI
RVEF
Abbreviation
CCI
C.O.
CI
SV
SVI
HR
Full Spelling
Continuous Cardiac Index
Cardiac Output
Cardiac Index
Stroke Volume
Stroke Volume Index
Heart Rate
GEF
CFI
Pulse Rate
End Systolic Volume
End Systolic Volume Index
Right Ventricular Ejection
Fraction
Global Ejection Fraction
Cardiac Function Index
Unit
L/min/m
2
L/min
L/min/m
2 ml ml/m
2 bpm bpm ml ml/m
2
%
% l/min cmH
2
O, kPa , or mmHg
End Diastolic Volume
End Diastolic Volume Index
Stroke Volume Variation ml ml/m
%
2
Vigilance II,
HemoSphere
Vigilance II,
HemoSphere
Vigileo, EV1000,
HemoSphere
EV1000
EV1000
Global End Diastolic Volume
Global End Diastolic Volume
Index
Intrathoracic Blood Volume
Intrathoracic Blood Volume
Index
Pulse Pressure Variation
Mean Arterial Pressure ml ml/m
2 ml ml/m
2
% mmHg or kPa
EV1000
EV1000
HemoSphere
Vigilance II
Systemic Vascular Resistance
Systemic Vascular Resistance
Index
Systolic Arterial Pressure from the EV1000 monitor
Mean Arterial Pressure from the EV1000 monitor
Diastolic Arterial Pressure from the EV1000 monitor
Arterial Oxygen Saturation
DS/cm
5
or kPa-s/l
DS•m
2
/cm
5
or kPa-s-m
2
/l mmHg or kPa mmHg or kPa mmHg or kPa
%
All
All
EV1000,
HemoSphere
EV1000,
HemoSphere
EV1000,
HemoSphere
Vigilance II
Central Venous Oxygen
Saturation
% All
Applicable Device
All
Vigilance II
Vigilance II
All
All
Vigilance II,
HemoSphere
EV1000,
HemoSphere
Vigilance II
Vigilance II
Vigilance II,
HemoSphere
EV1000
EV1000
All
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Organ
Function
VO2I
VO2E
VO2IE
O
2
EI
Hb
Abbreviation
SvO
2
DO
2
Full Spelling
Mixed Venous Oxygen
Saturation
Oxygen Delivery
DO
2
I Oxygen Delivery Index
VO
2
Unit
% ml/min ml/min/m
2
Oxygen Consumption
Oxygen Consumption Index ml/min ml/min/m
2
Estimated Oxygen
Consumption
Estimated Oxygen
Consumption Index
Oxygen Extraction Index
Hemoglobin ml/min ml/min/m
%
2 g/L, g/dl, or mmol/L
SpO2
EVLW
Arterial Oxygen Saturation from Pulse Oximetry
Extravascular Lung Water
% ml
ELWI
PVPI
TB
Extravascular Lung Water
Index
Pulmonary Vascular
Permeability Index
Blood Temperature ml/kg no unit
ºC or °F
Applicable Device
All
Vigilance II, EV1000,
HemoSphere
EV1000,
HemoSphere
Vigilance II, EV1000,
HemoSphere
EV1000,
HemoSphere
EV1000, EV1000,
HemoSphere
EV1000,
HemoSphere
Vigilance II
EV1000,
HemoSphere
EV1000,
HemoSphere
EV1000
EV1000
EV1000
EV1000,
HemoSphere
26.6.3
Physiology Graphics
The lungs, heart and circulatory system vary according to the patient’s condition at the time of the thermodilution measurement. The Physiology Graphics displays monitored parameters using animation, which gives a visual representation of the interaction between the heart, lungs, blood, and vascular system. The continuous parameter values are displayed in realtime. When the intermittent data is available, the animation changes to reflect this change. The heart rate showed by the animation is also a visual reflection of the patient’s heart rate.
(1) When ScvO
2
ScvO
2
or SvO
or SvO
2 is available, the color varies according to the value, so a change in color indicates a change of
2
value.
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(2)
(3)
When CVP and SVRI are available, the change in blood vessel diameter indicates the change of SVRI values. For more information, see
26.6.3.1 Systemic Vascular Resistance Status .
When SpO
2
SpO
2
value.
is available, the color varies according to the SpO
2
value, so a change in color indicates a change of
(4)
(5)
(6)
When EDVI or GEDI is available, the size change in the diastole indicates the change of end diastolic volume index.
For more information, see
26.6.3.3 End Diastolic Volume Status .
When ELWI is available, the change in liquid level of lung indicates the change of ELWI values. For more information,
see 26.6.3.2 Lung Water Status
.
When RVEF or GEF is available, the size change in the systole indicates the change of ejection fraction. For more information, see
26.6.3.4 Ejection Fraction Status .
26.6.3.1
Systemic Vascular Resistance Status
Systemic vascular resistance status is indicated by SVRI. The following pictures show the systemic vascular resistance status.
Normal resistance High resistance Low resistance
26.6.3.2
Lung Water Status
Lung water status is indicated by ELWI. The following picture shows the lung water status, which is indicated by the liquid level of lung. The dotted line marks the high limit of ELWI. The ELWI is considered too high if the liquid level exceeds the dotted line. When ELWI is not available, the lung is displayed in gray color.
26.6.3.3
End Diastolic Volume Status
End diastolic volume status is indicated by EDVI (from the CCO/SvO
2
module). The following pictures show different end diastolic volume statuses. The dotted line marks the normal end diastolic volume status. When EDVI or GEDI is not available, the heart in the diastole is displayed in gray color.
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High end diastolic volume Normal end diastolic volume Low end diastolic volume
26.6.3.4
Ejection Fraction Status
Ejection fraction status is indicated by RVEF (from the CCO/SvO
2
module). The following pictures show different ejection fraction statuses. The dotted line marks the normal ejection fraction status. When RVEF or GEF is not available, the heart in the systole is displayed in gray color.
Low ejection fraction Normal ejection fraction High ejection fraction
26.6.4
Physiology Relationship
The Physiology Relationship screen depicts the balance between oxygen delivery (DO
2
) and estimated oxygen consumption (VO
2
). It automatically updates as parameter values change so the displayed values are always current. The connecting lines highlight the relationship of the parameters to each other.
In the Physiology Relationship screen, the connecting lines have the following meanings:
■
■
■
■
■
Solid line: indicates that connected parameters have a direct relationship.
Dotted line: indicates that connected parameters have an indirect relationship.
Red frame: the parameter value is out of its normal range.
Green frame: the parameter value is within its normal range.
Gray frame: the parameter value is not available.
In the Physiology Relationship screen, each parameter frame displays the following contents:
■
■
■
■
Parameter name
Parameter value (”--” if parameter value is not available)
* (if the parameter is intermittent)
** (if the parameter value is input manually)
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■
↑ or ↓ (if the parameter value exceeds its upper or lower limit, as defined in the Setup dialog. See section
26.6.8 Setting Hemodynamic Parameter Ranges )
NOTE
•
When measuring the hemodynamic parameters with different modules or devices, parameters displayed in the Physiology Relationship screen are different.
26.6.5
Hemodynamic Test
The Test page in the HemoSight window provides the trends before and after a hemodynamic test. To access the Test page, follow this procedure:
1.
Select the numeric area of CCO , ScvO2, or SvO2 .
2.
Select HemoSight .
3.
Select the Test tab.
26.6.5.1
Renaming a Test
The passive leg raising (PLR) test and rapid fluid loading (RFL) test are default tests, and their names cannot be changed. To rename a custom defined test, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Test tab.
3.
Select Custom1 , Custom 2 , Custom 3 or Custom 4 .
4.
Select the symbol at the upper left corner of the current dialog.
5.
Input the test name in the input field.
26.6.5.2
Setting Test Time Duration
To set test time duration, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Test tab.
3.
Set Test Duration .
26.6.5.3
Selecting Parameters for Testing
To set test parameters, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Test tab.
3.
Select Setup .
4.
From desired parameter page, select parameters for testing.
26.6.5.4
Performing a Hemodynamic Test
To measure and record a hemodynamic test, follow this procedure, along with hospital guidelines for the test to be administered:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Test tab.
3.
Select Setup to select the involved parameters.
4.
Select Test Duration to set test duration.
5.
Prepare the patient and select the Start button to begin recording the measurements.
6.
Wait until the test finishes automatically, or select the Stop button to end the test.
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7.
View the parameter trends. After the test, the Test page displays the current parameter value, reference parameter value, and Delta value (the variation of current value and reference value). For more information,
NOTE
•
Hemodynamic tests can also run in background. If the Test page is closed during a test or the
HemoSight dialog is closed, then the monitor gives a prompt tone and pops up the Test page after the test ends.
26.6.6
Following Up the Patient Hemodynamic Status
You can view the cardiac function curve, lung water curve and SVV/PPV slope indicator in the Follow-up page.
To view these curves or indicator, follow this procedure:
1.
Access the HemoSight
dialog. For more information, refer to 26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Follow-up tab.
3.
View the following curves or indicator:
◆ Cardiac function curve
◆ SVV/PPV slope indicator
◆ Lung water curve
26.6.6.1
Cardiac Function Curve and Lung Water Curve
Cardiac function curve and the lung water curve are used to assess the fluid responsiveness.
(1)
(2)
(1) Cardiac function curve (2) Lung water curve
.
26.6.6.2
Setting the Cardiac Function Curve and Lung Water Curve
To set the cardiac function curve and lung water curve, follow this procedure:
1.
Access the HemoSight
dialog. For more information, refer to 26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Follow-up tab.
3.
Make the following settings:
◆ Interval : set the time interval between coordinate points on the X-axis and Y-axis of the cardiac function curve and lung water curve. This setting is effective only when continuous parameters are selected at both the X-axis and Y-axis. When ELWI is unavailable and all the other parameters selected are continuous parameters, coordinate points will not be drawn on the lung water curve, but will be drawn on the cardiac function curve at the configured interval.
◆ Output : set the Y-axis parameter for cardiac function curve.
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◆ Preload Volume : set the X-axis parameter for both cardiac function curve and lung water curve.
NOTE
•
If intermittent parameters are selected at either the X-axis or Y-axis, coordinate points will be drawn for all the intermittent parameters. In this case, coordinates drawn for continuous parameters and intermittent parameters are consistent.
26.6.6.3
SVV/PPV Slope Indicator
The SVV/PPV slope indicator is a visual representation of the cardiac function curve used when assessing the stroke volume variation value or pulse pressure variation. The curved line indicates the SVV/PPV slope.
The dot moves up and down the curved line according to the SVV or PPV value. The color of the dot changes based upon set target ranges.
■
■
SVV/PPV≤10%: the dot is green, and may predict that the patient is fluid unresponsive.
SVV/PPV>10%: the dot is red, and may predict that the patient is fluid responsive.
CAUTION
•
PPV and SVV are only applicable in patients on controlled mechanical ventilation and sinus rhythm.
26.6.6.4
Setting the SVV/PPV Slope Indicator
To set the SVV or PPV slope, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Follow-up tab.
3.
Select SVV or PPV to set which Curve is the indicator. You can also set it to Off to hide the indicator.
26.6.7
Evaluating the Hemodynamic Parameters
You can review the hemodynamic parameter trends on the Evaluation page. The changes of hemodynamic parameters are shown by the trends or Spidervision diagram. The trends and Spidervision diagram display both current values and reference values of parameters, which let you conveniently see the hemodynamic status at different timepoints.
To enter the Evaluation page, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Evaluation tab.
26.6.7.1
Viewing the Spidervision Diagram
The Spidervision diagram shows hemodynamic parameters in dynamic conjunction. To enter the Spidervision diagram, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Evaluation tab.
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(1)
(2)
(3) (4) (5) (6)
(1) Current value
(4) Middle segment
(2) Reference value
(5) Inner segment
(3) Outer segment
(6) Link between legs of the graoh
Each leg of the graph is divided into 3 segments indicating different value ranges for the respective parameters.
The middle segment indicates the normal range for the respective parameter. The outer segment will be highlighted when corresponding parameter value exceeds the upper limit. The inner segment will be highlighted when its corresponding parameter value exceeds the lower limit.
■
■
■
The links between legs of the graph are displayed in green when all displayed parameters are within the normal range.
The links between legs of the graph and the corresponding spider segment are displayed in yellow when one of the displayed parameters is outside the normal range.
The links between legs of the graph and the corresponding spider segments are displayed in red when two or more displayed parameters are outside the normal range.
26.6.7.2
Viewing Trends
To view the trends of hemodynamic parameters, follow this procedure:
1.
Access the HemoSight
dialog. For more information, refer to 26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Evaluation tab.
3.
Select the Trends tab.
For more information on trends review, see 25.2.2 Example Review Dialog
.
26.6.7.3
Viewing Hemodynamic Parameters
You can view the hemodynamic parameters on the Evaluation page. The timeline below the Spidervision diagram indicates the entire time length. The timeline below the Trends page indicates the time length of
on the timeline indicate different types of events:
■
■
■
■
■
Red: high priority physiological alarm event
Yellow: medium priority physiological alarm event
Cyan: low priority physiological alarm event
Green: manual event
White: operation-related event, such as accepting the C.O. average
■
■
To locate a hemodynamic event, choose any of the following methods:
Move the slider to the target position.
Use the following buttons:
◆ Select or beside to go to the previous or next hemodynamic event.
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◆ Select
◆ Select
to view the event list and select the desired hemodynamic event.
or beside to go to the previous or next C.O. average acceptance event.
◆ Select to enter the list of C.O. average acceptance events, and select the desired C.O. average acceptance event.
◆ Select or to move the white vertical line to the left or right. Alternately, the cursor will move to any location you touch on the graph.
NOTE
•
If a physiological alarm event or manual event occurs simultaneously with a C.O. average acceptance event, this event will be displayed in preference to a C.O. average acceptance event.
26.6.7.4
Changing the Time Length of Trends
To change the time length of trends, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Evaluation tab.
3.
Select Trends Tab.
4.
Select Zoom and set the time length of trends.
26.6.7.5
Selecting the Spidervision Pattern
The pattern defines the hemodynamic parameters and their numbers displayed in the Spidervision diagram and Trends page. To select the pattern, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Evaluation tab.
3.
Select the Spidervision tab or Trends tab.
4.
Click the Pattern button and select a Spidervision pattern.
For more information, see
for detailed information of creating or updating a pattern.
26.6.7.6
Saving Reference Values
To save the hemodynamic parameter values of any moment as reference values, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Evaluation tab.
3.
Select the Spidervision tab or Trends tab.
4.
Move the timeline below the trends or Spidervision graph to select a desired time, or refer to
26.6.7.3 Viewing Hemodynamic Parameters
to select an event.
5.
Select Set Reference to save the parameter values at the selection time as reference values.
26.6.8
Setting Hemodynamic Parameter Ranges
To set the ranges of hemodynamic parameters, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Setup button.
3.
Select the Range tab.
4.
Set the normal ranges of the hemodynamic parameters.
26.6.9
Restoring Default HemoSight Range Values
To restore the default values, follow this procedure:
1.
Access the HemoSight dialog. For more information, refer to
26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Setup button.
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3.
Select the Defaults button.
NOTE
•
Selecting Defaults restores all the parameter ranges to default values.
26.6.10
Setting the Pattern
To set the pattern, follow this procedure:
1.
Access the HemoSight
dialog. For more information, refer to 26.6.1 Accessing the HemoSight Dialog
.
2.
Select the Setup button.
3.
Select the Spidervision tab.
4.
Make the following settings:
◆ Select the number of parameters (three to seven).
◆
Select the parameters to be displayed in Spidervision. The same parameters will show in the Trends as they are listed in Spidervision clockwise, starting at the top.
◆ Select Save , Save As or Delete to save, create or delete a pattern.
NOTE
•
You cannot delete the default pattern or the pattern that is in use.
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27
Calculation
27.1
Calculation Overview
The monitor provides calculation functions. The calculated values, which are not directly measured, are computed based on the values you provide. The calculation function is independent of other monitoring functions and can therefore be used for patients being monitored by other monitors. Any operation in a calculation dialog does not affect the patient monitored by the current monitor.
You can perform the following calculations:
■
■
■
■
■
Drug calculations
Hemodynamic calculations
Oxygenation calculations
Ventilation calculations
Renal calculations
27.2
Calculation Safety Information
WARNING
•
Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge. The drug calculations are based on the values input; it does not check the plausibility of the calculation performed.
•
Check that the entered values are correct and the calculated values are appropriate. Mindray assumes no responsibility for any consequences caused by wrong entries and improper operations.
27.3
Drug Calculations
27.3.1
Performing Drug Calculations
To perform drug calculations, follow this procedure:
1.
Access the drug calculator by either of the following ways:
◆ Select the Calculations quick key → select the Drug tab.
◆ Select the Main Menu quick key → from the Calculations column select Drug .
2.
Set Drug Name and Patient Category.
If the dose of drug is weight dependent, you must input the patient’s weight. The dose calculation program has a library of commonly used drugs, while Drug A through Drug E are user defined.
3.
Enter the known values, for example Drug Amount and Solution Volume.
4.
Select Calculate . The calculated values are indicated by red arrows.
NOTE
•
If available, the patient category and weight from the Patient Demographics dialog are automatically entered when you first access drug calculation. You can change the patient category and weight. This will not change the patient category and weight stored in the patient demographic information.
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27.3.2
Checking the Titration Table
The titration table shows information on the currently used drugs. Use the titration table to see what dose of a drug your patient will receive at different infusion rates. To access the titration table, follow this procedure:
1.
Access drug calculator by either of the following ways:
◆ Select the Calculations quick key.
◆ Select the Main Menu quick key → from the Calculations column select Drug .
2.
Select the Titration Table tab.
3.
Select Dose Type to set the type of dose unit in the titration table.
4.
Select Interval to set the interval between two adjacent titration table items.
You can select how to display the titration table:
■
■
Dose : the titration table is listed in the sequence of increased drug dose.
Infusion Rate : the titration table is listed in the sequence of increased infusion rate. By default the resolution of the infusion rate is one (1). By selecting Exact Rate the resolution of the infusion rate can reach 0.01 so that you can display the infusion rate more accurately.
27.3.3
Drug Calculation Formula
Description
Dose
Dose (weight based)
Drug Amount
Drug Amount (weight based)
Duration
Duration (weight based)
Concentration
Solution volume
Infusion rate
Infusion rate (weight based)
Unit Formula
Dose/hr
Dose/min
Dose/kg/hr
Dose/kg/min g series: mcg, mg, g unit series: Unit, KU, MU mEq series: mEq g series: mcg, mg, g unit series: Unit, KU, MU mEq series: mEq hr hr mcg/ml, mg/ml, g/ml, Unit/ml,
KU/ml, MU/ml, mEq/ml ml ml/hr g•ml/hr
Dose = Infusion Rate × Concentration
Dose (weight based) = Infusion Rate ×
Concentration/Weight
Drug Amount =Dose × Duration
Drug Amount (weight based) = Dose × Duration ×
Weight
Duration = Amount/Dose
Duration (weight based) = Amount/(Dose × Weight)
Concentration = Drug Amount/Solution Volume
Volume = Infusion Rate × Duration
Infusion Rate = Dose/Concentration
Infusion Rate = Dose × Weight/Concentration
27.3.4
Titration Table Calculation Formula
Description
Infusion Rate
Infusion Rate (weight based)
Dose
Dose (weight based)
Unit ml/hr ml/hr
Dose/hr
Dose/min
Dose/kg/hr
Dose/kg/min
Formula
Infusion Rate = Dose/Concentration
Infusion Rate = Weight × Dose/Concentration
Dose = Infusion Rate × Concentration
Dose (weight based) = Infusion Rate ×
Concentration/Weight
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27.4
Hemodynamic Calculations
The monitor provides the hemodynamic calculation function and can save the results of up to 10 calculations, which are displayed in groups.
27.4.1
Performing Hemodynamic Calculations
To perform hemodynamic calculation, follow this procedure:
1.
Access hemodynamic calculation by either of the following ways:
◆ Select the Calculations quick key → Hemodynamics tab.
◆ Select the Main Menu quick key → from the Calculations column select Hemodynamics .
2.
Enter the known values. For a patient who is being monitored, the currently measured values are automatically entered.
3.
Select Calculate .
A calculated value greater than the normal upper limit is indicated by an up arrow “ ↑ ”. A calculated value lower than the normal lower limit is indicated by a down arrow “
↓
”.
You can select Range to show the normal range of each parameter.
27.4.2
Input Parameters for Hemodynamic Calculations
Input Parameter cardiac output heart rate pulmonary artery wedge pressure mean arterial pressure pulmonary artery mean pressure central venous pressure end-diastolic volume height weight
Label
C.O.
HR
PAWP
MAP
PA-M
CVP
EDV
Height
Weight
Unit
L/min bpm mmHg mmHg mmHg mmHg ml cm kg
NOTE
•
If you enable Use PA-D as PAWP, PA-D value will be used to replace PAWP value for hemodynamic
calculation. For more information, refer to 15.6.8 Setting the Use PA-D as PAWP Switch
.
27.4.3
Calculated Parameters and Formulas for Hemodynamic Calculations
Calculated Parameters cardiac index body surface area
Label
C.I.
BSA stroke volume stroke index systemic vascular resistance
SV
SVI
SVR
Unit
L/min/m
2 m
2 ml ml/m
2
DS/cm
5
Formula
C.I. (L/min/m
2
) = C.O. (L/min)/BSA (m
2
)
BSA (m
2
) = Wt
0.425
(kg) × Ht
0.725
(cm) ×
0.007184
SV (ml) = 1000× C.O. (L/min)/HR (bpm)
SVI (ml/m
2
) = SV (ml)/BSA (m
2
)
SVR (DS/cm
5
) = 79.96 × [APMAP (mmHg) -
CVP (mmHg)]/C.O. (L/min)
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Calculated Parameters systemic vascular resistance index pulmonary vascular resistance pulmonary vascular resistance index left cardiac work
Label
SVRI
PVR
PVRI
LCW left cardiac work index left ventricular stroke work left ventricular stroke work index right cardiac work
LCWI
LVSW
LVSWI
RCW right cardiac work index right ventricular stroke work right ventricular stroke work index
RCWI
RVSW
RVSWI ejection fraction end-diastolic volume index
EF
EDVI end-systolic volume ESV end-systolic volume index ESVI
Unit
DS•m
2
/cm
5
DS/cm
5
DS•m
2
/cm
5 kg•m kg•m/m
2 g•m g•m/m
2 kg•m kg•m/m
2 g•m g•m/m
2
% ml/m2 ml ml/m
2
Formula
SVRI (DS•m
2
/cm
5
) = SVR (DS/cm
5
) × BSA (m
2
)
PVR (DS/cm
5
) = 79.96 × [PAMAP (mmHg) -
PAWP (mmHg)]/C.O. (L/min)
PVRI (DS•m
2
/cm
5
) = PVR (DS/cm
5
) × BSA (m
2
)
LCW (kg•m) = 0.0136 × APMAP (mmHg) × C.O.
(L/min)
LCWI (kg•m/m
2
) = LCW (kg•m)/BSA (m
2
)
LVSW (g•m) = 0.0136 × APMAP (mmHg) × SV
(ml)
LVSWI (g•m/m
2
) = LVSW (g.m)/BSA (m
2
)
R CW (kg•m) = 0.0136 × PAMAP (mmHg) × C.O.
(L/min)
R CWI (kg•m/m
2
) = RCW (kg.m)/BSA (m
2
)
R VSW (g•m) = 0.0136 × PAMAP (mmHg) × SV
(ml)
R VSWI (g•m/m
2
) = RVSW (g•m)/BSA (m
2
)
EF (%) = 100 × SV (ml)/EDV (ml)
EDVI (ml/m
2
) = EDV (ml)/BSA (m
2
)
ESV (ml) = EDV (ml) –SV (ml)
ESVI (ml/m
2
) = ESV (ml)/BSA (m
2
)
27.5
Oxygenation Calculations
The monitor provides the oxygenation calculation function and can save the results of up to 10 calculations, which are displayed in groups.
27.5.1
Performing Oxygenation Calculations
To perform oxygenation calculations, follow this procedure:
1.
Access oxygenation calculation by either of the following ways:
◆ Select the Calculations quick key
→
Oxygenation tab.
◆ Select the Main Menu quick key
→
from the Calculations column select Oxygenation .
2.
Enter the known values. For a patient who is being monitored, the currently measured values are automatically entered.
3.
Select Calculate .
A calculated value greater than the normal upper limit is indicated by an up arrow “
↑
”. A calculated value lower than the normal lower limit is indicated by a down arrow “ ↓ ”.
In the Oxygenation page, you can also perform the following operations:
■
■
Select OxyCont Unit , Hb Unit , and Pressure Unit . Then corresponding parameter values will be automatically converted and updated accordingly.
Select Range to show the normal range of each parameter.
27 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
27.5.2
Input Parameters for Oxygenation Calculations
Input Parameter cardiac output percentage fraction of inspired oxygen partial pressure of oxygen in the arteries partial pressure of carbon dioxide in the arteries arterial oxygen saturation partial pressure of oxygen in venous blood venous oxygen saturation hemoglobin respiratory quotient atmospheric pressure height weight
Label
C.O.
FiO
2
PaO
2
PaCO
2
SaO
2
PvO
2
SvO
2
Hb
RQ
ATMP
Height
Weight
27.5.3
Calculated Parameters and Formulas for Oxygenation Calculations
Unit
L/min
% mmHg, kPa mmHg, kPa
% mmHg, kPa
% g/L, g/dl, mmol/L
None mmHg, kPa cm, inch kg, lb
Calculated Parameters body surface area
Label
BSA alveolar-arterial oxygen difference capillary oxygen content
AaDO
2
CcO
2 venous admixture QS/QT
Unit m
2 oxygen consumption arterial oxygen content venous oxygen content
VO
2
ml/min
CaO
2 ml/L, ml/dL
CvO
2 ml/L, ml/dL arteriovenous oxygen content difference oxygen extraction ratio oxygen transport partial pressure of oxygen in the alveoli
C(a-v)O
2
O
2
ER
DO
2
PAO
2 ml/L, ml/dl
% ml/min mmHg, kPa mmHg, kPa ml/L, ml/dl
% oxygen transport index oxygen consumption
DO
2
I
VO
2
I ml/min/m
2 ml/min/m
2
Formula
BSA (m
2
) = Wt
0.425
(kg) × Ht
0.725
(cm) ×
0.007184
VO
2
(ml/min) = C(a-v)O
2
(ml/L)× C.O. (L/min))
CaO
2
(ml/L) = 10× (0.0134 × Hb (g/dl) × SaO
2
(%)) +0.031× PaO
2
(mmHg)
CvO
2
(ml/L) = 10× (0.0134 × Hb (g/dl) × SvO
2
(%)) +0.031 × PvO
2
(mmHg)
C(a-v)O
2
(ml/L) = CaO
2
(ml/L) - CvO
2
(ml/L)
O
2
ER (%) = 100×C(a-v)O
2
(ml/L)/CaO
2
(ml/L)
DO
2
(ml/min) = C.O. (L/min) × CaO
2
(ml/L)
PAO
2
(mmHg) = [ATMP (mmHg) - 47 mmHg] ×
FiO
2
(%)/100 - PaCO
2
(mmHg) × [FiO
2
(%)/100
+ (1 - FiO
2
(%)/100)/RQ]
AaDO
2
(mmHg) = PAO
2
(mmHg) - PaO
2
(mmHg)
CcO
2
(ml/L) = Hb (g/L) × 1.34 + 0.031 × PAO
2
(mmHg)
QS/QT (%) = 100× [1.34 × Hb (g/L) × (1 - SaO2
(%)/100) + 0.031 × (PAO2 (mmHg) - PaO2
(mmHg))]/[1.34 × Hb (g/L) × (1 - SvO2 (%)/
100) + 0.031× (PAO2 (mmHg) - PvO2
(mmHg))]
DO2I (ml/min/m
2
) = CaO2 (ml/L) × (C.O. (L/ min)/BSA (m
2
))
VO2I (ml/min/m
2
) = C (a-v) O2 (ml/L) ×(C.O. (L/ min)/BSA (m
2
))
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 27 - 5
27.6
Ventilation Calculations
The monitor provides the ventilation calculation function and can save the results of up to 10 calculations, which are displayed in groups.
27.6.1
Performing Ventilation Calculations
To perform ventilation calculations, follow this procedure:
1.
Access ventilation calculation by either of the following ways:
◆ Select the Calculations quick key → Ventilation tab.
◆ Select the Main Menu quick key → from the Calculations column select Ventilation .
2.
Enter the known values. For a patient who is being monitored, the currently measured values are automatically taken. If the anesthesia machine or ventilator is connected, measured values for ventilation calculation are also automatically entered.
3.
Select Calculate .
A calculated value greater than the normal upper limit is indicated by an up arrow “ ↑ ”. A calculated value lower than the normal lower limit is indicated by a down arrow “
↓
”.
On the Ventilation page, you can also perform the following operations:
■
■
Select Pressure Unit . Then corresponding parameter values will be automatically converted and updated accordingly.
Select Range to show the normal range of each parameter.
27.6.2
Input Parameters for Ventilation Calculations
Input Parameter percentage fraction of inspired oxygen respiration rate partial pressure of mixed expiratory CO2 partial pressure of carbon dioxide in the arteries partial pressure of oxygen in the arteries tidal volume respiratory quotient atmospheric pressure
Label
FiO
2
RR
PeCO
2
PaCO
2
PaO
2
TV
RQ
ATMP
27.6.3
Calculated Parameters and Formulas for Ventilation Calculations
Unit
% rpm mmHg, kPa mmHg, kPa mmHg, kPa ml
None mmHg, kPa
Calculated Parameters Label partial pressure of oxygen in the alveoli
PAO
2 alveolar-arterial oxygen difference oxygenation ratio
AaDO
2
Pa/FiO
2 arterial to alveolar oxygen ratio minute volume a/AO
2
MV
Unit mmHg, kPa mmHg, kPa mmHg, kPa
%
L/min
Formula
PAO
2
(mmHg) = [ATMP (mmHg) - 47 mmHg] ×
FiO
2
(%)/100 - PaCO
2
(mmHg) × [FiO
2
(%)/100
+ (1 - FiO
2
(%)/100)/RQ]
AaDO
2
(mmHg) = PAO
2
(mmHg) - PaO
2
(mmHg)
Pa/FiO
2
(mmHg) = 100 × PaO
2
(mmHg)/FiO
2
(%) a/AO
2
(%) = 100 × PaO
2
(mmHg)/PAO
2
(mmHg)
MV (L/min) = [TV (ml) × RR (rpm)]/1000
27 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Calculated Parameters Label volume of physiological dead space physiologic dead space in percent of tidal volume alveolar volume
Vd
Vd/Vt
VA
Unit ml
%
L/min
Formula
Vd (ml) = TV (ml) × [1 - PeCO
2
(mmHg)/PaCO
2
(mmHg)]
Vd/Vt (%) = 100 × Vd (ml)/TV (ml)
VA (L/min) =[TV (ml) - Vd (ml)] × RR (rpm)/
1000
27.7
Renal Calculations
The monitor provides the renal calculation function and can save the results of up to 10 calculations, which are displayed in groups.
27.7.1
Performing Renal Calculations
To perform renal calculations, follow this procedure:
1.
Access renal calculation by either of the following ways:
◆ Select the Calculations quick key
→
select the Renal tab.
◆ Select the Main Menu quick key
→
from the Calculations column select Renal .
2.
Enter the known values.
3.
Select Calculate .
A calculated value greater than the normal upper limit is indicated by an up arrow “
↑
”. A calculated value lower than the normal lower limit is indicated by a down arrow “ ↓ ”.
You can select Range to show the normal range of each parameter.
27.7.2
Calculated Parameters and Formulas for Renal Calculations
Input Parameter urine potassium urinary sodium urine plasm osmolality urine osmolality serum sodium creatinine urine creatinine blood urea nitrogen height weight
Label
URK
URNa
Urine
Posm
Uosm
SerNa
Cr
UCr
BUN
Height
Weight
Unit mmol/L mmol/L ml/24 hrs mOsm/kgH
2
O mOsm/kgH
2
O mmol/L
μmol/L
μmol/L mmol/L cm kg
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 27 - 7
27.7.3
Calculated Parameters and Formulas for Renal Calculations
Calculated Parameters urine sodium excretion
Label
URNaEx urine potassium excretion URKEx sodium potassium ratio Na/K clearance of sodium fractional excretion of sodium osmolar clearance
CNa creatinine clearance rate Clcr
FENa
Cosm free water clearance CH2O urine to plasma osmolality ratio blood urea nitrogen creatinine ratio urine-serum creatinine ratio
U/P osm
BUN/Cr*
U/Cr
*: BUN/Cr is a ratio under the unit of mol.
Unit mmol/24 hrs mmol/24 hrs
% ml/24 hrs ml/min
% ml/min ml/hr
None
Mmol/L
Formula
URNaEx (mmol/24 hrs) = Urine (ml/24 hrs) ×
URNa (mmol/L)/1000
URKEx (mmol/24 hrs) = Urine (ml/24 hrs) ×
URK (mmol/L)/1000
Na/K (%) = 100 × URNa (mmol/L)/URK (mmol/
L)
CNa (ml/24 hrs) = URNa (mmol/L) × Urine (ml/
24 hrs)/SerNa (mmol/L)
Clcr (ml/min) = Ucr (μmol/L) × Urine (ml/24 hrs)/[Cr (μmol/L) × (BSA (m
2
)/1.73) × 1440]
FENa (%) = 100 × URNa (mmol/L) × Cr (μmol/
L)/[SerNa (mmol/L) × Ucr (μmol/L)]
Cosm (ml/min) = Uosm (mOsm/kgH
2
O) ×
Urine (ml/24 hrs)/(Posm (mOsm/kgH
2
O) ×
1440)
CH2O (ml/hr) = Urine (ml/24 hrs) × [1 - Uosm
(mOsm/kgH
2
O)/Posm (mOsm/kgH
2
O)]/24
U/P osm = Uosm (mOsm/kgH
2
O)/Posm
(mOsm/kgH
2
O)
BUN/Cr = 1000 × BUN (mmol/L)/Cr (μmol/L)
27 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
28
Recording
28.1
Recorder
The thermal recorder records patient information, measurement data, and up to three waveforms.
N17/N15/N12 can be configured with a built-in recorder. If the built-in recorder is not configured, the monitor can be configured to use an external recorder module.
N22 and N19 do not have a built-in recorder. To perform recording, insert the recorder module into the SMR.
(1)
(3)
(2)
(5)
(4)
(1)
(2)
(3)
(4)
(5)
Start/Stop key: press to start a recording or stop the current recording.
Module status indicator
◆
On: when the recorder is powered and ready for use.
◆
Off: when the monitor is switched off.
◆
Flashes: if an error has occurred with the recorder.
Paper outlet
Recorder door
Latch: pull it away from the recorder to open the recorder door.
28.2
Starting Recordings
Recordings can be started manually or automatically.
28.2.1
Manually Starting Recordings
To manually start a recording, you can either:
■
■
Press the
Select
hardkey on the front of the recorder to start a Realtime Segment Waveform Recording.
on the current dialog to start a recording corresponding to that dialog or page.
28.2.2
Automatic Recordings
In the following conditions, you can set the recorder to automatically start recording:
■
■
At a preset interval. For more information, see
28.5 Setting up the Recorder .
.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 28 - 1
28.3
Stopping Recordings
Recordings can be stopped manually or automatically.
28.3.1
Stopping Recordings Manually
To manually stop a recording, press the
Record Tasks in the Record Setup menu.
hardkey while the recorder is creating a strip or select Clear All
28.3.2
Stopping Recordings Automatically
Recordings stop automatically in the following conditions:
■
■
■
■
■
The recording is completed.
The recorder runs out of paper.
The recorder has an alarm condition.
The recorder module is removed from the monitor.
The monitor is turned off.
28.4
Recording Related Flags
■
■
You can find the following flags on the recording reports:
■
For automatically stopped recordings, there are two columns of asterisks “*” at the end of the report.
For manually or abnormally stopped recordings, there is one column of asterisks “*” at the end of the report.
If the parameter data is from external devices connected to the monitor via the BeneLink module, the parameter label is prefixed with the plus sign “+”.
28.5
Setting up the Recorder
To configure the recorder for waveforms and printing intervals, follow this procedure:
1.
Select the Main Menu quick key
→ from the Report column select Record Setup .
2.
In the Record Setup dialog, select the desired waveform for Waveform 1 , Waveform 2 and Waveform 3 in turn. The recorder can record up to 3 waveforms at a time.
3.
Switch on or off IBP Overlap to enable or disable IBP recordings in the overlapping format.
◆ When the IBP Overlap is enabled: If two or more waveforms in the selected waveforms for recording are IBP waveforms, the IBP waveforms will be recorded in the overlapping format.
◆ When the IBP Overlap is disabled: IBP waveforms will be recorded without overlap.
4.
Select Recording Duration to set the duration of real-time recording.
5.
Select Interval to set the time interval for automatic recording.
6.
Select Recorder Paper Speed to set the speed for recording waveforms.
28.6
Clearing Recording Tasks
To clear recording tasks, follow this procedure:
1.
Select the Main Menu quick key → from the Report column select Record Setup .
2.
In the Record Setup dialog, select Clear All Record Tasks . This clears all queued recording tasks and stops the current recording.
28 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
28.7
Loading Paper
To load paper, follow this procedure:
1.
Use the latch at the upper right of the recorder door to pull the door open.
2.
Insert a new roll into the compartment as shown below. Feed the paper through and pull some paper out from the top of the roller.
3.
Close the recorder door.
CAUTION
•
Use only specified thermal paper. Otherwise, it may cause damage to the recorder’s printhead, the recorder may be unable to print, or poor print quality may result.
•
Never pull the recorder paper with force when a recording is in process. Otherwise, it may cause damage to the recorder.
•
Do not leave the recorder door open unless you are reloading paper or cleaning a paper jam.
28.8
Removing Paper Jam
If the recorder works incorrectly or produces unusual sounds, check if there is a paper jam. If a paper jam is detected, follow this procedure to remove it:
1.
Open the recorder door.
2.
Take out the paper and tear off the draped part.
3.
Reload the paper and close the recorder door.
28.9
List of Recording Reports
The recorder can output the following reports:
■
■
Realtime reports
◆
Realtime Segment Waveform Record
◆
Realtime Continuous Waveform Record
◆
Auto Realtime Record
◆
ST Record
◆
QT Record
◆
12-Lead Interpretation Record
◆
Record on Alarm Report
◆
12-Lead Waveform Record
History reports
◆
Event Detail
◆
Full Disclosure Detail Record
◆
12 Lead Review Record
◆
ST Review Record
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 28 - 3
◆ Tabular Trend Report
◆ Graphic Trend Report
28 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
29
Printing
29.1
Supported Printer
The monitor can output patient reports via a connected network printer. The monitor supports the following printers:
■
■
■
■
■
■
HP LaserJet Pro M202dw
HP LaserJet Pro 400 M401n
HP LaserJet P4015n
HP LaserJet 600 M602
HP LaserJet Enterprise M605
HP LaserJet Enterprise M608n
NOTE
•
For more details about the printer, refer to the document accompanying the printer. With product upgrades, the monitor may support additional printers without prior notice. If you have any doubts about the compatibility of the printer used with this monitor, contact Mindray.
29.2
End Case Reports
29.2.1
Printing the End Case Report
To print the end case report, choose one of the following ways:
■
■
■
Select Print from the End Case Report menu.
Select Print End Case Report when you discharge a patient.
Select the End Case Report quick key.
29.2.2
Setting a Report as An End Case Report
The following reports can be set as end case reports:
■
■
■
■
■
■
■
Tabular Trends Report
Graphic Trends Report
Event Report
12-lead Interpretation
Alarm Limits Report
Realtime Report
ECG Report
To set a report as an end case report, follow this procedure:
1.
Select the Main Menu quick key
→
from the Report column select End Case Report .
2.
From the Select Reports page, select the desired report tab, for example ECG Report .
29.2.3
Configuring the End Case Reports
To configure the end case reports, follow this procedure:
1.
Select the Main Menu quick key → from the Report column select End Case Report .
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 29 - 1
2.
From the Report Setup page, set the following end case reports:
◆ Select the Tabular Trends Report , Graphic Trends Report , Realtime Report , and ECG Report tab, and set these end case report by referring to section
◆ Select the Event Report tab, and select the event that needs to be printed.
◆ Select the 12-Lead Interpretation tab, and set the switch of Median Complex , Measurements ,
Interpretation , or Interpretation Summary . For other settings, refer to section
29.2.4
Setting the End Case Report Period
To set the end case report print period, follow this procedure:
1.
Select the Main Menu quick key → from the Report column select End Case Report .
2.
From the Select Reports page, set the Period .
NOTE
•
End case report print period is calculated from the patient discharged time to the configured period.
•
Period setting is applicable to all of the end case reports.
29.3
Manually Starting a Printing Task
This section describes different methods for manually printing a report.
29.3.1
Printing from the Screen
The button will be shown at the top of dialogs that have associated reports. If the button is gray, then there is not enough information to begin the report, or the printer has not been set up.
When the icon is white, pressing it opens a Print Setup dialog or starts printing a report. If the Print Setup dialog is entered, configure the report and press Print to start printing.
29.3.2
Printing Realtime Reports
Select the Print quick key to print a realtime report. You can also print a realtime report from the Report Setup
dialog. For more information, see 29.3.3 Printing Most Common Reports .
29.3.3
Printing Most Common Reports
The following most common reports can be printed:
■
■
■
■
ECG Report
Realtime Report
Tabular Trends Report
Graphic Trend Report.
To print these reports, follow this procedure:
1.
Select the Main Menu quick key
→ from the Report column select Report Setup .
2.
Select the desired report tab.
3.
Check the settings.
4.
Select Print .
29.4
Automatically Printing Reports
When a parameter alarm switch is set to on and an alarm is triggered for this parameter, you can set the monitor to automatically print a Print on Alarm Report.
To do so, follow this procedure:
29 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1.
Access alarm related tabs such as the Alarm tab for a parameter in one of the following ways:
◆ Select the Alarm Setup quick key at the bottom of the screen.
◆ Select the parameter or waveform area of the desired parameter → select the Alarm tab.
◆ Select the Parameters Setup quick key at the bottom of the screen → select the desired parameter
→
select the Alarm tab.
◆
Select the Main Menu quick key
→
from the Parameters column select Setup
→
select the desired parameter → select the Alarm tab.
2.
Switch on Alarm Outputs for desired parameters.
29.5
Stopping a Printing Task
To stop a printing task, follow this procedure:
1.
Select the Main Menu quick key
→ from the Report column select Print Queue .
2.
Select desired printing tasks and then select Delete . Alternately, select Delete All to stop all the printing tasks.
29.6
Configuring Reports
This section focuses on how to configure ECG reports, realtime reports, tabular trends reports, and graphic trends reports.
29.6.1 Configuring ECG Reports
To configure ECG reports, follow this procedure:
1.
Select the Main Menu quick key
→ from the Report column select Report Setup .
2.
Select the ECG Report tab.
3.
Set the desired options.
The following table explains some of the less familiar options.
Menu item
Speed
Auto Interval
12-Lead Format
Rhythm Lead 1
Rhythm Lead 2
Rhythm Lead 3
Function Description
Set the print speed of
ECG waveforms
25 mm/sec : prints 25 mm of ECG waveform per second.
50 mm/sec : prints 50 mm of ECG waveform per second.
Defines the spacing between the ECG waveforms on a printout
On: automatically adjusts the space between waveforms to avoid overlapping.
Off : each waveform area has the same size on a printout.
Note: Auto Interval is only enabled when 12×1 is selected for 12-Lead Format .
Select the format of 12lead ECG waveforms on a printout.
12×1: displays 12-lead ECG waveforms on one page in one column.
6×2 : displays 12-lead ECG waveforms on one page in two columns, with 6 lines in each column.
6×2+1 : displays 12-lead ECG waveforms on one page in two columns, with 6 lines in each column, and one rhythm lead waveform at the bottom.
3×4+1 : displays 12-lead ECG waveforms on one page in 4 columns, with 3 lines in each column, and one rhythm lead waveform at the bottom.
3×4+3 : displays 12-lead ECG waveforms on one page in 4 columns, with 3 lines in each column, and three rhythm lead waveforms at the bottom.
Select the lead that will be used as Rhythm
Lead 1, 2, or 3.
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6
Note: Rhythm Lead setting is only enabled when 6×2+1 , 3×4+1 , or 3×4+3 is selected for
12-Lead Format .
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 29 - 3
Menu item
Format Sequence
Function
Select the recording method of ECG report generated by auto measurement
Description
Sequential : 12-lead ECG data are recorded sequentially and displayed in 3 lines and 4 columns with 2.5 seconds of ECG data for each column.
Simultaneous : Record simultaneous 12-lead ECG data.
NOTE
•
When ECG Lead Set is set to 3-Lead, the ECG report cannot be printed.
29.6.2
Configuring Realtime Reports
To configure tabular realtime reports, follow this procedure:
1.
Select the Main Menu quick key
→
from the Report column select Report Setup .
1.
Select the Realtime Report tab.
2.
Set the desired options.
The following table explains some of the options.
Menu item
Select Waveform
Function
Select the desired waveform to print
Description
Current Waveforms : prints the realtime report for the currently displayed waveforms and all the currently measured parameter values.
Selected Waveforms : prints the realtime report for the waveforms configured in the Select Waveform dialog, accessed by clicking the
Select Waveform button.
29.6.3
Configuring Tabular Trends Reports
To configure tabular trends reports, follow this procedure:
1.
Select the Main Menu quick key
→ from the Report column select Report Setup .
2.
Select the Tabular Trends Report tab.
3.
Set the desired options.
The following table explains some of the options.
Menu Item
Time
Period
Interval
Function Description
Select the time before which a tabular trends report will be printed
Select the period during which a tabular trends report will be printed.
/
Select the resolution of the tabular trends printed on a report.
Auto : one page of a tabular trends before the current time will be printed at the selected Interval .
All : all stored tabular trends will be printed at the selected
Interval .
30 min to 96 hrs : 30 min to 96 hrs of tabular trends before the selected Time will be printed at the selected Interval .
NIBP, EWS , GCS , C.O
.: at an interval of acquiring the values of selected parameter.
Auto : using the Interval setting of the Tabular Trends review page.
5 sec to 3 hrs : the tabular trends will be printed at the interval of 5 sec to 3 hrs .
29 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Menu Item
Report Format
Function
Select the printing principle.
Description
Parameter Oriented : print one page span of report with parameters listed by row and time listed by column when
Interval is set to Auto .
Time Oriented : print one page span of report with time listed by row and parameter listed by column when Interval is set to Auto .
Note that Interval on Auto only limits the number of rows or columns for Time. The report may have multiple pages to accommodate the number of parameters. To limit the parameters, change the Trend Group .
29.6.4
Configuring Graphic Trends Reports
To set graphic trends reports, follow this procedure:
1.
Select the Main Menu quick key → from the Report column select Report Setup .
2.
Select the Graphic Trends Report tab.
3.
Set the desired options.
Menu Item
Period
Function
Select the period during which a graphic trends report will be printed.
Description
Auto : one page of a graphic trends before the current time will be printed.
All : all stored graphic rends will be printed..
30 min to 96 hrs : 30 min to 96 hrs of graphic trends before the selected Time will be printed.
29.7
Viewing Printer Status
■
■
■
■
You can view the status of the most recent ten printing tasks in the Print Queue dialog. To view the status of printing tasks, follow this procedure:
1.
Select the Main Menu quick key → from the Report column select Print Queue .
2.
View the status of printing tasks in the Print Queue dialog.
Each printing task includes the following information:
Print time
Report title
Printer name (when using the printer server) or IP address (when using the network printer)
Printing status, for example, printing, failed, retrying, and waiting.
29.8
Printer Out of Paper
When the printer runs out of paper, the print request will remain incomplete. If there are too many print jobs that remain incomplete, then a printer error may occur. To resolve the error, install paper. Some print requests may be lost if the incomplete tasks overflow the printer buffer. Missing or lost reports must be recreated and printed.
To reduce risks of printer errors, maintain enough paper in the printer.
29.9
List of Reports
The monitor can output the following reports to the printer:
■ Realtime reports
◆ Realtime Report
◆
Freeze Report
◆ ECG Report (5-lead, 6-lead , 12-lead)
◆
12-Lead Interpretation Report (realtime)
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 29 - 5
■
■
◆ Print on Alarm Report
◆
Alarm Limits Report
◆ Titration Table Report
◆
Hemodynamic Calculation Report
◆ Oxygenation Calculation Report
◆
Ventilation Calculation Report
◆ Renal Calculation Report
◆
EEG Report
◆ CSA Report (EEG expand View - CSA)
◆
EEG Report (EEG expand View - EEG)
◆ Hemodynamic Report (hemodynamic parameters)
◆ Hemodynamic Report (hemodynamic graphics)
◆ ST Report (Realtime)
◆ QT Report (Realtime)
◆ OxyCRG Report
◆ C.O. Measure Report
◆ PAWP Report
◆ ECG 24h Summary & Typical Strips
◆ Device Integration - Loops Report (BeneLink)
History reports
◆ Tabular Trends Report
◆ Graphic Trends Report
◆ Event List Report
◆ Event Detail Report
◆ Full Disclosure Overview Report
◆ Full Disclosure Detail Report
◆ 12-Lead Review Interpretation Report (review)
◆ ST Report (review)
◆ OxyCRG review Report (review)
End Case Report
◆ End Case Report Realtime Report
◆ End Case Report ECG Report
◆ End Case Report Tabular Trends Report
◆ End Case Report Graphic Trends Report
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30
Using the On-Screen Timers
The monitor has a Timer function to notify you when a preset time period is expired or how much time has elapsed. You can simultaneously display up to four timers.
30.1
Displaying Timers
To display a timer, follow this procedure:
1.
Access Tile Layout in either of the following ways:
◆ Select the Screen Setup quick key → select the Tile Layout tab.
◆ Select the Main Menu quick key → from the Display column select Tile Layout .
2.
Click the numeric tile area where the timer is to be displayed, and then select a timer from the popup list.
30.2
Controlling the Timer
The timer provides the following controls, depending on the state and settings of the timer:
■
■
■
■
Start
Reset
: starts the timer.
Pause : pauses the timer.
Resume : resumes the timer.
: clears the timer.
30.3
Setting the Timer
You can set each timer independently. To set the timer, follow this procedure:
1.
Select the timer area to enter the Timer Setup dialog.
2.
Set Timer Type :
◆
Normal : The timer has a single and defined run time, and stops with a notification beep when the run time is reached.
◆ Advanced : The timer has a single and defined run time. When the run time is reached, the timer makes a notification beep and continuously displays the time beyond the end of run time.
◆
Cycled : The timer has a single and defined run time. When the run time is reached, the timer makes a notification beep and restarts automatically. The number of elapsed cycles is also displayed on the left of the Timer tile.
◆
Unlimited : The timer displays the time elapsed since the timer was started.
◆
Clock : The timer displays the system time.
3.
Set Direction .
◆
Up : the timer counts up, from zero to Run Time.
◆
Down : the timer counts down, from Run Time to zero.
4.
Set Run Time .
5.
Set Reminder Volume .
A progress bar is shown with the run time. When the remaining time is 10 seconds, the monitor issues a reminder tone and the timer flashes in red, prompting you that the run time is about to expire.
NOTE
•
You cannot change timer settings, other than Reminder Volume when a timer is running.
•
You can set Direct, Run Time, and Reminder Volume only for normal, advanced, and cycled timers.
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31
Managing Configurations
31.1
Configuration Introduction
■
■
■
■
■
When performing continuous monitoring on a patient, the clinical professional often needs to adjust the monitor’s settings according to the patient’s condition. The collection of all these settings is called a configuration. The system configuration items can be classified as: parameter configuration items, conventional configuration items, and user maintenance items. Allowing you to configure the monitor more efficiently, the monitor provides different sets of configurations to accommodate the varying patient categories and departments. You can change some settings from a certain set of configuration and then save the changed configuration as a user configuration.
The default configurations provided for your monitor are department-oriented. You can choose either from:
General
OR
ICU
Neonatology
CCU
Each department has three different sets of configurations tailored for adult, pediatric and neonatal patients respectively.
WARNING
•
The configuration management function is password protected. The configuration management tasks must be performed by clinical professionals.
31.2
Changing the Department
If the current department configuration is not the one you want to view, you can change the department by following this procedure:
1.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→ select .
2.
Select Change Department .
3.
Select a department.
4.
Select Ok .
CAUTION
•
Changing the department will delete all current user configurations.
31.3
Setting Default Patient Category
To set the default patient category when admitting a new patient, follow this procedure:
1.
Select the Main Menu quick key
→
from the Configuration column select Manage
→ input the required password → select .
2.
Set Default Patient Category .
31.4
Setting Default Configuration
The monitor will load the pre-set default configuration in the following cases:
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■
■
■
A patient is admitted.
A patient is discharged.
Patient category is changed.
To set the default configuration, follow this procedure:
1.
Select the Main Menu quick key
→
from the Configuration column select Manage
→ input the required password → Select .
2.
Select Select Default Config .
3.
Select Load the Latest Config or Load Specified Config .
◆ When you select Load the Latest Config , the latest configuration is loaded when the monitor is started or a patient is admitted.
◆
When you select Load Specified Config , the selected configuration of Default Adult Config , Default
Ped Config , or Default Neo Config is loaded when the monitor is started or a patient is admitted. The specified configuration can be the factory default configuration, the age segments configuration, or a saved user defined configuration. As an example, select Default Neo Config and then select Factory
Default , Neo GA Segments , or a user configuration. For more information on defining age segments, see
.
31.5
Defining Age Segments
You must define age segments for any patient category you want to load configurations based on the patient’s age. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
Select .
2.
Select Select Default Config .
3.
Respectively select the edit icons followed Customize Configurations for Adult Age Segments ,
Customize Configurations for Ped Age Segments , Customize Configurations for Neo Gestational Age
Segments to define the age segments for each patient category. The age segment of the neonatal patient is based on the baby’s gestational age.
31.6
Saving Current Settings
Current settings can be saved as a user configuration. Up to 25 user configurations can be saved.
To save current settings, follow this procedure:
1.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
Select .
2.
Select Save Current Settings .
3.
Input the configuration name.
4.
Select Ok to save current settings as a user configuration.
31.7
Deleting a Configuration
To delete a configuration, follow this procedure:
1.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
Select .
2.
Select Delete Configuration .
3.
Select the configuration you want to delete:
◆ In the Delete Configuration dialog, selecting Local tab shows the existing user configurations on the monitor.
◆
In the Delete Configuration dialog, selecting USB Drive tab shows the existing user configurations on the USB drive.
4.
Select Delete .
5.
Select Ok .
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31.8
Transferring a Configuration
When installing several monitors with identical user configurations, it is not necessary to set each unit separately. Use a USB drive to transfer the configuration from monitor to monitor.
31.8.1
Exporting a Configuration
To export the current monitor’s configuration, follow this procedure:
1.
Connect the USB drive to the monitor’s USB port.
2.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
Select .
3.
Select Export Configuration .
4.
Select the configurations and User Maintenance Settings to export.
5.
Select Export .
31.8.2
Importing a Configuration
To import the configuration from the USB drive to the monitor, follow this procedure:
1.
Connect the USB drive to the monitor’s USB port.
2.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
Select .
3.
Select Import Configuration .
4.
Select the configurations and User Maintenance Settings to import.
5.
Select Import .
31.8.3
Loading a Configuration
You may make changes to some settings during operation. However, these changes or the pre-selected configuration may not be appropriate for the newly admitted patient. Therefore, the monitor allows you to load a desired configuration to ensure that all the settings are appropriate for your patient.
To load a configuration, follow this procedure:
1.
Select the Main Menu quick key
→
from the Configuration column select Load .
2.
Select the desired configuration.
◆ Select the configuration on this monitor in the Local page.
◆ Select the configuration on the USB drive in the USB Drive page.
3.
Select Load .
NOTE
•
The monitor may configure some settings by default when you load a configuration of different software version with the current configuration.
31.9
Printing Configurations
To print both factory configurations and user configurations, follow this procedure:
1.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
select .
2.
Select Print Configuration .
3.
Select desired configurations.
4.
Select Print .
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31.10
Modifying Configuration Password
To modify the configuration password, follow this procedure:
1.
Select the Main Menu quick key → from the Configuration column select Manage → input the required password
→
Select .
2.
Select Modify Password .
3.
Respectively input the old password and new password.
4.
Select OK .
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32
Password-protected User Settings
This chapter describes the password-protected functions accessed in the Maintenance dialog.
32.1
Setting the Device Location
32.1.1
Setting Monitor Information
To set monitor information, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Device Location tab.
3.
Input monitor name, facility name and department name.
32.1.2
Setting Monitor Location
If your monitor is installed at a fixed position, or you do not need clinicians to change the room number and bed number, you can set Monitor Location to Fixed . To set the monitor location, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Device Location tab.
3.
Set Location .
◆ Fixed : the Patient Management dialog displays Bed No.
and Room No.
, but you cannot change them.
◆
Unfixed : you can change Bed No.
and Room No.
from the Patient Management dialog.
4.
Input the room number and bed number.
NOTE
•
If Location is set to Unfixed, Bed No.
and Room No.
are cleared from the Device Location tab each time you discharge a patient.
32.1.3
Enabling the Auto Obtain Bed Number Function
If the monitor is connected to the wired network, the monitor can automatically set the patient’s bed number according to the bed number information bonded to the bedside network connector.
To enable this function, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Device Location tab.
3.
Select Unfixed .
4.
Switch on Auto Obtain Bed No..
NOTE
•
The Auto Obtain Bed Number function is available only when the switch connected to the monitor supports the LLDP or CDP protocol, and the corresponding protocol is enabled.
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32.2
Changing Patient Management Settings
32.2.1
Selecting Displayed Patient Information
You can define which items can be displayed and edited from the Patient Management tab. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Patient Management tab.
3.
Select the fields you want to display in the Patient Management dialog.
4.
If necessary, select the customized fields and input names for these fields.
NOTE
•
If the monitor is connected with the CMS, the patient information items and customized fields are loaded from the CMS.
32.2.2
Setting the Range of Finding Patient
You can configure which patient can be found in the CMS or the ADT server. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→
select .
2.
Select the Patient Management tab.
3.
Select Find Patient :
◆
All Patients : search from all patients in the CMS or ADT server.
◆
Current Department Patients : only searches from the current department in the CMS or ADT server.
32.2.3
Setting the Length of Data Transferred by N1 or T1
When using N1 or T1 to transfer the patient data, you can set the data transfer length. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Patient Management tab
→ select the Transfer tab.
3.
Set Transfer Data Length .
32.2.4
Setting the Strategy of Transferring Patient Information
When N1, T1or MPM is connected to the monitor, N1, T1 or MPM automatically uploads the data to the monitor if the patient demographic information in the monitor are consistent with those of in N1, T1 or MPM. However, the monitor needs a data transfer strategy if the patient demographic information in the monitor are not consistent with those of in the N1/T1/MPM. To set the data transfer strategy, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Patient Management tab → select the Transfer tab.
3.
Select Data Transfer Strategy .
◆ Always Ask : always prompts a dialog box to ask for strategy.
◆ Continue Patient in Module : continue to use the patient data in N1/T1/MPM. The monitor discharges the patient, and automatically admits a new patient and copies all data from N1/T1/MPM.
◆
Continue Patient in Monitor : continue to use the patient information in the monitor. The monitor deletes all patient information in the N1/T1/MPM and copies the parameter settings in the monitor to the N1/T1/MPM.
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32.2.5
Transferring the N1 or T1 Settings
When transferring the N1 or T1 data, the settings can also be transferred. To transfer settings, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Patient Management tab
→ select the Transfer tab.
3.
Set Apply Module Settings to On .
32.2.6
Auto Discharging a Patient after Monitor Power Off
You can let the monitor automatically discharge after the monitor has been switched off for a period of time.
To set the time period of discharging a patient, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Patient Management tab → select the Discharge tab.
3.
Select a time for Auto Discharge When Power Off . The monitor will automatically discharge the patient when it is turned off for the designated period of time. The default is Never . That is to say the monitor will not automatically discharge a patient, regardless of how long the monitor has been switched off.
32.2.7
Configuring Alarms for Auto Deleting Discharged Patients
The monitor automatically delete earlier discharged patients when the memory is limited. You can select whether an alarm is issued when discharged patients are automatically deleted and the monitor memory is very low.
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Patient Management tab
→
Discharged tab.
3.
Configure the alarms as needed:
◆ Prompt on patient auto deleted: an alarm is issued when the monitor automatically deletes earlier discharged patients.
◆ Alarm on storage is nearly full : selects whether an alarm is issued when the monitor memory is very low and the priority of this alarm.
32.2.8
Configuring Discharged Patients Data
To configure discharged patient data, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Patient Management tab → Discharged tab.
3.
Switch on Include Patient Demographics When Exporting Patient Data if you want to include patient demographics when exporting the patient data.
4.
Selects whether patient data is deleted when the patient is discharged.
◆ Auto : patient data is not deleted when the patient is discharged. The oldest discharged patient data will be deleted when the storage space of the monitor is full.
◆ Right Now : deletes patient data as soon as the patient is discharged.
◆ 7 days : deletes discharged patient data seven days after the patient was discharged.
◆ 1 Month : deletes discharged patient data one month after the patient was discharged
32.2.9
Clearing All Patient Data
You can delete all patient information and data in the monitor. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→
select .
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2.
Select the Patient Management tab → select the Discharge tab.
3.
Select Clear All Patient Data .
4.
Select OK . Select OK again for confirmation until a message indicating you that all data is cleared.
CAUTION
•
Clearing patient data will discharge the current patient. Make sure there is no patient is being monitored before you clear all data.
32.2.10
Selecting Query Criteria for Searching Patients in ADT Server
You can define which criteria can be used to search patients in the ADT server. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Patient Management tab → ADT Query tab.
3.
Select the query criteria as desired.
32.2.11
Setting Patient Location Options for the Discharge Screen
To set options for patient location, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Patient Management tab → select the Location tab.
3.
Input or edit patient location options.
32.2.12
Hiding Patient Name
To hide patient name on specific screens, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Patient Management tab → select the Display tab.
3.
Set the following switches as desired:
◆ Switch off Primary Screen Display Full Name : does not display patient name in the patient information area on the primary display.
◆
Switch off Secondary Screen Display Full Name : does not display patient name in the patient information area on the secondary display, if configured.
◆ Switch off Remote View Display Full Name : does not display patient name in the patient information area on the remote monitors when this monitor is viewed by other monitors.
◆
Switch off Remote View Bedlist Display Full Name : does not display patient name in bed list on the remote monitors when this monitor is viewed by other monitors.
32.3
Changing the Alarm Settings
32.3.1
Setting Alarm Tone Properties
32.3.1.1
Setting the Minimum Alarm Volume
To set the minimum alarm volume, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
Audio tab.
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3.
Set Minimum Alarm Volume .
32.3.1.2
Setting the Audible Alarm Tone Pattern
You can distinguishes the heart beat tone, pulse tone, and keystroke tone by frequency. You can choose any of the three tone patterns: ISO, Mode 1, and Mode 2. For more information, see
To set the alarm tone pattern, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Audio tab.
3.
Set Alarm Sound to ISO , Mode 1 or Mode 2 .
32.3.1.3
Setting the Interval between Alarm Sounds
If you choose the ISO pattern, you can change the interval between alarm tones. To change the interval between alarm tones, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Audio tab.
3.
Set High Alarm Interval , Med Alarm Interval , and Low Alarm Interval .
32.3.1.4
Setting Alarm Volume Escalation
The monitor provides the function of automatically escalating the alarm tone volume. When this function is enabled, if an alarm is not reset within the designated delay time after the alarm occurs, the volume of the alarm tone increases automatically.
To set the alarm volume escalation, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Audio tab.
3.
Set Auto Increase Volume .
◆ 2 Steps : if an alarm is not reset within the designated delay time after the alarm occurs, the alarm volume automatically increases by two levels.
◆
1 Step : if an alarm is not reset within the designated delay time after the alarm occurs, the alarm volume automatically increases by one level.
◆ Off : if an alarm is not reset within the designated delay time after the alarm occurs, the volume of the alarm tone does not change.
4.
Select Increase Volume Delay to set the delay time of alarm volume escalation.
NOTE
•
The alarm volume escalation function is not applied to the latched alarms.
32.3.2
Setting Alarm Pausing and Resetting Properties
32.3.3
Defining the Pause Function
You can either pause alarms or pause alarm tones. This depends on the pause setting. To set the pause function, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→
select .
2.
Select the Alarm tab → Pause/Reset tab.
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3.
Set Pause to Alarm Pause or Audio Pause .
32.3.3.1
Setting the Alarm Pause Time/Alarm Tone Pause Time
The alarm pause time or alarm tone pause time can be set to 1 min , 2 min , 3 min , or Permanent . The default audio pause time is two minutes.
To set the alarm tone pause time, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Pause/Reset tab.
3.
Set Pause Time .
32.3.3.2
Setting the Priority of Audio Paused Alarms
To select alarm of what priority can be paused or alarm sound of what priority can be paused, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Pause/Reset tab.
3.
Set Pause Priority .
◆ All : pressing the Alarm Pause quick key pauses all alarms.
◆ Med & Low : pressing the Alarm Pause quick key pauses alarms of medium and low priority. The high priority alarms will not be paused.
◆
Disable : the Alarm Pause quick key is disabled.
32.3.3.3
Disabling the Options of Prolonging Alarm Pause Time/Alarm Tone Pause Time
To disable specific options for the clinician when prolonging alarm pause time or the alarm tone pause time, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Pause/Reset tab.
3.
Switch off Pause 5 min , Pause 10 min , or Pause 15 min .
32.3.3.4
Setting Alarm Light Status on Alarm Reset
When the alarm system is reset, the monitor presents the alarm light by default , but you can switch off the alarm light. To change the alarm light setting, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Alarm tab → Pause/Reset tab.
3.
Set Alarm Light .
◆ On When Reset : when the alarm system is reset, the alarm tones of the current alarms are switched off, but the alarm lamp remains flashing.
◆
Off When Reset : when the alarm system is reset, both the alarm tone and alarm lamp of the current alarms are switched off.
32.3.3.5
Setting the Reminder Tones
When the alarm volume is set to zero, or the alarm is reset or switched off, the monitor issues a periodical reminder tone. The reminder tone is enabled by default.
To set the reminder tone, follow this procedure:
32 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password → select .
2.
Select the Alarm tab
→
Pause/Reset tab.
3.
Set Alarm Reset Reminder and Alarm Off Reminder .
◆
On : the monitor issues reminder tones at a designated interval.
◆
Re-alarm : if the alarm condition persists the alarms marked with “√” will be re-generated after the designated reminder tone interval.
◆ Off : the monitor does not issue reminder tones at a designated interval. The alarms marked with “√” will be silenced.
4.
Set Reminder Interval to 10 min , 5 min , 3 min , 2 min , or 1 min .
32.3.4
Latching Physiological Alarms
To latch physiological alarms, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→
Latching tab.
3.
Select how you want to latch the alarms.
■
■
■
■
■
Alarm latching rules are as follows:
You can separately latch visible alarm signals and audible alarm signals.
Latching audible alarm signals simultaneously latches the corresponding visible signals.
Selecting alarms of lower priority simultaneously latches higher priority alarms.
Switching V-Tach Latching Lock off allows you to switch on or off V-Tach Latching .
When V-Tach Latching Lock is switched on, V-Tach latching follows the setting of Lethal alarm latching and you cannot control V-Tach Latching .
32.3.5
Changing Remote Alarm Settings
32.3.5.1
Resetting Alarms for Remote Devices
You can reset the alarms occurring on the remote devices that are viewed on the Remote View screen of the monitor. To enable this function, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
Remote View tab.
3.
Switch on Reset Remote Bed Alarms . Then the Alarm Reset button appears on the bottom left of the
Remote View screen.
To reset any remote device alarms, the clinician may now select the Alarm Reset button at the bottom of the
Remote View screen.
NOTE
•
You can reset remote device alarms only if the Alarm Reset By Other Bed switch is on at the remote devices and alarms are occurring on the remote device.
32.3.5.2
Authorizing the Alarm Reset to Other Devices
Alarms on your monitor can be reset by remote devices if you enable this function. To do so, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→ input the required password
→ select .
2.
Select the Alarm tab
→
Remote View tab.
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3.
Switch on Alarm Reset By Other Bed .
32.3.5.3
Selecting the Alarm Reminder for Remote Devices
You can configure what alarm indicators are necessary for the remote devices. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
Remote View tab.
3.
Select Alarm Reminder :
◆ Visible + Audible : the monitor provides visual alarm indication, and continuous audible alarm indication if the alarm persists at the remote device.
◆
Visible + Single Tone : the monitor provides visual alarm indication, and a single tone when the alarm occurs at the remote device.
◆ Visible Only : the monitor only provides visual alarm indication.
32.3.5.4
Presenting Alarm Sound for Remote Devices as per Alarm Priority
You can configure what priority of remote device alarms are presented for audible notification. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
Remote View tab.
3.
Select Alarm Priority :
◆ All : the monitor sounds if an alarm occurs.
◆ High & Med : the monitor sounds if a high or medium priority alarm occurs.
◆ High Only : the monitor sounds only if a high priority alarm occurs.
32.3.5.5
Setting the Tone Pattern for Alarms from Remote Devices
The monitor provides the same alarm tone pattern for the remote device alarms as those for your monitor
alarms. For more information on alarm tone pattern, see 8.3.3 Alarm Indicators
.
To set the alarm tone pattern for the remote device alarms, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→ select the Remote View tab.
3.
Set Alarm Sound to ISO , Mode 1 or Mode 2 .
32.3.5.6
Switching Off the Remote Device Disconnection Alarm
The monitor can provide an alarm if remote devices, for example, a bedside monitor or a telemetry, are disconnected. By default, the function is enabled. To disable the alarm, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
Remote View tab.
Switch off Remote Disconnected Alarm .
32.3.6
Setting Nurse Call Properties
32.3.6.1
Selecting Alarms to be Sent to the Nurse Call System
To set the type and priority of alarms that are sent to the nurse call system, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
32 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
2.
Select the Alarm tab → Nurse Call tab.
3.
Select Signal Type
◆ Pulse : the nurse call signal is a pulse signal and each pulse lasts one second. When multiple alarms simultaneously occur, only one pulse signal is outputted. If an alarm occurs but the previous one is not cleared, a new pulse signal will also be outputted.
◆ Continuous : the nurse call signal lasts until the alarm ends. That is to say the duration of a nurse call signal is equal to that of the alarm condition.
4.
Select Contact Type to set the work mode of the nurse call relay.
5.
Select Alarm Priority to set the priority of alarms sent to the nurse call system.
6.
Select Alarm Type to set the type of alarms sent to the nurse call system.
32.3.6.2
Disabling the Receiving Call Help Function
If a monitor in the same department calls for help, you can receive the calling signal. This function is enabled by default. To disable this function, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→
Nurse Call tab.
3.
Switch off Receive Call Help.
32.3.6.3
Selecting the Source of Call Help Signals
You can choose which calling for help signals the monitor can receive. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Nurse Call tab.
3.
Set the switch of Only Beds from Remote View.
◆ On : The monitor can only receive the calling for help signals from the remote monitors being viewed.
◆ Off : The monitor can receive the calling for help signals from all the monitors in the same department.
32.3.6.4
Enabling Presenting the Nurse Call from the Telemetry
If the telemetry is connected, the monitor can pops up the nurse call dialog if nurse call is initiated from the telemetry. To enabling this function, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→
Nurse Call tab.
3.
Switch on Telemetry Nurse Call.
32.3.7
Changing Alarm Priority Settings
32.3.7.1
Setting the Priority of the ECG Lead Off Alarm
To set the priority of the ECG lead off alarm, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
select the Other tab.
3.
Set the priority of ECG Lead Off .
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32.3.7.2
Setting the Priority of the SpO
2
Sensor Off Alarm
To set the priority of the SpO
2
sensor off alarm, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→
select the Other tab.
3.
Set the priority of SpO2 Sensor Off .
32.3.7.3
Setting the Priority of the IBP No Sensor Alarm
To set the priority of the IBP no sensor alarm, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
select the Other tab.
3.
Set the priority of IBP No Sensor .
32.3.7.4
Setting the Priority of the Integrated Device Disconnected Alarm
To set the priority of the alarm when the external device is disconnected, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→
select the Other tab.
3.
Set the priority of Integrated Device Disconnected .
32.3.7.5
Setting the Switch of the CMS and eGateway Disconnection Alarm
You can choose whether to issue an alarm when the monitor is not connected or disconnected from the CMS/ eGateway. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password → select .
2.
Select the Alarm tab
→
Other tab.
3.
In the Other block, switch on or off CMS/eGW Disconnected Alarm . If CMS/eGW Disconnected Alarm is switched off, the “Offline” alarm is not presented when the monitor is not connected or disconnected from the CMS/eGateway.
32.3.7.6
Setting the Priority of the CMS and eGateway Disconnection Alarm
To set the priority of the CMS and eGateway disconnection alarm, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→
select .
2.
Select the Alarm tab
→
Other tab.
3.
Set CMS/eGW Disconnected .
32.3.7.7
Setting the Switch of the SpO
2
Desat Alarm Off
You can choose whether switching off the SpO
2
Desat alarm is permissible or not. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→ select the Other tab.
3.
Set SpO2 Desat Alarm Off .
◆
Disable : the SpO
2
Desat alarm is always on. You cannot switch it off.
32 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
◆ Enable : you can switch off the SpO
2
Desat alarm. For more information, see 12.6.1 Changing the SpO
.
WARNING
•
If a clinician switches off the SpO2 Desat alarm, the monitor will not alarm when the patient’s SpO
2
is extremely low. This may result in a hazard to the patient.
32.3.7.8
Setting the Switch of the Apnea Alarm Off
You can choose whether switching off the apnea alarm is permissible or not. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → select the Other tab.
3.
Set Apnea Alarm Off .
◆ Disable : the apnea alarm is always on. The clinician cannot switch it off.
◆ Enable : the clinician can switch off the apnea alarm. For more information, see
WARNING
•
If a clinician switches off the apnea alarm, the monitor will not issue the apnea alarm when that situation occurs. This may result in a hazard to the patient. Keep the patient under close surveillance.
32.3.8
Changing Alarm Delay Settings
32.3.8.1
Setting the Alarm Delay Time
For continuously measured parameters, you can set the alarm delay time. If the alarm condition is resolved within the delay time, the monitor does not present the alarm.
To set the alarm delay time, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab → Other tab.
3.
Set Alarm Delay .
◆ Off : an alarm is presented as soon as the alarm condition occurs.
◆ 1 sec ~ 8sec : for continuously measured parameters, an alarm is not presented if the alarm condition is resolved within the designated delay time.
The setting of Alarm Delay is not applied to the apnea alarms and the ST alarms. You can set Apnea Delay and
ST Alarm Delay separately.
WARNING
•
The alarm delay time can be set to a maximum of 8 seconds. Changing this setting to an inappropriate level could result in a hazard to the patient.
32.3.8.2
Setting the ST Alarm Delay Time
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→
select .
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2.
Select the Alarm tab → Other tab.
3.
Set ST Alarm Delay .
32.3.9
Adjusting the Alarm Light Brightness
To adjust the alarm light brightness, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Alarm tab → Other tab.
3.
From the Alarm Light Brightness area, set Primary Screen (note that you may have to scroll up the dialog to see this option). If you set alarm light brightness to Auto , the monitor automatically adjusts the alarm light brightness according to the ambient light. The stronger the ambient light is, the brighter the alarm light is.
For N22/N19, if you are using a secondary display, set the Secondary Screen too.
32.3.10
Changing Other Alarm Settings
32.3.10.1 Setting the Lethal Arrhythmia Alarms Switch
To allow a clinician to disable the lethal arrhythmia alarms, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Alarm tab
→
select the Other tab.
3.
From the Other block, set Lethal Arrh Alarms Off as follows.
◆
Lethal Arrh Alarms Off is set to Disable by default. In this case, a clinician cannot switch off lethal arrhythmia alarms.
◆ If you set Lethal Arrh Alarms Off to enable , a clinician can switch off lethal arrhythmia alarms from the ECG
dialog. For more information, see 9.6.4.1 Changing Arrhythmia Alarm Settings .
WARNING
•
If any of lethal arrhythmia alarms are switched off, the ECG waveform area displays a message to indicate that corresponding alarms are off.
•
If a clinician switches off all arrhythmia alarms, the monitor will not present arrhythmia alarms.
Always keep the patient under close surveillance.
32.3.10.2 Setting the Intubation Time
The default intubation time is 2 minutes. To change the intubation time, following this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab
→
Other tab.
3.
Set the Intubation Mode Period .
32.3.10.3 Enabling Automatic Recordings on an Alarm
Print on Alarm is set to Printer by default. To enable automatic recording via recorder when a parameter alarm is triggered, set Print on Alarm to Recorder . To do so, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→ input the required password
→ select .
2.
Select the Alarm tab
→ select Other .
3.
Set Print on Alarm to Recorder .
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32.3.10.4 Setting Arrhythmia Alarm Timeout Period
The arrhythmia algorithm can disable alarm light and alarm tone for designated period of time when certain arrhythmia alarms are detected.
To set the arrhythmia alarm timeout period, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Alarm tab → select the Other tab.
3.
From the Other block, set Arrhy Shield Time .
NOTE
•
For the following alarms, alarm light and alarm tone cannot be disabled: HR high, HR low,
Tachycardia, Bradycardia, Afib End, Irr Rhythm End.
•
The arrhythmia alarm timeout period is only applied to the medium priority chains and atrial fibrillation chain. For the alarms in the high priority chain, alarm tone and alarm light are presented
as soon as the alarm condition is detected. Refer to 9.6.5.1 Arrhythmia Alarm Chains for more
information on the arrhythmia alarm chain.
•
Alarm indication rules for alarms in the atrial fibrillation chain are the same with those for the medium priority chains.
32.4
Changing CAA Settings
32.4.1
Enabling Inputing the Clinician ID
To display the clinician ID on the EWS screen, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the CAA tab
→ select the EWS tab.
3.
Switch on Clinician ID .
4.
Select Clinician ID Timeout to set how long the clinician ID will remain valid.
NOTE
•
The EWS tab is only available if a license for EWS is installed in the monitor.
32.4.2
Selecting the Default Scoring Tool
To set the default scoring tool for different patient category, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the CAA tab → select EWS tab.
3.
From the Select Default Score area, set Default Adult Score , Default Ped Score , and Default Neo Score .
32.4.3
Managing the Scoring Tools
To manage the scoring tool, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the CAA tab
→ select EWS tab.
3.
Select the Manage Score button.
◆
Delete local scoring tools: from the Local page, delete any unnecessary scoring tools.
◆
Import the desired scoring tools to the monitor: from the USB drive page, select the scoring tools on the USB drive, and then select Import .
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NOTE
•
The monitor provides MEWS and NEWS by default. You cannot delete them.
32.4.4
Setting GCS Threshold for Each Consciousness Level
You can configure the threshold and color of each consciousness level. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the CAA tab → select the GCS tab.
3.
Set high limit, low limit for each level.
32.4.5
Changing SepsisSight Settings
To change SepsisSight settings, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the CAA tab
→ select the SepsisSight tab.
3.
Select The first of resuscitation to define the desired period of initial resuscitation. Select and edit the goals for initial resuscitation.
4.
In the Bundles area, select and edit treatments to be completed in 1 hour, 3 hour, and 6 hours.
32.5
Changing Module Settings
32.5.1
Selecting the ECG Standard
Select the ECG standard according to the leadwires you are using. To select the ECG standard, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Module tab
→
ECG tab.
3.
Set ECG Standard to AHA or IEC .
32.5.2
Changing the QTc Formula
The monitor uses the Hodges correction formula by default to correct the QT interval for heart rate. To select the
QTc formula, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→
input the required password → select .
2.
Select the Module tab → ECG tab.
3.
Set QTc Formula .
◆ Hodges:
QTc = QT + 1.75
HeartRate – 60
◆ Bazett:
QTc = QT
HeartRate
60
2
◆ Fridericia:
QTc = QT
HeartRate
3
◆ Framingham:
QTc = QT + 154
1 –
60
HeartRate
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32.5.3
Setting the 12-Lead Order Switch
To set whether to send the order number of 12-lead interpretation report to the hospital information system while saving the report, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → i nput the required password
→ select .
2.
Select the Module tab.
3.
Select the ECG tab.
4.
Set 12-Lead Order .
32.5.4
Calibrating ECG
The ECG signal may be inaccurate due to hardware or software problems. As a result, the ECG waveform amplitude becomes greater or smaller. In that case, you need to calibrate the ECG module. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→
select .
2.
Select the Module tab
→
ECG tab.
3.
From the bottom left corner of the dialog select Calibrate .
32.5.5
Manually Zeroing the CO
2
Module
To zero the CO
2
module, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Module tab → CO2 tab.
3.
From the bottom left corner of the dialog select Zero .
32.5.6
Hiding the Invalid Display after Zeroing the CO
2
Module
After the zero calibration is completed, the CO
2
module reacquires the CO
2
readings. During the reacquisition period, “ Zero Recovering ” is displayed in the CO
2
numeric area. Valid data will reappear 30 seconds after the zero calibration is started.
To hide the display of the “ Zero Recovering ” message, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Module tab
→
CO2 tab.
3.
Switch off Zero Recovery for 30s .
Selecting Defaults from the bottom of the dialog can restore this setting to the factory default.
32.5.7
Manually Zeroing the AG Module
To zero the AG module, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Module tab
→
AG tab.
3.
From the bottom left corner of the dialog select Zero .
32.5.8
Hiding the Invalid Display after Zeroing the AG Module
After the zero calibration is completed, the AG module reacquires the AG readings. During the reacquisition period, “ Zero Recovering ” is displayed in the AG numeric area. Valid data will reappear 30 seconds after the zero calibration is started.
To hide the display of the “ Zero Recovering ” message, follow this procedure:
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1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Module tab
→
AG tab.
3.
Switch off Zero Recovery for 30s .
Selecting Defaults from the bottom of the dialog can restore this setting to the factory default.
32.5.9
Selecting the Gas Type for Measurement
You can select what gases detected by the monitor are used for measurements. To do so, follow this procedure:
1.
Ensure that the AG module is inserted in the monitor.
2.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
3.
Select the Module tab
→
AG tab.
4.
Set Types of Gas Measurement . Any gas that is not selected, will not be displayed or used for calculating the MAC value. When the concentration of any unselected gas is equal to or greater than 1%, you will be prompted to select the gas and enable the measurement ( Set XX measurement to On) .
Selecting Defaults from the bottom of the dialog can restore this setting to the factory default.
32.5.10
Setting Parameter Measurement Timeout
NIBP measurements become outline fonts after a preset time. This feature prevents older values being misinterpreted as current measurements. To adjust the timeout period for PAWP, C.O., and NIBP, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password → select .
2.
Select the Module tab → select the Other tab.
3.
Set the timeout period for PAWP, C.O., and NIBP.
32.5.11
Setting Flow Rate (For Sidestream CO
2
Module Without O
2
)
When you are using the sidestream CO
2
module without the O
2
monitoring function to monitor a neonatal patient, you can select flow rate. To do so, follow this procedure:
1.
Ensure that the sidestream module without O
2
is inserted in the monitor.
2.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
3.
Select the Module tab → Other tab.
4.
Set CO2 Flow Rate For Neo .
32.6
Changing the Review Settings
32.6.1
Hiding Undesired Review Tabs
If you do not need to review some items, you can hide them. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Review tab.
3.
From the Tabs page, Event page or Arrh Mark page deselect those that do not need to be available to clinicians during review.
32.6.2
Renaming Events
You can rename manual events and arrhythmia events. To do so, follow this procedure:
32 - 16 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Review tab.
3.
Switch on Rename Event .
32.6.3
Exporting Patient Data
To export data of the current and discharged patients, follow this procedure:
1.
For N17/N15/N12, connect the USB drive to the monitor’s USB connector. For N22/N19, connect the USB drive to the monitor’s MSB connector.
2.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
3.
Select the Review tab
→
Export tab.
4.
Select Export Patient Data .
5.
From the patient list select desired patients.
6.
Select Export Patient Data .
32.7
Setting the Printer
32.7.1
Setting the Printer Properties
To set a network printer, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Print tab.
3.
In the Printer tab, select Connection Type to choose whether you want to output patient reports via the print server or a network printer.
4.
If you set Connection Type to Print Server , perform the following settings:
◆ Print Server Address : select
◆ Port : selects to input the print server name or IP address.
to input the print server port. If the CMS is used as the print server, set Port to 6603 .
◆ Set the report type in the Report Type area. For more information, see section
5.
If you set Connection Type to Printer , perform the following settings:
◆ Select Printer IP Address . Select
◆ Select Paper Size .
◆ Select Resolution .
to input the IP address of the desired network printer.
After finishing configurations, you can select the Print Test Page button to verify that the printer works properly.
32.7.2
Setting the Report Type
If the Connection Type is set to Print Server , you need to set the report type:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→ i nput the required password → select .
2.
Select the Print tab.
3.
Set Connection Type to Print Server .
4.
Select the report you intend to set, for example, General Report .
5.
Set the Print Action :
◆ Paper : outputs paper report.
◆ PDF : outputs the electronic report in PDF format.
◆ Paper And PDF : outputs both the paper report and the PDF report.
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6.
For paper report, respectively select Printer and Printer Resolution to set the default printer and the resolution for the default printer.
7.
For PDF report, select the PDF Resolution to set the resolution.
NOTE
•
General reports refer to the reports other than the end case report and realtime alarm report.
32.7.3
Setting the Report Layout
To set the patient information you want to display on general reports, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Print tab.
3.
Select the Report Layout tab.
4.
Select the desired items under Report Name . N/A indicates that this item is not displayed on a report.
32.7.4
Setting Patient Information on 12-lead ECG Reports
To set the patient information you want to display on 12-lead ECG reports, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Print tab.
3.
s elect the ECG Report tab.
4.
On the right of the ECG Report page, select the desired patient information items. Patient ID, Patient
Name, Age, and Gender are displayed on an ECG report by default.
NOTE
•
You can only set the patient information to display on the ECG report from the ECG Report page.
Patient information configured in the Report Layout page is not applied to ECG reports.
32.7.5
Configuring the Name of PDF Files
If you use the print server to output patient reports, you can use the PDF printer to output PDF format reports. To configure the name of PDF files, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→ input the required password → select .
2.
Select the Print tab → PDF File Name tab.
3.
Select the desired items and their sequence under PDF File Name . N/A refers to no information.
32.7.6
Showing the Second Mark
To set whether you want to show second marks on the report output by the printer, follow this procedure.
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Print tab
→
Other tab.
3.
Enable or disable Second Mark (Printer) .
32.7.7
Setting the Arrhythmia Information to Output by the Recorder
To set whether you want to include arrhythmia thresholds and QRS thresholds in the report output by the recorder, follow this procedure.
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1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Print tab
→
Other tab.
3.
Enable or disable Arrhy Settings (Recorder) .
32.7.8
Setting Parameter Unit
To set parameter unit, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Set the Unit tab.
3.
Set unit for each parameter.
32.8
Setting the Time
32.8.1
Setting the Time Synchronization
If the NTP Time Synchronization function is enabled, the monitor can automatically synchronize its time with a time server on which NTP (Network Time Protocol) is implemented. If there are many monitors connected within one network, you can enable the time synchronization to synchronize the time, and make it unnecessary to manually set the time for individual monitors.
32.8.1.1
Enabling NTP Time Synchronization
To enable the NTP Time Synchronization function, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Time tab
→
Time Synchronization tab.
3.
Switch on Start NTP Time Sync .
32.8.1.2
Setting the Time Server Address
To set the DNS name of the time server address, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Time tab
→
Time Synchronization tab.
3.
Input the name or IP address of the time server.
After configuring the NTP time server, select Network Test to verify that the NTP server is properly connected.
32.8.1.3
Setting the Time Synchronization Interval
To set the time synchronization interval, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Time tab → Time Synchronization tab.
3.
Set Interval .
32.8.1.4
Defining the Hours of Nighttime
To define the nighttime, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 32 - 19
2.
Select the Time tab → Time Synchronization tab.
3.
Select From and To to define the beginning and end of Nighttime.
32.8.2
Enabling Auto Daylight Savings Time
By default, daylight savings time is disabled. If this function is needed, you need to manually enable the daylight savings time. To auto start the daylight savings time, follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→
input the required password → select .
2.
Select the Time tab → Daylight Savings Time tab..
3.
Switch on Auto Daylight Savings Time .
4.
Adjust daylight savings time settings as necessary.
NOTE
•
If you enable Auto Daylight Savings Time you cannot manually switch it on or off from the System
Time dialog. For more information, see 3.8.2 Setting the Date and Time.
32.9
Viewing Version Information
To view the system software version, module hardware and software version, and firmware version , follow this procedure:
1.
Select the Main Menu quick key
→ from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Version tab.
You can also view the system software version by selecting the Main Menu quick key → from the System column select Version .
32.10
Checking Battery Information
To check the battery information, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Battery Information tab.
32.11
Changing Secondary Display Settings (for N22/N19)
You can separately set the orientation, brightness, alarm indications, and the display contents of the secondary display.
NOTE
•
If you change the Maintenance dialog settings for the secondary display, you need to restart the monitor for the changes to take effect.
•
If you plug in a secondary display when the monitor is on, you need to restart the monitor before you use the secondary display.
32.11.1
Configuring Secondary Display Screen Contents
(for N22/N19/N17)
The contents of the secondary display is configurable. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Display tab.
3.
Set Screen Contents .
32 - 20 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
◆ Mirrored: The contents of the secondary display is exactly the same with the primary display. The orientation of the secondary display is also the same with the primary display. It is not available for the N17 monitor.
◆ Independent : You can separately configure the contents and layout of the primary display and secondary display. The independent secondary display cannot share the mouse and keyboard with the primary display. For N22/N19, separate mouse and keyboard connected to the MSB connectors of the secondary display is required.
◆
Extended : You can separately configure the contents and layout of the primary display and secondary display. The extended secondary display shares the mouse and keyboard with the primary display. You cannot use separate mouse and keyboard to operate the extend secondary display.
4.
If the Screen Contents is set to Extended , set Secondary Screen Location .
32.11.2
Enabling Secondary Display Alarm Indications (for N22/N19)
The secondary display can provide visual and audible indications. This function is disabled by default. To enable the secondary display to present alarm light and alarm sound, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Display tab.
3.
Switch on Alarm Sound/Light .
32.12
Changing Scanner Settings
For the 2D barcode reader, you can change the scanner settings.
32.12.1
Establish the Relationship between Patient Demographics and 2D Barcode
Fields (for the Mindray Custom 2D Barcode Reader)
To configure 2D barcode reader, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→
select .
2.
Select the Scanner tab
→
2D Barcode tab.
3.
Establish the relationship between the monitor data and hospital’s barcode data for selectable patient demographics. For example, the monitor has an option of Ped for patient category. In your hospital barcode, the text may read as Pediatric . So input Pediatric for the field Ped to establish their relationship.
32.12.2
Setting the Barcode Reader Information
To set the barcode reader information, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Scanner tab → Scanner Info.
tab.
3.
Set Scanner Type :
◆ 1D Scanner : select this option when using a 1D scanner or a 2D scanner other than the Mindray custom 2D scanner.
◆ 2D Scanner : select this option when using the Mindray custom scanner.
NOTE
•
When you set Scanner Type to 2D Scanner, default settings are applied to Data Encoding Type and
Data Parse Mode. You do not need to change these setting.
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32.12.3
Identifying the Barcode Reader (for the non-Mindray Custom 2D Barcode
Reader)
When you are using barcode readers other than the JADAK Flexpoint HS-1R or HS-1M, you should select the barcode reader from the USB device list, so that the monitor can identify the barcode reader. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Scanner tab → Identify Scanner tab.
3.
From the USB device list, select the barcode reader you are using.
32.12.4
Selecting Patient Information Read by the Barcode Reader (for the Mindray
Custom 2D Barcode Reader)
To select desired patient information that will be read by the barcode reader, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→
select .
2.
Select the Scanner tab
→
Field tab.
3.
Select the patient information. The selected information can be read by the barcode reader.
NOTE
•
The patient information read by the barcode reader is dependent on the patient information encoded in the hospital's barcodes.
32.13
Configuring the Network
You can connect the monitor to the central monitoring system (CMS), eGateway, and other monitors through wired LAN or wireless LAN.
32.13.1
Network Safety Information
CAUTION
•
Wireless network designing, deploying, debugging, and maintenance should be executed by
Mindray service personnel or authorized technicians.
•
Always set the wireless network according to local wireless regulations.
•
Using 5G frequency band is recommended whenever possible. There are more interference sources in 2.4G frequency band.
•
Private APs and wireless routers are not allowed. These devices may cause radio interference and result in monitor and CMS data loss.
32 - 22 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
•
Data communication must be performed within a closed network or within a virtually isolated network provided by a hospital for all network functions. The hospital is responsible for ensuring the security of the virtually isolated network.
•
WPA2-PSK and WPA2-Enterprise verification and encryption should be used if possible. Otherwise, the equipment may not be able to work or patient information may be divulged. WPA2-Enterprise and a long password are recommended.
•
Keep network authentication information, for example passwords, safe, to protect the network from being accessed by unauthorized users.
•
Do not connect non-medical devices to the monitor network.
•
If wireless network signal is poor, there may be a risk of CMS-destined data loss.
•
Maximum number of monitors connected to a single AP is 16 for N17/N15/N12 or 12 for N22/N19.
Too many monitors connected to the same AP may result in network disconnection.
•
RF interference may result in wireless network disconnection.
•
Disconnecting from the network may result in CMS-destined data loss and function failure. Check the patient in case of network disconnection and solve the network problem as soon as possible.
•
Ensure that the monitor IP address setting is correct. Changing the network settings may result in network disconnection. Contact your service personnel if there are any problems with the IP address.
•
If the device remains in service following the end of support, the cybersecurity risks for end-users can be expected to increase over time.
•
Network disconnection does not have an impact on local monitoring functions.
•
Contact Mindray service personnel if cybersecurity problems occur.
32.13.2
Selecting a Network Type
To select network type, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Network Type tab.
3.
Set Monitor to Auto , LAN1 IP , or WLAN according to your network type. The default is Auto , which means the monitor will automatically use LAN1 IP when detected and the available WLAN when LAN1 IP is not detected..
32.13.3
Setting the Wired Network
To set the wired network, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab → LAN1 IP tab.
3.
Select how to get the IP address.
◆ Obtain IP Address Automatically : the monitor automatically gets the IP address.
◆ Use the following Address : you need to input the IP address , Subnet mask , and Gateway .
4.
Select how to get the DNS address:
◆ Obtain DNS Address Automatically : the monitor automatically gets the DNS address.
◆ Use the following DNS Address : you need to input the IP address of Preferred DNS server and
Alternate DNS server .
32.13.4
Setting the Wireless Network
To add and set the wireless network, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab → WLAN tab.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 32 - 23
3.
Select Add WLAN . In the popup dialog, input network name, SSID, and password. Set Security .
4.
Select the WLAN IP tab and select how to get the IP address and DNS address.
◆ Obtain IP Address Automatically : the monitor automatically gets the IP address.
◆ Use the Following Address : you need to input the IP address , Subnet Mask , and Gateway .
◆ Obtain DNS Address Automatically : the monitor automatically gets the DNS address.
◆ Use the following DNS Address : you need to input the IP address of Preferred DNS server and
Alternate DNS server .
5.
Select the WLAN Setup tab and set WLAN band and channels. The default is Auto , which means the monitor can automatically identify the WLAN band.
After configuring the wireless network, select Network Test to verify that the wireless network can be properly connected.
If you need to change network settings, select beside the desired wireless network. Selecting deletes the wireless network.
32.13.5
Managing Certifications
You can delete certifications from the monitor, or import certifications from the USB memory device. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab → WLAN tab.
3.
Select the Certificate Management button from the bottom left corner of the dialog.
◆ From the Local tab, select certifications you want to delete from the monitor, and then select Delete .
◆ From the USB Drive tab, select certifications you want to import from the USB memory device, and then select Import .
32.13.6
Enabling Selecting a CMS
To enable selecting a CMS, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→
select .
2.
Select the Network Setup tab
→
Central Station Setup tab.
3.
Switch on Select CMS .
32.13.7
Adding CMSs
You can add up to 30 central monitoring systems (CMS) for your monitor. To add CMSs, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab → Central Station Setup tab.
3.
Select Add Central Station , and then input the CMS name and IP address of this department.
32.13.8
Setting Multicast Parameters
Multicast helps device discovery between monitors and other devices on the network. Devices in the same multicast group can be mutually discovered.
To set multicast parameters, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Network Setup tab
→
Device Discover tab.
3.
Set Multicast TTL .
4.
Set Multicast Address .
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32.13.9
Setting the Master Server Address
To set the DNS name of the master server, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab → Device Discover tab.
3.
Select Master Server Address to input the DNS name or IP address of the master server.
32.13.10 Setting the Network Service Quality Level
To set the quality of service (QoS), follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Network Setup tab
→
QoS tab.
3.
Select QoS Level For Realtime Monitoring to set the service quality of network connection for realtime monitoring, for example parameter measurements and waveforms, alarms, etc.
4.
Select QoS Level For Others to set the service quality of network connection for non-realtime monitoring, for example history data, printing, etc.
32.13.11 Using the ADT Gateway
The ADT (admit-discharge-transfer) gateway is normally deployed in the eGateway. You can obtain patient information from the hospital ADT server through the ADT gateway.
To configure the ADT gateway, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Network Setup tab
→
ADT tab.
3.
Select Server Address to input the host name or IP address of the ADT gateway.
4.
Select Port to input the port of the ADT gateway.
ADT Query is switched off by default. You can load patient information to the monitor from the ADT server only when this function is enabled.
After configuring the ADT gateway, select Network Test to verify that the ADT server is properly connected.
32.13.12 Sending Realtime Data, Waveforms and Alarms via HL7 Protocol
You can send the realtime data, waveforms, and alarms from the monitor to the hospital servers via HL7 protocol. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Network Setup tab
→
HL7 Configuration tab.
3.
From the Data + Waveforms area, select Server Address to input the name or IP address for the server receiving the realtime data and waveform. Set Port .
4.
Switch on Send Data and Send Waveform , as needed. Set Data Interval .
5.
From the Alarms area, select Server Address to input the name or IP address for the server receiving the alarm data. Set Port .
6.
Switch on Send Alarms as needed.
7.
From the Compatibility area, set HL7 Protocol Version .
This page also displays the server connection status.
NOTE
•
Licenses are required for sending realtime data, waveforms, and alarms via HL7. For more
information on checking the licenses, see 26.1 Checking Software Licenses .
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32.13.13 Selecting Data Encryption Type
To set data encryption type, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab → Information Security tab.
3.
Select Encryption Connection Type to set data encryption type when connecting devices:
◆ Only Private Encryption : Mindray private encryption is used to encrypt the transmitted data. You cannot connect devices supporting SSL (secure sockets layer) encryption.
◆ SSL Encryption Priority : for devices supporting SSL encryption, SSL encryption is used when connecting the devices. For devices not supporting SSL encryption, private encryption is used when connecting the devices.
32.13.14 Disabling the Broadcasting Patient Demographics Function
When viewing other patients, device location and patient information of remote devices are displayed in the remote device list by default. To protect patient privacy, you can disable the broadcasting of patient demographics function to prevent the monitor from sending patient information via broadcast. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select Network Setup tab → Information Security tab.
3.
Switch off Broadcast Patient Demographics .
Thus, patient information will not display in the remote device list.
32.14
MLDAP
■
■
■
MLDAP refers to Mindray LDAP (Lightweight Directory Access Protocol). It is an independent process which can be installed on the eGateway or other application server (Windows). MLDAP provides user identity and authentication.
The MLDAP server is connected with the hospital LDAP server. All monitoring devices are connected to the
MLDAP server to implement identity and authentication for the following operations:
Changing alarm settings
Changing arrhythmia settings
Accessing the Maintenance dialog
32.14.1
Setting MLDAP
To access the MLDAP server, you should set your monitor as follows:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Network Setup tab
→
MLDAP tab.
3.
Set Server address and port of the MLDAP server.
32.14.2
Testing MLDAP Server Connection
To test whether the monitor is properly connected with the MLDAP server, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Network Setup tab
→
MLDAP tab.
3.
Select Network Test .
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32.14.3
Selecting Password for User Authentication
You can select what password is used when changing alarm settings, arrhythmia settings, viewing current or discharged patient data, and accessing the Maintenance dialog. To do so, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Authorization Setup tab.
3.
From the Maintenance area, set User Maintenance to select the password for accessing the monitor’s
Maintenance dialog.
◆ Local Password : the monitor’s password for accessing the Maintenance dialog is required.
◆ User Password : the user name and password saved in the MLDAP server are required.
4.
From the Clinical Setting area, set passwords for Alarm Setup , Arrhythmia , View Discharged Patients , and Viewing Patient Review Data .
◆ No Password : changing alarm settings and arrhythmia settings, reviewing data of the current patient and discharged patients are not password protected.
◆ Local Password : changing alarm settings, arrhythmia settings, and reviewing data of the current patient are password protected. The clinical password is required.
◆ User Password : changing alarm settings, arrhythmia settings, and reviewing data of discharged patients are password protected. The user name and password saved in the MLDAP server are required.
From the Maintenance area, selecting Modify Local Password can change the monitor’s password for accessing the Maintenance dialog.
From the Clinical Setting area, selecting Modify Local Password can change the monitor’s password for accessing alarm settings, arrhythmia settings, and reviewing data of the current patient and discharged patients.
32.14.4
Setting the Password Timeout Period
If you use the password saved in the MLDAP server to access the Maintenance dialog, alarm settings and arrhythmia settings, you can set the password timeout period. Once the timeout period is reached, you will need to re-enter the password. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Authorization Setup tab.
3.
Set Automatic Logout Time .
32.15
32.16
Defining Other Functions
32.16.1
Setting Notch Filter Frequency
Set notch filter frequency according to the power line frequency of your country. To set notch filter frequency, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Other tab.
3.
Set Notch Frequency to 50 Hz or 60 Hz according to the power line frequency.
32.16.2
Setting Mouse Sensitivity
The mouse sensitivity is adjustable. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
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2.
Select the Other tab.
3.
Set Mouse Sensitivity .
32.16.3
Setting the Manual Event Edit Switch
You can set whether selecting and editing the name of a manual event is allowed. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Other tab.
3.
Switch on or off Manual Event Edit .
32.16.4
Setting the SpO
2
Tone Mode
The monitor adjusts the QRS tone (pitch tone) according to the SpO
2
values. To set the SpO
2
tone mode, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Other tab.
3.
Set SpO2 Tone to Mode 1 or Mode 2 . The pitch changes more rapidly in Mode 2 than in Mode 1, as saturation levels change.
The SpO
2
tone mode chart for SpO
2
between 40% to 100% is as follows:
CAUTION
•
It is highly recommended to use the same SpO
2
tone mode for the same monitors in a single area to prevent issues arising from inconsistent operation.
32.16.5
Selecting the Language
To set the user interface (UI) language, follow this procedure:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Other tab
3.
Set Language .
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32.16.6
Switching On or Off a Parameter
If there is no Parameters On/Off tab in the Screen Setup dialog then setting parameter switches is password protected. Follow this procedure to set parameter switches:
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
2.
Select the Other tab.
3.
Select Parameters On/Off .
4.
Enable or disable desired parameters.
When a parameter is switched off, the monitor stops data acquisition and alarming for this measurement.
NOTE
•
When a parameter is manually switched off and the corresponding parameter module is plugged in, you cannot monitor this parameter.
32.16.7
Setting If Setting Parameter Switches is Protected
You can set whether setting parameter switches is password protected. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Other tab.
3.
Switch on or off Parameters On/Off Protected .
32.16.8
Setting If Parameter Switch is Influenced by Configuration
You can set if the settings of parameter switches are influenced by loading a configuration. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password
→ select .
2.
Select the Other tab.
3.
Switch on or off Parameters On/Off Config Influenced .
32.16.9
Setting Whether the Monitor Stands by if MPM module is Removed
You can set whether the monitor enters the Standby mode if the MPM module, including the N1 and T1, is removed from the monitor. To do so, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Other tab.
3.
Set Auto Standby after MPM Module Removed . If Off is selected, the monitor does not enter the standby mode if the MPM module is removed.
32.16.10 Browsing System Log
To browse the system log, follow this procedure:
1.
Select the Main Menu quick key
→
from the System column select Maintenance
→
input the required password → select .
2.
Select the Other tab.
3.
Select Browse System Log to enter the System Log page.
4.
Select the log classifications you want to view, and then select Search . To view logs of certain date and time, select Jump To and define the date and time.
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32.16.11 Exporting System Log
To export the system log, follow this procedure:
1.
For N17/N15/N12, connect the USB drive to the monitor’s USB connector. For N22/N19, connect the USB drive to the monitor’s MSB connector.
2.
Select the Main Menu quick key → from the System column select Maintenance → input the required password
→ select .
3.
Select the Other tab.
4.
Select Export System Log .
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33
Battery
33.1
Battery Introduction
This monitor is designed to operate on battery power when the mains power is not available. The monitor uses mains power as primary power source. In case of mains power failure, the monitor automatically runs on the battery power.
NOTE
•
If the mains power fails and the monitor runs on battery power, the display brightness automatically lowers to the value of Brightness on Battery (set in Screen Setup
→
Display). You can manually adjust the display brightness as required.
33.2
Battery Safety Information
WARNING
•
Keep batteries out of the reach of children.
•
Use only Mindray specified batteries. Use of a different battery may present a risk of fire or explosion.
•
Keep the batteries in their original package until you are ready to use them.
•
Do not expose batteries to liquid.
•
Do not crush, drop or puncture the battery. Mechanical abuse can lead to internal damage and internal short circuits. If a battery has been dropped or banged against a hard surface, whether damage is externally visible or not, remove the battery from use and dispose of it properly.
•
If the battery shows signs of damage or signs of leakage, replace it immediately. Use caution in removing the battery. Avoid contacting the leakage.
•
Batteries should be charged only in this monitor.
•
Extremely high ambient temperature may cause battery overheat protection, resulting in monitor shutdown.
•
The lithium-ion battery has a service life of two years (for N22/N19) or three years (for N17/N15/
N12). Replace the battery when it reaches the end of its service life. Failure to replace the battery may cause serious damage to the equipment from battery overheating.
•
Do not open batteries, heat batteries above 60 °C, incinerate batteries, or short battery terminals.
They may ignite, explode, leak or heat up, causing personal injury.
CAUTION
•
Remove the battery before shipping the monitor or when it will not be used for an extended period of time.
•
When the monitor runs on battery power, the monitor may automatically shutdown due to high power consumption if too many external modules are connected.
•
For N22/N19, the battery run time is about one hour. Connect the mains power as long as the mains power is available.
•
Use only the AC mains to power the monitor when the iView system is in use.
33.3
Installing or Replacing the Battery
No battery is installed when the monitor is shipped from the factory.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 33 - 1
For N22/N19, the battery must only be installed or replaced by service personnel trained and authorized by
Mindray.
For N12, to install the battery, follow this procedure:
1.
Turn off the monitor. Disconnect the power cable and other cables.
2.
Place the monitor on the worktable with monitor face down. Ensure that the worktable is free of dirt and debris where the monitor face will rest to reduce risk of damage to the monitor screen.
3.
If the monitor is installed on a mounting arm, remove the monitor from the mounting arm and remove any mounting plates.
4.
Open the battery door as indicated by Figure 1 below.
5.
Turn the latch aside.
6.
Insert the battery into the battery compartment with the battery terminal inwards. Turn the latch back to the middle as indicated by Figure 2 below. To replace the battery, remove the old battery and insert a new one.
7.
Close the battery door.
Figure 1
Figure 2
For N17/N15, to install the battery, follow this procedure:
1.
Turn off the monitor. Disconnect the power cable and other cables.
2.
Place the monitor on the worktable with monitor face down.
3.
If the monitor is installed on a mounting arm, remove the monitor from the mounting arm and remove any mounting plates.
4.
Pull up the battery door to open the battery compartment as indicated by Figure 1 below.
5.
Insert the battery into the battery compartment. Push the battery downwards till the battery terminal is plugged into the battery connector as indicated by Figure 2 below. To replace the battery, remove the old battery and insert a new one.
6.
Close the battery door.
Figure 1
Figure 2
33.4
Battery Indications
The battery LED, on-screen battery power indicator, and related alarm messages indicate the battery status.
33.4.1
Battery LED
The battery LED indications are as follows:
33 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■
■
■
■
Green: the battery is fully charged.
Yellow: the battery is being charged.
Flashing green: the monitor is running on battery power.
Off: no battery is installed, or the battery malfunctioned, or the AC mains is not connected when the monitor is powered off.
33.4.2
Battery symbols
The on-screen battery symbols indicate the battery status as follows:
■
■
■
■
■ indicates that the battery is working correctly. The green portion represents the remaining charge.
indicates that the battery power is low and needs to be charged.
indicates that the battery is almost depleted and needs to be charged immediately. Otherwise, the monitor will automatically shut down soon.
indicates that the battery is being charged.
indicates that no battery is installed or the battery has failed.
33.4.3
Battery-related Alarms
The capacity of the battery is limited. When the battery level is low, the monitor presents the Low Battery alarm, the alarm lamp flashes, and the monitor produces an alarm sound.
If the battery is almost depleted, the monitor presents the Critically Low Battery alarm. In this case, immediately connect the AC mains to power the monitor and charge the battery. Otherwise, the monitor will automatically shut down soon.
For N22/N19, if the battery is aged, the Battery Service Required alarm is presented each time the monitor is turned on, indicating that the battery has reached its lifetime.
For more information on battery-related alarms, see Appendix D Alarm Messages .
33.5
Charging the Battery
The battery is recharged automatically when the monitor is connected to AC mains power.
33.6
Maintaining the Battery
33.6.1
Conditioning the Battery
The performance of batteries deteriorates over time. For N22/N19, you should condition the batteries periodically or when you notice a degradation in performance. If the battery is not conditioned for a prolonged time, its charge indication may not be accurate and you may wrongly evaluate the remaining battery runtime.
To condition a battery, follow this procedure:
1.
Disconnect the monitor from the patient and stop all monitoring and measuring procedures.
2.
Turn off the monitor, and connect the monitor to the external power source.
3.
Allow the battery to be charged uninterruptedly until it is fully charged.
4.
Disconnect the monitor from the external power source, and turn on the monitor.
5.
Allow the monitor to run on the battery until the battery is completely depleted and the monitor automatically shuts down.
6.
Fully charge the battery again for use or charge it to 40 - 60% for storage.
NOTE
•
Do not use the monitor to monitor a patient during battery conditioning.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 33 - 3
•
Do not interrupt battery conditioning. Interrupting battery conditioning to use the monitor will prevent completion of the conditioning cycle and require repeating the conditioning process completely to properly condition the battery.
33.6.2
Checking Battery Performance
The performance of a rechargeable battery deteriorates over time. You should check the battery performance periodically or if you are concerned that the battery may fail.
See steps 1 to 5 of 33.6.1 Conditioning the Battery
to check battery performance. The operating time of the batteries reflects their performance directly. If the operating time of a battery is noticeably shorter than that stated in the specifications, the battery may have reached its service life or be malfunctioning. If the battery performance meets the requirement, fully charge the battery again for use or charge it to 40 - 60% for storage.
NOTE
•
Battery operating time depends on equipment configuration and operation. For example, high display brightness or measuring NIBP repeatedly will shorten the battery operating time.
33.7
Storing Batteries
When storing batteries, make sure that the battery terminals do not come into contact with metallic objects. If batteries are stored for an extended period of time, place the batteries in a cool place with a partial charge of
40% to 60% capacity.
NOTE
•
Remove the battery from the equipment if the equipment is not used for a prolonged time (for example, several weeks). Otherwise the battery may overdischarge.
•
Storing batteries at high temperature for an extended period of time will significantly shorten their life expectancy.
•
Storing batteries in a cool place can slow the aging process. Ideally the batteries should be stored at
15 °C.
33.8
Recycling Batteries
Discard a battery in the following situations:
■
■
■
■
The battery has visual signs of damage.
The battery fails.
The battery is aged and its runtime significantly less than the specification.
The battery service life is reached.
Properly dispose of batteries according to local regulations.
WARNING
•
Do not open batteries, heat batteries above 60 °C, incinerate batteries, or short the battery terminals. They may ignite, explode, leak or heat up, causing personal injury.
33 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
34
Care and Cleaning
34.1
Care and Cleaning Introduction
■
■
■
■
■
In this chapter we only describe cleaning and disinfection of the main unit, modules, satellite module rack (SMR) and certain accessories. For the cleaning and disinfection of other reusable accessories, refer to their instructions for use of the corresponding accessories.
Keep your equipment and accessories clean. To avoid damage to the equipment, follow these guidelines:
Always follow the manufacturer’s instructions for each cleaning / disinfecting agent.
Do not immerse any part of the equipment or accessories into liquid.
Do not pour liquid onto the equipment or accessories.
Do not allow liquid to enter the case.
Never use abrasive materials (such as steel wool or silver polish), or erosive cleaners (such as acetone or acetone-based cleaners).
34.2
Care and Cleaning Safety Information
WARNING
•
Be sure to turn off the system and disconnect all power cables from the outlets before cleaning the equipment.
CAUTION
•
If you spill liquid on the equipment or accessories, contact Mindray or your service personnel.
•
Avoid wetting the pins and metal parts of the equipment, mounting kits or accessories during cleaning and disinfection.
•
Use only Mindray approved cleaners and disinfectants and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by unapproved substances or methods.
•
We make no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. For the method to control infection, consult your hospital’s Infection Control
Officer or Epidemiologist.
•
The responsible hospital or institution shall carry out all cleaning and disinfection procedures specified in this chapter.
•
Refer to the respective instructions for use of the cleaning agents and disinfectants.
•
Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.
NOTE
•
To clean or disinfect reusable accessories, refer to the instructions delivered with the accessories.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 34 - 1
34.3
Cleaning and Disinfecting the Equipment and Mounting Kits
Use approved cleaning and disinfecting agents for cleaning or disinfecting the main unit, parameter modules, and SMR.
34.3.1
Approved Cleaning and Disinfecting Agents
The following table lists approved cleaning and disinfecting agents:
:
Product Name Product Type Active Ingredients
Liquid Sodium hypochlorite bleach
Hydrogen peroxide
Isopropanol
1-Propanol
Metrex CaviCide1™
Virex® II 256 (1:256)
Virex® TB
Rely+OnTM Virkon® High Level
Surface Disinfectant
Alpet® D2 Surface Sanitizing
Wipes
Powder
Wipes
Sodium hypochlorite bleach 0.5%
Hydrogen peroxide 3%
Isopropanol 70%
1-Propanol 50%
Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%,
Isopropanol 17.2%
Didecyl dimethyl ammonium chloride 8.704%, n-Alkydimethyl benzyl ammonium chloride 8.190% n-Alkyl dimethyl benzyl ammonium chlorides 0.105%, n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.105%
Used as 1% solution
Biocidal active:
Pentapotassium bis (peroxymonosulphate) bis (sulphate)(500g/ kg),
Contains dipotassium peroxodisulphate.
Isopropyl Alcohol 58.6000%,
Octyl Decyl Dimethyl Ammonium chloride 0.0075%,
Dioctyl Dimethyl Ammonium Chloride 0.0030%
Sodium Hypochlorite 0.65% Clorox Dispatch® Hospital
Cleaner Disinfectant Towels with
Bleach
Clorox Healthcare® Bleach
Germicidal Wipes
Clorox Healthcare® Hydrogen
Peroxide Cleaner Disinfectant
Wipes
Diversey Oxivir® TB Wipes
Metrex CaviWipes™
Sodium Hypochlorite 0.55%
Hydrogen Peroxide 1.4%
Hydrogen Peroxide 0.5%
Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%,
Isopropanol 17.2% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.14%, n-Alkyl dimethyl benzyl ammonium chlorides 0.14%
Sodium Hypochlorite 0.63%,other ingredients 99.37%
PDI Sani-Cloth® AF3 Germicidal
Disposable Wipe
PDI Sani-Cloth® Bleach
Germicidal Disposable Wipe
PDI Sani-Cloth® HB Germicidal
Disposable Wipe
PDI Sani-Cloth® Plus Germicidal
Disposable Cloth
PDI Super Sani-Cloth® Germicidal
Disposable Wipe n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.07%, n-Alkyl dimethyl benzyl ammonium chlorides 0.07% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.125%, n-Alky dimethyl benzyl ammonium chlorides 0.125% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.25%, n-Alkyl dimethyl benzyl ammonium chlorides 0.25%,
Isopropyl Alcohol 55.0%
34 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Product Name
VIRAGUARD Hospital Surface
Disinfectant Towelettle
Product Type
Wipes
Active Ingredients
Isopropanol 70%,
Other ingredients 30%
NOTE
•
For equipment with the symbol , all the listed cleaning and disinfecting agents are available for use.
34.3.2
Cleaning the Equipment and Mounting Kits
The main unit, parameter modules, and SMR should be cleaned on a regular basis. Before cleaning the equipment and mounting kits, consult your hospital’s regulations for cleaning the equipment.
To clean your equipment, follow this procedure:
1.
Shut down the monitor and disconnect it from the AC power.
2.
Clean the display screen with wipes or a soft cloth moistened with one of the cleaning agents listed in
34.3.1 Approved Cleaning and Disinfecting Agents only.
3.
Clean the exterior surface of the equipment, module, and SMR with wipes or a soft cloth moistened with
one of the cleaning agents listed in 34.3.1 Approved Cleaning and Disinfecting Agents
only.
4.
Wipe off all the cleaning agent residue with a dry cloth.
5.
Dry your equipment in a ventilated, cool place.
34.3.3
Disinfecting the Equipment and Mounting Kits
Disinfect the main unit, parameter modules, and SMR as required in your hospital’s servicing schedule using the disinfecting agents listed in the table above. Cleaning equipment before disinfecting is recommended.
CAUTION
•
Never use EtO or formaldehyde for disinfection.
34.4
Cleaning and Disinfecting the Accessories
For the NIBP air hose, SpO
2
cable, and NMT accessories, you should clean and disinfect them using the cleaners and disinfectants and methods listed in this section. For other accessories, you should consult the instructions delivered with the accessories.
CAUTION
•
Fluids entering the NIBP air hose can damage the equipment. When cleaning and/or disinfecting the
NIBP air hose, prevent liquid from entering the hose.
•
Periodically inspect the NIBP air hose and connector for signs of wear or deterioration. Replace the
NIBP air hose if you detect a leak. Dispose of damaged NIBP air hose according to local laws for disposal of hospital waste.
•
Never immerse or soak the accessories in any liquid.
•
Never clean or disinfect the metalic connectors at either end of the accessories.
•
Use only Mindray approved cleaners and disinfectants and methods listed in this section to clean or disinfect the accessories. Warranty does not cover damage caused by unapproved substances or methods.
•
To avoid long term damage, the accessories should be disinfected only when necessary as determined by your hospital’s policy.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 34 - 3
34.4.1
Approved Accessories Cleaning and Disinfecting Agents
The following table lists approved NIBP air hose cleaning and disinfecting agents:
:
Product Name Product Type Active Ingredients
Isopropanol
1-Propanol
Metrex CaviCide1™
Virex® TB
Rely+OnTM Virkon® High Level
Surface Disinfectant
Alpet® D2 Surface Sanitizing
Wipes
Liquid
Powder
Wipes
Isopropanol 70%
1-Propanol 50%
Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%,
Isopropanol 17.2% n-Alkyl dimethyl benzyl ammonium chlorides 0.105%, n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.105%
Used as 1% solution
Biocidal active:
Pentapotassium bis (peroxymonosulphate) bis (sulphate)(500g/ kg),
Contains dipotassium peroxodisulphate.
Isopropyl Alcohol 58.6000%,
Octyl Decyl Dimethyl Ammonium chloride 0.0075%,
Dioctyl Dimethyl Ammonium Chloride 0.0030%
Sodium Hypochlorite 0.65% Clorox Dispatch® Hospital
Cleaner Disinfectant Towels with
Bleach
Metrex CaviWipes™
PDI Sani-Cloth® AF3 Germicidal
Disposable Wipe
PDI Sani-Cloth® Plus Germicidal
Disposable Cloth
PDI Super Sani-Cloth® Germicidal
Disposable Wipe
VIRAGUARD Hospital Surface
Disinfectant Towelettle
Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%,
Isopropanol 17.2% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.14%, n-Alkyl dimethyl benzyl ammonium chlorides 0.14% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.125%, n-Alky dimethyl benzyl ammonium chlorides 0.125% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.25%, n-Alkyl dimethyl benzyl ammonium chlorides 0.25%,
Isopropyl Alcohol 55.0%
Isopropanol 70%,
Other ingredients 30%
:
The following table lists approved Masimo SpO
2
cable cleaning and disinfecting agents:
Product Name Product Type Active Ingredients
Isopropanol Liquid Isopropanol 70%
34 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
:
The following table lists approved Nellcor SpO
2
cable cleaning and disinfecting agents:
Product Name Product Type Active Ingredients
Liquid Sodium hypochlorite bleach
Isopropanol
1-Propanol
Virex® TB
Rely+OnTM Virkon® High Level
Surface Disinfectant
Powder
Sodium hypochlorite bleach 0.5%
Isopropanol 70%
1-Propanol 50% n-Alkyl dimethyl benzyl ammonium chlorides 0.105%, n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.105%
Used as 1% solution
Biocidal active:
Pentapotassium bis (peroxymonosulphate) bis (sulphate)(500g/ kg),
Contains dipotassium peroxodisulphate.
Sodium Hypochlorite 0.65% Clorox Dispatch® Hospital
Cleaner Disinfectant Towels with
Bleach
Clorox Healthcare® Bleach
Germicidal Wipes
Clorox Healthcare® Hydrogen
Peroxide Cleaner Disinfectant
Wipes
Diversey Oxivir® TB Wipes
PDI Super Sani-Cloth® Germicidal
Disposable Wipe
Wipes
VIRAGUARD Hospital Surface
Disinfectant Towelettle
Sodium Hypochlorite 0.55%
Hydrogen Peroxide 1.4%
Hydrogen Peroxide 0.5% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.25%, n-Alkyl dimethyl benzyl ammonium chlorides 0.25%,
Isopropyl Alcohol 55.0%
Isopropanol 70%,
Other ingredients 30%
:
The following table lists approved NMT accessory cleaning and disinfecting agents:
Product Name Product Type Active Ingredients
Liquid Sodium hypochlorite bleach
Isopropanol
1-Propanol
Metrex CaviCide1™
Virex® TB
Rely+OnTM Virkon® Powder
(Used as 1% solution)
Powder
Sodium hypochlorite bleach 0.5%
Isopropanol 70%
1-Propanol 50%
Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%,
Isopropanol 17.2% n-Alkyl dimethyl benzyl ammonium chlorides 0.105%, n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.105%
Used as 1% solution
Biocidal active:
Pentapotassium bis (peroxymonosulphate) bis (sulphate)(500g/ kg),
Contains dipotassium peroxodisulphate.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 34 - 5
Product Name
Alpet® D2 Surface Sanitizing
Wipes
Clorox Dispatch® Hospital
Cleaner Disinfectant Towels with
Bleach
Clorox Healthcare® Bleach
Germicidal Wipes
Clorox Healthcare® Hydrogen
Peroxide Cleaner Disinfectant
Wipes
Diversey Oxivir® TB Wipes
Metrex CaviWipes™
PDI Sani-Cloth® AF3 Germicidal
Disposable Wipe
PDI Sani-Cloth® Bleach
Germicidal Disposable Wipe
PDI Sani-Cloth® Plus Germicidal
Disposable Cloth
PDI Super Sani-Cloth® Germicidal
Disposable Wipe
VIRAGUARD Hospital Surface
Disinfectants
Product Type
Wipes
Active Ingredients
Isopropyl Alcohol 58.6000%,
Octyl Decyl Dimethyl Ammonium chloride 0.0075%,
Dioctyl Dimethyl Ammonium Chloride 0.0030%
Sodium Hypochlorite 0.65%
Sodium Hypochlorite 0.55%
Hydrogen Peroxide 1.4%
Hydrogen Peroxide 0.5%
Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%,
Isopropanol 17.2% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.14%, n-Alkyl dimethyl benzyl ammonium chlorides 0.14%
Sodium Hypochlorite 0.63%,other ingredients 99.37% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.125%, n-Alky dimethyl benzyl ammonium chlorides 0.125% n-Alkyl dimethyl ethylbenzyl ammonium chlorides 0.25%, n-Alkyl dimethyl benzyl ammonium chlorides 0.25%,
Isopropyl Alcohol 55.0%
Isopropanol 70%,
Other ingredients 30%
34.4.2
Cleaning the Accessories
You should clean the accessories (NIBP air hose, Masimo SpO
2
cable, Nellcor SpO
2
cable and NMT accessories) on a regular basis. Before cleaning the accessories, consult your hospital’s regulations for cleaning the accessories.
To clean the accessories, follow this procedure:
1.
Clean the accessories with wipes or a soft cloth moistened with one of the cleaning agents listed in
34.4.1 Approved Accessories Cleaning and Disinfecting Agents
only.
2.
Wipe off all the cleaning agent residue with a dry cloth.
3.
Allow the accessories to air dry.
34.4.3
Disinfecting the Accessories
We recommend that the accessories (NIBP air hose, SpO
2
cables, and NMT accessories) should be disinfected only when necessary as determined by your hospital’s policy, to avoid long term damage to the accessories.
Cleaning the accessories before disinfecting is recommended.
34.5
Sterilization
Sterilization is not recommended for this equipment, related products, accessories, or supplies unless otherwise indicated in the Instructions for Use that accompany the products, accessories or supplies.
34 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
35
Maintenance
35.1
Maintenance Introduction
Regular maintenance is essential to ensure that the equipment continues to function properly. This chapter contains information on periodic testing and maintenance.
35.2
Maintenance Safety Information
WARNING
•
To avoid electric shock, stop using the equipment if you find the housing is damaged, and contact the service personnel.
•
Failure on the part of the responsible individual hospital or institution using this equipment to implement a recommended maintenance schedule may cause undue equipment failure and possible health hazards.
•
No modification of this equipment is allowed.
•
This equipment contains no user serviceable parts.
•
Software upgrades to the monitor can only be done by Mindray service engineers with Mindray upgrading tools.
•
The safety checks or maintenance involving any disassembly of the equipment should be performed by professional service personnel. Otherwise, undue equipment failure and possible health hazards could result.
•
Do not open batteries, heat batteries to above 60 °C, incinerate batteries, or short the battery terminals. Batteries may ignite, explode, leak or heat up, causing personal injury.
•
The service personnel must be properly qualified and thoroughly familiar with the operation of the equipment.
CAUTION
•
The equipment and accessories shall not be serviced or maintained while in use on a patient.
•
If you discover a problem with any of the equipment, contact your service personnel or Mindray.
•
Use and store the equipment within the specified temperature, humidity, and altitude ranges.
•
When disposing of the packaging material, be sure to observe the applicable waste control regulations and keep it out of the reach of children.
•
At the end of its service life, the equipment, as well as its accessories, must be disposed of in compliance with the guidelines regulating the disposal of such products. If you have any questions concerning disposal of the equipment, please contact Mindray.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 35 - 1
35.3
Maintenance and Testing Schedule
Follow the maintenance and testing schedule or local regulations to perform testing and maintenance such as defined in section
35.5 Testing Methods and Procedures
. Follow your hospital policy on cleaning and disinfecting the equipment before testing and maintenance.
The following table lists the maintenance and testing schedule:
Test/Maintenance Item
Performance Tests
Visual inspection
Measurement module performance test and calibration
Analog output test
Defibrillation synchronization test
Nurse call test
Electrical Safety Tests
Electrical safety tests
Other Tests
Power-on test
NMT sensor check
Recorder check
Network printer tests
Device integration check
Battery check Functionality test
Performance test
Recommended Frequency
Every day, before first use.
1. If you suspect that the measurement values are incorrect.
2. Follow any repairs or replacement of relevant module.
3. Once a year for CO
2
and AG tests.
4. Once every two years for other parameter module performance tests.
If you suspect that the analog output function does not work properly.
If you suspect that the defibrillation synchronization function does not work properly.
If you suspect that the nurse call function does not work properly.
Once every two years.
Before use
Once a year.
1. When the recorder is used for the first time.
2.Follow any repair or replacement of the recorder.
1. When first installed.
2.Follow any repair or replacement of the printer.
1. When first installed.
2. Following any repair or replacement of the external device.
1. When first installed.
2. When battery is replaced.
Every three months or if the battery runtime is reduced significantly.
35.4
Checking System Software Version
To view system software version information, select the Main Menu quick key
→
from the System column select
Version .
You can check the detailed system software version, module hardware and software version, and firmware version only from the Maintenance dialog.
35.5
Testing Methods and Procedures
■
■
Except for the following maintenance tasks, all other test and maintenance tasks should be performed by
Mindray-qualified service personnel only.
Regular checks, including visual inspection and power-on test
NMT sensor check
35 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
■
■
Printer and recorder tests
Battery check
If your monitor needs a safety test and performance test, contact the service personnel.
35.5.1
Performing Visual Inspection
Visually inspect the equipment before its first use every day. If you find any signs of damage, remove the monitor from use and contact the service personnel.
Verify that the equipment meets the following requirements:
■
■
■
■
■
Environment and power supply specifications are met.
The monitor housing and display screen are free from cracks or other damage.
The power cord is not damaged and the insulation is in good condition.
Connectors, plugs, and cables are not damaged or kinked.
Power cord and patient cables are securely connected to the equipment and modules.
35.5.2
Performing Power-on Test
The monitor automatically performs a power-on test at startup. Verify the following items for the power-on test:
■
■
■
The equipment powers on properly.
The alarm system works properly, denoted by alarm sounds and display of all 3 alarm light colors.
The monitor displays properly.
35.5.3
Checking the NMT Sensor
NMT sensor check is required once a year or when you doubt the measured values.
To calibrate the NMT sensor,
1.
Select the Main Menu quick key → from the System column select Maintenance → input the required password → select .
2.
Select the Module tab → NMT tab.
3.
Follow the on-screen instructions to check the NMT sensor in four ways.
If sensor check completes successfully, the message “Test passed. The function of NMT sensor is OK” is presented. If any of the four steps fails, check if the sensor is placed correctly as instructed and perform the sensor check again. Replace the sensor or contact your service personnel if it cannot pass the sensor check.
NOTE
•
Stop NMT measurement or calibration before starting an NMT sensor check.
•
Take care when handling the NMT sensor. Avoid forceful strikes to the sensor.
35.5.4
Testing the Recorder
To test the recorder, follow this procedure:
1.
Start a recording task to print waveforms and reports.
2.
Check that the recorder functions correctly.
3.
Check that the printout is clear without missing dots.
35.5.5
Testing the Network Printer
To check the printer, follow this procedure:
1.
Start a printing task to print waveforms and reports.
2.
Check that the printer is properly connected and functions correctly.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 35 - 3
3.
Check that the printout is clear with no missing information.
35.5.6
Checking the Battery
For information on battery check, see 33.6.2 Checking Battery Performance
.
35.6
NIBP Maintenance
35.6.1
NIBP Leakage Test
The NIBP leakage test checks the integrity of the system and of the valve. The NIBP leakage test should be performed once every two years or when you doubt the NIBP measurements. The NIBP leakage test should be performed by Mindray-qualified service personnel only.
35.6.2
NIBP Accuracy Test
The NIBP accuracy test should be performed once every two years or when you doubt the NIBP measurements.
The NIBP accuracy test should be performed by Mindray-qualified service personnel only.
35.7
Disposing of the Monitor
Dispose of the monitor and its accessories when its service life is reached. Follow local regulations regarding the disposal of such product.
WARNING
•
For disposal of parts and accessories, where not otherwise specified, follow local regulations regarding disposal of hospital waste.
35 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
36
Accessories
The accessories listed in this chapter comply with the requirements of IEC 60601-1-2 when in use with the patient monitor. The accessory material that contacts the patients has undertaken the bio-compatibility test and is verified to be in compliance with ISO 10993-1. For details about the accessories, refer to the instructions for use provided with the accessory.
WARNING
•
Use accessories specified in this chapter. Using other accessories may cause damage to the patient monitor or not meet the claimed specifications.
•
Single-use accessories are not designed to be reused. Reuse may cause a risk of contamination and affect the measurement accuracy.
CAUTION
•
The accessories may not meet the performance specifications if stored or used outside the specified temperature and humidity ranges. If accessory performance is degraded due to aging or environmental conditions, contact your service personnel.
•
Check the accessories and their packages for any sign of damage. Do not use them if any damage is detected.
•
Use the accessories before the expiration date if an expiration date is indicated.
•
Discard disposable accessories according to hospital regulations.
NOTE
•
This manual describes all the accessories that are validated for use. Not all accessories are available in every market.
36.1
ECG Accessories
36.1.1
ECG Electrodes Available for Purchase
Model Part No.
31499224 0010-10-12304
1050NPSMKittycat 0681-00-0098-01
1051NPSMKittycat 0681-00-0098-02
Description
Electrode, Kendall, pkg of 10
NEO pre-wired electrode radio
Opaque, pkg of 100
NEO pre-wired electrode radio
Translucent, pkg of 100
36.1.2
ECG Electrodes Also Compatible
Model
2245-50
Part No.
9000-10-07469
Description
ECG electrode, 3M, pkg of 50
Usage
Disposable
Disposable
Disposable
Applicable patient
Adult
Neonate
Neonate
Usage
Disposable
Applicable patient
Pediatric
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 1
36.1.3
12-Pin Trunk Cables Available for Purchase
Model
EV6206
EV6207
EV6216
EV6217
EV6208
EV6202
EV6212
EV6222
Part No.
009-005266-00
009-005267-00
009-005268-00
009-005269-00
040-003528-00
0010-30-42720
0010-30-42724
040-000754-00
Description
ECG cable, 10' (3.1 m), defibrillation-proof, for N/T
ECG cable, 20' (6.2 m), defibrillation-proof, for N/T
ECG cable, 10' (3.1 m), ESU-proof, for N/T
ECG cable, 20' (6.2 m), ESU-Proof , for N/T
ECG cable, 10' (3.1 m), 12-lead, defibrillation-proof, for N/T 5-lead leadwires
12Pin 3-Lead ECG trunk cable, defibrillation-proof
12Pin 3-Lead ECG trunk cable, ESUproof
12Pin 3-Lead trunk cable, defibrillation-proof, DIN Conn
Usage
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Note: 040-003528-00 uses 5-Lead N/T leadwires for the limb leads.
36.1.4
12-Pin Trunk Cables Also Compatible
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Pediatric/Neonate
Pediatric/Neonate
Pediatric/Neonate
/
/
Model
EV6201
EV6203
EV6211
Part No.
0010-30-42719
0010-30-42721
0010-30-42723
040-001416-00
009-003652-00
Description
12Pin 3/5-Lead ECG trunk cable, defibrillation-proof
12Pin 12-Lead trunk cable, defibrillation-proof
12Pin 3/5-Lead ECG trunk cable,
ESU-proof
12Pin 3/5-Lead ECG trunk cable, defibrillation-proof
12Pin 3/5-Lead ECG trunk cable,
ESU-proof
Usage
Reusable
Reusable
Reusable
Reusable
Reusable
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
36.1.5
3-lead ECG Leadwires Available for Purchase
Model
EY6316B
EY6305B
EY6316A
EY6305A
EY6310B
EY6310B
EL6305A
Part No.
009-004765-00
009-004766-00
009-004771-00
009-004772-00
009-004777-00
115-032954-00
0010-30-42896
Description
3-Lead, N/T, AHA, snap, 24’’
3-Lead, N/T, AHA, snap, 36’’
3-Lead, N/T, AHA, clip, 24’’
3-Lead, N/T, AHA, clip, 36’’
3-Lead, N/T, AHA, snap, 24’’
3-Lead, N/T, AHA, snap, 24’’, pkg of
20
3-Lead leadset, AHA, clip Reusable
Usage
Reusable
Reusable
Reusable
Reusable
Disposable
Disposable
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Neonate
36 - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Model
EL6311B
EL6311A
Part No.
040-000146-00
040-000148-00
Description
3-Lead leadset, AHA, snap
3-Lead leadset, AHA, clip
Usage
Disposable
Disposable
36.1.6
3-lead ECG Leadwires Also Compatible
Model
EL6303A
EL6301B
/
/
/
/
Part No.
0010-30-42731
0010-30-42734
0012-00-1503-05
0012-00-1503-06
0012-00-1514-05
0012-00-1514-06
Description Usage
3-Lead leadset, AHA, clip, Long
3-Lead leadset, AHA, snap
3-Lead leadset, snap, 24" (61.0 cm),
AAMI
3-Lead leadset, snap, 36" (101.6 cm), AAMI
3-Lead leadset, clip, 24" (61.0 cm),
AAMI
3-Lead leadset, clip, 36" (101.6 cm),
AAMI
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
36.1.7
5-lead ECG Leadwires Available for Purchase
Applicable patient
Pediatric/Neonate
Pediatric/Neonate
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Model
EY6511B
EY6512B
EY6511A
EY6512A
EY6507B
EY6507B
Part No.
009-004782-00
009-004783-00
009-004786-00
009-004787-00
009-004790-00
115-032955-00
Description
5-Lead, N/T, AHA, snap, 24’’
5-Lead, N/T, AHA, snap, 36’’
5-Lead, N/T, AHA, pinch, 24’’
5-Lead, N/T, AHA, pinch, 36’’
5-Lead, N/T, AHA, snap, 24’’
5-Lead, N/T, AHA, snap, 24’’, pkg of
20
Usage
Reusable
Reusable
Reusable
Reusable
Disposable
Disposable
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
36.1.8
5-lead ECG Leadwires Also Compatible
/
/
Model
EL6503A
EL6501B
EL6501A
/
/
Part No.
0010-30-42729
0010-30-42735
0010-30-42727
0012-00-1503-02
0012-00-1503-03
0012-00-1514-02
0012-00-1514-03
Description Usage
5-Lead leadset, AHA, clip, Long
5-Lead leadset, AHA, snap
5-Lead leadset, AHA, clip
5-Lead leadset, snap, 24" (61.0 cm),
AAMI
5-Lead leadset, snap, 36" (101.6 cm), AAMI
5-Lead leadset, clip, 24" (61.0 cm),
AAMI
5-Lead leadset, clip, 36" (101.6 cm),
AAMI
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 3
36.1.9
6-lead ECG Leadwires Available for Purchase
Model
EY6601B
EY6602B
EY6601A
EY6602A
Part No.
009-004794-00
009-004795-00
009-004798-00
009-004799-00
Description
6-Lead, N/T, AHA, snap, 24’’
6-Lead, N/T, AHA, snap, 36’’
6-Lead, N/T, AHA, pinch, 24’’
6-Lead, N/T, AHA, pinch, 36’’
36.1.10
12-lead ECG Chest Leadwires Available for Purchase
Usage
Reusable
Reusable
Reusable
Reusable
Model
EL6803A
EL6803B
Part No.
0010-30-42904
0010-30-42908
Description
12-Lead leadset, chest, AHA, clip
12-Lead leadset, chest, AHA, snap
Usage
Reusable
Reusable
36.1.11
12-lead ECG Leadwires Also Compatible
Applicable patient
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Adult/Pediatric
Applicable patient
Adult/Pediatric
Adult/Pediatric
Model
EL6801A
EL6801B
Part No.
0010-30-42902
0010-30-42906
Description
12-Lead leadset, limb, AHA, clip
12-Lead leadset, limb, AHA, snap
Usage
Reusable
Reusable
36.2.2
Extension Cables and Adapter Cables Also Compatible
Model
582A
Part No.
115-020768-00
Description
8-pin SpO2 extension cable, Masimo
Usage
Reusable
Applicable patient
Adult/Pediatric
Adult/Pediatric
36.2
SpO
2
Accessories
Wavelength emitted by the sensors is between 600 nm and 1000 nm. The maximum photic output consumption of the sensor is less than 18 mW.
The information about the wavelength range and maximum photic output consumption can be especially useful to clinicians, for example, when photodynamic therapy is performed.
36.2.1
Extension Cables and Adapter Cables Available for Purchase
Model
572A
583A
4089
4092
Part No.
0010-20-42712
040-003310-00
040-003381-00
040-003426-00
Description
8-pin SpO2 extension cable, Nellcor
8 pin, RD SET, Masimo
RD to LNCS adapter cable, Masimo
LNCS to RD adapter, Masimo
Usage
Reusable
Reusable
Reusable
Reusable
Applicable patient
/
/
/
/
/
Applicable patient
36 - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
36.2.3
Masimo SpO
2
RD Set Sensors Available for Purchase
4002
4003
4004
4005
Model
4050
4051
4053
4000
4001
Part No.
040-003376-00
040-003377-00
040-003380-00
040-003382-00
040-003383-00
040-003384-00
040-003385-00
040-003386-00
040-003387-00
Description Usage
SpO2 sensor, RD SET DCI
SpO2 sensor, RD SET DCI
SpO2 sensor, RD Set TC-I, tip-clip ear sensor, 3ft
SpO2 sensor, RD SET Adt, adhesive, pkg of 20
SpO2 sensor, RD SET PDT, adhesive, pkg of 20
SpO2 sensor, RD Set Inf, adhesive, pkg of 20
SpO2 sensor, RD Set Neo, adhesive, pkg of 20
SpO2 sensor, RD Set NeoPt, adhesive, pkg of 20
SpO2 sensor, RD Set NeoPt-500, nonadhesive, pkg of 20
Reusable
Reusable
Reusable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Applicable patient
Adult (> 30 kg)
Pediatric (10-50 kg)
Adult (> 30 kg)
Adult (> 30 kg)
Pediatric (10 to 50 kg)
Infant (3 to 20 kg)
Neonatal /Adult
(<3Kg or >40Kg)
Neonate (<1 kg)
Neonate (<1 kg)
36.2.4
Masimo SpO
2
LNCS Sensors Also Compatible
Model Part No.
Description
LNCS Adtx
LNCS Pdtx
LNCS DCI
LNCS DCIP
LNCS NeoPt
LNCS Neo-L
0600-00-0121
0600-00-0122
0600-00-0126
0600-00-0127
0600-00-0156
0600-00-0157
SpO2 sensor, finger-clip, 20 pcs/box
SpO2 sensor, finger-clip, 20 pcs/box
SpO2 sensor, finger-clip
SpO2 sensor, finger-clip
SpO2 sensor, finger-clip
SpO2 sensor, 20 pcs/box
Usage
Disposable
Disposable
Reusable
Reusable
Disposable
Disposable
Disposable
Applicable patient
Adult (>30 kg)
Pediatric (10-50 kg)
Adult (>30 kg)
Pediatric (10-50 kg)
Neonate (<1Kg)
Neonate /Adult
(<3 kg or > 40 kg)
Infant (3-20 kg) LNCS Inf 0600-00-0158 SpO2 sensor, 20 pcs/box
36.2.5
Nellcor SpO
2
Sensors Also Compatible
Model
DS100A
D-YS
OXI-P/I
OXI-A/N
MAXAI
MAXPI
MAXII
MAXNI
Part No.
9000-10-05161
0010-10-12476
9000-10-07308
9000-10-07336
0010-10-12202
0010-10-12203
0010-10-12204
0010-10-12205
Description
SpO2 sensor, finger-clip
SpO2 sensor, with wraps
SpO2 sensor, finger, band
SpO2 sensor, finger/foot, band
SpO2 sensor, 24 pcs/box
SpO2 sensor, 24 pcs/box
SpO2 sensor, 24 pcs/box
SpO2 sensor, 24 pcs/box
Usage
Reusable
Reusable
Reusable
Reusable
Disposable
Disposable
Disposable
Disposable
Applicable patient
Adult
/
Pediatric/Infant
Adult/Neonate
Adult (>30 kg)
Pediatric (10-50 Kg)
Infant (3-20 kg)
Adult/Neonate
(<3 kg or >40 kg)
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 5
36.3
Temp Accessories
36.3.1
Temp Cable Available for Purchase
Model
MR420B
Part No.
040-001235-00
36.3.2
Temp Cable Also Compatible
Description
2-pin Temperature adapter cable
Usage
Reusable
Model
MR420B
Part No.
0011-30-37391
Description
2-pin, extension cable
36.3.3
Temp Probes Available for Purchase
Usage
Reusable
/
Applicable patient
/
Applicable patient
Model
MR401B
MR402B
MR403B
MR404B
MR411
MR411
MR412
MR412
ES400-12
ES400-18
ER400-9
ER400-12
STS-400
Part No.
0011-30-37392
0011-30-37394
0011-30-37393
0011-30-37395
040-003292-00
040-003294-00
040-003293-00
040-003295-00
0206-03-0112-02
0206-03-0118-02
0206-03-0209-02
0206-03-0212-02
0206-03-0300-02
Description Usage
Temperature probe, endocavity
Temperature probe, endocavity
Temperature probe, skin surface
Temperature probe, skin surface
Temperature probe, esophageal/ rectal, 9FR
Temperature probe, esophageal/ rectal, 9FR, pkg of 20
Reusable
Reusable
Reusable
Reusable
Disposable
Disposable
Temp probe, skin surface Disposable
Temp probe, skin surface, pkg of 20 Disposable
PROBE,D TEMP,ES400-12 (box of 20) Disposable
PROBE,D TEMP,ES400-18 (box of 20) Disposable
PROBE,D TEMP,ER 400-9 (box of 20) Disposable
PROBE,D TEMP,ER400-12 (box of 20) Disposable
PROBE,D TEMP,STS-400 (box of 20) Disposable
All
All
All
Adult
Adult
Adult
Adult
Adult
Applicable patient
Adult
Pediatric/Infant
Adult
Pediatric/Infant
All
36.3.4
Temp Probes Also Compatible
Model
MR411
MR412
Part No.
0011-30-90446
0011-30-90447
Description
Disposable temperature probe, esophageal
Disposable temperature probe, skin
Usage
Disposable
Disposable
Applicable patient
All
All
36 - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
36.4
NIBP Accessories
36.4.1
NIBP Hoses Available for Purchase
Model
CM1903
CM1901
Part No.
6200-30-09688
6200-30-11560
Description
NIBP hose, inbuilt connector, 3m
NIBP hose, inbuilt connector, 3m
Usage
Reusable
Reusable
36.4.2
Cuffs Available for Purchase
Applicable patient
Adult/Pediatric
Neonate
CM1504
CM1505
CM1506
CM1507
CM1500A
CM1500B
CM1500C
CM1500D
/
Model
CM1301
CM1302
CM1303
CM1304
CM1305
CM1306
CM1307
CM1501
CM1502
CM1503
115-027566-00
115-027567-00
115-027568-00
115-027569-00
125-000051-00
125-000052-00
125-000053-00
125-000054-00
115-031807-00
Part No.
115-027713-00
115-027714-00
115-027715-00
115-027716-00
115-027717-00
115-027718-00
115-027719-00
115-027563-00
115-027564-00
115-027565-00
Description
Cuff, 10-19 cm, bladderless
Cuff, 18-26 cm, bladderless
Cuff, 25-35 cm, bladderless
Cuff, 33-47 cm, bladderless
Cuff, 46-66 cm, bladderless
Cuff, 24-35 cm, bladderless
Cuff, 33-47 cm, bladderless
Cuff, 10-19 cm, bladderless, pkg of
10
Cuff, 18-26 cm, bladderless, pkg of
10
Cuff, 25-35 cm, bladderless, pkg of
10
Cuff, 33-47 cm, bladderless, pkg of
10
Cuff, 46-66 cm, bladderless, pkg of
5
Cuff, 25-35 cm, bladderless, pkg of
10, long
Cuff, 33-47 cm, bladderless, pkg of
10, long
Cuff, 3.1-5.7 cm, pkg of 20
Cuff, 4.3-8.0 cm, pkg of 20
Cuff, 5.8-10.9 cm, pkg of 20
Cuff, 7.1-13.1 cm, pkg of 20
Cuff starter kit, bladderless
Usage
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Reusable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Reusable
Large adult
Adult thigh
Adult
Large adult
Neonate
Neonate
Neonate
Neonate
Child/Small adult/
Adult/Adult thigh
Applicable patient
Infant
Small Adult
Adult
Adult
Adult thigh
Adult
Adult
Child
Small adult
Adult
36.4.3
Cuffs Also Compatible
Model
CM1500A
CM1500B
Part No.
001B-30-70692
001B-30-70693
Description
Cuff, 3.1-5.7 cm, pkg of 20
Cuff, 4.3-8.0 cm, pkg of 20
Usage
Disposable
Disposable
Applicable patient
Neonate
Neonate
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 7
Model
CM1500C
CM1500D
Part No.
001B-30-70694
001B-30-70695
36.5
IBP Accessories
Description
Cuff, 5.8-10.9 cm, pkg of 20
Cuff, 7.1-13.1 cm, pkg of 20
Usage
Disposable
Disposable
Applicable patient
Neonate
Neonate
36.5.1
IBP Accessories Available for Purchase
Model
IM2202
IM2201
/
Part No.
001C-30-70757
001C-30-70759
125-000123-00
Description
12 Pin IBP cable, Argon
12 Pin IBP cable, ICU Medical
12 Pin IBP cable, Edwards (not for transportation)
Usage
Reusable
Reusable
Reusable
36.5.2
ICP Accessories Available for Purchase
Applicable patient
/
/
/
Model
82-6653
/
CP12601
Part No.
040-002336-00
115-025257-00
009-005460-00
36.5.3
ICP Accessories Also Compatible
Description
Codman ICP sensor kit, Johnson &
Johnson, pkg of 1
Camino ICP cable kit
12-pin ICP cable
Usage
Disposable
Reusable
Reusable
/
/
Applicable patient
/
626631US / Codman microsensor basic kit for subdural/intraparenchyma1 procedure
Disposable /
36.6
C.O. Accessories Available for Purchase
Model
CO7702
9850A
SP4042
SP5045
TR0012
93522
Part No.
0010-30-42743
0012-00-1519
6000-10-02079
6000-10-02080
040-006154-00
0012-00-1520
Description
12Pin C.O. cable, Edwards
Cable, bath probe adapter
In-line injection temperature sensor, BD
In-line injection temperature sensor housing, BD, pkg of 25
12cc control syringe w/Rotator
(MEDEX MX387)
In-line inject temperature probe
Usage
Reusable
Reusable
Reusable
Disposable
Disposable
Reusable
/
/
Applicable patient
/
/
/
/
36 - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
36.7
ScvO2 Accessories Available for Purchase
Model
PC3030
PV2022-37
PV2022-35
Part No.
115-008191-00
040-000919-00
040-000920-00
Description Usage
ScvO2 optical module
CeVOX fiberoptic probe, 37 cm, pkg of 1
CeVOX fiberoptic probe, 35 cm, pkg of 1
Reusable
Disposable
Disposable
Applicable patient
/
/
/
36.8
CO
2
Accessories
36.8.1
Sidestream CO
2
Accessories Available for Purchase
Model
4000
4100
4200
60-15200-00
60-15300-00
60-14100-00
040-001187-00
60-14200-00
100-000080-00
100-000081-00
Part No.
115-043001-00
115-043002-00
115-043003-00
115-043017-00
115-043018-00
115-043020-00
115-043019-00
115-043021-00
115-058733-00
115-058734-00
Description
CO2 Nasal sample cannula, 7'’ line, pkg of 25
CO2 Nasal sample cannula, 7'’ line, pkg of 25
CO2 Nasal sample cannula, 7'’ line, pkg of 25
Sampling line, 2.5 m, pkg of 25
Sampling line, 2.5 m, pkg of 25
Dryline airway adapter, straight, pkg of 10
Airway Adapter pkg of 10
Dryline airway adapter, elbow pkg of 10
DRYLINE II water trap, pkg of 10
DRYLINE II water trap, pkg of 10
Usage
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Reusable
Reusable
Applicable patient
Adult
Pediatric
Neonatal
Adult/Pediatric
Neonatal
Adu/Ped
Neonatal
/
Adult/Pediatric
Neonatal
36.8.2
Microstream CO
2
Accessories Also Compatible
Model
XS04620
XS04624
006324
007768
007737
007738
009818
007266
009822
007269
Part No.
0010-10-42560
0010-10-42561
0010-10-42562
0010-10-42563
0010-10-42564
0010-10-42565
0010-10-42566
0010-10-42567
0010-10-42568
0010-10-42569
Description Usage
FilterLine Set Disposable
FilterLine H Set Disposable
FilterLine H Set
FilterLine Set, long
Disposable
Disposable
FilterLine H Set, long
FilterLine H Set, long
S CapnoLine Plus
Smart CapnoLine
S CapnoLine Plus O2
Smart CapnoLine O2
Disposable
Disposable
Disposable
Disposable
Disposable
Disposable
Applicable patient
Adult, pediatric
Neonate
Adult, pediatric
Adult, pediatric
Neonate
Adult
Pediatric
Adult
Pediatric
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 9
Model
009826
007743
008177
008178
008179
008180
008181
008174
008175
36.9
AG Accessories
Part No.
0010-10-42570
0010-10-42571
0010-10-42572
0010-10-42573
0010-10-42574
0010-10-42575
0010-10-42576
0010-10-42577
0010-10-42578
Description Usage
S CapnoLine Plus O2, long
S CapnoLine O2, long
CapnoLine H
CapnoLine H
Disposable
Disposable
Disposable
Disposable
CapnoLine H
CapnoLine H O2
Disposable
Disposable
CapnoLine H O2 Disposable
NIV-Line Disposable
NIV-Line Disposable
36.9.1
AG Accessories Available for Purchase
Applicable patient
Adult
Pediatric
Adult
Pediatric
Neonate
Adult
Pediatric
Adult
Pediatric
Model
60-15200-00
60-15300-00
60-14100-00
60-14200-00
100-000080-00
100-000081-00
115-052370-00
115-052162-00
Part No.
115-043017-00
115-043018-00
115-043020-00
115-043021-00
115-058733-00
115-058734-00
115-052370-00
115-052162-00
Description
Sampling line, 2.5 m, pkg of 25
Sampling line, DRYLINE, 2.5m, pkg of 25
DRYLINE airway adapter, straight, pkg of 10
DRYLINE airway adapter, elbow, pkg of 10
DRYLINE II water trap, pkg of 10
DRYLINE II water trap, pkg of 10
A7 Recirculation line
Generic scavenging line
Usage
Disposable
Disposable
Disposable
Disposable
Reusable
Reusable
Reusable
Reusable
Applicable patient
Adult/Pediatric
Neonate
Adult/Pediatric
Adult/Pediatric
/
/
Adult/Pediatric
Neonate
36.9.2
AG Accessories Also Compatible
Model
115-052160-00
Part No.
115-052160-00
Description
A3/A4/A5 Scavenging line
36.10
EEG Accessories Available for Purchase
Usage
Reusable /
Applicable patient
Model Part No.
B8830085010 040-001594-00
B9721104003 040-001598-00
B9721105004
B9600085001
040-001602-00
040-001596-00
Description
Cup electrodes for EEG
Cup electrodes for EEG (D=6 mm)
Subdermal for EEG
Usage
Reusable
Reusable
Reusable
Disposable
Applicable patient
Adult/Pediatric
Adult/Pediatric
Pediatric
Adult/Pediatric
36 - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
36.11
BIS Accessories
36.11.1
BIS Accessories Available for Purchase
Model
186-0195-MR
186-0224-MR
Part No.
6800-30-50761
115-005707-00
Description
Bispectral Index kit, Covidien
BISx4 cable kit, Covidien
36.11.2
BIS Accessories Also Compatible
Usage
Reusable
Reusable
Applicable patient
/
/
Model
186-0106
186-0200
186-0212
186-0160
Part No.
0010-10-42672
0010-10-42673
040-000392-00
6800-10-50652
Description Usage
BIS Sensor Quatro(186-0106), Covidien Disposable
BIS Pediatric sensor(186-0200),
Covidien
Disposable
BISx4 Sensor(Bilateral)(186-0212),
Covidien
Disposable
BIS Extend Sensor(186-0160), Covidien Disposable
Applicable patient
Adult
Pediatric
Adult
Adult
36.12
NMT Accessories Available for Purchase
Model
NM13101
NM13401
NM13701
NM13901
Part No.
040-001462-00
040-001463-00
040-001464-00
040-002258-00
Description
NMT cable
NMT sensor cable
NMT stimulation cable
Bandage for NMT sensor, pkg of 20
36.13
rSO
2
Accessories
36.13.1
rSO
2
Accessories Available for Purchase
Usage
Reusable
Reusable
Reusable
Disposable
Applicable patient
Adult, pediatric
Adult, pediatric
Adult, pediatric
Adult, pediatric
Model
RSC-1
RSC-2
5100C-PA
Part No.
100-000164-00
100-000165-00
100-000173-00
Description Usage
Sensor cable, channel 1, INVOS 5100C
Sensor cable, channel 2, INVOS 5100C
Reusable
Reusable
Preamplifier, channel 1 & 2, INVOS 5100C Reusable
36.13.2
rSO
2
Accessories Also Compatible
Model
SAFB-SM
SPFB
SNN
Applicable patient
/
/
/
Part No.
100-000168-00
100-000169-00
100-000181-00
Description
SomaSensor (>40 kg)
SomaSensor (<40 kg)
OxyAlert NIRSensor (<5kg), somatic, with sensor cable
Usage
Disposable
Disposable
Disposable
Applicable patient
Adult
Pediatric
Neonate
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 11
Model
CNN
CNN/SNN
Part No.
100-000180-00
100-000182-00
Description
OxyAlert NIRSensor (<5kg), cerebral, with sensor cable
OxyAlert NIRSensor (<5kg), somatic/ cerebral, with sensor cable
Usage
Disposable
Disposable
36.14
CCO/SvO2 Accessories Available for Purchase
Model
/
Part No.
009-000259-00
Description
CCO/SvO
2
cable
Usage
Reusable
36.15
BeneLink Accessories
Applicable patient
Neonate
Neonate
Applicable patient
/
Part No.
009-001767-00
009-001768-00
009-001769-00
009-002943-00
009-004613-00
009-008485-00
009-008624-00
115-011465-00
115-007277-00
047-004857-00
047-004859-00
009-001770-00
36.16
External Modules
Module
MPM module
Part No.
M51CE-PA00001
MPM module
MPM module
MPM module
MPM module
MPM module
Masimo SpO
2 module
Nellcor SpO
2 module
M51CE-PA00002
M51CE-PA00003
M51CE-PA00005
M51CE-PA00006
M51CE-PA00007
115-047244-00
115-053719-00
Description
Serial port adapting cable, type A
Serial port adapting cable, type B
Serial port adapting cable, type C
Serial port adapting cable, type D
Serial port adapting cable, type E
Serial port adapting cable, type F
Serial port adapting cable, type G
ID Adapter kit (contains ID Adapter with label and RJ45 cable with label)
ID Adapter
ID adapter label
Network line label
RJ45 connecting cable
Comments
Integrates 3/5/6-lead ECG, arrhythmia, ST, Resp, Masimo SpO
2
, Temp,
NIBP, IBP
Integrates 3/5/6-lead ECG, arrhythmia, Resp, Masimo SpO
2
, Temp,
NIBP, IBP
Integrates 12-lead ECG, arrhythmia, ST, Glasgow algorithm, Resp,
Masimo SpO
2
, Temp, NIBP, IBP, analog output
Integrates 3/5/6-lead ECG, arrhythmia, ST, Resp, Nellcor SpO
2
, Temp,
NIBP, IBP
Integrates 3/5/6-lead ECG, arrhythmia, Resp, Nellcor SpO
2
, Temp,
NIBP, IBP
Integrates 12-lead ECG, arrhythmia, ST, Glasgow algorithm, Resp,
Nellcor SpO
2
, Temp, NIBP, IBP, analog output
Supports SpO2 monitoring, Masimo SpO
2
Supports SpO2 monitoring, Nellcor SpO
2
36 - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Module
Temp module
C.O. module
IBP module
CCO/SvO
2 module
Part No.
115-053714-00
115-047283-00
115-047286-00
115-053718-00
ScvO
2 module
EEG module
BIS module
NMT module
INVOS rSO
2 module
Microstream CO
2 module
Sidestream CO
2 module
Sidestream CO
2 module
AG module
AG module
115-013199-00
115-053713-00
115-013194-00
115-053717-00
115-037264-00
6800-30-50820
115-049134-00
115-053711-00
115-051561-00
115-049189-00
BeneLink module
Recorder module
115-053710-00
115-053716-00
Comments
Supports temperature monitoring
Supports C.O. monitoring
Supports IBP monitoring
Connects Edwards Vigilance II®, Vigileo
TM
, EV1000, or HemoSphere monitor, supports CCO and SvO2 monitoring
Supports ScvO2 monitoring
Supports EEG monitoring‘
Supports BIS monitoring
Supports NMT monitoring
Supports rSO
2
monitoring
Supports CO2 monitoring
Supports CO2 monitoring, with adult and pediatric accessories
Supports CO2 monitoring, with neonatal accessories
Supports AG monitoring, integrates O
2
(paramagnetic) monitoring
Supports AG monitoring, integrates O
2
(paramagnetic) and BIS monitoring
Connects external devices
Supports recording (for N22/N19)
36.17
Mount and Mounting Accessories
Part No.
115-033887-00
0010-30-11972
034-000457-00
034-000458-00
042-014101-00
043-006060-00
115-035995-00
115-033911-00
115-045621-00
Description
8-slot satellite module rack (SMR), with handle, hook, and 2 m cable
SMR clamp assembly
GCX M series pivot arm, 12" VESA mount
GCX M series articulating arm, 12" x 12" for SMR
NIBP cuff holder
Cable hooks
SMR clamp mounting kit, w/ 6" post
SMR cable management mounting kit
SMR clamp mounting kit, w/ 9" post
The following installation accessories are for N17/N15/N12 only.
Part No.
045-000915-00
045-003424-00
045-000955-00
045-001190-00
045-003425-00
Description
N17/N15 rolling stand with mounting plate
N12 quick release mount for rolling stand
N17/N15 quick release mount for rolling stand
N12 transport stand (MR) with GCX shoe
N17/N15/N12 Mount Transition Plate
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 13
045-003426-00
045-003253-00
045-003255-00
115-045865-00
045-003254-00
N17/N15/N12 M Series 12" arm with Transition Plate
N17/N15/N12 GCX VHM Series arm with Transition Plate
N12 rolling stand with quick release mount
N12 Bedrail Hook
TDS cross clamp with 9" riser post (for N17/N15/N12)
The following installation accessories are for N22/N19 only.
Part No.
034-000782-00
034-000454-00
045-001976-00
045-002198-00
115-033880-00
115-033871-00
115-051379-00
041-017853-00
Description
GCX VHM arm
GCX M series arm, 16", with 6” riser
Rotatory assembly kit for display
Dock install to bracket package
Host to GCX mounting kit
Keyboard kit with 9” downpost
Separate host & display mounting kit, for rotation
Host mounting block
36.18
Miscellaneous Accessories
Part No.
009-005121-00
009-011808-00
009-005122-00
009-006593-00
009-005123-00
009-006594-00
009-009766-00
009-005391-00
8000-21-10361
023-001566-00
0683-00-0505-02
115-056983-00
115-055522-00
023-001788-00
115-049288-00
115-049289-00
115-034030-00
115-037270-00
009-005115-00
009-007740-00
Description
SMR cable, 2m
SMR cable, 4m
SMR cable, 10m
N Series to N1/T1 docking station cable, 2 m
N Series to N1/T1 docking station cable, 4 m
N Series to N1/T1 docking station cable, 10 m
N Series to N1/T1 docking station cable, 20 m
MPM analog output and defib sync cable
Nurse call cable
HP LaserJet Enterprise M608n, black and white
Recording paper, 50 mm*20 m, pkg of 12 A30-000001---
Clinical Scoring Custom CD
Field-installed iView module (N22/N19)
External display, 21.5’(for N17/N15/N12)
Display assembly kit, 22", with AC adapter and 5 m video cable (for N22)
Display assembly kit, 19", with AC adapter and 5 m video cable (for N19)
Display handle, without encoder (for N22/N19)
Display handle, with encoder (for N22/N19)
Video cable, 2.3 m (for N22/N19)
Video cable, 5 m (for N22/N19)
36 - 14 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Part No.
009-005117-00
009-005118-00
009-008237-00
009-005120-00
115-065140-00
115-034132-00
DA8K-10-14452
1000-21-00122
009-003648-00
009-003903-00
023-000247-00
023-000248-00
023-000524-00
023-000525-00
115-039575-00
115-039635-00
115-045643-00
042-007382-00
034-000666-00
Description
Video cable, 10 m (for N22/N19)
USB cable, 2.3 m (for N22/N19)
USB cable, 5 m (for N22/N19)
USB cable, 10 m (for N22/N19)
Lithium-ion battery, LI23S002A (for N17/N15/N12)
Lithium-ion battery, LI23S003A (for N22/N19)
Power cord, USA
Grounding cable
Cable protecting tube
Accessory management tape
Keyboard, wired USB connector, black
Mouse, wired USB connector, black
Wireless keyboard and mouse set
Wired keyboard and mouse set
2D Barcode reader, HS-1M, JADAK
2D Barcode reader, HS-1R, JADAK
Remote control
Cable management hook
Barcode reader holder (for JADAK Barcode reader)
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual 36 - 15
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36 - 16 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
A
Product Specifications
A.1
A.2
Monitor Safety Specifications
The monitor is classified, according to IEC 60601-1: 2005:
Degree of protection against electrical shock
Type CF defibrillation proof for ECG, Resp, TEMP, IBP, SpO
2
, C.O., NIBP, EEG, and
NMT
Type BF defibrillation proof for ScvO
2
, CO
2
, AG, BIS, and rSO
2
Class I Type of protection against electrical shock
Degree of protection against harmful ingress of water
Degree of safety of application in the presence of flammable anesthetic mixture with air or with oxygen or nitrous oxide
Mode of operation
IPX1
The equipment is not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide
Continuous
Physical Specifications
A.2.1
BeneVision N22/N19
Item Maximum
Weight (kg)
10.30
N19 monitor
(main unit and primary display installed together)
N22 monitor
(main unit and primary display installed together)
Main unit
Display, 19 inch
Display, 22 inch
11.50
3.40
6.20
7.40
W × H × D (mm) Comments
509 × 423 × 115
(display horizontally installed)
584 × 348 × 115
(display vertically installed)
566 × 458 × 115
(display horizontally installed)
641 × 383 × 115
(display vertically installed)
268 × 268 × 68
509 × 348 × 48
566 × 383 × 48
Including the battery, iView module, Wi-Fi module, display with the handle and navigation knob.
Excluding SMR, modules, and accessories.
Including the battery, iView module, Wi-Fi module, display with the handle and navigation knob.
Excluding SMR, modules, and accessories.
Including the battery.
Excluding the handle.
Excluding the handle.
A.2.2
BeneVision N17/N15/N12
Item
N17
N15
N12
Maximum
Weight (kg)
7.3
5.4
4.1
W × H × D (mm)
466×355×210
396×313×193
313×290×161
Comments
Excluding iView module, Wi-Fi module, SMR, measurement modules, recorder, battery and accessories.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 1
A.2.3
SMR and Modules
Item Maximum
Weight (kg)
Satellite module rack (SMR) 2.30
MPM module 0.63
SpO
2 module
Temp module
0.29
0.25
C.O. module
IBP module
CCO/SvO
2 module
ScvO
2 module
EEG module
BIS module
NMT module rSO
2 module
Microstream CO
2 module
Sidestream CO
2 module
AG module
0.25
0.26
0.26
0.26
0.28
0.26
0.29
0.30
BeneLink module
Recorder
0.38
0.63
1.03
0.35
0.40
W × H × D (mm)
403 × 221 × 145
136.5 × 80.5 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 40 × 102
136.5 × 80.5 × 102
136.5 × 40 × 102
136.5 × 80.5 × 102
A.3
Comments
/
/
/
/
Including the handle and cable hooks.
/
Masimo SpO
2
or Nellcor SpO
2
/
/
/
/
/
/
/
With built-in O
2
module
/
/
Environmental Specifications
WARNING
•
The monitor may not meet the performance specifications if stored or used outside the specified temperature and humidity ranges. If the performance of the equipment is degraded due to aging or environmental conditions, contact your service personnel.
•
When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.
NOTE
•
The environmental specification of unspecified parameter modules are the same as those of the main unit.
Components
Main Unit
Property (unit)
Temperature (°C)
Relative humidity
(noncondensing) (%)
Barometric (mmHg)
Operating Condition
0 to 35 (for N17 configured with iView module)
0 to 40 for other configuration
15 to 95
Storage Condition
-20 to 60
10 to 95
427.5 to 805.5
120 to 805.5
A - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Components
Microstream CO
2 module
Sidestream CO
2 module
AG module
ScvO
2 module rSO
2 module
Property (unit)
Temperature (°C)
Relative humidity
(noncondensing) (%)
Barometric (mmHg)
Temperature (°C)
Relative humidity
(noncondensing) (%)
Barometric (mmHg)
Temperature (°C)
Relative humidity
(noncondensing) (%)
Barometric (mmHg)
Temperature (°C)
Relative humidity
(noncondensing) (%)
Barometric (mmHg)
Temperature (°C)
Relative humidity
(noncondensing) (%)
Barometric (mmHg)
Operating Condition
0 to 40
15 to 95
430 to 790
5 to 40
15 to 95
430 to 790
10 to 40
15 to 95
525 to 805.5
10 to 40
15 to 75
427.5 to 805.5
16 to 32
20 to 80
525 to 805.5
A.4
A.4.1
Power Supply Specifications
External Power Supply Specifications
Line voltage
Input Current
Frequency
100 to 240 VAC (±10%)
N22/N19: 2.8 A to 1.6 A
N17/N15/N12: 2.0 A to 0.9 A
50/60 Hz (± 3 Hz)
A.4.2
Battery Specifications
A.4.2.1
N22/N19 Battery Specifications
Battery type
Voltage
Rechargeable lithium-ion battery
10.8 VDC
Run time
Charge time
At least 1 hour continuously on a typical configuration, powered by a new, fully-charged battery.
Note: A typical configuration is 12-lead ECG, Resp, SpO
2
, 4-channel IBP, 2channel Temp, CO
2
, C.O., and NIBP module set at an interval of 15 minutes.
WI-Fi is enabled.
The screen brightness is set to the factory default.
For a new battery:
5 hours to 90% when the monitor is off
9 hours to 90% when the monitor is on.
Storage Condition
-20 to 60
10 to 95
430 to 790
-20 to 60
10 to 95
430 to 790
-20 to 60
10 to 95
525 to 805.5
-20 to 60
10 to 90
120 to 805.5
-20 to 70
10 to 95
435.7 to 822
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 3
Shutdown delay At least 15 minutes (after a low battery alarm first occurs)
A.4.3
N17/N15/N12 Battery Specifications
Battery type
Voltage
Rechargeable lithium-ion battery
10.95 VDC
A.5
A.6
A.7
Run time
Charge time
Shutdown delay
At least 2 hours continuously for N17/N15 or at least 4 hours continuously for
N12 on a typical configuration, powered by a new, fully charged battery.
The monitor is powered by a new, fully-charged battery at 25 °C with a 5-lead
ECG and SpO2 cable connected, auto NIBP measurements at an interval of 15 minutes, and the screen brightness is set to 1.
No more than 4.5 hours to 90% when the monitor is off
No more than 10 hours to 90% when the monitor is on
At least 15 minutes (after a low battery alarm first occurs)
Display Specifications
Screen type
Screen Size (diagonal)
Resolution
Medical-grade color TFT LCD
N22: 22 inches
N19: 19 inches
N17: 18.5 inches
N15: 15.6 inches
N12: 12.1 inches
N22/N19: 1680 x 1050 pixels
N17/N15: 1920 x1080 pixels
N12: 1280 x 800 pixels
Recorder Specifications
Method
Horizontal resolution
Vertical resolution
Paper width
Paper length
Paper speed
Number of waveform channels
Thermal dot array
16 dots/mm (25 mm/s paper speed)
8 dots/mm
50 mm
20 m
25 mm/s, 50 mm/s
Accuracy: ±5%
A maximum of 3
LEDs
Alarm lamp
Power-on LED
AC power LED
Battery LED
1 (three color-coded: red, yellow, and cyan)
1 (green)
1 (green)
1 (two color-coded: yellow and green)
A - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
A.8
Audio Indicator
Speaker Give alarm tones (45 to
85
dB), reminder tones, key tones, QRS tones; support PITCH TONE and multi-level tone modulation; alarm tones comply with IEC 60601-1-8:2012.
A.9
A.9.1
Monitor Interface Specifications
Interface Specifications of the N22/N19 Main Unit
AC power input
Network connector (LAN1, LAN2, LAN3)
Serial bus connector (MSB)
USB connector
Satellite module rack (SMR) connector
Video output connector (VP1, VP2)
Nurse call connector (NC)
Equipotential grounding terminal
Primary display connectors
1
3 standard RJ45 connectors (one on the iView module), 100 Base-TX, IEEE
802.3
6: 3 connectors and each connector contains 2 sub-connectors
4, USB 2.0 (for iView only)
3
2, VP1 connects the secondary display (DisplayPort). VP2 connects the display for iView system (DisplayPort)
1, standard BNC
1
1 set (VP3, SIG1, MSB4, and DC-in), for connecting to separate primary display, hidden when the display is integrated with the main unit.
A.9.2
Interface Specifications of the N22/N19 Separate Primary Display
Serial bus connector (MSB)
Serial bus hub connector (SBH)
Signal input connector (SIG1)
DC-in connector
Video input connector (VP)
1
1
3
1
1
A.9.3
Interface Specifications of the N22/N19 Integrated Primary Display
Serial bus connector (MSB) 1
A.9.4
Interface Specifications of the N22/N19 Secondary Display
Serial bus connector (MSB)
Serial bus hub connector (SBH)
Signal input connector (SIG1)
DC-in connector
Video input connector (VP)
1
1
3
1
1
A.9.5
Interface Specifications of the N17/N15/N12
AC power input 1
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 5
Network connector
USB connector
Satellite module rack (SMR)/Docking station connector
Video output connector
Nurse call connector
Equipotential grounding terminal
N17: 2 standard RJ45 connectors (one on the iView module)
N15/N12: 1 standard RJ45 connector
4, USB 2.0
1 (For N17/N15, it connects the SMR or the docking station. For N12, it connects the N1/T1 docking station)
N17: 2, (configuration A: 1 mirrored (DVI), 1 independent (DVI); configuration
B: 1 mirrored (DVI), 1 iView (DVI).)
N15/N12: 1 mirrored (DVI)
1, standard BNC
1
A.10
Signal Outputs Specifications
Auxiliary Output
Standard Meets the requirements of IEC 60601-1:2005 for short-circuit protection and leakage current
ECG Analog Output
Bandwidth
(-3dB; reference frequency: 10Hz)
Maximum QRS delay
Gain (reference frequency 10Hz)
Pace enhancement
Diagnostic mode: 0.05 to 150 Hz
Monitor mode: 0.5 to 40 Hz
Surgical mode: 1 to 20 Hz
ST mode: 0.05 to 40 Hz
25 ms (in diagnostic mode, and non-paced)
1V/mV (±5%)
Signal amplitude: V oh
≥2.5V
Pulse width: 10 ms±5%
Signal rise and fall time: ≤100μs
IBP Analog Output
Bandwidth (-3dB; reference frequency:1Hz)
Maximum transmission delay
Gain (reference frequency 1 Hz)
Nurse Call Signal
Amplitude
0 to 40 Hz
30 ms
1 V/100 mmHg, ±5%
High level: 3.5 to 5 V, ±5%, providing a minimum of 10 mA output current;
Low level: < 0.5 V, receiving a minimum of 5 mA input current.
≤1 ms Rise and fall time
Defib Sync Pulse
Output impedance
Maximum time delay
Amplitude
Pulse width
Maximum rise and fall time
Alarm output
≤100 Ω
35 ms (R-wave peak to leading edge of pulse)
High level: 3.5 to 5 V, ±5%, providing a maximum of 10 mA output current;
Low level: < 0.5 V, receiving a maximum of 5 mA input current.
100 ms ±10%
1 ms
A - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Alarm delay time from the monitor to remote equipment
Alarm signal sound pressure level range
The alarm delay time measured at the monitor signal output connector:
From the monitor to the CMS and remote monitors: ≤2 seconds
From the monitor to the TM80 telemetry monitor: ≤3 seconds
From the monitor to the TM70 telemetry monitor: ≤4 seconds
45 dB(A) to 85 dB(A) within a range of one meter
A.11
Data Storage
Trends
Events
NIBP measurements
Interpretation of resting 12-lead ECG results
Full-disclosure waveforms
ST view
OxyCRG view
A minimum of 120 hours of trend data for trend interval as low as 1 minute.
1000 events
1000 sets
20 sets
48 hours at maximum. The specific storage time depends on the waveforms stored and the number of stored waveforms.
A maximum of 120 hours of ST segment waveforms. One group of ST segment waveforms is stored every minute.
A maximum of 48 hours of oxyCRG events
A.12
Wi-Fi Specifications
A.12.1
Wi-Fi Technical Specifications (MSD45N)
Protocol
Modulation mode
Operating frequency
Channel spacing
Wireless data rate
Output power
Operating mode
Data security
IEEE 802.11a/b/g/n
BPSK, QPSK, 16QAM, 64QAM
2.4 GHz to 2.495 GHz.
5.15 GHz to 5.25 GHz, 5.725 GHz to 5.85 GHz
IEEE 802.11b/g: 5 MHz
IEEE 802.11n (at 2.4 GHz): 5 MHz
IEEE802.11a: 20 MHz
IEEE802.11n (at 5 GHz): 20 MHz
IEEE 802.11b: 1 Mbps to 11 Mbps
IEEE 802.11g: 6 Mbps to 54 Mbps
IEEE 802.11n: 6.5 Mbps to 72.2 Mbps (MCS0-MCS7)
IEEE 802.11a: 6 Mbps to 54 Mbps
<20 dBm (CE requirements, detection mode: RMS)
<30 dBm (FCC requirements, detection mode: peak power)
As station, access AP for data transmission
Standards: WPA-PSK, WPA2-PSK, WPA-Enterprise, WPA2-Enterprise, WPA CCKM, WPA2
CCKM
EAP method: EAP-FAST, EAP-TLS, EAP-TTLS, PEAP-GTC, PEAP-MSCHAPv2, PEAP-TLS, LEAP
Encryption: AES
A.12.2
Wi-Fi Technical Specifications (SX-SDMAC-2832S+)
Protocol
Modulation mode
IEEE 802.11a/b/g/n
BPSK, QPSK, 16QAM, 64QAM
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 7
Operating frequency
Channel spacing
Wireless data rate
Output power
Operating mode
Data security
2412 MHz to 2462 MHz
5180 MHz to 5320 MHz, 5500 MHz to 5700 MHz, 5745 MHz to 5825 MHz
WARNIGN: SX-SDMAC-2832S+ supports the DFS channels. When using the DFS channels, Wi-Fi performance stability and roaming time can be undermined due to avoiding interfering with Radar systems. DFS channels are disabled by default and not recommended. The operator should comprehensively assess the risk before using the DFS channels.
IEEE 802.11b/g: 5 MHz
IEEE 802.11n (at 2.4 GHz): 5 MHz
IEEE802.11a: 20 MHz
IEEE802.11n (at 5 GHz): 20 MHz
IEEE 802.11b: 1 Mbps to 11 Mbps
IEEE 802.11g: 6 Mbps to 54 Mbps
IEEE 802.11n: MCS0 - MCS7
IEEE 802.11a: 6 Mbps to 54 Mbps
<20 dBm (CE requirements, detection mode: RMS)
<30 dBm (FCC requirements, detection mode: peak power)
As station, access AP for data transmission
Standards: WPA-PSK, WPA2-PSK, WPA-Enterprise, WPA2-Enterprise, WPA CCKM, WPA2
CCKM
EAP method: EAP-FAST, EAP-TLS, EAP-TTLS, PEAP-GTC, PEAP-MSCHAPv2, PEAP-TLS, LEAP
Encryption: AES
A.12.3
Wi-Fi Performance Specifications
WARNING
•
All network functions of data communication are designed to operate on a private network.
A.12.3.1
System Capacity
Number of the monitors supported by a single AP: ≤ 12 (for N22/N19) or ≤ 16 (for N17/N15/N12).
■
■
■
■
Testing conditions are as follows:
Each monitor can communicate with the CMS.
Two monitors are used to view other monitors.
Only one monitor can transmit history data.
The weakest strength of the AP signal where the monitor is located cannot be less than -65 dBm.
A.12.3.2
Resistance to Wireless Interference
The distance between the interfering devices and the monitor is greater than 20 cm. A Wi-Fi interference (no greater than -85 dBm) in the same channel and a Wi-Fi interference (no greater than -50 dBm) in an adjacentchannel are presented synchronously. The interfering devices include, but are not limited to, 2.4 GHz wireless devices, cellular mobile networks, microwave ovens, intercoms, cordless phones, and ESU equipment. The interfering devices do not include Wi-Fi devices.
■
■
■
■
■
The monitoring network must support the following requirements:
All the monitors do not encounter communication loss.
The total delay of data transmission from the monitor to the CMS: ≤ 2 seconds.
The delay for monitor-related settings configured at the CMS to be effective: ≤ 2 seconds.
The total delay of data transmission from one monitor to the other: ≤ 2 seconds.
The delay for the monitor to reset alarms of another to be effective: ≤ 2 seconds.
A - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
NOTE
•
When the monitor works at 2.4G, the most serious interference source is other 2.4G Wi-Fi devices not sharing the same network with the monitor and LTE devices. When the monitor works at 5G, the most serious interference source is other 5G Wi-Fi devices not sharing the same network with the monitor.
•
To make sure that the monitor works well, the separation distance between the monitor and unintended interference device or the distance between the AP and interference devices should be greater than the distance listed below:
Working frequency band
Interference devices
2.4G (2412-
2462MHz)
Adjacent channel Wi-Fi
Co-channel Wi-Fi lower adjacent band LTE upper adjacent band LTE
5G (5190 -5 210MHz) Adjacent channel Wi-Fi
Co-channel Wi-Fi
5G (5270 -5 290MHz) Adjacent channel Wi-Fi
Co-channel Wi-Fi
5G (5590 -5 610MHz) Adjacent channel Wi-Fi
Co-channel Wi-Fi
5G (5755 -5 775MHz) Adjacent channel Wi-Fi
Co-channel Wi-Fi
0.
5 m
3.0 m
0.
6 m
0.
6 m
2 .
5 m
4.0 m
2.0 m
3.5 m
2.0 m
3.5 m
2 .
5 m
4.0 m
Separation distance between the monitor and interference devices
Separation distance between the AP that the monitor is connected to and interference devices
2.0 m
3 .
5 m
2.0 m
3 .
5 m
2.0 m
3 .
5 m
2.0 m
3 .
5 m
0.
5 m
4.0 m
0.
8 m
0.
8 m
A.12.3.3
Wi-Fi Network Stability
The ratio of the communication data loss on the CMS from any monitor does not exceed 0.1% over a 24-hour period.
■
■
■
■
■
■
Testing conditions are as follows:
Number of the monitors supported by a single AP: ≤ 12 (for N22/N19) or ≤ 16 (for N17/N15/N12).
For N17/N15/N12, 12 of the 16 monitors connected to the network roam for 30 times
Each monitor can communicate with the CMS.
Two monitors are used to view other monitors.
Only one monitor can transmit history data.
The weakest strength of the AP signal where the monitor is located cannot be less than -65 dBm.
A.12.3.4
Line of Sight Distance
The line of sight distance between the monitor and the AP is no less than 50 meters.
A.13
Measurement Specifications
The adjustable range of alarm limits is the same with the measurement range of signals unless otherwise specified.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 9
A.13.1
ECG Specifications
ECG
Standards
Lead set
ECG standard
Display sensitivity
Sweep speed
Bandwidth (-3dB)
Common mode rejection ratio
(with Notch filter off )
Notch filter
Differential input impedance
Input signal range
Accuracy of signal reproduction
Electrode offset potential tolerance
Lead-off detection current
Input offset current
Defibrillation protection
Patient leakage current
Calibration signal
ESU protection
Meets the requirements of IEC 60601-2-27: 2011 and IEC 60601-2-25: 2011
3-lead: I, II, III
5-lead: I, II, III, aVR, aVL, aVF, V
6-lead: I, II, III, aVR, aVL, aVF, Va, Vb
12-lead: I, II, III, aVR, aVL, aVF, V1 to V6
AHA, IEC
1.25 mm/mV (×0.125), 2.5 mm/mV (×0.25), 5 mm/mV (×0.5), 10 mm/mV (×1),
20 mm/mV (×2), 40 mm/mV (×4), Auto, less than 5% error
6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s, less than 5% error
Diagnostic mode:
Monitor mode:
Surgery mode:
ST mode:
High frequency cut-off (for 12lead ECG analysis):
Diagnostic mode:
Monitor mode:
Surgery mode:
ST mode:
0.05 to 150 Hz
0.5 to 40 Hz
1 to 20 Hz
0.05 to 40 Hz
350 Hz (0.05 to 350 Hz), 150 Hz (0.05 to 150
Hz), 35 Hz (0.05 to 35 Hz), 20 Hz (0.05 to 20
Hz) selectable
>90 dB
>105 dB (with notch filter on)
>105 dB (with notch filter on)
>105 dB (with notch filter on)
50/60 Hz
Monitor, surgical, and ST mode: notch filter turns on automatically
Diagnostic mode and High Freq Cut-off: notch filter is turned on/off manually
≥5 MΩ
±8 mV (peak-to-peak value)
Use A and D methods based on IEC 60601-2-25: 2011 to determine frequency response.
±500 mV
Measuring electrode: <0.1 μA
Drive electrode: <1 μA
≤0.1 μA, (drive lead≤1μA)
Withstands 5000V (360 J) charge without data loss or corruption
Baseline recovery time: <5 s
Polarization recovery time: <10 s
Defibrillation energy absorption: ≤10% (100 Ω load)
<10 uA
1mV (peak-to-peak value) ±5%
Cut mode: 300 W
Coagulate mode: 100 W
Recovery time: ≤10 s
In compliance with the requirements in clause 202.6.2.101 of IEC 60601-2-27:
2011
Pace Pulse
A - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Pace pulse markers
Pace pulse rejection
Pace pulses meeting the following conditions are labelled with a PACE marker:
Amplitude:
Width:
Rise time:
No overshoot
±2 mV to ±700 mV
0.1 ms to 2 ms
10 μs to 100 μs (< 10% of pulse width)
When tested in accordance with the IEC 60601-2-27: 2011: 201.12.1.101.13, the heart rate meter rejects all pulses meeting the following conditions.
Amplitude:
Width:
Rise time:
No overshoot
±2 mV to ±700 mV
0.1 ms to 2 ms
10 μs to 100 μs (< 10% of pulse width)
HR
Measurement range
Resolution
Accuracy
Sensitivity
HR averaging method
Response to irregular rhythm
Response time to heart rate change
Time to alarm for tachycardia
Tall T-wave rejection capability
Arrhythmia Analysis Classifications
Neonate: 15 to 350 bpm
Pediatric: 15 to 350 bpm
Adult: 15 to 300 bpm
1 bpm
±1 bpm or ±1%, whichever is greater.
200 μV (lead II)
In compliance with the requirements in Clause 201.7.9.2.9.101 b) 3) of IEC
60601-2-27: 2011, the following method is used:
If the last 3 consecutive RR intervals are greater than 1200 ms, the 4 most recent RR intervals are averaged to compute the HR. Otherwise, heart rate is computed by subtracting the maximum and minimum ones from the most recent 12 RR intervals and then averaging the remaining 10 RR intervals.
The HR value displayed on the monitor screen is updated every second.
In compliance with the requirements in Clause 201.7.9.2.9.101 b) 4) of IEC
60601-2-27: 2011, the heart rates for the specified test signals after 20 seconds of stabilization are:
Ventricular bigeminy (waveform A1): 80±1 bpm
Slow alternating ventricular bigeminy (waveform A2): 60±1 bpm
Rapid alternating ventricular bigeminy (waveform A3): 120±1 bpm
Bidirectional systoles (waveform A4): 90±2 bpm
Meets the requirements of IEC 60601-2-27: 2011: Clause 201.7.9.2.9.101 b) 5).
From 80 to 120 bpm: less than 11 s
From 80 to 40 bpm: less than 11 s
Meets the requirements in Clause 201.7.9.2.9.101 b) 6) of IEC 60601-2-27: 2011.
Waveform
B1h-range:
B1-range:
B1d-range:
B2h-range:
B2-range:
B2d-range:
<11 s
<11 s
<11 s
<11 s
<11 s
<11 s
When the test is performed based on Clause 201.12.1.101.17 of IEC 60601-2-27:
2011, the heart rate calculation is not affected for QRS of 1 mV amplitude and
100 ms duration, T-wave duration of 180 ms and amplitude lower than 1.2 mV, and QT interval of 350 ms.
Asystole, V-Fib/V-Tach, V-Tach, Vent Brady, Extreme Tachy, Extreme Brady, Vent
Rhythm, PVCs/min, Pauses/min, Couplet, Bigeminy, Trigeminy, R on T, Run
PVCs, PVC, Tachy, Brady, Missed Beats, Pacer Not Pacing, Pacer Not Capture,
Multiform PVC, Nonsus V-Tach, Pause, Irr Rhythm, A-Fib
ST Segment Analysis
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Measurement range
Accuracy
Resolution
QT/QTc Analysis
Measurement range
-2.0 mV to +2.0 mV RTI
-0.8 mV to +0.8 mV: ±0.02 mV or ±10%, whichever is greater
Beyond this range: not specified
0.01mV
Accuracy
Resolution
12-lead ECG Interpretation
Sampling rate
Amplitude quantisation
PVCs/min
Measurement range
QT: 200 to 800 ms
QTc: 200 to800 ms
QT-HR: 15 bpm to 150 bpm for adult, 15 bpm to 180 bpm for pediatric and neonate
QT: ±30 ms
QT: 4 ms
QTc: 1 ms
1000 samples/s (A/D)
500 samples/s (ECG algorithm)
24 bits
Adult: 0 to 300
Pediatric, neonate: 0 to 350
Alarm limit
HR High
HR Low
ST High
ST Low
QTc High
ΔQTc High
A.13.2
Resp Specifications
Technique
Lead
Respiration excitation waveform
Minimum respiration impedance threshold
Baseline impedance range
Bandwidth
Sweep speed
Respiration Rate
Range
HR≤40bpm: (low limit + 2 bpm) to 40 bpm
HR > 40 bpm: (low limit + 5 bpm) to 295 bpm (Adult/Pediatric)
(low limit + 5 bpm) to 300 bpm (Neonate)
HR≤40bpm: 16 bpm to (high limit - 2 bpm) (Adult/Pediatric)
15 bpm to (high limit - 2 bpm) (Neonate)
HR > 40 bpm: 40 bpm to (high limit - 5 bpm)
(low limit + 0.2 mV) to 2.0 mV (ST alarm mode: Absolute)
0 mV to 2.0 mV (ST alarm mode: Relative)
-2.0 mV to (high limit - 0.2 mV) (ST alarm mode: Absolute)
-2.0 mV to 0 mV (ST alarm mode: Relative)
200 ms to 800 ms
30 ms to 200 ms
Step
HR≤40bpm: 1 bpm
HR > 40 bpm: 5 bpm
0.05 mV
10 ms
Trans-thoracic impedance
Options are lead I, II, and Auto.
<300 μA RMS, 62.8 kHz (±10%)
0.3Ω
200 to 2500 Ω (using an ECG cable with 1kΩ resistance)
0.2 to 2.5 Hz (-3 dB)
3mm/s, 6.25 mm/s, 12.5 mm/s, 25 mm/s or 50 mm/s, less than 10% error
A - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Measurement range
Resolution
Accuracy
Apnea alarm delay
Alarm limit
RR High
RR Low
Adult: 0 to 120 rpm
Pediatric, neonate: 0 to 150 rpm
1 rpm
7 to 150 rpm: ±2 rpm or ±2%, whichever is greater
0 to 6 rpm: not specified
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Range (rpm)
Adult, pediatric:
RR≤20
RR>20
Neonate:
RR≤20
RR>20
RR≤20:
RR>20:
(low limit + 2) to 20
(low limit + 5) to 100
(low limit + 2) to 20
(low limit + 5) to 150
0 to (high limit - 2)
20 to (high limit - 5)
Step (rpm)
RR≤20: 1
RR>20: 5
A.13.3
SpO
2
Specifications
Refer to Appendix F SpO
2
Sensor Accuracy for the clinical study results of SpO
2
sensor accuracy.
Alarm limit
SpO
2
High
SpO
2
Low
ΔSpO
2
High
SpO
2
Desat Low
Range (%) Step (%)
(low limit + 2) to 100
Masimo: (Desat+1) to (high limit - 2)
Nellcor: (Desat+1) or 20 (whichever is greater) to (high limit - 2)
0 to 50
0 to (SpO2 low limit - 1)
1
Masimo SpO
2
Module
Standards
Measurement range
Resolution
Response time
Accuracy
1
Refresh rate
SpO
2
averaging time
Low perfusion conditions
Low perfusion SpO
2
accuracy
2
PI measurement range
Meets the requirements of ISO 80601-2-61: 2017
1 to 100%
1%
≤20 s (normal perfusion, no disturbance, SpO2 value sudden change from 70% to 100%)
70 to 100%: ±2%ABS (adult/pediatric, without motion)
70 to 100%: ±3%ABS (adult/pediatric, with motion)
70 to 100%: ±3%ABS (neonate)
1% to 69%: Not specified.
≤ 1 s
2-4 s, 4-6 s, 8 s, 10 s, 12 s, 14 s, 16 s
Pulse amplitude: >0.02%
Light penetration: >5%
±2%
0.02 to 20%
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 13
1
The Masimo pulse oximeter with sensors have been validated for no motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies in the range of 70% to 100% SpO2 against a laboratory co-oximeter and ECG monitor. This variation equals plus or minus one standard deviation. Plus or minus one standard deviation encompasses
68% of the population. One percent was added to the accuracies for neonatal sensors to account for accuracy variation due to properties of fetal hemoglobin.
The Masimo pulse oximeter with sensors has been validated for motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies while performing rubbing and tapping motions at 2 to 4 Hz. At an amplitude of 1 to
2 cm and non-repetitive motion between 1 to 5 Hz. At an amplitude of 2 to 3 cm in induced hypoxia studies in the range of
70% to 100% SpO2 against a laboratory co-oximeter and ECG monitor. This variation equals plus or minus one standard deviation. Plus or minus one standard deviation encompasses 68% of the population.
2
The Masimo pulse oximeter has been validated for low perfusion accuracy in bench top testing against a Biotek Index 2 simulator and Masimo's simulator with signal strengths of greater than 0.02% and a % transmission of greater than 5% for saturations ranging from 70 to 100%. This variation equals plus or minus one standard deviation. Plus or minus one standard deviation encompasses 68% of the population.
Nellcor SpO
2
Module
Standard
Measurement range
Resolution
Refresh rate
Meet the requirements of ISO 80601-2-61 2017
0 to 100%
1%
≤1 s
Response time
Accuracy
≤30 s (normal perfusion, no disturbance, SpO
2
value sudden changes from
70% to 100%)
70 to 100%: ±2%ABS (adult/pediatric)
70 to 100%: ±3%ABS (neonate)
0 to 69%: Not specified.
When the SpO
2
sensor is applied for neonatal patients as indicated, the specified accuracy range is increased by ±1%, to compensate for the theoretical effect on oximeter measurements of fetal hemoglobin in neonatal blood.
A.13.4
PR Specifications
Alarm limit
PR High
PR Low
Range (bpm)
PR≤40: (low limit + 2) to 40
PR > 40: (low limit + 5) to 295 (Adult/Pediatric),
(low limit + 5) to 300 (Neonate)
PR≤40: 16 to (high limit - 2) (Adult/Pediatric),
15 to (high limit - 2) (Neonate)
PR > 40: 40 to (high limit - 5)
PR from Masimo SpO
2
Measurement range
Resolution
Response time
Accuracy
Step (bpm)
PR≤40: 1
PR>40: 5
25 to 240 bpm
1 bpm
≤20 s (with normal perfusion, no disturbance, and a PR value transition from
25 to 220 bpm)
±3 bpm (without motion)
±5 bpm (with motion)
≤1 s Refresh rate
PR from Nellcor SpO
2
Measurement range
Resolution
20 to 300 bpm
1 bpm
A - 14 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Response time
Accuracy
Refresh rate
PR from NIBP
Measurement range
Resolution
Accuracy
PR from IBP
Measurement range
Resolution
Accuracy
≤30 s (with normal perfusion, no disturbance, and a PR value transition from
25 to 250 bpm)
20 to 250 bpm: ±3 bpm
251 to 300 bpm: not specified
≤1 s
30 to 300 bpm
1 bpm
±3 bpm or ±3%, whichever is greater
25 to 350 bpm
1 bpm
±1 bpm or ±1%, whichever is greater
A.13.5
Temp Specifications
Standard
Technique
Operating mode
Measurement range
Resolution
Accuracy
Minimum time for accurate measurement
Alarm limit
Txx High (xx refers to temperature site)
Txx Low (xx refers to temperature site)
ΔT High
Meets the requirements of ISO 80601-2-56: 2017
Thermal resistance
Direct mode
0 to 50 °C (32 to 122 °F)
0.1°C
±0.1 °C or ±0.2 °F (excluding probe error)
Body surface: <100 s
Body cavity: <80 s
Range
(low limit +1.0) to 50.0 °C
(low limit +2.0) to 122.0 °F
0.1 to (high limit - 1.0) °C
32.2 to (high limit - 2.0) °F
0.1 to 50.0 °C
0.2 to 90.0 °F
Step
0.1 °C
0.1 °F
A.13.6
NIBP Specifications
Standard
Technique
Mode of operation
Auto mode repetition intervals
STAT mode cycle time
Max measurement time
Heart rate range
Meets the requirements of IEC 80601-2-30: 2018
Oscillometry
Manual, Auto, STAT, Sequence
1, 2, 2.5, 3, 5, 10, 15, 20, 30, 60, 90, 120, 180, 240 or 480 min
5 min
Adult, pediatric: 180 s
Neonate: 90 s
30 to 300 bpm
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A - 16
Measurement ranges
(mmHg)
Accuracy
Resolution
Initial cuff inflation pressure range
(mmHg)
Default initial cuff inflation pressure
(mmHg)
Re-inflation increment (mmHg)
Software overpressure protection
Static pressure measurement range
Static pressure measurement accuracy
Alarm limit
NIBP-S High
NIBP-S Low
NIBP-M High
NIBP-M Low
NIBP-D High
NIBP-D Low
NIBP-S Extreme High
NIBP-S Extreme Low
Systolic:
Diastolic:
Mean:
Max mean error: ±5 mmHg
Max standard deviation: 8 mmHg
1mmHg
Adult: 80 to 280
Pediatric: 80 to 210
Neonate: 60 to 140
Adult: 160
Pediatric: 140
Neonate: 90
Adult/Pediatric: 40
Neonate: 15
Adult: 297±3 mmHg
Pediatric: 297±3 mmHg
Neonate: 147±3 mmHg
0 mmHg to 300 mmHg
±3 mmHg
Adult
25 to 290
10 to 250
15 to 260
Range (mmHg)
Adult: (low limit + 5) to 285
Pediatric: (low limit + 5) to 235
Neonate: (low limit + 5) to 135
26 to (high limit - 5)
Adult: (low limit + 5) to 255
Pediatric: (low limit + 5) to 210
Neonate: (low limit + 5) to 120
16 to (high limit - 5)
Adult: (low limit + 5) to 245
Pediatric: (low limit + 5) to 195
Neonate: (low limit + 5) to 110
11 to (high limit - 5)
NIBP-S high limit < 50
Adult: (NIBP-S high limit + 1) to 290
Pediatric: (NIBP-S high limit + 1) to 240
Neonate: (NIBP-S high limit + 1) to 140
NIBP-S high limit ≥ 50
Adult: (NIBP-S high limit + 5) to 290
Pediatric: (NIBP-S high limit +5) to 240
Neonate: (NIBP-S high limit +5) to 140
NIBP-S low limit ≤ 50
25 to (NIBP-S low limit - 1)
NIBP-S low limit > 50
25 to (NIBP-S low limit - 5)
Pediatric
25 to 240
10 to 200
15 to 215
Step (mmHg)
NIBP ≤ 50: 1
NIBP > 50: 5
NIBP ≤ 50: 1
NIBP > 50: 5
Neonate
25 to 140
10 to 115
15 to 125
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
NIBP-M Extreme High
NIBP-M Extreme Low
NIBP-D Extreme High
NIBP-D Extreme Low
NIBP-M high limit < 50
Adult: (NIBP-M high limit + 1) to 260
Pediatric: (NIBP-M high limit + 1) to 215
Neonate: (NIBP-M high limit + 1) to 125
NIBP-M high limit ≥ 50
Adult: (NIBP-M high limit + 5) to 260
Pediatric: (NIBP-M high limit + 5) to 215
Neonate: (NIBP-M high limit + 5) to 125
NIBP-M low limit ≤ 50
15 to (NIBP-M low limit - 1)
NIBP-M low limit > 50
15 to (NIBP-M low limit - 5)
NIBP-D high limit < 50
Adult: (NIBP-D high limit + 1) to 250
Pediatric: (NIBP-D high limit + 1) to 200
Neonate: (NIBP-D high limit + 1) to 115
NIBP-D high limit ≥ 50
Adult: (NIBP-D high limit + 5) to 250
Pediatric: (NIBP-D high limit + 5) to 200
Neonate: (NIBP-D high limit + 5) to 115
NIBP-D low limit ≤ 50
10 to (NIBP-D low limit - 1)
NIBP ≤ 50: 1
NIBP > 50: 5
NIBP ≤ 50: 1
NIBP > 50: 5
NIBP-D low limit > 50
10 to (NIBP-D low limit - 5)
*Measurement accuracy verification: In adult and pediatric modes, the blood pressure measurements measured with this device are in compliance with the Standard for Non-invasive sphygmomanometers (ISO 81060-2: 2013) in terms of mean error and standard deviation by comparing with intra-arterial or auscultatory measurements
(depending on the configuration) in a typical patient population. For auscultatory reference, the 5th Korotkoff sound was used to determine the diastolic pressure.
In neonatal mode, the blood pressure measurements measured with this device are in compliance with the
American National Standard for Non-invasive sphygmomanometers (ISO 81060-2) in terms of mean error and standard deviation by comparing with intra-arterial measurements (depending on the configuration) in a typical patient population.
A.13.7
IBP Specifications
Standard
Technique
IBP
Measurement range
Resolution
Accuracy
PPV
Measurement range
Pressure transducer
Excitement voltage
Sensitivity
Meets the requirements of IEC 60601-2-34: 2011
Direct invasive measurement
-50 to 300 mmHg
1 mmHg
±2% or ±1 mmHg, whichever is greater (excluding sensor error)
0% ~ 50%
5 VDC, ±2%
5 μV/V/mmHg
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Zero adjustment range
Impedance range
Volume displacement
Alarm limit
Sys High
Mean High
Dia High
Sys Low
Mean Low
Dia Low
Art-S Extreme High
Art-M Extreme High
Art-D Extreme High
Art-S Extreme Low
Art-M Extreme Low
Art-D Extreme Low
A.13.8
C.O. Specifications
Measurement method
Measurement range
±200 mmHg
300 to 3000Ω
<0.04 mm
3
/100 mmHg
Range (mmHg)
IBP ≤ 50: (low limit + 2) to 50
IBP > 50: (low limit + 5) to 295
IBP ≤ 50: -49 to (high limit - 2)
IBP > 50: 50 to (high limit - 5)
High limit < 50: (High limit+ 1) to 300
High limit ≥ 50: (High limit+ 5) to 300 low limit ≤ 50: -50 to (low limit- 1) low limit > 50: -50 to (low limit- 5)
Step (mmHg)
IBP ≤ 50: 1
IBP > 50: 5
IBP ≤ 50: 1
IBP > 50: 5
TB Operating mode
Minimum time for accurate TB measurement
Resolution
Accuracy
Repeatability
Alarm range
Alarm limit
TB High
TB Low
Thermodilution method
C.O.:
TB:
TI:
0.1 to 20 L/min
23 to 43 °C
0 to 27 °C
Direct mode
10 s
C.O.:
TB, TI:
C.O.:
TB, TI:
C.O.:
TB:
Range
(low limit + 1) to 43 °C
(low limit + 2) to 109.4 °F
23 to (high limit - 1) °C
73.4 to (high limit - 2) °F
0.1 L/min
0.1 °C (excluding sensor)
±5% or ±0.1 L /min, whichever is greater
±0.1 °C (excluding sensor)
±2% or ±0.1 L/min, whichever is greater
23 to 43 °C
Step
0.1 °C
0.1 °F
A.13.9
ScvO2/SvO2 Specifications from the Edwards Monitor
Operating mode
Measured parameters
Parameter alarms
Interfaces with Edwards Vigilance II®, Vigileo TM monitor, EV1000, or
HemoSphere monitor
Consistent with SvO
2
/ScvO
2
-related parameters output by Vigilance II®,
Vigileo TM monitor, EV1000, or HemoSphere monitor
SvO
2
, ScvO
2
A - 18 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Signal Output
Standard
Output impedance
Isolation voltage
SpO
2
Analog Signal Output
Output voltage
Output voltage error
Meets the requirements of IEC 60601-1 for short-circuit protection and leakage current
≤1000Ω
1500 VAC
0 to 10V (0 to 100%)
±5%
Alarm Limit
SvO
2
/ScvO
2
High
SvO
2
/ScvO
2
Low
Range
ScvO
2
<60%: (Low limit + 5%) to 60%
ScvO
2
≥60%: (Low limit + 1%) to 99%
ScvO
2
<60%: 0 to (High limit - 5%)
ScvO
2
≥60%: 60% to (Low limit - 1%)
Step
ScvO2<60%: 5%
ScvO2≥60%: 1%
A.13.10 CCO Specifications from the Edwards Monitor
Operating mode
Measured parameter
Parameter alarm
Interfaces with Edwards Vigilance II®, Vigileo
TM
monitor, EV1000, or
HemoSphere monitor
Consistent with CCO-related parameters output by Vigilance II®, Vigileo
TM monitor, EV1000, or HemoSphere monitor
CCO, CCI
Signal Outputs
Standard
Output impedance
Isolation voltage
ECG Analog Output
Bandwidth (-3dB; reference frequency:
10Hz)
Meets the requirements of IEC 60601-1 for short-circuit protection and leakage current
≤1000Ω
1500 VAC
Diagnostic mode: 0.05~150Hz
Monitor mode: 0.5~40Hz
Surgery mode: 1~20Hz
ST mode: 0.05~40Hz
2 V/mV ±5% Sensitivity
MAP Analog Signal Output
Output voltage
Output voltage error
CVP Analog Signal Output
Output voltage
Output voltage error
Alarm Limit
0 to 5 V (0 to 500 mmHg)
±5%
0 to 5 V (0 to 100 mmHg)
±5%
Range Step
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 19
CCO High
CCO Low
CCI High
CCI Low
(Low limit + 0.1) to 25 L/min
0.3 to (high limit - 0.1)L/min
(Low limit + 0.1) to 15 L/min/m
2
0.1 to (high limit - 0.1)L/min/m
2
0.1 L/min
0.1 L/min/m
2
A.13.11 ScvO
2
Specifications
Measured parameters
ScvO
2
Alarm Limit
ScvO
2
High
ScvO
2
Low
Measurement range
0 to 99%
Range
ScvO
2
<60%: (Low limit + 5%) to 60%
ScvO
2
≥60%: (Low limit + 1%) to 99%
ScvO
2
<60%: 0 to (High limit - 5%)
ScvO
2
≥60%: 60% to (High limit - 1%)
Measurement accuracy
50% to 80%: ±3%
Other ranges: Not specified.
Step
ScvO
2
<60%: 5%
ScvO
2
≥60%: 1%
A.13.12 CO
2
Specifications
Measurement mode
Technique
Apnea delay
Alarm limit
Sidestream, microstream
Infrared absorption
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
Range
EtCO
2
High
EtCO
2
Low
FiCO
2
High
Sidestream CO
2
Module
(low limit + 2) to 99 mmHg
1 to (high limit - 2) mmHg
1 to 99 mmHg
Step
1 mmHg
Standard Meets the requirements of ISO 80601-2-55: 2018
0 to 150 mmHg CO
2
Measurement range
CO
2
absolute accuracy* Full accuracy mode:
0 - 40 mmHg: ±2mmHg
41 - 76 mmHg: ±5% of reading
77 - 99 mmHg: ±10% of reading
100 - 150 mmHg: ±(3mmHg + 8% of reading
ISO accuracy mode: Add ±2mmHg to the full accuracy mode
Accuracy specifications are affected by the breath rate and I:E. The EtCO
2
accuracy is within specification for breath rate ≤
60 rpm and I/E ratio ≤ 1:1, or breath rate ≤ 30 rpm and I/E ratio ≤ 2:1.
CO
2 resolution
Accuracy drift
Sample flowrate
Sample flowrate tolerance
Start-up time
1 mmHg
Meets the requirements for measurement accuracy within 6 hours
Connected a DRYLINE II watertrap for adult and pediatric patient: 120 ml/min
Connected a DRYLINE II watertrap for neonatal patient: 70 ml/min, 90 ml/min
±15% or ±15 ml/min, whichever is greater.
Maximum: 90 s
Typically: 20 s
A - 20 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Rise time
Response time
Measured with a DRYLINE II neonatal watertrap and a 2.5-meter neonatal sampling line:
≤250 ms@70 ml/min
≤250 ms@90 ml/min
Measured with a DRYLINE II adult watertrap and a 2.5-meter adult sampling line:
≤300 ms@120 ml/min
Measured with a DRYLINE II neonatal watertrap and a 2.5-meter neonatal sampling line:
≤5.0 s @ 70 ml/min
≤4.5 s @ 90 ml/min
Measured with a DRYLINE II adult watertrap and a 2.5-meter adult sampling line:
≤5.0 s @ 120 ml/min awRR measurement range awRR measurement precision awRR resolution
Data sample rate
0 to 150 rpm
≤60 rpm: ±1 rpm
6 1 to 150 rpm: ±2 rpm
1 rpm
50 Hz
Effect of interference gases on CO
2 measurements
Gas Concentration (%) Quantitative effect*
N
2
O
Hal
Sev
Iso
≤60
≤4
≤5
≤5
±1 mmHg
Enf
Des
≤5
≤15 ±2 mmHg
*: means an extra error should be added in case of gas interference when CO
2
measurements are performed between 0 to
40 mmHg.
Microstream CO
2
Module
Standard
CO
2
Measurement range
Accuracy*
Meets the requirements of ISO 80601-2-55: 2018
0 to 99 mmHg
0 to 38 mmHg:
39 to 99 mmHg:
±2 mmHg
±5% of the reading (0.08% of the reading increased in error for every 1 mmHg if the reading is more than 38 mmHg)
Accuracy drift Meets the requirements for measurement accuracy within 6 hours
* Accuracy applies for respiration rate up to 80 rpm. For respiration rate above 80 rpm and EtCO
2
exceeding 18 mmHg, the accuracy is 4 mmHg or ±12% of the reading, whichever is greater. For respiration rate above 60 rpm, the above accuracy can be achieved by using the CapnoLine H Set for Infant/Neonatal. In the presence of interfering gases, the above accuracy is maintained to within 4%.
Resolution
Sample flow rate
1 mmHg
50 (- 7.5/+15) ml/min
Initialization time Maximum 180 s
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 21
Response time awRR measurement range awRR measurement accuracy awRR resolution
Data sample rate
A.13.13 AG Specifications
Standard
Technique
Warm-up time
Sample flow rate
Measurement range
Resolution
Iso accuracy
2.9 s (typical)
(The response time is the sum of the rise time and the delay time when using a FilterLine of standard length)
Rise time: <190 ms (10% to 90%)
Delay time: 2.7 s (typical)
0 to 150 rpm
0 to 70 rpm:
71 to 120 rpm:
121 to 150 rpm:
1 rpm
40 Hz
±1 rpm
±2 rpm
±3 rpm meets the requirements of ISO 80601-2-55: 2018
Infrared absorption, paramagnetic properties for O
2
monitoring
Iso accuracy mode:
Full accuracy mode:
≤45 s
≤10 min
Adult, pediatric:
Neonate:
Accuracy:
CO
2
:
O
2
:
N
2
O:
Des:
Sev:
Enf:
Iso:
Hal: awRR:
200 ml/min
120 ml/min
±10 ml/min or ±10%, whichever is greater
0 to 30%
0 to 100%
0 to 100%
0 to 30%
0 to 30%
0 to 30%
0 to 30%
0 to 30%
2 to 100 rpm
CO
2
:
O
2
:
N
2
O:
Des:
Sev:
Enf:
Iso:
Hal: awRR:
0.1%
1%
1%
0.1%
0.1%
0.1%
0.1%
0.1%
1 rpm
As full accuracy specifications, but derated as follows:
Add ±0.3%
ABS
to accuracy for CO
2
Add ±8%
REL
to accuracy for all anesthetic gases
N
2
O accuracy is ±(8%
REL
+2%
ABS
)
A - 22 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Full accuracy
Accuracy drift
Apnea alarm delay
Refresh rate
Rise time
(10% ~ 90%)
Delay time
Gases
CO
O
2
Sev
2
N2O
Des
Enf, Iso, Hal
Range (%REL)
0≤CO
2
≤1
1<CO
2
≤5
5<CO
2
≤7
7<CO
2
≤10
CO
2
>10
0≤NO
2
≤20
20<NO
2
≤100
0 to 25
25 to 80
80 to 100
0 to 1
1 to 5
5 to 10
10 to 15
15 to 18
>18
0 to 1
1 to 5
5 to 8
>8
0 to 1
1 to 5
>5
1
Accuracy (%ABS)
±0.1
±0.2
±0.3
±0.5
Not specified
±2
±3
±1
±2
±3
±0.15
±0.2
±0.4
±0.6
±1
Not specified
±0.15
±0.2
±0.4
Not specified
±0.15
±0.2
Not specified awRR 2 to 60 rpm
>60 rpm
±1 rpm
Not specified
Note
1
: The highest GAS LEVEL for a single halogenated anaesthetic gas in a gas mixture that is concealed when the anaesthetic concentration falls is 0.15/0.3%
(Full/ISO accuracy).
Meet the requirement for measurement accuracy within 6 hours
10 s, 15 s, 20 s, 25 s, 30 s, 35 s, 40 s
1 s
Gas sample flow rate 120 ml/min, using a DRYLINE II neonatal watertrap and sampling line (2.5 m):
CO
2
: ≤250 ms
N
2
O: ≤250 ms
Hal, Iso, Sev, Des: ≤300 ms
Enf: ≤350 ms
O
2
: ≤600 ms
Gas sample flow rate 200 ml/min, using the adult DRYLINE II water trap and sampling line (2.5 m):
CO
2
: ≤250 ms
N
2
O: ≤250 ms
Hal, Iso, Sev, Des: ≤300 ms
Enf: ≤350 ms
O
2
: ≤500 ms
<4 s
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 23
A - 24
Response time
Anesthetic agent limit
Measured with a DRYLINE II neonatal watertrap and a 2.5-meter neonatal sampling line:
120 ml/min:
CO
2
:
N
2
O:
O
2
:
Hal, Iso, Sev, Des, Enf:
≤4s
≤4.2s
≤4s
≤4.4s
Measured with a DRYLINE II adult watertrap and a 2.5-meter adult sampling line:
200 ml/min:
CO
2
:
N
2
O:
Hal, Iso, Sev, Des, Enf:
O
2
:
Primary anesthetic agent
In full accuracy mode: 0.15%
≤4.2s
≤4.3s
≤4.5s
≤4s
Secondary anesthetic agent:
In full accuracy mode: 5% of primary agent if primary agent is greater than 10%,
0.3% if primary agent is less than or equal to 10%.
Data sample rate 25 Hz
Accuracy specifications are affected by the breath rate and I:E change. The end-tidal gas reading is within specification for breath rate below 15 rpm and I:E ratio smaller than 1:1 relative to the gas readings without breath; Add ±6%REL to inaccuracy for Hal and O
2
for breath rate larger than 15 rpm; Add ±6%REL to inaccuracy for all gases for breath rate larger than 30 rpm (inaccuracy for HAL and O
2
are unspecified in this case); inaccuracy is unspecified for breath rate larger than
60 rpm.
Effect of interference gases on AG measurements
(low limit + 2) to 99 mmHg
1 to (high limit - 2) mmHg
0 to 99 mmHg
Quantitative effect(%ABS)3)
Gas
Alarm limit
EtCO
2
High
EtCO
2
Low
FiCO
2
High
Concentration(
%)
CO
2
N
2
O Agent 1)
CO
2
N
2
O
Agent 1) 2)
/
/
/
0.1
0.1
/
0
0.1
0.2
0.2
/
<100%
0.1
0.1
0.1
0
0.1
0
1
0.5
Xenon
Helium <50%
<0.1%
0.1
0
0
0
0
0
0.5
0.5
Ethanol
Acetone <1%
<1%
0.1
0.1
0.1
0.1
0
0
0.5
0.5
Methane
Saturated Isopropanol vapour /
/
0.1
Unspecified
0
Unspecified
0
Unspecified
0.5
Unspecified Metered dose inhaler propellants
O
2
/ 0.2
0.2
1.0
/
1) Agent represents one of Des, Iso, Enf, Sev, and Hal.
2) Multiple agent interference on CO
2
, N
2
O and O
2
is typically the same as single agent interference.
3) For CO
2
, N
2
O and Agents, maximum interference from each gas at concentrations within specified accuracy ranges for each gas. The total interference of all gases is never larger than 5%REL.
Range
O
2
Step
1 mmHg
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
EtO
2
High
EtO
2
Low
FiO
2
High
FiO
2
Low
EtN
2
O High
EtN
2
O Low
FiN
2
O High
FiN
2
O Low
EtHal/Enf/Iso High
EtHal/Enf/Iso Low
FiHal/Enf/Iso High
FiHal/Enf/Iso Low
EtSev High
EtSev Low
FiSev High
FiSev Low
EtDes High
EtDes Low
FiDes High
FiDes Low
A.13.14 EEG Specifications
Standard
Bandwidth
Input Signal Range
Max. DC Input Offset
Common Mode Rejection Ratio
Noise Level
Differential Input Impedance
Electrode Impedance
(low limit + 2%) to 100%
0 to (high limit - 2)%
(low limit + 2%) to 100%
18% to (high limit - 2)%
(low limit + 2) to 100%
0 to (high limit - 2)%
(low limit + 2) to 100%
0 to (high limit - 2)%
(low limit + 0.2) to 5.0%
0 to (high limit - 0.2)%
(low limit + 0.2) to 5.0%
0 to (high limit - 0.2)%
(low limit + 0.2) to 8.0%
0 to (high limit - 0.2)%
(low limit + 0.2) to 8.0%
0 to (high limit - 0.2)%
(low limit + 0.2) to 18.0%
0 to (high limit - 0.2)%
(low limit + 0.2) to 18.0%
0 to (high limit - 0.2)%
1%
1%
0.1%
0.1%
0.1% meets the requirements of IEC 60601-2-26: 2012
0.5 to 50 Hz (-3 dB)
-2 mVp-p to +2 mVp-p
± 500 mV
≥100 dB @51 kΩ imbalance and 60 Hz
≤0.5 uV rms (1 Hz to 30 Hz)
>15 MΩ @10 Hz
Range:
Accuracy:
0 to 90 kΩ,
± 1 kΩ or ± 10%, whichever is greater
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 25
A.13.15 BIS Specifications
Standard
Technique
Measured parameters
Calculated parameters
Impedance range
Sweep speed
Input impedance
Noise (RTI)
Input signal range
EEG bandwidth
Patient leakage current
Alarm limit
BIS High
BIS Low
Meet the standard of IEC 60601-2-26: 2012
Bispectral index
EEG
BIS, BIS L, BIS R: 0 to 100
SQI, SQI L, SQI R:0 to 100%
EMG, EMG L, EMG R: 0 to 100 dB
SR, SR L, SR R: 0 to 100%
SEF, SEF L, SEF R: 0.5 to 30.0 Hz
TP, TP L, TP R: 40 to 100 dB
BC, BC L, BC R: 0 to 30 sBIS L, sBIS R: 0 to 10.0
sEMG L, sEMG R: 0 to 10.0
ASYM: 0 to 100%
0 to 999 kΩ
6.25 mm/s, 12.5 mm/s, 25 mm/s or 50 mm/s, ±10% error
>5 MΩ
<0.3 μV (0.25 to 50 Hz)
±1 mV
0.25 to 100 Hz
<10 μA
Range
(low limit + 5) to 100
0 to (high limit - 5)
Step
5
A.13.16 NMT Specifications (NMT from Mindray NMT module)
Standard
Stimulation output
ST mode
TOF mode
PTC mode meets the requirements of IEC 60601-2-10: 2016
Pulse width 100, 200, or 300 μs; monophasic rectangle pulse
Accuracy: ±10%
Current range 0 to 60 mA in increments of 5 mA
Accuracy: ± 5% or ±2 mA, whichever is greater
Max. skin impedance
Max. output voltage
ST-Ratio
Measurement interval
3 kΩ @ 60 mA, 5 kΩ @ 40 mA
300 V
0 to 200%
Manual, 1 s, 10 s, 20 s
TOF-Count
TOF-Ratio
TOF-T1%
Measurement interval
PTC-Count
Measurement interval
0 to 4
5% to 160%
0 to 200%
Manual, 12s, 15s, 20s, 30s, 1min, 5 min, 15 min, 30 min, 60 min
0 to 20
Manual
A - 26 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
DBS mode Measurement interval
DBS-Count
DBS-Ratio
Manual, 15s, 20s, 30s, 1min, 5 min, 15 min,
30 min, 60 min
0 to 2
5% to 160%
Threshold
Off, 1, 2, 3, 4, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%
NMT message
Block Recovery
A.13.17 rSO
2
Specifications
Measurement range 15% to 95%
A.14
Software Specifications
Mindray’s software
OTS software
The BeneVision N12/N15/N17/N19/N22 patient monitor system software
BeneVision N22/N19 OS: Linux 3.8.0
BeneVision N17/N15/N12 OS: Linux 3.2.0
iView OS: Windows 10
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual A - 27
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A - 28 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
B
EMC and Radio Regulatory Compliance
B.1
EMC
The device meets the requirements of IEC 60601-1-2: 2014.
WARNING
•
Use of accessories, transducers and cables other than those specified or provided by the manufacturer of this equipment could result in increased electromagnetic emissions or decreased electromagnetic immunity of this equipment and result in improper operation.
•
The non-ME EQUIPMENT (e.g. information technology equipment (ITE)) that is a part of an ME
SYSTEM may be disrupted by the electromagnetic interference of nearby equipment. It may be necessary to take mitigation measures, such as re-orienting or relocating the non-ME EQUIPMENT or shielding the location.
•
Use of this equipment adjacent to, or stacked with, other equipment should be avoided because it could result in improper operation. If such use is necessary, this equipment and the other equipment should be observed to verify that they are operating normally.
•
This equipment is intended for use in professional healthcare facility environment only. If it is used in a special environment, such as a magnetic resonance imaging environment, the equipment/ system may be disrupted by the operation of nearby equipment.
•
Portable RF communications equipment (including peripherals such as antenna cables and external antennas) should be used no closer than 30 cm (12 inches) to any part of the this device, including cables specified by the manufacturer. Otherwise, degradation of the performance of this equipment could result.
Guidance and Declaration - Electromagnetic Emissions
The device is intended for use in the electromagnetic environment specified below. The customer or the user of the device should assure that it is used in such an environment.
Emission tests Compliance Electromagnetic environment - guidance
Conducted and radiated RF
EMISSIONS CISPR 11
Conducted and radiated RF
EMISSIONS CISPR 11
Harmonic distortion
EMISSIONS IEC61000-3-2:
2014
Voltage Fluctuations/Flicker
EMISSIONS IEC61000-3-3:
2013
Group 1
Class A
Class A
Complies
The device uses RF energy only for its internal function.
Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.
The device is suitable for use in all establishments other than domestic and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes
■
■
■
■
■
■
If the system is operated within the electromagnetic environment listed in Table Guidance and Declaration -
Electromagnetic Immunity, the system will remain safe and provide the following essential performance:
Operating mode
Accuracy
Function
Accessories identification
Data stored
Alarm
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual B - 1
B - 2
■ Detect for connection
NOTE
•
If the essential performance is lost or degraded, it may be necessary to take mitigation measures, such as re-orienting or relocating the ME EQUIPMENT or ME SYSTEM or shielding the location.
During this time, the user should stop using the monitor and contact the service personnel.
•
The device needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided below.
•
Other devices may interfere with this device even though they meet the requirements of CISPR.
•
When an input signal is below the minimum amplitude provided in technical specifications, erroneous measurements could result.
•
The EMISSIONS characteristics of this device make it suitable for use in industrial areas and hospitals
(CISPR 11 class A). If it is used in a residential environment (for which CISPR 11 class B is normally required) this device might not offer adequate protection to radio-frequency communication services. The user might need to take mitigation measures, such as relocating or re-orienting the device.
Guidance and Declaration - Electromagnetic Immunity
The device is intended for use in the electromagnetic environment specified below. The customer or the user of the device should assure that it is used in such an environment.
Immunity test IEC60601test level Compliance level Electromagnetic environment - guidance
Electrostatic discharge (ESD) IEC
61000-4-2: 2008
Electrical fast transient/burst IEC
61000-4-4: 2012
Surge IEC 61000-4-5:
2014
Voltage dips and voltage interruptions
IEC 61000-4-11: 2004
±8 kV contact
±15 kV air
±2 kV for power supply lines
±1 kV for input/ output lines
(length greater than 3 m)
±1 kV line(s) to line(s)
±2 kV line(s) to earth
0 % U
T
for 0.5 cycle: at
0°, 45°, 90°, 135°, 180°,
225°, 270° and 315°
0 % U
T
for 1 cycle and
70 % U
T
for 25/30 cycles: at 0°
±8 kV contact
±15 kV air
±2 kV for power supply lines
±1 kV for input/ output lines
(length greater than 3 m)
±1 kV line(s) to line(s)
±2 kV line(s) to earth
0 % U
T
for 0.5 cycle: at
0°, 45°, 90°, 135°, 180°,
225°, 270° and 315°
0 % U
T
for 1 cycle and
70 % U
T
for 25/30 cycles: at 0°
Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.
Mains power quality should be that of a typical commercial or hospital environment.
Mains power quality should be that of a typical commercial or hospital environment. If the user of our product requires continued operation during power mains interruptions, it is recommended that our product be powered from an uninterruptible power supply or a battery.
RATED power frequency magnetic fields
IEC 61000-4-8: 2009
0 % U
T
for 250/300 cycle
30 A/m
50 Hz/60 Hz
0 % U cycle
T
30 A/m
for 250/300
50 Hz/60 Hz
Note: U
T
is the AC mains voltage prior to application of the test level.
Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.
Guidance and Declaration - Electromagnetic Immunity
The device is intended for use in the specified electromagnetic environment. The customer or the user of the device should assure that it is used in such an environment as described below.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Guidance and Declaration - Electromagnetic Immunity
Immunity test IEC60601 test level Compliance level Electromagnetic environment - guidance
Conducted disturbances induced by RF fields
IEC61000-4-6: 2013
Radiated RF EM fields
IEC61000-4-3:
2006+A1:2007+A2:20
10
3 Vrms
150 kHz to 80 MHz
6 Vrms in ISM bands a between 0.15 MHz and 80 MHz
3 V/m
80 MHz to 2.7 GHz
3Vrms
6 Vrms
3V/m
Portable and mobile RF communications equipment should be used no closer to any part of the system, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter. Recommended separation distances: d = 1.2
P
Recommended separation distances:
80 MHz to 800 MHz: d = 1.2
P
800MHz - 2.7GHz: d = 2.3
P
Where, P is the maximum output power rating of the transmitter in Watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters
(m) b
.
Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey a
should be less than the compliance level in each frequency range b
.
Interference may occur in the vicinity of equipment marked with the following symbol:
Proximity fields from
RF wireless communications equipment
IEC61000-4-3:
2006+A1:2007+A2:20
10
27 V/m
380 - 390 MHz
28 V/m
430 - 470 MHz,
800 - 960 MHz
1700 - 1900 MHz,
2400 - 2570 MHz
27 V/m
28 V/m
/
9 V/m
704 - 787 MHz,
5100 - 5800 MHz
9 V/m
Note 1: At 80 MHz and 800 MHz, the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
a
: The ISM (industrial, scientific, and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz; 13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
b
: Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered.
If the measured field strength in the location in which the ME EQUIPMENT or ME SYSTEM is used exceeds the applicable
RF compliance level above, the ME EQUIPMENT or ME SYSTEM should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the ME EQUIPMENT or
ME SYSTEM .
c
: Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3V/m.
WARNING
•
The device is configured with a wireless network connector to receive wireless signal. Other devices may interfere with this device even though they meet the requirements of CISPR.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual B - 3
B.2
Recommended separation distances between portable and mobile RF communications equipment and the device
The device is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the device can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the device as recommended below, according to the maximum output power of the communications equipment.
Separation distance in meters (m) according to frequency of the transmitter
Rated maximum output power of transmitter (W)
150 kHz to 80 MHz d = 1.2
P
80 MHz to 800 MHz d = 1.2
P
800 MHz to 2.7 GHz d = 2.3
P
0.01
0.1
1
10
0.12
0.38
1.20
3.80
0.12
0.23
0.38 0.73
1.20 2.30
3.80
7.30
100 12.00
12.00 23.00
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in metres
(m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in Watts (W) according to the transmitter manufacturer.
Note 1: At 80 MHz and 800 MHz, the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
Radio Regulatory Compliance
This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.
Any changes or modifications to this equipment not expressly approved by Mindray may cause harmful radio frequency interference and void your authority to operate this equipment.
The maximum antenna gain permitted complies with the e.i.r.p. limits as stated in RSS-210.
The maximum antenna gain permitted complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210.
WARNING
•
Changes or modifications not expressly approved by the party responsible compliance could void the user’s authority to operate the equipment.
B - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
C
Default Settings
C.1
C.1.1
ECG, Arrhythmia, ST and QT Default Settings
ECG Default Settings
Item
HR Alarm switch
High limit
Priority
Alarm Outputs
Alarm Source
ECG1
ECG2 (5-lead, 6-lead, 12-lead)
Va (for 6-lead only)
Vb(for 6-lead only)
ECG Gain
Speed
Filter
Notch Filter
Lead Set
Smart Lead
QRS Volume
Baseline Drift Removal (for 12-lead only)
Waveform Layout (for 12-lead only)
QRS Threshold
Paced
Pacer Reject
Low limit
Default Setting
On
Adult: 120 bpm
Pediatric: 160 bpm
Neonate: 200 bpm
Adult: 50 bpm
Pediatric: 75 bpm
Neonate: 100 bpm
Med
Off
Auto
II
V (for 5-lead).Va (for 6-lead), V1 (for 12-lead)
Va
Vb
×1
25 mm/sec
OR: Surgery
CCU: Diagnostic
Other departments: Monitor
On
Auto
On
General and OR: 2
Other departments: 0
On
Standard
0.16 mV
Adult: Unspecified
Pediatric/neonate: No
Off
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 1
C.1.2
Arrhythmia Default Settings
C.1.2.1
Arrhythmia Alarm Default Settings
Item Alarm Switch
Asystole
V-Fib/V-Tach
V-Tach
Vent Brady
Extreme Tachy
Extreme Brady
R on T
Run PVCs
Couplet
Multiform PVC
PVC
Bigeminy
Trigeminy
Tachy
Brady
Pacer Not Capture
Pacer Not Pacing
Missed Beat
Nonsus V-Tach
Vent Rhythm
Pause
Irr Rhythm
A-Fib
PVCs/min
Pauses/min
On
On
On
On
On
On
CCU: On
Other departments: Off
Off
Off
Off
Off
CCU: On
Other departments: Off
CCU: On
Other departments: Off
Off
Off
Off
Off
Off
CCU: On
Other departments: Off
CCU: On
Other departments: Off
Off
Off
Off
CCU: On
Other departments: Off
CCU: On
Other departments: Off
Med
Low
Prompt
Prompt
Med
Med
Low
Prompt
Med
Prompt
Med
Med
Med
Med
Prompt
Prompt
Prompt
Med
Priority
High, unadjustable
High, unadjustable
High, unadjustable
High, unadjustable
High, unadjustable
High, unadjustable
Med
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Off
Alarm Outputs
Off
Off
Off
Off
Off
Off
Off
C - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
C.1.2.2
Arrhythmia Threshold Default Settings
Item Default Setting
Asystole Delay
Tachy
Brady
Extreme Tachy
Extreme Brady
Multif PVCs Window
PVCs/min
Pauses/min
Pause Threshold
AF/Irr Rhy End Time
V-Tach Rate
V-Brady Rate
V-Tach PVCs
V-Brady PVCs
Adult
5 sec
120 bpm
50 bpm
160 bpm
35 bpm
15 beats
10
8
6
5
2.0 sec
2 min
130 bpm
40 bpm
C.1.3
ST Default Settings
Item
ST Alarm Mode
ST Alarm Mode set to Absolute :
ST-I, ST-II, ST-III, ST-aVR, ST-aVL, ST-aVF, ST-V1, ST-
V2, ST-V3, ST-V4, ST-V5,ST-V6, ST-Va, ST-Vb
ST Alarm Mode set to
ST Single,
ST Dual
Relative :
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
ST Analysis
ST Segment
Show Marker
ST Point
Auto Adjust
J
ISO
Pediatric
5 sec
160 bpm
75 bpm
180 bpm
50 bpm
15 beats
10
8
6
5
2.0 sec
2 min
130 bpm
40 bpm
Default Setting
Auto
Off
J+60
On
-0.1 mV
Med
Off
Off
48
-80
Absolute
Off
0.2 mV
-0.2 mV
Med
Off
Off
0.1 mV
Neonate
5 sec
200 bpm
100 bpm
220 bpm
60 bpm
15 beats
10
8
6
5
2.0 sec
2 min
160 bpm
40 bpm
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 3
C.1.4
C.1.5
QT Default Settings
Item
QTc
ΔQTc
QT Analysis
QT Lead
Alarm switch
High limit
Priority
Alarm Outputs
Alarm switch
High limit
Priority
Alarm Outputs
Default Setting
Med
Off
Off
All
Off
Adult: 500
Pediatric: 480
Neonate: 460
Med
Off
Off
60
Glasgow 12-lead ECG Algorithm Default Settings
Item
High Freq Cut-off
Baseline Drift Removal
Tachy
Brady
Waveform Layout
Median Complex
Measurements
Interpretation
Interpretation Summary
Default Setting
35 Hz
On
On
On
On
100
50
Standard
Off
C.2
Respiration Default Settings
Item
RR
Apnea
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
Priority
Alarm Outputs
Default Setting
On
Adult: 30
Pediatric: 30
Neonate: 100
Adult: 8
Pediatric: 8
Neonate: 30
Med
Off
On
High, unadjustable
Off
C - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
C.3
Item
Apnea Delay
RR Source
Resp Lead
Gain
Speed
Auto Threshold Detection
Default Setting
Adult: 20 sec
Pediatric: 20 sec
Neonate: 15 sec
Auto
Adult: Auto
Pediatric: Auto
Neonate: II
×2
6.25 mm/s
On
SpO
2
/SpO
2
b Default Settings
Item
SpO
2
/SpO
2
High limit
SpO
2
/SpO
Desat
2 b
Low limit
Priority
Alarm Outputs
Alarm switch
Low limit
Priority
Alarm Outputs
ΔSpO
2
High limit
Priority
Alarm Outputs
Satsecond (for Nellcor SpO
2
)
NIBP Simul
FastSAT (for Masimo SpO
2
)
Display SIQ (for Masimo SpO
2
)
Display PI (for Masimo SpO
2
)
Speed
Default Setting
10%
Med
Off
Off
80%
High
Off
On
On
Adult: 100%
Pediatric: 100%
Neonate: 95%
90%
Med
Off
On
Off
Off
Off
On
25 mm/s
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 5
C.4
C.5
Item
PR Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Alarm Source
PR Source
Display PR
QRS Volume
Default Setting
On
Adult: 120
Pediatric: 160
Neonate: 200
Adult: 50
Pediatric: 75
Neonate: 100
Med
Off
Auto
Auto
On
General, OR: 2
Other departments: 0
Temperature Default Settings
Item
Txx
(xx refers to temperature site)
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
High limit
Priority
Alarm Outputs
NIBP Default Settings
Item
Default Setting
On
38.0 °C
35.0 °C
Med
Off
On
2.0 °C
Med
Off
High limit
Low limit
Priority
Alarm Outputs
Default Setting
On
Adult: 160 mmHg
Pediatric: 120 mmHg
Neonate: 90 mmHg
Adult: 90 mmHg
Pediatric: 70 mmHg
Neonate: 40 mmHg
Med
Off
C - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Item
NIBP-M
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
NIBP-S Extreme
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
NIBP-D Extreme
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
NIBP-M Extreme
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Default Setting
Adult: 75 mmHg
Pediatric: 60 mmHg
Neonate: 35 mmHg
High
Off
Off
Adult: 105 mmHg
Pediatric: 80 mmHg
Neonate: 65 mmHg
Adult: 35 mmHg
Pediatric: 30 mmHg
Neonate: 15 mmHg
High
Off
Off
Adult: 125 mmHg
Pediatric: 100 mmHg
Neonate: 75 mmHg
Adult: 45 mmHg
Pediatric: 40 mmHg
Neonate: 20 mmHg
High
Off
On
Adult: 90 mmHg
Pediatric: 70 mmHg
Neonate: 60 mmHg
Adult: 50 mmHg
Pediatric: 40 mmHg
Neonate: 20 mmHg
Med
Off
On
Adult: 110 mmHg
Pediatric: 90 mmHg
Neonate: 70 mmHg
Adult: 60 mmHg
Pediatric: 50 mmHg
Neonate: 25 mmHg
Med
Off
Off
Adult: 175 mmHg
Pediatric: 130 mmHg
Neonate: 95 mmHg
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 7
Item
Initial Pressure
Interval
C.6
Start Mode
NIBP End Tone
Venipuncture Pressure
Display Format
Display Alarm Limits
Display PR
IBP Default Settings
Item
IBP-S Alarm switch
High limit
Default Setting
Adult: 160 mmHg
Pediatric: 140 mmHg
Neonate: 90 mmHg
OR: 5 min
Neonatology: 30 min
Other departments: 15 min
Clock
Off
Auto
Sys/Dia (Mean)
Off
Off
Low limit
Priority
Alarm Outputs
Default Setting
On
■ Art/Ao/UAP/BAP/FAP/LV/P1-P2 arterial pressure
Adult: 160 mmHg
Pediatric: 120 mmHg
Neonate: 90 mmHg
■ PA
Adult: 35 mmHg
Pediatric and neonate: 60 mmHg
■ Art/Ao/UAP/BAP/FAP/LV/P1-P2 arterial pressure
Adult: 90 mmHg
Pediatric: 70 mmHg
Neonate: 55 mmHg
■ PA
Adult: 10 mmHg
Pediatric and neonate: 24 mmHg
Med
Off
C - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Item
IBP-D
IBP-M
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Default Setting
On
■ Art/Ao/UAP/BAP/FAP/LV/P1-P2 arterial pressure
Adult: 90 mmHg
Pediatric: 70 mmHg
Neonate: 60 mmHg
■ PA
Adult: 16 mmHg
Pediatric and neonate: 4 mmHg
■ Art/Ao/UAP/BAP/FAP/LV/P1-P2 arterial pressure
Adult: 50 mmHg
Pediatric: 40 mmHg
Neonate: 20 mmHg
■ PA
Adult: 0 mmHg
Pediatric and neonate: -4 mmHg
Med
Off
On
■ Art/pArt/Ao/UAP/BAP/FAP/LV/P1-P2 arterial pressure
Adult: 110 mmHg
Pediatric: 90 mmHg
Neonate: 70 mmHg
■ PA
Adult: 20 mmHg
Pediatric and neonate: 26 mmHg
■ CVP
Adult: 14 cmH
2
O
Pediatric and neonate: 5 cmH
2
O
■ ICP/RAP/LAP/UVP/P3-P4 venous pressure
Adult: 10 mmHg
Pediatric and neonate: 4 mmHg
■ Art/Ao/UAP/BAP/FAP/LV/P1-P2 arterial pressure
Adult: 70 mmHg
Pediatric: 50 mmHg
Neonate: 35 mmHg
■ PA
Adult: 0 mmHg
Pediatric and neonate: 12 mmHg
■ CVP
Adult: 0 cmH
2
O
Pediatric and neonate: 0 cmH
2
O
■ ICP/RAP/LAP/UVP/P3-P4 venous pressure
Adult: 0 mmHg
Pediatric and neonate: 0 mmHg
Med
Off
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 9
C - 10
Item
Art-S Extreme Alarm switch
High limit
Low limit
Art-D Extreme
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Art-M Extreme
Priority
Alarm Outputs
Alarm switch
High limit
CPP
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Measure (for P1, P2)
Measure (for P3, P4)
Sensitivity
Speed
Priority
Alarm Outputs
Default Setting
Adult: 55 mmHg
Pediatric: 40 mmHg
Neonate: 30 mmHg
High
Off
On
Adult: 130 mmHg
Pediatric: 100 mmHg
Neonate: 90 mmHg
Adult: 50 mmHg
Pediatric: 40 mmHg
Neonate: 30 mmHg
Med
Off
All
Mean Only
Med
25 mm/sec
Off
Adult: 175 mmHg
Pediatric: 130 mmHg
Neonate: 95 mmHg
Adult: 75 mmHg
Pediatric: 60 mmHg
Neonate: 50 mmHg
High
Off
Off
Adult: 105 mmHg
Pediatric: 80 mmHg
Neonate: 65 mmHg
Adult: 35mmHg
Pediatric: 30 mmHg
Neonate: 15 mmHg
High
Off
Off
Adult: 125 mmHg
Pediatric: 100 mmHg
Neonate: 75 mmHg
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
C.7
Item
Scale
Default Setting
0- 20 mmHg ICP/RAP/LAP/UVP venous pressure
Art/Ao/BAP/FAP/LV/P1/
P2 arterial pressure
UAP/P3/P4 venous pressure
CVP/PA
0-160 mmHg
0-80 mmHg
CVP: 0-30 cmH2O
PA: 0 - 30 mmHg
Sys/Dia (Mean)
Off
Off
Display Format
Display Alarm Limits
Use PA-D as PAWP (only available for independent external display)
PPV Measure
PPV Source
PAWP Reference Waveform 1
Reference Waveform 2
Speed
PA Scale
Overlapping
Waveform Setup
Left Scale
Right Scale
CVP Scale
ICP Scale
PA Scale
Speed
Gridlines
Off
Auto
II
Resp
12.5 mm/sec
0-30 mmHg
0-160 mmHg
0-20 mmHg
0-30 cmH2O
0-20 mmHg
0-30 mmHg
25 mm/sec
Off
C.O. Default Settings
Item
TB Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Comp const
Auto Start
Auto TI
Default Setting
Off
0.542
On
On
On
39.0 °C
36.0 °C
Med
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 11
C.8
ScvO
2
Default Settings
Item
ScvO
2
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Hb/Hct
Default Setting
On
90
40
Med
Off
Hb
C.9
CCO Default Settings(Vigilance II/Vigileo/EV1000/HemoSphere)
Item
CCO
CCI
SVR Unit
Select Parameter
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Default Setting
On
14.0
2.0
Med
Off
On
10.0
1.0
Med
Off
DS/cm
5
CCI, GEF, SVRI, ELWI, GEDI
C.10
ScvO
2
/SvO
2
Default Settings(Vigilance II/Vigileo/EV1000/
HemoSphere)
Item
SvO
2
/ScvO
2 switch
High limit
Low limit
Priority
Alarm Outputs
Default Setting
On
90
40
Med
Off
C - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
C.11
CO
2
Default Settings
C.11.1
General Settings
Item
EtCO
2
High limit
Low limit
Priority
Alarm Outputs
FiCO
2
Apnea Delay
RR Source
Speed
Scale
Waveform Type
High limit
Priority
Alarm Outputs
C.11.2
Sidestream CO
2
Default Settings
Item
BTPS Compensation
O
2
Compensation (for CO
2
module without
O
2
measurement)
N
2
O Compenation
AG Compenation
Auto Standby
Operating Mode
Default Setting
Off
OR: 100%
Other departments: 21%
0%
0%
60 min
Measure
C.11.3
Microstream CO
2
Default Settings
Item
BTPS Compen
Maximum Hold
Auto Standby
Operating Mode
Default Setting
Off
20 sec
Off
Measure
Default Setting
On
Adult and pediatric: 50 mmHg
Neonate: 45 mmHg
Adult and pediatric: 25mmHg
Neonate: 30mmHg
Med
Off
On
4 mmHg
Med
Off
Adult and pediatric: 20 s
Neonate: 15 s
Auto
6.25 mm/s
50 mmHg
Draw
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 13
C.12
Gas Default Settings
Item
EtCO
2
FiCO
EtO
FiO
2
2
2
High limit
Low limit
Priority
Alarm Outputs
High limit
Priority
Alarm Outputs
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
EtN
2
High limit
Low limit
Priority
Alarm Outputs
FiN
2
O Alarm
High limit
EtAA/FiAA
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Default Setting
Off
On
30%
0.0%
Med
Off
On
88%
18%
Med
On
4 mmHg
Med
Off
On
Adult and pediatric: 50 mmHg
Neonate: 45 mmHg
Adult and pediatric: 25 mmHg
Neonate: 30 mmHg
Med
Off
On
53%
0%
Med
55%
0%
Med
Off
18%
Med
Off
On
Off
On
Adult and pediatric: 100%
Neonate: 90%
C - 14 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Item
EtHal/EtEnf/EtIso
FiHal/FiEnf/FiIso
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
FiSev
Apnea Delay
RR Source
Operating Mode
Auto Standby
RR Source
Speed
High limit
Low limit
Priority
Alarm Outputs
High limit
Low limit
Priority
Alarm Outputs
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
High limit
Low limit
Priority
Alarm Outputs
Default Setting
0.0%
Med
Off
On
Med
Off
On
6.0%
Off
On
2.0%
0.0%
On
3.0%
0.0%
Med
On
8.0%
0.0%
Med
5.0%
0.0%
Med
Off
Off
On
6.0%
0.0%
Med
Off
Adult and pediatric: 20 sec
Neonate: 15 sec
Auto
Measure
Off
Auto
6.25 mm/sec
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 15
Item
Scale
Waveform Type
O2 compensation
Default Setting
O2: 400 mmHg
CO2: 50 mmHg
N2O: 50 %
Hal, Enf, and Iso: 2.5%
Sev: 4.0%
AA and Des: 9.0 %
Draw (for CO
2 only )
OR: 100%
Other departments: Off
C.13
EEG Default Settings
Item
Scale
Speed
Low Filter
High Filter
Notch Filter
EEG Expand View
EEG
Trends
DSA
EEG Channels
Scale
Speed
EEG Channels
Parameters
Trend Length
EEG Channels
Parameters
CSA
Trend Length
Power Scale
EEG Channels
Parameters
Trend Length
Power Scale
CSA Clipping
Default Setting
100 μV
30 mm/s
0.5 Hz
30 Hz
On
Default Setting
All
100 μV
30 mm/s
EEG1, EEG2, EEG3, EEG4
SEF
60 min
All
SEF
20 min
1 - 64 dB
All
SEF
20 min
1 - 64 dB
On
C - 16 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
C.14
BIS Default Settings
Item
BIS
Smoothing Rate
Display
Scale
Speed
Filter
Auto Check
BIS Expand View
Parameter 1
Parameter 2
Trend Length
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
C.15
NMT Default Settings
Item
Stimulation Current
Pulse Width
Block Recovery
Stimulation Beep Volume
Interval
DBS Mode
C.16
rSO
2
Default Settings
Item rSO2-1/rSO2-2/ rSO2-1’/rSO2-2’
Alarm switch
High limit
Low limit
Priority
Alarm Outputs
Default Setting
On
70
20
Med
Off
30 sec
OR: BIS Trend
Other departments: EEG LT/RT
100 μV
25mm/s
On
On
Default Setting
BIS L
EMG
60 min
Default Setting
Supra (60 mA)
200 μs
Off
2
TOF Mode: 1 min
ST Mode: 10 sec
DBS Mode: 1 min
3.3
Default Setting
On
90
40
Med
Off
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual C - 17
Item rSO2-1/rSO2-2/ rSO2-1’/rSO2-2’
Variance
Auto Low Limit rSO2-1 Label rSO2-2 Label rSO2-1’ Label rSO2-2’ Label
AUC Mode
Low Limit
Fixed Threshold
Percentage Below Baseline
Select Parameter
Default Setting
-20
Off
L
R
S1
S2
Below Baseline Percentage
50
25
Baseline, Baseline Variance
C.17
Alarm Default Settings
Item
Alarm Volume
High Alarm Volume
Reminder Volume
Apnea Delay
Printing Duration on Alarm
Auto Limits for New Patient
Default Setting
2
Alarm Volume + 2
2
Adult/Pediatric: 20 sec
Neonate: 15 sec
20 sec
On
C.18
Display Default Settings
Item
Choose Screen
Display
Night Mode
Screen Lock Duration
Brightness
Brightness On Battery
Brightness
Alarm Volume
QRS Volume
Key Volume
NIBP End Tone
Stop NIBP
Default Setting
1
0
Off
Off
1
2
5
1
Normal Screen
General: Permanent
CCU: Permanent
Other departments: 10 sec
C - 18 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
D
Alarm Messages
D.1
D.1.1
This chapter lists only the physiological and technical alarm messages. Some messages appearing on your monitor may not be included. In the “Cause and solution” column, corresponding solutions are given instructing you to troubleshoot problems. If the problem persists, contact your service personnel.
Physiological Alarm Messages
General Physiological Alarm Messages
D.1.2
Alarm messages
XX High
XX Low
Default priority
Med
Med
Cause and solution
XX value has risen above the high alarm limit or fallen below the low alarm limit. Check the patient’s condition and check if the patient category and alarm limit settings are correct.
Note: XX represents a measurement or parameter label, such as HR, NIBP, PVCs, RR, SpO
2
, PR, etc.
Arrhythmia Alarm Messages
Alarm message
Asystole
V-Fib/V-Tach
V-Tach
Vent Brady
Extreme Tachy
Extreme Brady
R on T
Run PVCs
Couplet
Multiform PVC
PVC
Bigeminy
Trigeminy
Tachy
Brady
Pacer Not Pacing
Pacer Not Capture
Missed Beats
Nonsus. Vtac
Vent Rhythm
Pause
Default priority
Prompt
Med
Prompt
Med
Med
Med
Med
Prompt
High
High
Med
Low
High
High
High
High
Prompt
Prompt
Med
Med
Low
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 1
D.1.3
Alarm message
Irr Rhythm
PVCs/min
Pauses/min
A-Fib
Default priority
Prompt
Med
Med
Prompt
Note: When arrhythmia alarms occur, check the patient’s condition and the ECG connections.
Resp Physiological Alarm Messages
Alarm message
Resp Artifact
Apnea
Default priority
High
High
Cause and solution
The patient’s heartbeat has interfered with the impedance respiration measurement. Check the patient’s condition and the ECG connections.
The respiration signal is so weak that the monitor cannot perform respiration analysis. Check the patient’s condition, module and patient connections.
D.1.4
SpO
2
Physiological Alarm Messages
Alarm message
SpO2/SpO2b Desat
ΔSpO2 High
Default priority
High
Med
Cause and solution
The SpO
2
or SpO
2 b value falls below the desaturation alarm limit.
Check the patient’s condition and check if the alarm limit settings are correct.
The ΔSpO2 value exceeds the alarm limit. Check the patient’s condition.
D.1.5
PR Physiological Alarm Messages
Alarm message
No Pulse
Default priority
High
Cause and solution
The pulse signal is so weak that the monitor cannot perform pulse analysis. Check the patient’s condition and the source of the PR, such as
IBP or SpO2 sensor, and measurement site.
D.1.6 NIBP Physiological Alarm Messages
Alarm message
NIBP-S Extremely
High/NIBP-D
Extremely High/NIBP-
M Extremely High
NIBP-S Extremely
High/NIBP-D
Extremely High/NIBP-
M Extremely Low
Default priority
High
High
Cause and solution
The NIBP value is higher than the NIBP Extreme alarm high limit. Check the patient’s condition and check if the alarm limit settings are correct.
The NIBP value is lower than the NIBP Extreme alarm low limit. Check the patient’s condition and check if the alarm limit settings are correct.
D - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
D.1.7 IBP Physiological Alarm Messages
Alarm message
Art-S/Art-D/Art-M
Extremely High
Art-S/Art-D/Art-M
Extremely Low
Default priority Cause and solution
High
High
The Art value is higher than the Art Extreme alarm high limit. Check the patient’s condition and check if the alarm limit settings are correct.
The Art value is lower than the Art Extreme alarm low limit. Check the patient’s condition and check if the alarm limit settings are correct.
D.1.8
CO
2
Physiological Alarm Messages
D.1.9
Alarm message
FiO2 Shortage
Default priority
High
Cause and solution
FiO
2
concentration is less than 18%. Check the patient’s condition, the ventilated O
2
content and the airway connection.
AG Physiological Alarm Messages
Alarm message
FiO2 Shortage
Mixed Agent and MAC≥3
Apnea
Default priority
High
Med
High
Cause and solution
FiO
2
concentration is less than 18%. Check the patient’s condition, the ventilated O
2
content and the AG connections.
The mixed anaesthetic gases concentration is too high. Verify the MAC parameters are correct and adjust the anaesthetic gases concentration as necessary.
The respiration signal was so weak that the monitor cannot perform respiration analysis. Check the patient’s condition, module and patient connections.
D.2
Technical Alarm Messages
This section lists technical alarms, their default priority, responses on alarm reset, and the actions that can be taken when an alarm occurs. Some of alarms may not be included.
Various technical alarms respond differently when the alarm system is reset. For easy clarification, in this section the technical alarms are classified into three categories of response when the alarm system is reset:
■
■
■
A: technical alarms are cleared. The monitor gives no alarm indications.
B: technical alarms are changed to the prompt messages.
C: the alarm is silenced and a √ appears before the alarm message.
In the following tables A, B, and C are used to refer to the responses on alarm reset.
D.2.1
General Technical Alarm Messages
Alarm message Default priority
Indication on alarm reset
C
Cause and solution
XX Module Error High XX module does not work properly. Reinsert the module, if the alarm persists, contact your service personnel.
Note: XX represents a measurement or parameter label, such as HR, RR, SpO2, or EtCO2, etc.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 3
D.2.2
ECG Technical Alarm Messages
D.2.3
Alarm message Default priority
Indication on alarm reset
A
Cause and solution
ECG Noisy
ECG Amplitude Too Small
ECG (XX) Lead Off
ECG Signal Invalid
ECG Learning
Low/Prompt
Low
Low
Low
Prompt
C
B
A
/
The ECG signal is noisy. Check for any possible sources of signal noise around the cable and electrode, and check the patient for excessive motion.
The ECG amplitude does not reach the detected threshold. Check for any possible source of interference around the cable and electrode.
The electrode has become detached from the patient or the lead wire has become disconnected from the adapter cable. Check the connections of the electrodes and leadwires.
Patient skin impedance is too high. Check ECG electrode application.
ECG learning is manually or automatically triggered.
/ Cannot Analyze QT Prompt /
Note: XX represents ECG lead name, for example RL, LL, V, Va, Vb, etc.
Resp Technical Alarm Messages
Alarm message
Resp Interference
Electrode Poor Contact
Default priority
Prompt
Indication on alarm reset
/
Prompt /
Cause and solution
The respiration circuit is disturbed. Check for any possible sources of signal noise.
Check the electrode application. Reposition or replace the electrodes if necessary.
D.2.4
SpO
2
Technical Alarm Messages
Alarm message
SpO2 Sensor Off/SpO2b
Sensor Off
Default priority
Low
Indication on alarm reset
B
SpO2 No Sensor/SpO2b
No Sensor
SpO2 Excess Light/SpO2b
Excess Light
SpO2 No Pulse/SpO2b No
Pulse
Low
Low
Low
A
C
C
Cause and solution
The SpO
2
sensor has become detached from the patient or the module. Check the sensor connection. If the alarm persists, replace the sensor.
The SpO
2
extension cable is detached from the
SpO
2
module, or the SpO
2
sensor is detached from the SpO
2
extension cable. Check the SpO cable and the sensor connection. If the alarm
2 persists, replace the sensor.
Ambient light is too strong. Move the sensor to a place with lower level of ambient light or cover the sensor to minimize the ambient light.
The SpO
2
sensor failed to obtain pulse signal.
Check the patient’s condition and replace the sensor application site. If the alarm persists, replace the sensor.
D - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Alarm message Default priority
Indication on alarm reset
C SpO2 Sensor
Incompatible/SpO2b
Sensor Incompatible
SpO2 Low Signal Quality/
SpO2b Low Signal Quality
Low
Low C
SpO2 Interference
/SpO2b Interference
Low
SpO2 Sensor Error/SpO2b
Sensor Error
SpO2 Searching Pulse/
SpO2b Searching Pulse
SpO2 Low Perfusion/
SpO2b Low Perfusion
Low
Prompt
Prompt
C
C
/
/
Cause and solution
Incompatible or an unspecified SpO
2
sensor is used. Use specified sensors.
1. Check the sensor and sensor position.
2. Make sure the patient is not shivering or moving.
3. The patient’s pulse may be too low to be measured.
The SpO
2
signal has interference. Check for any possible sources of signal noise and check the patient for excessive motion.
Replace the sensor and measure again.
SpO
2
is searching for pulse.
The SpO
2
sensor is not properly placed or the patient’s perfusion index is too low.
1. Check the sensor and sensor position.
2. Reposition the sensor if necessary.
D.2.5
Temp Technical Alarm Messages
Alarm message
T1/T2 Sensor Off
Default priority
Low
Indication on alarm reset
A
Cause and solution
Check the sensor connection and reconnect the sensor.
D.2.6
NIBP Technical Alarm Messages
Alarm message
NIBP Loose Cuff
NIBP Air Leak
NIBP Airway Error
NIBP Weak Signal
NIBP Overrange
NIBP Excessive Motion
NIBP Cuff Overpress
Default priority
Low
Indication on alarm reset
A
Low
Low
Low
Low
Low
Low
A
A
A
A
A
A
Cause and solution
There is a leak in the cuff or air tubing. Use a cuff of correct type based on the patient size. Apply the cuff and connect the air tubing as instructed in the manual.
Check the NIBP cuff and pump for leakages.
The air tubing may be occluded. Check the air tubing for an occlusion or kinking. If the alarm persists, contact your service personnel.
The patient’s pulse is weak or the cuff is loose.
Check the patient’s condition and replace the cuff application site.
The measured NIBP value exceeds the module measurement range. Check the patient’s condition.
Check the patient’s condition and reduce patient motion.
The NIBP airway may be occluded. Check the airway and measure again. If the alarm persists, contact your service personnel.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 5
Alarm message
NIBP Timeout
NIBP Cuff and Patient
Mismatch
NIBP Airway Leak
Default priority
Low
Indication on alarm reset
A
Low
Low
A
A
Cause and solution
The measurement time exceeds 120 seconds in the adult or pediatric mode, or exceeds 90 seconds in the neonatal mode, and the BP value cannot be obtained. Check the patient’s condition and NIBP connections, or replace the cuff and measure again.
The cuff type mismatches the patient category.
Verify the patient category or replace the cuff if necessary. If patient category is correct, check that the tubing is not bent and the airway is not occluded.
Airway leakage is found during the NIBP leakage test. Check the NIBP cuff and pump for leakages.
D.2.7
IBP Technical Alarm Messages
D.2.8
Alarm message
XX Sensor Error
XX No Sensor
XX No Pulse
XX Disconnected
Monitor Version Low
Default priority
Med
Med
Low
High
Low
C
A
Indication on alarm reset
A
C
A
Cause and solution
The IBP sensor fails. Replace the sensor.
The IBP patient cable and/or corresponding IBP sensor is not connected or detached. Check the cable and sensor connection.
The catheter may be occluded. Please flush the catheter.
The tubing is disconnected from the patient, or the three-way valve is open to the air. Check the connection of the tubing, or check the valve is open to the patient. If the alarm persists, contact your service personnel.
The N Series system software version is too low.
In order for the N Series monitor to connect to the N1 which connects to the external IBP module and perform IBP monitoring, the system software of N 1 and N series monitor should be
V01.11.00 and above.
Note: XX represents an IBP label, for example PA, CVP, FAP, P1, etc.
C.O. Technical Alarm Messages
Alarm message
TB Sensor Off
TI Sensor Off
Default priority
Low
Indication on alarm reset
A
Low A
Cause and solution
Check the sensor connection and reconnect the sensor.
Check the sensor connection and reconnect the sensor.
D - 6 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
D.2.9
ScvO
2
Technical Alarm Messages
Alarm message
ScvO2 High Signal
ScvO2 Low Signal
ScvO2 Excess Light
Optical Module
Disconnected
Unsupported CeVOX
Version
Disconnected from
Vigilance
Disconnected from
Vigileo
Disconnected from
EV1000
Disconnected from
HemoSphere
Default priority
Low
Indication on alarm reset
C
Low
Low
Low
Low
Low
C
C
A
A
A
Low
Low
Low
A
A
A
Cause and solution
Check the sensor and reposition the catheter.
Recalibrate the sensor.
Check the sensor and reposition the catheter.
Recalibrate the sensor.
Avoid excessively strong backlight.
Connect the optical module.
The module version is not compatible with the system. Contact your service personnel.
The Vigilance monitor is disconnected. Check the connection between the CCO/SvO
2
module and the Vigilance monitor.
The Vigileo monitor is disconnected. Check the connection between the CCO/SvO
2
module and the Vigileo monitor.
The EV1000 monitor is disconnected. Check the connection between the CCO/SvO
2
module and the EV1000 monitor.
The HemoSphere monitor is disconnected. Check the connection between the CCO/SvO
2
module and the HemoSphere monitor.
D.2.10
CO
2
Technical Alarm Messages
Alarm message
CO2 Module High Temp
Default priority
Low
Indication on alarm reset
C
CO2 Module Low Temp
CO2 Zero Failed
CO2 No Watertrap
CO2 High Airway Press.
Low
Low
Low
Low
C
C
B
C
Cause and solution
Ambient temperature is too high or there is a module failure.
1. Lower the operating temperature.
2. Reinsert the module.
3. If the alarm persists, the CO
2
module may have failed, contact your service personnel.
Ambient temperature is too low or there is a module failure.
1. Raise the operating temperature.
2. Reinsert the module.
3. If the alarm persists, the CO
2
module may have failed, contact your service personnel.
Reinsert the module. If the alarm persists, contact your service personnel.
Check the watertrap connections.
1. Check the airway pressure settings of the ventilator/anesthesia machine.
2. Disconnect the module from the ventilator/ anesthesia machine.
3. Reinsert the module.
4. If the alarm persists, contact your service personnel.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 7
Alarm message
CO2 Low Airway Press.
High Barometric
Low Barometric
CO2 Airway Occluded
CO2 No Filterline
CO2 Calibration Required
CO2 Airway Error
CO2 Adapter Error
CO2 No Sensor
CO2: Change Watertrap
CO2 Watertrap Mismatch
Default priority
Low
Indication on alarm reset
C
Low
Low
Low
Low
Low
Low
Low
Low
Low
Low
C
C
C
A
C
C
A
A
C
C
Cause and solution
1. Check the airway pressure settings of the ventilator/anesthesia machine.
2. Disconnect the module from the ventilator/ anesthesia machine.
3. Reinsert the module.
4. If the alarm persists, contact your service personnel.
The ambient pressure exceeds the operating pressure range or CO
2
module fails.
1. Make sure that the ambient pressure meets the specifications, and check for sources that affect the ambient pressure.
2. Reinsert the module. If the alarm persists, contact your service personnel.
The ambient pressure exceeds the operating pressure range or CO
2
module fails.
1. Make sure that the ambient pressure meets the specifications, and check for sources that affect the ambient pressure.
2. Reinsert the module. If the alarm persists, contact your service personnel.
1. Check if the sample line is kinked or occluded.
2. Replace the sample line.
3. Reinsert the module.
4. If the alarm persists, contact your service personnel.
Make sure that the filterline is connected.
Perform a calibration.
1. Check if the sample line is kinked or occluded.
2. Replace the sample line.
3. Reinsert the module.
4. If the alarm persists, contact your service personnel.
Check, clean or replace the airway adapter.
Perform a zero calibration.
Make sure that the CO
2 transducer is connected.
Replace the watertrap.
Check the patient category and use a correct watertrap.
D.2.11
AG Technical Alarm Messages
Alarm message
AG No Watertrap
Default priority
Low
Indication on alarm reset
B
AG: Change Watertrap
AG Watertrap and Patient
Mismatch
Low
Low
C
C
Cause and solution
Check the connections of the watertrap and reconnect it.
Replace the watertrap.
Check the patient category and use a correct watertrap.
D - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Alarm message
AG Zero Failed
Anesthetic Mixture
AG Airway Occluded
Default priority
Low
Indication on alarm reset
C
Low
Low
C
C
Cause and solution
There is external electromagnetic interference, airway occlusion or module failure.
1. Check for external inference sources.
2. Check for “AG Airway Occluded” alarm message. Remove the occlusion.
3. If the alarm persists, contact your service personnel.
Anesthetic mixture is detected.
1. Check if the sample line is occluded.
2. Replace the sample line.
3. Reinsert the module.
4. If the alarm persists, contact your service personnel.
D.2.12
EEG Technical Alarm Messages
Alarm message Default priority
Indication on alarm reset
A
Cause and solution
EEG No Sensor
EEG Sensor Off
EEG Electrode X + Y Off
EEG Electrode X + Y Poor
Contact
EEG: Module Protected
Low
Low
Low
Low
High
A
A
A
C
The EEG patient cable is not connected. Connect the cable.
EEG electrodes are not connected or detached.
Check electrode connection and reconnect the electrodes.
X + Y electrode is detached. Check the electrode connection and reconnect the electrode.
X + Y electrode does not properly contact the patient. Check the electrode connection and reconnect the electrode.
EEG module may have failed. Disconnect the EEG module and reconnect it. If the alarm persists, replace the module, or contact your service personnel.
Note: X represents EEG channel and polarity, for example A+, A-, A+, A-, etc. Y represents electrode location, for example Fp1, T3, etc.
D.2.13
BIS Technical Alarm Messages
Alarm message
BIS Sensor Off
BIS Electrode XX Off
BIS Electrode XX Poor
Contact
BISx Error
Default priority
Low
Indication on alarm reset
A
Low
Low
High
A
A
C
Cause and solution
Check and reconnect the BIS sensor. If the alarm persists, replace the sensor.
Check the electrode connection, and re-attach the electrodes if necessary.
Enter the Sensor Check menu, and check the connections of the sensor and electrodes.
Reinsert the module. If the alarm persists, contact your service personnel.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 9
Alarm message Default priority
Indication on alarm reset
A
Cause and solution
BIS No Sensor Low
BIS Sensor Too Many Uses Low
BIS Sensor Old Low
BIS XX Signal Quality Too
Low
Low
BIS XX Low Signal Quality
BIS Wrong Sensor Type
BIS Sensor Error
BISx Disconnected
Low
Low
Low
Low
A
C
A
A
A
A
A
BIS sensor is not properly connected, BIS cable failure, BISx or BISx4 failure.
1. Check the BIS sensor connection.
2. Reinsert the BIS module.
3. Replace the BIS cable.
4. Replace BISx or BISx4.
Replace the sensor.
Replace the sensor.
SQI < 15%
1. Check the patient’s condition.
2. Check the sensor position, and its contact with the patient’s skin.
3. Check that BISx or BISx4 is away from electrically radiating equipment.
SQI between 50% and 15%.
1. Check the patient’s condition.
2. Check the sensor position, and its contact with the patient’s skin.
3. Check that BISx or BISx4 is away from electrically radiating equipment.
Check or replace the sensor.
Replace the sensor.
BISx or BISx4 is not connected properly or fails, or
BIS patient cable fails.
1. Check that BISx or BISx4 is connected properly.
2. Replug the BIS Module.
3. Replace the BIS patient cable.
4. Replace BISx or BISx4.
Reinsert the BIS Module.
Reconnect BISx Low A
Note: XX represents BIS label, for example G, C, LE, LT, RL-RA, L-R, F-R, 1, 2, etc.
D.2.14
NMT Technical Alarm Messages
Alarm message
NMT No Cable
NMT No Sensor
NMT Stimulation
Electrode Off
NMT Sensor Error
Default priority
Low
Indication on alarm reset
A
Low A
Low
Low
A
C
Cause and solution
Check that NMT patient cable is properly connected to the NMT module.
Check that NMT sensor is properly connected to the NMT patient cable. If the alarm persists, replace the sensor.
Check that NMT sensor is properly connected to the NMT patient cable. If the alarm persists, check the application of electrodes.
Contact your service personnel.
D - 10 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
D.2.15
rSO
2
Technical Alarm Messages
Alarm message Default priority
Indication on alarm reset
A rSO2-1 No Sensor rSO2-2 No Sensor rSO2-1’ No Sensor rSO2-2’ No Sensor rSO2-1 Excess Light rSO2-2 Excess Light rSO2-1’ Excess Light rSO2-2’ Excess Light rSO2-1 Low Signal Quality rSO2-2 Low Signal Quality rSO2-1’ Low Signal Quality rSO2-2’ Low Signal Quality rSO2 -1/rSO2-2 No
Preamplifier rSO2-1’/rSO2-2’ No
Preamplifier rSO2 -1: Change Sensor rSO2-2: Change Sensor rSO2-1’: Change Sensor rSO2: Change Sensor
Low
Low
Low
Low
Low
C
C
A
C rSO2 -1/rSO2-2
Interference rSO2-1’/rSO2-2’
Interference rSO2-1 Auto Baseline rSO2-2 Auto Baseline rSO2-1’ Auto Baseline rSO2-2’ Auto Baseline
Disconnect/ Reconnect rSO2-1/rSO2-2
Disconnect/ Reconnect rSO2-1’/rSO2-2’
Low
Prompt
Low
C
/
A
Cause and solution rSO
2
sensor is detached, or the sensor cable is disconnected from the pre-amplifier. Re-connect the sensor to the pre-amplifier.
The sensor is detached or ambient light is too strong. Re-attach the sensor or reduce the level of ambient light.
The signal acquired by the sensor was unstable or weak due to power supply noise. Check the sensor connection. If the alarm persists, contact your service personnel.
Properly connect the pre-amplifier.
The sensor type mismatches patient category, the reusable sensor cable fails, the sensor reaches the lifetime, or the sensor type mismatches the monitor and patient category setting. Verify patient category and use sensors of correct patient category.
There is noise interference (such as electrosurgical unit). Check for any possible sources of signal noise.
The monitor automatically sets the rSO
2
baseline.
Remove the rSO
2
module and reconnect it.
D.2.16
Power Supply Technical Alarm Messages
Alarm message
Low Battery
Critically Low Battery
Default priority
Med
Indication on alarm reset
C
High C
B Battery Service Required
(N22/N19)
Battery Overload ( N22/
N19 )
Low
High C
Power Board Comm Error High C
Cause and solution
Connect the monitor to an AC power source and allow the batteries to charge.
Connect the monitor to an AC power source and allow the batteries to charge.
The battery has reached its lifetime. Contact the service personnel.
Too many parameter modules are connected, causing system overload and high power consumption. Use AC power supply.
Shutdown and restart the monitor. If the alarm persists, contact your service personnel.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 11
Alarm message
Battery Err
Default priority
High
Indication on alarm reset
C
C Battery Charging Error
( N22/N19 )
RT Clock Need Reset
RT Clock Not Exist
XX V Too High
XX V Too Low
High
High
High
High
High
Note: XX represents 2.5, 3.3, 5, or 12.
C
C
C
C
Cause and solution
The battery may have failed. Contact your service personnel.
The charging circuit fails or the battery fails.
Contact your service personnel.
Contact your service personnel.
Contact your service personnel.
There is a problem with the system power supply.
Shutdown and restart the monitor.
D.2.17
Recorder Technical Alarm Messages
Alarm message
Recorder Init Error
Recorder Comm Error
Recorder Unavailable
Recorderhead
Overheated
Recorder Initializing
Recorder No Paper
Recorder Busy
Recorder Not Found
Default priority
Low
Indication on alarm reset
A
Low
Low
Low
Prompt
Prompt
Prompt
Prompt
A
A
C
/
/
/
/
Cause and solution
An error occurred during the recorder initialization. Reinsert the module. If the alarm persists, contact your service personnel.
Reinsert the recorder. Shutdown and restart the monitor. If the alarm persists, contact your service personnel.
Recorder module failure. Replace the module.
The recorder has been printing for too long. Stop the recording and resume the recording after the recorder’s print head cools down.
Wait until the recorder initialization is completed.
The recorder paper is not loaded or the recorder door is not closed. Check the recorder, load the recorder paper or close the recorder door.
The buffer queue for recording is full.
The recorder module is not inserted in. Insert the module.
D.2.18
Printer Technical Alarm Messages
Alarm message
Printer Buffer Full
Printing Failed
Printing Stopped
Printer Unavailable
PDF storage space is nearly full
Default priority
Prompt
Indication on alarm reset
/
Prompt
Prompt
Prompt
Prompt
/
/
/
/
Cause and solution
The printer buffer is full. Wait until the printer finishes the printing task.
The printer ran out of paper or cannot be found on the network. Check the printer.
Printing was manually stopped.
The printer may have failed. Check the printer.
Delete the files saved under the PDF file path to release storage space. Otherwise you cannot save new PDF files.
D - 12 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Alarm message
Error storing PDF file
Change the print server language to be consistent with this monitor
Default priority
Prompt
Indication on alarm reset
/
Prompt
Print Server Disconnected Prompt
/
/
Cause and solution
The PDF file path settings on the print server and the PDF Creator are not consistent or the PDF storage space is full. Check the PDF file path settings for consistency, or delete the files saved under the PDF file path to release storage space.
Verify that the language settings of the print server and the monitor are consistent, Otherwise you cannot perform printing.
Check that the monitor is properly connected with the print server.
D.2.19
Technical Alarm Messages Related to Networked Monitoring
Alarm message Default priority
Indication on alarm reset
B
Cause and solution
CMS/eGW Disconnected
View Bed XX YY-ZZ,
Network Disconnected.
Viewed by Bed XX YY-ZZ,
Network Disconnected.
WLAN IP Address Conflict
LAN1 IP Address Conflict
Fail To Get WLAN IP
Address
Fail To Get LAN1 IP
Address
Low
Low
Low
Low
Low
Low
Low
A
A
C
C
C
C
The monitor is disconnected from the CMS.
Check the network connection.
The network is interrupted when the monitor is viewing the remote device. Check the network connection.
The network is interrupted when the monitor is viewed by another remote device. Check the network connection.
There is a wireless network IP address conflicts.
Check the network settings.
There is a wired network IP address conflicts.
Check the network settings.
Unable to automatically obtain the wireless network IP address. Check the network settings.
Unable to automatically obtain the wired network IP address. Check the network settings.
Note: XX refers to the department name, YY refers to the room number, and ZZ refers to the bed number.
D.2.20
Technical Alarm Messages Related to Telemetry Monitors
Alarm message
Telemetry Disconnected
Default priority
High
Indication on alarm reset
B
Telemetry Error High C
Cause and solution
The telemetry is powered off, the monitor or the telemetry is not connected to the wireless network, or out of the network coverage.
1. Power on the telemetry.
2. Connect the monitor and the telemetry to the network.
3. Move the telemetry in the network coverage.
4. The exchanger network connected by the telemetry and the monitor does not support multicast data transfer. Contact your service personnel.
An error occurred to the telemetry.
Restart the telemetry. If the problem still persists, replace with a known good telemetry.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 13
Alarm message
Telemetry Low Battery
Telemetry Battery
Depleted
Telemetry Battery
Maintenance Required
Telemetry Battery Error
Telemetry Battery Type
Error
Default priority
Med
Indication on alarm reset
C
High
Med
Med
Med
C
C
C
C
Cause and solution
The telemetry battery charge is low.
Replace with a known good battery.
The telemetry battery charge is critically low.
Replace with known good batteries.
The telemetry battery may reach its life. Replace with known good batteries.
The telemetry battery communication encounters an error. Replace with known good batteries.
The telemetry battery contacts may fail. Replace with known good batteries.
D.2.21
Other System Technical Alarm Messages
Alarm message
Primary Screen Alarm
Error
Secondary Screen Alarm
Error
High
XX: Disconnected
(XX refers to the name of the external device)
Storage Error
High
High
Loading Default Config
Failed
Low
XX Conflicts
(XX refers to the module label)
XX Measurement has been closed
(XX refers to the module label)
The display setup for XX is disabled.
(XX refers to the parameter label)
Prompt
Prompt
Prompt
Default priority
High
Indication on alarm reset
C
C
A
C
A
/
/
/
Cause and solution
The alarm signal communication between the primary display and the main unit is interrupted.
The primary display cannot provide alarm indications. Check the connection between the main unit and the primary display.
The alarm signal communication between the secondary display and the main unit is interrupted. The secondary display cannot provide alarm indications. Check the connection between the main unit and the secondary display.
Corresponding external device is disconnected.
Check the connection between the monitor and the external device.
The storage card failed or files are damaged.
Shutdown and restart the monitor. Format the storage card (CAUTION: this will clear all patient data stored on this monitor). If the alarm persists, contact your service personnel.
The default configuration was not correctly loaded. The monitor will restore to the factory default configuration for the current patient category.
The same type of corresponding module being used exceeds the supported number. Remove the conflict module.
The parameter module is disabled. Switch on the
module if you want to use it. For more information, see
3.9.1 Switching On or Off a
Parameter .
The parameter of the newly inserted module is not displayed on the screen. Select a desired area to display the parameter numerics and waveforms. For more information, see
3.9.2 Displaying Parameter Numerics and
Waveforms .
D - 14 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Alarm message Default priority
Indication on alarm reset
B The patient data storage space is nearly full. Please delete some discharged patients.
Med
Cause and solution
The storage space of the monitor is full. Delete unnecessary discharged patients.
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual D - 15
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D - 16 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
E
SpO
2
Sensor Accuracy
E.1
The Accuracy of Masimo SpO
2
Sensors
Table information for the plots below show A
RMS
values measured with Masimo SET Oximetry Technology in a clinical study.
Adtx/Pdtx/4000/4001
Inf/Neo/NeoPt/4002/4003/4004/4005
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual E - 1
DCI/DCIP/4050/4051
LNCS YI
4053
E - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
E.2
The Accuracy of Nellcor SpO
2
Sensors
SpO
2
Accuracy for Nellcor Sensors vs. Co-Oximeters (Arms)
SpO
2
Range
DS-100A
D-YS, OXI-P/I, OXI-A/N
MAXAI, MAXPI, MAXII
MAXNI
100% to 70%
1.64%
2.41%
1.62%
1.85%
100% to 90%
1.16%
1.38%
1.49%
1.71%
90% to 80%
1.67%
2.50%
1.57%
1.51%
80% to 70%
2.25%
3.60%
2.50%
1.59%
Modified Bland-Altman for SpO
2
- MAXAI, MAXPI, MAXII, MAXNI Sensors: (SpO
2 vs.SaO
2
- SaO
2
)
Modified Bland-Altman for SpO
2
- DS-100A Sensors: (SpO
2
- SaO
2
) vs.SaO
2
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual E - 3
Modified Bland-Altman for SpO2 - D-YS, OXI-A/N, OXI-P/I Sensors: (SpO
2
- SaO
2
) vs.SaO
2
E - 4 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
F
Units, Symbols and Abbreviations
F.1
Units
Abbreviation mEq mg min ml mm m mAh
Mb mcg
L lb kg kPa in k h
Hz
°F g
GHz
GTT cc cm dB
DS
Ah bpm bps
°C
μs
A
μA
μV
In Full hour hertz inch kilo kilogram kilopascal litre pound meter milliampere hour mega byte microgram milli-equivalents milligram minute milliliter millimeter microampere microvolt microsecond
Ampere
Ampere hour beat per minute bits per second
Celsius cubic centimeter centimeter decibel dyne second
Fahrenheit gram gigahertz gutta
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual F - 1
F.2
Abbreviation s
V
VA
Ω
W mW
MΩ nm rpm mmHg cmH2O ms mV
Symbols
Symbol
–
%
/
＝
＜
～
＋
＞
≤
×
©
≥
±
In Full millimeters of mercury centimeters of water millisecond millivolt milliwatt megaohm nanometer breaths per minute second volt volt ampere ohm watt
Explanation negative, minus percent per; divide; or to plus equal to less than greater than less than or equal to greater than or equal to plus or minus multiply copyright
F - 2 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
F.3
Abbreviations
Abbreviation
CCO
CCU
CE
CFI
C.I.
CIS
CISPR
CMOS
CMS
C.O.
CO
2
COHb
Compl
BTPS
CAA
CaO
2
CCI
BC
BL
BSA
BT aVL aVR awRR
BAP
ATMP
AUC
Avg aVF
AG
AHA
Ao
Art
AaDO
2
AC
ACI
Adu
In Full alveolar-arterial oxygen gradient alternating current acceleration index adult anaesthesia gas
American Heart Association aortic pressure arterial barometric pressure area under the curve rSO
2
average left foot augmented lead left arm augmented lead right arm augmented lead airway respiratory rate brachial arterial pressure burst count baseline body surface area blood temperature body temperature and pressure, saturated
Clinical Assistive Application arterial oxygen content continuous cardiac index continuous cardiac output cardiac (coronary) care unit
Conformité Européenne cardiac function index cardiac index clinical information system
International Special Committee on Radio Interference complementary metal oxide semiconductor central monitoring system cardiac output carbon dioxide carboxyhemoglobin compliance
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual F - 3
F - 4
Abbreviation
EtDes
EtEnf
EtHal
EtIso
EtSev
EtCO
2
EtN
2
O
EtO
ESVI
ESU
Et
EtAA
EMG
EMI
Enf
ESV
EtO
2
EVLW
ELWI
EWS
FAP
FCC
EDV
EEC
EEG
EMC dPmx
DVI
DO
2
DO
2
I
ECG
DC
Des
Dia dpi
COPD
CPI
CPO
CVP
In Full chronic obstructive pulmonary disease cardiac power index cardiac power output central venous pressure direct current desflurane diastolic dot per inch left ventricular contractility digital video interface oxygen delivery oxygen delivery index electrocardiograph end-diastolic volume
European Economic Community electroencephalogram electromagnetic compatibility electromyograph electromagnetic interference enflurane end systolic volume end systolic volume index electrosurgical unit end-tidal end-tidal anesthetic agent end-tidal anesthetic agent end-tidal carbon dioxide end-tidal nitrous oxide ethylene oxide end-tidal oxygen extravascular lung water extravascular lung water index
Early Warning Score femoral arterial pressure
Federal Communication Commission
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Abbreviation
Iso
ITBI
ITBV
LA
I:E
IEC
IEEE
IP
ICP
ICT/B
ICU
ID
HIS
HR
IBP
IBW
LAP
LCD
LCW
GEF
Hal
Hb
Hct
FV
GCS
GEDV
GEDI
FiEnf
FiHal
FiIso
FiSev
FDA
Fi
FiAA
FiDes
FiCO2
FiN
2
O
FiO
2
FPGA
In Full
Food and Drug Administration fraction of inspired inspired anesthetic agent inspired anesthetic agent fraction of inspired carbon oxygen fraction of inspired nitrous oxide fraction of inspired oxygen field programmable gate array flow-volume
Glasgow Coma Scale global end diastolic volume global end diastolic volume index global ejection fraction halothane hemoglobin haematocrit hospital information system heart rate invasive blood pressure ideal body weight intracranial pressure intracranial catheter tip pressure transducer intensive care unit identification inspiratory time: expiratory time ratio
International Electrotechnical Commission
Institute of Electrical and Electronic Engineers internet protocol isoflurane intrathoracic blood volume index intrathoracic blood volume left arm left atrial pressure liquid crystal display left cardiac work
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual F - 5
F - 6
Abbreviation
MAP
Mb
MetHb
MEWS
MLDAP
MRI
MV
MVe
LCWI
LDAP
LED
LL
LVET
LVSW
LVSWI
MAC
NEWS
NIBP
NIF
O
2
O
2
%
OR
MVi
N/A
N
2
N
2
O
Neo
PI
PIF
PIP
Pleth
Ped
PEEP
PEF
PEP
OxyCRG
PA
Paw
PAWP
In Full left cardiac work index
Lightweight Directory Access Protocol light emitting diode left leg left ventricular ejection time left ventricular stroke work left ventricular stroke work index minimum alveolar concentration mean arterial pressure myoglobin methemoglobin
Modified Early Warning Score
Mindray LDAP, Mindray lightweight directory access protocol magnetic resonance imaging minute volume expiratory minute volume inspiratory minute volume not applied nitrogen nitrous oxide neonate
National Early Warning Score noninvasive blood pressure negative inspiratory force oxygen oxygen concentration operating room oxygen cardio-respirogram pulmonary artery airway pressure pulmonary artery wedge pressure pediatric positive end expiratory pressure peak expiratory flow pre-ejection period perfusion index peak inspiratory flow peak inspiratory pressure plethysmogram
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
Abbreviation
SV
SVI
SVR
SVRI
SVV
SR
SSC
SSI
STR
Sev
SI
SIQ
SMR
RL
RR
RSBI
RVEF rSO
2
SaO
2
ScvO
2
SEF
SOFA
SpO
2
SQI
RAP
Raw
Rec
Resp
PVR
PVRI qSOFA
RA
Pmean
PO
2
Pplat
PPV
PR
PVC
PVPI
In Full mean pressure oxygen supply pressure plateau pressure pulse pressure variation pulse rate premature ventricular contraction pulmonary vascular permeability index pulmonary vascular resistance pulmonary vascular resistance index quick Sepsis-Related Organ Failure Assessment right arm right atrial pressure airway resistance record, recording respiration right leg respiration rate rapid shallow breathing index right ventricular ejection fraction regional oxygen saturation arterial oxygen saturation central venous oxygen saturation spectral edge frequency sevoflurane stroke index signal quality index satellite module rack
Sepsis-Related Organ Failure Assessment arterial oxygen saturation from pulse oximetry signal quality index suppression ratio
Surviving Sepsis Campaign signal strength index systolic time ratio stroke volume stroke volume index systemic vascular resistance systemic vascular resistance index stroke volume variation
BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual F - 7
Abbreviation
TVi
TV
UAP
UPS
TI
TP
TRC
TVe
SvO
2
Sync
Sys
TB tcpCO
2 tcpO
2
TD
Temp
TFC
TFI
TFT
USB
UVP
VAC
VEPT
VI
VPB
WOB
In Full venous oxygen saturation synchronization systolic pressure blood temperature transcutaneous carbon dioxide partial pressures transcutaneous oxygen partial pressures temperature difference temperature thoracic fluid content thoracic fluid index thin-film technology injectate temperature total power tube resistance compensation expiratory tidal volume inspiratory tidal volume tidal volume umbilical arterial pressure uninterruptible power supply universal serial bus umbilical venous pressure volts alternating current volume of electrically participating tissue velocity index ventricular premature beat per minute work of breathing
F - 8 BeneVision N22/N19/N17/N15/N12 Patient Monitor Operator’s Manual
P/N: 046-011259-00(1
7
.0)
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