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Dash
®
3000/4000/5000
Patient Monitor
Operator's Manual
2023896-026 Revision A
NOTE
Due to continuing product innovation, specifications in this manual are subject to change without notice. The information in this manual supports software versions 5.4 or later.
Listed below are GE Medical Systems Information Technologies trademarks used in this document. All other trademarks contained herein are the property of their respective owners.
CD TELEMETRY, CRG PLUS, DASH, DINAMAP, EAGLE, MARS, MUSE, RESPONDER, SAM, SOLAR, TRAM-
NET, TRAMSCOPE, TRAM-RAC, TRIM KNOB, UNITY and UNITY NETWORK are trademarks of GE Medical
Systems Information Technologies registered in the United States Patent and Trademark Office.
12SL, CENTRALSCOPE, CIC PRO, DASH PORT, EK-PRO, IMPACT, INTELLIRATE, MENTOR, PRISM, PRN 50-M and SUPERSTAT are trademarks of GE Medical Systems Information Technologies.
© 2005 General Electric Company. All rights reserved.
T-2 Dash
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10 May 2005
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Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-1
EN 60601-1 Component Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-15
Underwriters Laboratories, Inc. Classification . . . . . . . . . . . . . . . . . . . . . . . .1-16
AAMI EMI Environment Recommendations . . . . . . . . . . . . . . . . . . . . . . . . .1-16
FCC Compliance Information Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . .1-17
Equipment Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-1
TRAM-RAC 2A Module Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-10
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Cadex® SMart Two+ Charger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-14
Monitor Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-1
Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-1
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Managing Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1
Understanding the Split-View Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12
Removing a Viewed Monitor Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-13
Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1
Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-1
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Monitoring ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-1
Combo and Rover Combo Monitoring Guidelines . . . . . . . . . . . . . . . . . . . . . . . . .8-6
ECG Setting Source When Entering COMBO Mode. . . . . . . . . . . . . . . . . . .8-16
ECG Setting Source When Exiting COMBO Mode . . . . . . . . . . . . . . . . . . . .8-17
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Monitoring Invasive Pressures . . . . . . . . . . . . . . . . . . . . .9-1
Monitoring NBP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-1
Setup Custom Automatic NBP Measurements . . . . . . . . . . . . . . . . . . . . . . . . .10-10
Monitoring SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-1
Primary Parameter Monitoring Considerations . . . . . . . . . . . . . . . . . . . . . . . . . .11-3
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Measuring Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . .12-1
Monitoring Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . .13-1
Monitoring Temperature . . . . . . . . . . . . . . . . . . . . . . . . . .14-1
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Monitoring End-Tidal CO2 . . . . . . . . . . . . . . . . . . . . . . . .15-1
Monitoring Anesthesia Gases . . . . . . . . . . . . . . . . . . . . .16-1
Monitoring Impedance Cardiography (ICG) . . . . . . . . . .17-1
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Monitoring Bispectral Index (BIS) . . . . . . . . . . . . . . . . . .18-1
Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
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Cadex SMart Two+ Battery Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7
Software Packages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1
Factory Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1
Custom Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1
Interfacing with Non-GE Devices . . . . . . . . . . . . . . . . . . . E-1
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Parameter Windows and Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13
Transcutaneous pO2/pCO2 Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-14
Abbreviations and Symbols . . . . . . . . . . . . . . . . . . . . . . . .F-1
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CE Marking Information
CE Marking Information
Compliance
The Dash
®
3000/4000/5000 patient monitor bears CE mark CE-0459 indicating its conformity with the provisions of the Council Directive 93/42/EEC concerning medical devices and fulfills the essential requirements of Annex I of this directive.
The product is in radio-interference protection class A in accordance with
EN 55011.
The country of manufacture can be found on the equipment labeling.
The product complies with the requirements of standard EN 60601-1-2
“Electromagnetic Compatibility - Medical Electrical Equipment”.
The system meets the requirements of EN 60601-1-2 (2001) Medical Electrical
Equipment, Part 1: General Requirements for Safety, 2. Collateral Standard:
Electromagnetic compatibility — Requirements and tests.
Exceptions
Users should be aware of known RF sources, such as radio or TV stations and handheld or mobile two-way radios, and consider them when installing a medical device or system.
Be aware that adding accessories or components, or modifying the medical device or system may degrade the EMI performance. Consult with qualified personnel regarding changes to the system configuration.
Radio and Telecommunication Terminal Equipment Directive
The monitor contains a transmitter. The transmitter bears a CE mark indicating conformity with the essential requirements specified in Article 3 of the Council
Directive 1999/5/EC of 9 March 1999 concerning Radio Equipment and
Telecommunications Terminal Equipment (R&TTE).
The essential requirements are as follows:
Article 3.1 (a) Health Safety; the product complies with the particular medical device safety standards specified in the Medical Device Directive 93/42/EEC: EN
60601-1/1990 + A1: 1993 + A2: 1995: Medical electrical equipment. General requirements for safety.
Article 3.1 (b) EMC; the product complies with:
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CE Marking Information
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EN 60601-1-2 (2001) Medical electrical equipment: Part 1: General requirements for safety - 2. Collateral standard: Electromagnetic compatibility - requirements and test.
ETS 300 826 (1997): “Electromagnetic compatibility and Radio spectrum
Matters (ERM); ElectroMagnetic Compatibility (EMC) standard for 2.4 GHz wideband transmission systems and HIgh PErformance Radio Local Area
Network (HIPERLAN) equipment”.
Article 3.2 Protection of the Radio Spectrum: the product complies with: ETSI EN
300 328 (2003): “Radio Equipment and Systems (RES); Wideband transmission systems; Technical characteristics and test conditions for data transmission equipment operating in the 2.4 GHz ISM band and using spread spectrum modulation techniques.
General Information
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This manual is an integral part of the product and describes its intended use. It should always be kept close to the equipment. Observance of the manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety.
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The symbol means ATTENTION: Consult accompanying documents.
Information which refers only to certain versions of the product is accompanied by the model number(s) of the product(s) concerned. The model number is given on the nameplate of the product.
The warranty does not cover damages resulting from the use of accessories and consumables from other manufacturers.
GE is responsible for the effects on safety, reliability, and performance of the product, only if:
‹ assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by GE;
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‹ the electrical installation of the relevant room complies with the requirements of the appropriate regulations; and, the device is used in accordance with the instructions for use.
All publications conform with the product specifications and applicable EN publications on safety and essential performance of electromedical equipment as well as with applicable UL and CSA requirements and AHA recommendations valid at the time of printing.
The quality management system complies with the international standards ISO
9001 and ISO 13485, and the Council Directive on Medical Devices 93/42/
EEC.
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1
Introduction
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Introduction
Equipment Information
Intended Use
The intended use of this device is to monitor physiologic parameter data on adult, pediatric and neonatal patients within a hospital or facility providing patient care.
Physiologic data includes the parameters covered in this manual. The monitoring system is also intended to provide physiologic data over the optional network to clinical information systems. This information can be viewed, trended, stored and printed.
Safety Statements
The safety statements presented in this chapter refer to the equipment in general and, in most cases, apply to all aspects of the monitor. There are additional safety statements in the parameter chapters which are specific to that monitored parameter.
The order in which safety statements are presented in no way implies order of importance.
Dangers
Danger statements identify an imminent hazard which, if not avoided, will result in death or serious injury. No danger statements apply to this monitoring system.
Warnings
Warning statements identify a potential hazard or unsafe practice which, if not avoided, could result in death or serious injury.
The following warning statements apply to this monitoring system:
WARNING
ACCIDENTAL SPILLS — To avoid electric shock or device malfunction, liquids must not be allowed to enter the device. If liquids have entered a device, take it out of service and have it checked by a service technician before it is used again.
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Introduction
WARNING
ACCURACY — If the accuracy of any value viewed on the monitor, central station, or printed on a graph strip is questionable, determine the patient's vital signs by alternative means. Verify that all equipment is working correctly.
WARNING
ALARMS — Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in a hazard to the patient. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.
After connecting the monitor to the central station and/or nurse-call system, verify the function of the alarm system.
The functions of the alarm system for monitoring of the patient must be verified at regular intervals.
WARNING
BEFORE USE — Before putting the system into operation visually inspect all connecting cables for signs of damage.
Damaged cables and connectors must be replaced immediately.
Before using the system, the operator must verify that it is in correct working order and operating condition.
Periodically, and whenever the integrity of the product is in doubt, test all functions.
WARNING
CABLES — Route all cables away from patient's throat to avoid possible strangulation.
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Introduction
1-4
WARNING
CONDUCTIVE CONNECTIONS — Extreme care must be exercised when applying medical electrical equipment. Many parts of the human/machine circuit are conductive, such as the patient, connectors, electrodes, transducers. It is very important that these conductive parts do not come into contact with other grounded, conductive parts when connected to the isolated patient input of the device. Such contact would bridge the patient's isolation and cancel the protection provided by the isolated input. In particular, there must be no contact of the neutral electrode and ground.
WARNING
DEFIBRILLATION — Do not come into contact with patients during defibrillation. Otherwise serious injury or death could result.
WARNING
DISCHARGE TO CLEAR PATIENT DATA — When admitting a new patient, you must clear all previous patient data from the system. To accomplish this, disconnect patient cables then do a discharge.
WARNING
DISCONNECTION FROM MAINS — When disconnecting the system from the power line, remove the plug from the wall outlet first. Then you may disconnect the power cord from the device. If you do not observe this sequence, there is a risk of coming into contact with line voltage by inserting metal objects, such as the pins of leadwires, into the sockets of the power cord by mistake.
WARNING
DISPOSAL — Dispose of packaging material, observing the applicable waste control regulations and keeping it out of children’s reach.
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Introduction
WARNING
EXPLOSION HAZARD — Do not use this equipment in the presence of flammable anesthetics, vapors or liquids.
WARNING
WIRELESS COMMUNICATION INTERFERENCE — Wireless
LAN equipment contains an intentional RF radiator that has the potential of interfering with other medical equipment, including patient implanted devices.
Before installation and any time new medical equipment is added to the Wireless LAN coverage area, complete the following tests:
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Software version 5.3 or earlier — Perform the electromagnetic compatibility test as described in the Wireless LAN
Configuration Guide.
Software version 5.4 or later — Perform the ad-hoc tests AND the electromagnetic compatibility test as described in the
Wireless LAN Configuration Guide.
WARNING
INTERFACING OTHER EQUIPMENT — Devices may only be interconnected with each other or to parts of the system when it has been determined by qualified biomedical engineering personnel that there is no danger to the patient, the operator, or the environment as a result. In those instances where there is any element of doubt concerning the safety of connected devices, the user must contact the manufacturers concerned (or other informed experts) for proper use. In all cases, safe and proper operation should be verified with the applicable manufacturer's instructions for use, and system standard EN 60601-1-1 must be complied with.
WARNING
— Before using the monitor for the first time, please read the
“Safety Statements” on page 1-2.
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Introduction
1-6
WARNING
INTRACARDIAC APPLICATION — When applying devices intracardially, electrically conductive contact with parts connected to the heart (pressure transducers, metal tube connections and stopcocks, guide wires, etc.) must be avoided in all cases.
To prevent electrical contact, we recommend the following:
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Always wear isolating rubber gloves.
Keep parts that are conductively connected to the heart isolated from the ground.
Do not use tube fittings or stopcocks made of metal.
During intracardiac application of a device, a defibrillator and pacemaker whose proper functioning has been verified must be kept at hand.
WARNING
LEAKAGE CURRENT TEST — When interfacing with other equipment, a test for leakage current must be performed by qualified biomedical engineering personnel before using with patients.
WARNING
PATIENT AMBULATION — A patient must be assisted if ambulating with a roll-stand mounted monitor.
WARNING
POWER SUPPLY — The device must be connected to a properly installed power outlet with protective earth contacts only. If the installation does not provide for a protective earth conductor, disconnect the monitor from the power line and operate it on battery power, if possible.
All devices of a system must be connected to the same power supply circuit. Devices which are not connected to the same circuit must be electrically isolated when operated.
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Introduction
WARNING
PROTECTED LEADWIRES — Only use protected leadwires and patient cables with this monitor.
The use of unprotected leadwires and patient cables creates the potential for making an electrical connection to ground or to a high voltage power source which can cause serious injury or death to the patient.
WARNING
RATE METERS — Keep pacemaker patients under close observation. Rate meters may continue to count the pacemaker rate during cardiac arrest and some arrhythmias. Therefore, do not rely entirely on rate meter alarms.
WARNING
SITE REQUIREMENTS — For safety reasons, all connectors for patient cables and sensor leads are designed to prevent inadvertent disconnection, should someone pull on them.
Do not route cables in a way that they may present a stumbling hazard.
For devices installed above the patient, adequate precautions must be taken to prevent them from dropping on the patient.
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Introduction
Cautions
WARNING
— If an error message appears DURING operation, it is the physician’s responsibility to decide whether the unit is still suitable for patient monitoring. As a general rule, monitoring should only continue in extremely urgent cases and under the direct supervision of a physician. The unit must be repaired before being used again on a patient.
If an error message appears AFTER power-up, the unit must be repaired before being used on a patient.
WARNING
— If connecting a monitor to a central station, verify the alarm system is functional by temporarily changing one of the alarm limits to initiate an alarm.
Caution statements identify a potential hazard or unsafe practice which, if not avoided, could result in minor personal injury or product/property damage.
The following caution statements apply to this monitoring system:
CAUTION
ACCESSORIES (SUPPLIES) — To ensure patient safety, use only parts and accessories manufactured or recommended by GE.
Parts and accessories used must meet the requirements of the applicable EN 60601 series safety standards and essential performance standards, and/or the system configuration must meet the requirements of the EN 60601-1-1 medical electrical systems standard.
CAUTION
ACCESSORIES (EQUIPMENT) — The use of ACCESSORY equipment not complying with the equivalent safety requirements of this equipment may lead to a reduced level of safety of the resulting system. Consideration relating to the choice shall
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Introduction
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CAUTION
BATTERY POWER — If a device equipped with an optional battery pack will not be used or not be connected to the power line for a period of over six months, remove the battery.
CAUTION
BEFORE INSTALLATION — Compatibility is critical to safe and effective use of this device. Please contact your local sales or service representative prior to installation to verify equipment compatibility.
CAUTION
CO
2
PARAMETER INTERFERENCE — Capnostat CO
2 sensors with a serial number 26104 or greater require a separation distance of 0.25 meters (10 inches) from the Wireless LAN device to minimize potential interference.
CO
2
sensors with a serial number less than 26104 require a separation distance of 2.5 meters (8.2 feet) and are not recommended for use on monitoring equipment equipped with the
Wireless LAN option.
CAUTION
DEFIBRILLATOR PRECAUTIONS — Patient signal inputs labeled with the CF and BF symbols with paddles are protected against damage resulting from defibrillation voltages. To ensure proper defibrillator protection, use only the recommended cables and leadwires.
Proper placement of defibrillator paddles in relation to the electrodes is required to ensure successful defibrillation.
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Introduction
CAUTION
DISPOSABLES — Disposable devices are intended for single use only. They should not be reused as performance could degrade or contamination could occur.
CAUTION
DISPOSAL — At the end of its service life, the product described in this manual, as well as its accessories, must be disposed of in compliance with the guidelines regulating the disposal of such products. If you have questions concerning disposal of the product, please contact GE or its representatives.
CAUTION
ELECTROCAUTERY PRECAUTIONS — To prevent unwanted skin burns, apply electrocautery electrodes as far as possible from all other electrodes, a distance of at least 15 cm/6 in. is recommended.
CAUTION
ELECTRODES — Whenever patient defibrillation is a possibility, use non-polarizing (silver/silver chloride construction) electrodes for ECG monitoring. Polarizing electrodes (stainless steel or silver constructed) may cause the electrodes to retain a residual charge after defibrillation. A residual charge will block acquisition of the ECG signal.
CAUTION
EMC — Magnetic and electrical fields are capable of interfering with the proper performance of the device. For this reason make sure that all external devices operated in the vicinity of the monitor comply with the relevant EMC requirements. X-ray equipment or
MRI devices are a possible source of interference as they may emit higher levels of electromagnetic radiation.
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CAUTION
INSTRUCTIONS FOR USE — For continued safe use of this equipment, it is necessary that the listed instructions are followed.
However, instructions listed in this manual in no way supersede established medical practices concerning patient care.
CAUTION
LOSS OF DATA — Should the monitor at any time temporarily lose patient data, the potential exists that active monitoring is not being done. Close patient observation or alternate monitoring devices should be used until monitor function is restored.
If the monitor does not automatically resume operation within 60 seconds, power cycle the monitor using the power on/off switch.
Once monitoring is restored, you should verify correct monitoring state and alarm function.
CAUTION
MAINTENANCE — Regular preventative maintenance should be carried out annually. You are responsible for any requirements specific to your country.
CAUTION
MPSO — The use of a multiple portable socket outlet (MPSO) for a system will result in an enclosure leakage current equal to the sum of all individual earth leakage currents of the system if there is an interruption of the MPSO protective earth conductor. Do not use an additional extension cable with the MPSO as it will increase the chance of the single protective earth conductor interruption.
CAUTION
NEGLIGENCE — GE does not assume responsibility for damage to the equipment caused by improperly vented cabinets, improper or faulty power, or insufficient wall strength to support equipment mounted on such walls.
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Introduction
CAUTION
OPERATOR — Medical technical equipment such as this monitor/monitoring system must only be used by persons who have received adequate training in the use of such equipment and who are capable of applying it properly.
CAUTION
POWER REQUIREMENTS — Before connecting the device to the power line, check that the voltage and frequency ratings of the power line are the same as those indicated on the unit's label. If this is not the case, do not connect the system to the power line until you adjust the unit to match the power source.
In U.S.A., if the installation of this equipment will use 240V rather than 120V, the source must be a center-tapped, 240V, single-phase circuit.
This equipment is suitable for connection to public mains as defined in CISPR 11.
CAUTION
RESTRICTED SALE — U.S. federal law restricts this device to sale by or on order of a physician.
CAUTION
SINGLE PATIENT USE — This equipment is designed for use on one patient at a time. Using this equipment to monitor different parameters on different patients at the same time compromises the accuracy of data acquired.
CAUTION
SUPERVISED USE — This equipment is intended for use under the direct supervision of a licensed health care practitioner.
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Notes
Introduction
CAUTION
VENTILATION REQUIREMENTS — Set up the device in a location which affords sufficient ventilation. The ventilation openings of the device must not be obstructed. The ambient conditions specified in the technical specifications must be ensured at all times.
Note statements provide application tips or other useful information.
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The following note statements apply to this monitoring system:
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Put the monitor in a location where you can easily see the screen and access the operating controls.
This product is not likely to cause abnormal operation of other patientconnected equipment such as cardiac pacemaker or other electrical stimulators.
Exceptions are noted in the pacemaker monitoring section, if applicable.
This product is protected against the effects of cardiac defibrillator discharges to ensure proper recovery, as required by test standards. (The screen may blank during a defibrillator discharge but recovers within seconds as required by test standards.)
This equipment is suitable for use in the presence of electrosurgery.
Users should be aware of a possible time discrepancy between the waveforms from the telemetry device and the waveforms hardwired to the monitor. Users should not consider these waveforms to be synchronous. If absolute synchronicity is desired, COMBO mode should be discontinued and the ECG waveforms should be acquired via the hardwired bedside monitor.
The ambient conditions specified in the technical specifications of the service manual must be ensured at all times.
Connect the power cord supplied with the monitor. Use only the original cord or an equivalent one.
For measurements in or near the heart, GE recommends connecting the monitor to the equipotential stud. Use the green and yellow potential equalization cable and connect it to the equipotential stud on the back of the monitor.
Contact customer service engineers to connect monitors to a central station.
Monitors may be shipped with protective covers to protect unused parameter connector inputs from dust and liquids. Do not remove the protective covers; the parameter connectors will not function without them.
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Introduction
Equipment Symbols
NOTE
Some symbols may not appear on all equipment.
ATTENTION: Consult accompanying documents.
CAUTION: To reduce the risk of electric shock, do NOT remove cover. Refer servicing to qualified service personnel.
TYPE CF APPLIED PART: Isolated (floating) applied part suitable for intentional external and internal application to the patient including direct cardiac application. “Paddles” outside the box indicate the applied part is defibrillator proof.
[Medical Standard Definition:] F-type applied part (floating/isolated) complying with the specified requirements of EN 60601-1/UL 60601-1/CSA 601.1 Medical Standards to provide a higher degree of protection against electric shock than that provided by type BF applied parts.
TYPE BF APPLIED PART: Isolated (floating) applied part suitable for intentional external and internal application to the patient excluding direct cardiac application. “Paddles” outside the box indicate the applied part is defibrillator proof.
[Medical Standard Definition:] F-type applied part (floating/isolated) complying with the specified requirements of EN 60601-1/UL 60601-1/CSA 601.1 Medical Standards to provide a higher degree of protection against electric shock than that provided by type B applied parts.
NOTE
The rating of protection against electric shock (indicated by symbol for CF or BF) is achieved only when used with patient applied parts recommended by GE.
TYPE B APPLIED PART: Non-isolated applied part suitable for intentional external and internal application to the patient excluding direct cardiac application.
[Medical Standard Definition:] Applied part complying with the specified requirements of
EN 60601-1/UL 60601-1/CSA 601.1 Medical Standards to provide protection against electric shock, particularly regarding allowable leakage current.
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Introduction
Fuse
Equipotential Stud: A ground wire from another device can be tied here to ensure the devices share a common reference point.
Alternating current (AC)
Power
Indicates where to press to open the writer door.
This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately. Please contact an authorized representative of the manufacturer for information concerning the decommissioning of your equipment.
Equipment Compliance Information
EN 60601-1 Component Classification
The following components meet EN 60601-1 classification standards.
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Introduction
Type of protection against electrical shock
1
Degree of protection against electrical shock
2
Degree of protection against harmful ingress of water
3
Degree of safety of application in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide
4
Monitor
ICG Module
SAM Module
PRN-50 Writer
Remote Control
TRAM-RAC 2A
(powered)
I
N/A
I
I
N/A
BF (NBP, SpO
2
, CO
2
)
CF (ECG, Resp, IP, Temp/CO)
BF
B
Not Marked
Ordinary Not Suitable
1
The class of equipment — I or N/A (not applicable).
2
The type of applied part — B, BF, CF, Not Marked or none (no applied parts).
3
Ordinary equipment (enclosed equipment without protection against the ingress of water).
4
Equipment not suitable for use in the presence of a flammable anesthetic mixture with air, oxygen or nitrous oxide.
Method of sterilization/ disinfection recommended by the manufacturer
N/A
Mode of
Operation
Continuous
Underwriters Laboratories, Inc. Classification
Medical Equipment
With respect to electric shock, fire and mechanical hazards only in accordance with
UL 60601-1 and CAN/CSA C22.2 NO.601.1.
AAMI EMI Environment Recommendations
Review the AAMI EMC Committee technical information report (TIR-18) titled
Guidance of electromagnetic compatibility of medical devices for clinical/ biomedical engineers - Part 1: Radiated radio-frequency electromagnetic energy.
This TIR provides a means to evaluate and manage the EMI environment in the hospital.
The following actions can be taken.
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Introduction
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Managing (increasing) distance between sources of EMI and susceptible devices.
Managing (removing) devices that are highly susceptible to EMI.
Lower power from internal EMI sources under hospital control (such as, paging systems).
Labeling devices susceptible to EMI.
Educating staff (nurses and doctors) to be aware of, and to recognize, potential
EMI related problems.
FCC Compliance Information Statement
„
„
This device complies with Part 15 of the FCC Rules and with RSS-210 of Industry
Canada.
Operation is subject to the following two conditions:
This device may not cause harmful interference, and
This device must accept any interference received, including interference that may cause undesired operation.
WARNING
— Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment.
Manual Information
Purpose
This manual contains instructions necessary to operate the monitor safely and in accordance with its functions and intended use.
Intended Audience
This manual is intended for clinical professionals. Clinical professionals are expected to have a working knowledge of medical procedures, practices and terminology, as required for monitoring of critically ill patients.
This manual must be used in conjunction with the GE “Critical Care Monitoring
Clinical Reference and Troubleshooting Guide.” This document provides clinical reference information, such as ECG electrode placement, for GE patient monitors.
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Introduction
Conventions
Equipment
User Interface
This manual uses the following terms to simplify common equipment names.
Term
acquisition device central station docking station monitor printer writer
Equipment Name
„
„
„
„
„
SAM module
ICG module
Non-GE interfaced devices
CIC Pro Clinical Information Center
Centralscope central station
Dash Port docking station
„
„
Dash 3000/4000/5000 Patient Monitor
Direct digital writer (DDW)
Laser printer
PRN 50-M digital writer
This manual uses the following terms to identify common monitor user interface controls.
Term
key keypad main display menu
Definition
A labeled key found on the keypad or remote.
A pad containing multiple buttons.
The main monitoring display that includes the parameter windows, patient data and access to menus.
A menu is composed of a set of menu options.
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Term
menu option window screen text
Introduction
Definition
„
„
„
A choice found in a menu that performs one or more of the following functions:
Views another window.
Completes an action.
Views a report.
A window contains one or more of the following items:
„
„
„
„
Patient waveform and parameter data.
Parameter-specific controls.
List of menu options.
Data entry fields.
Any text that appears on the display screen.
Text
This manual uses the following text styles to identify hardware terms, software terms and the correct way to enter data.
Style bold
italic
>
Definition
Indicates hardware items, such as keys, labels or connectors.
Indicates software items, such as menus, menu options or screen text.
Indicates menu options or control settings to select consecutively.
Illustrations and Names
In this manual, all illustrations are provided as examples only. They may not necessarily reflect your monitoring setup or data viewed on your monitor.
All names appearing in examples and illustrations are fictitious. The use of any real person’s name is purely coincidental.
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Introduction
Ordering Manuals
Revision History
A paper copy of this manual will be provided upon request. Contact your local GE representative and request the part number on the first page of the manual.
Each page of this document has the document part number and revision letter at the bottom of the page. The revision letter changes whenever the document is updated.
Revision
A Release of software version
Comments
6.
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Equipment Overview
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Hardware Overview
Front
1
3000
AC Battery
Power
Charging Status
B A
Graph
NBP Go/Stop
Zero All
Trim Knob
Silence Alarm/
Admit
Charging Status
A B
Dash 4000
Power Graph Go/Stop NBP Go/Stop Zero All Silence Alarm/
Admit
4000
2
5000
1 Alarm light indicator
2 Control panel
Provides a visual alarm for patient status alarms.
Provides quick function keys and the Trim Knob control to navigate menus and select options.
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Equipment Overview
1
2
4000
1 Patient connectors Allows patient cables to connect to the monitor.
2 Enabled option labels Identifies the options enabled on the monitor.
NOTE
All patient connectors with the applied part symbol ( ) are high-insulation ports and defibrillator proof to ensure patient safety and protect the device during defibrillation and electrosurgery
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Equipment Overview
Left
1
1 Built-in writer
2 Battery doors
2
4000
Prints on two inch wide paper.
Holds up to two batteries to provide power during patient transport or whenever AC power is interrupted. For more
information, refer to “Batteries” on page A-6.
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Back
1
10
9
8
2
4
3000
5
6 7 3
1 Line voltage selector Matches the line voltage and frequency rating for your country.
2 Product code label Identifies the product code for this monitor for identification and service needs.
3 Equipotential stud Provides a common reference to an auxiliary device via a ground wire attached to the stud.
4 DC power connector Provides connection for DC power cable. The internal power supply converts the AC current to DC power.
The monitor is preset at the factory for a specific AC voltage. Refer to the label on the back of the unit for the voltage and current requirements. Before applying power, verify the power requirements match your power supply.
5 Wireless transmitter label
6 Ethernet connector
Identifies monitors that contain an internal wireless transmitter for network communication.
Provides network connections to other monitors and devices used in the patient monitoring network.
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Equipment Overview
7 Aux connector
8 Defib Sync connector
9 Voltage and current requirements
10 Speaker
„
„
„
„
„
Provides serial connection to compatible auxiliary devices, including:
Remote control
TRAM-RAC housing
Remote display
Nellcor
®
395 pulse oximeter
Aspect
®
BISx module
Provides analog output signals to other equipment. For more information, refer to
Identifies the voltage and electrical current requirements for proper and safe operation of this monitor.
Provides an audible announcement of patient and system
status alarms. For more information, refer to Chapter 4.
Control Panel
3000, 4000 and 5000
The following keys are on the monitor’s control panel.
Power
Graph Go/Stop
(3000/4000)
Print (5000)
Press once to turn the monitor on and off. For more information, refer to
Press once to print patient data or an information window. Press again to stop the print job. For more
information, refer to Chapter 6.
NBP Go/Stop
Press once to start one noninvasive blood pressure measurement. Press again to stop the measurement. For more information, refer to
“Monitoring NBP” on page 10-1.
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Equipment Overview
Zero All
Silence Alarm/
Admit (4000/
5000)
Silence Alarm
(3000)
Press once to zero all invasive pressures lines which are open to the atmosphere. For more information, refer to
Press Silence Alarm/Admit to quickly admit a patient to the monitor when the monitor is in the discharged state.
Press Silence Alarm to control audible alarms as configured in the monitor defaults. For more information, refer to
Standby
Main Display
Trend
NBP Auto
Admit/
Discharge
Press once to enter the standby mode. Press again to return to normal mode. For more information,
refer to “Getting Started” on page 3-2.
Press once to close all open menus and information windows and return to the main display.
For more information, refer to “User Interface
Press once to display patient trends. The type of trend displayed depends on the factory or custom default setting. For more information, refer to
“Customizing the Trends Key” on page 7-10.
Press once to view the NBP AUTO menu. Select one of the 13 pre-defined time intervals or select
CUSTOM to create a new automatic measurement interval cycle for the patient or begin a predefined custom interval cycle.
Press once to admit the patient. Press again to access the DISCHARGE PATIENT option and discharge an admitted patient. For more information, refer to
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Equipment Overview
Trim Knob Control
Use the Trim Knob control to select menus and options.
Selecting Menus or Parameter Window Labels
1.
Rotate the Trim Knob control in either direction to highlight a parameter window label or menu.
2.
Press the Trim Knob control to make your selection.
Selecting Options from Lists
1.
Rotate the Trim Knob control to scroll the pointer (>) up and down the list.
2.
When the pointer is in front of the desired option, press the Trim Knob control to select the option.
3.
If there are multiple options, turn the Trim Knob control until the desired option is highlighted.
4.
Press the Trim Knob control again to make your selection.
5.
To exit the menu, position the pointer in front RETURN and press the Trim
Knob control.
Selecting High/Low Values from Lists
1.
Rotate the Trim Knob control to scroll the pointer up and down the list.
2.
When the pointer is in front of the desired option, press the Trim Knob control to highlight the parameter.
3.
Turn the Trim Knob control to highlight the low or high limit.
4.
Press the Trim Knob control and rotate to change the value.
5.
Press the Trim Knob control to select the value.
6.
Press the Trim Knob control to move to the next parameter.
7.
Rotate the Trim Knob control to highlight the parameter.
8.
To exit the menu, position the pointer in front RETURN and press the Trim
Knob control.
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Indicators
Alarm Light
Power
Charging Status
Battery Status
„
„
Indicates an alarm condition. An optional alarm light indicator is built into the handle or the display bezel.
Flashing red — CRISIS patient status alarms.
Flashing yellow — WARNING patient status and system status alarms.
Indicates the monitor’s power source.
820A
Power Indicator
„
„
AC illuminated — The monitor is running on AC power.
Battery illuminated — The monitor is running on battery power.
Indicates the battery charging status of the internal batteries. One indicator for each battery (A and B).
821A
Charging Status Indicator
„
„
„
Yellow — The battery is charging.
Green — The battery is fully charged.
No light — The battery is not installed, not charging or “asleep”. Or the monitor is using this battery for power.
Indicates the power status of the internal batteries. One inside each battery door.
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Equipment Overview
Optional Components
„
„
Green — The monitor is using this battery for power.
No light — The monitor is not using this battery for power.
TRAM-RAC 2A Module Housing
The TRAM-RAC 2A module housing supports one single-parameter module. It has an optional internal power supply that runs the module housing and supports the needed voltages.
Single-Parameter Modules
Use the following single-parameter modules in the TRAM-RAC 2A module housing to acquire the patient’s physiological data and view it on the monitor.
SAM Module
The Smart Anesthesia Multi-gas (SAM) module is an infrared based, multi-gas analyzer module that measures inspired and expired values for patient gases and
calculates respiratory rate. For more information, refer to Chapter 16.
Solar ICG Module
The Solar ICG (impedance cardiography) module uses thoracic bioimpedance technology (TEB) to provide non-invasive, continuous hemodynamic data. For
more information, refer to Chapter 17.
Nellcor
®
395 Pulse Oximeter
The Nellcor 395 pulse oximeter is an external pulse oximeter that sends SpO
2 parameter data, including saturation and rate, to the monitor for review and print.
You can connect this device to the monitor, the docking station or both. For more information, refer to
“Nellcor 395 Pulse Oximeter” on page 11-13.
Unity Network
The Unity Network is a purchased software option that must be enabled in order use a central station, remote display, wireless LAN system or any other networked device.
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Equipment Overview
Centralscope Central Station
The Centralscope central station accepts patient data from monitors and allows bedto-bed communication via a network connection. The central station may have a built-in, two-inch writer or a laser printer. For more information, refer to the
Centralscope central station operator’s manual.
CIC Pro Clinical Information Center
The CIC Pro central station accepts patient data from monitors and allows bed-tobed communication via a network connection. For more information, refer to the
CIC Pro clinical information center operator’s manual.
Wireless LAN System
CAUTION
DATA LOSS — Operation of an access point or wireless LAN device in close proximity to microwave ovens may cause gaps in waveforms, loss of waveforms or "NO COMM" at the central station due to radio-frequency (RF) interference. Isolate the monitor from the interfering source or device or remove the interfering source or device.
NOTE
Wireless monitors moved from room to room must be configured as ROVER or
ROVER/COMBO.
The wireless LAN system allows monitors to roam (within the access point coverage area) and maintain a strong, seamless connection to the network. Access points connect wireless monitors to the wired network infrastructure within the building. The areas covered by each access point overlaps to ensure continuous coverage. Wireless monitors perform the same as monitors directly connected to the network.
Hardwired (directly connected to the network with a cable) or wireless network communication is transparent to the user. It is not indicated on the screen.
Wireless communication automatically occurs when the network cable is disconnected from a wireless monitor. Hardwired communication automatically occurs when the network cable is connected to the wireless monitor and the network.
Each mode of network communication is established within three seconds of connection or disconnection from the wired network.
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Equipment Overview
The hardwired network connection has priority when a monitor is wireless configured, but hardwired to the network.
If you experience any network communication issues, try the following:
„
„
„
Make sure the monitor is in the wireless network coverage area.
Try moving the monitor to a different access point location in the wireless network.
Isolate the monitor from the interfering source or device or remove the interfering source or device.
Laser Printer
PRN 50-M Digital Writer
The built-in, four channel writer prints on two-inch wide paper.
Remote Control
WARNING
SHOCK HAZARD — Laser printers are UL 60950/IEC 60950 certified equipment, which may not meet the leakage current requirements of patient care equipment. This equipment must not be located in the patient vicinity unless the medical system standard EN 60601-1-1 is followed.
Do not connect a laser printer to a multiple portable socket outlet
(MPSO) supplying patient care equipment. The use of MPSO for a system will result in an enclosure leakage current equal to the sum of all the individual earth leakage currents of the system if there is an interruption of the MPSO protective earth conductor.
A laser printer can be accessed through a central station. For more information, refer
The hand-held remote control operates the monitor. It connects to the monitor via a communications cable with a DIDCA connector plugged into the Aux port on the monitor or the docking station.
The remote control is available in three versions:
„
„
„
Adult
Neonatal
Operating Room
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Equipment Overview
Dose Calcs
Graph Go/Stop
Graphic Trends
Main Menu
NBP Auto
NBP Go/Stop
NBP Stat
New Case
PA Wedge
QRS Volume
Resp Relearn
Button Version
12-Lead
Adult
Admit/Discharge
Adult and Neonatal
Airway Gases: CO2
Operating Room
Airway Gases: Gas
Operating Room
Alarm Volume
Neonatal
All Limits
Cardiac Calcs
Adult and Neonatal
Adult and Operating Room
Cardiac Output
CRG Events
CRG Print
CRG Recall
Defaults
Display On/Off
Adult and Operating Room
Neonatal
Neonatal
Neonatal
Adult, Neonatal and Operating Room
Adult, Neonatal and Operating Room
Neonatal
Each version offers a unique set of buttons and a Trim Knob control.
Adult, Neonatal and Operating Room
Function
Opens the 12 LEAD ECG ANALYSIS menu.
Opens a menu to admit or discharge a patient.
Opens the CO
2
menu.
Opens the GAS menu.
Opens the ALARM VOL menu.
Opens the ALL LIMITS menu.
Opens the CARDIAC CALCS menu.
Opens the CARDIAC OUTPUT menu.
Opens the DOCUMENT CRG EVENTS window.
Prints the CRG waveforms.
Opens the CRG TRENDS menu at the most recent CRG event.
Opens the MONITOR DEFAULTS menu.
Turns the display, alarms and NBP off, but remaining on AC or battery power and active at the central station.
Opens the DOSE CALCS menu.
Prints the current patient data. Press again to stop.
Adult and Operating Room
Adult, Neonatal and Operating Room
Adult and Operating Room
Adult, Neonatal and Operating Room
Adult and Operating Room
Operating Room
Adult and Operating Room
Neonatal
Neonatal
Opens the GRAPHICS TRENDS menu.
Returns to the main display.
Opens the NBP AUTO menu.
Begins an NBP measurement. Press again to stop.
Starts five minutes of continuous, sequential NBP measurements.
Discharges and admits a patient.
Opens the PA WEDGE menu.
Opens a menu to adjust the QRS volume tone.
Relearns the patient’s respiration.
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Equipment Overview
Button
Silence Alarm
SpO2
View Other
Vital Signs
Zero All
Version
Adult, Neonatal and Operating Room
Operating Room
Adult and Neonatal
Adult and Neonatal
Adult, Neonatal and Operating Room
Function
Silences sounding alarms.
Opens the SPO
2
menu.
Opens the VIEW OTHER PATIENTS menu.
Opens the VITAL SIGNS menu.
Zeroes all invasive pressure lines open to the atmosphere.
Dash Port
The Dash Port is a docking station for a monitor. It gives the monitor easy connect/ disconnect access to AC power, the network, remote display and auxiliary devices.
For more information, refer to the docking station operating instructions.
Remote Display
The remote display provides a larger display or display in a separate room. The remote display must be located within 150 feet of the patient monitor. It also requires a docking station, a monitor running software version 5 or later and a network connection.
Cadex
®
SMart Two+ Charger
GE recommends using the Cadex SMart Two+ Charger (software version 1.1 or later) to care for all batteries used in this monitor. For more information, refer to
Operating Modes
Normal
Press the Power key to begin the normal operating mode. Normal mode provides all functional capabilities of the monitor, including vital signs monitoring, network communication and battery charging. During the power-up sequence, a splash screen displays and the control panel and alarm light indicators illuminate. After approximately 20 seconds, the Main Menu displays.
Before admitting a patient to the monitor, complete each of the following tasks to verify that the monitor is ready for use.
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Off/Charging
Off
Equipment Overview
1.
Verify the power, network and patient cables are connected to the monitor.
2.
Press the Power key to turn the monitor on.
3.
Verify the wireless network communication is functional, if applicable.
Approximately one minute after power-up, perform one of the following actions to verify network communication:
„
From the wireless monitor’s main display, select MORE MENUS > VIEW
OTHER PATIENTS > SELECT A BED TO VIEW. Select a bed from the network.
View the wireless monitor from a central station on the network.
„
„
Perform a LIST NETWORK from a central station on the network and verify the wireless monitor appears in the list. For more information, refer to the central station’s operator’s manual.
4.
Verify monitor is functioning correctly.
After power-up and during operation, the monitor automatically self-tests.
When a malfunction is detected, the monitor displays a message and a prompt asking whether the user wishes to continue operation.
WARNING
— Before using the monitor for the first time, please read the
“Safety Statements” on page 1-2.
When the monitor is in normal operating mode, press the Standby key to switch to the off/charging operating mode. All alarms are disabled and the Standby screen displays until you press the Trim Knob control, Standby or Admit/Discharge key.
Off/charging mode operation only provides one function: charging batteries.
Press the Power key and disconnect the monitor from AC power to turn the monitor off. When turned off, the monitor does not perform any operations.
NOTE
You cannot turn the monitor off when in COMBO or ROVER COMBO monitoring modes. If you disconnect from AC power and press the Power key, you are prompted to discharge the patient. The monitor receives power from the batteries until the patient is discharged.
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Equipment Overview
User Interface Overview
Main Display
The main display is the primary display. It includes all monitored parameter windows and waveforms. It also includes monitor information and access to all other monitor and parameter functions and menus. The monitor automatically returns to the main display when any other menu is idle for more than five minutes.
1
2
3
5
6
7
8
∗
Main Display
1 Time, date and factory or custom default name
2 Care unit and bed name
3 Patient name
4 Parameter windows
4
9
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Menus
Windows
Equipment Overview
5 Parameter waveforms
6
MORE MENUS
7 Large Clock/Date
8 Message line
9 Battery gauge
„
„
There are three types of menus.
„ Popup menus — A small menu that displays over the original menu. All popup menus require some action by the user. There are three types of action:
‹
‹
Scrolling — Use the Trim Knob control to scroll and select an option from a list.
Pointer — Use the Trim Knob control to move a pointer (>) and select an option from a list.
‹
Numeric — Use the Trim Knob control to scroll though a range of numbers and make a selection.
Subordinate menus — A complete set of menu options.
Direct action menus — A menu that allows you to select a status (for example,
ON or OFF) or start a process (for example, RELEARN).
There are two types of window: parameter and information.
A parameter window for every monitored parameter displays on the right side and bottom of the screen. Where and how each parameter window displays depends on
the priority set in MONITOR DEFAULTS. For more information, refer to “Defining
Parameter Window Priority” on page 3-12.
1
2
3
4
518A
Parameter Window
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Equipment Overview
1 Digital values
2 Parameter window label
3 Alarm limits
4 Units of measurement
An information window is a large popup window that displays over most of the screen. It contains help and other non-real-time information. Up to six parameter windows and the last two seconds of real-time waveforms remain visible.
Information Window
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Monitor Setup
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Monitor Setup
Getting Started
The main display has one menu option, MORE MENUS. The following menu options are starting points to access and adjust the monitor’s settings.
Option
ALARM CONTROL
VIEW OTHER PATIENTS
PATIENT DATA
MONITOR SETUP
ADMIT MENU
GO TO STANDBY
BATTERY STATUS
Function
View and modify alarm limits, change alarm levels and adjust alarm volume. For more information, refer to
“Control Settings” on page 4-5.
View other GE monitors on the network. For more
information, refer to Chapter 5.
View patient data and access the calculation programs.
For more information, refer to Chapter 7.
Access menu options to customize the monitor to meet your needs. For more information, refer to
Access the menu options to admit and discharge patients.
For more information, refer to “Admit” on page 5-2.
NOTE
The menu name changes in OPERATING ROOM patient-monitor type to NEW CASE SETUP.
NOTE
Only available in software version 6 or later.
Select to temporarily suspend monitoring. All patient monitoring, alarms and trending stop, until the Trim Knob control, the Standby key or Admit/Discharge key is pressed or the monitor is rebooted.
Review battery information. For more information, refer to
Identifying Your Configuration
Software Packages
There are three software packages.
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BASIC — Includes standard-of-care parameters, lethal arrhythmia detection, dose calculations and other features required by clinicians caring for acutely ill patients.
CARDIAC — Focuses on cardiac conductivity. Includes full arrhythmia analysis and storage, adjustable ST measurement point and ST segment trending, storage and templates.
„
CARDIO-PULMONARY — Focuses on cardiac and pulmonary hemodynamics.
Includes cardiac and pulmonary calculations, PA insert and wedge algorithms, intra-aortic balloon pump algorithm and a thermodilution cardiac output algorithm that includes predefined computation constants for major catheter manufacturers.
To determine the software running on a monitor, select MORE MENUS >
MONITOR SETUP > SOFTWARE CONFIGURATION. The software package is listed under ENABLED SOFTWARE OPTIONS.
For more information on the features and functionality of each software package,
Software Options
There are three software options. These options can be purchased separately and used with any software package or in combination with other software options.
„
„
„
High Resolution Trends — Provides storage of up to 100 CRG events and up to
24 hours of CRG trend data.
12SL ECG — Provides an analysis program that includes the Gender Specific
Criteria and the Acute Cardiac Ischemia-Time Insensitive Predictive Instrument
(ACI-TIPI). It uses recorded ECG data to produce a numerical score which is the predicted probability of acute cardiac ischemia. In addition, the gender specific criteria improves the detection of acute myocardial infarctions (AMI) for adult women under the age of 60.
Unity Network — Enables you to view other patients on the network, interface with a central station and other network devices and perform COMBO or
ROVER COMBO monitoring.
To determine the software options running on a monitor, select MORE MENUS >
MONITOR SETUP > SOFTWARE CONFIGURATION. The software options are listed under ENABLED SOFTWARE OPTIONS.
Monitoring/Admit Modes
There are four monitoring or admit modes. The mode determines how patients are admitted to the monitor and how the monitor functions within a network environment. It is defined during installation via the password protected SERVICE
MODE menu.
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Monitor Setup
Patient-Monitor Type
„
„
„
„
STANDARD — Permanently mount a monitor in a room. This mode does not accommodate telemetry and does not require a network connection unless central station communication is needed.
ROVER — Move or “rove” the monitor to the patient, rather than moving the patient to a monitored room. This mode does not accommodate telemetry and does not require a network connection unless central station communication is needed.
COMBO — Acquire ECG data from a monitor or a telemetry receiver cabinet and access all the available parameters from the monitor. A network connection is required.
ROVER COMBO — Combines the mobility of ROVER mode and the telemetry compatibility of COMBO mode.
To determine the mode running on a monitor, select MORE MENUS > MONITOR
SETUP > SOFTWARE CONFIGURATION. The monitoring mode is listed under
ADMIT MENU TYPE.
There are three patient-monitor types. The patient-monitor type controls the monitor defaults and monitor settings. It is defined during installation via the password protected SERVICE MODE menu.
„
„
„
ADULT-ICU
NEONATAL-ICU
OPERATING ROOM
To determine the patient-monitor type running on a monitor, select MORE MENUS
> MONITOR SETUP > SOFTWARE CONFIGURATION. The patient-monitor type is listed under PATIENT MONITOR TYPE.
For more information on the monitor default settings for each patient-monitor type, refer to
“Factory Defaults” on page C-1.
Language
The monitor language is set to one of 14 options when installed. In most cases, the language does not affect the monitor functionality or usability. However, in a few languages, you may experience the following conditions:
„
„
HUNGARIAN, POLISH and RUSSIAN — Special characters may appear as blanks, asterisks or square boxes due to the inability to display Cyrillic
(Russian) characters, as well as certain Polish and Hungarian characters.
CHINESE and JAPANESE — All text for alarm broadcast sent over the network is in English. All text input (for example, unit name, bed name, patient information, etc.) is also in English.
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Locale
France
Monitor Setup
NOTE
Special characters that are sent over the network in alarm broadcasts, patient status or system status messages, patient, bed or care unit names cannot be displayed by networked equipment that does not support these languages.
The monitor is set to one of two locale options when installed: DEFAULT or France.
If the monitor is set to FRANCE, the following functionality varies from the standard, default monitor functions.
„
„
„
„
„
„
„
Alarms
„ Alarm pause — Lasts no more than three minutes when in ADULT-ICU or
NEONATAL-ICU patient-monitor types.
„
Alarm volume — Alarms can not be turned off in NEONATAL-ICU patientmonitor type. The lowest possible setting is 10 percent.
When turned off, the monitor alarms every three minutes to remind you alarms are silenced. The volume resets to the monitor default setting when a patient is admitted, alarm pause breakthrough occurs or the monitor is turned on.
„
„
Discharge alarms — The monitor alarms every three minutes when a patient is discharged.
Alarm levels — All parameter patient status message level alarms (except
ECG) are automatically increased to a patient status advisory level alarm.
The following monitor default alarm limits are also unique:
NBP-S, NBP-D, NBP-M (ADULT-ICU and OPERATING ROOM) — 350 to -25.
NBP-S, NBP-D, NBP-M (NEONATAL-ICU) — 150 to -25.
ART — 300 to 30.
HR — 300 to 30.
SPO2 — 105 to 60.
SPO2-R — 235 to 40.
TEMP — 450 to 0.
Parameters
The following parameter values are unique:
„
„
ECG gain — Derived by mV (.25 mV to 2 mV) and displayed on the primary
ECG waveform.
Units of measurement — Metric only.
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„
„
„
Arrhythmia level — The default arrhythmia alarm level for ADULT-ICU is
FULL; NEONATAL-ICU and OPERATING ROOM are OFF.
Heart rate — Values under 30 bpm are not displayed. The values displayed in the parameter window are replaced with “X”.
SpO
2 saturation — Values under 60 percent are not displayed. The values displayed in the parameter window are replaced with “X”.
Customizing Monitor Setup
Monitor Defaults Overview
There are three types of monitor defaults:
„
„
„
Factory defaults
Custom defaults
Control settings
Factory Defaults
Factory defaults control alarm levels, alarm limits, display setup and parameter priority settings. Each monitor is programmed with three sets of factory defaults
(one for each patient-monitor type).
To review the factory defaults on a monitor, select MORE MENUS > MONITOR
SETUP > MONITOR DEFAULTS.
These are persistent settings; meaning they are recalled after a patient is discharged from the monitor.
You cannot change the factory defaults. If your care unit requires different settings, you can create custom defaults.
NOTE
If you are prompted for a password after selecting this option, access to monitor defaults was password protected during installation.
For a complete list of the factory defaults for each patient-monitor type, refer to
“Factory Defaults” on page C-1.
Custom Defaults
Custom defaults are a set of modified factory defaults. You can create up to five custom default profiles for each patient-monitor type used in your care unit.
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Custom defaults are retained when any of the following events occur:
„
„
„
„
A parameter cable is disconnected from the patient.
A parameter cable is disconnected from the monitor.
A parameter cable is disconnected from a single-parameter module.
A parameter was turned off, then turned on again.
CAUTION
— If a patient cable is disconnected from the monitor and the parameter window disappears from the display, alarm limits may revert to the factory defaults when the cable is reconnected.
These are persistent settings; meaning they are recalled when a patient is discharged from the monitor.
You cannot create or adjust custom defaults while a patient is admitted to the monitor.
If you change the patient-monitor type, all custom defaults are erased and the monitor returns to the factory default settings.
If you create custom defaults, record your changes in Appendix D.
Control Settings
Control settings are temporary adjustments you can make to parameter settings or basic monitor functions for the patient admitted to the monitor. These settings are erased when the patient is discharged from the monitor.
For more information on permanently changing monitor settings, refer to “Custom
Defining Custom Defaults
To define a new set of custom defaults, follow this procedure.
NOTE
All custom defaults are effective immediately, but you must admit the patient to the monitor for fully functional alarms.
NOTE
If you do not define a custom default name and make any changes to the monitor default settings, the custom default name displays with an asterisk. For example, ADULT 0*.
1.
Discharge the patient from the monitor.
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2.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
CUSTOM DEFAULTS.
3.
To create a name for a custom default set, select NAME DEFAULTS.
4.
Select the default name from the CUSTOM DEFAULTS window.
There are five default names for each patient monitor-type:
„
„
„
ADULT-ICU — ADULT 0 to ADULT 4.
NEONATAL-ICU — NEO 0 to NEO 4.
OPERATING ROOM — OR 0 to OR 4.
5.
Use the Trim Knob control to define a unique name (up to 12 characters).
6.
Select NAME DEFAULTS to save the new name.
7.
Select RETURN.
8.
Select PREVIOUS MENU.
9.
Select any of the following menus and make the desired changes.
SETUP DEFAULTS
ARRHYTHMIA ALARM
LEVELS
Option Function
Select the default alarm level for arrhythmias. The arrhythmias listed are determined by the software package, patient monitor type and whether arrhythmia is set for lethal or full.
„
„
„
BASIC software package — Only the V TACH alarm level can be changed.
ADULT-ICU patient-monitor type — The V FIB and
V TAC alarm levels cannot be changed.
NEONATAL-ICU patient-monitor type — The V FIB and V TAC alarm levels cannot be changed.
Select the default alarm level for all monitored parameters.
SETUP DEFAULT
PARAMETER ALARM
LEVELS
SETUP DEFAULT LIMITS
SETUP DEFAULT
DISPLAY
Select the default high and low alarm limits for all monitored parameters.
Select the display defaults for the current patient-monitor type and software package.
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Option
SETUP DEFAULT
PARAMETER PRIORITY
RECALL DEFAULT
Function
Select how parameter windows are prioritized on the
display. For more information, refer to “Defining Parameter
Window Priority” on page 3-12.
Select one of the factory or custom default names. Once selected, any changes you make to the settings are automatically saved.
Defining Control Settings
NOTE
All control settings are temporary and revert to the factory or custom defaults when the patient is discharged from the monitor. To permanently change these settings, refer to
“Defining Custom Defaults” on page 3-7.
To define control settings for the patient admitted to the monitor, select MORE
MENUS > MONITOR SETUP. Then select any of the following options and make the desired changes.
Option
WAVEFORMS ON/OFF
DISPLAY
Function
Select the desired lead option for each waveform or select
OFF to remove this waveform from the display.
NOTE
When the ECG parameter is turned off, the first waveform option displays the primary parameter monitoring the patient. The option cannot be changed until the ECG parameter is turned on.
Select the number of waveforms on the display.
„
„
„
„
INDV 6 WFS — Display up to six waveforms with independent scales. The waveforms automatically align with their associated parameter window.
INDV 3 WFS — Display up to three waveforms with independent scales. The waveforms automatically align with their associated parameter window.
FULL — Display up to five waveforms. The first two waveforms are individual scales, the next two are full scale (common) and the final is an individual scale.
FULL GRID — Display the FULL mode waveforms with additional graticules. The graticules do not print.
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3-10
COLOR
Option
PARAMETERS ON/OFF
PRINT SETUP
MONITOR DEFAULTS
Function
Select one of the display color options:
„
„
CLINICAL — Group physiological functions by color.
‹
Amber — ECG.
‹
‹
Green — Hemodynamics.
Blue — Cardiopulmonary, temperature and all other parameters.
‹
‹
Red — Alarms.
White — Gas.
TRANSDUCER — Match transducers to a color.
‹
Blue — CVP, RA and UVC.
‹
‹
‹
Green — ECG, SP and all other parameters.
Red — Highest priority arterial line (ART, FEM or
UAC), POC and alarms.
White — LA, ICP, non-highest priority arterial line
(ART, FEM or UAC), CO, CO
2
and gas data.
Yellow — BIS and PA.
„
‹
CRG PLUS
‹
Blue — SpO
2
.
‹
‹
Green — ECG.
Red — Alarms, MAP and highest priority arterial line (ART, FEM or UAC).
‹
White — All other pressures.
‹
Yellow — BIS, CO
2
and RR.
NOTE
The TRANSDUCER and CRG PLUS pressure colors are based on the priority set as monitor defaults. The arterial line (ART, FEM and UAC) set at the highest priority is red, all others are white.
Select the parameters to display. When turned off, the parameter window and waveform does not display, alarms do not sound and data is not collected in trends.
Select the print locations, content and timing. For more
information, refer to Chapter 6.
Select the custom defaults for any patient-monitor type.
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Option
CLOCK DISPLAY
BRIGHTNESS
LEARN THE MONITOR
SOFTWARE
CONFIGURATION
REVISION AND ID
SERVICE MODE
Function
Select the type of clock display.
„
„
OFF — Remove the clock display from the reduced parameter window location and display the smaller clock on the upper left of the screen.
ON W/SEC — Display the military time in hours, minutes and seconds.
„
ON W/OUT SEC — Display the military time in hours and minutes.
NOTE
This option uses the space of one parameter window.
If the maximum number of parameter windows are needed for patient monitoring, turn this option off.
Select the screen brightness.
Select any of the MENTOR educational program options for basic monitor function instructions.
Select to view the monitor’s software configuration, ADMIT menu type, PATIENT-MONITOR TYPE, enabled software options and NBP configuration.
Select to view the monitor’s software version and hardware configuration.
Access password-protected monitor settings. These features are intended for qualified service personnel to set up, troubleshoot and repair the monitor. The following settings are controlled in this menu:
„
„
PATIENT-MONITOR TYPE
Application monitoring mode
„
MONITOR DEFAULTS password protection
For more information, refer to the service manual.
NOTE
You can also change parameter settings from the main display by using the
Trim Knob control to select the parameter window label. For more information on specific parameter control settings, refer to the appropriate parameter chapter in this manual.
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Restoring Factory Defaults
To restore the factory default settings for the patient-monitor type, follow this procedure.
NOTE
Discharge patients from the monitor before restoring factory defaults.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS.
2.
Select CUSTOM DEFAULTS > RESTORE FACTORY DEFAULTS.
3.
Position the pointer in front of the desired custom name.
4.
Press the Trim Knob control.
Defining Parameter Window Priority
The number of parameter windows that display on the screen depends on the display mode. No more than six full-sized parameter windows can display on the right side of the monitor. No more than 10 automatically sized parameter windows can display in total; six on the right side and four on the bottom of the screen.
NOTE
The large CLOCK DISPLAY option uses the space of one parameter window. If the maximum number of parameter windows are needed for patient monitoring, turn this option off.
You can define which parameters display as full-sized parameter windows in the
DEFAULT PARAMETER PRIORITY window by selecting the parameters in priority order in the PARAMETER 2 to PARAMETER 6 fields.
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NOTE
PARAMETER 1 cannot be changed. It is always ECG. If PARAMETER 2 is set for ECG or ST, the ECG parameter window will display the size of two parameter windows.
You can also define which parameters display on the bottom of the screen by selecting the parameters in the order that you want them to display from the list of parameters on the bottom half of the DEFAULT PARAMETER PRIORITY window.
The parameters with an asterisk may be displayed in a reduced sized parameter window in order to accommodate 10 parameters.
The parameter priority also determines which parameters are displayed in
GRAPHIC TRENDS and ALL LIMITS menus.
You cannot select more than 10 parameters. The monitored parameters vary by patient-monitor type. For a complete list of all parameter priority definitions by patient-monitor type, refer to
“Factory Defaults” on page C-1.
NOTE
If you are not actively monitoring a parameter, the parameter window is not displayed. When you begin monitoring the parameter, the screen automatically reconfigures to display the parameter in the defined priority and screen position.
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4
Alarms
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Introduction
Overview
The monitor notifies you of patient or system status alarms by tone, light or onscreen messages. On-screen messages display in the following locations on the main display:
„
„
Alarming parameter waveform area
„
„
Alarming parameter window
ALRM parameter window
Message line
For more information on how and where you receive alarm notification, refer to
4-2
∗
810A
For ADULT-ICU and NEONATAL-ICU patient-monitor types, the alarm parameter window automatically displays when a patient is admitted to the monitor. It records any patient status alarms set to CRISIS, WARNING and ADVISORY.
Active alarms display in red. Resolved alarms are the designated color for that parameter.
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The four most recently resolved alarms are displayed in chronological order with the extreme parameter value and timestamp. The extreme numerical value for all active, displayed parameters is continuously updated.
To remove the alarm parameter window from the main display, select MORE
MENUS > MONITOR SETUP > PARAMETERS ON/OFF > ALRM > OFF.
Alarm Types
Patient Status Alarms
Patient status alarms are the highest priority alarms. They are triggered by a patient condition which exceeds a parameter’s alarm limits or by an arrhythmia condition.
There are four levels of patient status alarms.
„ CRISIS — Life-threatening events. CRISIS alarms sound until silenced by the user.
„
„
WARNING — Serious but non-life-threatening events. WARNING alarms sound until the condition is resolved.
ADVISORY — Events that require monitoring, but are not serious or life threatening. ADVISORY alarms sound until the condition is resolved.
„
MESSAGE — Additional information only; no alarms sound.
The monitor’s response to patient status alarms is as follows.
Indicator
CRISIS WARNING ADVISORY MESSAGE
Alarm tone
Alarm light
On-screen message
Automatic print
1
ALARM HISTORY
Alarm broadcast
Remote alarm terminal
Three beeps Two beeps
Red Yellow
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
One beep
No
Yes
No
Yes
Yes
Yes
1
The factory default for ADULT-ICU is ON; NEONATAL-ICU and OPERATING ROOM is OFF.
No
No
No
No
No
Yes
No
You can change patient status alarm levels and limits. For more information, refer to
“Control Settings” on page 4-5.
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System Status Alarms
System status alarms are triggered by mechanical or electrical problems. They are of lesser priority than patient status alarms.
There are three levels of system status alarms:
„
„
„
WARNING — Serious mechanical or electrical problems.
ADVISORY — Mechanical or electrical problems.
MESSAGE — Additional information only.
The monitor’s response to system status alarms is as follows.
Indicator
Alarm tone
Alarm light
On-screen message
Alarm broadcast
Remote alarm terminal
WARNING ADVISORY
Repeating foghorn Single foghorn
Yellow No
Yes Yes
Yes
Yes
No
No
No
No
Yes
No
No
MESSAGE
You cannot change system status alarm levels and limits.
Safety
WARNING
ALARM ACTIVATION — No alarms sound or display on the monitor until a patient is admitted to the monitor. The monitor will
NOT alarm if an unadmitted patient enters an alarm condition. You must admit the patient to activate alarms, automatic alarm printing and the ALARM HISTORY.
WARNING
— After an interruption of the electric power supply, verify the alarm processing is active and verify that no arrhythmia occurred.
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Control Settings
CAUTION
— GE recommends that monitors without arrhythmia detection monitoring patients at risk of asystole should define the HR alarm as CRISIS. If the HR alarm is set to WARNING, the alarm clears after three minutes of continued asystole.
NOTE
Always remove all patient cables from the monitor prior to discharging a patient to clear all alarm data from the monitor.
To adjust the control settings for the patient admitted to the monitor, select MORE
MENUS > ALARM CONTROLS. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
ALL LIMITS
Function
Select the high and low alarm limits for all monitored parameters.
Select the alarm level for arrhythmias.
ARRHYTHMIA ALARM
LEVEL
PARAMETER ALARM
LEVEL
ALARM VOLUME
ALARM HELP
Select the alarm level for all monitored parameters.
NOTE
In NEONATAL-ICU, the heart rate limit alarm level cannot be set to MESSAGE.
Select the alarm tone volume.
NOTE
In NEONATAL-ICU, the alarm volume cannot be turned off. The lowest alarm volume can be set to is
10 percent.
Select to learn about alarms levels and hear alarm tones.
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Option
DISPLAY OFF ALARM
PAUSE
CLEAR ALARMS
ALARM HISTORY
Function
Select one of the following options to temporarily pause patient and system status alarms.
„
„
MONITOR/CENTRAL PAUSE — Preserve the collected patient data, turn off the display and alarm light and pause alarms at the central station.
MONITOR PAUSE — Turn off the display and alarm light, print local alarms and send patient data and alarms to the central station.
Clear all alarm information displayed in the ALARM
WINDOW.
NOTE
CARDIAC software package only.
View ST references, stored arrhythmia waveforms and ST alarm event for CRISIS, WARNING and ADVISORY alarms. For more information, refer to
Silencing Alarms
Temporarily
WARNING
— Alarms do not sound, alarm histories are not stored, alarm graphs do not print and alarms are not sent to the central station during an alarm pause.
To silence alarms, press the Silence Alarm key. A “SILENCED” message displays and alarms will not sound. The length of time alarms are silenced depends on:
„
„
„
The patient-monitor type.
The number of times the Silence Alarm key is pressed.
Whether any alarms are active when the Silence Alarm key is pressed.
Alarms remained paused unless a CRISIS patient status alarm occurs. Alarm pause breakthrough allows any CRISIS patient status alarm to interrupt an alarm pause.
Only CRISIS alarms breakthrough, other patient status alarms will not sound.
When the monitor is in alarm pause:
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Active Alarm
No Active Alarms
Alarms
„
„
„
„
„
Countdown timer — Displays time left in the alarm pause when in ADULT-ICU or NEONATAL-ICU patient-monitor types.
NBP alarms — Silenced until the next measurement is taken.
ECG or arrhythmia alarms — If a patient condition of equal or greater priority occurs, the alarm pause is cancelled and the alarm will “break through”.
When ECG is turned off, the “ALARM PAUSE” system status message does not display on the central station.
FRANCE locale — Alarms are paused for no more than three minutes in
ADULT-ICU and NEONATAL-ICU patient-monitor types.
Key Pressed
One
Two
Three
Four
Five
ADULT-ICU
60 seconds
5 minutes
Pause cancelled
NEONATAL-ICU
3 minutes
OPERATING
ROOM
5 minutes
15 minutes
Permanent pause
Pause cancelled
NOTE
You can also select Silence Only from the monitor defaults. This disables the pause and a second push results in reactivation of alarm (versus an extended pause).
Key Pressed
One
Two
Three
Four
ADULT-ICU
5 minutes
Pause cancelled
NEONATAL-ICU
3 minutes
OPERATING
ROOM
5 minutes
15 minutes
Permanent pause
Pause cancelled
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Permanently
To permanently silence all audible alarms for the patient admitted to the monitor, select MORE MENUS > ALARM CONTROL > ALARM VOLUME > OFF.
NOTE
In NEONATAL-ICU, the alarm volume cannot be turned off. The lowest alarm volume can be set to is 10 percent.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
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5
Managing Patients
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Managing Patients
Introduction
Managing patients includes the following tasks:
„
„
„
Admitting patients to the monitor.
Discharging patients from the monitor.
Viewing other patients.
Admit
Overview
Standard Admit
You can admit a patient to the monitor from the bedside or a central station. There are three ways to admit a patient to the monitor from the bedside.
The information required to admit patients to the monitor varies by the monitoring mode and patient-monitor type.
To manually admit a patient to the monitor, follow this procedure:
1.
Select MORE MENUS > ADMIT MENU.
2.
Use the Trim Knob control to select the following patient information:
LAST NAME
FIRST NAME
PATIENT ID
SEX
BIRTH DATE
AGE
HEIGHT
Select the patient’s last name (up to 16 characters).
Select the patient’s first name (up to 10 characters).
Select a patient identification number (up to 13 characters) for a MUSE or a Lab Access Server. The default is
9999999999999.
Select male or female.
Select the patient’s birth date to automatically calculate the age from today’s date and year. If a birth date is not entered, the default is 1948.
Age is calculated in years for adults; months, weeks and days for neonates.
Select the patient’s height.
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WEIGHT
RACE
SECONDARY ID
REF PHYSICIAN
Select the patient’s weight.
Select the appropriate race.
Select a secondary identification number (up to 13 characters).
Select the patient’s referring physician’s name or telephone number (up to 16 characters).
3.
When finished, select SAVE.
4.
To admit a patient to the monitor with a custom default, follow this procedure.
a.
Select RECALL DEFAULT.
b.
Select the desired custom default name from the RECALL DEFAULT window.
5.
Select ADMIT PATIENT.
Quick Admit
Automatic Admit
To quickly admit a patient to the monitor, select MORE MENUS > ADMIT MENU >
ADMIT PATIENT or NEW CASE without entering any patient information.
When time permits, add the patient’s information by selecting MORE MENUS >
ADMIT MENU >CHANGE ADMIT INFO.
NOTE
Only available in software version 6 or later. Not available in the OPERATING
ROOM patient-monitor type.
To automatically admit a patient to the monitor, press the Silence Alarm/Admit or
Admit/Discharge key.
When time permits, add the patient’s information by selecting MORE MENUS >
ADMIT MENU >CHANGE ADMIT INFO.
Control Settings
To adjust the control settings for the patient admitted to the monitor, select MORE
MENUS > ADMIT MENU. Then select any of the following options and make the desired changes.
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NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
CHANGE ADMIT INFO
REQUEST ADMIT INFO
RECALL DEFAULT
ADMIT HELP
ADMIT PATIENT
NEW CASE
UNITS OF MEASURE
SET UNIT NAME
SET BED NUMBER
All
All
All
1
Monitoring
Mode
All
All
All
All
Patient-
Monitor Type
All
2
Function
All
All
ADULT-ICU and
NEONATAL-ICU
ADULT-ICU and
NEONATAL-ICU
OPERATING
ROOM
All
All
Select the patient information.
NOTE
When monitoring ECG, entering the sex and age of the patient provides information needed for the 12SL with
Gender-Specific Analysis or ACI-TIPI algorithms.
NOTE
If you change any patient information requested from a Lab
Access Server, notify the appropriate hospital personnel.
Request patient information from a Lab Access Server with an interface to hospital information.
NOTE
Use the VIEW MANUAL ADMIT INFO menu option to review the manually entered information separately from the automatically populated information.
Recall factory defaults.
Review the patient information required to admit a patient for the current monitoring mode.
Admit a patient to the monitor with the information entered on the
MANUAL ADMIT INFORMATION information window.
Discharge the existing patient data and ready the monitor for the next patient admission.
Select the units of measure for the patient’s age, height and weight.
Select the unit name for network identification.
ROVER and
ROVER
COMBO
ROVER and
ROVER
COMBO
All Select the bed number for network identification.
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Option
Monitoring
Mode
Patient-
Monitor Type
Function
PRINT LOCATION
SET LOCATION ID
ECG SOURCE
ROVER and
ROVER
COMBO
ROVER and
ROVER
COMBO
COMBO and
ROVER
COMBO
All
All
All
Select writers from the network.
Select the MUSE Cardiology Information System for network identification.
Select the monitor or telemetry transmitter to receive ECG data. If you select telemetry you must also select the transmitter number before you can admit a patient to the monitor.
1
All includes all four monitoring modes; STANDARD, ROVER, COMBO and ROVER COMBO.
2
All includes all three patient-monitor types; ADULT-ICU, NEONATAL-ICU and OPERATING ROOM.
Discharge
Discharging a patient from a monitor clears all patient information while retaining the unit name, bed number and factory or custom defaults.
WARNING
DISCHARGE TO CLEAR PATIENT DATA — When admitting a new patient to the monitor, you must clear all previous patient data from the monitor. To accomplish this, disconnect all patient cables and discharge the patient from the monitor.
To manually discharge a patient from the monitor, follow this procedure:
1.
Disconnect all patient cables.
2.
Select MORE MENUS > ADMIT MENU > DISCHARGE PATIENT or NEW
CASE.
3.
If in COMBO or ROVER COMBO monitoring modes, select on of the following to terminate telemetry monitoring:
„
„
„
MONITOR — Discharge from monitor only. If ECG was acquired from telemetry, telemetry will be monitored by the central station.
TELEMETRY — Discharge from telemetry only. ECG monitoring automatically switches to the monitor.
BOTH — Discharge from monitor and telemetry.
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4.
If the monitor is setup to view other monitors, the following events occur when the host monitor is discharged:
„
When running the VOA or AVOA software option, the viewed bed is removed from the display and the monitor reverts to the factory or custom defaults.
„ When running the AutoView XM software option, the viewed bed is removed from the display, the monitor reverts to the factory or custom defaults. All monitors from other care units are removed from the list of watched monitors. All monitors in the same care unit are retained and monitored according to the VIEW ON ALARM control settings.
NOTE
To automatically discharge a patient from the monitor in ADULT-ICU or
NEONATAL-ICU, press the Silence Alarm/Admit or Admit/Discharge key.
View Other Patients
„
„
„
There are three ways to view patients admitted to other monitors on the network:
„
„
„
Select another monitor on the network.
Select an alarming monitor on the network.
Automatically view an alarming monitor on the network.
How and when monitors display on a host monitor varies by software option. There are three software options that control how you can select and view other monitors on the network.
View On Alarm (VOA)
Auto View On Alarm (AVOA)
AutoView XM
Software Option Comparison
NOTE
GE recommends using ONE software option per care unit. All monitors outside the care unit have all automatic view on alarm functionality disabled.
View On Alarm (VOA) Auto View On Alarm (AVOA)
Host monitor software version Dash 3000/4000/5000 Patient Monitor (V1 or later)
Monitor (source of alarm) software version
Solar 8000M Patient Monitor (V4 or later)
Solar 9500 Information Monitor
AutoView XM
Dash 3000/4000/5000 (V5 or later)
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View On Alarm (VOA) Auto View On Alarm (AVOA) AutoView XM
Number of monitors viewable on a host monitor
1
Unity Network Information
Server V1 or greater
Network connection
40 or 10
Not required
Automatic split-screen display No
Monitors you can view
View on alarm functionality
All monitors in the care unit.
Manually select the alarming monitor. Up to four alarming monitors are available.
100
Required
Continuous
Yes
All monitors in the care unit with SEND AUTO VIEW turned on.
Automatically displays the most recent, highest priority alarming monitor in the care unit.
40 or 10
Not required
Yes
All monitors on the network from the host monitor and have
SEND AUTO VIEW turned on.
Automatically displays the oldest, highest priority alarming monitor.
1
Monitors without an installed wireless card and software version 5 or greater can send data to up to 40 other monitors or network devices.
Limitations
CAUTION
ALARM NOTIFICATION — A maximum of four monitors can be displayed in the message line at one time, even if more than four monitors are alarming. Because of this limitation, automatic view on alarm should not be used in place of a central station.
The following conditions prevent an alarming monitor from automatically displaying on another monitor:
„
„
If any of the following menus are active:
‹ CHANGE ADMIT INFO or UNITS OF MEASURE.
‹ Any automatic view on alarm configuration.
If any of the following information windows are open:
‹
‹
Any LEARN THE MONITOR.
ECG SOURCE (COMBO).
‹
‹
UNIT NAME, BED NUMBER and CONFIRM BED NUMBER (ROVER).
ALL LIMITS, ARRHYTHMIA ALARM LEVEL, PARAMETER ALARM
LEVEL or any parameter alarm limit.
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Custom Defaults
„
‹
SELECT A BED TO VIEW, SELECT A BED TO AUTOVIEW, SELECT A
CARE UNIT.
If any of the following functions are being performed or updated:
‹
PA WEDGE, PA INSERT/WEDGE.
‹
‹
‹
CARDIAC OUTPUT.
CARDIAC CALCS.
PULMONARY CALCS.
‹
DOSE CALCS.
NOTE
If an alarming monitor is blocked, text alarm messages are still available and you can manually access the alarm event.
All monitors in a care unit have the same factory or custom defaults. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
The following options control how and when other monitors are viewed on a host monitor. Some settings are only available for a specific software option.
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Option
VIEW ON ALARM
VOA BROADCAST
VOA ALERT TONE
All
1
Software Option
All
All
Function
Select one of the following options:
„
„
„
OFF — Do not allow this monitor to view other monitors.
ON — Display alarm messages from alarming monitors in the care unit.
If running AutoView XM, the alarm levels that trigger an automatic display on a host monitor are defined in the AVOA ALARM LEVEL setting.
AUTO — When running AutoView XM, select this option to display alarm messages and enable an automatic split-screen view on alarm on a host monitor.
Select one of the following options:
„
„
OFF — Do not send any alarms from this monitor to other monitors on the network.
ON — Send all ADVISORY, WARNING and CRISIS alarms to other monitors on the network. Only monitors that have this monitor selected to automatically view on alarm receive the alarms.
WARNING
ALARM NOTIFICATION LIMITATION — If a viewing bed is configured to auto view a bed that has SEND AUTO
VIEWS turned OFF, the viewing bed will only receive the alarm line message, NOT the split-screen view of the accompanying audible alarm. To avoid this limitation, verify that all viewing beds in the watch list have SEND AUTO
VIEWS turned ON.
„
„
„
Select one of the following options:
OFF — No tone sounds at host monitor.
ON — Tone sounds once at host monitor.
REPEAT — Tone sounds at the host monitor until the condition is resolved.
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Option Software Option Function
AVOA ALARM LEVEL
REMOTE SILENCE
AVOA SILENCE
AutoView XM
All
AutoView XM
Select the lowest alarm level to automatically view on the host monitor. All alarm levels of higher priority will also display.
NOTE
If the monitor is not running AutoView XM, all patient status warnings, system warnings and CRISIS alarms in the care unit display in the alarm message window.
Select the highest alarm level that can be silenced at the host monitor. All alarm levels of lesser priority can also be silenced. Alarms cannot be silenced in OPERATING
ROOM.
Select when the split view of the alarming monitor is removed after an alarm is silenced at the host monitor.
„
„
SILENCED — Split view of silenced monitor displays until RETURN or MAIN MENU is selected, even if another monitor is alarming.
NEW ALARM — Split view of silenced monitor replaced when another monitor alarms.
1
All software options include View On Alarm (VOA), Auto View On Alarm (AVOA) and AutoView XM.
Control Settings
To adjust the control settings for the patient admitted to the monitor, select MORE
MENUS > VIEW OTHER PATIENTS. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
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Option Function
VIEW ALARM
VIEW ON ALARM
OPTIONS
„
„
„
Select the alarming monitor to display or print patient data or silence alarms.
Select how this monitor receives automatic alarm displays.
„
„
VIEW OTHER BEDS ON ALARM — Select ON, OFF or AUTO.
SEND AUTO VIEWS — Select ON or OFF.
ALERT TONE — Select ON, OFF or REPEAT.
CONFIGURE AUTO VIEW ON ALARM — (AutoView
XM only) Select a care unit to automatically display on alarm.
CURRENT CONFIGURATION — (AutoView XM only)
View the current alarm configuration for a care unit.
SELECT A BED TO VIEW
Select the automatic view on alarm level for any monitor on the network. Select ALLBEDS to apply to selected beds.
SELECT ANOTHER CARE
UNIT
Select any care unit from the network.
PRINT VIEWED BED
VIEWED PATIENT DATA
Print 20 seconds of the viewed patient data.
Display the patient’s last event, TABULAR TRENDS or
GRAPHIC TRENDS.
Viewing Other Monitors
Selecting a Monitor
If more than one monitor is alarming, the bed with the most recent and highest priority alarm is displayed first. Up to three other alarming monitors display in order of decreasing priority.
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WARNING
— Due to space limitations in the alarm message line, it is possible that the alarm line will only display the beds that are in alarm, but not the alarm reason. Or the alarm reason may be abbreviated to the point where the reason is not immediately obvious to the user. To view alarm reason, select VIEW ALARM for the bed you wish to view.
To select an alarming monitor, follow this procedure.
1.
Select MORE MENUS > VIEW OTHER PATIENT.
2.
Select the alarming monitor from the associated VIEW ALARM menu.
3.
Select one or more of the following functions:
„
„
„
„
„
GRAPH/ PRINT
SILENCE (60 seconds)
LAST EVENT
VITAL SIGNS
GRAPHIC TRENDS
4.
Select RETURN, PREVIOUS MENU or MAIN MENU to exit.
Understanding the Split-View Display
„
„
When viewing another monitor, the split view divides the display in half, Each side displays one monitor’s patient information.
Right — Host monitor patient information.
Left — Viewed monitor patient information, including the first six parameter windows and up to four waveforms. The “VIEWED PATIENT” message displays on the bottom of the split-view.
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The viewed monitor displays until you select MAIN MENU or view another monitor.
The host monitor is completely functional and two seconds of waveforms data continue to display. The menus still control the host monitor and any changes you make do not affect the function of the viewed monitor. Information windows will also display over the viewed monitor.
„
„
„
Keep in mind the following guidelines when viewing a split view:
„
„
Admit a patient to view. If the monitor is discharged, the parameter windows display (no waveforms) with a “DISCHARGED” message.
To maintain CO
2
monitoring on the host monitor while viewing another monitor, change the position of CO
2
to the sixth position. The slower CO
2 sweep speed will block all other waveforms adjacent or below the CO
2
position.
CO
2
waveform and parameter windows are not sent to the host monitor.
ST trends and complexes are not sent to the host monitor.
CRG+ display is not sent to the host monitor.
Removing a Viewed Monitor Display
To remove an alarming monitor display from the host monitor:
„
„
VOA — Select MAIN MENU or RETURN.
AVOA — Perform any one of the following actions:
‹
‹
Select MAIN MENU or RETURN.
Silence the alarming monitor at the host monitor or central station.
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‹
‹
Resolve the alarm condition at the alarming monitor (all alarm levels except CRISIS).
Silence the remote alarm. This also prevents new alarms from sounding, even if a new alarm is of higher priority.
„
AutoView XM — Perform any one of the following actions:
‹
‹
Select MAIN MENU or RETURN.
Silence the alarming monitor at the host monitor or central station.
‹ Resolve the alarm condition at the alarming monitor (all alarm levels except CRISIS).
‹
Silence the remote alarm when the host monitor’s AVOA SILENCE setting is set to SILENCED. This also prevents new alarms from sounding, even if a new alarm is of higher priority.
‹ A more recent, higher priority alarm is received at the host monitor when the host monitor’s AVOA SILENCE setting is set to NEW ALARM.
NOTE
To remove a non-alarming monitor display from the host monitor, select MORE
MENUS > VIEW OTHER PATIENTS > SELECT A BED TO VIEW. The viewed bed is indicated with the word “VIEW”. Selecting that bed again will remove from the host monitor.
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Printing
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Printing
Introduction
Overview
„
„
„
You can print patient waveforms and most information windows. There are three possible printing devices:
Built-in writer
Writer on the network (another monitor or central station)
Laser printer on the network
Options
Control Settings
There are two printing options:
„ On demand — Press the Graph Go/Stop or Print key on the monitor to print the data displayed on the monitor. The real-time print opportunities depend on the monitored parameters and the data, tasks or windows displayed.
„
Scheduled, automatic — Automatically print patient data when a CRISIS or
WARNING patient status alarm sounds.
Once a print job is started, press the Graph Go/Stop or Print key on the print source (monitor or central station) to cancel the print job.
To adjust the control settings for the patient admitted to the monitor, select MORE
MENUS > MONITOR SETUP > GRAPH SETUP or PRINT SETUP. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
WAVEFORM
ECG 1
WAVEFORM 2
Function
Select a lead and its associated waveform to print first.
Select a lead and its associated waveform to print second.
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Option
WAVEFORM 3
WAVEFORM 4
GRAPH LOCATION
PRINT LOCATION
ALARM GRAPH
PRINT ON ALARM
SPEED
TIMED GRAPH
TIMED PRINT
GRAPH BP INVASIVE
PRINT BP INVASIVE
Function
Select a lead and its associated waveform to print third.
Select a lead and its associated waveform to print fourth.
„
„
„
Select the writer or printer for the following:
Manual printing.
Automatic printing on alarm.
Specific patient date, parameter or calculation information printing.
Select whether alarms print automatically.
Select the print speed. The slower the speed, the more condensed the data.
NOTE
Alarms print at 25 mm/sec. Laser printers do not support 0.1 mm/sec print speed.
Select the amount of time to print for each manual print job.
NOTE
Arrhythmia alarms run until a normal sinus rhythm is detected or the print job is manually stopped. All other alarms run for 20 seconds or until the print job is manually stopped.
Select the blood pressure waveforms. When selected, BP waveforms are the only parameters that can be printed.
They print on one scale on the full grid space.
NOTE
You cannot switch BP selections while a print job is in progress. To select a different BP, you must stop the current job. If a different parameter is printing, the BP print job is ignored.
Printed Output
All waveforms begin with 10 seconds of delayed data. The header information printed with the waveforms is real time data. Print output contains the following basic information in the header.
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Guidelines
„
„
„
„
„
„
„
„
„
„
„
„
„
„
„
„
Type (alarm, manual or saved)
Alarm violation (if any)
Unit name, bed number and patient name
Date and time
Patient-monitor type
Alarm volume
Speed
Lead failed (if any)
Heart rate
Arrhythmia call (if any)
Pace mode (if on)
Arrhythmia mode (full, lethal, off)
PVC count (if arrhythmia mode is on)
ST value for top displayed lead (if on)
ECG filter (Hz range)
Monitored parameter values
Keep in mind the following printing guidelines:
„
„
„
„
„
When printing to a laser printer, there may be a slight (one minute) delay to print the first page of data when any speed slower than 25 mm/sec is selected.
Each page contains 20 seconds of waveforms per page in a cascade format.
If the selected printer is removed from use, you must update the location to an available printer. All failed print jobs are saved until a printer is available. They print as soon as a functioning printer is selected.
A one millivolt ECG signal at normal (1X) size equals 10 millimeters on the graph paper.
To convert an arrhythmia alarm to a manual print, stop the print job by pressing the Graph Go/Stop or Print key and immediately restart by pressing the
Graph Go/Stop or Print key again.
Invasive pressure scales print on individual and full scales as follows:
Displayed Scale
30
40
60
Printed Scale
0-30 (PA, CVP, LA, RA, ICP)
0-45
0-60
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Displayed Scale
100
160
200, 300
Auto
Printed Scale
0-90
0-150
0-300
0-150 (ART, FEM, UAC, SP)
0-45 (PA, CVP, UVC, LA, RA, ICP)
Printing
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7
Patient Data
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Patient Data
Introduction
Working with patient data includes the following tasks:
„
„
„
„
„
„
„
„
„
Reviewing ALARM HISTORY.
Reviewing VITAL SIGNS.
Reviewing GRAPHIC TRENDS.
Reviewing CRG TRENDS.
Customizing the Trend key.
Reviewing lab data.
Managing cardiac calculations.
Managing pulmonary calculations.
Managing dose calculations.
Reviewing Patient Data
Alarm History
When running the CARDIAC software package, the ALARM HISTORY information window displays CRISIS, WARNING and ADVISORY alarm level arrhythmia and ST events in chronological order beginning with the most recent event. No parameter information is stored in ALARM HISTORY.
NOTE
In ADULT-ICU and NEONATAL-ICU patient-monitor types, events are not stored during an alarm pause or when the patient is discharged.
To review ALARM HISTORY, select MORE MENUS > PATIENT DATA > ALARM
HISTORY.
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Up to 36 arrhythmia events and 10 ST events (including alarms and references) are stored. Up to 15 events are displayed in the ALARM HISTORY information window at one time. When monitoring from telemetry, the event is stored at the tower and the last 36 events are viewable from the monitor.
The ALARM HISTORY contains 10 seconds of the arrhythmia event in a compressed format. Due to the display size, only eight seconds of waveform data is shown. For asystole, the first eight seconds of an event is displayed. All other arrhythmia events display the last eight seconds of the event.
WARNING
MEASURING DATA STORED IN ALARM HISTORY —
Waveform data stored in ALARM HISTORY uses compression technology that may not allow perfect reconstruction of the waveform data when subsequently viewed. Although differences occur relatively frequently, they are usually very minor. Users are urged to verify diagnostic waveform measurements with the waveform data from real-time graph strips.
Three leads of ECG are displayed for arrhythmia events. If an ART line was monitored at the time of the event, two leads of ECG and the ART waveform are displayed with the associated numerics.
To select an alarm or event, position the pointer in front of the option and press the
Trim Knob control. Selecting an arrhythmia event displays the applicable waveform and new menu options.
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Vital Signs
When viewing an ST alarm or reference, a QRS complex of all available leads
(except AVR) is displayed. If viewing an ST alarm, an asterisk is displayed next to each lead in violation of ST limits.
Use the following options to review the ALARM HISTORY.
Option
VIEW OLDER ALARM
VIEW NEWER ALARM
DELETE ALARM
Function
View the previous event.
View the next event.
Delete the selected event.
VITAL SIGNS displays the patient’s monitored parameter values for the last 24 hours, including the last 20 cardiac calculations and the last 10 pulmonary calculations.
NOTE
If alarms were paused or the monitor was discharged, the word OFF displays in the ALARMS field of the VITAL SIGNS information window during the time either of these events occurred.
To review vital signs, select MORE MENUS > PATIENT DATA > VITAL SIGNS.
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Graphic Trends
Patient Data
Use the following options to review VITAL SIGNS.
Option
VIEW OLDER
VIEW NEWER
TIME INTERVAL
SPECIFIC TIME
SORT DATA
PAGE DOWN
PAGE UP
Function
View the previous event.
View the next event.
Select the desired time interval for the patient data display.
Select a specific time period of collected patient data to display in the information window.
„
„
„
Select one of the following episodic parameters to sort the collected patient data. The data prints in the same order displayed.
NBP
Cardiac calculations
Pulmonary calculations
View the next page.
View the previous page.
GRAPHIC TRENDS allows you to create a graphic representation of a parameter over a specified period of time. It uses median values from the collected patient data to create a one minute resolution trends.
Episodic parameters are stored every time an event occurs. Non-episodic parameters are sampled 30 times a minute.
To display GRAPHIC TRENDS, select MORE MENUS > PATIENT DATA >
GRAPHIC TRENDS.
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Use the following options to review GRAPHIC TRENDS.
Option
PRESET TRENDS
VIEW OLDER
VIEW NEWER
Select one of the preset parameter groups to trend.
View the previous trend.
View the next trend.
Function
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CRG Trends
Patient Data
Option
TIME PERIOD
SELECT PARAMETERS
Function
„
„
„
„
„
„
„
„
„
Select one of the following time periods to for the trends.
Displayed trends automatically update while displayed in the GRAPHIC TRENDS information window according to the following cycle for each time period.
24 hours — Updates every six minutes.
12 hours — Updates every four minutes.
Eight hours — Updates every two minutes.
Four hours — Updates every minute.
Two hours — Updates every minute.
One hour — Updates every minute.
30 minutes — Updates every minute.
15 minutes — Updates every minute.
Six minutes — Updates every 10 seconds.
Select up to three parameters to trend. HR is the default parameter.
NOTE
NBP and invasive pressure (with the associated systolic, diastolic and mean values) are considered one selection and will generate one trend. If you do not want all three pressure parameters included in the trend, unmark the parameters you do not want. This is also true for inspired and expired CO
2
.
NOTE
You cannot view older or newer trends when viewing a six minute time period.
CRG TRENDS allows you to create high resolution trends for up to three CRG parameters (including HR, SpO
2
, MAP, RESP and CO
2
).
To view CRG TRENDS, select MORE MENUS > PATIENT DATA > CRG TRENDS.
NOTE
The primary ECG lead and parameters windows remain displayed.
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The CRG TRENDS information window displays a directory of up to six stored
CRG events. Each event has an associated number, a minimum and maximum alarm value and an event start time. An asterisk indicates that you cannot access the trend trace data for this event, usually because the event just occurred and the data is not available yet.
The directory holds up to 100 of the most recent events. Only resolved alarms with an alarm level above MESSAGE are stored. The directory automatically updates when a valid alarm is resolved.
When the directory is full, the oldest event in the directory is removed to make room for a new event. Trend traces are stored for 24 hours. It is possible that trends may not be available for events that occurred more than 24 hours ago.
There may be a two minute delay before data can be displayed when the system is first connected or when admitting a patient. Data is displayed on an even minute boundary in either two minute or six hour segments. The display automatically updates every two minutes when the most recent data segment is displayed
NOTE
When the monitor is set for the NEONATAL-ICU patient-monitor type and an apnea, brady or desaturation alarm occurs within 30 seconds of the first alarm, the monitor groups the alarms in one text line in the event directory.
When more than one alarm is grouped in a text line, each alarm counts as a single event. Each event can be viewed separately, and three separate events are recorded in the event directory.
The respiration trend data for the two minute display is the respiration waveform.
The respiration trend data for the six hour summary varies by patient-monitor type:
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Lab Data
Patient Data
„
„
NEONATAL-ICU — Apnea per five minutes; printing as apnea per minute.
ADULT-ICU and OPERATING ROOM — Respiration rate.
Use the following options to review CRG TRENDS.
Option
LOCATE CURSOR
ZOOM IN
ZOOM OUT
VIEW OLDER
VIEW NEWER
SELECT PARAMETERS
SELECT EVENT
DELETE EVENT
PRINT EVENT
DOCUMENT CRG
EVENTS
Function
Select a specific time on the display and display the associated parameter values.
Select a specific two minute trend from a six hour summary and display the associated trace.
Display the six hour summary.
View the previous event.
View the next event.
Select the parameters to display as trends.
Select and view a single two minute trend event from the six hour summary.
Select and delete individual events (and associated traces) more than 24 hours old or all events more than 24 hours old.
Print all events in the event directory.
When in the NEONATAL-ICU patient-monitor type you can review, edit and save CRG events associated with the patient’s condition.
NOTE
The display and menu do not time out. To exit the display, select MAIN MENU.
If your monitoring system includes a Lab Access Server and an interface to a lab information system (LIS), you can access the patient’s laboratory data at a monitor.
While monitoring, you may also receive an alert when new lab data is available for the patient. The alert is displayed at the top of the screen as the lab data icon ( ).
To review lab data information, select MORE MENUS > PATIENT DATA > LAB
DATA.
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Patient Data
The LAB DATA information window displays all the available lab data for the patient in the LIS database. How information is display in the window varies by report type.
Use the following options to review LAB DATA reports.
Option
VIEW OLDER
VIEW NEWER
PAGE DOWN
PAGE UP
VIEW RANGES AND
UNITS OF MEASURE
Function
View the previous report
View the next report.
View the previous page of reports.
View the next page of reports.
View the high and low ranges and the units of measure used in the selected report.
Customizing the Trends Key
NOTE
Only available in software version 6 or later.
„
„
„
To select the default trend type, select MORE MENUS > MONITOR SETUP >
MONITOR DEFAULTS > SETUP DEFAULT DISPLAY > TRENDS HARDKEY and select one of the following options:
„
TABULAR ALL — Displays the VITAL SIGNS information window sorted by parameter priority. This is the factory default setting.
TABULAR NBP — Displays the VITAL SIGNS window sorted by NBP.
GRAPHIC — Displays the GRAPHIC TRENDS information window.
CRG — Displays the CRG TRENDS information window.
Calculations
Cardiac Calculations
NOTE
Only available in the CARDIO-PULMONARY software package.
The cardiac calculations program displays monitored and calculated hemodynamic parameter values that are used in cardiac output measurement.
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The calculated parameter values are computed with input values. The input values are obtained from available monitored patient data. The patient’s height and weight are required to compute cardiac calculations.
For more information on calculation parameters and formulas, refer to the GE
“Critical Care Monitoring Clinical Reference and Troubleshooting Guide”.
To adjust the control settings for the patient admitted to the monitor, select MORE
MENUS > PATIENT DATA > CARDIAC CALCS. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
CHANGE VALUE
SAVE CALC
REVIEW CALC
WEIGHT
HEIGHT
Function
Select a new value for any monitored value.
NOTE
When a change is made, the date on the information window changes to the current date and any applicable calculated values display.
Select to save the displayed data.
Select to review the saved calculation.
Select the units of measurement for the patient’s weight.
Select the units of measurement for the patient’s height.
Dosage Calculations
The dosage calculations program is used to determine appropriate doses and flow rates of intravenous medications.
NOTE
If you are using a drug that is not in the list, select one of the generic drug names (DRUG A, B, C or D). Make a note of the drug assigned to each generic drug name.
For more information on dosage calculations, refer to the GE “Critical Care
Monitoring Clinical Reference and Troubleshooting Guide”.
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To adjust the dosage calculations for the patient admitted to the monitor, select
MORE MENUS > PATIENT DATA > DOSE CALCS. Then select any of the following options and make the desired changes.
Option
CHANGE VALUE
SAVE CALC
RECALL SAVED CALC
DELETE CALC
TITRATION TABLE
WEIGHT
DRUG UNITS
DRUG QTY RANGE
RESUSCITATION
MEDICATIONS
Function
Select a drug name and values for the patient monitoring situation and drug use indications.
„
„
„
„
„
„
„
„
WEIGHT
SOL VOLUME (solution volume)
DRUG QTY (drug quantity) — Calculated the dose based on concentration from solution volume, dose and rate. If entered in milligrams the DOSE/KG/MIN is in micrograms.
DOSE/MIN, DOSE /HR OR DOSE/KG/MIN —
Calculated from volume, quantity and rate.
INF RATE (Infusion rate) — How long the bag takes to infuse (cc/hr).
DRIP RATE — When administrating medication with a pump that counts drops and the pump’s drop size is
NOT 60 gtt/cc.
DROP SIZE
INF TIME (infusion time) — Calculated from volume, quantity and rate.
Save all complete calculations displayed on the screen.
You can save up to four calculations. You cannot save incomplete calculations. If you modify an existing calculation for a specific drug name, the new calculation over writes the old calculation.
Display all saved calculations by drug name.
Delete the selected calculation.
Display the titration table for the selected calculation.
Select the correct patient weight.
Select the correct dosage unit for each of the generic drug.
Select the correct dosage quantity range for each of the generic drug names you are using.
When in the NEONATAL-ICU patient-monitor type, select the concentration and dose for resuscitation medications.
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Pulmonary Calculations
All aspects of oxygen uptake, transport and delivery are necessary in the assessment of critically ill patients. These parameters cannot be directly measured, but are derived from monitored cardiopulmonary variables.
The input values are obtained from available monitored patient data. The patient’s height and weight are required for these calculations. The calculated parameter values are figured using the input values.
For more information on pulmonary calculation parameters and formulas, refer to the GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide”.
To adjust the pulmonary calculations for the patient admitted to the monitor, select
MORE MENUS > PATIENT DATA > PULMONARY CALCS. Then select any of the following options and make the desired changes.
Option
CHANGE VALUE
SAVE CALC
REVIEW CALC
WEIGHT
HEIGHT
CALCULATED
Function
Select a new value for any monitored value.
NOTE
When a change is made, the date on the information window changes to the current date and any applicable calculated values display.
Select to save the displayed data.
Select to review the saved calculation.
Select the units of measurement for the patient’s weight.
Select the units of measurement for the patient’s height.
Select O2CI (requires O
2
CO value).
CI value) or FICK CO (requires
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Monitoring ECG
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Monitoring ECG
Introduction
Overview
ECG is the primary patient monitoring parameter. It measures heart rate, analyzes arrhythmia, detects pacemaker function and detects myocardial ischemia.
A parameter window and waveform display when a patient cable is connected to the monitor. The display updates every two seconds. The The parameter window varies by software package and the control settings.
1 2
3
4
5
6
655A
1 QRS indicator
2 Heart rate
3 Paced beat detection indicator (Pacemaker detection enabled)
4 PVC count (full arrhythmia only)
5 ST measurement point
6 ST analysis data (ST analysis only)
When the quality of an electrode signal degrades to an inadequate monitoring level, a lead failure message displays and monitoring automatically switches to another lead, as described in the following table.
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Message
RA FAIL
LL FAIL
LA FAIL
V FAIL
LEADS FAILED
New Lead Monitored
Lead III
Lead I
Lead II
Lead II
No waveforms displayed when RL or all leads fail.
If more than one lead fails, a system alarm will sound. The alarm is ADVISORY in
OPERATING ROOM patient-monitor type and a WARNING in ADULT-ICU and
NEONATAL-ICU patient-monitor types. You can change the alarm levels. For more information, refer to
Options
AFIB Arrhythmia Detection
NOTE
This option is only available in the CARDIAC software package in software versions 3B or later and for the ADULT-ICU and OPERATING ROOM patientmonitor types.
The AFIB (atrial fibrillation) identification option uses an algorithm to identify atrial fibrillation arrhythmias. AFIB arrhythmias are characterized by random, chaotic, low-amplitude deflections of the supraventricular component of the ECG waveform. This results in irregular timing of QRS complexes and the absence of uniform P waves preceding the QRS complex.
When an AFIB arrhythmia is detected, a patient status alarm is triggered. An
“ATRIAL FIB” message displays in the message line on both the monitor and the central station. AFIB arrhythmia alarms can take up to 90 seconds to display while the algorithm verifies the event.
When set for an alarm level of ADVISORY or greater, all AFIB alarms are displayed on the monitor in the ALARM parameter window and recorded in the ALARM
HISTORY, VITAL SIGNS and GRAPHIC TRENDS information windows.
To determine if AFIB is enabled on this monitor, select MORE MENUS >
MONITOR SETUP > SOFTWARE CONFIGURATION. If it is enabled, ATRIAL FIB is listed under the ENABLED SOFTWARE OPTIONS list.
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When a network device does not support AFIB arrhythmia identification, the following conditions apply.
„
„
The network device displays the “ATRIAL FIB” message in the message line.
The network device does not display the “ATRIAL FIB” message in the ALARM
HISTORY, GRAPHIC TRENDS or VITAL SIGNS information windows.
Alarm levels display on network devices that do not support AFIB arrhythmia identification as follows.
Network Device Actual Displayed Text
Central station
Dash 3000/4000 (version 3B or earlier)
Eagle 4000 patient monitor
<14>
No text is displayed.
Split View No text is displayed.
Solar 7000/8000 patient monitor
Full View
Split View
Solar View
OctaView
?
?
?
No text is displayed.
Solar 8000M patient monitor
Full View
Split View
Unity View
?
No text is displayed.
?
Solar 9500 information monitor
View Other Patient No text is displayed.
Tramscope patient monitor
?
No text is displayed.
Unity Network IS Information Suite
Full View
Split View
AVOA ?
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IntelliRate
Monitoring ECG
Network Device Actual Displayed Text
Unity Network IS Information Suite
Impact Pager ?
MARS PC workstation The AFIB arrhythmia alarm text does not appear in the MARS Event window.
WARNING
PATIENT RISK HAZARD — The heart rate reported by the
IntelliRate feature may reflect either the electrical or pulsatile heart rate. An electrical heart rate may be reported on some pulseless rhythms. A pulsatile heart rate may be reported by the IntelliRate feature during ASYSTOLE if the patient is on a cardiac assist device. In these situations, the monitor will not detect or call an
ASYSTOLE patient alarm. The user may elect to turn the
IntelliRate feature off for patients at risk of these events, otherwise patient treatment may be delayed. Such patients should always be kept under close observation.
The IntelliRate algorithm utilizes information contained in multiple physiologic signals (for example, ECG, arterial blood pressure and pulse oximetry) to improve the accuracy of the heart rate calculation.
After assessing the information extracted from each of the physiologic signals, the
IntelliRate algorithm applies rule-based logic to determine which heart rate source has the highest likelihood of being accurate. By reporting the most accurate rate, the trended heart rate is more accurate, and occurrences of false heart rate limit violation alarms are greatly reduced.
The IntelliRate value replaces the standard heart rate value in the ECG parameter window. It also indicates the source of the heart rate (SPO
2
or ART) when the heart rate source is not ECG.
To determine if IntelliRate is enabled on this monitor, select MORE MENUS >
MONITOR SETUP > SOFTWARE CONFIGURATION. If it is enabled, ECG
INTELLIRATE is listed under the ENABLED SOFTWARE OPTIONS list.
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Combo and Rover Combo Monitoring Guidelines
The following are guidelines to remember when monitoring in COMBO or ROVER
COMBO monitoring modes.
„ When monitoring ECG from telemetry:
‹
ECG limits and arrhythmia alarm levels are not your monitor defaults, but are the telemetry defaults from the central station. You can adjust these settings at the monitor.
‹ The alarm pause feature (if available on your transmitter) is honored at the monitor.
‹
‹
You should not turn off the monitor until you have discharged the patient from the monitor.
Second V lead data is not sent to the monitor from the telemetry transmitter. If you wish to see telemetry second V lead data, you must view the telemetry patient.
„
When switching ECG monitoring from the monitor to telemetry:
‹ Arrhythmia alarm histories from the monitor are merged in the telemetry system. CD Telemetry-LAN software version 5 or later is required.
‹
If you discharge the monitor, the telemetry arrhythmia alarm levels will be the same as the arrhythmia alarm levels supported by the monitor.
Therefore, when the monitor uses the BASIC software package, only lethal arrhythmia alarm levels will be detected from telemetry. If the monitor has the CARDIAC software package, full arrhythmia alarm levels will be detected from telemetry.
„
When switching ECG monitoring from telemetry to the monitor:
‹ Telemetry is automatically discharged and the most recent 36 alarm histories are transferred to the monitor.
‹
The ECG limits, arrhythmia alarm levels and display defaults are recalled from the monitor defaults.
NOTE
It is not likely that the COMBO or ROVER COMBO monitoring modes are used when the patient-monitor type is OPERATING ROOM.
NOTE
Users should be aware of a possible time discrepancy between the waveforms from the telemetry device and the waveforms from the monitor. Users should not consider these waveforms to be synchronous. If absolute synchronicity is desired, COMBO mode should be discontinued and the ECG waveforms should be acquired via the hard-wired monitor.
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Analog Output
The ECG analog output includes the top trace position lead and augmented leads. It provides the following signals:
„ A five-volt, two-millisecond artificial pacer spike to the analog output when pacemaker detection is on and detection occurs.
„
A defibrillator synchronization marker to determine the peak of the R wave.
In the event of a lead failure, the following output occurs:
Lead Failed
Right arm
Left arm
Chest
Right leg
Left leg
Lead III
Lead II
Lead II buzz
Lead I
1
All ECG outputs are one volt per millivolt of input.
ECG Analog Output
1
Additional Information
NOTE
In a single lead mode, if the lead is not available, a buzz signal occurs. The buzz signal can be either a zero volt flat-line or a 60 Hz sine wave. The buzz signal option is set in the SERVICE MODE > CALIBRATE > CAL ECG ANALOG
OUT. For more information, refer to the service manual.
„
„
„
„
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
„
Skin preparation.
Electrode placement.
Pacemaker detection.
Arrhythmia detection and analysis.
Clinical-level troubleshooting.
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Safety
Pacemaker
The following safety statements apply when monitoring pacemaker patients.
WARNING
FALSE CALLS — False low heart rate indicators or false asystole calls may result with certain pacemakers because of electrical overshoots.
WARNING
MONITORING PACEMAKER PATIENTS — Monitoring of pacemaker patients can only occur with the pace program activated.
WARNING
PACEMAKER SPIKE — An artificial pacemaker spike is displayed in place of the actual pacemaker spike. All pacemaker spikes appear uniform. Do not diagnostically interpret pacemaker spike size and shape.
WARNING
PATIENT HAZARD — A pacemaker pulse can be counted as a
QRS during asystole. Keep pacemaker patients under close observation.
WARNING
RATE METERS — Keep pacemaker patients under close observation. Rate meters may continue to count the pacemaker rate during cardiac arrest and some arrhythmias. Therefore, do not rely entirely on rate meter alarms.
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Monitoring ECG
WARNING
SURVEILLANCE — Maintain close surveillance of pacemaker patients. Heart rate errors can occur.
CAUTION
FDA POSTMARKET SAFETY ALERT — The United States
FDA Center for Devices and Radiological Health issued a safety bulletin October 14, 1998. This bulletin states “that minute ventilation rate-adaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment, causing the pacemakers to pace at their maximum programmed rate.”
The FDA further recommends precautions to take into consideration for patients with these types of pacemakers. These precautions include disabling the rate responsive mode and enabling an alternate pace mode. For more information contact:
Office of Surveillance and Biometrics, CDRH, FDA
1350 Piccard Drive, Mail Stop HFZ-510
Rockville, MD 20850
U.S.A.
NOTE
ECG monitoring with patients on non-invasive transcutaneous pacemakers may not be possible due to large amounts of energy produced by these devices.
Monitoring ECG with an external device (for example, a defibrillator) may be needed. Remember that there are no ECG alarms at the monitor if you are monitoring with an external devices.
The following safety statements apply when monitoring arrhythmia patients.
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Monitoring
WARNING
VENTRICULAR ARRHYTHMIAS — Occasionally the arrhythmia analysis program may incorrectly identify the presence or absence of an arrhythmia. Therefore a physician must analyze the arrhythmia information in conjunction with other clinical findings.
WARNING
SUSPENDED ANALYSIS — Certain conditions suspend arrhythmia analysis. When suspended, arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur.
The messages which alert you to the conditions causing suspended arrhythmia analysis are: Arr Off, Arrhy Suspend, and Leads Fail.
NOTE
Arrhythmia processing is suspended during an “Artifact” condition. Should the artifact condition persist for 20 seconds out of 30 seconds, an audible system
WARNING alarm will sound and the message “Arrhy Suspend” will be displayed in the top waveform window until the condition is resolved.
NOTE
The EK-Pro algorithm simultaneously uses leads I, II, III, and the V/VA lead for
ECG and arrhythmia analysis.
To verify that you are ready to monitor ECG, follow this procedure.
1.
Admit the patient to the monitor.
2.
Position the electrodes on the patient.
3.
Connect the patient cable to the electrodes.
NOTE
When using “snap” leadwires, attach leadwires to the electrodes first, then apply the electrodes to the patient.
4.
If using a 5- or 10-leadwire patient cable, verify the V lead labels are correct.
5.
Connect the patient cable to the ECG patient connector on the monitor.
6.
Verify that patient data displays in the ECG parameter window.
7.
Verify the ECG baseline is stable and the waveforms are noise-free.
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Control Settings
8.
Print a test graph strip.
9.
Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the ECG parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option Function
DISPLAY
ECG SIZE
DETECT PACE
ECG LIMITS
Select the primary (top trace) lead. The V lead choice is determined by the V lead identified in the ST menu.
Select the waveform size.
„
„
1X — Recommended for standard monitoring.
2X, 4X — Recommended for low amplitude QRS waveforms. However, this lowers the QRS detection threshold and baseline artifact may be detected as a
QRS.
Turn pacemaker detection on or off.
Select the alarm limits for heart rate and PVCs.
NOTE
PVC Limit is available in the CARDIAC software package only.
VIEW ALL ECG
RELEARN
Displays all six leads of ECG.
Relearn the patient’s ECG pattern to correct arrhythmia calls and heart rate value, restore ST measurements and enable more accurate monitoring.
ST ANALYSIS
Turn the ST analysis program on or off. For more information, refer to
“Performing ST Analysis” on page 8-
12 LEAD ECG ANALYSIS
Displays 12 leads of ECG. For more information, refer to
“Performing 12 Lead Analysis” on page 8-21.
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Option
ECG FILTER
Function
Select a ECG waveform signal filter to improve the waveform display and graphs. (Does not affect ST and arrhythmia analysis.)
„
„
„
„
DIAGNOSTIC — Provides the maximum available
ECG signal information. Recommended for highfidelity recordings in low-noise environments.
MONITORING — Provides modest reduction of high frequency interference. Recommended for typical monitoring applications.
MODERATE — Provides significant reduction of high frequency interference. Recommended for high-noise environments (for example, electrosurgical units).
MAXIMUM — Provides significant reduction of high frequency interference plus maximum stabilization of the ECG baseline. This mode alters the displayed
QRS morphology, but does not affect automated analysis. Do not rely upon the displayed QRS morphology for diagnostic purposes when this mode is selected.
WARNING
— The MAXIMUM filter alters displayed ECG morphology. Do not rely on ECG morphology for diagnostic purposes when this filter is selected.
NOTE
MODERATE and MAXIMUM filters are not recommended for pacemaker patients.
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Option
LD ANALYSIS
ARRHYTHMIA
CLEAR V2 - V6 FAIL
More ECG
Monitoring ECG
Function
Select one of the following for ECG and arrhythmia processing:
„
SINGLE LEAD — Uses the top trace position lead.
Recommended for adults using an external, temporary pacemaker with a Zoll interface cable or for troubleshooting pacemaker or arrhythmia detection.
NOTE
ECG is relearned when the lead changes.
„
MULTI-LEAD — Uses leads I, II, III and V lead to eliminate false alarms and improve the ability to:
‹
‹
Detect beats which occur isoelectric to a single chest lead.
Discriminate artifact that appears in one lead compared to the other lead vectors.
‹
‹
Allow failed leads to automatically switch to another lead.
Continue arrhythmia processing after a lead change.
Select the level of EK-Pro arrhythmia detection and relearns the patient’s ECG pattern.
„
„
„
FULL — CARDIAC software package only; detects and identifies all types of arrhythmia.
LETHAL — Detects and identifies only lethal arrhythmia.
OFF — Does not detect or identify arrhythmia.
NOTE
You cannot select an arrhythmia level lower than the MIN ARRHYTH LEVEL monitor default.
Clear the “V2-V6 Fail” message.
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Option
MORE ECG > QRS
VOLUME
MORE ECG > QRS
WIDTH
MORE ECG
>INTELLIRATE
MORE ECG > BEAT
PAUSE INTERVAL
MORE ECG > SPEED
Function
Select the alarm tone for QRS complex annunciation. If turned on, SpO
2
Rate volume is turned off.
In NEONATAL-ICU, BRADY ALARM option automatically starts a QRS alarm tone when the monitor alarms for bradycardia that is 20 percent louder than the set alarm volume.
NOTE
Not available from a telemetry transmitter when performing combination monitoring.
„
„
Select one of the following for use in ECG analysis algorithms:
NARROW — Default for NEONATAL-ICU.
NORMAL — Default for ADULT-ICU and OPERATING
ROOM.
Turn IntelliRate on or off. For more information, refer to
Select the maximum pause between consecutive heart beats before an alarm sounds.
Select a sweep speed for the displayed waveform.
Custom Defaults
Turning Off ECG
Permanently
To permanently turn the ECG parameter off, follow this procedure.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT DISPLAY.
2.
Locate and select ECG PARAMETER.
3.
Select OFF.
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Constraints
„
„
„
„
When the ECG parameter is turned off, the following constraints apply.
„
„
„
SpO
2
becomes the primary parameter for patient monitoring.
The patient’s heart rate is determined from pulse oximetry.
The SpO
2
and SpO
2
Rate parameter alarm levels become WARNING.
The SpO
2
pulse search and probe off system status alarm levels become
WARNING.
Connecting the ECG cable to the monitor will NOT automatically turn the ECG parameter on.
When the monitor is connected to a Dash Responder defibrillator, the ECG parameter will either automatically turn on or remain turned on.
When the monitor alarms are paused AND the ECG parameter is turned off, the following network devices will NOT display an “ALARM PAUSE” text message for that monitor.
‹
CIC clinical information center using software version 3.0 or earlier.
‹
Centralscope central station using any version of software.
ECG Setting Source
Selecting ECG Setting Source
When the monitor is in COMBO mode, you can select whether the monitor uses its own ECG settings or the telemetry ECG settings. The following ECG settings are affected when you select an ECG setting source:
„
„
„
„
„
„
„
„
„
Arrhythmia alarm levels
HR, PVC and ST parameter alarm levels
ECG SIZE
DETECT PACE
ARRHYTHMIA
ST ANALYSIS
LEAD ANALYSIS
HR HIGH LIMIT and HR LOW LIMIT
PVC LIMIT and PVC state
To select the source of ECG settings, follow this procedure.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT DISPLAY.
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2.
Locate and select COMBO DEFAULT SOURCE.
3.
Select one of the following:
„
„
TELE DEFINED — Use the telemetry ECG settings. This is the factory default.
USER DEFINED — Use the monitor’s ECG settings if telemetry is NOT admitted. Use the telemetry ECG settings if telemetry IS admitted.
ECG Setting Source When Entering COMBO Mode
The following tables indicate the source (monitor or telemetry) of ECG settings when entering COMBO mode.
Monitor
Not admitted
Admitted
Not admitted
Telemetry
Not admitted
Not admitted
Admitted
Tele Defined
Entering COMBO Mode
>
>
>
ECG Setting Source
Telemetry
Monitor
Not admitted
Admitted
Not admitted
Telemetry
Not admitted
Not admitted
Admitted
User Defined
Entering COMBO Mode
>
>
>
ECG Setting Source
Monitor
Telemetry
Notice that selecting Tele Defined means the ECG setting source is always telemetry when entering COMBO mode, while the ECG setting source for User Defined depends on whether the patient is admitted to the monitor or telemetry when entering COMBO mode.
NOTE
It is possible (but not a normal operation), to admit a patient to both a telemetry bed and a hardwired bed before entering COMBO mode. For example, bed101*
(telemetry) AND bed101 (monitor) are two separate beds for the same patient.
When you enter COMBO mode in this situation, the ECG setting source is always telemetry.
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ECG Setting Source When Exiting COMBO Mode
When discharging from telemetry, but remaining admitted to the monitor (exiting
COMBO mode), the ECG setting source (monitor or telemetry) depends on the
COMBO DEFAULT SOURCE selection.
„ TELE DEFINED — When exiting COMBO mode, the ECG settings return to the monitor’s ECG custom defaults.
„
USER DEFINED — When exiting COMBO mode, the ECG settings for the current patient persist until the patient is discharged from the monitor.
For both the TELE DEFINED and USER DEFINED options, when discharging from the monitor (exiting COMBO mode), but remaining admitted to telemetry, the
ECG settings for the current patient persist until the patient is discharged from telemetry.
ECG Rate Averaging
To select the number of heart beat intervals used to generate an average heart rate, follow this procedure. The factory default is eight beats.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT DISPLAY.
2.
Locate and select ECG RATE AVERAGING.
3.
Select one of the following:
„
„
8 BEATS — Averages the eight most recent heart beat intervals. This is the default setting.
4 BEATS — Averages the four most recent heart beat intervals to get a faster response to the changes in a patient’s heart rate.
IntelliRate
To turn IntelliRate on, follow this procedure. When this option is enabled, the factory default setting is on.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT DISPLAY.
2.
Locate and select ECG INTELLIRATE.
3.
Select ON or OFF.
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AFIB Alarm Level
To adjust the AFIB arrhythmia patient status alarm level, follow this procedure.
When this option is enabled, the factory default alarm level setting is MESSAGE.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT ARRHYTHMIA ALARM LEVELS.
2.
Locate and select ATRIAL FIB.
3.
Select the patient status alarm level.
Performing ST Analysis
Overview
ST analysis begins at the end of the QRS complex and ends with the onset of the T wave. The point at which the QRS complex meets the ST segment is referred to as the J point.
The ST numeric that displays in the ECG parameter window indicates the greatest positive or negative deviation from the isoelectric reference (I) point. Numerics update every two seconds.
If ST is the second priority parameter (ECG is the first) the ST values display in three groups:
„
„
„
Anterior (ANT) — V1 to V4.
Inferior (INF) — Lead II, III and AVF.
Lateral (LAT) — Lead I, AVL, V5 and V6.
The default ST display shows three, 30-minute ST trends and three ECG complexes for leads I, II and V. To change the display default settings, refer to
„ ST trends — Displays 30-minute real-time trends for each lead. When in
OPERATING ROOM patient-monitor type, a summation scale also displays.
„
ST complex — Displays current complex for each lead superimposed over the reference complex to show ST segment changes. Updates every 16 beats.
NOTE
Trends and complexes are not available from a telemetry transmitter when performing combination monitoring.
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Control Settings
Monitoring ECG
To adjust the control settings for the patient admitted to the monitor, select the ECG parameter window label then ST ANALYSIS. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
NOTE
ST analysis control settings are only available in the CARDIAC software package.
Option
TURN ST OFF
PRINT ST
STORE NEW
REFERENCES
Function
Turn ST analysis program on or off.
Print displayed ST trends and complexes.
NOTE
Trends with a scale of 2 or 4 mm print on a 3 mm scale; 6 or 8 mm print on a 6 mm scale.
Select a new set of reference complexes.
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ST LIMITS
Option
IDENTIFY V LEAD
TREND SCALE
ST DISPLAY
Function
Select the ST deviation limits.
„
„
„
„
ADJUST INDIVIDUAL LIMITS — Select the low and high limits for any of the available leads.
ADJUST ALL LIMITS — Select the range to trigger an alarm for all of the groups.
ADJUST INF LIMITS — Select the range to trigger an alarm for INF group only.
ADJUST LAT LIMITS — Select the range to trigger an alarm for LAT group only.
„
ADJUST ANT LIMITS — Select the range to trigger an alarm for ANT group only.
When any monitored lead has a deviation greater or less than the defined limit, an alarm sounds and the ST event is stored in the ALARM HISTORY.
Only the first lead in each group to exceed the alarm limit is stored in ALARM HISTORY. Subsequent alarms in the same group will not be stored until all leads in a group return to the normal range.
Locate the V lead being used for ECG and ST analysis.
For 5-Leadwire Cables — Verify the V Lead used in ST and arrhythmia analysis is selected. This V Lead is also used for ST trends and complex displays.
For 10-Leadwire Cables — Since ST measurement is performed with a different V lead I than arrhythmia analysis, any changes made to this selection only apply to the V lead used for arrhythmia analysis. This V lead is not used for ST trend and complex displays.
NOTE
Changing the V lead changes the displayed waveform, analog output, network data, ST trend and template, graphing and histories.
Select a ST trend scale.
Select up to three leads for trend or complex display.
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Option
INITIATE 12 LEAD ON ST
HISTORY
ADJUST ST POINT
Function
Enable automatic initiation of 12 lead analysis when an ST event is stored in history.
Change ST measurement point; J + 0 MS to J + 80 MS.
NOTE
Upon initialization of ST analysis, regardless of which IDENTIFY V LEAD option is selected, the V lead’s ST alarm limits will always be the default limits set for V1.
When the identified V lead’s position or label is changed, the previous identified V lead’s ST alarm limits will be retained.
For example, if you change the V lead’s ST alarm limits to +/- 3 and then change the identified V lead’s position and label, the ST alarm limits will remain at +/- 3 regardless of the default ST alarm limits for the new identified V lead.
This functionality occurs in both hard-wired and COMBO mode during 5-lead
ECG monitoring.
Performing 12 Lead Analysis
To analyze 12-lead ECG data, follow this procedure.
WARNING
— This device uses a computerized 12-lead ECG analysis program which can be used as a tool in ECG tracing interpretation. This computerized interpretation is only significant when used in conjunction with clinical findings. All computergenerated tracings should be overread by a qualified physician.
To ensure accuracy, use only computer-generated tracings and not the display for physician interpretation.
The intended use of this device is to record electrocardiograms and vectorcardiograms from surface ECG electrodes, not for positioning (floating) temporary pacemaker leadwires, performing pericardiocentesis, or other internal applications.
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NOTE
When monitoring ECG, entering the sex and age of the patient will provide information needed for using the 12SL Algorithm with Gender-Specific
Analysis or the ACI-TIPI algorithm. The 12SL Algorithm with Gender-Specific
Analysis improves the detection of acute myocardial infarctions (AMI) for adult women under the age of 60.
If the date of birth is not entered, the system will set the date of birth to the current month and day, but the year will be set to 1948.
ACI-TIPI analysis cannot be performed on patients less than 16 years of age.
1.
From the ECG menu, select 12 LEAD ECG ANALYSIS. All 12 leads of ECG display.
2.
Define the following information (if required). If ACI-TIPI is enabled, you may have to define additional information.
„
„
„
TECHNICIAN ID — Select up to four characters.
OPTION FIELD — Select up to two digits.
ORDER NUMBER — Select up to nine digits.
3.
Select 12 LEAD ECG NOW.
The “PERFORMING ANALYSIS, PLEASE WAIT” message displays for approximately 30 seconds until the analysis report displays.
4.
Select one of the following options:
„ TRANSMIT-PRINT — Send the report to MUSE system for storage and print to local printer.
„
„
TRANSMIT — Send the report to MUSE system for storage.
PRINT — Print analysis and waveforms to a laser printer or just the analysis to a writer.
„
DELETE — Erase the report.
„
NOTE
RETURN — Close the report.
You can schedule automatic 12-lead analysis (if you have a MUSE system) by selecting 12 LEAD AUTO and a time option.
NOTE
You can generate ACI-TIPI analysis separately by selecting ACI-TIPI
ANALYSIS and entering the required patient information.
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Troubleshooting
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide”.
Problem
Transmitting a 12-lead report to a MUSE when the report has an invalid ID.
ST numerics only display for the primary
(top) lead.
Printing a 12-lead analysis report fails.
Cause
There are communication problems with the network, Aware Gateway or MUSE system.
If SINGLE LEAD is selected for LD
ANALYSIS, only the primary lead is used for processing.
There is a printer error.
Contact service.
Solution
Change LD ANALYSIS selection to MULTI-
LEAD.
If you cannot resolve the printer error, contact service.
Contact service.
There are communication problems with the network
Clinician paused the alarms.
The monitor is in a discharged state.
The monitor is analyzing the ECG data.
Reactivate the alarms.
Admit a patient to the monitor.
This is a normal procedure message.
ALARM PAUSE or permanently paused
ALL ALARMS OFF
PERFORMING ANALYSIS, PLEASE
WAIT
LEADS FAIL
LA FAIL
LL FAIL
RA FAIL
V FAIL
ARR OFF
V2-V6 FAIL
DISCHARGED
LEARNING
Poor electrode signal quality.
Arrhythmia detection is turned off.
Five of the 10 leadwires were removed.
Reapply electrode using electrode manufacturer’s application recommendations.
This is a normal procedure message.
Clear the message by selecting the ECG parameter label > CLEAR V2-V6 FAIL.
The monitor is in a discharged state.
Admit a patient to the monitor.
The monitor is learning a new ECG pattern.
This is a normal procedure message.
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9
Monitoring Invasive
Pressures
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Monitoring Invasive Pressures
Introduction
Overview
Detailed operating procedures are given for the CVP pressure site. Other pressure sites function essentially the same, except for the PA pressure site which may include the optional PA Wedge feature.
Invasive blood pressure monitoring uses a transducer to convert the pressure variations into electrical signals. The electrical signals are amplified and displayed as numeric pressure values and waveforms.
A pressure parameter window and labeled waveform display when a patient cable is connected to the monitor. The display updates every two seconds.
1
3
2
1 Systolic value
2 Pulse rate value (ART, FEM, UAC)
3 Diastolic value
4 Mean value
4
518A
There are two BP patient connectors on the monitor. Depending on your monitor’s capabilities, you may be able to use a Y-adapter cable to monitor two sites per BP patient connector.
NOTE
When both ART and ICP pressure sites are monitored, a CPP values is calculated and displayed in the ICP pressure parameter window. The formula for CPP is the mean ART pressure value minus the ICP pressure value.
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Pressure Site Names and Values
The following invasive pressure site names are supported. The monitor displays the following labels and pressure values.
arterial femoral umbilical arterial pulmonary artery intracranial umbilical venous central venous left atrial right atrial special
ART
FEM
UAC
PA
ICP
UVC
CVP
LA
RA
SP
systolic, diastolic, mean and rate systolic, diastolic, mean and rate systolic, diastolic, mean and rate systolic, diastolic, and mean
CPP and mean mean mean mean mean mean
Default Site Labels
The BP patient connector default site labels are:
„
„
„
BP1 — ART
BP2 — PA
BP3 — CVP
„ BP4 — LA
NOTE
The default site labels in OPERATING ROOM are persistent, meaning they are retained after the patient is discharged from the monitor.
Analog Output
„
„
All pressure outputs are 10 mV/mmHg when zeroed.
NOTE
A buzz signal is sent to the analog output if the pressure is not zeroed.
The pressure labeled ART is sent to the analog output.
If both pressure sites are labeled ART, BP1 is sent to the analog output.
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„
If no pressure sites are labeled ART, BP1 is sent to the analog output.
Additional Information
„
„
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
IABP feature.
„
Smart BP feature.
Clinical level troubleshooting.
Monitoring
To verify that you are ready to monitor pressure, follow this procedure.
1.
Admit the patient to the monitor.
2.
Connect a patient cable to the BP patient connector on the monitor.
3.
Level transducers according to unit policy. GE recommends the LA/RA level.
4.
Remove trapped air from the hydraulic system. For more information, refer to the manufacturer’s instructions.
5.
Zero transducers.
a.
Remove all excess tubing between the transducer and the patient.
NOTE
GE recommends zeroing invasive lines at the transducer stopcock only. Zeroing invasive pressures with excessive amounts of tubing between the transducer and the stopcock can cause error messages.
This will cause a delay in obtaining invasive parameter information.
For more information, refer to “Troubleshooting” on page 9-9.
b.
Place the transducer at the LA level (phlebostatic axis).
c.
Close the transducer stopcock(s) to the patient.
d.
Open the venting stopcock(s) to the air (atmosphere).
e.
Press the Zero All key. f.
Verify that the zero reference is established.
g.
Close the venting stopcock(s) to the air (atmosphere).
h.
Open the transducer stopcock(s) to the patient.
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Control Settings
6.
Position the catheter in the patient.
7.
Verify that patient data displays in the pressure parameter window.
8.
Verify that a good quality waveform displays.
9.
Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the pressure parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
SCALES
CURSOR
Option
CLEAR CURSOR
LIMITS
CHANGE NAME
Function
Select the size of displayed waveforms. The higher the scale value, the smaller the waveform scale.
„
„
AUTO — Adjusts the scale to patient’s ART pressure,
Auto scaled waveforms print at a slightly different scale than the display scale.
FULL — Allows you to select the scale size and position on the display; right (R) or left (L).
Display a horizontal line with a numeric value over the waveform to indicate a pressure value at specific position on the waveform.
Remove the cursor from the waveform.
Select the high and low alarm limits for heart rate, systolic, diastolic and mean pressures. An alarm sounds when a value occurs outside of these limits.
NOTE
Adjusting the HR limits affects the pressure tracing, not the primary ECG HR alarm level.
Select the site name for the monitored pressure site for accurate waveform processing (for example, if monitoring the femoral pressure site, select FEM).
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Option
ZERO
BP FILTER
CALIBRATE
TRANSDUCER
SPEED
IABP
Function
Zero a single transducer. To zero all transducers, press the
Zero All key.
Select one of the following filter options:
„
„
12 HZ — Recommended for typical monitoring.
40 HZ — Recommended for higher frequency waveform component processing. May result is elevated pressure values.
Adjust the monitor to compensate for transducer errors.
Measurement errors can be identified when pressure calibration is measured with other instruments (for example, a manometer).
„
„
CAL# 100 — Select the percentage of error when the calibration error is known; (for example, 102 if the transducer measured two percent high).
ADJUST TO MMHG — Select the millimeters of mercury.
Select a sweep speed for the displayed waveform. The smaller the speed value, the slower the speed (greater number of complexes).
NOTE
Only available in the CARDIAC software package with
ART and FEM parameter sites.
NOTE
Not available when in the NEONATAL-ICU patientmonitor type.
NOTE
The maximum ECG analog output delay specification with diagnostic ECG filter is less than 35 milliseconds.
Turn the feature on or off. Measures the arterial (ART) pressure site and displays both pressure waveforms and numerical pressure values. It compensates for irregularities in the pressure waveforms caused by the use of an intra-aortic balloon pump.
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Option
SMART BP
DISCONNECT ALARM
PULSE RATE
PA WEDGE
Function
NOTE
Only available with ART and FEM parameter sites.
NOTE
Not available when in the NEONATAL-ICU patientmonitor type.
Turn the feature on or off. This is an arterial (ART) artifact rejection program that substantially reduces alarms associated with zeroing the transducer, fast flushing the system and drawing blood.
NOTE
Only available with ART and FEM parameter sites.
Turn the feature on or off. This detects potential catheter disconnections. When on, if the mean pressure falls below
25 mmHg, a Warning patient status alarm sounds and the message “DISCONNECT“ displays in the parameter window.
NOTE
Only available with ART, FEM and UAC parameter sites.
Turn the feature on or off to display pulse rate values in the parameter window.
NOTE
Only available with PA parameter site and in the
CARDIO-PULMONARY software package.
Make a PA wedge measurement to emphasize the PA
waveform. For more information, refer to “Performing PA
Wedge Measurements” on page 9-7.
Performing PA Wedge Measurements
Automatic
To perform an automatic PA wedge measurement, follow this procedure.
1.
Select the PA parameter window label.
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2.
From the PA menu, select PA WEDGE. A single beep sounds and the message
“INFLATE BALLOON” displays in the PA parameter window.
3.
Inflate the balloon according to your unit’s policy and procedure. The message
“WEDGE PROCESSING” displays.
4.
To add a cursor to the real-time wedged waveform, select PA CURSOR.
5.
Deflate the balloon after three or four respiratory cycles (no more than 20 seconds).
The PA WEDGE REVIEW information window displays 20 seconds of compressed waveform data with horizontal and vertical cursors identifying the end-exhalation point, PAW value and time of measurement.
9-8
6.
To change the calculated PA wedge value, select MOVE WEDGE CURSOR.
705B
Adjust the value and select main display to save the new cursor value.
7.
To save this PA wedge value in the cardiac calculations and VITAL SIGNS, select CARDIAC OUTPUT.
NOTE
To change the displayed waveform sweep speed, select SPEED and select an option.
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Manual
Troubleshooting
To manually begin a PA wedge measurement when the balloon does not automatically inflate, follow this procedure.
The monitor cannot detect a PA wedge with certain patient conditions (for example, valvular disease, respiratory variation during an automatic PA wedge measurement).
1.
Select the PA parameter window label.
2.
From the PA menu, select PA INSERT/WEDGE. The message “MANUAL
WEDGE” displays in the PA parameter window.
3.
Inflate the balloon according to your unit’s policy and procedure.
4.
To add a cursor to the real-time wedged waveform, select PA CURSOR.
5.
Deflate the balloon after three or four respiratory cycles (no more than 20 seconds).
6.
Select REVIEW WEDGE to review the last 20 seconds of data.
7.
To change the calculated PA wedge value, select MOVE WEDGE CURSOR.
Adjust the value and select MAIN MENU to save the new cursor value.
8.
To start a new PA wedge measurement, select NEW WEDGE.
NOTE
To change the scale of the displayed pressure waveform, select FULL SCALE and select a scale option.
To change the displayed waveform sweep speed, select SWEEP SPEED and select an option.
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
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Monitoring NBP
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Monitoring NBP
Introduction
Overview
Automatic non-invasive blood pressure monitoring uses the oscillometric measurement method. The oscillometric method uses a sensitive transducer which measures cuff pressure and minute pressure oscillations within the cuff to determine the mean pressure and calculate the systolic and diastolic pressures.
A parameter window display updates every second. There is no waveform.
1
2
3
4
5
6
7
1 Systolic value
2 Diastolic value
3 Pulse rate value
4 Time of last measurement (24 hour clock)
5 Cuff size
6 Automatic determination message
7 Mean value or cuff inflation pressure during a measurement
708B
The reference blood pressure is the intra-arterial blood pressure for neonatal, pediatric and adult populations.
After inflating the cuff, the monitor begins to deflate and the oscillations in the cuff is measured. Finally, systolic, mean, and diastolic pressure are calculated and the display is updated.
The monitor deflates the cuff one step each time it detects two pulsations of relatively equal amplitude. The time between deflation steps depends on the
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frequency of these matched pulses (pulse rate of the patient). However, if the monitor is unable to find any pulse within several seconds, it will deflate to the next step. The process of finding two matched pulses at each step provides artifact rejection due to patient movement and greatly enhances the accuracy. In stat mode, some steps only require one pulse.
NOTE
Values change to X when no monitoring has taken place for more than 15 minutes (OPERATING ROOM), two hours (ADULT-ICU) or 12 hours
(NEONATAL-ICU).
Options
The monitor supports two blood pressure technologies. To determine the technology on this monitor, select MORE MENUS > MONITOR SETUP > SOFTWARE
CONFIGURATION. The technology is listed under NBP.
DINAMAP Classic
DINAMAP SuperSTAT
The first determination initially pumps up to a target cuff pressure of about 160 mmHg for adult/pediatric patients or 110 mmHg for neonates depending on initial target pressure preset.
The first determination initially pumps up to a target cuff pressure of about 135 mmHg for adults or 110 mmHg for neonates, depending on initial target pressure preset. To allow for rapid setting of cuff pressure, the monitor will momentarily inflate to a higher pressure, then immediately deflate to the target pressure.
As a determination is taken, the monitor stores the pattern of the patient's oscillation size as a function of pressure. In any subsequent determination, as few as four pressure steps may be necessary to complete the process. When employing fewer pressure steps, the system uses the stored information from the previous blood pressure determination to decide the best pressure steps to take. The monitor measures the consistency of pulse size to tell if the oscillations taken at a step are good and if more steps are needed.
If the current blood pressure reading is similar to the previous reading, the monitor may use some information from the previous blood pressure in the current determination. The monitor constantly evaluates data during a measurement and tries to perform a blood pressure determination in the shortest possible time, providing greater comfort to the patient.
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If it has been 16 minutes or less since the last determination and the current blood pressure is similar to the previous reading, the monitor will try to make an accelerated determination of blood pressure.
During irregular rhythms, only pulses from the current determination are used in calculating the blood pressure values. In order to ensure adequate artifact rejection capability and optimal SuperSTAT NBP performance, several criteria used to match and qualify the oscillometric pulses at each pressure step are relaxed while supplementing the criteria with additional information from ECG.
NOTE
(Adult/Pediatric only) When ECG is monitored, SuperSTAT NBP is able to determine blood pressure in the presence of irregular heart rhythms. At the beginning of a SuperSTAT NBP determination, the coefficient of variation from the previous 120 ECG R-R intervals is used to determine if an irregular rhythm is present.
Additional Information
„
„
„
„
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
Oscillometric versus auscultation measurement methods.
Patient preparation.
NBP monitoring features.
Clinical-level troubleshooting.
Safety
The following safety statements apply when monitoring NBP.
WARNING
— The NBP parameter will not measure blood pressure effectively on patients who are experiencing seizures or tremors.
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WARNING
— Devices that exert pressure on tissue have been associated with purpura, skin avulsion, compartmental syndrome, ischemia, and/or neuropathy. To minimize these potential problems, especially when monitoring at frequent intervals or over extended periods of time, make sure the cuff is applied appropriately and examine the cuff site and the limb distal to the cuff regularly for signs of impeded blood flow.
WARNING
— The system is designed for use with dual-hose cuffs and tubing. The use of single-hose cuffs with dual-hose tubing can result in unreliable and inaccurate NBP data.
WARNING
— Do not place the cuff on a limb being used for A-V fistulas, intravenous infusion or on any area where circulation is compromised or has the potential to be compromised.
WARNING
— Do not apply external pressure against the cuff while monitoring. Doing so may cause inaccurate blood pressure values.
WARNING
— Use care when placing the cuff on an extremity used to monitor other patient parameters.
WARNING
— Arrhythmias will increase the time required by the NBP parameter to determine a blood pressure and may extend the time beyond the capabilities of the parameter.
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WARNING
— For SuperSTAT NBP (Adult/Pediatric) Only. It takes one to three minutes for the NBP parameter to establish irregular rhythm after ECG is connected. (The NBP parameter will relearn the rhythm in the event of a lead fault, disconnect, or lead switch.) In patients with irregular rhythm, wait three minutes after ECG has been connected and ECG heart rate is present on the monitor screen before performing an NBP determination.
CAUTION
— Accuracy of NBP measurement depends on using a cuff of the proper size. It is essential to measure the circumference of the limb and select the proper size cuff.
CAUTION
— The pulse rate derived from an NBP determination
(measurement) may differ from the heart rate derived from an ECG waveform because the NBP parameter measures actual peripheral pulses, not electrical signals or contraction from the heart.
Differences may occur because electrical signals at the heart occasionally fail to produce a peripheral pulse or the patient may have poor peripheral perfusion. Also, if a patient’s beat-to-beat pulse amplitude varies significantly (for example, because of pulsus alternans, atrial fibrillation, or the use of a rapid-cycling artificial ventilator), blood pressure and pulse rate readings can be erratic, and an alternate measuring method should be used for confirmation.
CAUTION
— For SuperSTAT NBP (Adult/Pediatric) Only —
Simultaneously monitoring ECG will enhance SuperSTAT NBP performance in irregular rhythm.
NOTE
A patient’s vital signs may vary dramatically during the use of cardiovascular agents such as those that raise or lower blood pressure or those that increase or decrease heart rate.
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Monitoring
Control Settings
To verify that you are ready to monitor NBP, follow this procedure.
1.
Admit the patient to the monitor.
2.
Connect a patient cable to the NBP patient connector on the monitor.
3.
Select a cuff appropriate for the limb size.
4.
Position the cuff on the patient.
5.
Verify the tubes between the cuff and the monitor are not kinked or blocked.
6.
Verify the correct cuff size is selected in the NBP menu.
7.
Start an NBP reading.
8.
Verify that patient data displays in the NBP parameter window.
9.
Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the NBP parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
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Option
NBP AUTO
NBP STAT
REVIEW NBPS
NBP LIMITS
Function
Turn automatic determination off or select the time interval to take automatic NBP measurements. The default setting is five minutes.
A countdown timer displays in the NBP parameter window when the time interval is less than 60 minutes.
To synchronize NBP measurements with actual clock times, change the MONITOR DEFAULTS > SETUP
DEFAULT DISPLAY > NBP CLOCK SYNC option to ON.
WARNING
— Periodically check patient limb circulation distal to the cuff. Check frequently when using Auto NBP in one or two minute intervals. Intervals below 10 minutes are not recommended for extended periods of time.
NOTE
Not available when in the NEONATAL-ICU patientmonitor type.
Start five minutes of automatic, continuous, sequential
NBP measurements.
When initiated, cuff inflation begins, a measurement is taken and the systolic, diastolic and mean pressure values are displayed. Thereafter, the systolic value displays after the measurement starts, but before the other pressure values are complete. The monitor beeps when all values are complete.
Press the NBP Go/Stop key to stop the measurements.
Review the previous 96 NBP measurements less than 24 hours old in the VITAL SIGNS information window.
Select the high and low alarm limits for systolic, diastolic and mean pressures. An alarm sounds when a value occurs outside of these limits.
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Option
CUFF SIZE
CLEAR NBP READINGS
SETUP CUSTOM AUTO
Function
Select the type of NBP cuff used on the patient (ADULT,
PEDIATRIC or NEONATAL).
WARNING
— The correct cuff size must be selected to obtain reliable NBP data and to prevent overpressure in neonatal or pediatric use.
NOTE
You must select CLEAR NBP READINGS after changing this setting for the target pressure to take affect.
Remove all values from the NBP parameter window, remove NBP messages from the display and remove all
NBP information from the VITAL SIGNS history.
CAUTION
— Changes made to these control settings are persistent. They are recalled when a patient is discharged from the monitor.
NOTE
Only available in software version 6 or later.
Create a custom series of automatic NBP measurements, including the time interval between measurements and the number of measurements to perform. For more information, refer to
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Option
INITIAL INFLATION
PRESSURE
PULSE RATE
Function
Select the target inflation pressure for the first NBP measurement. The choices vary by cuff size.
NOTE
You must select CLEAR NBP READINGS after changing this setting for the target pressure to take affect.
NOTE
SuperSTAT NBP briefly over-inflates beyond the initial inflation pressure and then steps down to the correct pressure. To benefit patient comfort, lower the default initial inflation pressure.
NOTE
Only available in software version 6 or later.
Turn the feature on or off to display pulse rate values in the parameter window when the display setting is INDV 3
WFS.
Custom Defaults
Setup Custom Automatic NBP Measurements
To define up to four individual automatic NBP measurement series, follow this procedure.
CAUTION
— Changes made to these control settings are persistent. They are recalled when a patient is discharged from the monitor.
NOTE
Only available in software version 6 or later.
1.
Select the NBP parameter window label.
2.
Select Setup Custom Auto.The Setup Custom Auto window displays. There are four BP SERIES sections
3.
To define the first measurement series, follow this procedure. a.
Select 1ST BP SERIES.
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b.
Select the time interval between measurements from the available options
(1 minute to 4 hours). c.
Select REPEAT.
d.
Select the number of times to repeat the measurement (1to 25 times or continuously until manually stopped).
4.
Repeat step 3 for each series (2ND, 3RD and 4TH).
5.
To begin the automatic measurement cycle, select START CUSTOM AUTO.
The measurement cycle begins with the first series, completes each measurement the defined number of times then proceeds to the second, third and fourth series. If any series is not defined or is turned off, it is skipped and the next series in the cycle is started.
6.
To change a series while in progress, select the NBP parameter window label and select SETUP SERIES.
„
„
To stop one of the defined series, select the SERIES > OFF.
To stop measurements for one of the defined series, select REPEAT > OFF.
Auto NBP Cancellation Notification
NOTE
Only available in software version 6 or later.
If the monitor is set to acquire measurements automatically (NBP AUTO), and a time-out or no determination occurs, automatic measurement is cancelled, the message “AUTO OFF” displays in the NBP parameter window and a system status alarm will sound.
To set the system status alarm level, select MORE MENUS > MONITOR SETUP >
MONITOR DEFAULTS > NBP NO DETERMINATION and select SYSTEM
ADVISORY or SYSTEM WARNING. This monitor default controls both no determination and pump timeout.
Extended NBP Alarm Silence
To extend the alarm silence, follow this procedure.
1.
Discharge the patient.
2.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT DISPLAY.
3.
From the SETUP DISPLAY information window, locate the NBP SILENCE
ALARM option and SELECT > 1 MINUTE.
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4.
Press the Silence Alarm/Admit key.
The NBP alarm is silenced until you change the NBP SILENCE ALARM setting to NORMAL or discharge the patient.
All patient status alarms that occur while alarms are silenced are stored in ALARM
HISTORY (as a patient status MESSAGE).
Troubleshooting
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
NOTE
The following messages display until the next measurement is initiated or manually cleared.
Problem
CUFF INFLATION OVER 5 MINS
DEFLATION FAIL, REMOVE CUFF
NBP HARDWARE MALFUNCTION
OVER PRESSURE
NO DETERMINATION
PUMP TIMEOUT
(Inflation failure or pressure leak.)
TOTAL TIMEOUT
(No measurement in over three minutes for adult and pediatrics or 90 seconds for neonatal patients.)
Monitor Response
Stops automatic NBP measurement after
ONE message.
Stops automatic NBP measurement after
TWO messages.
Solution
Make sure there is no air in the cuff and try a manual measurement.
Remove cuff and contact service.
Contact service.
Remove cuff and contact service.
Verify cuff placement and try a manual measurement.
Check connections between cuff and monitor, check for worn connector “O” rings and try a manual measurement.
Verify patient is not moving excessively or experiencing an arrhythmia condition and try a manual measurement.
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Monitoring SpO
2
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Monitoring SpO2
Introduction
Overview
Non-invasive SpO
2
monitoring measures the amount of oxygenated hemoglobin and pulse rate by measuring the absorption of selected wavelengths of light. The light generated in the sensor passes through the tissue and is converted into an electrical signal by photodetectors in the sensor.
The monitor processes the electrical signal and displays digital values for SpO
2
and pulse rate. A parameter window displays when a patient cable is connected to the monitor. The display updates every two seconds.
3
1
2
719A
1 Signal strength indicator
2 Derived pulse rate value
3 SpO
2
value
An SpO
2
waveform is also displayed. The following examples show a good quality and bad quality waveform. Bad quality waveforms display motion artifact. The motion at the sensor site is indicated by noise spikes in the normal waveform.
687A
Good quality waveform
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Bad quality waveform
Primary Parameter Monitoring Considerations
When ECG is turned off, the SpO
2
parameter becomes the primary patient monitoring parameter. The following conditions apply when ECG is turned off:
„
„
„
The SpO
2
and SpO
2
Rate parameter patient status alarm levels default to
WARNING.
The SpO
2
Pulse Search and Probe Off system status alarm levels default to
WARNING.
SpO
2
becomes the WAVEFORM 1 selection for waveform display and graphing.
031A
Configuration Options
To determine the option running on the monitor, look on the right side of the monitor next to the patient connectors. There will be a Masimo SET, Nellcor OxiMAX or an
Ohmeda label. This label indicates the technology option installed on the monitor.
NOTE
The patient cable should easily plug into the patient connector. Do not use excessive force to connect the cable. If the patient cable does not easily fit into the patient connector, it is likely that you do not have the appropriate cable for the enabled configuration option.
Masimo
The following measurement guidelines apply to Masimo SET:
„
„
„
The time period for acquiring a measurement average is adjustable.
The default setting for all patient-monitor types is eight seconds.
The pulse oximetry is calibrated to display functional saturation.
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Nellcor
„
The signal strength indicator denotes perfusion quality. Zero asterisks means no signal; three asterisks indicate high perfusion level.
Only Masimo LNOP sensors are supported. „
„
Masimo LNOP sensors non-invasively measure pulse rate and the amount of oxygenated hemoglobin.
„ 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.
NOTE
With motion, the plethysmographic waveform is often distorted and may be obscured by the artifact. With Masimo SET technology, the SpO
2
waveform is not an indication of signal quality or validity. Even with an SpO
2
waveform obscured by artifact, Masimo SET technology is able to read through the noise and locate the arterial pulsation.
Use the following guidelines when using Masimo LNOP sensors:
WARNING
MASIMO SET CABLES AND SENSORS — Do NOT immerse sensors or patient cables in water, solvents or cleaning solutions.
Do NOT reuse sensors intended for single patient use. Do NOT sterilize sensors or patient cables by irradiation, steam, or ethylene oxide.
CAUTION
MASIMO SET CABLES AND SENSORS — Tissue damage can be caused by incorrect application or use of an LNOP sensor, for example by wrapping the sensor too tightly. Inspect the sensor site as directed in the sensor’s directions for use to ensure skin integrity and correct positioning and adhesion of the sensor.
„
„
„
Do not use damaged LNOP sensors.
Do not use an LNOP sensor with exposed optical components.
Do not immerse the sensor in water, solvents or ethylene oxide. Refer to the cleaning instructions in the directions for use for reusable Masimo LNOP sensors.
The following measurement guidelines apply to Nellcor:
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Ohmeda
Monitoring SpO2
„
„
„
„
The time period for acquiring a measurement average is adjustable.
The pulse oximetry is calibrated to display functional saturation.
The signal strength indicator is not proportional to pulse amplitude. Zero asterisks means no signal; three asterisks means a strong signal.
The SpO
2
waveform corresponds to (but is not proportional to) the arterial pressure waveform.
Use the following guidelines when using OxiMAX SpO
2
accessories and sensors:
WARNING
— Intravascular dyes (such as indocyanine green, mythylene blue, etc.) and darkly pigmented skin can adversely affect SpO
2 readings.
WARNING
— Oximetry performance may be impaired when patient perfusion is low or signal attenuation is high.
„
„
NOTE
The Sat-Seconds feature has a “safety net” designed for patients whose saturation is frequently outside the limits but does not remain outside the limits long enough for the Sat-Seconds limit to be reached. When three or more limit violations occur within 60 seconds, an alarm sounds even if the Sat-Seconds limit has not been reached.
NOTE
Sat-Seconds is only available when the SpO
2 parameter block is full-sized.
„
Periodically inspect extension cables and sensors for damage and discontinue use if damage is found.
Do not immerse sensors.
Do not use NBP or constricting instruments on the same appendage as the SpO
2 sensor.
The following measurement guidelines apply to GE Ohmeda oximetry:
„
„
„
Adult measurements are averaged over a six second time period.
Neonate measurements are averaged over a 12 second time period. This longer averaging time decreases false alarms from patient motion artifact.
The pulse oximetry is calibrated to display functional saturation.
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„
„
The signal strength indicator is not proportional to pulse amplitude. Zero asterisks means no signal; three asterisks means a strong signal.
Ohmeda OxyTip+ sensors and Nellcor R-Cal technology compatible sensors are supported.
Use the following guidelines when using OxyTip+ sensors:
WARNING
PATIENT SAFETY — Patient conditions such as reddening, blistering, skin discoloration, ischemic skin necrosis and skin erosion may warrant changing the site frequently or using a different style of sensor.
Check the sensor site every four hours (more frequently of the perfusion is poor). Routinely check to ensure adequate circulation distal to the sensor site.
WARNING
DATA VALIDITY — Conditions that may cause inaccurate readings and impact alarms include interfering substances, excessive ambient light, electrical interference, excessive motion, low perfusion, low signal strength, incorrect sensor placement, poor sensor fit, and movement of the sensor on the patient
Do not use a blood pressure cuff or arterial blood pressure measurement device on the same limb as the sensor.
It is possible for any device to malfunction, therefore, always verify unusual data by performing a formal patient assessment.
Additional Information
„
„
„
„
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
Factors contributing to inaccurate measurements.
Patient preparation.
Masimo SET information.
„
Nellcor Sat-Seconds alarm management information.
Clinical-level troubleshooting.
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Safety
General
Monitoring SpO2
The following safety statements apply when monitoring SpO
2
.
WARNING
DATA VALIDITY — Do not expose sensor detector to strong ambient light while monitoring a patient. A poor signal may result.
WARNING
DATA VALIDITY — Do not allow tape to block the sensor photodetectors.
WARNING
PATIENT SAFETY — Prolonged monitoring may require changing the sensor site periodically. Move the sensor if there is any sign of skin irritation or impaired circulation. Change the sensor site at least every four hours to prevent ischemic skin necrosis. Be particularly careful when monitoring neonates. If required, reduce the application periods to half the times recommended above. If a sensor is damaged in any way, discontinue use immediately.
WARNING
APNEA — A pulse oximeter should NOT be used as an apnea
“no breath” monitor.
WARNING
CABLES — Route all cables away from the patient’s throat to avoid possible strangulation.
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WARNING
EARLY WARNING — A pulse oximeter should be considered an early warning device. As a trend toward patient deoxygenation is indicated, blood samples should be analyzed by a laboratory cooximeter to completely understand the patient’s condition.
WARNING
EXPLOSION HAZARD — Do not monitor SpO
2
in the presence of flammable anesthetics or other flammable substance in combination with air, oxygen-enriched environments, or nitrous oxide.
WARNING
INACCURATE MEASUREMENTS — Inaccurate measurements may be caused by various patient or mechanical conditions. These conditions include but are not limited to: venous pulsations; hypotension; severe vasoconstriction; severe anemia; hypothermia; shock; cardiac arrest; sensor tension; sensor placement on the same extremity as a blood pressure cuff, arterial catheter or intravascular line; or arterial occlusion proximal to the sensor.
WARNING
INTERFERING SUBSTANCES — Carboxyhemoglobin may erroneously increase SpO
2
readings. The level of increase is approximately equal to the amount of carboxyhemoglobin present.
Dyes, or any substance containing dyes, that change usual arterial pigmentation may cause erroneous readings.
WARNING
MRI INTERFERENCE — Do not monitor SpO
2
or use SpO
2 probes during magnetic resonance imaging (MRI) scanning.
Induced current could potentially cause burns. SpO
2
monitoring may affect the MRI image, and the MRI unit may affect the accuracy of the oximetry measurements.
NOTE
Read all literature accompanying sensors for specific safety information.
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Neonates and Infants
The following precautions apply when monitoring neonate and infant patients.
WARNING
— The display of inaccurate pulse oximetry values has been linked to the presence of poor signal strength or artifact due to patient motion during signal analysis. This condition is most likely to be encountered when the monitor is used on neonates or infants.
These same conditions in adults do not impact the values to the same extent.
Use the following criteria when measuring SpO
2
on neonates and infants.
„
„
The peripheral pulse rate (PPR) as determined by the SpO
2
function must be within ten percent of the ECG heart rate.
The SpO
2
signal strength indicator must have two or three asterisks displayed.
Monitoring
To verify that you are ready to monitor SpO
2
, follow this procedure.
1.
Admit the patient to the monitor.
2.
Connect the patient cable to the SpO
2
patient connector on the monitor.
3.
Position the sensor on the patient. Refer to the manufacturer’s instructions for placement information.
4.
Verify that patient data displays in the SpO
2
parameter window.
5.
Verify the signal and data validity: a.
The signal strength indicator displays a strong signal.
b.
Verify a good quality waveform displays.
6.
Adjust the control settings as necessary.
NOTE
If the measurements do not seem reasonable, check the patient’s vital signs by alternate means, then check the monitor for proper SpO
2
functioning.
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Control Settings
To adjust the control settings for the patient admitted to the monitor, select the SpO
2
parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Ohmeda, Nellcor and Masimo
The following settings control pulse oximetry monitoring for all configuration options.
SIZE
RATE
RATE VOL
SPEED
Option
SPO2 LIMITS
Function
Select the size of the displayed waveform.
NOTE
When using Nellcor Sat-Seconds, select 1X.
Turn the feature on or off to display pulse rate values in the parameter window.
Select the volume of the pulse rate tone to sound when an
SpO
2
pulse is detected. This is a variable pitch tone. The tone pitch decreases as the patient’s saturation level decreases. The lower the setting, the quieter the tone.
NOTE
Turning the pulse tone volume off also automatically turns off the ECG QRS volume.
Select the high and low alarm limits for SpO
2
percentage and pulse rate (beats per minute). An alarm sounds when a value occurs outside of these limits.
Select a sweep speed for the displayed waveform.
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Ohmeda and Masimo
The following settings control pulse oximetry monitoring for the Ohmeda and
Masimo configuration options.
Option
PERSISTENT
Function
Turn the feature on or off. When on, a “PROBE IS OFF
THE PATIENT” system status WARNING displays in the
SpO
2
parameter window when the patient cable is disconnected. The parameter window and waveform still display.
Nellcor
The following settings control pulse oximetry monitoring for the Nellcor configuration option.
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Masimo
Option
SAT SECONDS
RESPONSE
Function
NOTE
Only available in software version 6 or later.
Select the amount of time that the saturation values can fall outside the saturation limits before an alarm sounds.
„
„
„
OFF — Any alarm limit violation instantly alarms.
10 SECS — Triggers an alarm when the saturation violates the limits for more than 10 seconds.
25 SECS — Triggers an alarm when the saturation violates the limits for more than 25 seconds.
„
50 SECS — Triggers an alarm when the saturation violates the limits for more than 50 seconds.
„
100 SECS — Triggers an alarm when the saturation violates the limits for more than 100 seconds.
NOTE
When Sat-Seconds is turned on, the signal strength indicator is not displayed. In this event, check the amplitude of the waveform to determine signal strength. Be sure the SIZE (waveform scale) setting is
1X.
NOTE
Only available in software version 6 or later.
Select the averaging time (speed of response) to changes in a patient’s SpO
2
measurements.
„
„
Normal — Reports changes within four to six seconds under motion-free conditions.
Fast — Reports changes in less than four seconds under motion-free conditions.
The following settings control pulse oximetry monitoring for the Masimo configuration option.
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Option
SENSITIVITY
Function
„
„
Select the sensor sensitivity.
NORMAL — Select for normal patient monitoring.
MAXIMUM — Select for improved low perfusion performance and faster tracking of SpO changes.
2
saturation
CAUTION
— The MAXIMUM setting delays “PROBE IS OFF THE
PATIENT” detection alarms.
AVERAGING
CAUTION
— An increased averaging time may result in delayed startup, erroneous detection of minimum parameter values, missed alarms and desaturation and resaturation detection delays.
Select the sensor averaging time. The higher the setting, the more stable the reading. The default setting is eight seconds.
NOTE
For the two and four second settings, the actual averaging time may range from two to four and four to six seconds.
Nellcor 395 Pulse Oximeter
Connecting
Use the following diagram to connect one pulse oximeter to the AUX port on the monitor.
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Power cable
Standard category 5 cable
Nellcor 395 DIDCA cable kit
AC power source
Use the following diagram to connect two pulse oximeters to the AUX ports on the monitor and docking station.
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Guidelines
402A
When acquiring patient data from this external pulse oximeter, keep the following guidelines in mind.
„
The monitor uses the SpO
2
rate and saturation alarm levels as defined in the
PARAMETER ALARM LEVELS information window (SETUP DEFAULT
PARAMETER ALARM LEVELS menu).
„
„
The monitor sounds and display alarms for external alarm limit violations, probe off and pulse search. Any alarm settings for the monitor do not apply to the external device.
The central station displays alarm messages and highlights the single-view and multi-view window displaying the alarm condition.
„
„
SpO
2
data from the pulse oximeter can be viewed on alarm via the monitor.
Nellcor Oxismart XL, GE Nellcor R-Cal compatible or other Nellcor R-Cal compatible sensors are supported.
The following table identifies what conditions apply to the monitor and to other network devices when SpO
2
data is acquired from an external oximeter.
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External Parameter Conditions
SpO
2
trend data
„
„
The monitor displays external SpO
2
rate and saturation trend data with the following labels to identify whether the information is from the first or second external oximeter.
SPOX1-% or SPOX2-% (saturation)
SPOX1-R or SPOX2-R (rate)
SpO
2
parameter block The central station does not display the SpO
2
The monitor displays the SpO level.
2
parameter block.
rate and the oxygen saturation
SpO
2
parameter menu The monitor does not display a SpO
2
parameter menu or selectable menu options.
SpO
2
waveform display The monitor does not display an external SpO
2 waveform.
parameter
Secondary monitoring parameter
The monitor does not allow the external SpO
2 the primary monitoring parameter.
parameter to be
Secondary parameter display priority
The monitor does not allow the external SpO
2
parameter to have a higher display priority than the internal SpO
2 parameter. As a result, the monitor displays the internal
(primary) SpO
2
SpO
2
parameter before an external (secondary)
parameter.
Troubleshooting
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
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Message
SPO2 PULSE SEARCH
PROBE IS OFF THE PATIENT
LOW QUALITY SIGNAL
POOR SIGNAL QUALITY DETECTED
PROBE OR MODULE MALFUNCTION
(Masimo SET only)
Cause
Searching for a valid pulse for the purpose of computing saturation, when a valid sensor is connected.
No data is displayed because the sensor is unplugged, invalid or no longer on the patient.
Data is displayed, but signal quality is questionable.
No data displayed due to low patient pulse, patient motion or other interference.
No data displayed due to hardware failure or unrecognized sensor.
Solution
Check the patient and sensor.
Replace the cable and sensor.
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12
Measuring Cardiac
Output
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Measuring Cardiac Output
Introduction
Overview
NOTE
This parameter is only available with the CARDIO-PULMONARY software package.
The cardiac output (CO) program allows measurement of cardiac output by use of a thermodilution catheter. A numeric value and a real-time cardiac output washout curve are displayed.
A parameter window displays when a patient cable is connected to the monitor. The display updates every two seconds. The waveform does not display unless you are performing an injection procedure.
1
3
2
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1 Blood temperature value
2 Last saved calculation time stamp
3 Last saved calculation average
Performing a cardiac trial allows you to perform multiple measurements and to delete those not wanted. Up to four measurements are retained and included in the average value. The program automatically averages these and, when saved, enters the average value into cardiac calculations and GRAPHIC TRENDS. The monitor can save up to 20 calculations.
Additional Information
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
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„
„
„
„
„
Cardiac output washout curve information.
Clinical techniques that can help obtain an accurate cardiac output.
Patient preparation (bath probe setup and in-line setup).
Cardiac calculations program information.
Clinical-level troubleshooting.
Measuring
Control Settings
To verify that you are ready to measure CO, follow this procedure.
1.
Admit the patient to the monitor.
2.
Connect the patient cable to the Temp/CO patient connector on the monitor.
3.
Position the patient.
4.
Verify the in-line sensor is connected to the tubing or that the bath probe is correctly sensing injectate temperature.
5.
Verify that patient data displays in the CO parameter window.
6.
Verify the monitor is ready for cardiac output trials.
7.
Verify that a good quality waveform displays.
8.
Adjust the control settings as necessary.
9.
Verify that the swan catheter vendor, size and constant are correct.
To adjust the control settings for the patient admitted to the monitor, select the CO parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
NOTE
If you change the selections for USE, CATHETER, INJECT TEMP, SIZE or
INJECT VOL during or after beginning a cardiac trial, the trials saved in the history are deleted. Saved calculations are not deleted or changed. All new trials and calculations use the new selected values.
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Option Function
DELETE CO TRIALS
CARDIAC CALCS
CARDIAC OUTPUT NOW
Perform one manual cardiac output measurement when the “INJECT NOW!” message displays. Manual injections may be preferred for patients with extreme blood temperature fluctuations.
BT LIMITS
Select the blood temperature alarm limits and unit of measurement. An alarm sounds when a value occurs outside of these limits.
PRINT CO CURVE
Select and delete trials not wanted. Up to four trials are saved; when a new trial is made, the oldest trial is deleted.
Access the cardiac calculations program. For more information, refer to
“Cardiac Calculations” on page 7-10.
AUTO MODE
Print the displayed real-time waveform. A “PRINTING
MANUAL” message displays when the waveform is printing.
Turn automatic measurements on or off. The monitor searches for a stable baseline by averaging approximately
8.5 seconds of the patient’s blood temperature and displays the message “INJECT WHEN READY” when a stable baseline is established.
USE
CATHETER
INJECT TEMP
SIZE
INJECT VOL
Before the injection procedure begins, select one of the blood pressure values to be factored in the cardiac calculation:
Before the injection procedure begins, select the correct catheter type. The monitor guides you through the INJECT
TEMP, SIZE and INJECT VOL options to assure correct setup.
If you select OTHER, you must select a value for
COMPUTATION CONSTANT. Refer to the literature provided by the catheter manufacturer for the correct value.
Select the injectate probe type.
Select the catheter French size.
Select the injectate volume.
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Option Function
COMPUTATION
CONSTANT
Select a computation constant for a catheter manufacturer.
If you selected a specific manufacturer for the CATHETER, the correct value for the manufacturer is automatically selected for you.
If you selected OTHER for the CATHETER, you must select a value or you will not be able to complete a trial.
Refer to the literature provided by the catheter manufacturer for the correct value.
CARDIAC OUTPUT HELP
Display troubleshooting information.
Performing the CO Procedure
To perform a CO procedure, follow this procedure. Before you begin this procedure,
verify you are ready by reviewing “Measuring” on page 12-3.
1.
Select the CO parameter window label.
2.
If the monitor is configured for automatic measurements, the “INJECT WHEN
READY” message and CARDIAC OUTPUT information window displays.
3.
Watch for the “Inject Now” message and select CARDIAC OUTPUT NOW to calculate the cardiac output.
The information window displays the current cardiac trial information, a review
CO curve, the derived CO value, the average CO value between stored trials, the patient’s heart rate and other vital signs at the time of the trial. It also includes cardiac disturbances (RHY), the patient’s height and weight and calculated parameters.
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12-6
If the monitor is configured for manual measurements, the “PUSH CO NOW
730B
OR TURN AUTO ON” message displays. If this message displays, select
CARDIAC OUTPUT NOW and watch for the “INJECT NOW!” message.
If the message “UNSTABLE BT DETECTED” displays, refer to
“Troubleshooting” on page 12-7.
4.
Make sure the values for computation constant (CC), injectate temp (IT) and blood temperature (BT) in the lower left of the display are correct. If they are not, adjust the control settings before you perform the injection.
5.
Perform the injection. The washout curve displays within a few seconds of the injection and the message “COMPUTING CO” displays.
6.
When the message “CO COMPLETE” displays, the CARDIAC OUTPUT information window is populated with the relevant values for this trial and the values update in the CO parameter window.
7.
Perform another injection when prompted (up to four). The average value displays in the information window and parameter window.
8.
To print the displayed waveform and information window, select PRINT CO
CURVE.
NOTE
The washout curve cannot be printed during calculation. You can print the
CO curve once when calculation is complete.
9.
To save this trial average, select CARDIAC CALCS. The CARDIAC
CALCULATIONS information window displays.
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10. For information on adjusting the displayed calculation, refer to
11. Select SAVE CALC.
12. To view the saved calculation, select REVIEW CALCS to display the calculation in the VITAL SIGNS information window.
Troubleshooting
CO COMPLETE
Message
COMPUTING CO
INJECT NOW!
INJECT WHEN READY
PLEASE WAIT
PUSH CO NOW OR TURN AUTO ON
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
Cause
The numeric value of the cardiac output has been calculated and displayed on the screen.
The cardiac output waveform has been displayed and the monitor is preparing for numeric results.
A stable baseline temperature has been detected and the monitor is ready for the injectate.
A stable baseline temperature has been automatically detected and the monitor is ready for the injectate.
The monitor is searching for a stable baseline temperature.
A stable baseline temperature has been automatically detected and the monitor is ready for the injectate.
Solution
This is a normal procedure message.
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Message
CO IS TOO LOW (HIGH) TO DISPLAY
NO CO DUE TO BT SENSOR FAIL
NO CO DUE TO IT SENSOR FAIL
UNSTABLE BT DETECTED
BT TOO LOW (HIGH)
IT TOO LOW (HIGH)
Cause
The calculated cardiac output value has exceeded the acceptable range (0.2L to
20L).
Solution
A cable may be loose or there is equipment failure.
The monitor cannot detect a stable baseline temperature after over 12 seconds of attempts.
Blood temperature is too high or low to detect or there is an equipment failure.
Injectate temperature is too high or low to detect or there is an equipment failure.
Check the patient and catheter. If any of these problems persist, contact service.
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13
Monitoring Respiration
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Monitoring Respiration
Introduction
Overview
Respiration rate is detected by measuring thoracic impedance changes through ECG lead I or lead II.
„ Lead I provides good thoracic (upper chest) breath detection. However, lead I is more susceptible to cardiogenic artifact.
„
Lead II provides good thoracic breath detection and abdominal (lower chest) breath detection. However, lead II is more susceptible to both cardiogenic artifact and motion (head, neck or arm) artifact.
To enable respiration monitoring, select MORE MENUS > MONITOR SETUP >
PARAMETERS ON/OFF > RR.
A parameter window and waveform display when a patient cable is connected to the monitor and respiration monitoring is enabled. The display is updated every two seconds.
2 1
3
752A
1 Respiration rate
2 Breath indicator
3 Monitored lead
NOTE
Using an ESU ECG filter will not adversely affect respiration monitoring.
NOTE
When monitoring CO
2
, a respiration rate is always measured and displayed in the CO
2
parameter window. Using the respiration rate measurement from CO
2 should be the preferred measurement method as an impedance respiration rate can be disrupted by many conditions.
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Additional Information
„
„
„
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
ECG skin preparation.
Respiration lead placement.
Clinical-level troubleshooting.
Safety
The following safety statements apply when monitoring respiration.
WARNING
ELECTRODE CONFIGURATION — Impedance respiration monitoring is not reliable when ECG electrodes are placed on the limbs.
WARNING
APNEA — The monitor may not detect all episodes of inadequate breathing, nor does it distinguish between central, obstructive and mixed no breath events.
Monitoring
To verify that you are ready to monitor respiration, follow this procedure.
1.
Admit the patient to the monitor.
2.
Verify that respiration is enabled on the monitor.
3.
Position electrodes on the patient.
4.
Attach leadwires to the electrodes.
5.
Connect the patient cable to the leadwires.
6.
Connect the patient cable to the ECG patient connector on the monitor.
7.
Verify that patient data displays in the RR parameter window.
8.
Verify the respiration waveform is regular and even.
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Control Settings
9.
Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the RR parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option Function
LEAD
Select the lead to derive the respiration rate.
RELEARN RESPIRATION
Relearn the patient’s respiration pattern over the next eight breaths. While in process, the message “LEARNING” displays. When complete, the respiration rate value displays at 40 percent sensitivity and the waveform is automatically sized.
SENSITIVITY
Select the detection sensitivity of the average amplitude.
The lower the value, the greater the detection sensitivity.
RESPIRATION LIMITS
AUTO SIZE
MANUAL SIZE
Select the high and low alarm levels for respiration rate and apnea. An alarm sounds when a value occurs outside of these limits.
Select the size of the displayed waveform to fit as factoryintended on the display. The waveform size has no effect on detection.
Select the size of the displayed waveform. The waveform size has no effect on detection.
CARDIAC ARTIFACT
ALARM
SPEED
Turn this patient status ADVISORY alarm on or off. It alerts you when the respiration rate is within five percent of the heart rate over 30 consecutive breaths because the monitor may be counting heart beat artifact as respiration.
It displays the message “ARTIFACT” in the RR parameter window and sounds a one beep tone.
Select a sweep speed for the displayed waveform.
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Troubleshooting
LEARNING
APNEA
ARTIFACT
LD I (II) FAIL
LEADS FAIL
Message
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
Cause Solution
The monitor is relearning the patient’s respiration pattern.
No breath detected.
This is a normal procedure message.
Check the patient and the sensor.
The monitor cannot determine respiration.
Check the patient and sensor.
The monitor cannot detect patient data from the current lead.
The monitor cannot detect patient data from any lead.
Check the patient, and replace or switch the sensor.
Check the patient, and replace or switch the sensor.
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14
Monitoring Temperature
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Monitoring Temperature
Overview
Monitoring
Because the temperature patient connector on the monitor is also used for cardiac output, you cannot monitor temperature and cardiac output at the same time.
A parameter window displays up to two temperature sites when a patient cable is connected to the monitor. The display is updated every two seconds. There is no waveform.
1
2
764A
1 Temperature value
2 Temperature site and unit of measurement
You can monitor temperature from both internal and external temperature sensors from the YSI series 400 and 700.
To verify that you are ready to monitor temperature, follow this procedure.
1.
Admit the patient to the monitor.
2.
Position the sensor on the patient.
3.
If you are using a dual temperature cable, select 400 or 700 on the cable switch.
4.
Connect the patient cable to the Temp/CO patient connector on the monitor.
766A
5.
Verify that patient data displays in the TP parameter window.
6.
Adjust the control settings as necessary.
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Monitoring Temperature
Control Settings
Troubleshooting
To adjust the control settings for the patient admitted to the monitor, select the TP parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
T1
T2
UNITS
TEMPERATURE LIMITS
Function
Select the T1 temperature site to acquire patient data.
When off, no patient data is acquired or displayed.
Select the T2 temperature site to acquire patient data.
When off, no patient data is acquired or displayed.
Select the unit of measurement.
Select the high and low alarm limits for each temperature site. An alarm sounds when a value occurs outside of these limits.
CAL CHECK
CAL FAIL
SENSOR
Message Cause
The monitor detects a 0.1°C deviation between the temperature value and the internal calibration.
The monitor does not detect a sensor.
Solution
Check the sensor.
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Monitoring Temperature
14-4 Dash
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15
Monitoring End-Tidal
CO
2
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Monitoring End-Tidal CO2
Introduction
Overview
End-tidal CO
2
monitoring is a continuous, non-invasive technique that determines the concentration of carbon dioxide in respiratory gas by measuring the absorption of specific wavelengths of infrared light.
The light generated in the analyzer bench is passed through respiratory gas. The amount of absorption by CO
2
is measured and digitized by the photodectector. The monitor processed the electrical signal and displays a parameter window and a waveform.
1
2
3
773A
1 Respiration rate value
2 Inspired CO
2
value
3 Expired CO
2
value
It may take up to two minutes after the sensor is connected to the monitor to display patient data and a waveform. The message “WARMING UP” displays in the CO
2
parameter window and is replaced with patient data when available. The display updates every two seconds.
Compatible Devices/Sensors
Patients can be monitored whether intubated or non-intubated.
„
„
Intubated patients — Use the SAM module or a direct connection to the CO
2
patient connector on the monitor.
Non-intubated patients — Use the CapnoFlex LF CO
2
module.
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Monitoring End-Tidal CO2
Additional Information
„
„
The GE “Critical Care Monitoring Clinical Reference and Troubleshooting Guide” provides the following information:
Mainstream and sidestream setup.
Clinical-level troubleshooting.
Safety
The following safety statements apply when monitoring CO
2
.
WARNING
DEVICE PROXIMITY — Capnostat CO
2
sensors should not be used in close proximity to wireless networking equipment to strong electromagnetic fields (for example, radio station transmitters, citizen’s band radios, cellular phones, etc.). Using these sensors under these conditions may cause on or all of the following to occur:
„
„
Noise may be induced on the capnogram.
„
„
The CO
2
parameter values may be replaced by Xs.
The message “CHECK ADAPTER CAL” may display.
The message “CALIBRATE SAMPLE LINE” may display.
Normal operation will resume when the source of interference is removed.
CAUTION
CO
2
SOURCE — Do not attempt to use a combination of gas monitoring modules (for example, end-tidal CO
2
and SAM) at the same time. Only data from one acquisition source is displayed.
CAUTION
GAS EXHAUST LINE — Do not allow the gas exhaust line to become kinked or blocked. Back pressure may cause inaccurate gas readings. It may also cause serious damage to the module or monitor’s internal components.
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Monitoring End-Tidal CO2
Monitoring
CAUTION
INFECTIOUS DISEASE — To avoid the spread of infectious disease, do not allow the exhaust to discharge in the direction on the patient or the user.
CAUTION
VACUUM SOURCE — Do not connect the exhaust to an unregulated high vacuum source. Pressures may cause inaccurate gas readings. It may also cause serious damage to the module or monitor’s internal components.
To verify that you are ready to monitor CO
2
, follow this procedure.
1.
Admit the patient to the monitor.
2.
Attach the sensor to the patient.
3.
Attach the patient cable to the CO
2
patient connector on the monitor.
4.
Setup the monitoring method (sidestream or mainstream). For more information, refer to the GE “Critical Care Monitoring Clinical Reference and
Troubleshooting Guide”.
NOTE
Not required with CapnoFlex LF CO
2
module.
5.
Select MORE MENUS > MONITOR SETUP > PARAMETERS ON/OFF > CO2.
6.
Calibrate the sensor when using mainstream/sidestream or SAM modules. For
more information, refer to “Sensors” on page 15-6.
7.
If using a sidestream setup, calibrate the sample line. For more information, refer to
If using a mainstream setup, calibrate the airway adapter. For more information, refer to
8.
Verify that patient data displays in the CO
2
parameter window.
9.
Verify that a good quality waveform displays.
10. Adjust the control settings as necessary.
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Control Settings
To adjust the control settings for the patient admitted to the monitor, select the CO
2
parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
UNITS
CO2 SCALE
CO2 LIMITS
N20 COMPENSATION
O2 COMPENSATION
CO2 AVERAGING
Function
Select the units of measure of inspired and expired CO
2
.
NOTE
Respiration is measured in breaths per minute; no breath is measured in seconds.
Select a scale for the displayed CO
2
capnogram. The larger the scale, the smaller the displayed waveform. A waveform scale that exceeds the defined display area is flattened on top.
Select high and low alarm limits for inspired/expired CO
2
, respiration rate and apnea. An alarm sounds when a value occurs outside of these limits.
NOTE
Only available when in the OPERATING ROOM patient-monitor type.
Select the percentage of N
2 compensate for N
2
O concentration to
O-related elevation of the CO
2
value.
Obtain the concentration from an analyzer or anesthesia machine.
Select the percentage of O
2 for O
2
concentration to compensate
-related decrease of the CO
2
value. Obtain the concentration from an oxygen analyzer.
Select a time interval for averaging CO
2
.
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Monitoring End-Tidal CO2
Option
CAL SENSOR TO ZERO
CELL
CALIBRATE SAMPLE
LINE
CALIBRATE ADAPTER
SPEED
Function
NOTE
Only available with a Mainstream setup.
Zero the sensor each time a sensor is connected to the monitor.
NOTE
Only available with a Sidestream setup.
Calibrate the module each time a module is connected to the monitor.
NOTE
Only available with a Mainstream setup.
Calibrate the airway adapter each time a adapter is connected to the monitor.
Select the sweep speed for the displayed waveform.
Calibrating
Sensors
To calibrate a sensor, follow this procedure.
1.
Remove the adapter from the sensor.
2.
Verify the sensor cable is attached to the CO
2
patient connector on the monitor.
3.
Place the sensor on the cell marked “0”.
15-6
780A
4.
Select the CO
2
parameter window label.
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Adapters
Sample Lines
Monitoring End-Tidal CO2
5.
From the CO
2
menu, select CAL SENSOR TO ZERO CELL.
6.
Select READY. The message “CALIBRATING” displays in the CO
2
parameter window. When calibration is complete, the EXP value changes to 0.
7.
Remove the sensor from the cell marked “0” and attach to the cell marked
“REF”.
8.
The EXP value should update to 38mmHg (
±
2
). If the value is not within this range, the sensor is out of tolerance. Replace the sensor.
To calibrate an airway adapter, follow this procedure.
1.
Verify the sensor is connected to the adapter.
2.
Verify the sensor cable is connected to the CO
2
patient connector on the monitor.
3.
Verify the airway adapter is clean and free of foreign matter.
4.
Place the sensor and adapter away from all sources of CO
2
, including the patient’s exhaled breath, your exhaled breath and ventilator exhaust valves.
5.
Select the CO
2
parameter window label.
6.
From the CO
2
menu, select CALIBRATE ADAPTER.
7.
Select READY. The message “CALIBRATING” displays in the CO
2
parameter window. When calibration is complete, the message clears.
To calibrate sample lines, follow this procedure.
1.
Connect the sample line to the Capnoflex module, but not to the patient.
NOTE
A “spike” may display when attaching the sample line. Wait for the spike to finish its cycle before continuing.
2.
Select the CO
2
parameter window label.
3.
From the CO
2
menu, select CALIBRATE SAMPLE LINE.
4.
Select READY. The message “CALIBRATING” displays in the CO
2
parameter window. When calibration is complete, the message clears.
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Monitoring End-Tidal CO2
Troubleshooting
5.
Connect the sample line to the patient.
Message
CHECK SAMPLE LINE
CALIBRATE SAMPLE LINE
CAL SENSOR TO ZERO CELL
CANNOT CALIBRATE
CHECK ADAPTER ADAPTER CAL
INCOMPATIBLE SENSOR
NO BREATH DETECTED
NOT CALIBRATED
SERVICE CO2 MODULE
SERVICE CO2 MODULE TMP
SERVICE CO2 SENSOR
SERVICE CO2 SENSOR - SENSOR
TEMP
WARMING UP
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
NOTE
Sidestream setup messages only display on the monitor, not at the central station.
Cause Solution
The sample line is blocked, loose or not connected.
The sample line is not calibrated.
The sensor is not calibrated.
The calibration process failed.
The sensor signal is out of tolerance.
The CO
2
module failed.
The CO
2
module is overheated.
The CO
2
sensor failed.
The CO
2
sensor is overheated.
Connect or replace the sample line.
Calibrate the sample line.
Calibrate the sensor.
Calibrate the sensor again.
The adapter is not calibrated.
Calibrate the adapter.
The sensor is not compatible with the monitor.
Replace the sensor.
The sensor is not connected to the patient.
Check the patient and sensor placement.
Calibrate or replace the sensor.
Contact service.
Replace module or contact service.
Replace sensor.
Replace sensor or contact service.
The sensor is warming up.
If the message displays for more than four minutes, replace sensor or contact service.
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16
Monitoring Anesthesia
Gases
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Monitoring Anesthesia Gases
Introduction
Overview
The monitor uses a SAM module to monitor anesthesia gases. The SAM module is an infrared based multi-gas analyzer. It measures inspired and expired values for patient gas and calculates respiratory rate.
When all connections are made and the module has warmed up, the CO
2
and GAS parameter windows display. The display updates every two seconds. There is no waveform.
I
E
O2 CO2 RR
45
41
0
39
8
CO
2
mmHg
O2
%
002E
803B
The module detects the following gases:
„
„
„
„
„
„
„
„
Oxygen (O2)
Carbon dioxide (CO2)
Nitrous oxide (N2O)
Enflurane (ENF)
Halothane (HAL)
Isoflurane (ISO)
Desflurane (DES)
Sevoflurane (SEV)
The monitor can detect a mixture of anesthetic agents. A gas mixture is made up of two or more anesthetic agents, each greater than 0.30 percent in concentration. A third gas agent is displayed if its concentration is greater than 0.60 percent.
If two agents are detected, the primary and secondary agents are displayed with
N
2
O. The primary agent is always displayed on the left. The primary agent is defined as the agent with the greatest inspired value.
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Monitoring Anesthesia Gases
If a third agent is detected with a concentration greater than 0.60 percent, the N
2
O values will be removed to make room for the third agent. You can adjust the control settings to display the N
2
O values with the primary and secondary agents.
NOTE
Halothane and enflurane are identified and quantified in a mixture with desflurane if desflurane is less than seven percent.
Options
There are two models of the SAM module, one with an O
2
sensor and one without.
The module without the O
2
sensor is identified by a SAM 80 label on the top of the module and the words “No O2 Sensor” on the front panel label. Operating instructions are similar for both modules.
Guidelines
„
„
„
Use the following guidelines when monitoring anesthesia gases with an external gas analyzer:
Configure alarm limits at the gas analyzer.
Configure and adjust alarm levels at the monitor.
Review or adjust control settings from the CO
2
or GAS menus. The settings you may view or adjust are dependent upon the connected device and may vary between devices.
Additional Information
„
„
Refer to the GE “Critical Care Monitoring Clinical Reference and Troubleshooting
Guide” for the following information:
Patient tube connections.
Patient gas exhaust.
Safety
The following safety statements apply when monitoring anesthesia gases with a
SAM module.
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Monitoring Anesthesia Gases
WARNING
ISOFLURANE AND DESFLURANE — The SAM module cannot distinguish between isoflurane and desflurane. You must use tell the module which agent combination will be used.
If both are present (such as, when introducing one and discontinuing the other) inaccurate values are displayed for the selected agent (isoflurane or desflurane) until only the selected agent is present. If isoflurane is selected and concentration is greater than 5.0 percent, a “Desflurane?” prompt will be displayed, suggesting verification of correct selection.
CAUTION
AGENT EXPOSURE — Connect exhaust to a scavenging system to prevent exposure to exhaled agents.
CAUTION
ANESTHETIC AGENT VERIFICATION — When administering anesthetic agents, always verify your anesthetic vaporizer settings.
CAUTION
ETHANOL AND METHANE — The presence of ethanol or methane with halogenated agents causes inaccuracy in the agent values. Methane, even when no halogenated agent is present, will cause a halothane value to be displayed.
CAUTION
MULTIPLE CO2 MODULES — Do not attempt to use a combination of CO
2
or SAM modules at the same time. Only data from the first acquisition source to detect CO
2
will be displayed.
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Monitoring Anesthesia Gases
CAUTION
SAMPLE RATE — The SAM module continuously withdraws about 250 milliliters per minute (nominal) from the patient airway.
The SAM 80 module has a withdrawal rate of about 150 milliliters per minute. Do not use the module on any patient who may be adversely affected by this sampling rate.
CAUTION
AQUA-KNOT WATER TRAP USE — An Aqua-Knot water trap must always be used when the unit is running. Failure to use the water trap can result in contamination of the internal gas measurement instruments and may cause subsequent inaccurate gas analysis data.
CAUTION
AQUA-KNOT WATER TRAP REPLACEMENT — Replace and dispose of the Aqua-Knot water trap weekly or when occluded, whichever occurs first. Do not reuse. Reusing the water trap may cause incorrect readings to be displayed and may damage the equipment.
CAUTION
CONTAMINANT PREVENTION — Always keep an Aqua-Knot water trap or filter on the gas sample inlet when not in use. This will prevent dust particles from being drawn into the system, which may damage the equipment.
NOTE
Always position the Luer-Lok connection and patient sample line in an upright position to avoid aspiration of fluids into the patient sample line, which will cause premature blockage of the Aqua-Knot water trap.
NOTE
Delivery of bronchodilators, mucolytics via aerosol, and meter dose inhalers will cause premature blockage of the Aqua-Knot water trap. Discontinue gas analysis prior to treatment by removing the airway adapter from the ventilator circuit, or by disconnecting the sample line from the Aqua-Knot water trap.
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Monitoring Anesthesia Gases
Monitoring
Control Settings
CO
2
To verify that you are ready to monitor anesthetic gases, follow this procedure.
1.
Install the SAM module into the TRAM-RAC 2A module housing. You will hear a click when the module is fully inserted.
2.
Connect one end of the TRAM-NET communication cable into the Auto or
TRAM-NET port on the back of the module housing.
3.
Connect the other end of the communication cable into the Aux port on the back of the monitor.
4.
Turn on the power switch on the back of the module housing.
5.
Turn on the monitor.
6.
Admit the patient to the monitor.
7.
Position the sensor on the patient.
8.
Verify that patient data displays in the CO
2
and GAS parameter windows.
9.
Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the CO
2
parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
NOTE
The following options are additional CO
2 control settings. These are only available when using a SAM module. The other CO
2 control settings are defined in the CO
2
chapter. For more information, refer to “Control Settings” on page 15-5.
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O2 LIMITS
CLEAR MESSAGE
MODE
Option
O2 COMPENSATION
CO2 DISPLAY MODE
CALIBRATE MODULE
Function
NOTE
Only available with O
2
sensor.
Select the high and low alarm limits for inspired/expired
O
2
, respiration rate and apnea. An alarm sounds when a value occurs outside of these limits.
NOTE
Only available with O
2
sensor.
Select the percentage of O
2 concentration to compensate for O
2
-related decrease of the CO
2
value. Obtain the concentration from an oxygen analyzer.
Clear hardware error messages after the condition is corrected.
Select one of the following:
„
„
RUN — The pump is on.
STANDBY — The pump is in a low flow state or off.
NOTE
Only available with O
2
sensor.
Select the value display size:
„
„
„
INSP/EXP — Displays both inspired and expired values at normal size.
EXP ONLY — Displays the expired value larger; no inspired value displayed. If an inspired alarm limit is exceeded, the display reverts to INSP/EXP.
AUTO — Displays the expired value larger and the inspired value when less than five mmHg.
NOTE
Only perform when the patient is discharged.
Calibrate the module with a special calibration gas cylinder.
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Monitoring Anesthesia Gases
Gas
To adjust the control settings for the patient admitted to the monitor, select the GAS parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
UNITS
VIEW OTHER GASES
REVIEW GAS DATA
MONITOR
GAS LIMITS
CP BYPASS
Function
Select the units of measure for gas parameters.
„
„
Select one of the following to select the gases displayed:
N2O — Display just N
2
0.
MIX — Displays the primary and secondary agents if a mix of three agents are detected
Review GRAPHIC TRENDS information.
Select one of the following to select the agent combination for analysis.
„
„
ISO — Isoflurane, halothane, enflurane and sevoflurane.
DES — Desflurane, halothane, enflurane and sevoflurane.
Select the high and low alarm limits for gas parameters. An alarm sounds when a value occurs outside of these limits.
Select to deactivate alarms when the patient is on bypass.
Alarms are automatically reactivated when three minutes of uninterrupted ventilation is detected.
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Option
CLEAR MESSAGE
MAC VALUES
Function
Clear hardware error messages after the condition is corrected.
Display the MAC value until the patient is discharged. The
MAC value is the minimum alveolar concentration of an agent needed to produce an anesthetizing effect in 50 percent of the population.
WARNING
— The MAC values correspond to healthy adults. Other factors, such as age and physical condition, need to be accounted for.
NOTE
The displayed value reflects the expired MAC value.
NOTE
If N
2
0 and two other agents are displayed, the MAC value does not display in the GAS parameter window.
Enabling HAL and ENF
When using a SAM module, you can enable the monitor to detect and display low values of halothane and enflurane (greater than one percent) due to non-analyzed gases in the circuit in the GAS parameter window.
To enable the HAL and ENF display, follow this procedure.
1.
Select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT DISPLAY.
2.
In SETUP DISPLAY locate DISABLE SAM HAL and DISABLE SAM ENF and select ON.
Troubleshooting
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
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Message
BLOCKED LINE
CALIBRATE
MODULE CELL SERVICE CO2
CP BYPASS
DESFLURANE?
ISOFLURANE?
CONNECT AQUA KNOT
LOW TEMP
GAS LIQUEFIED/WARMING UP
NO BREATH DETECTED
AIR CAL IN PROGRESS
SERVICE…
UNKNOWN ERROR
WARMING UP
Cause Solution
The sample or exhaust line blocked.
The SAM module is not calibrated.
The SAM module failed.
The alarms are deactivated for bypass.
Desuflurane is selected, but isoflurane is detected.
Clean or replace sample or exhaust line.
Calibrate the module.
Contact service.
This is a normal procedure message.
Change the gas agent selection.
Isoflurane is selected, but desoflurane is detected.
The Aqua-Knot water trap is disconnected.
Connect or replace the Aqua-Knot water trap.
Gas cells are liquefied.
Apply power and wait for the module to warm up (30 minutes to one hour).
Due to extreme temperature change, gas in one or more of the internal cells is liquefied.
Check the patient and the sensor.
No breath detected or sample line disconnected.
Room air calibration in progress.
This is a normal procedure message,
Unknown hardware failure.
Contact service.
The SAM module is warming up. If the message displays for more than four minutes, replace module or contact service.
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17
Monitoring Impedance
Cardiography (ICG)
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Monitoring Impedance Cardiography (ICG)
Introduction
Overview
The monitor uses an ICG module to acquire impedance cardiography data. When the
ICG module is installed into the TRAM-RAC 2A module housing, the ICG parameter window displays one primary ICG parameter and up to three secondary
ICG parameters. The display updates every two seconds.
The ICG parameter also displays a waveform. The ICG waveform is not synchronized with any parameter. A message “DELAYED” displays with the waveform due to an approximately four-second patient data delay.
Monitored Parameters
„
„
„
„
„
„
„
„
„
„
„
„
The following measured parameters are available for display.
„
„
Thoracic Fluid Content (TFC)
„
„
Acceleration Index (ACI)
Velocity Index (VI)
Heart Rate (HR)
The following calculated parameters are available for display.
Cardiac Output (CO)
Cardiac Index (CI)
Stroke Volume (SV)
Stroke Index (SI)
Systemic Vascular Resistance (SVR)
Systemic Vascular Resistance Index (SVRI)
Left Ventricular Stroke Work Index (LVSWI)
Left Cardiac Work Index (LCWI)
Systolic Time Ratio (STR)
Estimated Delivered Oxygen Index (eDO2I)
Pre Ejection Period (PEP)
Left Ventricular Ejection Time (LVET)
Additional Information
Refer to the GE “Critical Care Monitoring Clinical Reference and Troubleshooting
Guide” for the following information:
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Safety
Monitoring Impedance Cardiography (ICG)
„
„
„
„
„
ICG formulas.
Patient preparation.
Sensor and cable placement.
ICG reference literature.
Clinical-level troubleshooting.
For important information about monitoring pacemaker patients, refer to
“Pacemaker” on page 8-8 and the GE “Critical Care Monitoring Clinical Reference
and Troubleshooting Guide”.
„
„
WARNING
— The ICG module is designed for use on adult patients in the resting position meeting the following height and weight criteria:
Patient heights between 120–230 cm (48–90 in).
Patient weights between 30–155 kg (67–341 lbs).
WARNING
— The ICG module and its components are not designed, sold or intended for use except as described in this document.
WARNING
— Use only GE approved ICG module accessories.
WARNING
— ICG sensors are intended for skin application only and are not for direct cardiac application.
WARNING
— The conductive gel of the ICG sensors should not contact any other conductive materials during patient monitoring.
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Monitoring
WARNING
— ICG sensors are specified for single patient use.
WARNING
— The patient cables specified and included with the ICG module are specifically designed for protection against the effects of cardiac defibrillators and radio-surgery equipment.
„
„
„
„
„
„
„
„
„
CAUTION
— Impedance cardiography is a theoretical model of blood flow and is subject to inaccuracies in cases where the model does not fit an individual patient's clinical profile. Conditions which may impede the accuracy of the ICG data are as follows:
Septic shock.
Aortic valve regurgitation.
Severe hypertension (MAP >130 mmHg).
Patient heights < 120 cm (48 in) or > 230 cm (90 in).
Patient weights < 30 kg (67 lbs) or > 155 kg (341 lbs).
Aortic balloon pump insertion.
Patient movement, including shivering.
Signal interference caused by cable and/or power cord.
Open chest surgery in which the normal patterns of blood flow or electrical current flow of the thorax are altered.
CAUTION
— Hemodynamic parameter calculations are dependent on accurate patient height, weight, sex and age values. Ensure that these values have been properly entered.
To verify that you are ready to monitor ICG, follow this procedure.
1.
Install the ICG module into the TRAM-RAC 2A module housing. You will hear a click when the module is fully inserted.
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Control Settings
2.
Connect one end of the TRAM-NET communication cable into the Auto or
TRAM-NET port on the back of the module housing.
3.
Connect the other end of the communication cable into the Aux port on the back of the monitor.
4.
Turn on the power switch on the back of the module housing.
5.
Turn on the monitor.
6.
Verify the status light on the front of the module illuminates green.
7.
Position the sensors on the patient.
8.
Connect the ICG cable to the sensors.
9.
Connect the ICG cable to the module.
10. Admit the patient to the monitor.
11. Enter the required patient information.
12. Verify that patient data displays in the ICG parameter window.
13. Verify that a good quality waveform displays.
14. Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the ICG parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
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Monitoring Impedance Cardiography (ICG)
Option
ICG PATIENT
INFORMATION
FAST LOOK
SECONDARY
PARAMETERS
LIMITS
TRENDS
HELP
WAVEFORMS
Function
„
„
Select the required patient information. When monitoring the following parameters additional information is required:
„
„
MAP — Select NBP or Arterial Line.
CVP — Select invasive CVP or enter a specific value for SVR and SVRI calculations.
PAW — Select invasive PAW or enter a specific value for LVSWI and LCWI calculations.
HB — Enter a specific value for eDO
2
I monitoring.
This value is retained for 12 hours and may be used in other calculations (for example, pulmonary calculations).
Select one of the following options for viewing and printing parameter data:
„
„
NORMAL RANGES — Display data with normal parameter ranges. A plus (+) or minus (-) indicates values outside the normal range.
UNITS OF MEASURE — Displays data with units of measurement.
Select three parameters from the available parameters to display in the parameter window. The default selections are CO, SVR and TFC.
Select the high and low parameter alarm limits. An alarm sounds when a value occurs outside of these limits.
Display the GRAPHIC TRENDS information window. All
ICG parameters display with an “i” preceding the parameter label (for example, iHR, iMAP, iCO2, etc.).
Display the HELP information window for help with patient preparation, proper sensor placement and troubleshooting issues.
Select one of the following options for waveform display:
„
„
ICG — Reflects beat-to-beat changes in the impedance consistent with events of the cardiac cycle.
DZ/DT — Reflects the rate of change at the first derivative of the waveform.
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Option
SPEED
SIGNAL QUALITY
BEAT AVERAGE
CHANGE NORMALS
CHECK LEADS
Function
Select a sweep speed for the displayed waveform.
Select one of the following options for signal quality. This overrides the automatic signal selection made by the module for data acquisition and processing.
„
„
AUTO SEARCH — Search all leads for optimum signal. Displays the message “Signal Search” in the parameter window.
SIGNAL 1 to SIGNAL 4 — Select to switch the vector designation to a specific lead.
Select the number of heart beats that are averaged. When monitoring begins, beat averaging begins at 10, 20, 30 and
60 beats. The averaging remains at 60 beats unless a new value is selected. The smaller the number selected, the more likely the data will be affected by artifact. The higher the number selected, the more the beat average will be smoothed out with minimum fluctuation.
Select the normal range for the parameters.
Check for lead failures.
Troubleshooting
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
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Monitoring Impedance Cardiography (ICG)
Message
ENTER REQUIRED ICG PATIENT INFO
ENTER PATIENT WEIGHT
ENTER PATIENT HEIGHT
ENTER PATIENT AGE
ENTER PATIENT SEX
PATIENT WEIGHT OUT OF RANGE
PATIENT HEIGHT OUT OF RANGE
PATIENT AGE OUT OF RANGE
SERVICE MODULE
RIGHT THORACIC LEAD FAIL
LEFT THORACIC LEAD FAIL
RIGHT NECK LEAD FAIL
LEFT NECK LEAD FAIL
CABLE DISCONNECTED
SIGNAL SEARCH
Cause
Required patient information missing or incorrect.
Hardware failure.
Lead failure.
Hardware or lead failure.
Solution
Enter the required patient information.
Contact service.
Check patient and sensor.
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18
Monitoring Bispectral
Index (BIS)
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Monitoring Bispectral Index (BIS)
Introduction
Overview
NOTE
Only available in software version 6 or later.
NOTE
Although the external Aspect
®
BISx can monitor EEG, the monitor does not support EEG monitoring.
The external BISx uses an internal digital signal converter (DSC). The DSC uses
EEG amplifiers and analog filters, and digitizes the resulting waveforms for transmission and processing by the monitor. It also amplifies and digitizes the EEG signal close to the patient, to limit the effect of ambient noise sources.
When connected to the monitor, BISx computes the BIS value and other processed
EEG parameters in real-time using three steps:
„
„
„
The raw EEG signal is broken down second by second and the segments that have artifact are identified and removed.
BISx calculates the BIS value by combining EEG features associated with the anesthetic effect.
The index is modified to reflect the amount of suppressed EEG signal in the raw waveform.
The monitor displays the digital values in a parameter window. The display is updated every two seconds.
1
4
2
3
900A
1 Electromyograph (EMG) value
2 Suppression ratio value
3 Signal quality index value
4 Bispectral index value
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Additional Information
The monitor also displays a single raw EEG waveform.
Refer to the GE “Critical Care Monitoring Clinical Reference and Troubleshooting
Guide” for the following information:
„
„
„
BIS sensor placement.
Patient preparation.
BIS reference literature.
„ Clinical-level troubleshooting.
NOTE
You can also refer to the sensor packaging for instructions on patient preparation and sensor placement.
Safety
Considerations
„
„
„
Clinical judgement 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.
As with any monitored parameter, artifacts and poor signal quality may lead to inappropriate BIS values. Potential artifacts may be caused by poor skin contact
(high impedance), muscle activity or rigidity, head and body motion, sustained eye movements, improper sensor placement and unusual or excessive electrical interference.
Due to limited experience in the following applications, BIS values should be interpreted cautiously in patients with known neurological disorders, those taking psychoactive medications and in children below the age of one.
General
The following safety statements apply when monitoring BIS.
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Monitoring
WARNING
INTENDED USE — BISx is intended for use under the direct supervision of a licensed health care practitioner or by personnel trained in its proper use. It is intended for use on adult and pediatric patients within a hospital or medical facility providing patient care to monitor the state of the brain by data acquisition of EEG signals.
The BISx may be used as an aid in the monitoring of certain anesthetic agents. Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation.
WARNING
CABLES — Route all cables away from the patient’s throat to avoid possible strangulation.
WARNING
— The BISx may remain connected to a patient during defibrillation as long as the sensor is not located between the defibrillator pads.
CAUTION
— Due to elevated surface temperature, do not place in prolonged direct contact with the patient.
CAUTION
— Continuous impedance checking may need to be disabled if the impedance check signal interferes with other equipment.
To verify that you are ready to monitor BIS, follow this procedure.
1.
Verify BISx is securely mounted to an IV pole, bedrail or clipped to a bedsheet.
2.
Connect the BISx communication cable in the AUX connector on the back of the monitor.
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Control Settings
3.
Connect BISx to an AC power source.
4.
Position the sensor on the patient. For more information, refer to the sensor packaging or the GE “Critical Care Monitoring Clinical Reference and
Troubleshooting Guide”.
5.
Insert the BIS sensor paddle into the patient interface cable.
6.
Admit the patient to the monitor.
7.
Verify that patient data displays in the BIS parameter window.
8.
Verify that the SQI value indicates a strong signal.
9.
Verify that a good quality waveform displays.
10. Adjust the control settings as necessary.
To adjust the control settings for the patient admitted to the monitor, select the BIS parameter window label. Then select any of the following options and make the desired changes.
NOTE
All changes are temporary and revert to the factory or custom defaults when the patient is discharged. To permanently change the these settings, refer to
“Defining Custom Defaults” on page 3-7.
Option
SMOOTHING
BIS LIMITS
Function
Select the averaging time used to calculate BIS: The factory default setting is 15 seconds.
„
„
15 SEC — Select for operating room or sedation patient monitoring to increase the responsiveness to changes in the patient’s state.
30 SEC — Select for intensive care patient monitoring to provide a smoother BIS trend with less variability and sensitivity to artifact.
Select the high and low alarm limits for BIS parameter. An alarm sounds when a value occurs outside of these limits.
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Monitoring Bispectral Index (BIS)
Option
SENSOR CHECK
BIS SETUP
RESUME BIS
EEG WAVEFORM
EEG SCALE
BIS RANGES
BIS TRENDS
SPEED
Function
„
„
„
„
Select to automatically detect sensors and display the impedance value and status of each lead. This data is updated every two seconds.
PASS — This lead passed the sensor check.
LD OFF — No impedance value; check the lead.
NOISE — No impedance value; check the lead.
HIGH — Re-prep the sensor.
Provides access to the following controls:
„
„
„
LEAD DETECT — For more information, refer to
“Disabling Continuous Lead Detection” on page 18-6.
EEG FILTER — For more information, refer to
“Disabling the Waveform Filter” on page 18-7.
BIS TEST — For more information, refer to
“Testing the BIS” on page 18-7.
Select to initiate a sensor check when the “EXPIRED
SENSOR” message displays.
Select ON to display EEG waveform data.
Select the scale of the displayed waveform. The larger the scale, the smaller the waveform. The factory default setting is 25 µV/DIV.
Displays a description of the factory default BIS ranges.
Display the trended BIS values in the VITAL SIGNS information window.
Select a sweep speed for the displayed waveform.
Disabling Continuous Lead Detection
By default, the BISx continuously checks electrode impedances. This 1 nA 128 Hz impedance check signal may interfere with other equipment, such as evoked potential. To temporarily stop the continuous lead detect signal, select the BIS parameter window label > BIS SETUP > LEAD DETECT > OFF.
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Disabling the Waveform Filter
The monitor uses an EEG filter to modify the raw EEG waveform with a combination of low pass, high pass and notch filters. This produces waveform data display between 2 and 70 Hz. To temporarily remove filters and display only the raw waveform for troubleshooting purposes, select the BIS parameter window label >
BIS SETUP > EEG FILTER > OFF. When the filter is removed, the waveform data between 0.25 and 100 Hz displays.
Testing the BIS
BISx uses an internal DSC to filter and transmit data to the monitor. To test the function of the DSC, select the BIS parameter window label > BIS SETUP > BIS
TEST > ON. The message “BIS TEST IN PROGRESS” displays until the evaluation is complete.
A “PASS” message displays if BISx is functioning within normal operating parameters.
A “FAIL” message displays if BISx did not meet the noise, gain, high and low pass normal values. If BISx fails, contact service.
Understanding Displayed Values
BIS
BIS is a processed EEG parameter which corresponds to the patient’s level of consciousness. The resulting BIS values range from 100 (patient is wide awake) to
0. Since BIS is an absolute value, baseline information about the patient is not required for monitoring patients.
BIS Value
100
80
60
Patient State
Patient is awake; responds to normal voice.
Patient is moderately sedated; responds to loud commands or mild prodding/shaking.
Patient is in deep sedation; low probability of explicit recall and unresponsive to verbal stimulus.
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Monitoring Bispectral Index (BIS)
20
0
BIS Value Patient State
Patient is in deep sedation; burst suppression.
No brain activity detected.
SR
The suppression ratio value identifies the percentage of epochs in the last 63 seconds in which the EEG signal is considered suppressed, or the percentage of time the
EEG waveform is flat-line over the previous minute. The range is zero to 100 percent.
SQI
The signal quality index value identifies the percentage of good epochs (episodes) in the last 60 seconds that could be used to calculate the bispectral index. The optimum
SQI is 100.
SEF
The spectral edge frequency is the frequency between zero and 30 Hz at which 95 percent of the total power is a lower frequency and five percent exceeds the spectral edge frequency.
EMG
Troubleshooting
The electromyograph value measures the absolute power in the 70 to 110 Hz range.
The power value is in dB (decibels). This is the measurement of the facial muscle activity or other artifact in the EEG signal within this frequency range.
The indicator displays up to seven bars; the more bars the greater the EMG activity.
No bars display when EMG values are less than 30 dB. Seven bars display when the
EMG values are 55 dB.
For clinical-level troubleshooting, refer to the GE “Critical Care Monitoring Clinical
Reference and Troubleshooting Guide.”
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BIS FAILURE
Message
CHECK SENSOR - RESET BIS
CHECK BIS - RESET BIS
COMM ERROR
CONNECT SENSOR
BIS TEST IN PROGRESS
EXPIRED SENSOR
INCOMPATIBLE SENSOR
BIS ERROR
PATIENT ISOELECTRIC
REPREP SENSOR
SENSOR CHECK IN PROGRESS
SENSOR ERROR
SERVICE BIS
SIM CONNECTED
SQI BELOW 50%
SQI TOO LOW
Monitoring Bispectral Index (BIS)
Sensor failure.
Hardware failure.
Cause
Communication failure.
Connection or communication failure.
Over-current electrical condition.
A self test is in progress.
The current time and date exceeds the recommended usage date of the sensor.
The sensor is not compatible.
Solution
Reposition or replace the sensor, PIC cable or BISx.
Reconnect BISx.
Reinstall BISx.
Reposition or replace the sensor, PIC cable or BISx.
Contact service.
This is a normal procedure message.
Select Resume BIS to initiate a sensor check. If the sensor check passes, BIS monitoring will begin. Then Re-prep or replace the sensor, PIC cable or BISx.
Reconnect or replace the sensor, PIC cable or BISx.
Contact service.
Check the patient and sensor
Hardware failure.
No EEG activity detected for several minutes.
Sensor impedance/status failure.
A self test is in progress.
Sensor failure.
Hardware failure.
A BIS demonstration device is connected to the patient interface cable.
The signal quality is low.
The signal quality is low.
Press firmly on each sensor electrode for five seconds. If the impedance check fails, reposition or replace the sensor, PIC cable or BISx.
This is a normal procedure message.
Replace the sensor.
Contact service.
This is a normal procedure message.
The system is unable to attain high quality
EEG signal. Run sensor self-test to confirm sensor impedances are in range. If not, reprep or replace the sensor or the PIC cable.
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A
Maintenance
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Maintenance
Overview
Biocompatibility
Inspection
Disposal
When used as intended, the parts of the product described in this operator’s manual, including accessories that come in contact with the patient during the intended use, fulfill the biocompatibility requirements of the applicable standards. If you have questions about this matter, please contact GE or its representatives.
An effective maintenance schedule should be established for your monitoring equipment and reusable supplies. This should include inspection as well as general cleaning on a regular basis. The maintenance schedule must comply with the policies of your institution’s infection control unit and/or biomedical department.
WARNING
— Failure on the part of responsible hospital or institution employing the use of this monitoring equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.
Check with your biomedical department to be sure preventive maintenance and calibration is complete. Refer to the service manual for detailed maintenance and repair information.
Follow these guidelines when inspecting the equipment:
„
„
Locate obvious physical damage; replace all damaged items.
Inspect cords and plugs for any damage; schedule repair or replacement with qualified service personnel.
WARNING
PACKAGING DISPOSAL — Dispose of all packaging material, observing all applicable waste control regulations and keeping out of children’s reach.
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WARNING
DISPOSAL — At the end of its service life, the product described in this manual, as well as its accessories, must be disposed of in compliance with the guidelines regulating the disposal of each product. If you have any questions concerning disposal of a product, please contact GE or its representatives.
Cleaning
Exterior Surface
WARNING
— Disconnect the monitor from AC power before cleaning or disinfecting its surface.
CAUTION
— Failure to follow these rules may melt, distort or dull the exterior surface finish, blur lettering on labels or cause equipment failure.
Clean the exterior surface on a regular basis in compliance with your institution’s infection control and/or biomedical department. Use any of the following approved solutions to dampen a clean, lint-free cloth:
„
„
„
Diluted ammonia.
Cidex
®
.
Diluted sodium hypochlorite bleach.
„ Diluted mild soap.
NOTE
Always dilute solutions according to the manufacturer’s suggestions and wipe all the cleaning solution from the exterior surface with a dry cloth.
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NOTE
Always avoid the following:
„
„
„
„
„
Cleaning solutions containing wax.
Pouring or spraying water or cleaning solution directly on the exterior surface, connectors or ventilation openings.
Abrasive cleansers or solvents.
Acetone, ketone or alcohol-based cleansers.
Betadine
®
.
Display
Dampen a soft, clean, lint-free cloth with a glass cleaner.
NOTE
Do not spray cleaner directly on the screen. Do not use alcohol-based cleansers or hospital disinfectants like Cidex or Betadine.
Applied Parts
Cables and Leadwires
CAUTION
— Do not use acetone or ketone solvents, an autoclave or steam cleaner to clean cables and leadwires.
CAUTION
— The decision to sterilize must be made per your institution’s requirements with an awareness of the effect on the integrity of the cables or leadwires.
Use a warm, damp cloth and mild soap to clean cables and leadwires. For more intensive disinfecting (near sterile) you can use Ethylene Oxide (ETO); however, this method will reduce the useful lifetime of the cable or leadwire.
Capnostat Sensor and Adapter
To clean the sensor, use a damp cloth to wipe clean and dry (including the sensor windows). Do not immerse or sterilize the sensor.
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To clean the reusable adapters, rinse in warm, soapy solution then soak in a liquid disinfectant (pasteurized or cold sterilized) such as glutaraldehyde. Rinse and dry well with sterile water.
To clean adult and low volume dead space adapters, sterilize with the ETO gas method or a steam autoclave. Using the steam autoclave may reduce the useful lifetime of the adapter.
Before reusing any adapter, make sure the sensor windows are dry and residue-free.
Also ensure the adapter was not damaged during handling, cleaning or sterilization.
NBP Cuff and Hose
To clean an NBP cuff, consult the manufacturer for the correct cleaning information.
Make sure cleaning fluid used does not enter the valves. Fluid trapped in the valves can enter the monitor and may result in damage to the monitor.
Other
For other applied parts, such as temperature sensors, catheters, pulse oximetry probes and NBP cuffs, consult the manufacturer for cleaning, sterilization or disinfecting methods.
Printer/Writer(s)
Changing Writer Paper
1.
Press the button on the top of the writer to open the writer door.
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2.
Remove the old spool and install a new paper roll. Install the paper so it unrolls from the bottom.
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3.
Close the door. Make sure the paper protrudes from the opening.
639A
640A
Batteries
Overview
General
4.
Test the writer by initiating a graph strip.
5.
Remove the test graph by tearing downward.
A complete battery management system provides maximum battery performance.
Depending on usage, the run time per battery for new, fully-charged batteries is up to
3.5 hours. Monitoring NBP, CO
2
and SpO
2
drains battery power faster than other
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Maintenance
parameters. The display brightness, graphing, and connection to a wireless network can also alter battery run times.
Audible and visual alarms alert you when loss of power is imminent and on-screen capacity gauges indicate battery charge condition and capacity. A “BATTERY LOW” message at the top of the screen warns you prior to complete loss of battery power.
You should replace the battery or connect the monitor to an AC power source when the message is displayed.
Lithium-Ion Technology
„
„
The batteries used in this monitor are rechargeable batteries containing lithium-ion cells. Each battery contains an integrated electronic fuel gauge and a safety protection circuit. The following are the key points you should know about lithiumion battery technology:
„
„
The battery will discharge on its own, even when it is not installed in a monitor.
This discharge is the result of the lithium-ion cells and the bias current required for the integrated electronics.
By the nature of lithium-ion cells, the battery will self-discharge. The selfdischarge rate doubles for every 10°C (18°F) rise in temperature.
The capacity loss of the battery degrades significantly at higher temperatures.
As the battery ages, the full charge capacity of the battery will degrade and be permanently lost. As a result, the amount of charge that is stored and available for use is reduced.
Cadex SMart Two+ Battery Charger
NOTE
To extend the life of batteries, GE recommends using the external Cadex SMart
Two+ battery charger to perform all battery care functions.
To use the external battery charger, the monitor must be running software version
2A or later and the charger must be running software version 1.1 or later.
The following LEDs appear on the battery charger. The combination of LEDs and their meaning change by illumination type (solid or flashing).
LED
RUN
RUN and CONDITION
READY
Illuminated
Charging in progress.
Conditioning in progress.
Charging is complete.
Flashing
Initializing the battery.
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Safety
LED
READY and CONDITION
FAIL
FAIL and CONDITION
Illuminated
Conditioning is complete
(pass target).
Battery fault.
Conditioning is complete
(fail target).
Flashing
Conditioning is required.
Charger fault.
WARNING
PHYSICAL INJURY — Do NOT install the monitor above a patient. Make sure the batteries are completely inserted and battery doors are completely closed. Falling batteries could seriously or fatally injure neonatal or other vulnerable patients.
WARNING
EXPLOSION OR FIRE — Using non-recommended batteries could result is injury/burns to the patients or users. Only use batteries recommended or manufactured by GE. The warranty can be voided if non-recommended batteries are used.
WARNING
PHYSICAL INJURY — Do NOT install the monitor above a patient. The potential exists for a battery to leak a chemical on the patient if the monitor is mounted above the patient.
Leaks from battery cells can occur under extreme conditions. The liquid is caustic to eyes and skin. If the liquid comes in contact with eyes or skin, flush with clean water and seek medical attention.
NOTE
For optimal performance and safety, use only batteries supplied by GE.
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Identifying Capacity
One new, fully charged battery lasts about 3.5 hours. Two new, fully charged batteries last about 5 hours.
The following terms are used to define the battery capacity:
„
„
„
Design capacity — The theoretical capacity of the battery cells when the battery is new.
Full charge capacity — The actual amount of charge the battery can store and deliver to the monitor.
Remaining charge capacity — The amount of full charge capacity currently remaining in the battery. This is a percent of the full charge capacity.
Battery Gauges
The battery gauge for each battery displays on the screen when installed in the monitor. The example shows a battery that has lost about 20 percent of its design capacity and has about 50 percent remaining charge capacity (approximately 1.4 hours).
1
2
3
1 Filled (white) area — Remaining charge capacity.
2 Empty (black) area — Full charge capacity.
3 Dotted outline area — Design capacity.
If the message “ERROR” displays in the battery gauge, refer to “Battery Status
859B
Battery Charger
When you select the Target Capacity switch on the charger, the charger compares the battery’s performance to a 60, 70, or 80 percent target capacity set on the battery charger. If the battery fails to meet the target performance, the battery charger will prompt you to condition the battery. If after the condition cycle has been completed, the battery does NOT meet the target performance, then the battery charger will illuminate a “fail” light.
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Battery Status Menu
To display the BATTERY STATUS menu, select MORE MENUS > BATTERY
STATUS.
637B
„
„
Select BATTERY HELP for more information on batteries.
„
„
SLOT STATUS — Definitions of the information presented in the BATTERY
STATUS information window.
TIMES — Definitions of the information presented in the BATTERY STATUS information window.
FUEL GAUGES — Explains the battery capacity gauges.
ALARMS — Lists the battery messages and solutions.
Installation Guidelines
Position the monitor in a location that does not artificially increase the operating temperature of the battery.
„
To optimize battery life and performance, select a location that does NOT artificially increase the ambient temperature surrounding the monitor.
„ Do not place the monitor near a heat vent or near heat-generating equipment, such as computer monitors.
„
Avoid placing the monitor in corners where the airflow may be restricted.
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Battery Care
Charging
Conditioning
Maintenance
Charging a battery takes approximately 9 hours for both the external and the internal charging method.
External Charger Method (Preferred)
The Cadex SMart Two+ charger maintains a lower battery cell temperature during the charge cycle than the monitor. This reduction in temperature will extend the life of the battery.
To charge a battery, use the following procedure.
1.
Insert the battery into the battery charger. The RUN LED illuminates.
2.
Leave the battery in the charger until the READY LED illuminates.
3.
If the FAIL LED illuminates, remove and reinsert the battery. This will correct any battery charger time out errors.
Internal Method
To charge a battery, use the following procedure.
1.
Insert battery into the monitor. The battery CHARGING STATUS indicator illuminates yellow.
2.
When the battery CHARGING STATUS indicator illuminates green, the battery is fully charged.
Condition the battery every six months or whenever the BATTERY STATUS information window displays CONDITION in the BATTERY QUALITY field.
External Charger Method (Preferred)
Remove the battery from the monitor every six months and condition it using the
SMart Two+ charger. This condition cycle recalibrates the electronic fuel gauge.
To condition a battery, use the following procedure.
1.
Insert the battery into the battery charger.
2.
Press the CONDITION button when one of the following conditions occur:
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Storing
A-12
„
„
When the RUN LED light is flashing.
When the CONDITION LED is flashing.
3.
Remove the battery when the READY LED illuminates.
Internal Method
WARNING
PATIENT RISK — Never condition a battery while the monitor is connected to a patient. Serious injury or death could result.
To condition a battery, use the following procedure.
1.
Remove all batteries from the monitor.
2.
Insert one battery in slot A.
3.
Disconnect the monitor from AC power.
4.
Select MORE MENUS > BATTERY STATUS.
5.
Allow battery to discharge to less than 90 percent (CHARGE LEVEL).
6.
Connect the monitor to AC power and fully charge the battery.
7.
Disconnect the monitor from AC power again.
8.
Allow the monitor to run on battery power until the “BATTERY LOW” message displays or until the monitor shuts down.
9.
Connect the monitor to AC power again and allow the battery to fully charge.
Store the battery outside of the monitor at a temperature between 20°C and 25°C
(68°F to 77°F).
„ When the battery is stored inside a monitor that is powered by an AC power source, the battery cell temperature increases by 15°C to 20°C (27°F to 36°F) above the room’s ambient temperature. This reduces the life of the battery.
„
When the battery is stored inside a monitor that is continuously powered by an
AC power source and is not powered by battery on a regular basis, the life of the battery may be less than 12 months. GE recommends that you remove the battery and store it near the monitor until it is needed for transport.
When the battery is stored for a long period of time without being charged, it will eventually lose all of its charge and “fall asleep.” When the battery is “asleep,” none of the LEDs on the battery will illuminate when the battery’s Test button is pressed.
You must “wake up” the battery before you can use it again.
Dash
®
3000/4000/5000 2000966-338A
Waking Up
Recycling
Maintenance
The procedure for waking up a battery inside the monitor should only be performed by qualified service personnel. For more information, refer to the service manual.
To wake up a battery with the external charger (preferred method), use the following procedure.
NOTE
A deeply discharged battery will require you to repeat the following steps more than once before the battery will “wake up”.
1.
Insert the battery into the battery charger and wait for the RUN LED light to illuminate (approximately three minutes).
2.
If the RUN LED light does NOT illuminate, complete the following steps: a.
Remove the battery from the battery charger.
b.
Insert the battery into the battery charger and let the battery trickle charge for two to three minutes while the FAIL LED flashes. If the RUN LED light illuminates, ignore it.
c.
Watch the battery charger LEDs and immediately remove the battery from the battery charger when the FAIL LED stops flashing AND remains illuminated, OR when both the RUN and CONDITION LEDs flash.
d.
Wait for one to two seconds, then reinsert the battery into the battery charger. The RUN and CONDITION LEDs will flash for five to ten seconds while the charger initializes the battery. If the FAIL LED illuminates, remove the battery and reinsert it into the battery charger.
e.
Watch the battery charger LEDs. The RUN LED should stop flashing and remain illuminated for approximately one minute, then the CONDITION
LED should stop flashing. At this time, the battery is awake and being charged.
WARNING
EXPLOSION HAZARD — DO NOT incinerate the battery or store at high temperatures. Serious injury or death could result.
When the battery no longer holds a charge, it should be replaced. The battery is recycleable. Remove the old battery from the monitor and follow your local recycling guidelines.
2000966-338A Dash
®
3000/4000/5000 A-13
Maintenance
Troubleshooting
In the United States and Canada, the Rechargeable Battery Recycling Corporation
(RBRC) can help you locate your nearest rechargeable battery collection site. You can contact RBRC by telephone (1-800-8-BATTERY) or by accessing their internet web site ( www.rbrc.org
).
There are three conditions that activate battery alarms:
„
„
„
Low battery
Battery failure
Charger failure
Refer to the following table for solutions to alarm messages that display in the ECG waveform area.
BATTERY LOW
Message
POWERING DOWN!
CHECK BATT STATUS
BATTERY ERROR
CHECK BATT STATUS
Solution
When this system WARNING sounds and displays, only 10 minutes of battery run time is remaining. Replace the battery or connect the monitor to AC power.
When this system WARNING sounds and displays, there is no battery run time left.
The monitor will power off unless connected to AC power.
When this system message displays, the battery is not functioning. Remove and insert or replace the battery.
When this system WARNING sounds and displays, the battery cannot be charged in the monitor. Attempt charging in the external battery charger or replace the battery.
When this system message displays, the external charger failed to charge the battery. Attempt charging the battery again or replace the battery.
A-14 Dash
®
3000/4000/5000 2000966-338A
Maintenance
Technical Maintenance
Diagrams, technical specifications and other relevant technical information can be found in the service manual supplied with this equipment. Comply with the policies of your institution’s biomedical department and the preventive maintenance recommendations in the service manual.
Safety Tests
General
WARNING
— Failure on the part of all responsible individuals, hospitals or institutions employing the use of this device to implement the recommended maintenance schedule may cause equipment failure and possible health hazards. The manufacturer does not in any manner assume the responsibility for performing the recommended maintenance schedule, unless an Equipment Maintenance
Agreement exists. The sole responsibility rests with the individuals, hospitals or institutions utilizing the device.
„
„
„
„
„
„
General safety tests should be performed every 12 months. NBP and temperature measuring devices should be tested every two years.
Safety tests may only be performed by qualified personnel not subject to directives with respect to these tests.
If a service contract exists, safety tests may be performed by GE service personnel.
Detailed information about safety tests can be found in the service manual.
Once the safety tests have been performed, no additional regular maintenance is required.
Only use standards that guarantee sufficient accuracy. All such standards must be based upon national or European standards.
Temperature Testing
To test temperature, use the following procedure and a MARQIII patient simulator.
1.
Connect the simulator to the Temp/CO patient connector.
2000966-338A Dash
®
3000/4000/5000 A-15
Maintenance
NBP Testing
017C
2.
Turn on the simulator, set the adapter to 400 and set the temperature output to
37°C.
3.
Check the temperature values in the TEMP parameter window. The displayed value must be within ± 0.4°Cof the simulator setting.
If the readings fail, re-calibrate the Temp/CO circuit. For more information, refer to the service manual
4.
Repeat the procedure with the simulator adapter set to 700.
To test NBP, use the following procedure and a digital pressure or calibrated mercury manometer (for example, Sensym PDM200M or Diptron Plus 3).
WARNING
— When the NBP cuff is used in this procedure, it must be tightly wrapped around a rigid cylinder or pipe. Do not place the NBP cuff around a human limb during this procedure due to the potential for injury.
A-16 Dash
®
3000/4000/5000 2000966-338A
Maintenance
1.
Connect the manometer to the NBP cuff.
2.
Connect the manometer to the BP 1/3 patient connector.
3.
Press the Power key to turn the monitor on.
4.
Verify the parameter window, waveform label and other parameter information display.
5.
Turn the manometer on and set range switch to 1000 mmHg.
6.
Wrap the NBP cuff around rigid cylinder or pipe (at least six inches in diameter).
2000966-338A
021B
7.
Verify the calibration: a.
Select MORE MENUS > MONITOR SETUP > SERVICE MODE.
b.
Select CALIBRATE > CALIBRATE NBP > CHECK CALC OFF > START.
c.
Verify the readings in the NBP parameter window and the readings on the manometer are within ±1 mmHg for at least one full minute.
If the readings fail, re-calibrate the NBP circuit. For more information, refer to the service manual.
Dash
®
3000/4000/5000 A-17
Maintenance
Alarm Verification
d.
Select CHECK CALC IN PROGRESS > STOP to deflate the NBP cuff.
8.
Repeat procedure for the BP 2/4 patient connector.
To verify the system alarm functions, use the following procedure.
1.
Raise the heart rate limit until it is higher that the patient’s current heart rate.
2.
Verify the following:
„
„
„
„
The audible alarm sounds the correct tone.
The heart rate in the ECG parameter window flashes in the correct color.
The alarm light flashes the correct color.
An alarm graph printed.
3.
Silence the alarms and verify they react correctly.
4.
Return the heart rate alarm settings to the original monitoring levels.
NOTE
For more information on alarms, refer to Chapter 4.
A-18 Dash
®
3000/4000/5000 2000966-338A
B
Software Packages
2000966-338A Dash
®
3000/4000/5000 B-1
Software Packages
Feature Comparison by Software Package
Capability or Feature
6-trace color display
On-screen invasive BP site labels
Common scale and individual scale BP displays
Persistent SPO
2
parameter window display
Right-left overlapping BP scale display
Waveform and numeric alignment
MENTOR on-screen operational support
Adult, neonate, and operating room customization
User-programmable, monitor default/monitor setup
Storage of up to 100 CRG events
Storage of up to 24 hours of CRG trend data
Simultaneous, multi-lead ECG acquisition
3-lead or 5-lead ECG cable compatibility
Selectable beat pause interval
Selectable heart rate averaging
Pacemaker detection/rejection
Smart-lead fail
All ECG display format
Lethal arrhythmia detection package (Asystole, VTach, and VFib alarms)
Full arrhythmia package w/alarm level adjust
Multi-lead arrhythmia storage and recall
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Basic Cardiac
Cardiopulmonary
High
Resolutio n CRG
Trends
X
X
X
X
X
Gender
Specific
12SL &
ACI-TIPI
X
X
B-2 Dash
®
3000/4000/5000 2000966-338A
Capability or Feature
Multi-lead ST segment measurement—7 leads
12-lead ST segment monitoring—12 leads
Multi-lead ST segment template and trending
Multi-lead ST segment history storage
Selectable ST points
12SL ECG Analysis
Automatic 12 lead on ST alarm
Respiration monitoring and apnea detection
Invasive BP measurement cursor
Arterial disconnect alarm
Arterial Smart BP function
Intra-aortic balloon pump BP algorithm
PA wedge measurement program
PA insert wedge measurement program
Non-invasive BP (NBP) measurement
NBP clock sync
NBP cuffs/measurement for adult, pediatric, neonate
NBP manual, automatic, and stat measurement modes
Pulse oximetry monitoring
Pulse oximetry desaturation tones
Pulse oximetry — Masimo probe compatibility
Pulse oximetry — Nellcor probe compatibility
Pulse oximetry — factory probe compatibility
Temperature monitoring support
Software Packages
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Basic Cardiac
Cardiopulmonary
High
Resolutio n CRG
Trends
X
X
X
X
X
Gender
Specific
12SL &
ACI-TIPI
X
X
X
X
X
X
X
2000966-338A Dash
®
3000/4000/5000 B-3
Software Packages
Capability or Feature
Thermodilution cardiac output support
Cardiac computation constants stored for major manufacturers
Cardiac calculations
CapnoFlex LF Sidestream CO
2
SAM (Smart Anesthesia Multi-gas module) interface
Vital Signs—24 hr
Graphic trending—24 hr
Pulmonary calculations w/fick CO calculation
Dose calculations—adult/neonate
High/low alarms, all parameters
Alarm window
Multi-level, user-programmable, “graded” alarms package
Laser printer support
Two or four inch direct digital writer (DDW) support
View other patient (float)
View on alarm
Auto view on alarm (requires Prism Information Server)
LAN COMBO (telemetry/hardwire) monitoring
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Basic Cardiac
Cardiopulmonary
High
Resolutio n CRG
Trends
X
X
X
X
Gender
Specific
12SL &
ACI-TIPI
B-4 Dash
®
3000/4000/5000 2000966-338A
C
Factory Defaults
2000966-338A Dash
®
3000/4000/5000 C-1
Factory Defaults
Arrhythmia Alarm Levels
The following are the arrhythmia alarm level factory defaults. To access these options, select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT ARRHYTHMIA ALARM LEVELS.
ADULT-ICU NEONATAL-ICU
OPERATING
ROOM
ASYSTOLE
VFIB/VTAC
V TACH
VT > 2
V BRADY
COUPLET
BIGEMINY
ACC VENT
PAUSE
TRIGEMINY
R ON T
PVC
TACHY
BRADY
IRREGULAR/
ATRIAL FIB
CRISIS
MESSAGE
CRISIS
—
CRISIS
—
ADVISORY
—
Parameter Alarm Levels
The following are the parameter alarm level factory defaults. To access these options, select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT PARAMETER ALARM LEVELS.
C-2 Dash
®
3000/4000/5000 2000966-338A
Factory Defaults
CVP
RA
UVC
LA
NBP
FEM
UAC
GAS
ST
ART
PA
CO2
HR
CO2 NO BREATH
VENT
PVC/MIN
ICP
SP
SVO2
TC
SPO2
1
ADULT-ICU
WARNING
—
NEONATAL-ICU
WARNING
OPERATING
ROOM
ADVISORY
—
ADVISORY ADVISORY ADVISORY
2000966-338A Dash
®
3000/4000/5000 C-3
Factory Defaults
ADULT-ICU NEONATAL-ICU
OPERATING
ROOM
ART RATE
BT
ICG
RR
RESP APNEA
FEM RATE
UAC RATE
CCO
SPO2 RATE
TMP
ICG
MESSAGE
MESSAGE
CRISIS
MESSAGE
1
When ECG is turned off, SpO2 alarm levels are elevated from advisory to warning.
MESSAGE
Parameter Limits
The following are the parameter alarm limit factory defaults. To access these options, select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS >
SETUP DEFAULT LIMITS.
HR
PVC/MIN
ADULT-ICU
LOW
50
—
HIGH
150
6
NEONATAL-ICU
LOW
90
—
HIGH
200
6
OPERATING
ROOM
LOW
–1
—
HIGH
150
6
C-4 Dash
®
3000/4000/5000 2000966-338A
2000966-338A
Factory Defaults
ADULT-ICU
LOW HIGH
NEONATAL-ICU
LOW HIGH
OPERATING
ROOM
LOW HIGH
ST-V3
ST-V4
ST-V5
ST-V6
NBP-S
NBP-D
NBP-M
ART-S
ST-I
ST-II
ST-III
ST-V1
ST-AVL
ST-AVF
ST-AVR
ST-V2
ART-D
ART-M
ART-R
FEM-S
FEM-D
FEM-M
FEM-R
UAC-S
–2.0
2.0
–2.0
2.0
–2.0
2.0
80
20
40
80
20
40
50
80
20
40
50
80
200
120
140
200
120
140
150
200
120
140
150
200
40
20
30
40
20
30
90
40
20
30
90
40
100
60
70
100
60
70
200
100
60
70
200
100
120
140
150
200
200
120
140
200
120
140
150
200
–1
40
20
40
40
40
40
20
–1
40
20
40
Dash
®
3000/4000/5000 C-5
Factory Defaults
C-6
PA-D
PA-M
CVP
RA
UAC-D
UAC-M
UAC-R
PA-S
UVC
LA
ICP
SP
CO2-EXP
CO2-INSP
CO2-RESP
NO BREATH
SPO2
SPO2-R
BT
SVO2
RR
RR-APNEA
TEMP 1
ADULT-ICU
LOW
20
40
50
–99
HIGH
120
140
150
350
NEONATAL-ICU
LOW
20
30
90
–99
HIGH
60
70
200
350
OPERATING
ROOM
LOW
20
40
–1
–99
HIGH
120
140
150
350
90
50
30.0°C/
86.0°F
5
—
–1
—
60
5
—
30.0°C/
86.0°F
105
150
42.0°C/
107.6°F
30
20
50
5
80
30
20
42.0°C/
107.6°F
88
90
30.0°C/
86.0°F
15
—
–1
—
60
15
—
30.0°C/
86.0°F
50
5
100
15
100
200
42.0°C/
107.6°F
80
100
15
42.0°C/
107.6°F
50
5
200
30
105
150
42.0°C/
107.6°F
80
200
20
42.0°C/
107.6°F
90
–1
0.0°C/
32.0°F
1
—
–1
—
60
1
—
0.0°C/
32.0°F
Dash
®
3000/4000/5000 2000966-338A
2000966-338A
TEMP 2
DES-INSP
DES-EXP
ENF-INSP
ENF-EXP
HAL-INSP
HAL-EXP
HE-INSP
HE-EXP
O2-INSP
O2-EXP
N2O-INSP
N2O-EXP
N2-INSP
N2-EXP
SEV-INSP
SEV-EXP
ISO-INSP
ISO-EXP
AR-INP
AR-EXP
CI
TFC
BIS
Factory Defaults
ADULT-ICU NEONATAL-ICU
LOW
30.0°C/
86.0°F
18
–1
HIGH
42.0°C/
107.6°F
102
102
80.0
80.0
85.0
85.0
7.0
7.0
12.0
12.0
LOW
30.0°C/
86.0°F
18
–1
HIGH
42.0°C/
107.6°F
102
102
80.0
80.0
85.0
85.0
7.0
7.0
12.0
12.0
OPERATING
ROOM
LOW
0.0°C/
32.0°F
18
–1
HIGH
42.0°C/
107.6°F
102
102
80.0
80.0
85.0
85.0
7.0
7.0
12.0
12.0
–1.0
–1.0
–1.0
1.5
10
-1
7.0
5.0
60
100
1.5
10
7.0
5.0
60
1.5
10
7.0
5.0
60
Dash
®
3000/4000/5000 C-7
Factory Defaults
Display Defaults
The following are the display factory defaults. To access these options, select MORE
MENUS > MONITOR SETUP > MONITOR DEFAULTS > SETUP DEFAULT
DISPLAY.
PATIENT AGE
DISPLAY MODE
COLOR FORMAT
PRIMARY ECG
ECG WAVEFORM
2
MIN ARRHYTH
LEVEL
ARRHYTHMIA
DETECT PACE
ARTERIAL RATE
LEAD ANALYSIS
ST ANALYSIS
ST TEMPLATES
ST V LEAD
ST TEMPLATE 1
ST TEMPLATE 2
ST TEMPLATE 3
ADJUST ST POINT
12 LD ON ST
HISTORY
ECG WF SPEED
ADULT-ICU
ADULT
V1
FULL
OFF
OFF
J + 60 MS
NEONATAL-ICU
0-2
INDV 6 WFS
TRANSDUCER
II
OFF
OFF
LETHAL
OFF
ON
MULTI-LEAD
OFF
OFF
V5
II
V5
I
J + 30 MS
OFF
25
OPERATING
ROOM
ADULT
ST
OFF
ON
TRENDS
J + 60 MS
C-8 Dash
®
3000/4000/5000 2000966-338A
2000966-338A
Factory Defaults
ADULT-ICU
WAVEFORM 2
WAVEFORM 3
WAVEFORM 4
PRINT ON ALARM
TIMED PRINT
ART
DISCONNECT
SMART BP
ARTERIAL SCALE
PA SCALE
CVP-RA-UVC
SCALE
LA SCALE
ICP SCALE
SP SCALE
BP WF SPEED
CO2 SCALE
CO2 WF SPEED
NBP AUTO
ADULT CUFF
PRESSURE
PED CUFF
PRESSURE
NEO CUFF
PRESSURE
CO CATHETER
OFF
ON
CONTINUOUS
ON
ON
160
30
160
25
50
6.25
OFF
160 MMHG
140 MMHG
110 MMHG
BAXTER/EDWARDS
NEONATAL-ICU
ART
RR
OFF
OFF
CONTINUOUS
—
—
100
60
OPERATING
ROOM
OFF
OFF
20 SECONDS
OFF
ON
160
Dash
®
3000/4000/5000 C-9
Factory Defaults
C-10
CO INJ TEMP
CO SIZE
CO INJ VOL
CO AUTO MODE
N2O
COMPENSATION
O2
COMPENSATION
RR PARAMETER
RR LEAD
RR WF SPEED
SPO2 WF SPEED
VIEW ON ALARM
VOA BROADCAST
VOA ALERT TONE
REMOTE ALARM
LEVEL
ALARM VOLUME
OFF
MIN ALARM
VOLUME
ALARM VOLUME
SILENCE ALARM
QRS VOLUME
RATE VOLUME
ECG LEADS FAIL
SPO2 PROBE OFF
ADULT-ICU
ON
—
OFF
NEONATAL-ICU
IN-LINE
7.5
10 CC
ON
—
0-60% O2
ON
II
25
OFF
OPERATING
ROOM
OFF
0-40% N2O
OFF
ENABLE
70%
OFF
SYSTEM
WARNING
CRISIS
DISABLE
10%
70%
NORMAL
OFF
OFF
SYSTEM
WARNING
SYSTEM WARNING
ENABLE
40%
40%
SYSTEM
ADVISORY
Dash
®
3000/4000/5000 2000966-338A
2000966-338A
Factory Defaults
ADULT-ICU
SPO2 PULSE
SEARCH
MONITOR ISO/
DES
DISPLAY LIMITS
DISPLAY UNITS
UNITS FOR
HEIGHT
UNITS FOR
WEIGHT
TEMPERATURE
UNITS
CO2 UNITS
O2 UNITS
GAS UNITS
NBP LIMITS TYPE
ARTERIAL LIMITS
TYPE
PA LIMITS TYPE
MENU TIMEOUT
ECG FILTER
BP FILTER
QRS WIDTH
CO2 DISPLAY
MODE
DISCHARGE
ALERT
VENT WF SPEED
ON
MONITORING
NORMAL
NEONATAL-ICU
SYSTEM ADVISORY
ON
ISOFLURANE
OFF
CM
KG
C DEG
MMHG
%
SYSTOLIC
DIASTOLIC
5 MINUTES
MONITORING
12 HZ
NARROW
AUTO
OFF
6.25
OFF
OPERATING
ROOM
MODERATE
NORMAL
Dash
®
3000/4000/5000 C-11
Factory Defaults
C-12
ADULT-ICU
DISPLAY MAC
VALUE
DISABLE SAM
HAL
DISABLE SAM
ENF
TECH ID FIELD
ICG PRIMARY PAR
ICG SECONDARY
PAR1
ICG SECONDARY
PAR2
ICG SECONDARY
PAR3
NBP SILENCE
ALARM
PAUSE
BREAKTHRU
MASIMO
AVERAGING
SAT-SECONDS
SPO2 RESPONSE
MODE
ECG INTELLIRATE
ECG PARAMETER
DISCONNECT
OPTION
NBP CLOCK SYNC
AVOA ALARM
LEVEL
OFF
NORMAL
NEONATAL-ICU
OPERATING
ROOM
OFF
CI
CO
SVR
TFC
NORMAL
CRISIS
8 SECS
ON
TO DEFAULT
OFF
WARNING
Dash
®
3000/4000/5000 2000966-338A
Factory Defaults
REMOTE
SILENCE
AVOA SILENCE
PERSISTENT
SPO2
ECG RATE
AVERAGING
BEAT PAUSE
INTERVAL
UNIT ROVING
DOSE CALCS WT
XFER
NBP PULSE RATE
NBP NO
DETERMINATION
TRENDS
HARDKEY
COMBO DEFAULT
SOURCE
CLOCK DISPLAY
BIS SMOOTH
RATE
EEG WF SCALE
EEG WF SPEED
Default Parameter Priority
ADULT-ICU
OFF
NEONATAL-ICU
CRISIS
SILENCED
OFF
8 BEATS
3 SEC
ON
ON
OFF
SYS ADVISORY
TABULAR ALL
TELE DEFINED
ON W/SEC
15 SEC
25
25
OPERATING
ROOM
ON
The following are the parameter priority factory defaults. To access these options, select MORE MENUS > MONITOR SETUP > MONITOR DEFAULTS > SETUP
DEFAULT PARAMETER PRIORITY.
2000966-338A Dash
®
3000/4000/5000 C-13
Factory Defaults
Adult-ICU
The following parameters, when monitored, always appear in the parameter window.
ADULT-ICU NEONATAL-ICU
OPERATING
ROOM
PARAMETER 1
1
PARAMETER 2
PARAMETER 3
PARAMETER 4
PARAMETER 5
PARAMETER 6
ECG
ECG
ART
PA
SPO2
CO2
ECG
UAC
UVC
RR
SPO2
NBP
ECG
NBP
ART
PA
SPO2
CO2
1
When ECG is turned on, it is first and cannot be changed. If turned off, SPO2 is first and cannot be changed.
The following highlighted parameters’ parameter windows may display on the bottom of the screen when there is no room on the right side of the screen. The parameters preceded with an asterisk (*) may display in reduced size.
UAC
PA
CO2
VENT*
GAS
NBP
ART
FEM
CVP*
RA*
UVC*
LA*
ICP*
SP*
SVO2
SPO2
CO*
CCO
RESP
TEMP*
TC
UO*
ICG
ALARMS
BIS
C-14 Dash
®
3000/4000/5000 2000966-338A
Neonatal-ICU
Operating Room
VENT*
ART
FEM
UAC
PA
CO2
GAS
RESP*
NBP
CVP*
RA*
UVC*
LA*
ICP*
SP*
SPO2*
SVO2*
TC
TEMP*
CO*
CCO
UO*
ICG
ALARMS
BIS
CO2
GAS
SPO2*
CO*
CCO
TEMP*
NBP
ART
FEM
UAC
PA
VENT*
CVP*
RA*
UVC*
LA*
ICP*
SP*
SVO2*
RESP*
TC
UO*
ICG
ALARMS
BIS
Factory Defaults
2000966-338A Dash
®
3000/4000/5000 C-15
Factory Defaults
C-16 Dash
®
3000/4000/5000 2000966-338A
D
Custom Defaults
2000966-338A Dash
®
3000/4000/5000 D-1
Custom Defaults
Overview
Use this worksheet to record the custom defaults used in your care unit. Keep it in a prominent place. You may want to make additional copies of the worksheet for future use before filling it out.
General Information
Custom Default Name: _____________________________________________
Unit Name: ________________________________________________________
Patient-monitor type: _______________________________________________
Arrhythmia Alarm Levels
Crisis Warning Advisory Message
ASYSTOLE
VFIB/VTAC
V TACH
VT > 2
V BRADY
COUPLET
BIGEMINY
ACC VENT
PAUSE
TRIGEMINY
R ON T
PVC
TACHY
BRADY
IRREGULAR/ATRIAL FIB
D-2 Dash
®
3000/4000/5000 2000966-338A
Parameter Alarm Levels
GAS
CVP
RA
UVC
LA
ICP
SP
SVO2
TC
SPO2
ART RATE
BT
ICG
RR
RESP APNEA
ART
PA
CO2
NBP
FEM
UAC
HR
CO2 NO BREATH
PVC/MIN
ST
Custom Defaults
Crisis Warning Advisory Message
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Custom Defaults
Parameter Limits
FEM RATE
UAC RATE
SPO2 RATE
TMP
HR
PVC/MIN
ST-I
ST-II
ST-III
ST-V1
ST-AVL
ST-AVF
ST-AVR
ST-V2
ST-V3
ST-V4
ST-V5
ST-V6
NBP-S
NBP-D
NBP-M
ART-S
ART-D
ART-M
D-4 Dash
®
3000/4000/5000
LOW HIGH
2000966-338A
2000966-338A
CVP
RA
UVC
LA
UAC-R
PA-S
PA-D
PA-M
ART-R
FEM-S
FEM-D
FEM-M
FEM-R
UAC-S
UAC-D
UAC-M
ICP
SP
CO2-EXP
CO2-INSP
CO2-RESP
NO BREATH
SPO2
SPO2-R
BT
RR
Dash
®
3000/4000/5000
LOW
Custom Defaults
HIGH
D-5
Custom Defaults
N2-INSP
N2-EXP
SEV-INSP
SEV-EXP
DES-INSP
DES-EXP
ENF-INSP
ENF-EXP
SVO2
RR-APNEA
TEMP 1
TEMP 2
O2-INSP
O2-EXP
N2O-INSP
N2O-EXP
HAL-INSP
HAL-EXP
ISO-INSP
ISO-EXP
HE-INPS
HE-EXP
AR-INP
AR-EXP
CI
LOW HIGH
D-6 Dash
®
3000/4000/5000 2000966-338A
Display Defaults
TFC
BIS
PATIENT AGE
DISPLAY MODE
COLOR FORMAT
PRIMARY ECG
ECG WAVEFORM 2
ARRHYTHMIA
DETECT PACE
ARTERIAL RATE
LEAD ANALYSIS
ST ANALYSIS
ST TEMPLATES
ST V LEAD
ST TEMPLATE 1
ST TEMPLATE 2
ST TEMPLATE 3
ADJUST ST POINT
12 LD ON ST HISTORY
ECG WF SPEED
PRINT WAVEFORM 2
PRINT WAVEFORM 3
PRINT WAVEFORM 4
LOW
Custom Defaults
HIGH
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®
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Custom Defaults
D-8
PRINT ON ALARM
TIMED GRAPH
ART DISCONNECT
SMART BP
ARTERIAL SCALE
PA SCALE
CVP-RA-UVC SCALE
LA SCALE
ICP SCALE
SP SCALE
BP WF SPEED
CO2 SCALE
CO2 WF SPEED
NBP AUTO
ADULT CUFF PRESSURE
PED CUFF PRESSURE
NEO CUFF PRESSURE
CO CATHETER
CO INJ TEMP
CO SIZE
CO INJ VOL
CO AUTO MODE
N2O COMPENSATION (OR ONLY)
O2 COMPENSATION
RR PARAMETER
RR LEAD
RR WF SPEED
Dash
®
3000/4000/5000 2000966-338A
2000966-338A
SPO2 WF SPEED
VIEW ON ALARM
VOA BROADCAST
VOA ALERT TONE
REMOTE ALARM LEVEL
ALARM VOLUME
ALARM VOLUME OFF
MIN ALARM VOLUME
SILENCE ALARM
QRS VOLUME
RATE VOLUME
ECG LEADS FAIL
SPO2 PROBE OFF
SPO2 PULSE SEARCH
MONITOR ISO/DES
DISPLAY LIMITS
DISPLAY UNITS
UNITS FOR HEIGHT
UNITS FOR WEIGHT
TEMPERATURE UNITS
CO2 UNITS
O2 UNITS
GAS UNITS
NBP LIMITS TYPE
ARTERIAL LIMITS TYPE
PA LIMITS TYPE
MENU TIMEOUT
Dash
®
3000/4000/5000
Custom Defaults
D-9
Custom Defaults
D-10
ECG FILTER
BP FILTER
QRS WIDTH
CO2 DISPLAY MODE
DISCHARGE ALERT
VENT WF SPEED
DISPLAY MAC VALUE
DISABLE SAM HAL
DISABLE SAM ENF
TECH ID FIELD
ICG PRIMARY PAR
ICG SECONDARY PAR1
ICG SECONDARY PAR2
ICG SECONDARY PAR3
NBP SILENCE ALARM
PAUSE BREAKTHRU
MASIMO AVERAGING
ECG INTELLIRATE
ECG PARAMETER
DISCONNECTION OPTION
NBP CLOCK SYNC
AVOA ALARM LEVEL
REMOTE SILENCE
AVOA SILENCE
PERSISTENT CO2
ECG RATE AVERAGING
BEAT PAUSE INTERVAL
Dash
®
3000/4000/5000 2000966-338A
Custom Defaults
UNIT ROVING
DOSE CALCS WT XFER
NBP PULSE RATE
NBP NO DETERMINATION
TRENDS HARDKEY
COMBO DEFAULT SOURCE
CLOCK DISPLAY
BIS SMOOTH RATE
EEG WF SCALE
EEG WF SPEED
Parameter Priority Defaults
Indicate which parameters you want to have priority in the first six positions on the display.
PARAMETER 1 ECG
PARAMETER 2
PARAMETER 3
PARAMETER 4
PARAMETER 5
PARAMETER 6
Circle the other parameters you want to have priority after position 6. Size of the parameter window determines how many selections you can make (three full size, five reduced size, or combination thereof). The software prevents you from selecting more parameters than allowable.
GAS
NBP
RA*
UVC*
TEMP*
ALARMS
ART
FEM
LA*
ICP*
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®
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Custom Defaults
.
UAC
PA
CO2
CVP*
SP*
SPO2*
CO*
RESP*
* May be displayed as reduced size (determined by software).
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®
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E
Interfacing with Non-GE
Devices
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®
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Interfacing with Non-GE Devices
Introduction
General
Safety
When connected to a Unity Network Interface Device (ID) connectivity device, the monitor can interface with up to seven non-GE peripheral bedside devices at the same time. The connectivity device is intended for use on one patient at a time.
For more information on the Unity Network ID connectivity device, refer to the operator and service manuals.
The following safety statements apply when interfacing with non-GE devices.
WARNING
ACCURACY — Patient information transferred by the connectivity device must be qualified by medical personnel before permanent storage in a database.
WARNING
ALARMS — The peripheral device’s alarms must not be turned off or the volume reduced in any way to diminish the importance of the peripheral device as the primary alarm source for parameters monitored by the peripheral device.
WARNING
CORRECT INTERFACE ADAPTER — Use of the wrong interface adapter may cause improper operation of the supported peripheral device. Verify that the correct interface adapter on the peripheral device is operational before the device is used on a patient.
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WARNING
INSTALLATION — Qualified technical personnel must connect the interface adapter to the peripheral device and make any necessary adjustments to the peripheral device (baud rate, parity, etc.) as described in the specific installation instructions for the interface adapter.
Insert cabling from the Unity Network ID connectivity device only into specified interface adapters and specified peripheral devices.
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 and personnel. Do not install in a location where the device may drop on a person.
WARNING
SINGLE PATIENT USE — All eight serial ports on the connectivity device must only be used by ONE patient.
CAUTION
INSTALLATION — To avoid accidental ingress of liquids, always mount the connectivity device in a vertical position with the connectors at the bottom.
CAUTION
TREATMENT — Do not treat a patient based solely on the alarm messages and/or numerics presented via the connectivity device to the monitor. You must verify the accuracy of the alarm message and/or numerics at the peripheral device itself before initiating treatment. Treatment should be based on the information presented at the peripheral device.
Non-GE Device Information
Displayed Data
The peripheral device data that displays on the monitor varies by device, as shown in the following table.
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Device
Anesthesia machines
Continuous cardiac output
Gas analyzers
IV pumps
Pulse oximeters
Transcutaneous monitors
Urometers
Ventilators
Compatible Devices
Waveform
Yes
No
Yes
No
No
No
No
Yes
Parameter
Window
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Trends
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Alarm
Broadcast
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Graphing
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
The monitor only displays the information the peripheral device sends to the connectivity device. The parameters sent vary with each external device and are subject to change without notice by the manufacturer.
If the peripheral device manufacturer changes any parameters or information sent, the connectivity device will not send any of the new parameter information over the network.
The following peripheral devices are compatible with the monitor at the time this document was published.
NOTE
These devices are compatible with Dash 3000/4000/5000 software version 3 or later and Unity Network Interface Device software version 1 or later.
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Device Type
Anesthesia machine
Continuous cardiac output
Continuous cardiac output with
SVO2
Gas analyzer
Manufacturer and Model
Dräger
®
Julian
Dräger Cato, PM8050
Dräger Cicero EM
Dräger PM8060
Dräger Primus (Not for sale in the United States)
North American Dräger
Narkomed
2B, 2C, GS: Vent only
3, 4, 6000: Vent, Gas, CO
2
Ohmeda
®
7800, 7810
Ohmeda 7900
Ohmeda Aestiva 3000
Ohmeda Engstrom
Ohmeda Aisys
Ohmeda Avance
Abbott Q-Vue
Pulsion Picco, Picco Plus
Abbott Q-2
Baxter Edwards
®
Vigilance
Datex Capnomac Ultima
Ohmeda 5250 RGM
Ohmeda Rascal II
Parameters
VNT, CO
2
, GAS
VNT, CO
2
, GAS
VNT, CO
2
, GAS
VNT, CO
2
, GAS
VNT, CO
2
, GAS
All versions: VNT
3, 4, 6000: VNT, CO
2
, GAS
VNT
VNT
VNT
VNT
VNT
VNT
CCO
CCO
CCO, SVO2
CCO, SVO2
GAS, CO
2
GAS, CO
2
GAS, CO
2
Alarms
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Status messages only
Status messages only
Status messages only
Yes
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Device Type
IV pump
Multi-parameter monitor
Pulse oximeter
Pulse oximeter/gas analyzer
Transcutaneous monitor
Urometer
Manufacturer and Model Parameters
Abbott LifeCare 5000
Alaris
®
Medical Systems 560M,
570
Alaris Medical Systems Gemini
PC-1, PC-2, PC-2TX, PC-4
Alaris Medical IVAC Signature
7130, 7230
NA
NA
NA
IV
Baxter Edwards Flowgard
6201, 6301
Hellige SMU EVO
NA
Siemens
®
SC9000
GAS, CO
2
, SpO
2
, TCO
2
SpO
2
Nellcor Puritan Bennett
®
N-200
SpO
2
Nellcor Puritan Bennett N-395 SpO
2
, CO
2
Nellcor Puritan-Bennett N1000 SpO
2
, CO
2
, GAS
Nellcor Puritan-Bennett N2500 SpO
2
, CO
2
, GAS
Novametrix 840 PtcO2/
PtcCO2, TCO2M
TCO
2
Radiometer TINA (TCM3) TCO
2
TCO
2
Linde MicroGas 7650
(Not for sale in the United
States)
Bard CritiCore UO
Alarms
Status messages
Status messages
Status messages
Status messages
Status messages
No
No
Yes
Yes
Yes
Yes
Status messages
Yes
Yes
Status messages
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®
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Device Type
Ventilator
Ventilator (adult/neonatal)
Ventilator (neonatal)
Interfacing with Non-GE Devices
Manufacturer and Model
Bear 1000
Bird 6400ST, 8400ST
Dräger Evita
Dräger Evita XL
Dräger Fabius GS
Dräger Savina
Hamilton Amadeus, Veolar
Hamilton Galileo
Nellcor Puritan Bennett Adult
Star, Adult Star 1500, 2000
Nellcor Puritan Bennett
7200SPE, AE, E
Puritan-Bennett 840
Parameters
VNT
VNT
VNT
VNT
VNT
VNT
VNT
VNT, CO
2
VNT
VNT
Yes
Yes
Yes
Yes
Yes
Alarms
Yes
Yes
Yes
Yes
Yes
VNT
Respironics Espirit
Stephan Christina, Stephanie
(Not for sale in the United
States)
Bird VIP
Dräger Babylog 8000
VNT
Siemens Servo-i VNT
Siemens SV900C, 900D, 900E VNT
Siemens SV300
Nellcor Puritan Bennett Infant
Star, Infant Star 500, 950
VNT
VNT
VNT
VNT
Yes
VNT Yes
Yes
No
Yes
No
Yes
Yes
Yes, with the following exceptions:
•
V
E TOT
V
TE MAND
V
TE SPONT
V
TI SPONT
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Limitations
Duplicate Devices
Duplicate Parameters
„
„
„
„
„
„
„
„
The connectivity device can support a pre-defined number of each device type and up to eight total devices, including the monitor. When the maximum number is exceeded on any device type, the connectivity device ignores all data from the duplicate device.
One ventilator, anesthesia machine or gas analyzer.
Seven IV pumps.
One transcutaneous monitor.
One urometer.
One continuous cardiac output monitor.
One multi-parameter monitor.
Two pulse oximeters.
One auto-association device (GE monitor).
„
„
„
„
„
„
The connectivity device can support a pre-defined number of parameters. When the maximum number is exceeded, the connectivity device ignores all data from the duplicate parameter.
Two SpO
2
parameters.
Four temperature parameters.
Eight BP parameters.
Eight IV parameters.
One CO
2
or Gas parameter.
One each of all other parameters
CO
2
and Gas Parameter Handling
The connectivity device requires that CO
2
and Gas parameters originate from the same peripheral device. If a device only provides one of the parameters, the connectivity device does not recognize the other parameter from any other peripheral device.
However, when the connectivity device is connected to a Dash 3000/4000 monitor, the monitor controls which source of CO
2
and Gas parameter data is used. The monitor does NOT require that CO
2
and Gas parameters originate from the same peripheral device.
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SAM Module
No
No
No
Yes
Yes
Yes
Yes
Setup
Refer to the following table for more information CO
2
and Gas parameter data.
Monitor CO
2
Option
Yes
Yes
No
No
Yes
No
Yes
Unity Network ID
No
Yes
Yes
No
No
Yes
Yes
CO
2
Data Source
SAM module
SAM module
SAM module
SAM module
Monitor
Monitor
Unity Network ID
Gas Data Source
SAM module
SAM module
SAM module
SAM module
None
Unity Network ID
Unity Network ID
Connecting the Monitor
The monitor and the connectivity device much be connected to the same network.
To connect a monitor to a connectivity device, follow this procedure.
1.
Turn off the monitor and connectivity device.
2.
Connect one end of the purple interconnect cable to the AUX connector on the monitor or docking station.
3.
Connect the other end of the purple interconnect cable to the serial port labeled
1 on the connectivity device.
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I
0
4.
Connect one end of the network cable to the Ethernet connector on the connectivity device.
5.
Connect the other end of the network cable to the Ethernet connector on the monitor or docking station.
6.
Turn on the monitor and connectivity device.
Connecting Peripheral Devices
A unique, factory-programmed interface adapter is required for each peripheral device. Refer to the instructions provided with the interface adapter for setup and installation instructions.
To assure proper operation, GE recommends permanently connecting interface adapters to peripheral device cables.
To connect peripheral devices to the connectivity device, follow this procedure.
1.
Connect the interface adapter to the peripheral device cable.
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2.
Connect the interface adapter in any of the remaining serial ports labeled 2-8.
Serial port 1 is reserved for the monitor.
3.
Turn on the connectivity device and peripheral devices.
Establishing Communication
When properly connected, the monitor and the connectivity device automatically identify each other and the connected peripheral device. You can determine the connection status for each serial port with the following connectivity device status indicators:
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®
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Interfacing with Non-GE Devices
off
Green
Indicator
off
Yellow
Indicator
on slow flash fast flash
Serial Port Status
No connection
Pending communication
Communication error
Other errors
Communicating
Description
Nothing is connected to this serial port or the interface connector is not operational.
The cable and interface adapter are connected, but communication with the peripheral device is not established yet.
The peripheral device is connected, but there is a communication error.
Use the following guidelines to identify the error:
„
„
„
Too many devices of one type are connected.
Device software is not compatible with monitor software.
Interface adapter is not supported by the monitor software.
Communication with the device is working.
on
Customizing Data Display
Default Parameter Alarm Levels
Configure all alarm levels on the monitor. When connected to a monitor, the connectivity device follows the alarm levels defined in the MONITOR DEFAULTS menu. The peripheral device does not determine the alarm level displayed or broadcast by the monitor.
Refer to the following table for the monitor’s factory default parameter alarm levels.
CRISIS WARNING
X
ADVISORY MESSAGE
VENT
SVO2
TC
X
X
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CCO
ICG
CRISIS WARNING ADVISORY MESSAGE
X
X
Alarm Limits
You must configure all alarm limits on the monitor. The monitor only displays and enunciates the alarm limit violations defined on the peripheral device.
Parameter Windows and Menus
The parameters displayed by the monitor from a peripheral device vary from device to device. Anesthesia machines, parameter modules, gas analyzers and ventilators are capable of sending parameters to the monitor. In some cases, not all parameters can be displayed at one time.
To add parameters to the display, use the following procedure.
1.
Select MONITOR SETUP.
2.
Select PARAMETERS ON/OFF. All parameters sent to the monitor display in the AVAILABLE PARAMETERS information window.
3.
Select the parameters you want to display.
4.
Select RETURN to close the window.
Peripheral Device Monitoring Guidelines
Anesthesia Interface
„
„
„
When an anesthesia interface is connected, the following applies:
The monitor can display up to three parameters: CO
2
, GAS and Vent.
The information displayed varies by device.
For more information, refer to Chapter 15 and Chapter 16.
Gas Interface
When a gas interface is connected, the following applies:
„
The monitor displays CO
2
and GAS parameter windows.
2000966-338A Dash
®
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Interfacing with Non-GE Devices
„
„
The information displayed varies by device.
For more information, refer to Chapter 15.
Pulse Oximeter Interface
Transcutaneous pO
2
/pCO
2
Interface
When a transcutaneous pO
2
/pCO
2
interface is connected, the following applies:
„
„
The monitor displays a TC parameter window.
The information displayed varies by device.
Ventilator Interface
When a pulse oximeter interface is connected, the following applies:
„
„
„
The monitor displays an SpO
2
parameter window.
The information displayed varies by device.
For more information, refer to Chapter 11.
Continuous Cardiac Output
When a ventilator interface is connected, the following applies:
„
„
„
„
The monitor displays a VENT parameter window.
The monitor displays up to four ventilator parameters.
The information displayed varies by device.
The control settings vary by device.
When a cardiac output interface is connected, the following applies:
„
„
„
„
The monitor displays a CCO parameter window.
The monitor may display an additional SvO
2
parameter window.
The information displayed varies by device.
For more information, refer to Chapter 12.
IV Pump
When an IV pump interface is connected, the following applies:
„ The monitor does not display a parameter window for IV pumps.
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„
„
The monitor does not broadcast alarms.
The information displayed varies by device.
Interfacing with Non-GE Devices
Urometers
When a urometer interface is connected, the following applies:
„
„
„
The monitor displays a UO parameter window.
The information displayed varies by device.
The temperature is displayed and trended as an indicator of core temperature.
Additional Information
For more information on the intended use, safety and setup information for any interface with the Unity Network ID connectivity device, refer to the Unity Network
ID connectivity device operator’s manual.
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F
Abbreviations and
Symbols
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®
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Abbreviations and Symbols
Abbreviations
Arr, Arrhy
ART
Auto
Aux
A-V
AVG
AVOA
AC
Acc
ACI
AD
AFIB
ALRM
AMI
ANT
The following abbreviations and symbols that you may encounter while reading this manual are listed below with their meanings.
12SL
BIS
BP
Brady
BT
C
12-lead ECG analysis
A alternating current accelerated acceleration index adult atrial fibrillation alarm acute myocardial infarctions anterior arrhythmia arterial automatic auxiliary arterial venous average automatic view on alarm
B bispectral index blood pressure bradycardia blood temperature
C celsius
F-2 Dash
®
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2000966-338A
D
DDW
DES
DIDCA
DSC
E e.g.
cm
CO
CO
CO
2 comm
CP
CPP
CRG
CSA
CVP
CCO
CD
CI
CIC
Cal
Calc, calcs cc
CC
Abbreviations and Symbols
calibrate calculation(s) cubic centimeter computation constant continuous cardiac output compact disc cardiac index
Clinical Information Center centimeter cardiac output carbon monoxide carbon dioxide communication cardiopulmonary cerebral perfusion pressure cardiorespirogram
Canadian Standards Association central venous pressure
D diastolic direct digital writer desflurane direct interface device connection adapter digital signal converter
E expired for example
Dash
®
3000/4000/5000 F-3
Abbreviations and Symbols
F
FEM
G gHz gtt
ECG eDO2I
EEG
EMC
EMI
ENF
ESU et al
ET CO
2 etc.
ETO
EXP
HAL
Hb
HR
Hz
I
IABP electrocardiograph estimated delivered oxygen index electroencephalograph electromagnetic compatibility electromagnetic interference enflurane electrosurgical cautery unit and others end-tidal carbon dioxide etcetera ethylene oxide expired
F
Fahrenheit femoral
G gram gigahertz drops
H halothane hemoglobin heart rate hertz
I inspired intra-aortic balloon pump
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J kg
LA
LAN
LAT
LBS
L
L
L
LA
IT
IV
INSP
INT
INF
ISO in
INDV
INF
Inject
ICG
ICP
ICU
ID impedance cardiography intracranial pressure intensive care unit identification inches individual infusion, inferior injectate inspired interior inferior isoflurane injectate temperature intravenous
J
ST measurement point
K kilogram
L lead left liter left arm left atrial local area network lateral pounds
Abbreviations and Symbols
Dash
®
3000/4000/5000 F-5
Abbreviations and Symbols
M
MAC
MAP
Min mm mmHg
MPSO
MRI ms mV
LCWI
LD
LED
LIS
LL
LVET
LVSWI
N/A
N
2
O
NBP, NIBP
Neo
O
2
O
2
CI
OR left cardiac work index lead light emitting diode lab information system left leg left ventricular ejection time left ventricular stroke work index
M mean minimum alveolar concentration mean arterial pressure minimum millimeters millimeters of mercury multiple portable socket outlet magnetic resonance image milliseconds millivolt not applicable
N nitrous oxide non-invasive blood pressure neonatal
O oxygen oxygen consumption index operating room
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®
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2000966-338A
P
PA
PAD
Par
PAW
PC pCO
2
, pO
2
PED
PEP
PVC
QRS
Qty
RF
RHY
RL
RR
R
R
RA
RA
REF
Reprep
RES
Resp
Abbreviations and Symbols
P pace pulmonary artery pulmonary artery diastolic parameter pulmonary artery wedge personal computer partial pressure of arterial carbon dioxide right rate right arm right atrial reference re-prepare resistance respiration pediatric pre-ejection period premature ventricular contractions
Q interval of ventricular depolarization quantity
R radio-frequency rhythm right leg respiration rate
Dash
®
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Abbreviations and Symbols
SvO2
SVR
SVRI
Sync
ST
Stat
STR
SV
Sol
SP
SpO
2
SQI
S sec
SEV
SIM
T1, T2
Tachy
TC
Tech
Temp, TMP, TP
TFC
TIR
UAC
S systolic second sevoflurane simulator solution special arterial oxygen saturation (pulse oximetry) signal quality index interval of ventricular repolarization right away systolic time ratio stroke volume mixed venous oxygen saturation systemic vascular resistance systemic vascular resistance index synchronized
T temperature site tachycardia transcutaneous technical temperature thoracic fluid content technical information report
U umbilical artery catheter
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®
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Symbols
-
#
%
>
<
&
°
UO
UVC
V
V
V
Vent
VFib
VI
VOA
Vol
VTach
WF, WFS
X
X urometer umbilical venous catheter
V volt version ventrical lead ventilator ventricular fibrillation velocity index view on alarm volume ventricular tachycardia
W waveform(s) multiplier (2X)
X invalid data
Abbreviations and Symbols
and degree(s) greater than less than minus number percent
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Abbreviations and Symbols
"
±
µ plus or minus inches micro
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®
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Index
Index
Numerics
12 lead analysis .................................................... 8-21
12SL........................................................................ 3-3
A
admit ................................................................ 5-2–5-5
manual.............................................................. 5-2
quick ................................................................. 5-3
admit mode
see monitoring mode ........................................ 3-3
AFIB ........................................................................ 8-3
alarm history ........................................................... 7-2
alarms .............................................................. 4-2–4-8
pause ......................................................... 4-6
volume........................................................ 4-5
pause breakthrough.......................................... 4-6
safety ................................................................ 4-4
silence .............................................................. 4-6
analog output
ECG.................................................................. 8-7
IP ...................................................................... 9-3
anesthesia gases ....................................... 16-2–16-10
control settings ............................................... 16-6
analysis .................................................... 16-8
CP alarm bypass...................................... 16-8
display mode ............................................ 16-7
gas alarm limits ........................................ 16-8
MAC values.............................................. 16-9
mode ........................................................ 16-7
HAL and ENF ................................................. 16-9
safety .............................................................. 16-3
troubleshooting ............................................... 16-9
B
basic........................................................................ 3-3
batteries ........................................................ A-6–A-14
capacity ............................................................ A-9
gauge................................................................ A-9
recycling ......................................................... A-13
storing............................................................. A-12
troubleshooting ............................................... A-14
waking-up ....................................................... A-13
BIS ............................................................... 18-2–18-9
EEG scale ................................................ 18-6
waveform smoothing ................................ 18-5
DSC test ......................................................... 18-7
safety .............................................................. 18-3
troubleshooting ............................................... 18-8
C
dosage............................................................ 7-11
pulmonary....................................................... 7-13
cardiac .................................................................... 3-3
cardiac calculations............................................... 7-10
cardiopulmonary ..................................................... 3-3
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Index
cleaning........................................................... A-3–A-5
CO................................................................ 12-2–12-8
control settings ............................................... 12-3
computation constant ............................... 12-5
troubleshooting ............................................... 12-7
CO trial .................................................................. 12-5
CO2.............................................................. 15-2–15-8
calibrating sensors.......................................... 15-6
calibrate adapter ...................................... 15-6
capnogram scale...................................... 15-5
N2O compensation .................................. 15-5
zero sensor .............................................. 15-6
safety .............................................................. 15-3
troubleshooting ............................................... 15-8
CO2 control settings
compliance ................................................... 1-15–1-17
EMI ................................................................. 1-16
EN................................................................... 1-15
FCC ................................................................ 1-17
UL ................................................................... 1-16
auxiliary ............................................................ 2-6
DC power.......................................................... 2-5
defib sync ......................................................... 2-6
ethernet ............................................................ 2-5
patient............................................................... 2-3
control settings ........................................................ 3-9
display colors.................................................. 3-10
IP ...................................................................... 9-5
waveforms ........................................................ 3-9
control setttings
waveform display options ................................. 3-9
CRG trends ............................................................. 7-7
custom defaults
D
Danger .................................................................... 1-2
discharge .......................................................... 5-5–??
manual.............................................................. 5-5
dosage calculations .............................................. 7-11
E
ECG ............................................................... 8-2–8-23
12 lead analysis.............................................. 8-21
AFIB.................................................................. 8-3
control settings ............................................... 8-11
arrhythmia ................................................ 8-13
beat pause interval................................... 8-14
clear messages ........................................ 8-13
IntelliRate ................................................. 8-14
lead analysis ............................................ 8-13
QRS volume............................................. 8-14
QRS width ................................................ 8-14
relearn pattern.......................................... 8-11
waveform filter.......................................... 8-12
waveform size .......................................... 8-11
waveform speed....................................... 8-14
custom defaults
AFIB alarm level....................................... 8-18
source ...................................................... 8-15
IntelliRate.......................................................... 8-5
safety ................................................................ 8-8
ST analysis ..................................................... 8-18
troubleshooting ............................................... 8-23
equipment symbols ............................................... 1-14
G
graphic trends ......................................................... 7-5
I
IABP ........................................................................ 9-6
ICG............................................................... 17-2–17-8
control settings ............................................... 17-5
beat average ............................................ 17-7
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Index
fastlook..................................................... 17-6
signal quality ............................................ 17-7
waveform speed....................................... 17-7
waveform types ........................................ 17-6
safety .............................................................. 17-3
troubleshooting ............................................... 17-7
IntelliRate ................................................................ 8-5
interfaced devices ................................................... E-2
compatible devices ........................................... E-4
defaults ........................................................... E-12
displayed data .................................................. E-3
guidelines ....................................................... E-13
installation......................................................... E-9
limitations.......................................................... E-8
IP...................................................................... 9-2–9-9
analog output.................................................... 9-3
control settings ................................................. 9-5
alarm .......................................................... 9-7
alarm limits ................................................. 9-5
calibrate transducer.................................... 9-6
cursor ......................................................... 9-5
filters........................................................... 9-6
IABP ........................................................... 9-6
smart BP .................................................... 9-7
troubleshooting ................................................. 9-9
K
keys......................................................................... 2-6
Admit ................................................................ 2-7
Discharge ......................................................... 2-7
Main Menu........................................................ 2-7
NBP Go/Stop .................................................... 2-6
Power ............................................................... 2-6
Print .................................................................. 2-6
Silence Alarm ................................................... 2-7
Standby ............................................................ 2-7
Trends .............................................................. 2-7
Zero All ............................................................. 2-7
L
lab data ................................................................... 7-9
M
custom defaults ................................................ 3-6
parameter alarm levels .............................. 3-8
factory defaults ................................................. 3-6
monitoring modes ................................................... 3-3
N
NBP............................................................ 10-2–10-12
control settings ............................................... 10-7
options ............................................................ 10-3
safety .............................................................. 10-4
troubleshooting ............................................. 10-12
O
optional components .................................... 2-10–2-14
P
manual.............................................................. 9-9
parameter windows
BIS.................................................................. 18-2
CO .................................................................. 12-2
CO2 ....................................................... 15-2, 16-2
ECG.................................................................. 8-2
GAS ................................................................ 16-2
IP ...................................................................... 9-2
RR .................................................................. 13-2
SPO2 .............................................................. 11-2
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Index
TP ................................................................... 14-2
patient information .................................................. 5-2
patient status alarms ............................................... 4-3
patient-monitor type ................................................ 3-4
control settings ................................................. 6-2
pulmonary calculations ......................................... 7-13
Pulse Oximeter ................................................... 11-13
R
RR ................................................................ 13-2–13-5
safety .............................................................. 13-3
troubleshooting ............................................... 13-5
RR control settings
S
safety ...................................................................... E-2
alarms............................................................... 4-4
anesthesia gases............................................ 16-3
arrhythmia......................................................... 8-9
BIS.................................................................. 18-3
CO2 ................................................................ 15-3
ECG.................................................................. 8-8
general..................................................... 1-2–1-13
cautions...................................................... 1-8
dangers ...................................................... 1-2
notes ........................................................ 1-13
warnings..................................................... 1-2
ICG ................................................................. 17-3
interfaced devices............................................. E-2
NBP ................................................................ 10-4
pacemaker........................................................ 8-8
respiration....................................................... 13-3
SPO2 .............................................................. 11-7
service mode......................................................... 3-11
SmartBP.................................................................. 9-7
software
software options ...................................................... 3-3
Unity Network ................................................... 3-3
software packages .................................................. 3-2
SPO2 ......................................................... 11-2–11-17
persistent ............................................... 11-11
pulse rate ............................................... 11-10
response mode ...................................... 11-12
SatSeconds............................................ 11-12
options ............................................................ 11-3
Masimo .................................................... 11-3
Nellcor ...................................................... 11-4
Ohmeda ................................................... 11-5
safety .............................................................. 11-7
neonates .................................................. 11-9
troubleshooting ............................................. 11-16
waveforms ...................................................... 11-2
ST analysis ........................................................... 8-18
control settings ............................................... 8-19
12 lead analysis ....................................... 8-21
off ............................................................. 8-19
point ......................................................... 8-21
trend scale ............................................... 8-20
standby ................................................................. 2-15
system staus alarms ............................................... 4-4
T
The .......................................................................... 4-2
TP ................................................................ 14-2–14-3
trends
CRG (high resolution)....................................... 7-7
graphic.............................................................. 7-5
vital signs.......................................................... 7-4
Index-4 Dash
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Index
Trim Knob control.................................................... 2-8
troubleshooting
anesthesia gases............................................ 16-9
batteries.......................................................... A-14
BIS.................................................................. 18-8
CO .................................................................. 12-7
CO2 ................................................................ 15-8
ECG................................................................ 8-23
ICG ................................................................. 17-7
IP ...................................................................... 9-9
NBP .............................................................. 10-12
RR .................................................................. 13-5
SPO2 ............................................................ 11-16
TP ................................................................... 14-3
V
view other patients ......................................... 5-6–5-14
control settings ............................................... 5-10
custom defaults ................................................ 5-8
alarm level................................................ 5-10
view on alarm ............................................. 5-9
limitations.......................................................... 5-7
options .............................................................. 5-6
split-view display............................................. 5-12
W
SPO2 .............................................................. 11-2
wireless LAN ......................................................... 2-15
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Index
Index-6 Dash
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World Headquarters
GE Medical Systems
Information Technologies, Inc.
8200 West Tower Avenue
Milwaukee, WI 53223 USA
Tel: + 1 414 355 5000
1 800 558 5120 (US only)
Fax: + 1 414 355 3790
European Representative
GE Medical Systems
Information Technologies GmbH
Munzinger Straße 3-5
D-79111 Freiburg
Germany
Tel: + 49 761 45 43 - 0
Fax: + 49 761 45 43 - 233
Asia Headquarters
GE Medical Systems
Information Technologies Asia; GE (China) Co., Ltd.
24th Floor, Shanghai MAXDO Center,
8 Xing Yi Road, Hong Qiao Development Zone
Shanghai 200336, P.R. China
Tel: + 86 21 5257 4650
Fax: + 86 21 5208 2008
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