PM-9000 Portable Multi-Parameter Patient Monitor

PM-9000 Portable Multi-Parameter Patient Monitor
PM-9000
Portable Multi-parameter
Patient Monitor
Operation Manual
Copyright
SHENZHEN MINDRAY BIO-MEDICAL ELECTRONICS CO., LTD. 2002
Version:
V5.4
Issued date: 2004/08/08
Serial No:
PM-9000
Statement
SHENZHEN MINDRAY BIO-MEDICAL ELECTRONICS CO., LTD. (hereinafter called Mindray)
owns all rights to this unpublished work and intends to maintain this work as confidential.
Mindray may also seek to maintain this work as an unpublished copyright. This publication is
to be used solely for the purposes of reference, operation, maintenance, or repair of Mindray
equipment. No part of this can be disseminated for other purposes.
In the event of inadvertent or deliberate publication, Mindray intends to enforce its rights to
this work under copyright laws as a published work. Those having access to this work may
not copy, use, or disclose the information in this work unless expressly authorized by Mindray
to do so.
All information contained in this publication is believed to be correct. Mindray shall not be
liable for errors contained herein nor for incidental or consequential damages in connection
with the furnishing, performance, or use of this material. This publication may refer to
information and protected by copyrights or patents and does not convey any license under the
patent rights of Mindray, nor the rights of others. Mindray does not assume any liability arising
out of any infringements of patents or other rights of third parties.
Content of this manual is subject to changes without prior notice.
PROPERTY OF
SHENZHEN MINDRAY BIO-MEDICAL ELECTRONICS CO., LTD. 2002
ALL RIGHTS RESERVED
Responsibility on the manufacturer party
Mindray is responsible for safety, reliability and performance of this equipment only in the
condition that:
Patient Monitor user’s manual (V 5.4)
I
• all installation, expansion, change, modification and repair of this equipment are conducted
by Mindray qualified personnel; and,
• applied electrical appliance is in compliance with relevant National Standards; and,
• the monitor is operated under strict observance of this manual.
Note
This equipment is not intended for family usage.
Warning
This monitor is not a device for treatment purpose.
It is important for the hospital or organization that employs this equipment to carry out a
reasonable maintenance schedule. Neglect of this may result in machine breakdown or injury
of human health.
II
Patient Monitor user’s manual (V 5.4)
Warranty
Workmanship & Materials
Mindray guarantees new equipment other than accessories to be free from defects in
workmanship and materials for a period of 18 months (six months for multi-site probes and
SpO2 sensor) from date of shipment under normal use and service. Mindray's obligation
under this warranty is limited to repairing, at Mindray’s option, any part which upon Mindray's
examination proves defective.
THIS WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER WARRANTIES,
EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF MERCHANT ABILITY OR
FITNESS FOR ANY PARTICULAR PURPOSE.
Exemptions
Mindray's obligation or liability under this warranty does not include any transportation or
other charges or liability for direct, indirect or consequential damages or delay resulting from
the improper use or application of the product or the substitution upon it of parts or
accessories not approved by Mindray or repaired by anyone other than a Mindray authorized
representative.
This warranty shall not extend to any instrument which has been subjected to misuse,
negligence or accident; any instrument from which Mindray's original serial number tag or
product identification markings have been altered or removed, or any product of any other
manufacturer.
Safety, Reliability and Performance
Mindray is not responsible for the effects on safety, reliability and performance of the
PM-9000 Portable Patient Monitor if:
assembly operations, extensions, re-adjusts, modifications or repairs are carried out by
persons other than those authorized by Mindray.
the PM-9000 Portable Patient Monitor is not used in accordance with the instructions for
use, or the electrical installation of the relevant room does not comply with NFPA 70:
National Electric Code or NFPA 99: Standard for Health Care Facilities (Outside the
United States, the relevant room must comply with all electrical installation regulations
mandated by the local and regional bodies of government).
Patient Monitor user’s manual (V 5.4)
III
Return Policy
Return Procedure
In the event that it becomes necessary to return a unit to Mindray, the following procedure
should be followed:
1.
Obtain return authorization. Contact the Mindray Service Department and obtain a
Customer Service Authorization (Mindray) number. The Mindray number must appear on
the outside of the shipping container. Return shipments will not be accepted if the
Mindray number is not clearly visible. Please provide the model number, serial number,
and a brief description of the reason for return.
2.
Freight policy. The customer is responsible for freight charges when equipment is
shipped to Mindray for service (this includes customs charges).
Company Contact
Address:
Mindray Building, Keji 12th Road South, Hi-tech
Industrial Park, Nanshan, Shenzhen, P. R. China
518057,
Phone:
+86 755 2658 2888
Fax:
+86 755 2658 2680
Free hot line: +86 800 830 3312
EC Representative
IV
Name:
Shanghai International Holding Corp. GmbH(Europe)
Address:
Eiffestrasse 80 D-20537 Hamburg Germany
Phone:
+49 40 2513174
Fax:
+49 40 255726
Patient Monitor user’s manual (V 5.4)
Preface
This manual gives detailed description to PM-9000 Portable Patient Monitor concerning its
performance, operation, and other safety information. Reading through this manual is the first
step for the user to get familiar with the equipment and make the best out of it.
Following symbols indicates some important facts that you have to pay special attention to:
Warning
Caution
Note
Points to be noted to avoid injury to the patient and the operator.
Points to be noted to avoid damage to the equipment.
Points to be noted.
This manual is intended for persons who are trained in the use of this field and have adequate
experience in operation of monitoring equipment.
Patient Monitor user’s manual (V 5.4)
V
Content
Content
Chapter 1 Introduction ...................................................................................................... 1-1
1.1 General Information................................................................................................... 1-3
1.2 Screen Display .......................................................................................................... 1-5
1.3 Button Functions ....................................................................................................... 1-8
1.4 Interfaces................................................................................................................. 1-10
1.5 Built-in Battery ......................................................................................................... 1-14
Chapter 2 Getting Started.................................................................................................. 2-1
2.1 Open the Package and Check .................................................................................. 2-1
2.2 Connect the Power Cables........................................................................................ 2-1
2.3 Power on the Monitor ................................................................................................ 2-2
2.4 Connect Patient Sensors........................................................................................... 2-3
2.5 Check the Recorder .................................................................................................. 2-3
Chapter 3 System Menu .................................................................................................... 3-1
3.1 Patient Information Setup.......................................................................................... 3-1
3.2 Default Setup............................................................................................................. 3-3
3.3 Review....................................................................................................................... 3-4
3.4 System Setup ............................................................................................................ 3-4
3.5 Selection Setup ....................................................................................................... 3-11
3.6 Monitor Version ....................................................................................................... 3-12
3.7 Drug Calculation...................................................................................................... 3-12
3.8 Maintenance ............................................................................................................ 3-13
3.9 DEMO Function....................................................................................................... 3-16
Chapter 4 Face Select........................................................................................................ 4-1
4.1 Select Operating Screen ........................................................................................... 4-1
4.2 Standard Screen........................................................................................................ 4-1
4.3 Trend Screen ............................................................................................................. 4-2
4.4 oxyCRG Screen ........................................................................................................ 4-3
4.5 Viewbed Screen ........................................................................................................ 4-4
Chapter 5 Alarm ................................................................................................................. 5-1
5.1 Alarm Modes.............................................................................................................. 5-1
5.2 Alarm verification during power on ............................................................................ 5-4
5.3 Alarm Cause .............................................................................................................. 5-4
5.4 SILENCE and PAUSE ............................................................................................... 5-5
5.5 Parameter Alarm ....................................................................................................... 5-6
5.6 When an Alarm Occurs ............................................................................................. 5-6
Chapter 6 Freeze ................................................................................................................ 6-1
6.1 General...................................................................................................................... 6-1
6.2 Enter/Exit Freeze Status............................................................................................ 6-1
6.3 Frozen Menu ............................................................................................................. 6-2
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1
Content
6.4 Reviewing Frozen Waveform .................................................................................... 6-3
6.5 Recording Frozen Waveform .................................................................................... 6-3
Chapter 7 Recording.......................................................................................................... 7-1
7.1 General Information on Recording ............................................................................ 7-1
7.2 Recording Type ......................................................................................................... 7-1
7.3 Recording Startup...................................................................................................... 7-4
7.4 Recorder Operations and Status Messages ............................................................. 7-5
Chapter 8 Trend and Event ............................................................................................... 8-1
8.1 Trend Graph .............................................................................................................. 8-1
8.2 Trend Table................................................................................................................ 8-3
8.3 NIBP Recall ............................................................................................................... 8-4
8.4 Alarm Event Recall .................................................................................................... 8-5
Chapter 9 Drug Calculation and Titration Table.............................................................. 9-1
9.1 Drug Calculation........................................................................................................ 9-1
9.2 Titration Table ............................................................................................................ 9-3
Chapter 10 Patient Safety................................................................................................ 10-1
Chapter 11 Care / Cleaning ............................................................................................. 11-1
11.1 System Check........................................................................................................ 11-1
11.2 General Cleaning................................................................................................... 11-2
11.3 Cleaning Agents..................................................................................................... 11-2
11.4 Sterilization ............................................................................................................ 11-3
11.5 Disinfection ............................................................................................................ 11-3
Chapter 12 ECG/RESP Monitoring ................................................................................. 12-1
12.1 What Is ECG Monitoring........................................................................................ 12-1
12.2 Precautions during ECG Monitoring...................................................................... 12-1
12.3 Monitoring Procedure ............................................................................................ 12-2
12.4 ECG Screen Hot Keys........................................................................................... 12-6
12.5 ECG Menu............................................................................................................. 12-7
12.6 ECG Alarm Information and Prompt.................................................................... 12-11
12.7 ST Segment Monitoring (optional)....................................................................... 12-12
12.8 Arr. Monitoring (optional) ..................................................................................... 12-16
12.9 Measuring RESP................................................................................................. 12-20
12.10 Maintenance and Cleaning................................................................................ 12-24
Chapter 13 SpO2 Monitoring .......................................................................................... 13-1
13.1 PART 1 (MASIMO SpO2 board configuration) ...................................................... 13-1
13.1.1 Precautions ........................................................................................................ 13-3
13.1.2 Monitoring Procedure ......................................................................................... 13-5
13.1.3 Sensors and Accessories: .................................................................................. 13-8
13.1.4 Alarm Description and Prompt.......................................................................... 13-11
13.1.5 Masimo Information.......................................................................................... 13-13
13.2 PART 2 (MINDRAY SpO2 board configuration) .................................................. 13-14
13.2.1 What is SpO2 Monitoring.................................................................................. 13-14
13.2.2 Precautions during SpO2/Pulse Monitoring ..................................................... 13-15
13.2.3 Monitoring Procedure ....................................................................................... 13-16
2
Patient Monitor user’s manual (V 5.4)
Content
13.2.4 Limitations for Measurement ............................................................................ 13-18
13.2.5 SpO2 Menu ...................................................................................................... 13-18
13.2.6 Alarm Description and Prompt.......................................................................... 13-20
13.2.7 Maintenance and Cleaning............................................................................... 13-22
Chapter 14 NIBP Monitoring ........................................................................................... 14-1
14.1 Introduction............................................................................................................ 14-1
14.2 NIBP Monitoring .................................................................................................... 14-1
14.3 NIBP SETUP menu ............................................................................................... 14-5
14.4 NIBP Alarm Message ............................................................................................ 14-8
14.5 Maintenance and Cleaning.................................................................................. 14-10
Chapter 15 TEMP Monitoring.......................................................................................... 15-1
15.1 TEMP Monitoring................................................................................................... 15-1
15.2 TEMP SETUP Menu.............................................................................................. 15-2
15.3 TEMP Alarm message........................................................................................... 15-3
15.4 Care and Cleaning ................................................................................................ 15-4
Chapter 16 IBP Monitoring .............................................................................................. 16-1
16.1 Introduction............................................................................................................ 16-1
16.2 Precautions during IBP Monitoring........................................................................ 16-1
16.3 Monitoring Procedure ............................................................................................ 16-2
16.4 IBP Menu............................................................................................................... 16-3
16.5 Alarm Information and Prompts............................................................................. 16-9
16.6 Maintenance and Cleaning.................................................................................. 16-11
16.7 ICP Transducer ICT/B (Optional Accessory) ................................................. 16-12
Chapter 17 CO Measuring ............................................................................................... 17-1
17.1 General.................................................................................................................. 17-1
17.2 Monitoring Procedure ............................................................................................ 17-1
17.3 C.O. SETUP Menu ................................................................................................ 17-6
17.4 Hemodynamic Calculation..................................................................................... 17-8
17.5 Alarm Information and Prompt............................................................................... 17-9
17.6 Maintenance and Cleaning.................................................................................. 17-10
Chapter 18 CO2 Measuring ............................................................................................. 18-1
18.1 General.................................................................................................................. 18-1
18.2 Monitoring Procedure ............................................................................................ 18-1
18.3 CO2 Menu ............................................................................................................. 18-3
18.4 Alarm Information and Prompt............................................................................... 18-7
18.5 Maintenance and Cleaning.................................................................................... 18-9
Chapter 19
AG Measuring ............................................................................................. 19-1
19.1 General.................................................................................................................. 19-1
19.2 Measuring principle and operating process ....................................................... 19-2
19.3 AG Menu................................................................................................................ 19-4
19.4 Alarm Information and Prompt............................................................................... 19-9
19.5 Maintenance and Cleaning.................................................................................. 19-12
Chapter 20 Accessories and Ordering Information...................................................... 20-1
20.1 ECG Accessories .................................................................................................. 20-1
Patient Monitor user’s manual (V 5.4)
3
Content
20.2 SpO2 Accessories ................................................................................................. 20-2
20.3 NIBP Accessories .................................................................................................. 20-3
20.4 TEMP Accessories ................................................................................................ 20-3
20.5 IBP Accessories..................................................................................................... 20-3
20.6 CO Accessories..................................................................................................... 20-4
20.7 CO2 Accessories................................................................................................... 20-4
20.8 Anesthetic Gas Accessories .................................................................................. 20-5
Appendix I EC Declaration of Conformance......................................................................... 1
Appendix II Product Specification ......................................................................................... 1
Appendix III EMC ..................................................................................................................... 1
Appendix IV System Alarm Prompt ....................................................................................... 1
4
Patient Monitor user’s manual (V 5.4)
Chapter 1 Introduction
For an overall introduction to the monitor, please refer to General Information.
For various messages displayed on the screen, please refer to Screen Display.
For basic operating instructions, please refer to Button Function.
For allocation of interface sockets, please refer to Interfaces.
For important facts to be noted during the battery recharging procedure, please refer to
Built-in Battery.
For safety precautions of the monitor, please refer to Patient Safety.
Warning
PM-9000 Portable Multi-Parameter Patient Monitor is intended for clinical monitoring
application with operation only granted to appropriate medical staff.
Warning
Monitor can only monitoring one patient at a time.
Warning
There could be hazard of electrical shock by opening the monitor casing. All servicing
and future upgrading to this equipment must be carried out by personnel trained and
authorized by Mindray.
Warning
Possible explosion hazard if used in the presence of flammable anesthetics or other
flammable substance in combination with air, oxygen-enriched environments, or
nitrous oxide.
.
Warning
You must verify if the device and accessories can function safely and normally before
use.
Warning
You must customize the alarm setups according to individual patient situation and
make sure that alarm sound can be activated when alarm occurs.
Warning
Do not use cellular phone in the vicinity of this device. High level electromagnetic
radiation emitted from such devices may greatly affect the monitor performance.
Patient Monitor user’s manual (V 5.4)
1-1
Introduction
Warning
Do not touch the patient, table, or the device during defibrillation.
Warning
Devices connected to the monitor shall form an equipotential system (protectively
earthed).
Warning
When used with Electro-surgery equipment, you (doctor or nurse) must give top
priority to the patient safety.
Warning
Do not place the monitor or external power supply in any position that might cause it
to fall on the patient. Do not lift the monitor by the power supply cord or patient cable,
use only the handle on the monitor.
Warning
Consult IEC-601-1-1 for system interconnection guidance. The specific requirements
for system interconnection are dependent upon the device connected to the monitor
and the relative locations of each device from the patient, and the relative location of
the connected device to the medically used room containing the monitor. In all
circumstance the monitor must be connected to a grounded AC power supply. The
monitor is referred to as an IEC 601/F device in the summary of situations table
contained in IEC 601-1-1.
Warning
Dispose of the packaging material, observing the applicable waste control regulations
and keeping it out of children’s reach.
Warning
This equipment is accord with the standard CISPR11(EN55011) class A.
Warning
Grounding:
Connect the monitor only to a three-wire, grounded, hospital-grade receptacle. The
three-conductor plug must be inserted into a properly wired three-wire receptacle; if a
three-wire receptacle is not available, a qualified electrician must install one in
accordance with the governing electrical code.
Do not under any circumstances remove the grounding conductor from the power
plug.
Do not use extension cords or adapters of any type. The power cord and plug must be
intact and undamaged.
1-2
Patient Monitor user’s manual (V 5.4)
Introduction
If there is any doubt about the integrity of the protective earth conductor arrangement,
operate the monitor on internal battery power until the AC power supply protective
conductor is fully functional.
Note
The software was developed per IEC601-1-4. The possibility of hazards arising from
errors in the software program is minimized.
Caution
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 regulation the
disposal of such products. If you have questions concerning disposal of the product,
please contact MINDRAY or its representatives.
Caution
If you have any doubt to the grounding layout and its performance, you must use the
built-in battery to power the monitor.
1.1
General Information
Environment:
Temperature
Working
0 ~ 40 (°C)
Transport and Storage -20 ~ 60 (°C)
Humidity
Working
15%~ 85 %
Transport and Storage 10%~ 93 %
Altitude
Working
-500 to 4,600m(-1,600 to 15,000ft)
Transport and Storage -500 to 13,100m(-1,600 to 43,000ft)
Power Supply
100/250 (V)AC, 50/60 (Hz)
Pmax = 110VA
FUSE T 1.6A
General instruction:
PM-9000 is a Portable Patient Monitor that has abundant monitoring functions and is used for
the clinical monitoring of adult, pediatric and neonate. In addition, the user may select the
different parameter configuration according to different requirements.
PM-9000 can be connected to the central monitoring system via the Mindray network so as to
form a network monitoring system.
PM-9000 (Figure 1-1) can monitor vital signals as ECG, Respiratory Rate, SpO2, NIBP,
Patient Monitor user’s manual (V 5.4)
1-3
Introduction
Dual-TEMP, Dual-IBP, CO, CO2 and anesthetic gases. It integrates parameter measuring
modules, display and recorder in one device, featuring in compactness, lightweight and
portability.
Replaceable
built-in
battery
facilitates
transportation
of
patient.
Large
high-resolution display provides clear view of 8 waveforms and full monitoring parameters.
The POWER switch is on the bottom left quarter of the front panel (① in Figure 1-1). It lights
when the device is on. The CHARGE indicator (② in Figure 1-1) is on the right side of the
POWER switch. It is used to indicate the AC Mains condition.. The ALARM indicator is on the
upper side of the front panel. The ALARM indicator flashes or lights when alarm occurs (③ in
Figure 1-1). The sockets of the sensors are at the left side. The recorder socket is at the right
side. Other sockets and power plug-in are at the rear panel.
PM-9000 is a user-friendly device with operations conducted by a few buttons on the front
panel (④ in Figure 1-1) and a rotary knob (⑤ in Figure 1-1). Refer to 1.3 Button Functions
for details.
③
①
⑤
②
④
Figure 1-1 PM-9000 Portable Patient Monitor
The visible LEDs are CLASS 1 LED PRODUCT according with EN 60825-1 A11 Oct 1996.
PM-9000 Portable Patient Monitor performs monitoring of:
ECG
RESP
SpO2
NIBP
TEMP
IBP
CO
CO2
1-4
Heart Rate (HR)
2-channel ECG waveforms
Arrhythmia and S-T segment analysis(optional)
Respiratory Rate (RR)
Respiration Waveform
Oxygen Saturation (SpO2), Pulse Rate (PR)
SpO2 Plethysmogram
Systolic Pressure (NS), Diastolic Pressure (ND), Mean Pressure
(NM)
Channel-1 Temperature (T1), Channel-2 Temperature (T2),
Temperature Difference between two channels (TD)
Channel-1 SYS, DIA, MAP
Channel-2 SYS, DIA, MAP
Dual-IBP waveforms
Blood Temperature (TB)
Cardiac Output (CO)
End Tidal CO2 (EtCO2)
Inspired Minimum CO2 (InsCO2)
Patient Monitor user’s manual (V 5.4)
Introduction
Air Way Respiration Rate (AwRR)
Inhale and exhale CO2 (FiCO2, EtCO2)
Inhale and exhale N2O (FiN2O, EtN2O)
Inhale and Exhale O2 (FiO2, EtO2)
Inhale and exhale anesthetic agent (FIAA, ETAA, Note: AA refers
to one of anesthetic agents listed below:
HAL (Halothance)
ISO (Isoflurance)
ENF (Enflurance)
SEV (Sevoflurance)
DES (Desflurance)
Airway Respiration Rate (respiratory times per minute, unit: rpm)
AwRR
MAC(Minimum alveolar concentration)
Waveforms of four anesthetic gases including CO2, N2O, O2, AA
PM-9000 provides extensive functions as visual & audible alarm, storage and report printout
AG
for trend data, NIBP measurements, and alarm events, oxyCRG, viewbed, and drug dose
calculation function is provided either.
1.2
Screen Display
The display of PM-9000 parameter monitor is a color LCD, which can display the collected
patient parameters, waveforms, alarm information as well as bed number, time and monitor
status, etc.
The screen is divided into three areas(Figure 1-2): Information area①④; waveform area②;
parameter area③.
①
③
②
④
Figure 1-2 PM-9000 Main Display
Information Area
The Message Area is at the top part of the screen, displaying the current status of both the
monitor and the patient.
Patient information include:
BED NO
Bed numbers of all patients under monitoring
Patient type
Three options: Adult, Pediatric, Neonate
“01-01-2000”
Current date
“13:51:32”
Current date and time
Patient Monitor user’s manual (V 5.4)
1-5
Introduction
Male
Patient sex, Male or Female
ZHANG SHAN
Patient name This item will display blank if the operator does not
input patient name
Other information in the Message Area will appear and disappear together with the reported
status. According to the content, the information is divided into:
■ Prompt information, reporting the current status of the monitor or sensor/probe, which
always appears to the right of the system time. When this information appears, it will cover
patient sex and name.
■
flag for alarm PAUSE. Press “SILENCE” button once (less than 1 second) to mute all
alarm sounds are muted for the time being and the flag appears at the same time. Press the
button again to terminate the PAUSE status. The duration for PAUSE status can be 1 minute,
2 minutes or 3 minutes.
■
flag for alarm SILENCE. Press “SILENCE” button once (more than 1 second) to
manually mute the alarm sound and this flag appears at the same time. The SILENCE status
terminates when you discharge the status or new alarm occurs.
■
flag for Alarm Volume Off. It appears indicating that you have closed the alarm
sound permanently. This status terminates when you discharges the status.
Note
If
symbol appears, the system will no longer give audible alarm sound. You
must be very careful in using this function. Two ways can be used to discharge this
status. One is set the alarm volume to an option other than OFF in the USER MAINTAIN
menu. The other method is to press SILENCE button to make the flag turn to
. And
then press SILENCE again and the system will restore the normal alarm status.
■ Parameter alarm information is displayed always in the upper right corner of the screen.
■ When the waveforms on the screen are frozen, the FREEZE prompt will appear in the
bottom part of the screen.
Waveform / Menu Area
The waveform area can maximally display 8 waveforms. The displaying order of the
waveforms on the screen can be adjusted. For the maximum configuration, the waveforms
provided by the system for selection are: 2 ECG waveforms, SpO2 waveform, 4 waveforms of
IBP module (IBP1/2/3/4), RESP waveform, CO2 waveform and 4 waveforms of AG
module(CO2/N2O/O2/AA). But CO2 waveforms and AG waveforms can’t display at the same
time.
All the waveforms in the system are listed out in the “WAVEFORM SETUP” menu. The user
may select the waveform to be displayed and adjust their displaying positions. The specific
1-6
Patient Monitor user’s manual (V 5.4)
Introduction
method is illustrated in the part: Set Up Screen Waveform.
The name of the waveform is displayed on the upper left part of the waveform. The user may
choose ECG lead based on the requirements. The gain of the channel and the filter way are
also displayed on each ECG waveform. A 1mV scale bar is also displayed to the right side of
ECG waveform. The IBP waveform scale can also be selected according to the actual
requirement. Its range is described in the part: Measure IBP. In the IBP waveform area, the
waveform scale is displayed. The three dotted lines for each IBP waveform form up to down
represent respectively the upper limit scale, reference scale and lower limit scale. The values
of these three scales can be set. The specific method is given in the part: Measure IBP.
When menu is wanted during screen operation, the menu always occupies the fixed position
in the middle part of the waveform area, therefore part of waveform can not be viewed
temporarily. After exiting the menu, the system will restores the original screen.
The user may set up the rate to refresh the waveform. The method to adjust the refreshing
rate of each waveform is discussed in the setup description of each parameter.
Parameter Area
The parameter area lies to the right side of the waveform area, whose position basically
corresponds to the waveform. The parameters displayed in the parameter area include:
ECG
— heart rate or pulse rate (unit: beats/minute)
— The ST analyzing result of channel 1 and 2: ST1, ST2 (unit: mV)
— PVCs(unit: times/minute)
NIBP
— From left to right, there are Systolic pressure, Mean pressure and Diastolic
pressure(unit: mmHg or kPa)
SpO2
— SpO2(unit: %)
— Pulse Rate(unit: beats/minute)(When “BOTH” item is selected)
CO
─ CO(unit: liter/minute);
─ TB(unit: ℃ or ℉)
IBP
— The blood pressure of channel 1 and 2. From left to right, there are Systolic
pressure, Mean pressure and Diastolic pressure(unit: mmHg or kPa).
RESP
— Respiration Rate(unit: times/minute)
CO2
— EtCO2(unit: mmHg or kPa)
— INS CO2 (unit: mmHg or kPa)
— AwRR (times/minute)
TEMP
— Temperature of channel 1 and 2: T1, T2 and the difference between them
TD. (unit: ℃ or ℉)
Patient Monitor user’s manual (V 5.4)
1-7
Introduction
AG
─ AwRR (times/minute)
─ MAC
─ CO2(unit: mmHg or kPa)
─ O2(unit: % or mmHg or kPa)
─ N2O(unit: % or mmHg or kPa)
─ AA(unit: % or mmHg or kPa)
Alarm lamp and alarm status:
In normal status: the alarm lamp is not on.
When alarm exists, the alarm lamp flashes or lights on. The color of the lamp corresponds to
the alarm level. Refer to related chapter: Alarm.
For the details of alarm information and prompt information, refer to the related content of
each parameter in related chapter.
Warning
Always verify the self-check function of audible and visual (LED) alarms when PM-9000
powers on.
1.3
Button Functions
All the operations to PM-9000 are through the buttons and a knob at the bottom of the screen.
The names of the buttons are above them. They are (from left to right, Figure 1-3):
⑦
①
②
③
④
⑤
⑥
Figure 1-3 PM-9000 Buttons and Knob
MAIN(Figure 1-3①)
Whatever levels of menu the system is in, press the button and the system will always return
to the main screen.
FREEZE(Figure 1-3②)
Press this button and the system will access the FREEZE status. In this status the user may
review the waveform of 40 seconds. Also, the frozen waveform can be printed out. In the
1-8
Patient Monitor user’s manual (V 5.4)
Introduction
FREEZE status, press this button again to discharge the FREEZE status. For detailed
information, refer to related chapter: Freeze.
SILENCE(Figure 1-3③)
Push this button to suspend alarm for maximum 3 minutes (with 1 minute, 2 minutes and 3
minutes selectable). In Alarm PAUSE status, a
symbol appears in the Message Area.
Push this button for more than 1 second to mute all kinds of sounds (including alarm sound,
heart beat, pulse tone, key sound). At the same time, a
symbol appears in the
Message Area. Push this button again to restore all kinds of sounds and the
symbol
disappears from the screen.
Note
If new alarm occurs in Alarm Pause/Silence status, the system will discharge
Pause/Silence status automatically. For specific rules, see Chapter Alarm.
Note
The system will begin to give alarm information again once there exist alarm-triggering
event. Nevertheless, remember pushing SILENCE button can permanently shut off
audible alarm sound of ECG LEAD OFF and SPO2 SENSOR OFF alarms.
REC/STOP(Figure 1-3④)
Press to start a real time recording. The recording time is set in REC TIME of RECORD
SETUP submenu. Press during recording to stop the recording. For detailed information, refer
to related chapter.
START(Figure 1-3⑤)
Press to inflate the cuff to start a blood pressure measurement. When measuring, press to
cancel the measurement and deflate the cuff.
MENU(Figure 1-3⑥)
Press this button to call up the SYSTEM MENU, in which the user may set up system
information and perform review operation. For detailed information, refer to related chapter:
System Menu and related chapter: Trend and Event.
Rotary knob(Figure 1-3⑦)
The user may use the rotary knob to select the menu item and modify the setup. It can be
rotated clockwise or counter-clockwise and pressed like other buttons. The user may use the
knob to realize the operations on the screen and in the system menu and parameter menu.
Method to use the knob to operate on the screen:
The rectangular mark on the screen that moves with the rotation of the knob is called “cursor”.
Operation can be performed at any position at which the cursor can stay.
When the cursor is in the waveform area, the user may immediately modify the current setup.
When the cursor is in the parameter area, the user may open the setup menu of the
corresponding parameter module so as to set up the menu items of the module.
Patient Monitor user’s manual (V 5.4)
1-9
Introduction
Operating method:
■ Move the cursor to the item where the operation is wanted
■ Press the knob
■ One of the following four situations may appear:
1.The cursor with background color may become into the frame without
background color, which implies that the content in the frame can change with
the rotation of the knob.
2.Menu or measuring window may appear on the screen, or the original menu is
replaced by the new menu.
3.A check mark “√” appears at the position, indicating that the item is confirmed.
4.The system immediately executes a certain function.
1.4
Interfaces
For the convenience of operation, the different kinds of interfaces are in different parts of the
monitor.
At the right side is AG watertrap (Figure 1-4 ①) and the recorder’s paper inlet cover(Figure
1-4②), as shown in Figure 1-4.
①
②
Figure 1-4 Right Side
At the left side are the connectors to patient cables and the sensors, as shown in Figure 1-5
1-10
①
Socket for CO2 sensor
②
Socket for channel 1 TEMP probe
③
Socket for channel 2 TEMP probe
④
Socket for channel 1 IBP transducer
⑤
Socket for channel 2 IBP transducer
⑥
Socket for ECG cable
⑦
Socket for Cardiac Output
⑧
Socket for NIBP cuff
⑨
Socket for Spo2 Sensor
Patient Monitor user’s manual (V 5.4)
Introduction
②
①
③
④
⑤
⑥
⑦
⑧
⑨
Figure 1-5 Left Side
! This symbol means “BE CAREFUL". Refer to the manual.
Indicates that the instrument is IEC 60601-1 Type CF equipment. The unit displaying
this symbol contains an F-Type isolated (floating) patient applied part providing a high degree
of protection against shock, and is suitable for use during defibrillation.
⑦
①
②
⑤
③
⑥
④
Figure 1-6 Rear Panel
■
Power Supply: 100-250 (VAC), 50/60 (Hz). (Socket ③)
■
VGA MONITOR: (Socket ⑤)
Monitor interface for external standard VGA color monitor.
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1-11
Introduction
Appliance:
1)
Install the VGA monitor in the same room with the patient but keep away from the
patient for more than 1.5m. The monitor is intended to be used as an assistant
monitoring device.
2)
Plug and insert the connection cable while the VGA monitor is in power off status.
3)
Power on at the same time, or power on the PM-9000 patient monitor after VGA.
4)
Adjust brightness and contrast properly.
■
(Socket ⑥)
Equipotential grounding terminal for connection with the hospital’s grounding system.
■
AUX OUTPUT (socket ④)
This port is used for both Analog Output and NURSE CALL.
The user could select the function of this port in “NURSE CALL SETUP” menu of “USER
MAINTAIN” menu. Refer to the section about “USER MAINTAIN” menu to know the
detailed information.
ANALOG OUTPUT: connected to oscillograph and pen recorder. BNC Jack.
NURSE CALL: connected to the CALL system of the hospital by using dedicated
NURSE CALL cable.
Note
The output terminal of NURSE CALL cable has two leads in free status (ie., no distinction
between positive or negative). Before use, the service engineer from MINDRAY or equipment
engineer of the hospital must first install the accompanying connectors according to the real
situation of the CALL system of the hospital.
■
FUSE ( Socket ②) T 1.6A
■
Network Interfaces (Socket ①):
Standard RJ45 Socket.
When using wireless network module, connect this part to the wireless network module.
■
Wireless network module(⑦):
The wireless network module is used to connect the monitor to the Central Monitoring
System.
The Indicator lights and the meanings are:
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Patient Monitor user’s manual (V 5.4)
Introduction
Power (green)
Indicates power when active.
Status (amber)
Indicates the software has detected an
abnormal condition. See event log for
status information.
Associated (green)/
Radio Activity (amber)
A green LED indicates association between the
CB 1000 and an AP or a MicroAP operating in
the Spectrum24 Network.
Amber indicates Spectrum24 Radio traffic
detected.
Wired LAN Attached
(green)/
In Use (amber)
A green LED indicates a connection
between the CB 1000 and the wiredEthernet.
Lights amber to indicate activity is detected on
the wired Ethernet.
Serial Activity Transmit
(green)/
Receive (amber)
A green LED indicates the CB 1000 is receiving
data through the serial port and displays amber
when the CB 1000 is transmitting data through
theserial port.
Note
Monitor must be connected with specific network equipment such as Harb during
using net function.
Warning
Through network interface only MINDRAY Clinical Information Center can be
connected in.
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1-13
Introduction
Warning
Accessory equipment connected to the analog and digital interfaces must be certified
according to the respective IEC standards (e.g. IEC 60950 for data processing
equipment and IEC 60601-1 for medical equipment). Furthermore all configurations
shall comply with the valid version of the system standard IEC 60601-1-1. Everybody
who connects additional equipment to the signal input part or signal output part
configures a medical system, and is therefore responsible that the system complies
with the requirements of the valid version of the system standard IEC 60601-1-1. If in
doubt, consult the technical service department or your local representative.
1.5
Built-in Battery
PM-9000 Portable Patient Monitor is equipped with a rechargeable battery( Figure 1-7 ①).
The battery in the Monitor can automatically recharge when connected to AC INPUT until it is
full. A symbol “
” is displayed on the lower left quarter of the screen to indicate the status of
recharging, in which the CYAN part represents the relative electric energy of the battery. This
symbol will be covered when some information appears. And, if the battery is not installed in
PM-9000, battery state will be displayed as “
” under a cross to indicate that no battery is
available.
There are two battery slots inside PM-9000, each can hold a battery, and one battery can
support PM-9000 working. Battery can be installed into and pulled off from battery slot. Under
connectors to patient cables there are battery slots with cover. See Figure 1-7 Battery Slot
Cover.
Warning
Don’t pull off battery when the monitor is working.
When operating on battery, the monitor will prompt alarm and shut off automatically when the
energy is low. When the electric energy is going out, the monitor will sound continuous level 1
alarm beeping and display “BATTERY LOW” in the Message Area. Connect the monitor to AC
power at this moment can recharge the battery while operating. If keep operating on the
battery, the monitor will shut off automatically (more than 5 minutes since alarming) upon
exhaustion of the battery.
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Patient Monitor user’s manual (V 5.4)
Introduction
①
Figure 1-7 Battery Slot Cover
Warning
After the patient monitor has been placed unused for a long time, the battery must be
recharged before use again. When not using the patient monitor for a long time without
charging the battery, the battery capacity will decrease. Connect the patient monitor to
appropriate AC mains to charge the battery.
Mindray recommends replace the sealed Lead-Acid battery once per year. Dispose or
recycle the battery and other parts of the patient monitor by following local government
regulations.
Patient Monitor user’s manual (V 5.4)
1-15
Chapter 2 Getting Started
■
Open the package and check
■
Connect the power cables
■
Power on the monitor
■
Connect patient sensors
■
Check the recorder
Note
To ensure that the monitor works properly, please read Chapter Patient Safety, and
follow the steps before using the monitor.
2.1 Open the Package and Check
Open the package and take out the monitor and accessories carefully. Keep the package for
possible future transportation or storage. Check the components according to the packing list.
■
Check for any mechanical damage.
■
Check all the cables, modules and accessories.
If there is any problem, contact the distributor immediately.
2.2 Connect the Power Cables
Connection procedure of the AC power line:
Make sure the AC power supply complies with following specification: 100~250 VAC,
50/60 Hz.
Apply the power line provided with the monitor. Plug the power line to INPUT interface of
the monitor(Socket ③ in Figure 1-6). Connect the other end of the power line to a
grounded 3-phase power output.
Note
Connect the power line to the jack special for hospital usage.
Note
Mindray does not provide MULTIPLE PORTABLE SOCKET-OUTLETS. IF use it, please
do not place it on the floor. Mindray advises that every one monitor uses one
MULTIPLE PORTABLE SOCKET-OUTLETS.
Connect to the ground line if necessary. Refer to Chapter Patient Safety for details.
Patient Monitor user’s manual (V 5.4)
2-1
Getting Started
Note
Make sure that the POWER lamp now lights. If it does not light, check your local power
supply. If the problem still exists, contact the local Customer Service Center.
Note
The battery need to be charged after transportation or storage. If the power supply is
not properly connected before turning on the monitor, it may not work properly
because of insufficient power. Connect the power supply to charge the battery.
2.3 Power on the Monitor
Press POWER(① in Figure 1-1) to power on the monitor. Then a beep will be heard and at
the same time the indicator will flash twice in yellow and red. After 10 seconds or so, the
system will enter monitoring screen after self-test, and you can perform normal monitoring
now.
During self-test, the software version will display.
Note
If the monitor finds any fatal error during self-test, it will alarm.
Note
Check all the functions that may be used to monitor and make sure that the monitor is
in good status.
Note
The battery must be recharged to the full electricity after each use to ensure adequate
electricity reserve.
Warning
If any sign of damage is detected, or the monitor displays some error messages, do
not use it on any patient. Contact biomedical engineer in the hospital or Mindray
Customer Service Center immediately.
Note
The interval between twice press of POWER should be more than 1 minute.
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Patient Monitor user’s manual (V 5.4)
Getting Started
2.4 Connect Patient Sensors
Connect all the necessary patient sensors between the monitor and the patient.
Note
For information on correct connection, refer to related chapter 12-19.
2.5 Check the Recorder
If your monitor is equipped with a recorder, open the recorder door to check if paper is
properly installed in the output slot. If no paper present, refer to Chapter Recording for
details.
Patient Monitor user’s manual (V 5.4)
2-3
Chapter 3 System Menu
■
New patient enrolment
■
Recording
■
Trend Graph/Table and Alarm Review
■
System Setup
■
Drug Calculation
■
Maintenance
PM-9000 Portable Multi-Parameter Patient Monitor features flexible configurations. You can
customize monitoring content, waveform sweep speed, sound volume, and output content.
Turn knob to select the MENU hot key on the lower right part of the screen to call up the
“SYSTEM MENU” menu. You can perform following operations in this menu.
Figure 3-1
SYSTEM MENU
Trend graph/table review, NIBP review and alarm review are discussed in Chapter: Trend and
Event.
3.1 Patient Information Setup
Note
To clear current patient data, refer to New Patient for details.
Pick the [PATIENT SETUP] item in the “SYSTEM MENU” to call up the following menu.
Patient Monitor user’s manual (V 5.4)
3-1
System Menu
Figure 3-2
PATIENT SETUP
You can setup following patient information:
DEPT.
Department in which the patient receives treatment.
PAT NO
Patient No.
BED NO
Patient bed number (Range: 1-100)
DOCTOR
Name of the doctor.
NAME
Patient name (Valid characters: A-Z, 0-9 and space bar; Max. length: 12
characters)
SEX
Patient gender (Available options: "F" for Female, "M" for Male)
PAT TYPE
Patient type (Available options: ADU, PED, and NEO)
ADMIT
Hospitalization starting date (format: year\month\ day)
BIRTH
Patient date of birth (format: year\month\day)
HT. (cm/inch )
Patient height (turning the knob with the increase/decrease of 0.5 cm/inch
each time)The other HT. unit in the other menus accord with the unit which
you choosed here.
WT. (kg/Ib)
Patient weight (turning the knob with the increase/decrease of 0.5 kg/Ib
each time)The other WT. unit in the other menus accord with the unit which
you choosed here.
BLOOD
Patient blood type (Pick A, B, O, AB, or N. "N" represents unknown blood
type)
NEW PATIENT
Admission of new patient
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Patient Monitor user’s manual (V 5.4)
System Menu
Also in this menu, you may select the [NEW PATIENT] item to access the “CONFIRM TO
UPDATE PATIENT” dialog box as shown below, in which you can decide whether to monitor a
new patient.
Figure 3-3
Confirm To Update Patient Menu
Pick [YES] to delete all information of the patient being currently monitored and exit the menu.
Pick [NO] to give up updating the patient and the system will keep the information of the
current patient and exit the menu.
Note
If you select [YES], the system will delete all information of the patient being currently
monitored.
3.2 Default Setup
Note
After selecting any item in this sub-menu, the selected item will replace the current
setup of the system and accordingly become the system default configuration.
Figure 3-4
DEFAULT Menu
Patient Monitor user’s manual (V 5.4)
3-3
System Menu
In this sub-menu, you can select both the factory default and the user-defined default. Also in
this sub-menu, you can save the current system configuration as the user-defined default
configuration. But at this time, the system will automatically save all the setups in the
parameter menu, ECG gain and filter way as the user-defined default configuration according
to the patient type. Also, the dialog box as shown below will pop up.
Figure 3-5
CONFIRM DEFAULT CONFIG
Note
After selecting any item in the DEFAULT menu and exiting the box, the “CONFIRM
DEFAULT CONFIG” Dialog box will pop up, in which you can select [YES] to confirm
your selection or [NO] to give up your selection.
Warning
All configurations in the system will be replaced by “default configurations”.
3.3 Trend Review, Measurement Review and Alarm
Event Review
In the “SYSTEM MENU”, there are [TREND GRAPH], [TREND TABLE], [NIBP RECALL] and
[ALARM RECALL] items. Please refer to Chapter 7: Trend and Event for detailed information.
3.4 System Setup
Select the [system setup] item in the [system menu]:
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Patient Monitor user’s manual (V 5.4)
System Menu
Figure 3-6 System setup
In the [System setup] menu , users can setup the following items.
3.4.1 Face select
Select “FACE SELECT” item in “SYSTEM SETUP” menu to access “FACE SELECT” dialog
box as shown below, in which four selections are available: STANDARD SCREEN, TREND
SCREEN, oxyCRG SCREEN and VIEWBED SCREEN. Only one selection can be chosen for
each time.
Figure 3-7
FACE SELECT
3.4.2 Alarm setup
The system provides three levels of alarm volume. You can select any of them as per the
clinical requirement. The procedures are:
Select the [ALARM SETUP] item in the “SYSTEM SETUP” sub-menu of the “SYSTEM
SETUP” menu. The menu as shown below will pop up, in which you can set up the alarm
volume and other alarm information. For detailed information, refer to Chapter Alarm.
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3-5
System Menu
Figure 3-8 Alarm Setup
Pick “ALARM VOL” item, turn the knob to set the volume. The options are from “10” to “1”.
“10” indicates the maximum volume while “1” the minimum.
3.4.3 Time Setup
Select the [TIME SETUP] item in the “SYSTEM SETUP” menu. The menu as shown below
will pop up. System time is in the format of year, month, day, hour, minute and second. Use
cursor to highlight the item that you want to modify and turn the knob to select time. Then
select [EXIT].
Note
You shall set up the system time upon turning on the monitor (if you need to set up the
system time); otherwise, when you review the content with time information, the
system may not display the correct time.
Figure 3-9 System Time Setup
When this monitor is linked to the Central Station, its system time will keep consistent with
that of the Central Station. Method to adjust time:Once link is successfully established, the
Central Station will send its current time to the monitor. The monitor will automatically adjust
its system time accordingly. Besides, the Central Station will keep on sending its current time
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Patient Monitor user’s manual (V 5.4)
System Menu
to the monitor once per hour to maintain consistent time between them. However, the monitor
will not adjust its time if it is different from the Central Station only in second. Please note that
if you are setting up the system time when link is just established successfully, the monitor will
immediately close the setup menu of system time. The setup button of system time in the
system setup menu is disabled when the monitor is linked to the Central Station. That means
you cannot open the setup menu of system time.(If the Central Station has no this function,
you can skip over this paragraph.)
3.4.4
Analog
The monitor can output an analog waveform, whose time delay is less than 30ms. The output
terminal is on the rear panel.
Select “ANALOG” item in “SYSTEM SETUP” menu to call up the ANALOG menu. The first
item is for setting up On/Off of the switch of the analog output. The second item is for
selecting the waveform name to be output.
Select “EXIT” item to return to the previous menu.
Figure 3-10
ANALOG
Note
In the USER MAINTAIN menu, If the AUX OUTPUT item being selected with NURSE
CALL, the AUX OUTPUT port will be used to realize NURSE CALL function while
“ANALOG OUT” function is switched off at the same time.
3.4.5 Recorder setup
Select the [RECORD] in the “SYSTEM SETUP” menu to call up the following menu:
Figure 3-11 Record Setup
Patient Monitor user’s manual (V 5.4)
3-7
System Menu
Note
In the USER MAINTAIN menu, If the AUX OUTPUT item being selected with NURSE
CALL, the AUX OUTPUT port will be used to realize NURSE CALL function while
“ANALOG OUT” function is switched off at the same time.
In this menu, the user can set up to output two waveforms. The waveforms that can be
selected include:
ECG1~
The first to the seventh ECG waveform on the screen (there are seven ECG
ECG6
waveforms in full leads display)(If no ECG waveform is currently displayed on
the screen, this item cannot be picked).
SPO2
SpO2 Plethysmogram.
IBP1
The first IBP waveform on the screen (If no IBP waveform is currently displayed
on the screen, this item cannot be picked).
IBP2
The second IBP waveform on the screen (If less than two IBP waveforms are
currently displayed on the screen, this item cannot be picked).
RESP
RESP waveform (If no RESP waveform is currently displayed on the screen,
this item cannot be picked).
CO2
Displayed waveform either of anesthetic gas or generated by CO2 module.
AG
CO2/O2/N2O/anesthetic gas generated by AG module.
RT REC TIME this item has two options, CONTINUAL and 8s. “CONTINUAL” means
once pushing the “REC/STOP” button on the recorder panel or the monitor panel, the
recorder will continuously print out the waveform or parameter until this button is pushed
again.
TIMING REC TIME OFF used to set up the time interval between two recordings. 10
selections are available: “OFF, 10min, 20min, 30min, 40min, 50min, 1hour, 2hours,
3hours and 4hours”. The system will start the recording process according to the selected
time interval. The recording time is always 8 seconds.
Note
RT REC TIME takes priority over TIMING REC TIME OFF.
REC RATE: this item has two options, 25.0 and 50.0 mm/s.
REC GRID: used to decide output format: OFF is without grid, and ON is with grid.
CLEAR REC TASK: used to clear the alarm event that has been generated and is waiting
for recording out.
Note
If two same waveforms are selected, the system will automatically change one of the
waveform to a different one.
3.4.6 Module Setup
Select the [MODULE SETUP] item in the “SYSTEM SETUP” menu to call up the following
menu:
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Patient Monitor user’s manual (V 5.4)
System Menu
Figure 3-12 Module Setup
You can choose the parameters to be monitored in this menu. This can avoid the interference
from the parameters that need not attention.
3.4.7 Tracing Waveforms Selection
Select the [TRACE SETUP] in the “SYSTEM SETUP” menu to call up the following menu.
Figure 3-13
Tracing Waveforms Selection
You can define the traces displayed on the screen in this menu. The waveforms available for
selection are those whose modules have been selected in “MODULE SETUP” menu.
This user can only decide the display sequence of the waveforms on the screen. Select the
“WAVE SEQUENCE” item in the menu to access the sub-menu of the same name as shown
in the figure below.
Patient Monitor user’s manual (V 5.4)
3-9
System Menu
Figure 3-14
Wave sequence
3.4.8 Event Setup
The monitor has four types of events. You can specify their representations by yourself.
Select the [MARK EVENT] item in the “SYSTEM SETUP” to call up the following menu:
Figure 3-15
MARK EVENT Menu
How to mark the event: Use the rotary knob to select one from event A, B, C and D. The @
symbol will appear in the frame of the event being selected. Once making a wrong selection,
you can push the knob on the event again to give up the selection. Select [EXIT] to exit the
menu and consequently the selection will come into effect.
Event function has following significance:
To classify the records into different categories, such as those having influence on patients
and those having influence on parameter monitoring including dose taking, injection, therapy
status. Event will be displayed on the trend graph/table in order to assist the analysis on the
patient parameters when the event happens.
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System Menu
3.5 Selection Setup
Select the [SELECTION] item in the “SYSTEM SETUP” to call up the following menu.
Figure 3-16
Selection Setup
Key Volume:
Pick “KEY VOL” item in “SELECTION” menu, turn the knob to set the volume. The options are
from “3” to “0”. “3” indicates the maximum volume while “0” the minimum.
Help Function:
The system provides On-line Help to menu operations. You can choose any help information
as per your need. The method is:
Select the [SELECTION] item in the “SYSTEM MENU” to access the “SELECTION”
sub-menu, in which you can highlight the [HELP] item and turn the knob to select “ON” or
“OFF”. When it is “ON”, you can browse the on-line help information. When it is “OFF”, the
system will turn off the on-line help function.
Scan type:
The system can display all waveforms about monitored patient on the screen either in
“Refresh” or “Scroll” way. The method is:
Select “SELECTION” item in “SYSTEM MENU” to access “SELECTION” sub-menu, in which
there is the item “SCAN TYPE”. The user may decide the way to display the waveform by
choosing either “REFRESH” or “SCROLL”.
Alarm Limits:
The system can display the alarm limits. You can choose this function as per your need. The
method is:
Select the [SELECTION] in the “SYSTEM MENU” to call up the “SELECTION” menu. You can
set the “ALM LIMIT” switch to “ON” or “OFF”.
Patient Monitor user’s manual (V 5.4)
3-11
System Menu
3.6 Monitor Version
Select the [VERSION] item in the “SYSTEM MENU” to know the software version of the
monitor.
Figure 3-17 Monitor Version
Select the [DEVICE CONFIG LIST] to know the configuration of the monitor.
Figure 3-18
Device Configuration List
3.7 Drug Calculation
You can use the drug calculation and titration table function of PM-9000 to calculate the
concentration of 15 kinds of drugs. Refer to Chapter: Drug Calculation and Titration Table for
detailed information.
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System Menu
3.8 Maintenance
Select the [MAINTAIN] item in the “SYSTEM MENU” to call up the “ENTER MAINTAIN
PASSWORD” dialog box as shown below, in which you can enter password and then
customize maintenance settings. You cannot execute factory maintenance function, which is
only available for the service engineers of MINDRAY company.
Figure 3-19
Enter Maintain Password
Input the password into the “ENTER MAINTAIN PASSWORD” box and press [CONFIRM], the
“USER MAINTAIN” menu will pop up, in which you can set up following items.
Figure 3-20
User Maintain
For the [LANGUAGE] language, you can set the screen language which display on the
screen..
For the [AUX OUTPUT] item, there are two options available:
Patient Monitor user’s manual (V 5.4)
3-13
System Menu
■ ANALOG OUT: if being selected, the AUX OUTPUT port will be used to realize
“ANANOG OUT” function while NURSE CALL function is switched off at the same time.
And visually the “NURSE CALL SETUP” item in “USER MAINTAIN” menu will become
gray indicating that the function is disabled.
■ NURSE CALL: if being selected, the AUX OUTPUT port will be used to realize NURSE
CALL function while “ANALOG OUT” function is switched off at the same time.
For the [LEAD NAMING] item, you can select “AHA” or “EURO”. To know the difference
between these two styles, refer to Chapter: ECG/RESP Monitoring.
For the [ALM SOUND] item, you can set the alarm volume to “ON” or “OFF”.
For the [NET TYPE] item, two selections are available: HYPER III and CMS.
For the [LOCAL NET NO] item, it refers to the net No.
Note
When using the monitor with wireless network module, do not change network bed
number freely. Contact the manufacturer in this case.
Warning
When the alarm volume is set to “OFF”, you will not hear the alarm sound if new alarm
occurs. Therefore, you must be very careful in using this selection.
If setting the alarm volume to “OFF” when the system is in Silence or Pause status, the
system will automatically discharge Silence or Pause status.
If you select “Silence” or “Pause” when the alarm volume is set to “OFF”, the system
will restore the alarm volume before the alarm volume is set to “OFF” and enter Silence
or Pause status.
Note
After the alarm volume is set to OFF, a
symbol will appear in the Technical Alarm
Area.
Note
Setting Alarm Volume to “OFF” is valid only when the monitor is turned on for this time.
After turning on the monitor next time, this setup will restore its value of the previous
time when the system is turned on.
COLOR SELF-DEFINE: is used by the user to define the color of the waveform displayed on
the screen. Five colors can be chosen from: green, cyan, red, yellow and white.
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Patient Monitor user’s manual (V 5.4)
System Menu
Figure 3-21
Color Self-define
NURSE CALL SETUP: If the NURSE CALL item in AUX OUTPUT being selected, the NURSE
CALL SETUP submenu will be available.
Figure 3-22 Nurse Call Setup
SIGNAL DURATION: “PULSE” and “CONTINUUM” two types of signals are available.
Selecting “PULSE” indicates that the NURSE CALL is the pulse signal of 1s duration;
selecting “CONTINUUM” indicates that the NURSE CALL signal is synchronous with the
alarm signal designated in the triggering condition.
SIGNAL TYPE: “NORMAL OPEN” or “NORMAL CLOSE”.
NORMAL OPEN: select this item when the CALL system of the hospital is set to
“NORMAL OPEN”;
NORMAL CLOSE: select this item when the CALL system of the hospital is set to
“NORMAL CLOSE”.
ALM LEV and ALM TYPE: after NURSE CALL function is activated, the monitor provides
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System Menu
the following combination options of alarm level and alarm type for the user to choose in
order to trigger NURSE CALL signal. “ALM LEV” provides three combination options, i.e.,
NURSE CALL signal will be triggered when it is “HIGH” alarm, “MED” alarm or “LOW”
alarm. “ALM TYPE” provides two combination options, i.e., NURSE CALL signal will be
triggered when it is “TECH” alarm or “PHYS” alarm.
Warning
When no option in “ALM TYPE” is selected, the NURSE CALL signal will not be
triggered in whatever condition.
Warning
When in ALARM SILENCE/PAUSE status, the monitor will automatically switch off
NURSE CALL signal; after discharging ALARM SILENCE/PAUSE status, the monitor will
automatically return to the status before ALARM SILENCE/PAUSE is activated.
If the user select “CLOSE” in the ALARM SOUND item of the “USER MAINTAIN” menu,
it will does not affect the function of NURSE CALL.
Warning
The nurse call feature should not be used as the primary source of alarm notification.
The audible and visual alarms of the monitor, used in conjunction with clinical signs
and symptoms, are the primary source for notifying medical personnel that an alarm
condition exists.
3.9 DEMO function
Select the [DEMO] item in the “SYSTEM MENU” to call up the “ENTER DEMO PASSWORD”.
After entering the password, the system enters DEMO status.
The purpose of waveform demonstration is only to demonstrate the machine performance,
and for training purpose. In clinical application, this function is not forbidden because the
DEMO will mislead the medical staff to treat the DEMO waveform and parameter as the
actual data of the patient, which may result in the delay of treatment or mistreatment.
Therefore before entering this menu, you shall enter password.
Figure 3-23
3-16
Input Demo Key
Patient Monitor user’s manual (V 5.4)
Chapter 4
Face Select
This monitor has four different operating screens, which are “Standard Screen”, “Trend
Screen”, “oxyCRG Screen”, and “Viewbed Screen”. When required, you can select
different operating screens for necessary information. Let’s probe into these four
operating screens one by one.
4.1
Select Operating Screen
In the “SYSTEM MENU”, select the “FACE SELECT” option in the “SYSTEM SETUP”
menu to call up the dialog box as shown in the figure below. There are four options in
this dialog, which are “STANDARD SCREEN”, “TREND SCREEN”, “oxyCRG
SCREEN” and “VIEWBED SCREEN”. Only one item can be selected at one time.
Figure 4-1
4.2
FACE SELECT
Standard Screen
In the “FACE SELECT” menu, Select the “STANDARD SCREEN” option to enter the
Standard Screen. The Standard Screen displays to us the parameters in the Parameter
area and the waveforms being monitored. This screen is the basic operating screen of
the monitor.
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4-1
Face Select
Figure 4-2
4.3
STANDARD SCREEN
Trend Screen
Enter TREND SCREEN
In the “FACE SELECT” menu, select the“TREND SCREEN”option to enter the Trend
Screen.
Figure 4-3
TREND SCREEN
Position of trend graph
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Patient Monitor user’s manual (V 5.4)
Face Select
Trend graph is located to the right of the corresponding waveform in the Waveform
area. Its color is the same as that of the corresponding parameter.
Trend length
Dynamic trend length is 2 hours. On the trend graph, the scale of the right end of the
X-axis is 0 hour while the left end is 2-hour.
Select trend parameter
If multiple parameters are located at the same position on the trend graph, by selecting
the corresponding hot key of a parameter on the trend graph, you can have the trend
graph of this parameter displayed on the screen. For example, in ECG trend graph,
you can select hot keys such as HR, ST or PVCs, then the system will display their
corresponding trend graphs respectively.
Close trend screen
In the “FACE SELECT” menu, select options of other operating screens to close the
Trend Screen.
4.4
oxyCRG Screen
Enter oxyCRG screen
In the “FACE SELECT” menu, select the “oxyCRG SCREEN” to enter the oxyCRG
Screen.
Figure 4-4
oxyCRG SCREEN
Trend graph of oxyCRG screen
Located at the lower part of the screen, oxyCRG screen consists of three trends: HR
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Face Select
Trend, SpO2 Trend and RR Trend or Compressed Resp. Waveform.
Select OxyCRG trend length
Three are three hot keys at the bottom part of the oxyCRG Screen, which are
4MIN/2MIN/1MIN, RR/RESP WAVE, and REC.
By using hot keys for trend time, you may select to display trend graphs of three
different lengths, i.e., 1 min, 2 min and 4 min.
Select RR trend or Compressed Resp. Waveform
By using the hot keys for RR/RESP WAVE, you may select either RR trend graph or
compressed Resp. Wave. They occupy the same position. Therefore, if select “RR”,
the position displays the dynamic trend of RR. If select “RESP WAVE”, the position
displays the compressed Resp. Wave.
Record
Select the “REC” hot key in the “OxyCRG Screen”, you may use the recorder to output
the three waveforms in the oxyCRG at the same time.
Close OxyCRG
In the FACE SELECT menu, select options of other operating screens to close the
OxyCRG Screen.
4.5
Viewbed Screen
If another monitor is connected on the same LAN of this monitor, you can use this
monitor to view any measured waveform and information about all measured
parameters from another monitor.
Enter Viewbed Screen
Select the “VIEWBED SCREEN” option in the “FACE SELECT” menu. Viewbed
Screen window occupies the space of the bottom four waveforms.
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Face Select
Figure 4-5 VIEWBED SCREEN
Hot key of Viewbed
There are two hot keys in the Viewbed Screen: Select Bed Number and Select
Waveform.
The hot key of Select Bed Number displays the bed numbers and patient names of
other monitors currently connected on the LAN. You can select a monitor to be
monitored according to the patient name and bed number. If at this time no other
monitors are connected on the same LAN of this monitor, the hot key of Bed Number
will therefore display “N/A”. After you use this hot key to select a monitor to be viewed,
the system will toggle to the display of the selected monitor for your view. The selected
waveform is one of those listed in the hot key of Select Waveform.
The hot key of Select Waveform is used to select a waveform generated by the
monitor being viewed. If the hot key of Select Waveform displays “N/A”, it indicates that
the bedside monitor being viewed has no waveforms. You can use this hot key to
select and therefore view different waveforms of the monitor being viewed.
Alarm indicator of Viewbed
On the upper right side of the Viewbed Screen, there is an Alarm Indicator used to tell
the alarm status of the monitor being viewed. The activity of this alarm indicator is
identical with that of the alarm lamp on the panel of the monitor being viewed. That is
to say, if the monitor being viewed occurs medium/low level alarm, this alarm indicator
illuminates yellow; if it occurs high level alarm, this alarm indicator illuminates red. If
the monitor being viewed has no alarm or the alarm is screened, the icon for this alarm
indicator will not be displayed.
Parameter area of Viewbed Screen
Under the hot key of Select Bed Number is the Parameter area, in which parameters
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4-5
Face Select
of all monitors being viewed are displayed.
Waveform area of Viewbed Screen
Under the hot key of Select Waveform is the Waveform area. The Sweep manner
(refreshing or scrolling) of the waveform is identical with that of this monitor. The
feature description of the displayed waveform is given above the waveform. Sweep
speed is also identical with that set up for the same waveform on this monitor.
Technical Information area
Technical Information area is to the right of patient name in Viewbed Screen. This area
displays related technical information to Viewbed, such as due to network failure or
network too busy, Viewbed is disabled.
Close Viewbed Screen
In the FACE SELECT menu, select options of other operating screens to close the
Viewbed Screen.
Rules for automatically selecting monitor to be viewed and waveform
When you turn on the monitor or enter Viewbed Screen, the system will automatically
select a networked bedside monitor and a waveform of this monitor for you to view. If
the monitor being currently viewed is disconnected, the viewed monitor will
automatically close, clear displays of all alarms, parameters and waveforms. However
in this situation, the Viewbed Screen still displays. If you want to view another monitor,
you must select again through using hot keys.
If a measure module of the viewed monitor is plugged out or closed, its corresponding
waveform will disappear and the waveform in the Waveform area will not be refreshed.
Instead this Waveform area will display empty. At this time, if you want to view other
waveforms of this monitor, you need to select again.
Note
When connecting by using wireless net card, Viewbed function is disabled.
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Chapter 5 Alarm
This chapter gives general information about the alarm and corresponding remedies.
Alarm setup and prompt messages are provided in respective parameter setup sections.
Warning
When PM-9000 is powered on, the system may verify the audio and visual alarm
function. Upon turning on the monitor, a “Dang” will be heard and at the same time the
indicator will flash twice in yellow and red. This is used to verify the audio and visual
alarm function of the system. Therefore, the user should be carefully observe the
status. If the audio and visual alarm function is not normal, it indicates that the monitor
cannot be used to monitor a patient. Please contact Mindray Company or service
center.
5.1 Alarm Modes
5.1.1
Alarm Level
Each alarm, either technical or physiological, has its own level. For alarm of higher level,
when it occurs, the system will give prompt in a more alert way. Some alarm’s level can be set
by the user via software. Others can not by changed once defined by the system. Alarms in
PM-9000 are divided into three levels, that is, high, medium and low.
High-level alarm indicates the patient’s life is in danger or the monitor under using has serious
problem in technical respect. It is the most serious alarm.
Medium-level alarm means serious warning.
Low-level alarm is a general warning.
Alarms are classified into three categories, which are physiological alarm, technical alarm and
general alarm. Physiological alarm refer to those alarms triggered by patient’s physiological
situation which could be considered dangerous to his or her life, such as heart rate (HR)
exceeding alarm limit (parameter alarms). Technical alarm refer to system failure which can
make certain monitoring process technically impossible or make monitoring result
unbelievable. Technical alarm is also called System Error Message. General alarm belongs to
those situations that can not be categorized into these two cases but still need to pay some
attention.
PM-9000 has preset the alarm level for the parameters. You can also modify the alarm level
using the method described in this chapter.
Alarm level of the System Error Message (technical alarm) is pre-set in the system.
All technical alarm level and general alarm level, some of the physiological alarm level are
pre-set in the system and can not be changed by user.
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Alarm
5.1.2
Alarm Modes
When alarm occurs, PM-9000 may raise the user’s attention in at least three ways, which are
audio prompt, visual prompt and description.Audio and visual prompt is given by TFT display
device, the speaker on the display device and the alarm indicator. Description is displayed on
the screen. Physiological alarm is displayed in the Physiological Alarm area. Most of technical
alarms are displayed in the Technical Alarm area. Technical alarms related to NIBP
measurement are displayed in the NIBP Technical Alarm area at the bottom of NIBP
parameter area.
Note
The Physiological Alarm area is on the upper right part of the screen. The Technical
Alarm area is to the left side of the Physiological Alarm area.
Note
If PM-9000 is connected to the external alarm prompt system (e.g. the alarm speaker
and indicator connected onto the rear panel of PM-9000), when alarm occurs, the
external alarm prompt system responds in the same way as the PM-9000.
Note
The concrete presentation of each alarm prompt is related to the alarm level.
Alarm prompt of the parameter exceeding the alarm limit.
When physiological alarm of the monitored parameter exceeds the alarm limit, besides using
the above-mentioned three ways to give the alarm prompt, the monitor also gives alarm by
making the monitored parameter flash in the frequency of 1Hz. If at this time the upper and
lower limits of the parameter are displayed, they will flash in the same frequency (1Hz).
Screen Display
When an alarm occurs, the parameter triggering the alarm flashes. “*” signal appears on the
screen indicating the occurrence of alarm. Red “***” indicates high-level alarm, yellow “**”
indicates medium-level alarm, and yellow “*” indicates low-level alarm. Technical alarm will not
prompts “*” signal.
Lamp light
The high/medium/low-level alarms are indicated by the system in following different visual
ways:
Alarm level
High
Medium
Low
Visual prompt
Alarm indicator flashes in red with high frequency.
Alarm indicator flashes in yellow with low frequency.
Alarm indicator lights on in yellow.
Alarm Sound
The high/medium/low-level alarms are indicated by the system in following different audio
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Patient Monitor user’s manual (V 5.4)
Alarm
ways:
Alarm level
Audio prompt
High
Mode is “DO-DO-DO------DO-DO, DO-DO-DO------DO-DO”, which is
triggered once every 8 seconds.
Medium
Mode is “DO-DO-DO”, which is triggered once every 24 seconds.
Low
Mode is “DO-”, which is triggered once every 24 seconds.
Note
When alarms of different levels occur at the same time, the monitor prompts the one of
the highest level.
Alarm Setup
The setup of the alarms can be realized in the alarm menu.
Press the “ALARM SETUP” button on the SYSTEM SETUP menu to call up “ALARM SETUP”
menu (default menu) as shown below. In the “ALM SEL” item, the user may set up the
information about common alarm setup (represented by “COMMON ALM SETUP”) and the
alarm setup of each parameter.
Figure 5-1
ALARM SETUP
COMMON ALM SETUP
Select “COMMON ALM SETUP” selection in “ALM SEL” item. This operation may call up the
dialog box as the default one.
ALARM VOL: The options are from “10” to “1”. “10” indicates the maximum volume while
“1” the minimum.
ALM REC TIME: which has three selections: 8S, 16S, 32S.
ALM PAUSE TIME: refers to the alarm suspension time span, which has three selections:
1MIN, 2MIN, 3MIN.
PARA ALM TYPE: which has two selections: LATCH, UNLATCH. LATCH refers to the
situation once alarm occurs, the system will alarm always until the intervention of the
operator (press SILENCE on the panel). UNLATCH refers to the situation that once the
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5-3
Alarm
alarm condition is discharged, the alarm will disappear automatically.
Alarm setup of each parameter
In “ALARM SETUP” menu select “ALM SEL” item to set up the alarm information of following
parameters. They are HR, ST, PVC, SPO2, NIBP, IBP (1, 2), RESP, TEMP. For example:
Method to set up alarm information of HR:
Step 1: Select “HR ALM SETUP” in “ALM SEL” item to call up the dialog box “ALARM
SETUP” for HR only.
Step 2: Five items are available for the user to set up, which are HR ALM (on/off of the alarm
switch), ALM LEV(alarm level), ALM REC(alarm recording switch), ALM HI (higher limit of HR
alarm), ALM LO (lower limit of HR alarm). When use the knob to select each item and press
the knob, a pull-down list appears for the user to choose his desired selection.
The method for setting the alarm information of other parameters is the same as HR.
5.2 Alarm verification during power on
During PM-9000 power on, audible and visual alarm capability will be tested by the system.
Every time when PM-9000 powers on, alarm beeps “DO-”, and the LED indicator on the
display device flashes yellow and red once. If no beeps heard or no alarm indicator flashing
viewed, do not use this device to monitor any patient, and notify Customer Service Center.
5.3 Alarm Cause
Alarm occurs when:
1.Physiological alarm is evoked;
2. Alarm for error of the system (technical alarm) is evoked;
3. General alert occurs.
A. Conditions that activate the parameter alarms:
When the measurement value exceeds the alarm limit and the alarm is set “ON”. Alarm will
not activate if the alarm is set “OFF”.
B. Conditions that activate the system alarms (technical alarm):
Upon the system error, the monitor prompts alarm immediately and proceeds corresponding
remedy, stops all monitoring and eliminates the final results in order to avoid faulted treatment.
If more than one error occur, they will be displayed by turns.
C. General alert
In some circumstances, alerts will behave as physiological alarm but in normal sense, we
don’t regard them as real patient health related items.
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Patient Monitor user’s manual (V 5.4)
Alarm
5.4 SILENCE and PAUSE
SILENCE
Push the SILENCE button on the panel for more than 1 second, the system will shut off all
sounds. Push the SILENCE button again, the system can exit the SILENCE status and
restore the PAUSE status and accordingly suspend the alarm as per the previously defined
time duration. Push the SILENCE button for the third time, the system will exit the PAUSE
status and restore the normal alarm status by giving the alarm sound again. When the system
is in the SILENCE status, any new alarm will terminate the SILENCE status and make the
system restore the normal alarm status.
Note
When the
symbol appears indicating the alarm sound is shut off and
accordingly the system will not give alarm sound. Therefore, you must be very careful
in using this function. There are two methods to terminate this status. One is to set the
alarm volume to “ON” in the MAINTAIN menu. The other method is to push the
SILENCE button shortly to make the
symbol become
; push the SILENCE
button again and the system will restore the normal alarm status again. Or you can
push the SILENCE button for longer time to let the system restore the normal alarm
status.
PAUSE
Push the SILENCE button on the panel shortly, the system will shut off all alarm sound and
visual prompt as well as description of physiological alarm, and enter the PAUSE status. The
countdown of PAUSE status is displayed in the Physiological Alarm area, in which area the
symbol is also displayed.
The time duration of the PAUSE status can be set to 1min, 2min or 3min. You can select in
the [ALM PAUSE TIME] item in the “SYSTEM MENU\MAINTAIN”.
After pushing the SILENCE button again, the system will restore the normal status. Besides,
the occurrence of any new technical alarm will also terminate the PAUSE status and let the
system restore the normal status. The
symbol disappears, too.
Note
After the system goes back to the normal status, the existence of alarm depends on
whether the alarm condition is complied with. After pushing the SILENCE button, the
system will permanently shut off the alarm sound for LEAD OFF/SENSOR OFF alarm.
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5-5
Alarm
5.5 Parameter Alarm
The setup for parameter alarms is in their menus. In the menu for a specific parameter, you
can check and set the alarm limit, alarm status. The setup is isolated from each other.
When a parameter alarm is off, a symbol “
” displays near the parameter. If the alarms
are turned off individually, they must be turned on individually.
For the parameters whose alarm is set to ON, the alarm will be triggered when at least one of
them exceeds alarm limit. The following actions take place:
1.
Alarm message displays on the screen as described in alarm mode;
2.
The monitor beeps in its corresponding alarm class and volume;
3.
Alarm lamp flashes;
4.
Store all parameter values during the alarm and 4,8 or 16 second waveform prior to and
after alarm.
5.
If alarm recording is on, the recorder starts alarm recording. For further information on
alarm recording, please refer to Chapter Recording.
5.6 When an Alarm Occurs
Note
When an alarm occurs, you should always check the patient's condition first.
The alarm message appears at the top of the screen on the right side. It is needed to identify
the alarm and act appropriately, according to the cause of the alarm.
1.
Check the patient's condition.
2.
Identify the cause of the alarm.
3.
Silence the alarm, if necessary.
4.
When cause of alarm has been over, check that the alarm is working properly.
You will find the alarm messages for the individual parameter in their appropriate parameter
chapters of this manual.
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Patient Monitor user’s manual (V 5.4)
Chapter 6
Freeze
General
Freeze & Unfreeze
Review & Record Frozen Waveforms
6.1
General
When monitoring a patient, you may freeze the waveforms of interest so as to view them
carefully. Generally you can review maximally 40 seconds of a frozen waveform. If required,
you may also use recorder to print out a frozen waveform. The Freeze function of this monitor
has following features:
Freeze status can be activated on any operating screen;
At the same time of entering the Freeze status, the system exits all other operating
menus. Besides, the system freezes all waveforms in the Waveform area of the Basic
Screen, or Full-lead ECG waveforms and the extra waveform (if available) on the
Full-lead ECG screen. Nevertheless the Parameter area refreshes normally.
In the Freeze status, it does not affect the display and refresh of the Trend Graph
area on the trend screen, the display and refresh of oxyCRG on the Dynamic Refresh
screen, or the display and refresh of the Viewbed window on the Viewbed screen.
The frozen waveforms can be reviewed or recorded.
6.2
Enter/Exit Freeze Status
Enter Freeze Status
In the Non-Freeze status, press the “FREEZE” button on the front panel of the monitor to let
the system exit the Menu being currently displayed (if available), then enter the Freeze status
and display the popup “FROZEN” menu. In the Freeze status, except Viewbed waveforms, all
other waveforms are frozen. In other words, the system will no longer refresh all other
waveforms.
Exit Freeze Status
In the Freeze status, executing any of the following operations will command the system to
exit the Freeze status:
Select the “EXIT” option on the “FROZEN” menu;
Press the “FREEZE” button on the front panel again;
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Freeze
Press the non-immediate-to-execute button (such as a button once pressed, a
menu will pop up for you to further select an option )on the front panel and system
buttons of MAIN and MENU;
Execute any operation that may trigger the adjustment of the screen or display of
a new menu.
After exiting the Freeze status, the system will discharge the Freeze status, clear
screen waveforms and resume to display real-time waveforms. In the Screen Refresh
mode, the system begins scanning waveforms from the extreme left one. In the Screen
Scroll mode, the system begins displaying and scrolling waveforms from the extreme
right one.
6.3
FROZEN Menu
Press the “FREEZE” button on the button module, the FROZEN menu will appear on the
bottom part of the screen. At the same time, the system enters the Freeze status.
Figure 6-1
WAVE 1:
FROZEN menu
used to select the first frozen waveform to record. The
pull-down list of this item gives you the names of all frozen waveforms
displayed on the screen.
WAVE 2:
used to select the second frozen waveform to record. The
pull-down list of this item gives you the names of all waveforms displayed
on the screen.
RECALL:used to review frozen waveforms.
REC: after selected, the system begins recording the frozen waveforms
selected in“WAVE 1” and“WAVE 2”.
EXIT: after pressed, the system closes the FROZEN menu and exits
the Freeze status。
Note
Pressing the “FREEZE” button repeatedly in short time period may result in
discontinuous waveforms on the screen.
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Patient Monitor user’s manual (V 5.4)
Freeze
6.4
Reviewing Frozen Waveform
By moving the waveform, you may review a waveform of 40 seconds before the moment
when it is frozen. For a waveform less than 40 seconds, the remaining part is displayed as a
straight line. Use the rotary snob on the front panel to move the cursor to the “RECALL”
option on the FROZEN menu. Press the knob, the option displays “L-RIGHT”. By turning the
knob left or right, frozen waveforms on the screen will move left or right correspondingly.
There is an arrow indicating upward under the right side of the last waveform. There is also a
time scale beside the arrow. “0S” is used to mark the moment when waveforms are frozen.
With waveforms moving right, this time mark will in turn change into -1S, -2S, -3S… These
time marks are applied to all waveforms on the screen.
6.5
Recording Frozen Waveform
In the Freeze status, you may output displayed frozen waveforms via the recorder. Maximum
2 waveforms can be output at one time. On the FROZEN menu, the pull-down lists of both
“WAVE 1” and “WAVE 2” give you all names of frozen waveforms on the screen, from which
you may select two. Select the “REC” option on the FROZEN menu to output parameters
generated upon the freezing moment and the two selected frozen waveforms. If one of the
two selected waveforms is closed or not available, only parameters and the other waveform
are recorded. If these two selected waveforms are all closed or not available, only parameters
are recorded. As for the function of recording frozen waveforms, you can only record the
waveforms displayed upon the freezing moment. The recording time length is the same as the
length of the waveform displayed on the screen. For example, if the speed of a waveform is
relatively fast, then it needs shorter time to record it. When recording frozen waveforms, the
system is still in the Freeze status. After completion of recording, if required, you may select
once more the waveform to be output and select “REC” option again to record the whole
selected waveforms. You may also record frozen waveforms by pressing the “REC/STOP”
button on the front panel. If the recorder does not exist, selecting the “REC” option can only
call out the prompt “Recorder does not exist” in the STATUS bar. For more detailed
information about recording, please refer to the chapter of “Recording”.
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6-3
Chapter 7 Recording
General information on recording
Instructions for configuring and recording
Recording messages
7.1
General Information on Recording
A thermal dot matrices recorder with 48mm wide printout paper is used for PM-9000 Portable
Patient Monitor.
Performance of the Recorder
Waveform record is printed out at a rate of 25 or 50 mm/s.
It can record up to 2 waveforms.
Output with grid selectable.
English / Chinese printout.
The real time recording time and waveform are user-configurable.
Auto recording interval is set by the user, the waveform is in accordance with the real
time recording.
The alarm recording waveform is automatically selected by the monitor.
7.2
Recording Type
PM-9000 provides several stripe recording types:
Continuous real-time recording
8 second real-time recording
Auto 8 second recording
Alarm recording
Waveform freeze recording
Trend graph/table recording
ARR events review recording
Alarm event recording
NIBP review recording
CO2 Measurement review recording
AG Measurement review recording
CO Measurement curve recording
Hemodynamic Calculation result recording
Monitor information recording
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7-1
Recording
Drug calculation titration recording
OxyCRG recording
Real-time Recording
Real-time recording starts as you press the REC/STOP button on the recorder.
The waveforms for continuous real-time recording and continuous 8 second recording are
automatically set by the monitor (usually the first two waveforms displayed on the screen).
You can also configure it through the menu. Refer to related section for details.
In RECORD menu, the user can choose two waveforms to be printed out. The User can setup
one waveform off. Thus, the real time record will print out one waveform. If two waveforms are
off, the real time record will print out measure parameters only.
Note
If certain recording is in process, and another parameter demands alarm recording, it
will only be executed after the earlier recording is finished.
Auto recording
The monitor starts the recorder for 8 seconds according to interval time set in the “TIMING
REC TIME” of the “RECORDER ” menu. Refer to Chapter 3.5 Recorder Setup for details.
Alarm Recording
Parameter Alarm
The monitor records waveforms 4, 8, or 16 seconds prior to and after the alarm (totally 8, 16
or 32 seconds) (which can be selected in System Menu). All parameter values during the
alarm will also be recorded.。
When parameter alarm occurs, two recorded waveforms can be printed out.
In order to avoid repeated printout of alarm waveforms:
If more than two parameter alarms are switched on and triggered simultaneously, the
recorder will print out those of the highest level. If of the same alarm level, the latest
alarm will be printed out.
If an alarm occurs during the alarm of another parameter, it will be printed out after the
current recording is finished.
If many alarms occur at the same time, some of waveforms will be stored for printout in
turn.
ST Segment Alarm
The monitor records 2-channel ECG waveforms 4, 8, or 16 seconds prior to and after the
alarm (totally 8, 16, or 32 seconds) (which can be selected in the ECG SETUP menu). All
parameter values during the alarm will also be recorded.
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Patient Monitor user’s manual (V 5.4)
Recording
Arrhythmia Alarm
The monitor records 2-channel ECG waveforms 4 seconds prior to and after the alarm (totally
8 seconds). All measurement results during the alarm will also be recorded.
Freeze Waveform Recording
The monitor prints out the selected waveforms under the FREEZE mode. In this way you can
snap the abnormal waveforms on the screen and record it.
Trend Graph / Table Recording
The monitor can print out the trend graph and table in the current TREND GRAPH or TREND
TABLE window.
Arrhythmia Review Recording
The monitor can print out the alarm Arrhythmia event in the current ARR RECALL window.
Alarm Review Recording
The monitor can print out the alarm events include waves and parameters in the current
ALARM RECALL window.
NIBP Review Recording
The monitor can print out all the NIBP review events in NIBP RECALL window.
CO Measurement Curve Recording
The monitor can print out CO Measurement curve in WINDOWS FOR CO MEASUREMENT.
Hemodynamic Calculation result recording
The monitor can print out parameters and results in HEMOD WINDOWS.
Monitor Information
The monitor can print out messages in the current STATUS window.
Titration Table
The monitor can print out the messages in the current TITRATION window.
Notes on Recording
Recording texts:
Real time Report
Periodic Report
Para Alarm Report: XXX (name of the alarm parameter)
Arrhythmia Report: XXX (Arrhythmia type)
Freeze Wave Report
Trend Graph
Trend Table
Para Alarm Review
NIBP Test Review
Patient Monitor user’s manual (V 5.4)
7-3
Recording
CO Test Curve
HEMOCAL PARAMETERS
Status Report
Titration Table
Alarm parameters, alarm time and freeze time
Patient bed number, name, sex, height, weight, date of birth, admission date
Parameter name and value
Recording time
Waveform name
Waveform scale (for ECG waveform)
ECG lead, scale, filter mode, (if having ECG waveforms, it will be printed out within the
first second or when changing the lead, gain and filter mode during real-time recording. )
IBP scale (the first second of IBP waveform)
CO2 scale (the first second of CO2 waveform)
Date and time
Company name
7.3
Recording Startup
You can start the recording in the following ways:
Continuous real-time recording
Press REC/STOP to start/stop the recording.
8 second real-time recording
Press REC/STOP to start recording. It will automatically
stop in 8 seconds.
Auto recording
Record the two waveforms selected in RECORD menu
according to the setup time interval in RECORD menu.
When alarm recording is set ON, it automatically starts
when alarm occurs.
Alarm recording
Frozen waveform recording
Trend graph recording
Trend table recording
7-4
---After accessing FREEZE menu, use knob to select two
waveforms to be output. Then press REC button in the
menu to print out the waveforms.
If two waveforms are off, the measure parameters in frozen
are printed out only.
Pick ”REC” button in the “TREND GRAPH” menu when
viewing the trend graph to print out the currently displayed
trend graph.
Pick ”REC” button in the “TREND TABLE” menu when
viewing the trend table to printout the currently displayed
Patient Monitor user’s manual (V 5.4)
Recording
trend table.
Arrhythmia review recording
Access ARR RECALL window from ARR ANALYSIS of ECG
SETUP menu and Pick ”WAVE” button to access “ARR
WAVE RECALL” menu. Then press “REC” button to output
the Arr. Waveform and related information currently
displayed on the screen.
Access the “ALARM RECALL” window from “ALARM
RECALL CONDITION” menu from “SYSTEM MENU” and
pick “REC” button to print out the alarm review waveform
and related information currently displayed in the “ALARM
RECALL” window.
Alarm review recording
NIBP review recording
Access the “NIBP RECALL” window from “SYSTEM MENU”
and pick “REC” button to print out the NIBP information
currently displayed in the window.
CO measurement curve record
Press the MEASURE button on the CO module to call up
the “WINDOWS FOR CO MEASUREMENT” window.
Pick ”REC” button to print out the CO value and
measurement curve.
Access the MEASURE button on the CO module to call up
the “WINDOWS FOR CO MEASUREMENT” window. Pick
the “EDIT” button in the window to call up the “WINDOWS
FOR C.O. EDIT” window, in which pick the “HEMO
CALCULATE” button to access the “HEMOD WINDOW”
window. Then pick the “REC” button to print out the
calculated result.
Access the “ENTER MAINTAIN PASSWORD” menu from
the “MAINTAIN” menu. Then pick the “STATUS” button to
access the ‘’STATUS” window. Pick “REC” button to print
out the status monitor information currently displayed in the
window.
Hemodynamic
result recording
Calculation
Monitor information recording
Titration table recording
Access the “DRUG CALC” menu from the “SYSTEM
MENU” menu. Pick the “TITRATION” button in the menu to
access the “TITRATION” window. Pick the “REC” button to
print out the titration currently displayed in the window.
OxyCRG recording
In oxyCRG screen, pick the “REC” button to print out
oxyCRG currently displayed in the window.
Note
You can press REC/STOP button on the recorder to stop the current recording process.
Access the “RECORD” menu from the “SYSTEM SETUP” menu. Then pick the “CLEAR REC
TASK” button to stop all recording tasks.
7.4
Recorder Operations and Status Messages
Record Paper Requirement
Only standard 50 (+0/-1) mm thermosensitive record paper can be used, otherwise the
recorder may not function, the recording quality may be poor, and the thermosensitive
Patient Monitor user’s manual (V 5.4)
7-5
Recording
printhead may be damaged.
Function Properly
■
When the recorder is working, the record paper goes out steadily. Do not pull the paper,
or the recorder will be damaged.
■
Do not operate the recorder without record paper.
Paper Out
When "RECORDER OUT OF PAPER" alarm is displayed, the recorder cannot start. Please
insert record paper properly.
Inserting Paper
■
Open the recorder catch.
■
Pull down the switch on the left axis of the recorder.
■
Insert a new roll of paper into the paper cassette, printing side facing the thermosensitive
printhead.
■
When the paper can be seen from the other side, pull it out. Ensure proper position and
tidy margin.
■
Pull back the switch on the left axis of the recorder.
■
Give out the paper from the recorder outlet.
■
Close the recorder catch.
Note
Be careful when inserting paper. Avoid damaging the thermosensitive printhead.
Unless when inserting paper or shooting troubles, do not leave the recorder catch
open.
Removing Paper Jam
When the recorder functions or sounds improperly, open the recorder catch to check for a
paper jam. Removing the paper jam in the following way:
■
Cut the record paper from the feeding edge.
■
Pull up the switch on the left axis of the recorder.
■
Pull the paper from below.
■
Re-insert the paper.
Recorder Status Message (Technical Alarms)
Message
RECORDER
HOT
Cause
HEAD
REC HEAD IN
WRONG POS.
7-6
Alarm
Level
The thermal terminal is
too hot.
low
The thermal head is not
in recording place.
low
Patient Monitor user’s manual (V 5.4)
Remedy
Stop operation
Push down the switch on
the left axis of the
recorder.
Recording
RECORDER OUT OF
PAPER
Record paper runs out.
RECORDER COMM
ERR
Operating status error
RECORDER PAPER
JAM
RECORDER
INITIALIZING
low
low
Recording continuously for
more than 30m
The recorder is
initialization process.
in
low
Insert a new
record paper.
roll
of
Reset the recorder.
Re-insert paper.
low
Wait for the completion
of initialization
TOO MANY REC
TASKS
Too many alarm events
take place simultaneously.
Low
Send recording
after a while.
RECORDER PAPER
W.P.
The paper is in wrong
position.
low
Insert the record paper
again.
low
Wait for the completion
of printing out
Low
Gives recording order
after
the
recorder
restores to the normal
status or the failure is
removed.
Low
Stop recording until the
recorder restores normal
status.
Low
Stop recording until the
recorder restores normal
status.
Shut down the monitor
and re-start it again.
RECORDER BUSY
In the status of printing out
Recorder stops working.
REC NOT AVAILABLE
The voltage of
recorder is too high.
the
The voltage of
recorder is too low.
the
RECORDER VLT LOW
RECORDER S. COMM
ERR
Unrecoverable serial port
communication error.
Low
RECORDER
SELFTEST ERR
Possibly caused by the
RAM, ROM, CPU or
WATCHDOG.
Low
RECORDER VLT
HIGH
RECORDER INIT ERR
Error
occurs
initialization
during
RECORDER INIT
ERR1
Error
occurs
initialization
during
RECORDER INIT
ERR2
Error
occurs
initialization
during
RECORDER INIT
ERR3
Error
occurs
initialization
during
RECORDER INIT
ERR4
Error
occurs
initialization
during
RECORDER INIT
ERR7
Error
occurs
initialization
during
RECORDER INIT
ERR8
Error
occurs
initialization
during
order
Reset the recorder.
low
low
low
low
low
low
low
Shutdown and re-start
Shutdown and re-start
Shutdown and re-start
Shutdown and re-start
Shutdown and re-start
Shutdown and re-start
Shutdown and re-start
If after shutdown and re-start, error still exists, contact out service engineers.
Patient Monitor user’s manual (V 5.4)
7-7
Chapter 8
Trend and Event
PM-9000 provides 72-hour trend data of all parameters, storage of 400 NIBP measurement
results and 60 alarm events. This chapter gives detailed instruction for review of all data.
8.1
Trend Graph
■
The latest 1-hour trend is displayed every 1 or 5 seconds;
■
The latest 72-hour trend is displayed every 1, 5 or 10 minutes;
Pick "TREND GRAPH" in the SYSTEM MENU to call up the following menu:
Figure 8-1
TREND GRAPH Menu
The uppermost part is the name of the parameter, in which y-axis stands for value and x-axis
time. "
" Indicates the value of the parameter, which it points to, is below the x-axis, with
corresponding time displayed beyond the trend graph. Other trends except NIBP trend are
displayed as continuous curves. In NIBP trend graph, "σ" indicates systolic value, "τ" indicates
diastolic value, and "*" indicates mean value.
To select trend graph of a specific parameter:
Pick PARA SELECT item (the first selection of the upper line) and select a requested
parameter name by turning the knob.
Patient Monitor user’s manual (V 5.4)
8-1
Trend and Event
To select 1-hour or 72-hour trend graph:
Pick RESOLUTION item (the latter selection of the upper line), choose 1 or 5 sec for 1-hour
trend graph and 1, 5 or 10 min for 72-hour trend graph.
To view other trend curves:
When "
" appears on the right part of the screen, pick "L-RIGHT" (the button at the
"
extreme left of the lower line), turn the knob clockwise to view later trend curves. When "
appears on the left part of the screen, pick the same item, turn the knob counterclockwise to
view earlier trend curve.
To change the display scale
Pick the “ZOOM” button in the lower line to adjust the y-axis scale and thus change the trend
curve in proportion. The value beyond maximum value will be represented by the maximum
value.
To obtain trend data of a specific time
The time to which the cursor points will change as the knob is turned. Parameter at this time
is displayed below the x-axis. When "
" appears on the right part of the screen, the trend
graph pages down for later trend curve as the cursor moves here. When "
" appears on
the left part of the screen, the trend graph pages up for earlier trend curve as the cursor
moves here.
To print out the trend curve
Press REC button to print out the trend curve of current selected parameter.
Mark event
If an event is marked A, B, C, or D, then the corresponding event type will display on the axis
time of the trend graph. The event sign (A, B, C or D) is displayed in a frame.
Operation example
To view the NIBP trend graph of the last 1 hour:
Pick the MENU hot key lower right of the screen.
Pick TREND GRAPH item.
Pick the first item and switch to NIBP by turning the knob.
Adjust the second item to be 1 or 5 sec.
Pick the ZOOM button and turn the knob to view changes of the trend graph time
and trend curve.
Stop at requested trend time section for careful review. Pick the ZOOM button to
adjust the display scale if necessary.
For measurement result of a specific time, pick CURSOR to move the cursor to the
point, corresponding time and value will display on above and below respectively.
For printout of trend graph, pick REC to start report printing of NIBP trend of this
hour.
Pick EXIT to return to trend graph display.
8-2
Patient Monitor user’s manual (V 5.4)
Trend and Event
8.2
Trend Table
The latest 72-trend table data can be displayed at every 1, 5, 10, 30, or 60 minutes.
Pick TREND TABLE in the SYSTEM MENU to call up the following menu:
Figure 8-2
TREND TABLE Menu
Time in response to each group of trend data is displayed at the leftmost list with date in
bracket. Marked event corresponds to marking time. Trend data of each parameter is divided
into 8 groups.
HR, RR, PVC
ST1, ST2
TEMP1, TEMP2, TEMPD
SPO2, PR
NIBP NS/ND (NM)
IBP1 (S/D/M), IBP2 (S/D/M)
CO2, INS, AwRR
TB
NIBP trend data presents different specificity. A certain NIBP measuring time is displayed
below the TEST AT item, as well as the measurement value. For more than one measurement
in one time, it can display only one group, and mark a "*" on the MORE to indicate two and
above measurement results.
To choose trend table of different resolution
Pick the leftmost item and change the time interval of trend data.
To view other trend data:
When "
" appears on the upper part of the screen, pick UP-DOWN button and turn the knob
clockwise to view later trend data. When " " appears on the lower part of the screen, pick the
Patient Monitor user’s manual (V 5.4)
8-3
Trend and Event
same item and turn the knob counterclockwise to view earlier trend data.
To obtain trend data of different parameter
Pick L-RIGHT to select one from the 8 groups of parameters. A ">" by the rightmost item
indicates following page available. And "<" by the leftmost item indicated previous page
available.
To print out the trend data
Pick REC to print out the trend data of current displayed parameter.
Mark event
If an event is marked A, B, C, or D, the corresponding event type will display on the axis time
of the trend table.
Operation example
To view a NIBP trend table:
Pick MENU hot key lower right of the screen to access “SYSTEM MENU”.
Pick TREND TABLE.
Pick L-RIGHT and switch to NIBP by turning the knob.
Pick the first item from the left and select requested time interval.
Pick UP-DOWN and turn the knob to view NIBP trend data of different time.
For printout of trend table, pick REC to start report printing of all trend data including
NIBP of this time span.
Pick EXIT to return to SYSTEM MENU.
8.3
NIBP Recall
PM-9000 can review the latest 400 NIBP measurement data.
Pick NIBP RECALL in the SYSTEM MENU to invoke the result and time of the latest 10
measurements, as shown in the figure below.
Figure 8-3
8-4
NIBP RECALL
Patient Monitor user’s manual (V 5.4)
Trend and Event
Data is listed chronologically from the latest to the earliest. 10 measurements can be
displayed in one screen. Pick UP-DOWN to view other trend curve up to 400 results. Pick
REC to print out all measurement data of NIBP RECALL.
8.4
Alarm Event Recall
PM-9000 can display the latest 60 alarm events.
Select “ALARM RECALL” in the SYSTEM MENU to access ALARM RECALL
CONDITION menu as shown below.
Figure 8-4
ALARM RECALL CONDITION Menu
In this menu, the user may select the conditions for alarm review, including:
1.
Start and End time of review:
The user may select the start time of review in the item of START.
Then the user may select the end time of review. Two selections are available: current
time and the user-defined time.
For user-defined end time, the user can use the knob to select.
2.
ALARM RECALL EVENT
In the pull-down list of ALARM RECALL EVENT, the user can select the parameter
whose alarm events he wants to review. The selections include ALL(alarm events of all
parameters), ECG, REST, SPO2, NIBP, IBP, TEMP, CO2, CO, HR_H>180(the value of
HR is higher than the upper alarm limit), HR_L<60(the value of HR is below the lower
alarm limit), SPO2<90%, IBP_H>200mmHg, IBP_L<40mmHg, RR_H>40, RR_L<10,
TEMP_H>40℃, TEMP_L<34℃.
After setting up all the review conditions, press the “ALARM RECALL” button to access
“ALARM RECALL” window.
ALARM RECALL
The ALARM RECALL window is as shown below, in which following data are displayed:
① Time span (Format: month-day-year hour: minute- month-day-year hour: minute).
② Event type.
Patient Monitor user’s manual (V 5.4)
8-5
Trend and Event
③ Serial number (Format: NO. xx of XX ).
④ The value at the time of alarm. NIBP result is with time.
⑤ Two 8/16/32-second waveforms.
①
②
③
④
⑤
Figure 8-5
ALARM RECALL Menu
To view all waveforms during the alarming process
Pick L-RIGHT and turn the knob to view all 8/16/32-second waveforms stored.
To view other alarm events
Events of up to 60 are listed chronologically from the latest to the earliest. Pick UP-DOWN
button and turn the knob to view later or earlier events.
Recording
Pick REC to print our all data and waveform of this event.
8-6
Patient Monitor user’s manual (V 5.4)
Chapter 9 Drug
Titration Table
Calculation
and
PM-9000 Portable Patient Monitor provides Drug calculation and titration table display
functions for fifteen drugs and outputs the content of titration table on the recorder.
9.1 Drug Calculation
The drug calculations that can be performed by the system are AMINOPHYLLINE,
DOBUTAMINE, DOPAMINE, EPINEPHRINE, HEPARIN, ISUPREL, LIDOCAINE, NIPRIDE,
NITROGLYCERIN and PITOCIN. Besides DRUG A, DRUG B, DRUG C, DRUG D and DRUG
E are also provided to flexibly replace any of the drugs.
Select “DRUG CALC” in SYSTEM MENU, the following “DRUG CALC” display appears:
Figure 9-1
DRUG CALC
The following formulas are applied for dose calculation:
Concentrat
= Amount / Volume
INF Rate
=DOSE/Concentrat
Duration
Dose
= Amount / Dose
= Rate × Concentrat
Operating method:
In the Drug Calculation window, the operator should first select the name of the drug to be
Patient Monitor user’s manual (V 5.4)
9-1
Drug Calculation and Titration Table
calculated, and then confirm the patient weight. Afterwards, the operator should also enter
other known values.
Turn the knob to select the value of the item to be calculated. Turn the knob to change the
value. When it is the required value, press the knob to view the calculation result. Each item
has its calculation range. If the result exceeds the range, display “---.--”
Note
For the drug calculation, the prerequisite is that the operator must first of all enter the
patient weight and drug name. The system first gives a group of random initial values,
which cannot be used by the operator as the calculation reference. Instead, he should
enter a new group of values at the doctor’s instruction.
Note
Each drug has its fixed unit or unit series. Operator must select the proper unit at the
doctor’s instruction. If the result exceeds the system-defined range, it will display “---”.
Note
After entering a value, a conspicuous prompt will appear in the menu warning the
operator to confirm the correctness of the entered value. The correct value is the
guarantee for the reliability and safety of the calculated results.
Note
In neonate mode, Drip Rate and Drop Size items are disabled.
Note
For each entered value, the system will always give a dialog box asking for the user’s
confirmation. You must be careful when answering each box. The calculated result is
reliable only after the entered value is confirmed to be correct.
Select the drug name:
Turn the knob to pick the DRUG NAME item in DRUG CALC menu. The user may select the
drug name in the pull-down list, including AMINOPHYLLINE、DOBUTAMINE、DOPAMINE、
EPINEPHRINE、HEPARIN、ISUPREL、LIDOCAINE、NIPRIDE、NITROGLYCERIN、
PITOCIN、Drug A、Drug B、Drug C、Drug D and Drug E. Calculation for only one type can be
generated each time.
NOTE: A、B、C、D、E are only codes for drugs instead of their real names. The units for these
five drugs are fixed. The operator may select the appropriate units according to the
convention of using these drugs. The rules for expressing the units are:
“mg” series units are fixedly used for drug A, B and C: g, mg, mcg.
“unit” series units are fixedly used for drug D: unit, k unit, m unit.
“mEq” is fixedly used for drug E.
9-2
Patient Monitor user’s manual (V 5.4)
Drug Calculation and Titration Table
Patient weight:
After accessing the DRUG CALC window, the operator should enter the patient weight into
the first or the second item. The entered weight will be used as the independent data only for
the calculation of drug concentration.
Note
This drug calculation function acts only as a calculator. That means the patient weight
in Drug Calculation menu and the patient weight in Patient Information menu are
independent from each other. Therefore if the Weight in Drug Calculation changes, the
Weight in Patient Information does not change. In this way, we can say, the Drug
Calculation menu is independent from other menus in the system. Any change of it will
not affect other information about the patient being currently monitored.
9.2 Titration Table
Access titration table:
Select TITRATION item in DRUG CALC menu to enter titration table display.
Titration table display for drug is as following:
Figure 9-2
TITRATION
Method to operate the titration table:
1.
In the TITRATION table, turn the knob to pick BASIC item. Press and turn the knob to
select either FLOW RATE or DOSE or DROP RATE.
2.
Then turn the knob to pick STEP item. Press and turn the knob to select step. 1 ~ 10 are
available for selection with the increment being 1.
Patient Monitor user’s manual (V 5.4)
9-3
Drug Calculation and Titration Table
3.
Turn the knob to pick DOSE TYPE item. Press and turn the knob to select the unit in the
pull-down list.
4.
Use UP-DOWN item in the table to view the data in previous or following pages.
5.
Turn the knob to pick REC item. After pressing the knob, the recorder prints out the data
displayed in the current titration table.
6.
Turn the knob to pick EXIT to return to DRUG CALC menu.
Total amount, dose, volume, flow-rate, drop rate and patient weight and drug name are
displayed on the top of the titration table. Meaning of each English identifier is:
AMOUNT:drug amount
VOLUME:liquid volume
DOSE/min:drug dose
FLOW RATE:flow rate
DROP RATE:drop rate
WEIGHT:patient weight
9-4
Patient Monitor user’s manual (V 5.4)
Chapter 10 Patient Safety
The PM-9000 Portable Patient Monitor is designed to comply with the International National
Safety requirements for medical electrical equipment. This device has floating inputs and is
protected against the effects of defibrillation and electrosurgery. If the correct electrodes are
used and applied in accordance with the manufacturer instructions, the screen display will
recover within 10 seconds after defibrillation.
This symbol indicates that the instrument is IEC 60601-1 Type CF equipment. The unit
displaying this symbol contains an F-Type isolated (floating) patient applied part providing a
high degree of protection against shock, and is suitable for use during defibrillation.
Warning
Do not touch the patient, bed or instrument during defibrillation.
Environment
Follow the instructions below to ensure a completely safe electrical installation. The
environment where the PM-9000 Portable Patient Monitor will be used should be reasonably
free from vibration, dust, corrosive or explosive gases, extremes of temperature, humidity, and
so on. For a cabinet mounted installation, allow sufficient room at the front for operation and
sufficient room at the rear for servicing with the cabinet access door open.
The PM-9000 Portable Patient Monitor operates within specifications at ambient temperatures
between 0℃ and 40℃. Ambient temperatures that exceed these limits could affect the
accuracy of the instrument and cause damage to the modules and circuits. Allow at least 2
inches (5cms) clearance around the instrument for proper air circulation.
Power Source Requirements
Refer to chapter Production Specification.
Grounding the PM-9000 Portable Patient Monitor
To protect the patient and hospital personnel, the cabinet of the PM-9000 Portable Patient
Monitor must be grounded. Accordingly, the PM-9000 Portable Patient Monitor is equipped
with a detachable 3-wire cable which grounds the instrument to the power line ground
(protective earth) when plugged into an appropriate 3-wire receptacle. If a 3-wire receptacle is
not available, consult the hospital electrician. If completeness of the protective grounding wire
is in doubt, the equipment must be operated with internal power supply.
Patient Monitor user’s manual (V 5.4)
10-1
Patient Safety
Warning
Do not use a 3-wire to 2-wire adapter with this instrument.
Connect the grounding wire to the equipotential grounding terminal on the main system. If it is
not evident from the instrument specifications whether a particular instrument combination is
hazardous or not, for example due to summation of leakage currents, the user should consult
the manufacturers concerned or else an expert in the field, to ensure that the necessary
safety of all instruments concerned will not be impaired by the proposed combination.
Equipotential Grounding
Protection class 1 instruments are already included in the protective grounding (protective
earth) system of the room by way of grounding contacts in the power plug. For internal
examinations on the heart or the brain, the PM-9000 Portable Patient Monitor must have a
separate connection to the equipotential grounding system. One end of the equipotential
grounding cable (potential equalization conductor) is connected to the equipotential grounding
terminal on the instrument rear panel and the other end to one point of the equipotential
grounding system. The equipotential grounding system assumes the safety function of the
protective grounding conductor if ever there is a break in the protective grounding system.
Examinations in or on the heart (or brain) should only be carried out in medically used rooms
incorporating an equipotential grounding system. Check each time before use that the
instrument is in perfect working order. The cable connecting the patient to the instrument must
be free of electrolyte.
Warning
If the protective grounding (protective earth) system is doubtful, the monitor must be
supplied by inner power only.
Condensation
Make sure that during operation, the instrument is free of condensation. Condensation can
form when equipment is moved from one building to another, thus being exposed to moisture
and differences in temperature.
Warning
Possible explosion hazard if used in the presence of flammable anesthetics.
Explanation of Symbols in the Monitor
This symbol means 'BE CAREFUL '. Refer to the manual..
This symbol indicates that the instrument is IEC 60601-1 Type CF equipment. The
10-2
Patient Monitor user’s manual (V 5.4)
Patient Safety
unit displaying this symbol contains an F-Type isolated (floating) patient applied part providing
a high degree of protection against shock, and is suitable for use during defibrillation.
Equipotential grounding system.
Protective earth ground.
Partial On/Off
This item is compliant with Medical Device Directive 93/42/EEC of 14 June 1993, a directive
of the European Economic Community.
Patient Monitor user’s manual (V 5.4)
10-3
Chapter 11 Care / Cleaning
11.1
System Check
Before using the monitor, do the following:
■
check if there is any mechanical damage;
■
check all the outer cables, inserted modules and accessories;
■
check all the functions of the monitor to make sure that the monitor is in good condition.
If you find any damage on the monitor, stop using the monitor on patient, and contact the
biomedical engineer of the hospital or Mindray Customer Service immediately.
The overall check of the monitor, including the safety check, should be performed only by
qualified personnel once every 6 to 12 month, and each time after fix up.
You should check the synchronism of the defibrillator in the frequency described in the
hospital regulations. At least every 3 months, it should be checked by a qualified customer
service technician.
All the checks that need to open the monitor should be performed by qualified customer
service technician. The safety and maintenance check can be conducted by persons from
Mindray. You can obtain the material about the customer service contract from the local
Mindray office.
Warning
If the hospital or agency that is responding to using the monitor does not follow a
satisfactory maintenance schedule, the monitor may become invalid, and the human
health may be endangered.
Note
To ensure maximum battery life, it is recommended that, at least once a month, the
monitor be run on battery until it turns itself off and then recharged.
Warning
Refer the battery replacement only to Mindray service technician.
Patient Monitor user’s manual (V 5.4)
11-1
Care / Cleaning
11.2
General Cleaning
Warning
Before cleaning the monitor or the sensor, make sure that the equipment is switched
off and disconnected from the power line.
The PM-9000 Patient Monitor must be kept dust-free.
Regular cleaning of the monitor shell and the screen is strongly recommended. Use only
non-caustic detergents such as soap and water to clean the monitor shell.
Note
Please pay special attention to the following items:
1.
Avoid using ammonia-based or acetone-based cleaners such as acetone.
2.
Most cleaning agents must be diluted before use. Follow the manufacturer's
directions carefully to avoid damaging the monitor.
3.
Don't use the grinding material, such as steel wool etc.
4.
Don't let the cleaning agent enter into the chassis of the system.
5.
Don't leave the cleaning agents at any part of the equipment.
11.3
Cleaning Agents
Examples of disinfectants that can be used on the instrument casing are listed below:
■
Diluted Ammonia Water
■
Diluted Sodium Hyoichlo (Bleaching agent).
Note
The diluted sodium hyoichlo from 500ppm(1:100 diluted bleaching agent) to 5000ppm
(1:10 bleaching agents) is very effective. The concentration of the diluted sodium
hyocihlo depends on how many organisms (blood, mucus) on the surface of the
chassis to be cleaned.
■
Diluted Formaldehyde 35% -- 37%
■
Hydrogen Peroxide 3%
■
Alcohol
■
Isopropanol
Note
PM-9000 monitor and sensor surface can be cleaned with hospital-grade ethanol and
dried in air or with crisp and clean cloth.
11-2
Patient Monitor user’s manual (V 5.4)
Care / Cleaning
Note
Mindray has no responsibility for the effectiveness of controlling infectious disease
using these chemical agents. Please contact infectious disease experts in your
hospital for details.
11.4
Sterilization
To avoid extended damage to the equipment, sterilization is only recommended when
stipulated as necessary in the Hospital Maintenance Schedule. Sterilization facilities should
be cleaned first.
Recommended sterilization material: Ethylate, and Acetaldehyde.
Appropriate sterilization materials for ECG lead, blood pressure cuff are introduced in
Chapters ECG/RESP Monitoring, Chapter NIBP Monitoring respectively.
Caution
Follow the manufacturer’s instruction to dilute the solution, or adopt the lowest
possible density.
Do not let liquid enter the monitor.
No part of this monitor can be subjected to immersion in liquid.
Do not pour liquid onto the monitor during sterilization.
Use a moistened cloth to wipe up any agent remained on the monitor.
11.5
Disinfection
To avoid extended damage to the equipment, disinfection is only recommended when
stipulated as necessary in the Hospital Maintenance Schedule. Disinfection facilities should
be cleaned first.
Appropriate disinfection materials for ECG lead, SpO2 sensor, blood pressure cuff, TEMP
probe, IBP sensor and CO cable are introduced in Chapters 12-18 respectively.
Caution
Do not use EtO gas or formaldehyde to disinfect the monitor.
Patient Monitor user’s manual (V 5.4)
11-3
Chapter 12 ECG/RESP Monitoring
12.1 What Is ECG Monitoring
Monitoring the ECG produces a continuous waveform of the patient's cardiac electric activity
to enable an accurate assessment of his current physiological state. Only proper connection
of the ECG cables can ensure satisfactory measurement. On the Normal Display, PM-9000
provides display of 2-channel ECG waveforms.
■
The patient cable consists of 2 parts(See Chapter Accessories and Ordering
Information for detail information of the ECG accessories);
The cable that connects to the monitor;
The lead set that connects to the patient.
■
Using a 5-lead set, the ECG can derive up to two waveforms from two different leads.
For requested lead, you may choose from the left side of ECG waveform.
■
The monitor displays the Heart Rate (HR), ST segment and Arrhythmia analysis.
■
All of the parameters above can be set as alarm parameters.
Note
In the default settings of PM-9000, the ECG waveforms are the first two waveforms
from top in the Waveform Area.
12.2 Precautions during ECG Monitoring
Warning
Do not touch the patient, table nearby, or the equipment during defibrillation.
Warning
Use only the original PM-9000 ECG cable for monitoring.
Warning
When connecting the cables and electrodes, make sure no conductive part is in
contact with the ground. Verify that all ECG electrodes, including neutral electrodes,
are securely attached to the patient.
Patient Monitor user’s manual (V 5.4)
12-1
ECG/RESP Monitoring
Warning
When apply the ECG cable with no resistances to Mindray patient monitor or other
patient monitors which themselves with no current limit resistance, it can’t be applied
to defibrillation.
Note
Interference from a non-grounded instrument near the patient and ESU interference
can cause inaccuracy of the waveform.
12.3 Monitoring Procedure
12.3.1
1.
Preparation
Prepare the patient's skin prior to placing the electrodes.
■
The skin is a poor conductor of electricity, therefore preparation of the patient's skin
is important to facilitate good electrode contact to skin.
■
Shave hair from sites, if necessary.
■
Wash sites thoroughly with soap and water. (Never use ether or pure alcohol,
because this increases skin impedance).
■
Rub the skin briskly to increase capillary blood flow in the tissues and remove skin
scurf and grease.
2.
Attach clip or snap to electrodes prior to placement.
3.
Put the electrodes on the patient. Before attaching, apply some conductive jelly on the
electrodes if the electrodes are not electrolyte self-supplied.
4.
Connect the electrode lead to the patient's cable.
5.
Make sure the monitor is ready with power supply.
Warning
Check everyday whether there is skin irritation resulted from the ECG electrodes. If so,
replace electrodes every 24 hours or change their sites.
Note
For protecting environment, the electrodes must be recycled or disposed of properly.
Warning
Verify lead fault detection prior to the start of monitoring phase. Unplug the ECG cable
from the socket, the screen will display the error message “ECG LEAD OFF” and the
audible alarm is activated.
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Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
12.3.2
Installing ECG lead
Placing the Electrodes for ECG Monitoring
Electrode placement for 5-lead set (Figure 12-1)
■
Red (R) electrode - Be placed near the right shoulder, directly below the clavicle.
■
Yellow (L) electrode - Be placed near the left shoulder, directly below the clavicle.
■
Black (N) electrode - Be placed on the right hypogastrium.
■
Green (F) electrode - Be placed on the left hypogastrium.
■
White (C) electrode - Be placed on the chest as illustrated in the F Figure 12-2
Note: the following table gives the corresponding lead names used in Europe and America
respectively. (Lead names are represented by R, L, N, F and C respectively in Europe, whose
corresponding lead names in America are RA, LA, RL, LL and V.)
America
Euro
Lead names
color
Lead names
color
RA
White
R
Red
LA
Black
L
Yellow
LL
Red
F
Green
RL
Green
N
Black
V
brown
C
White
Figure 12-1
Electrode placement for 5-lead set
Note
Patient Monitor user’s manual (V 5.4)
12-3
ECG/RESP Monitoring
To ensure patient safety, all leads must be attached to the patient.
For 12-lead set, attach the C-electrode to one of the indicated positions as below (Figure
12-2):
■
V1
On the 4th intercostal space at the right sterna margin.
■
V2
On the 4th intercostal space at the left sterna margin.
■
V3
Midway between V2 and V4 electrodes.
■
V4
On the 5th intercostal space at the left clavicular line.
■
V5
On the left anterior axillary line, horizontal with V4 electrode.
■
V6
On the left middle axillary line, horizontal with V4 electrode.
■
V3R-V7R
On the right side of the chest in positions corresponding to those on the
left.
■
VE
Over the xiphoid position.
■
V7
On the 5th intercostal space at the left posterior axillary line of back.
■
V7R
On the 5th intercostal space at the right posterior axillary line of back.
Figure 12-2
C-electrode placement for 12-lead set
Recommended ECG Lead Placement for Surgical Patients
Warning
When using Electrosurgery equipment, leads should be placed in a position in equal
distance from Electrosurgery electrotome and the grounding plate to avoid cautery.
Electrosurgery equipment wire and ECG cable must not be tangled up.
The placing of the ECG leads will depend on the type of surgery that is being performed. For
example, with open chest surgery the electrodes may be placed laterally on the chest or on
the back. In the operating room, artifacts can sometimes affect the ECG waveform due to the
use of ES (Electrosurgery) equipment. To help reduce this you can place the electrodes on
12-4
Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
the right and left shoulders, the right and left sides near the stomach, and the chest lead on
the left side at mid-chest. Avoid placing the electrodes on the upper arms, otherwise the ECG
waveform will be too small.
Warning
When using Electrosurgery equipment, never place an electrode near the grounding
plate of the Electrosurgery device, otherwise there will be a great deal of interference
with the ECG signal.
■
Using 5-lead ECG set
The default setting is ECG CH1 corresponding to Channel II, and ECG CH2 to Channel I,
you can modify the setting to meet your needs. You can set them to correspond to any
two from I, II, III, AVR, AVL, AVF and V. If you set both to the same value, one of them will
be adjusted to another option automatically. (Figure 12-3)
Figure 12-3
ECG lead
Note
If a ECG waveform is not accurate, while the electrodes are tightly attached, try to
change the lead.
Note
Interference from a non-grounded instrument near the patient and ESU interference
can cause inaccuracy of the waveform.
Normal QRS complex should be:
Tall and narrow with no notches.
With tall R-wave completely above or below the baseline.
Patient Monitor user’s manual (V 5.4)
12-5
ECG/RESP Monitoring
With pacer spike no higher than R-wave height.
With T-wave less than one-third of the R-wave height.
With P-wave much smaller than the T-wave.
For getting 1 mv calibrated ECG wave, choose ECG CAL button in ECG SETUP menu. A
message "when CAL, can't monitor! " prompts on the screen.
R
T
P
Q
Figure 12-4
S
Standard ECG Waveform
Warning
Do not touch the patient, table nearby, or the equipment during defibrillation.
12.4 ECG Screen Hot Keys
Figure 12-5
the hot key for ECG
① Leads of channel 1:
1) The selectable leads are I, II, III, aVR, aVL, aVF,.V.
2) When the ECG is 5-lead, the selectable leads are: I, II, III, aVR, aVL, aVF, V; when
ECG is 3-lead, the selectable leads are: I,II,III.
3) Leads on the ECG wave must not have the same name. Otherwise, the system will
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Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
automatically change the ECG waveform name that has the same name as the waveform
being currently adjusted to another name.
② Waveform gain of channel 1: used to adjust the size of ECG waveforms
Select gain value for each channel from ×0.25,×0.5,×1,×2, and auto. Under "auto"
mode, the monitor chooses an appropriate level automatically. A 1mv scale displays on
each ECG channel's right side. The height of 1mV bar is directly proportional to the
waveform amplitude.
Note
When the input signals are too large, the peak of the waveform may be not able to be
displayed. In this case the user may manually change the setup method of ECG
waveform according to the actual waveform so as to avoid the occurrence of the
unfavorable phenomena.
③ Filter method: used for displaying clearer and more detailed waveform
There are three filter modes for selection. DIAGNOSTI, MONITOR and SURGERY
modes may reduce perturbance and interference from Electrosurgery equipment. The
filter method is the item applicable for both channels, which is always displayed at the
waveform place of the channel 1 ECG waveform.
Note
Only in Diagnosis mode, the system can provide non-processed real signals. In
Monitor or Sugery mode, ECG waveforms may have distortion of different extent. In
either of the latter two modes, the system can only show the basic ECG and the results
of ST analysis may also be greatly affected. In Surgery mode, results of ARR analysis
may be somewhat affected. Therefore, it is suggested that in the environment having
relative small interference, you’d better monitor a patient in Diagnosis mode.
④ Leads of channel 2: refer to ① for detailed information.
⑤ Waveform gain of channel 2: refer to ② for detailed information.
Note
Pacemaking signal detected is marked by a "|" above the ECG waveform.
12.5 ECG Menu
ECG SETUP Menu
Pick the ECG hot key on the screen, and the following menu will popup.
Patient Monitor user’s manual (V 5.4)
12-7
ECG/RESP Monitoring
Figure 12-6
ECG SETUP menu
ECG alarm setting
• HR ALM: pick "ON" to enable prompt message and data record during the ECG alarm;
pick "OFF" to disable the alarm function, and there will be a
beside “ECG”.
• ALM LEV: selectable from HIGH, MED, LOW. Level HIGH represents the most serious
case.
• ALM REC: pick "ON" to enable report printing upon ECG alarm.
• ALM HI: used to set up the upper limit of ECG alarm.
• ALM LO: used to set up the lower limit of ECG alarm.
ECG alarm is activated when the heart beat exceeds set ALM HI value or falls below
ALM LO value.
ECG alarm limits:
Max. ALM HI
Min. ALM LO
Step
HR ADU
300
15
1
HR PED
350
15
1
HR NEO
350
15
1
Note
Please set the alarm limits according to clinical condition of individual patient. The
upper limit shall not exceed 20 beat/min higher than the patient's heart rate.
■
HR FROM
ECG, SpO2, AUTO and BOTH may detect heart rate. AUTO distinguishes heart rate
source according to the quality of signal. By picking ECG, the monitor prompts HR and
activates HR beep. By picking SpO2, the monitor prompts PULSE and activates pulse beep.
BOTH mode displays HR and PR simultaneously, when this item is picked, PR parameter is
displayed to the right side of SpO2. As for the sound of HR or PR in BOTH mode, HR is given
the priority, i.e., if HR is available, whose sound will be sent out, but if HR is not available,
12-8
Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
then the sound will be for PR.
■
HR CHANNEL
"CH1"
to count the heart rate by CH 1 waveform
"CH2"
to count the heart rate by CH 2 waveform
"AUTO" the monitor selects a channel automatically
■
LEAD TYPE: used to select either 5 LEADS or 3 LEADS.
■
SWEEP
Available options for ECG SWEEP are 12.5, 25.0, and 50.0 mm/s.
■
ST ANALYSIS
Pick this item to access ST ANALYSIS menu, the detailed information about the menu is
to be discussed in the following section.
■
ARR ANALYSIS
Pick this item to access ARR ANALYSIS menu, the detailed information about the menu
is to be discussed in the following section.
■
OTHER SETUP
Pick this item to access ECG SETUP menu as shown below:
Figure 12-7
ECG SETUP menu
In the sub-menu, following functions are available:
ECG DISPLAY: Select NORMAL DISPLAY to display 2 ECG waveforms for 5-lead (for
3-lead, only 1 ECG waveform is displayed.). Select MULTI-LEADS DISPLAY, the
waveform area on the screen displays 6 ECG waveforms. Select HALF-SCAN
MULTI-LEADS, there are 4 ECG waveforms are displayed on the screen.
Note: If 3 LEADS is selected in the ECG SETUP menu, only NORMAL DISPLAY can be
selected for ECG DISPLAY item in the sub-menu.
BEAT VOL
The options are from “3” to “0”. “3” indicates the maximum volume while “0” the
minimum.
Note
PITCH TONE volume is controlled through adjusting the heart beat volume. However, if
SPO2 is selected as “HR FROM” in “ECG SETUP”, the PITCH TONE volume will
accordingly controlled through adjusting “PR SOUND” in “SPO2 SETUP” menu. Refer
Patient Monitor user’s manual (V 5.4)
12-9
ECG/RESP Monitoring
to the chapter about SPO2 to know the detailed information about PITCH TONE.
PACE
"ON"
detected signal will be marked by a "|" above the ECG waveform
"OFF"
for non-pacemaking patient
Note
If monitoring a patient with the pacemaker, set “PACE” to On. If monitoring a patient
without pacemaker, set “PACE” to Off.
If “PACE” is on, the system will not perform some types of ARR analysis. For detailed
information, please refer to the section: ARR ALARM. In the table, the ARR type marked
by All types applies to the analysis in all situations, marked by Non-paced applies only
to the analysis in the situation when the patient does not use pacemaker.
CASCADE: switch for ECG cascade. CASCADE: wave of each channel is displayed in
two lines. This function effects only when NORMAL DISPLAY is selected for ECG
DISPLAY.
ECG CAL: pick this item to start calibrating ECG. The method to end CAL: re-select the
CAL key in the menu or re-select the lead name on the screen.
ADJUST WAVE POS: used to adjust the position of the waveform on the screen. Pick to
access ADJUST WAVE POS dialog box. The user may use CH NAME item to select the
channel to be adjusted, UP-DOWN to adjust the position of the selected channel on the
screen, BACK TO DEFAULT to let the wave go back to the default position on the
screen.
Figure 12-8
ADJUST WAVE POS menu
DEFAULT: pick this item to access the ECG DEFAULT CONFIG dialog box, in which the
user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT
CONFIG is to be used. After selecting any of the items and exiting the dialog box, the
system will pop up the dialog box asking for the user’s confirmation.
Warning
For pacemaker patient, the pacing impulse analysis function must be switched on,
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Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
otherwise, the pacing impulse may be counted as normal QRS complex, which results
in failure of “ECG LOST” error detection.
■
For monitor with ST segment & Arrhythmia analysis software, refer to ST Segment
Monitoring and Arrhythmia Analysis for details.
Note
When Pacer Switch is On, the Arrhythmia events related to PVCs will not be monitored.
At the same time, the ST analysis will not be performed either.
12.6 ECG Alarm Information and Prompt
Alarm Message
Alarms occurring in the process of ECG measurement contain two types: physiological alarm
and technical alarm. Prompt message may also appear in the mean time. For the audio and
visual features during the appearance of these alarms and prompt messages in the process
of ECG measurement, please refer to the related description in Chapter Alarm. In the screen,
physiological alarm messages and the prompt messages able to trigger alarms (general alerts)
all displayed in the alarm area of the monitor while technical alarms and prompt messages
unable to trigger alarms are then displayed in the information area of the monitor. This section
does not describe the content about Arr. and ST analysis.
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe respectively the possible various alarms those may occur during the
measurement.
Physiological alarms:
Message
Cause
Alarm level
ECG LOST
HR TOO HIGH
HR TOO LOW
Technical alarms:
No ECG signal of the patient is detected.
HR measuring value is above the upper alarm limit
HR measuring value is below the lower alarm limit
HIGH
User-selectable
User-selectable
Message
ECG LEAD OFF
ECG V LEAD OFF or
Cause
ECG electrodes fall off
the skin or ECG cables fall off
the monitor.
Alarm
level
LOW
ECG C LEAD OFF
Remedy
Make sure that all
electrodes, leads and
patient cables are
properly connected.
ECG LL LEAD OFF or
ECG F LEAD OFF
Patient Monitor user’s manual (V 5.4)
12-11
ECG/RESP Monitoring
ECG LA LEAD OFF or
ECG L LEAD OFF
ECG RA LEAD OFF or
ECG R LEAD OFF
ECG INIT ERR
ECG INIT ERR1
ECG INIT ERR2
HIGH
Stop
using
measuring function
provided by ECG
module,
notifies
biomedical engineer
or Mindray service
staff.
HIGH
If failure persists,
notify
biomedical
engineer or Mindray
service staff.
HIGH
If failure persists,
notify
biomedical
engineer or Mindray
service staff.
HIGH
Stop using HR alarm
function,
notify
biomedical engineer
or Mindray service
staff.
LOW
Make
sure
the
patient is quiet, the
electrodes
are
properly connected
and
AC
power
system
is
well
grounded.
ECG INIT ERR3
ECG INIT ERR4
ECG module failure
ECG INIT ERR5
ECG INIT ERR6
ECG INIT ERR7
ECG INIT ERR8
ECG COMM STOP
Occasional
failure
communication
ECG COMM ERR
Occasional
failure
communication
HR ALM LMT ERR
ECG NOISE
Functional safety failure
ECG measuring
greatly interfered.
signal
is
Prompt messages (include general alerts):
Message
HR EXCEED
Cause
HR measuring value
measurement range.
Alarm Level
exceeds
the
HIGH
12.7 ST Segment Monitoring (optional)
ST Segment Monitoring (Optional)
■
ST segment monitoring function is shutoff by default. You can switch it to ON when
necessary.
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Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
NOTE: When setting ST ANALYSIS on, the monitor will select “DIAGNOSTIC” mode. You
can set it to “MONITOR” mode or “OPERATE” mode as required. However at this time
ST value has been severely distorted.
■
It is available to measure the variance of ST segment with ST analysis at the waveform
tracks for selected lead. The corresponding ST measurement result displays numerically
at ST1 and ST2 in the Parameter Area. The trend can be viewed with table or graphic
form.
■
Measurement unit of ST segment: mv.
■
Measurement symbol of ST segment: "+" = elevating, "-" = depressing.
■
Measurement range of ST segment: -2.0 mv, ~ + 2.0 mv.
Pick the ST ANALYSIS item in the ECG SETUP menu to access the ST ANALYSIS sub-menu
as shown below.
ST ANALYSIS menu
Figure 12-9
ST ANALYSIS menu
ST analysis alarm setting
ST ANAL: the switch for ST analysis. Set it to ON to activate the ST analysis or OFF to
disable the ST analysis.
ST ALM: pick "ON" to enable prompt message and data record during the ST analysis
alarm; pick "OFF" to disable the alarm function, and there will be a
beside ST. ST
alarm is activated when the result exceeds set ST HI value or falls below ST LO value.
ALM LEV: used to set up the ST alarm level. There are three selections: HIGH, MED and
LOW.
ALM REC: pick "ON" to enable report printing upon ST analysis alarm.
ALM HI: used to set up the upper limit of ST alarm. The max. higher limit is 2.0. The
minimum higher limit is 0.2 larger than the set lower limit.
ALM LOW: used to set up the lower limit of ST alarm. The minimum lower limit is –2.0.
The max. lower limit is 0.2 lower than the set higher limit.
ST analysis alarm limits:
ST
Max. ST HI
Min. ST LO
Step
2.0 mv
-2.0 mv
0.1
Patient Monitor user’s manual (V 5.4)
12-13
ECG/RESP Monitoring
■
DEF POINT pick this item to access the DEF POINT window, in which the position of ISO
and ST point can be set up.
ISO
Base point. Default is 78 ms.
ST
Measurement point.
Figure 12-10 DEF POINT window
The operator can adjust the position of both ISO and ST measurement points.
The reference point is the position where the peak of R-wave locates (see Figure 12-11).
R Wave
T
P
}
Q
ISO
-78 ms
ST Value
S
ST
+109 ms
Figure 12-11 DEF Point
The ST measurement for each beat complex is the vertical difference between the two
measurement points.
Note
the ST measurement point should be adjusted if the patient's HR or ECG morphology
changes significantly.
Adjusting ISO, ST
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Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
These two points can be adjusted turning the knob.
When adjusting ST measurement point, the system will show the ST Measurement Point
Window. The QRS complex template displays in the window (If the template is not established,
a horizontal line will display. If the channel is not at ON position, a horizontal line will also
display). It is adjustable of the highlight bar in the window. You may select ISO or ST, then
switch the knob left or right to move the cursor line. When the cursor is at the required
position, you may select the base point or the measurement point.
Note
Abnormal QRS complex is not considered in ST segment analysis.
ST Alarm Message
Note: The alarm limits for two ST measurements are identical. No setting of alarm limits can
be made only for one channel.
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages during ST measurement.
Physiological alarms:
Message
Cause
Alarm Level
ST1 TOO HIGH
ST measuring value of channel 1 is
above the upper alarm limit.
User-selectable
STI TOO LOW
ST measuring value of channel 1 is
below the lower alarm limit.
User-selectable
ST2 TOO HIGH
ST measuring value of channel 2 is
above the upper alarm limit.
User-selectable
ST2 TOO LOW
ST measuring value of channel 2 is
below the lower alarm limit.
User-selectable
Technical alarms:
Message
ST ALM LMT ERR
Cause
Alarm Level
Remedy
HIGH
Stop using ST alarming
function, notify biomedical
engineer
or
Mindray
service staff.
Functional safety failure
Prompt messages (include general alerts):
Message
Cause
Alarm Level
ST1 EXCEED
ST measuring value of channel 1 exceeds the
measurement range.
HIGH
Patient Monitor user’s manual (V 5.4)
12-15
ECG/RESP Monitoring
ST measuring value of channel 2 exceeds the
measurement range.
ST2 EXCEED
HIGH
12.8 Arr. Monitoring (optional)
Arrhythmia Analysis
The arrhythmia algorithm is used to monitor ECG of neonate and adult patient in clinical,
detect the changing of heart rate and ventricular rhythm, and also save arrhythmia events and
generate alarming information. Arrhythmia algorithm can monitor paced and non-paced
patients. Qualified personnel can use arrhythmia analysis to evaluate patient’s condition (such
as heart rate, PVCs frequency, rhythm and ectopic beat) and decide the treatment. Besides
detecting changing of ECG, arrhythmia algorithm can also monitor patients and give proper
alarm for arrhythmia.
■
The arrhythmia monitoring is shutoff by default. You can enable it when necessary.
■
This function can call up the doctor's attention to the patient's heart rate by measuring
and classifying the arrhythmia and abnormal heart beat and triggering the alarm.
■
The monitor can conduct up to 13 different arrhythmia analyses.
■
The monitor can store the latest 60 alarm events when taking arrhythmia analysis to a
peculiar buffer. The operator can edit these arrhythmia events through the menu below.
Pick the item ARR ANALYSIS in ECG SETUP menu to access the ARR ANALYSIS sub-menu.
ARR ANALYSIS Menu
Figure 12-12
ARR ANALYSIS Menu
■
ARR ANAL:
■
PVCs ALM: pick "ON" to enable prompt message and data record when alarm occurs;
Pick "ON" during monitoring. Default set is "OFF".
pick "OFF" to disable the alarm function, and there will be a
■
beside “PVCs”.
ALM LEV: selectable from HIGH, MED, LOW. Level HIGH represents the most serious
case.
■
ALM REC: pick "ON" to enable report printing upon PVCs alarm.
PVCs alarm is activated when the PVCs exceeds set PVCs ALM HI value.
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Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
PVCs alarm upper limits:
Max
PVCs
10
PVCs alarm and prompt message:
Min
Step
1
1
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during pvcs measurement.
Physiological alarms:
Message
Cause
Alarm Level
PVCs TOO HIGH
PVCs measuring value is above upper alarm
limit.
User-selectable
Technical alarms:
Message
PVCs ALM LMT ERR
Cause
Functional
failure
safety
Alarm Level
Remedy
HIGH
Stop using PVCs alarming
function, notify biomedical
engineer or Mindray service
staff.
■
ARR RELEARN
Pick this item to start a learning procedure.
■
ARR ALARM
Pick this item to access the ARR ALARM dialog box to set
arrhythmia alarm parameters.
Set ALM to ON/OFF to enable/disable the alarm function; Set REC to ON/OFF to
enable/disable alarm record function, turn the knob under LEV column to set alarm level
to HIGH, MED or LOW.
Figure 12-13
ARR ALARM Menu
Patient Monitor user’s manual (V 5.4)
12-17
ECG/RESP Monitoring
You can pick ALL ALM ON to enable alarm function of all arrhythmia types and pick ALL ALM
OFF to disable this function. Likewise, you can pick ALL REC ON to enable recording function
for all arrhythmia types and pick ALL REC OFF to disable this function. Changing the ALM
LEV can reset alarm level of all arrhythmia types to the same value.
■
ARR RECALL
Pick this item to review and edit the ARR analysis result.
The latest arrhythmia events (up to 60) are displayed.
Figure 12-14
ARR RECALL Menu
UP-DOWN
Observe other event lists of other page.
CURSOR
Select the Arr. event, whose name is displayed in a protruding frame.
DELETE
Delete the selected Arr. event.
RENAME
Rename the selected Arr. event, whose name is displayed in a
sunken frame.
Switch the knob until the name you want appears.
WAVE
12-18
To display the Arrhythmia waveform, time and parameter value.
UP-DOWN
To observe waveforms of other Arrhythmia events.
L_RIGHT
To observe 8-second waveform of Arrhythmia events.
REC
To print out displayed Arrhythmia event.
EXIT
To return to ARR RECALL menu of Arrhythmia event.
Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
Figure 12-15 ARR WAVE RECALL Menu
Note
If there are more than 60 Arrhythmia events, the latest will be retained.
ARR ALARM
The alarm is triggered when an Arrhythmia occurs. If the ALM is ON, the alarm sounds and
the alarm indicator flashes. If the REC is ON, the alarm record will be printed out (4 seconds
prior to and after the alarm, with the ECG waveforms of analysis channel).
Physiological alarms:
Prompt
Applicable
Patient
Type
ASYSTOL
All patients
E
VFIB
/VTAC
Without
pacemaker
Without
pacemaker
Without
COUPLET
pacemaker
VT>2
BIGEMINY
Without
pacemaker
TRIGEMIN Without
Y
pacemaker
Occurring Condition
No QRS is detected for 4 consecutive
seconds
Fibrillatory wave for
consecutive 4
seconds; or
The number of continuous Vent beats is
larger than the upper limit of cluster
Vent beats (>5).
The RR interval is less than 600ms.
Alarm Level
User-selectable
User-selectable
3 < the number of cluster PVCs < 5
User-selectable
2 consecutive PVCs
User-selectable
Vent Bigeminy
User-selectable
Vent Trigeminy
User-selectable
Patient Monitor user’s manual (V 5.4)
12-19
ECG/RESP Monitoring
R ON T
Without
pacemaker
PVC
Without
pacemaker
TACHY
All patients
BRADY
All patients
MISSED
BEATS
Without
pacemaker
PNP
With
pacemaker
PNC
With
pacemaker
A type of single PVC under the
condition that HR<100,R-R interval is
less than 1/3 the average interval,
followed by a compensating pause of
1.25X the average R-R interval(the next
R wave advances onto the previous T
wave).
Single PVCs not belonging to the type
of above mentioned PVCs.
5 consecutive QRS complex , RR
interval is less than 500ms.
5 consecutive QRS complex, RR
interval is longer than 1.5s.
When HR is less than 100 beats/min.,
no heart beat is tested during the
period 1.75 times of the average RR
interval; or
When HR is larger than 100 beats/min.,
no beat is tested with 1 second.
No QRS complex and pacing pulse are
availabe during the period 1.75 times
of the average R-R interval (only
considering patients with pacemaker.)
When pacing pulse is available, no
QRS exists during the period 1.75 times
of the average RR interval (only
considering patients with pacemaker.)
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
Patient type:
All patients: refers to perform Arr.analysis on patients either with pacemakers or without
pacemakers.
Without pacemaker: refers to perform Arr. Analysis only on the patients without pacemakers.
With pacemaker: refers to perform Arr. Analysis only on the patients with pacemakers.
Prompt message:
Message
Cause
Alarm Level
ARR LEARNING
The QRS template building
required for Arr. Analysis is in
process.
No alarm
Note
Arrhythmia name displays in the Alarm Message Area.
12.9 Measuring RESP
12.9.1
How to measure RESP?
The monitor measures respiration from the amount of thoracic impedance between two ECG
electrodes. The change of impedance between the two electrodes, (due to the thoracic
movement), produces a respiratory waveform on the screen.
12-20
Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
12.9.2
Setting Up RESP measurement
For RESP monitoring, it is not necessary for additional electrodes, however, the placing of
electrodes is important.
Some patients, due to their clinical condition, expand their chest laterally, causing a negative
intrathoracic pressure. In these cases it is better to place the two RESP electrodes laterally in
the right axillary and left lateral chest areas at the maximum point of breathing movement to
optimize the respiratory waveform.
Note
The RESP monitoring is not recommended to be used on patients who are very active,
as this can cause false alarms.
Checklist for RESP Monitoring
1.
Prepare the patient's skin prior to placing the electrodes.
2.
Attach snap or clip to the electrodes and attach the electrodes to the patient as described
below.
3.
Switch on the monitor.
12.9.3
Installing electrode for RESP measurement
Placing the Electrodes for Respiratory Monitoring
Figure 12-16
Electrodes placement (5-lead)
Note
Place the red and green electrodes diagonally to optimize the respiration waveform.
Avoid the liver area and the ventricles of the heart in the line between the RESP
electrodes so as to avoid cardiac overlay or artifacts from pulsating blood flow. This is
Patient Monitor user’s manual (V 5.4)
12-21
ECG/RESP Monitoring
particularly important for neonates.
12.9.4
RESP menu
RESP SETUP Menu
Pick RESP hot key on the screen to call up the following menu:
Figure 12-17
RESP SETUP Menu
RESP alarm setting
• ALM: pick "ON" to enable prompt message and data record during the RESP alarm; pick
"OFF" to disable the alarm function, and there will be a
beside “RESP”.
• ALM REC: pick "ON" to enable report printing upon RESP alarm.
• ALM LEV: selectable from HIGH, MED and LOW. Level HIGH represents the most serious
case.
• ALM HI: used to set up the upper alarm limit.
• ALM LO: used to set up the lower alarm limit.
RESP alarm is activated when the respiration rate exceeds set ALM HI value or falls below
ALM LO value.
RESP alarm limits:
Max. RR HI
Min. RR LO
Step
RESP ADU
120
0
1
RESP NEO/PED
150
0
1
• APNEA ALM: to set the standard of judging an apnea case. It ranges from 10 to 40
seconds, increases / decreases by 5.
• SWEEP: Available options for RESP SWEEP are 6.25, 12.5 and 25.0 mm/s.
• WAVE AMP: The user may set up the displaying amplitude of the RESP waveform. The
selections are 0.25, 0.5, 1, 2, 3, 4, 5.
• HOLD TYPE: AUTO/MANUAL adjustable. When it is AUTO mode, HOLD HI and HOLD LO
12-22
Patient Monitor user’s manual (V 5.4)
ECG/RESP Monitoring
menus cannot be used and the monitor automatically calculates the RESP RATE.
• HOLD HI and HOLD LO: When it is AUTO mode, HOLD HI and HOLD LO menus cannot
be used and the monitor automatically calculates the RESP RATE. When the HOLD TYPE
is MANUAL, the user can use the knob to pick either HOLD HI or HOLD LO and turn the
knob to adjust the two dashed lines in the RESP WAVEFORM area respectively. The
positions of the dashed lines will be used to calculate the upper and lower limits of RESP
RATE by the monitor.
• DEFAULT: pick this item to access the RESP DEFAULT CONFIG dialog box, in which the
user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT
CONFIG is to be used. After selecting any of the items and exiting the dialog box, the
system will pop up the dialog box asking for the user’s confirmation
RESP Alarm Message
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during resp measurement.
Physiological alarms:
Message
Cause
Alarm Level
RR TOO HIGH
RESP measuring value is above upper alarm limit.
User-selectable
RR TOO LOW
RESP measuring value is below lower alarm limit.
User-selectable
RESP APNEA
RESP can not be measured within specific time
interval.
HIGH
Technical alarms:
Message
RESP ALM LMT
ERR
Cause
Functional safety
failure
Alarm Level
HIGH
Remedy
Stop using RESP
alarming
function,
notify
biomedical
engineer or Mindray
service staff.
Prompt message (general alerts):
Message
Cause
Alarm Level
RR EXCEED
RR measuring value exceeds
the measure range.
HIGH
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12-23
ECG/RESP Monitoring
12.10 Maintenance and Cleaning
Care and Cleaning
Warning
Before cleaning the monitor or the sensor, make sure that the equipment is switched
off and disconnected from the power line.
If there is any sign that the ECG cable may be damaged or deteriorated, replace it with a new
one instead of continuing its application on the patient.
■
Cleaning:
Use fine-hair cloth moistened in mild soap liquid or cleaning agent containing 70%
ethanol to clean the equipment.
■
Sterilization
To avoid extended damage to the equipment, sterilization is only recommended when
stipulated as necessary in the Hospital Maintenance Schedule. Sterilization facilities
should be cleaned first.
Recommended sterilization material:
Ethylate: 70% alcohol, 70% isopropanol
Acetaldehyde
■
Disinfection
To avoid extended damage to the equipment, disinfection is only recommended when
stipulated as necessary in the Hospital Maintenance Schedule. Disinfection facilities
should be cleaned first.
12-24
Patient Monitor user’s manual (V 5.4)
Chapter 13
SpO2 Monitoring
13.1 PART 1 (MASIMO SpO2 board configuration)
General description
SpO2 is a non-invasive measurement of the functional oxygen saturation.
The measurement is taken by placing a sensor on a patient , usually on the fingertip for adults,
and the hand or foot for neonates. The sensor is connected to the patient monitor with pulse
oximetry measurement module (Masimo Set, which is called MS-7). The monitor displays the
calculated data from MS-7 in three ways: 1)as a percent value for arterial oxygen saturation
(SpO2) ; 2)as a pulse rate (PR) and 3)as a plethysmographic waveform on the screen.
Principles of Operation
This MS-7 is based on three principles:
„
Oxyhemoglobin and deoxyhemoglobin differ in their absorption of red and infrared
light(spectrophotometry).
„
The volume of arterial blood in tissue and the light absorbed by the blood changes during
the pulse(plethysmography)
„
Arterio-venous shunting is highly variable and that fluctuating absorbance by venous
blood is a major component of noise during the pulse.
This MS-7 determines SpO2 by passing red and infrared light into a capillary bed and
measuring changes in light absorption during the pulsatile cycle. Red and infrared
light-emitting diodes (LEDs) in oximetry sensors serve as the light sources, a photodiode
serves as the photodetector.
Traditional pulse oximeter assumes that all pulsations in the light absorbance signal are
caused by oscillations in the arterial blood volume. This assumes that the blood flow in the
region of the sensor passes entirely through the capillary bed rather than through any
arterio-venous shunts. The traditional pulse oximeter calculates the ratio of pulsatile
absorbance (AC) to the mean absorbance (DC) at each of two wavelengths, 660 nm and 940
nm:
Patient Monitor user’s manual (V 5.4)
13-1
SpO2 Monitoring
S(660) = AC(660)/DC(660)
S(940) = AC(940)/DC(940)
This traditional instrument then calculates the ratio of these two arterial pulse-added
absorbance signals:
R = S(660)/S(940)
This value of R is used to find the saturation SpO2 in a look-up table built into the instrument’s
software. The values in the look-up table are based upon human blood studies against a
laboratory co-oximeter on healthy adult volunteers in induced hypoxia studies.
This MS-7 assumes that arterio-venous shunting is highly variable and that fluctuating
absorbance by venous blood is the major component of noise during the pulse. The MS-7
decomposes S(660) and S(940) into an arterial signal plus a noise component and calculates
the ratio of the arterial signals without the noise:
S(660) = S1 + N1
S(940) = S2 + N2
R = S1/S2
Again, R is the ratio of two arterial pulse-added absorbance signals and its value is used to
find the saturation SpO2 in an empirically derived equation into the software. The values in the
empirically derived equation are based upon human blood studies against a laboratory
co-oximeter on healthy adult volunteers in induced hypoxia studies.
The above equations are combined and a noise reference (N’) is determined:
N’ = S(660) - S(940) x R
If there is no noise N’ = 0: then S(660) = S(940) x R which is the same relationship for the
traditional pulse oximeter.
The equation for the noise reference is based on the value of R, the value being seeked to
determine the SpO2. This instrument’s software sweeps through possible values of R that
correspond to SpO2 values between 1% and 100% and generates an N’ value for each of
these R values. The S(660) and S(940) signals are processed with each possible N’ noise
reference through an adaptive correlation canceler (ACC) which yields an output power for
each possible value of R (i.e., each possible SpO2 from 1% to 100%). The result is a Discrete
Saturation Transform (DST™) plot of relative output power versus possible SpO2 value as
shown in the following figure where R corresponds to SpO2 = 97%:
13-2
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
Discrete Saturation Transform
DST
Relative Correlation Canceler
Energy Output
TM
65
70
75
80
85
90
95
97 100
%SpO2
The DST plot has two peaks: the peak corresponding to the higher saturation is selected as
the SpO2 value. This entire sequence is repeated once every two seconds on the most recent
four seconds of raw data. The SpO2 value therefore corresponds to a running average of
arterial hemoglobin saturation that is updated every two seconds.
13.1.1 Precautions
Warning
This pulse wave from M-7 should NOT be used as an apnea monitoring.
Warning
This monitor with M-7 should be considered an early warning device for SpO2. As a
trend towards patient deoxygenation is indicated, blood samples should be analyzed
by a laboratory co-oximeter to completely understand the patient’s condition.
Warning
If an alarm condition (other than exceptions listed herein) occurs while the alarm
silence period is set to off, the only alarm indications will be visual displays and
symbols related to the alarm condition.
Warning
Measure the monitor’s leakage current whenever an external device is connected to
Patient Monitor user’s manual (V 5.4)
13-3
SpO2 Monitoring
the serial port. Leakage current must not exceed 100 microamperes.
Warning
To ensure patient electrical isolation, connect only to other equipment with
electronically isolated circuits.
Warning
Do not connect to an electrical outlet controlled by a wall switch or dimmer.
Warning
As with all medical equipment, carefully route patient cabling to reduce the possibility
of patient entanglement or strangulation.
Warning
Interfering Substances: Carboxyhemoglobin may erroneously increase 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
Do not use this instrument and the sensors during magnetic resonance imaging (MRI)
scanning. Induced current could potentially cause burns. The monitor may affect the
MRI image, and the MRI unit may affect the accuracy of the oximetry measurements.
Warning
Pulse oximetry can overestimate the SpO2 value in the presence of Hb-CO, Met-Hb or
dye dilution chemicals.
Warning
Verify sensor cable fault detection before beginning of monitoring phase. Unplug the
SpO2 sensor cable from the socket, the screen will display the error message “SpO2
SENSOR OFF” and the audible alarm is activated.
Warning
Do not use the sterile supplied SpO2 sensors if the packaging or the sensor is
damaged and return them to the vendor.
13-4
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
Warning
Prolonged and continuous monitoring may increase jeopardy of unexpected change of
dermal condition such as abnormal sensitivity, rubescence, vesicle, repressive
putrescence, and so on. It is especially important to check the sensor placement of
neonate and patient of poor perfusion or immature dermogram by light collimation and
proper attaching strictly according to changes of the skin. Check per 2~3 hours the
sensor placement and move it when the skin deteriorates. More frequent examinations
may be required for different patients.
Note
Do not perform SpO2 measuring and NIBP measuring in same arm at one time, because
obstruction of blood flow during NIBP measuring may adversely affect the reading of
SpO2 value.
Note
z
Make sure the nail covers the light window;
z
The wire should be on the backside of the hand.
Note
SpO2 value always displays at the same position. Pulse Rate will display when HR
FROM is set at "SpO2", “BOTH” in the ECG SETUP menu.
Note
SpO2 waveform is not proportional to the pulse volume.
13.1.2 Monitoring Procedure
Note
This monitor with MS-7 is intended for continuous noninvasive monitoring of
functional oxygen saturation of arterial hemoglobin (SpO2) and pulse rate (measured
by an SpO2 sensor) for adult, pediatric, and neonatal patients in a hospital and mobile
environment.
Limitations for Measurement
If the accuracy of any measurement does not seem reasonable, first check the patient’s vital
signs by alternate means and the check the instrument for proper functioning.
Inaccurate measurements may be caused by:
•
incorrect sensor application or use
Patient Monitor user’s manual (V 5.4)
13-5
SpO2 Monitoring
•
significant levels of dysfunctional hemoglobins (e.g., carboxyhemoglobin or
methemoglobin)
•
intravascular dyes such as indocyanine green or methylene blue.
•
exposure to excessive illumination, such as surgical lamps (especially ones with a
xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps, or
direct sunlight (exposure to excessive illumination can be corrected by covering the
sensor with a dark or opaque material)
•
excessive patient movement
•
venous pulsations
•
placement of a sensor on an extremity with a blood pressure cuff, arterial catheter,
or intravascular line
the monitor can be used during defibrillation, but the readings may be inaccurate for a
short time.
Loss of pulse signal can occur in any of the following situation:
the sensor is too tight
•
•
there is excessive illumination from light sources such as a surgical lamp, a
bilirubin lamp, or sunlight
•
a blood pressure cuff is inflated on the same extremity as the one with a SpO2
sensor attached.
•
the patient has hypotension, severe vasoconstriction, severe anemia, or
hypothermia
•
•
there is arterial occlusion proximal to the sensor
the patient is in cardiac arrest or is in shock
SpO2 plethysmogram measurement: (MASIMO SETTM ONLY)
1. Switch on the monitor.
2. Attach the sensor to the appropriate site of the patient finger.
3. Plug the connector of the sensor extension cable into the SpO2 socket on the PM-9000.
Figure 13-1
mounting of the sensor
SpO2 SETUP Menu
Pick the SpO2 hot key on the screen to call up the SpO2 SETUP menu as shown below.
13-6
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
Figure 13-2
SpO2 SETUP menu
Warning
Setting the SpO2 upper alarm limit to 100% is equivalent to switching off the alarm on
upper limit. High oxygen levels may predispose a premature infant to retrolental
fibroplasia. Therefore, the upper alarm limit for oxygen saturation must be carefully
selected in accordance with commonly accepted clinical practices.
SpO2 alarm setting
• ALM: pick "ON" to enable prompt message and data record during the SpO2 alarm;
pick "OFF" to disable the alarm function, and there will be a
beside “SpO2”.
• ALM REC: pick "ON" to enable report printing upon SpO2 alarm.
• ALM LEV: used to set up alarm level, selectable from HIGH, MED and LOW. HIGH
represents the most serious case.
• SpO2 ALM HI and SpO2 ALM LO:SpO2 alarm is activated when the result exceeds set
SpO2 ALM HI value or falls below SpO2 ALM LO value. Use the knob to pick the SpO2
ALM HI or SpO2 ALM LO item and turn the knob to select the desired alarm limit.
• PR ALM HI and PR ALM LO: PR alarm is activated when the pulse rate exceeds set
PR ALM HI value or falls below PR ALM LO value. Use the knob to pick the PR ALM
HI or PR ALM LO item and turn the knob to select the desired alarm limit.
Warning
Check alarm limits each time the monitor is used to ensure that they are
appropriate for the patient being monitored.
SpO2 and PR alarm limits:
Max. Upper Limit
Min. Lower Limit
Step
SpO2
100
0
1
PR
240
25
1
Patient Monitor user’s manual (V 5.4)
13-7
SpO2 Monitoring
■
SWEEP
Available options are 12.5, 25.0 mm/s.
■
PR SOUND
Pulse beep volume. The options are from “3” to “0”. “3” indicates the maximum volume
while “0” the minimum.
■
AVG TIME
2~4S,4~6S, 8S,10S,12S,14S, 16S represent times that SpO2 average value is counted.
■
SENSITIVITY MODE
Available options are normal and high.
■
DEFAULT:
Pick this item to access the SpO2 DEFAULT CONFIG dialog box, in which the user may
select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to
be used. After selecting any of the items and exiting the dialog box, the system will pop
up the dialog box asking for the user’s confirmation.
PITCH TONE function
When SPO2 changes, if the “BEAT VOL” in “ECG SETUP” menu is set to a value other than
“0” (which means “BEAT VOL” is switched ON), the heart beat volume will change
automatically according to SPO2 value. This monitor has 20 kinds of PITCH TONE; the higher
the SPO2 value is, the higher the PITCH TONE will be.
Although these 20 kinds of PITCH TONE could not be adjusted in menu, their volume could
be controlled. For example, when “SPO2” is selected as “HR SOURCE” in “ECG SETUP”
menu, the volume of PITCH TONE will be controlled by “PR SOUND” in “SPO2 SETUP”
menu. If other item than “SPO2” is selected as “HR SOURCE” in “ECG SETUP” menu, the
volume of PITCH TONE will be consequently controlled by “BEAT SOUND” in “ECG SETUP”
MENU.
Note
When SPO2 module is switched OFF, PITCH TONE function will become disabled
automatically.
13.1.3 Sensors and Accessories:
Before use, carefully read the LNOP sensor Directions for Use.
Use only Masimo oximetry sensors for SpO2 measurements. Other oxygen transducers or
sensors may cause improper Radical Pulse Oximeter performance.
Tissue damage can be caused by incorrect application or use of an LNOP sensor, for
example by wrapping the sensor too tightly. Inspect he sensor site as directed in he sensor
Directions for Use to ensure skin integrity and correct positioning and adhesion of he sensor.
Caution
Do not use the damaged sensors. Do not use a sensor with exposed optical
components. Do not immerse the sensor in water, solvents, or cleaning solutions
(the sensors and connectors are not waterproof ). Do not sterilize by irradiation,
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Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
steam, or ethylene oxide.
Caution
Do not use damaged patient cables. Do not immerse the patient cables in water,
solvents, or cleaning solutions (the sensors and connectors are not waterproof ).
Do not sterilize by irradiation, steam, or ethylene oxide.
„
Selecting a Masimo sensor:
When selecting a sensor, consider, the patient’s weight, the adequacy of perfusion, the
available sensor sites, and the duration of monitoring. For more information refer to the
following table or contact Masimo. Use only Masimo sensors and sensor cables. Select an
appropriate sensor, apply it as directed, and observe all warnings and cautions presented in
the directions for use accompanying the sensor.
High ambient light sources such as surgical lights(especially those with a xenon light source),
bilirubin lamps, fluorescent lights, infrared heating lamps, and direct sunlight can interfere with
the performance of an SpO2 sensor. To prevent interference from ambient light, ensure that
the sensor is properly applied, and cover the sensor site with opaque material, if required.
Failure to take this precaution in high ambient light conditions may result in inaccurate
measurements.
SENSOR
LNOP ADT
LNOP PDT
LNOP NEO
LNOP NEO PT
LNOP DCI
LNOP DCIP
LNOP DCSC
LNOP Ear sensor
LNOP YI Multi-site
USAGE
SINGLE USE
SINGLE USE
SINGLE USE
SINGLE USE
REUSABLE
REUSABLE
REUSABLE
REUSABLE
REUSABLE
PATIENT WEIGHT
ADULTS > 30 kg
Adults >10 kg and <50 kg
Neonate <10 kg
Neonate <1 kg,or with poor skin integrity
Adults and Pediatrics >30 kg
Pediatrics >10 kg and <50 kg
Adult and Pediatrics >30 kg,for spot check applications
Adult/Pediatric >30 kg
Adult/Pediatric/Infant/Neonatal > 1 kg
Cleaning and reuse of Masimo LNOP sensors
Reusable sensors can be cleaned per the following procedure:
„ Remove the sensor from the patient.
„ Disconnect the sensor from the monitor.
„ Wipe the entire sensor clean with a 70%isopropyl alcohol pad.
„ Allow the sensor to air dry before returning it to operation.
Reattachment of single use adhesive sensors
„
LNOP single use sensors may be reapplied to the same patient if the emitter and
detector windows are clear and the adhesive still adheres to the skin.
„
The adhesive can be partially rejuvenated by wiping with a 70%isopropyl alcohol wipe
Patient Monitor user’s manual (V 5.4)
13-9
SpO2 Monitoring
and allowing the sensor to thoroughly air dry prior to replacement on the patient.
Warning
To avoid cross contamination only use Masimo LNOP single use sensors on the same
patient.
Note
If the sensor fails to track the pulse consistently, the sensors may be incorrectly
positioned. Reposition the sensor or choose a different monitoring site.
Caution
Do not reprocess any LNOP single use sensors.
„
MASIMO SET PATIENT CABLES:
Reusable patient cables of various lengths are available. All cables that display the Masimo
SET logo are designed to work with any Masimo LNOP sensor and with any pulse oximeter or
multiparameter instrument displaying the Masimo SET logo.
Only use Masimo oximetry patient cables for SpO2 measurements. Other patient cables may
cause improper Radical pulse oximeter performance.
Caution
Carefully route patient cables to reduce the possibility of patient entanglement or
strangulation.
Caution
Do not soak or immerse patient cables in any liquid solution. Do not sterilize patient
cables by irradiation steam or ethylene oxide see the cleaning instructions in the
directions for use for reusable Masimo patient cables.
„
Maintenance
Warning
Before cleaning the monitor or the sensor, make sure that the equipment is switched
off and disconnected from the power line.
For cleaning:
13-10
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
„
Use a cotton ball or a soft mull moistened with hospital-grade ethanol to wipe the surface
of the sensor, and then dry it with a cloth. This cleaning method can also be applied to
the luminotron and receiving unit.
„
The cable can be cleaned with 3% hydrogen dioxide, 70% isopropanol, or other active
reagent. However, connector of the sensor shall not be subjected to such solution.
13.1.4 Alarm Description and Prompt
SpO2 Alarm Message
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
TABLES BELOW DESCRIBE THE POSSIBLE PHYSIOLOGICAL ALARMS,
TECHNICAL ALARMS AND PROMPT MESSAGES OCCURRING DURING SPO2
MEASUREMENT.
Physiological alarm:
Message
SPO2TOO HIGH
Cause
SpO2 measuring value is above upper alarm
limit.
Alarm Level
User-selectable
SpO2 TOO LOW
SpO2 measuring value is below lower alarm limit.
User-selectable
PR TOO HIGH
PR measuring value is above upper alarm limit.
User-selectable
PR TOO LOW
PR measuring value is below lower alarm limit.
User-selectable
Technical alarms:
Message
SpO2 NO
Possible Cause(s)
Sensor not fully inserted
into the connector.
Alarm
Level
Recommendation
LOW
May be an incorrect sensor, or
a defective sensor or cable.
Insert
sensor
into
the
connector. Disconnect and
reconnect sensor. Refer to the
instructions for the sensor
being used.
SENSOR
Sensor
inserted
upside down.
SpO2 SENSOR
OFF
SpO2 sensor may be
disconnected from the
patient or the monitor.
LOW
LOW
Patient Monitor user’s manual (V 5.4)
Disconnect and reconnect he
sensor
with
the
logos
matching.
Disconnect and reconnect the
sensor.
Reattach sensor.
13-11
SpO2 Monitoring
SpO2
SENSOR
FAULT
This message appears
when the sensor is faulty
HIGH
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
SpO2
UNRECOGNIZED
SENSOR
Masimo board does not
recognize the sensor.
LOW
Make sure that the monitor
and the patient are in correct
connection with the cables.
SpO2
INCOMPATIBLE
SENSOR
This
message
is
displayed
when
the
masimo sensor is finding
incompatible sensor.
LOW
Make sure that the monitor
use incompatible sensor.
SpO2
INTERFERENCE
Outside signal or energy
preventing reading.
LOW
Remove outside interference.
SpO2 PULSE
SEARCH
Unit is searching for the
patients pulse.
LOW
If values are not displayed
within 30 seconds, disconnect
and reconnect sensor. If pulse
search continues, remove
sensor and replace on a better
perfused site.
SpO2
LOW
PERFUSION
Signal too small.
LOW
Move
sensor
perfused site.
Too much light on
patient(sensor).
Inadequate
tissue
covering
sensor
detector.
LOW
Remove or reduce lighting.
Cover sensor from light.
Reposition sensor.
Low signal quality.
LOW
Ensure
proper
sensor
application. Mover sensor to a
better perfused site.
HIGH
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
HIGH
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
HIGH
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
SpO2 TOO
MUCH LIGHT
SpO2 LOW
SIGNAL IQ
SpO2
BOARD FAULT
This message appears
when the Masimo Set
board malfunctions.
SpO2
COMMUNICATION
ERROR
This
message
is
displayed when the front
end module is having
problems communicating
( ie: framing errors or bad
checksums)
with
the
Masimo board.
SpO2
COMMUNICATION
STOP
This
message
is
displayed when the host
can not receive the data
from Masimo board for 5
seconds
13-12
Patient Monitor user’s manual (V 5.4)
to
better
SpO2 Monitoring
This
message
is
displayed when the SpO2
module initialization error
happened.
SpO2 INIT ERR
HIGH
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
Prompt message (include general alerts):
Message
Cause
SpO2 EXCEED
PR EXCEED
SEARCH PULSE
Alarm Level
SpO2 measuring value exceeds the range.
HIGH
PR measuring value exceeds the range.
HIGH
SpO2 module is searching for pulse.
No alarm
SpO2 module cannot detect SpO2 signal for a
long time.
NO PULSE
HIGH
13.1.5 Masimo Information
The MASIMO SET® Product
®
Masimo Patents
This device is covered under one or more the following U.S. Patents: 5,482,036; 5,490,505;
5,632,272; 5,685,299; 5,758,644; 5,769,785; 6,002,952; 6,036,642; 6,067,462; 6,206,830,
6,157,850 and international equivalents. U.S.A. and international patents pending.
No Implied License
Possession or purchase of this device does not convey any express or implied license to use
the device with 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.
Patient Monitor user’s manual (V 5.4)
13-13
SpO2 Monitoring
13.2 PART 2(MINDRAY SpO2 board configuration)
13.2.1 What is SpO2 Monitoring
SpO2 Plethysmogram measurement is employed to determine the oxygen saturation of
hemoglobin in the arterial blood. If, for example, 97% hemoglobin molecules in the red blood
cells of the arterial blood combine with oxygen, then the blood has a SpO2 oxygen saturation
of 97%. The SpO2 numeric on the monitor will read 97% .The SpO2 numeric shows the
percentage of hemoglobin molecules which have combined with oxygen molecules to form
oxyhemoglobin. The SpO2/PLETH parameter can also provide a pulse rate signal and a
plethysmogram wave.
How the SpO2 / PLETH Parameter Works
■
Arterial oxygen saturation is measured by a method called pulse oximetry. It is a
continuous, non-invasive method based on the different absorption spectra of reduced
hemoglobin and oxyhemoglobin. It measures how much light, sent from light sources on
one side of the sensor, is transmitted through patient tissue (such as a finger or an ear),
to a receiver on the other side.
The sensor measurement wavelengths are nominally 660nm for the Red LED and
940nm for Infrared LED. Maximum optical power output for LED is 4 mW.
■
The amount of light transmitted depends on many factors, most of which are constant.
However, one of these factors, the blood flow in the arteries, varies with time, because it
is pulsating. By measuring the light absorption during a pulsation, it is possible to derive
the oxygen saturation of the arterial blood. Detecting the pulsation gives a PLETH
waveform and pulse rate signal.
■
The SpO2 value and the PLETH waveform can be displayed on the main screen.
■
SPO2 is a non-invasive measurement of the functional oxygen saturation.
Warning
Pulse oximetry can overestimate the SpO2 value in the presence of Hb-CO, Met-Hb or
dye dilution chemicals.
SpO2 / Pulse Monitoring
Warning
ES (Electrosurgery) equipment wire and SpO2 cable must not be tangled up.
Warning
Do not put the sensor on extremities with arterial catheter or venous syringe.
Note
13-14
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
Do not perform SpO2 measuring and NIBP measuring on same arm at one time,
because obstruction of blood flow during NIBP measuring may adversely affect the
reading of SpO2 value.
13.2.2 Precautions during SpO2/Pulse Monitoring
Note
■ Make sure the nail covers the light window;
■ The wire should be on the backside of the hand.
Note
■ SpO2 value is always displayed at the same position.
■ Pulse Rate will be displayed only under following situations:
◆ Select HR FROM as "SPO2" or “BOTH” in the ECG SETUP menu.
◆ Select HR FROM as “AUTO” in the ECG SETUP menu and there is no ECG
signal.
Note
SpO2 waveform is not proportional to the pulse volume.
Warning
Check if the sensor cable is in normal condition before monitoring. After unplugging
the SpO2 sensor cable from the socket, the system shall display the error message
“SPO2 SENSOR OFF” and give the audible alarm.
Warning
Do not use the SpO2 sensor once the package or the sensor is found damaged. Instead,
you shall return it to the vendor.
Warning
Prolonged and continuous monitoring may increase jeopardy of unexpected change of
dermal condition such as abnormal sensitivity, rubescence, vesicle, repressive
putrescence, and so on. It is especially important to check the sensor placement of
neonate and patient of poor perfusion or immature dermogram by light collimation and
proper attaching strictly according to changes of the skin. Check per 2~3 hours the
sensor placement and move it when the skin deteriorates. More frequent examinations
may be required for different patients.
Patient Monitor user’s manual (V 5.4)
13-15
SpO2 Monitoring
13.2.3 Monitoring Procedure
SpO2 plethysmogram measurement
1.
Switch on the monitor.
2.
Attach the sensor to the appropriate site of the patient finger.
3.
Plug the connector of the sensor extension cable into the SpO2 socket on the SpO2
module.
Figure 13-3
■
Mounting of the sensor
Neonate SpO2 Measurement
The process of measuring neonate SpO2 is similar to that of measuring adult SpO2. Below is
the description of neonate SpO2 sensor and its installation.
1. Neonate SpO2 sensor
Neonate SpO2 sensor consists of Y-form SpO2 sensor and its sheath. Insert the LED and PD
ends of the Y-form SpO2 sensor respectively into the upper and lower grooves on the sheath
(figure 13-4). Figure 13-5 shows us the neonate SpO2 sensor after insertion.
Figure 13-4 Neonate SpO2 sensor (1)
13-16
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
Figure 13-5 Neonate SpO2 sensor (2)
2. Attaching Neonate SpO2 sensor
Wind the SpO2 sensor around a hand or foot. Hold the sensor, pull the belt and fit one of its
sides with “V” edge into the “V” groove on the corresponding side of the sheath. Appropriately
elongate the belt (about 20mm) and fit the “V” edge of the other side of the belt into the “V”
groove of the other side of the sheath and then loosen the belt. After the “V” edges of the two
sides of the belt fit well into the “V” grooves on the two sides of the sheath, put the belt into
the first lock bar to fasten the belt. See figure 13-6. If the belt is too much long, you may put it
into the second lock bar. You must position the SpO2 sensor in this way so as to make the
photoelectric component face the correct position. In the mean time, note not to elongate the
belt too much, which may lead to inaccurate measurement and also blocking the blood
circulation severely.
Figure 13-6
mounting of the neonate sensor
Note
If the sensor cannot be positioned accurately to the part to be measured, it may
result in inaccurate SpO2 reading, or even that the SpO2 cannot be measured
because no pulse is detected. If this is true, you must position the sensor again.
The excessive patient movement may result in inaccurate reading. In this situation,
you must keep the patient quiet or change the part for monitoring to reduce the
adverse influence of excessive movement.
Warning
In the process of extended and continuous monitoring, you should check the
Patient Monitor user’s manual (V 5.4)
13-17
SpO2 Monitoring
peripheral circulation and the skin every 2 hours. If any unfavorable changes take
place, you should change the measured position in time.
In the process of extended and continuous monitoring, you should periodically
check the position of the sensor. In case that the position of the sensor moves
during monitoring, the measurement accuracy may be affected.
13.2.4 Limitations for Measurement
Measurement Limitations
In operation, the accuracy of oximetry readings can be affected by:
z
High-frequency electrical noise, including noise created by the host system, or noise
from external sources, such as electrosurgical apparatus connected to the system.
z
Do not use oximeters and oximetry sensors during magnetic resonance imaging (MRI)
scanning. Induced current could potentially cause burns.
z
Intravascular dye injections
z
Excessive patient movement
z
External light radiation
z
Improper sensor installation or incorrect contact position of the patient
z
Sensor temperature (optimal temperature between 28°C and 42°C)
z
Placement of the sensor on an extremity that has a blood pressure cuff, arterial catheter,
or intravascular line.
z
Significant concentrations of dysfunctional hemoglobin, such as carboxyhemoglobin and
methemoglobin.
z
SpO2 too low
z
Bad circular injection of the part being measured
z
Shock, anemia, low temperature and application of vasomotor may all cause the arterial
blood flow to reduce and hence make the measurement impossible.
z
The absorption of oxyhemoglobin (HbO2) and deoxyhemoglobin to the light of special
wavelength may also affect SpO2 measurement. If there exist other objects (carbon
hemoglobin, methemoglobin, methylene blue and indigo carmine) absorbing the light of
the same wavelength, they may result in false or low SpO2 value.
z
It is recommended to use SpO2 sensors described in chapter Accessories and Ordering
Information.
13.2.5 SpO2 Menu
SPO2 SETUP Menu
Turn the knob to move the cursor onto the SPO2 hot key in the Parameter area, push the
knob to access the SPO2 SETUP menu.
13-18
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
Figure 13-7
SPO2 SETUP menu
Warning
Setting the SpO2 upper alarm limit to 100% is equivalent to switching off the alarm on
upper limit. High oxygen levels may predispose a premature infant to retrolental
fibroplasia. Therefore, the upper alarm limit for oxygen saturation must be carefully
selected in accordance with commonly accepted clinical practices.
SpO2 alarm setting
■ ALM: pick "ON", the system will give alarm prompt and store alarm information when SpO2
alarm occurs; pick "OFF", the system will not give alarm and instead display a
beside
“SpO2”.
■ ALM REC: pick "ON", the system will command the recorder to output alarm information
when SpO2 alarm occurs.
■ ALM LEV: used to set up alarm level, selectable from HIGH, MED and LOW. HIGH
represents the most serious case.
■ SPO2 ALM HI and SPO2 ALM LO: SpO2 alarm is activated when the result exceeds set
SPO2 ALM HI value or falls below SPO2 ALM LO value.
■ PR ALM HI and PR ALM LO: PR alarm is activated when the pulse rate exceeds set PR
ALM HI value or falls below PR ALM LO value.
SpO2 and PR alarm limits:
Max. Upper Limit
Min. Lower Limit
Step
100
0
1
0
1
SpO2
PR
254
The default SpO2 and PR alarm limits:
Max. Upper Limit
Min. Lower Limit
Adult
100
90
Pediatric
100
90
Parameters
SpO2
Patient Monitor user’s manual (V 5.4)
13-19
SpO2 Monitoring
Neonatal
95
85
Adult
120
50
Pediatric
160
75
Neonatal
200
100
PR
■
SWEEP
Available options are 12.5mm/s, 25.0 mm/s.
■
PR SOUND
Pulse beep volume. The options are from “3” to “0”. “3” indicates the maximum volume
while “0” the minimum.
■
AVG TIME
4S, 8S, 16S represent times that SpO2 average value is counted.
■
DEFAULT:
Pick this item to access the SpO2 DEFAULT CONFIG dialog box, in which the user may
select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to
be used. After selecting any of the items and exiting the dialog box, the system will pop
up the dialog box asking for the user’s confirmation.
PITCH TONE function
When SPO2 changes, if the “BEAT VOL” in “ECG SETUP” menu is set to a value other than
“0” (which means “BEAT VOL” is switched ON), the heart beat volume will change
automatically according to SPO2 value. This monitor has 20 kinds of PITCH TONE; the higher
the SPO2 value is, the higher the PITCH TONE will be.
Although these 20 kinds of PITCH TONE could not be adjusted in menu, their volume could
be controlled. For example, when “SPO2” is selected as “HR SOURCE” in “ECG SETUP”
menu, the volume of PITCH TONE will be controlled by “PR SOUND” in “SPO2 SETUP”
menu. If other item than “SPO2” is selected as “HR SOURCE” in “ECG SETUP” menu, the
volume of PITCH TONE will be consequently controlled by “BEAT SOUND” in “ECG SETUP”
MENU.
Note
When SPO2 module is switched OFF, PITCH TONE function will become disabled
automatically.
13.2.6 Alarm Description and Prompt
SpO2 Alarm Message
When the alarm switches are set to ON in relevant menus, the physiological alarms caused
by the parameter exceeding the alarm limit may possibly trigger the recorder to automatically
output alarming parameter value and corresponding waveforms.
TABLES BELOW DESCRIBE THE POSSIBLE PHYSIOLOGICAL ALARMS,
TECHNICAL ALARMS AND PROMPT MESSAGES OCCURRING DURING SPO2
13-20
Patient Monitor user’s manual (V 5.4)
SpO2 Monitoring
MEASUREMENT.
Physiological alarm:
Message
Cause
Alarm Level
SPO2 TOO HIGH
SpO2 measuring value is above upper alarm limit.
User-selectable
SpO2 TOO LOW
SpO2 measuring value is below lower alarm limit.
User-selectable
PR TOO HIGH
PR measuring value is above upper alarm limit.
User-selectable
PR TOO LOW
PR measuring value is below lower alarm limit.
User-selectable
Technical alarms:
Message
SPO2 SENSOR OFF
Cause
SpO2 sensor may
be disconnected
from the patient
or the monitor.
Alarm
Level
Remedy
LOW
Make sure that the
monitor and the patient
are
in
correct
connection with the
cables.
HIGH
Stop
using
the
measuring function of
SpO2 module, notify
biomedical engineer or
Mindray service staff.
HIGH
Stop
using
the
measuring function of
SpO2 module, notify
biomedical engineer or
Mindray service staff.
HIGH
Stop
using
the
measuring function of
SpO2 module, notify
biomedical engineer or
Mindray service staff.
HIGH
Stop
using
the
measuring function of
SpO2 module, notify
biomedical engineer or
Mindray service staff.
HIGH
Stop
using
the
measuring function of
SpO2 module, notify
biomedical engineer or
Mindray service staff.
SPO2 INIT ERR
SPO2 INIT ERR 1
SPO2 INIT ERR 2
SPO2 INIT ERR 3
SPO2 INIT ERR 4
SpO2
failure
module
SPO2 INIT ERR 5
SPO2 INIT ERR 6
SPO2 INIT ERR 7
SPO2 INIT ERR 8
SPO2 COMM STOP
SpO2
module
failure
or
communication
error
SPO2 COMM ERR
SpO2
module
failure
or
communication
error
SPO2 ALM LMT ERR
PR ALM LMT ERR
Functional safety
failure
Functional safety
failure
Patient Monitor user’s manual (V 5.4)
13-21
SpO2 Monitoring
Prompt message (include general alerts):
Message
SPO2 EXCEED
PR EXCEED
SEARCH PULSE
NO PULSE
Cause
Alarm Level
SpO2 measuring value exceeds the range.
HIGH
PR measuring value exceeds the range.
HIGH
SpO2 module is searching for pulse.
SpO2 module cannot detect SpO2 signal for a long
time.
No alarm
HIGH
13.2.7 Maintenance and Cleaning
Care and Cleaning
Warning
Turn of the monitor and disconnect the line power before cleaning the monitor or the
sensor
Warning
Do not subject the sensor to autoclaving.
Do not immerse the sensor into any liquid.
Do not use any sensor or cable that may be damaged or deteriorated.
Cleaning:
„
Use a cotton ball or a soft mull moistened with hospital-grade ethanol to wipe the surface
of the sensor, and then dry it with a cloth. This cleaning method can also be applied to
the luminotron and receiving unit.
„
The cable can be cleaned with 3% hydrogen dioxide, 70% isopropanol, or other active
reagent. However, connector of the sensor shall not be subjected to such solution.
13-22
Patient Monitor user’s manual (V 5.4)
Chapter 14 NIBP Monitoring
14.1 Introduction
■
Reference to the European standard EN 1060-1: Specification for Non-invasive
sphygmomanometers Part 1, General requirements.
■
The Non-invasive Blood Pressure (NIBP) module measures the blood pressure using the
oscillometric method.
■
It is applicable for adult, pediatric, and neonatal usage.
■
There are three modes of measurement available: manual, automatic and continuous.
Each mode displays the diastolic, systolic and mean blood pressure.
In the MANUAL mode, only one measurement is conducted for each time.
In the AUTO mode, the measurement is cycled; you can set the interval time to
1/2/3/4/5/10/15/30/60/90/120/180/240/480 minutes.
In the continuous mode, the monitor measures the blood pressure as many times as
possible in five minutes.
Warning
1. You must not perform NIBP measurements on patients with sickle-cell disease or
under any condition which the skin is damaged or expected to be damaged.
2. For a thrombasthemia patient, it is important to determine whether measurement of
the blood pressure shall be done automatically. The determination should be based
on the clinical evaluation.
3. Ensure that the correct setting is selected when performing measurements on
children. It may be dangerous for the children to use an over pressure level.
14.2 NIBP Monitoring
14.2.1
NIBP Measuring
Warning
■
Before starting a measurement, verify that you have selected a setting appropriate
for your patient (adult, pediatric or neonate.)
■
Do not apply the cuff to a limb that has an intravenous infusion or catheter in
place. This could cause tissue damage around the catheter when infusion is
slowed or blocked during cuff inflation.
Patient Monitor user’s manual (V 5.4)
14-1
NIBP Monitoring
Warning
Make sure that the air conduit connecting the blood pressure cuff and the monitor is
neither blocked nor tangled.
1.
Plug in the air hose and switch on the system.
2.
Apply the blood pressure cuff to the patient's arm or leg following the instructions below
(Figure 14-1).
■
Ensure that the cuff is completely deflated.
■
Apply the appropriate size cuff to the patient, and make sure that the symbol "Φ" is over
the appropriate artery. Ensure that the cuff is not wrapped too tightly around the limb.
Excessive tightness may cause discoloration and eventual ischemia of the extremities.
Figure 14-1
Applying Cuff
Note
The width of the cuff should be either 40% of the limb circumference (50% for neonates)
or 2/3 of the upper arm length. The inflatable part of the cuff should be long enough to
encircle 50-80% of the limb. The wrong size of cuff can cause erroneous readings. If
the cuff size is in question, then use a larger cuff.
Size of reusable cuff for neonate/children/adult
Patient Type
Cuff width
Infant
10 ~19 cm
8 cm
Child
18 ~ 26 cm
10.6 cm
Adult
25 ~ 35 cm
14 cm
Large Adult
33 ~ 47 cm
17 cm
Thigh
Size No.
14-2
Limb perimeter
Hose
1.5 m or
3m
46 ~ 66 cm
21 cm
Size of disposable cuff for neonate/children/adult
Limb perimeter
Cuff width
Hose
1
3.1 ~ 5.7 cm
2.5 cm
2
4.3 ~ 8.0 cm
3.2 cm
1.5 m or
3
5.8 ~ 10.9 cm
4.3 cm
3m
4
7.1 ~ 13.1 cm
5.1 cm
Patient Monitor user’s manual (V 5.4)
NIBP Monitoring
■
Make sure that the cuff edge falls within the range of mark <->. If it does not, use a larger
or smaller cuff that fits better.
3.
Connect the cuff to the air hose. The limb chosen for taking the measurement should be
placed at the same level as the patient's heart. If this is not possible you should apply the
following corrections to the measured values:
■
If the cuff is placed higher than the heart level, add 0.75 mmHg (0.10 kPa) for each inch
of difference.
■
If it is placed lower than the heart level, deduct 0.75 mmHg (0.10 kPa) for each inch of
difference.
4.
Check whether the patient mode is appropriately selected. Access PATIENT SETUP
menu from SYSTEM MENU and pick PAT TYPE item and turn the knob to select the
required patient type.
5.
Select a measurement mode in the NIBP SETUP menu. Refer to the following
paragraphs Operation Hints for details
6.
Press the START button on the front panel to start a measurement.
Operation Hints
1.
To start auto measuring:
Access NIBP SETUP menu and pick the INTERVAL item, in which the user may choose
the selections other than MANUAL to set up the time interval for auto measurement. After
that, press START button on the front panel to start the auto measuring according to the
selected time interval.
Warning
Prolonged non-invasive blood pressure measurements in Auto mode may be
associated with purport, ischemia and neuropathy in the limb wearing the cuff. When
monitoring a patient, examine the extremities of the limb frequently for normal color,
warmth and sensitivity. If any abnormality is observed, stop the blood pressure
measurements.
2.
To stop auto measuring:
During auto measuring press START button on the front panel at any time to stop auto
measurement.
3.
To start a manual measuring:
Access NIBP SETUP menu and pick the INTERVAL item. Select the MANUAL
selection. Then press the START button on the front panel to start a manual
measurement.
During the idle period of auto measuring process, press the START button on the
front panel at any time to start a manual measurement. Then press the START
button on the front panel to stop manual measurement and the system continues
executes auto-measuring program according to selected time interval.
4.
To start a manual measuring during the AUTO mode:
Press START button on the front panel.
5.
To stop a manual measuring
Patient Monitor user’s manual (V 5.4)
14-3
NIBP Monitoring
Repress the START button on the front panel again.
6.
To perform continuous measuring:
Access NIBP SETUP menu and pick the CONTINUAL item to start the continuous
measurement. The monitor will measure as many times of NIBP as possible within 5
minutes.
Warning
Prolonged non-invasive blood pressure measurements in continual mode may be
associated with purport, ischemia and neuropathy in the limb wearing the cuff. When
monitoring a patient, examine the extremities of the limb frequently for normal color,
warmth and sensitivity. If any abnormality is observed, stop the blood pressure
measurements.
7.
To stop continuous measuring:
During continuous measuring press START button on the front panel at any time to stop
continuous measurement.
Note
If you are in doubt about the accuracy of any reading(s), check the patient's vital signs
by an alternative method before checking the functioning of the monitor.
Warning
If liquid is inadvertently splashed on the equipment or its accessories, or may enter the
conduit or inside the monitor, contact local Customer Service Center.
Measurement Limitations
To different patient conditions, the oscillometric measurement has certain limitations. The
measurement is in search of regular arterial pressure pulse. In those circumstances when the
patient's condition makes it difficult to detect, the measurement becomes unreliable and
measuring time increases. The user should be aware that the following conditions could
interfere with the measurement, making the measurement unreliable or longer to derive. In
some cases, the patient's condition will make a measurement impossible.
Patient Movement
Measurements will be unreliable or may not be possible if the patient is moving, shivering or
having convulsions. These motions may interfere with the detection of the arterial pressure
pulses. In addition, the measurement time will be prolonged.
Cardiac Arrhythmia's
Measurements will be unreliable and may not be possible if the patient's cardiac arrhythmia
has caused an irregular heartbeat. The measuring time thus will be prolonged.
Heart-lung Machine
14-4
Patient Monitor user’s manual (V 5.4)
NIBP Monitoring
Measurements will not be possible if the patient is connected to a heart-lung machine.
Pressure Changes
Measurements will be unreliable and may not be possible if the patient's blood pressure is
changing rapidly over the period of time during which the arterial pressure pulses are being
analyzed to obtain the measurement.
Severe Shock
If the patient is in severe shock or hypothermia, measurements will be unreliable since
reduced blood flow to the peripheries will cause reduced pulsation of the arteries.
Heart Rate Extremes
Measurements can not be made at a heart rate of less than 40 bpm and greater than 240
bpm.
14.2.2
NIBP monitoring screen
NIBP measurement result and corresponding message are displayed as follows:
Time of measurement
Measurement value
Measurement mode
Message
NIBP
16: 50
108
84
mmHg
70
BP unit
NS
160
90
NS Alarm limit
MANUAL
Current cuff pressure
Manual measure ……
CUFF:100
14.3 NIBP SETUP menu
Pick the NIBP hot key on the screen to call up the NIBP menu shown as below:
Figure 14-2
NIBP SETUP Menu
NIBP alarm setting
• ALM: pick "ON" to enable prompt message and data record during the NIBP alarm;
pick "OFF" to disable the alarm function, and there will be a
Patient Monitor user’s manual (V 5.4)
beside “NIBP” .
14-5
NIBP Monitoring
• ALM LEV: selectable from HIGH, MED to LOW. HIGH represents the most serious
case.
• ALM REC: pick "ON" to enable report printing upon NIBP alarm.
• SYS ALM HI, SYS ALM LOW, MEAN ALM HI, MEAN ALM LO, DIA ALM HI, DIA ALM
LO are for the user to set up the alarm limit for each type of pressure. NIBP alarm is
activated when the pressure exceeds set upper alarm limits or falls below lower alarm
limits.
NIBP alarm limits:
Adult Mode
SYS
40-270 mmHg
DIA
10-210 mmHg
Mean
20-230 mmHg
Pediatric Mode
SYS
40-200 mmHg
DIA
10-150 mmHg
Mean
20-165 mmHg
Neonatal Mode
SYS
■
40-135 mmHg
DIA
10-95 mmHg
Mean
20-105 mmHg
RESET
Restore measurement status.
Pick this item to restore initial settings of the pressure pump.
When the pressure does not work properly and the system fails to give message for the
problem, pick this item to activate self-test procedure, thus restore the system from
abnormal performance.
■
CONTINUAL
Start continuous measuring.
When this item is picked, the menu will disappear automatically.
■
INTERVAL
Interval
time
for
automatic
measuring.
Available
selections:
1/2/3/4/5/10/15/30/60/90/120/180/240/480 minutes. Press START/STOP button on the
NIBP module to start the first auto measuring.
Pick MANUAL selection in INTERVAL item to set up the measuring mode to MANUAL.
■
UNIT
Pick this item to set measurement unit. (Option: mmHg or kPa)
■
CALIBRATE
Calibrate the cuff pressure reading with a calibrated reference manometer. Pick the
CALIBRATE item to start the calibration and the item will change into STOP CAL, which if
picked, the system will stop calibration.
■
DEFAULT
Pick this item to access the NIBP DEFAULT CONFIG dialog box, in which the user may
select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to
be used. After selecting any of the items and exiting the dialog box, the system will pop up
14-6
Patient Monitor user’s manual (V 5.4)
NIBP Monitoring
the dialog box asking for the user’s confirmation.
Warning
The calibration of the NIBP measurement is necessary for every two years (or as
frequently as dictated by your Hospital Procedures Policy). The performance should be
checked according to the following details.
Procedure of the Pressure Transducer Calibration:
Replace the cuff of the device with a rigid metal vessel with a capacity of 500 ml ± 5%.
Connect a calibrated reference manometer with an error less than 0.8 mmHg and a ball pump
by means of a T-piece connector and hoses to the pneumatic system. Set the monitor in
CALIBRATE mode. Inflate the pneumatic system to 0, 50 and 200 mmHg by ball pump
separately. The difference between the indicated pressure of the reference manometer and
the indicated pressure of the monitor will not exceed 3 mmHg. Otherwise, please contact our
customer service.
Figure 14-3
■
Diagram of NIBP calibration
PNEUMATIC
This item is used for air leakage test. Turn the knob to pick the item to start the air
leakage test. Then the item will change into STOP PENUM, which if picked, the system
will stop air leakage test.
Warning
This pneumatic test other than being specified in the EN 1060-1 standard is to be used
by the user to simply determine whether there are air leaks in the NIBP airway. If at the
end of the test the system gives the prompt that the NIBP airway has air leaks, please
contact the manufacturer for repair.
Procedure of the air leakage test:
1) Connect the cuff securely with the socket for NIBP air hole.
2) Wrap the cuff around the cylinder of an appropriate size.
Patient Monitor user’s manual (V 5.4)
14-7
NIBP Monitoring
3) Access the NIBP SETUP menu.
4) Turn the knob to the PNEUMATIC item and press the knob. Then the prompt “Pneum
testing…” will appear on the bottom of the NIBP parameter area indicating that the
system has started performing pneumatic test.
5) The system will automatically Inflate the pneumatic system to about 180mmHg.
6) After 20 seconds or so, the system will automatically open the deflating valve, which
marks the completion of a pneumatic measurement.
7) If no prompt appears on the bottom of the NIBP parameter area, it indicates that the
airway is in good situation and no air leaks exist. However if the prompt “PNEUMATIC
LEAK” appears in the place, it indicates that the airway may have air leaks. In this case,
the user should check for loose connection. After confirming secure connections, the
user should re-perform the pneumatic test. If the failure prompt still appears, please
contact the manufacturer for repair.
Figure 14-4
Diagram of NIBP air leakage test
14.4 NIBP Alarm Message
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during NIBP measurement.
Physiological alarms:
Message
NS TOO HIGH
NS TOO LOW
ND TOO HIGH
ND TOO LOW
NM TOO HIGN
NM TOO LOW
14-8
Cause
NIBP SYS measuring value
is above upper alarm limit.
NIBP SYS measuring value
is below lower alarm limit.
NIBP DIA measuring value is
above upper alarm limit.
NIBP DIA measuring value is
below lower alarm limit.
NIBP MAP measuring value
is above upper alarm limit.
NIBP MAP measuring value
is below lower alarm limit.
Patient Monitor user’s manual (V 5.4)
Alarm Level
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
NIBP Monitoring
Technical alarms 1: (display in information area)
Alarm
Message
Cause
Level
NS ALM LMT
ERR
Functional safety failure
HIGH
NM ALM LMT
ERR
Functional safety failure
HIGH
ND ALM LMT
ERR
Functional safety failure
HIGH
Remedy
Stop using alarming functions of
NIBP module and notify biomedical
engineer or Mindray service staff.
Stop using alarming functions of
NIBP module and notify biomedical
engineer or Mindray service staff.
Stop using alarming functions of
NIBP module and notify biomedical
engineer or Mindray service staff.
Technical alarms 2: (display in the area below the NIBP value)
Alarm
Message
Cause
Remedy
Level
Sensor
or
other
Stop using measuring function of
NIBP SELF TEST
hardware of NIBP HIGH NIBP module, notify biomedical
ERR
module is incorrect.
engineer or Mindray service staff.
If failure persists, stop using
measuring function of NIBP module,
Communication with
HIGH
NIBP COMM ERR
notify
biomedical
engineer
or
NIBP module is failed.
Mindray service staff.
Cuff is no properly
LOOSE CUFF
wrapped or no cuff LOW Properly wrap the cuff
exists.
Cuff,
hose
or
Check and replace the leaking parts,
AIR LEAK
connector
is LOW if
required,
notify
biomedical
damaged.
engineer or Mindray service staff.
Stable pressure value
Check if the hoses are tangled, if
AIR PRESSURE
is not available. e.g. LOW failure persists, notify biomedical
ERROR
hoses are tangled.
engineer or Mindray service staff.
Cuff is too loose or
Use other method to measure blood
WEAK SIGNAL
patient pulse is too LOW
pressure.
weak.
Reset NIBP module, if failure
Measuring
range
persists, stop using measuring
RANGE
exceeds the specified HIGH function of NIBP module, notify
EXCEEDED
upper limit.
biomedical engineer or Mindray
service staff.
Affected
by
arm
motion, signal noise is
Make sure that the patient under
EXCESSIVE
LOW
monitoring is motionless.
MOTION
too large or pulse rate
is not regular.
Measure again, if failure persists,
Pressure
has
stop using measuring function of
exceeded
the
HIGH
OVER PRESSURE
NIBP module and notify biomedical
specified upper safety
engineer or Mindray service staff.
limit.
SIGNAL
Excessive motion
LOW Stop the patient from moving.
STURATED
Check and replace the leaking parts,
During
pneumatic
PNEUMATIC LEAK
LOW if
required,
notify
biomedical
test, leak is detected.
engineer or Mindray service staff.
Operation of blood
Stop using measuring function of
NIBP SYSTEM
pressure
pump HIGH NIBP module, notify biomedical
FAILURE
system is failed.
engineer or Mindray service staff.
Cuff type does not
LOW Select appropriate cuff type
CUFF TYPE ERR
comply
with
the
Patient Monitor user’s manual (V 5.4)
14-9
NIBP Monitoring
patient type.
NIBP TIME OUT
NIBP ILLEGALLY
RESET
MEASURE FAIL
Measuring time has
exceeded
120
seconds (adult) or 90
seconds (neonatal).
Abnormal
module
reset
Problem
happens
when measuring the
curve. The system
cannot
perform
measurement,
analysis
or
calculation.
HIGH
Measure again or
measuring method.
use
other
HIGH
Reset again
HIGH
Check the cuff. Make sure that the
patient
under
monitoring
is
motionless. Measure again.
Prompt message: (display in the prompt area below NIBP value)
Message
Cause
Manual measure…
During manual measuring mode.
Cont measuring…
During continuous measuring mode.
Auto measuring…
During automatic measuring mode.
Please start
Measurement over
Calibrating…
Alarm Level
After
selecting
interval
between
measurements in MENU
Press START/STOP key during measuring
to stop measurement
During calibrating
Calibration over
Calibration over
Pneum testing…
During pneumatic test
Pneum test over
pneumatic test over
Resetting...
NIBP module in resetting
Reset failed
NIBP module reset failed
No alarm
14.5 Maintenance and Cleaning
Warning
■
Do not squeeze the rubber tube on the cuff.
■
Do not allow liquid to enter the connector socket at the front of the monitor.
■
Do not wipe the inner part of the connector socket when cleaning the monitor.
■
When the reusable cuff is not connected with the monitor, or being cleaned,
always place the cover on the rubber tube to avoid liquid permeation.
Reusable Blood Pressure Cuff
The cuff can be sterilized by means of conventional autoclaving, gas, or radiation sterilization
in hot air ovens or disinfected by immersion in decontamination solutions, but remember to
remove the rubber bag if you use this method. The cuff should not be dry-cleaned.
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Patient Monitor user’s manual (V 5.4)
NIBP Monitoring
The cuff can also be machine-washed or hand-washed, the latter method may prolong the
service life of the cuff. Before washing, remove the latex rubber bag, and for
machine-washing, close the Velcro fastening. Allow the cuff to dry thoroughly after washing,
then reinsert the rubber bag.
Figure 14-5
Replace Rubber Bag in Cuff
To replace the rubber bag in the cuff, first place the bag on top of the cuff so that the rubber
tubes line up with the large opening on the long side of the cuff. Now roll the bag lengthwise
and insert it into the opening on the long side of the cuff. Hold the tubes and the cuff and
shake the complete cuff until the bag is in position. Thread the rubber tubes from inside the
cuff, and out through the small hole under the internal flap.
Disposable Blood Pressure Cuffs
Disposable cuffs are intended for one-patient use only. Do not use the same cuff on any other
patient. Do not sterilize or use autoclave on disposable cuffs. Disposable cuffs can be cleaned
using soap solution to prevent infection.
Note
For protecting environment, the disposable blood pressure cuffs must be recycled or
disposed of properly.
Patient Monitor user’s manual (V 5.4)
14-11
Chapter 15 TEMP Monitoring
15.1 TEMP Monitoring
Two TEMP probes can be used together to obtain 2 temperature data and compare them to
work out the temperature difference.
TEMP monitoring setup
If you are using disposable TEMP probes you need to plug the TEMP cable into the
monitor and then connect the probe to the cable. With a reusable TEMP probe you can
plug the probe directly into the monitor.
Apply the TEMP probe(s) securely to the patient.
Switch on the system.
Warning
Verify probe cables fault detection before beginning of monitoring phase. Unplug the
temperature probe cable of the channel 1 from the socket, the screen will display the
error message “TEMP SENSOR1 OFF” and the audible alarm is activated. The other
channel is the same.
Warning
If use two TEMP probes, them must be made by the same manufacture.
Note
Disposable TEMP probe can only be used once for one patient.
Warning
The calibration of the temperature measurement is necessary for every two years (or
as frequently as dictated by your Hospital Procedures Policy). When you need calibrate
the temperature measurement, contact the manufacture please.
Note
The self-test of the temperature measurement is performed automatically once per
hour during the monitoring. The test procedure lasts about 2 seconds and does not
affect the normal measurement of the temperature monitoring.
Patient Monitor user’s manual (V 5.4)
15-1
TEMP Monitoring
15.2 TEMP SETUP Menu
Pick the TEMP hot key on the screen to call up the TEMP SETUP menu shown as below:
Figure 15-1
TEMP SETUP Menu
TEMP alarm setting
■ ALM: pick "ON" to enable prompt message and data record during the TEMP alarm;
pick "OFF" to disable the alarm function, and prompt the
symbol beside TEMP
numeric.
■ ALM LEV: used to set up the alarm level, selectable from HIGH, MED or LOW.
■ ALM REC: used to start/stop recording TEMP alarms. Pick "ON" to enable report
printing upon TEMP alarm.
■ Alarm for T1, T2 and TD occurs when the measured temperature exceeds set alarm
high limit or falls below alarm low limit.
T1 is Channel-1 temperature, T2 is Channel-2 temperature, TD is the temperature
difference between the above two.
TEMP alarm limits:
Max. TEMP HI
Min. TEMP LO
Step
50
0
0.1
TD
■ UNIT
50
0
To set temperature unit (ºC or ºF).
0.1
■ DEFAULT
Pick this item to access the TEMP DEFAULT CONFIG dialog box, in which
T1, T2
the user may select whether the FACTORY DEFAULT CONFIG or the
USER DEFAULT CONFIG is to be used. After selecting any of the items
and exiting the dialog box, the system will pop up the dialog box asking for
the user’s confirmation.
15-2
Patient Monitor user’s manual (V 5.4)
NIBP Monitoring
15.3 TEMP Alarm message
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during TEMP measurement.
Physiological alarms:
Message
Cause
Alarm Level
T1 TOO
HIGH
Measuring value of channel 1 is above upper alarm limit.
User-selectable
TI TOO LOW
Measuring value of channel 1 is below lower alarm limit.
User-selectable
T2 TOO
HIGH
Measuring value of channel 2 is above upper alarm limit.
User-selectable
T2 TOO LOW
Measuring value of channel 2 is below lower alarm limit.
User-selectable
TD TOO
Difference between two channels is larger than upper
User-selectable
HIGH
limit.
Technical alarms:
Alarm
Alarm Message
Cause
Remedy
Level
T1 SENSOR OFF
T2 SENSOR OFF
T1 ALM LMT ERR
T2 ALM LMT ERR
TD ALM LMT ERR
Temperature
cable
of
channel
1
may
be
disconnected
from
the
monitor.
Temperature cable of channel
2 may be disconnected from
the monitor.
Functional safety failure
Functional safety failure
Functional safety failure
LOW
Make sure that the cable is
properly connected.
LOW
Make sure that the cable is
properly connected.
HIGH
Stop
using
alarming
function of TEMP module,
notify biomedical engineer
or Mindray service staff.
HIGH
Stop
using
alarming
function of TEMP module,
notify biomedical engineer
or Mindray service staff.
HIGH
Stop
using
alarming
function of TEMP module,
notify biomedical engineer
or Mindray service staff.
Prompt message:
Message
T1 EXCEED
T2 EXCEED
Cause
Measuring value of channel 1 is
beyond measuring range.
Measuring value of channel 2 is
beyond measuring range.
Patient Monitor user’s manual (V 5.4)
Alarm Level
HIGH
HIGH
15-3
TEMP Monitoring
15.4 Care and Cleaning
Warning
Before cleaning the monitor or the probe, make sure that the equipment is switched off
and disconnected from the power line.
Reusable TEMP Probes
1
The TEMP probe should not be heated above 100℃ (212℉). It should only be
subjected briefly to temperatures between 80℃ (176℉) and 100℃ (212℉).
2
The probe must not be sterilized in steam.
3
Only detergents containing no alcohol can be used for disaffection.
4
The rectal probes should be used, if possible, in conjunction with a protective rubber
cover.
5
To clean the probe, hold the tip with one hand and with the other hand rubbing the
probe down in the direction of the connector using a moist lint-free cloth.
Note
Disposable TEMP probe must not be re-sterilized or reused.
Note
For protecting environment, the disposable TEMP probe must be recycled or disposed
of properly.
15-4
Patient Monitor user’s manual (V 5.4)
Chapter 16 IBP Monitoring
16.1
Introduction
This chapter introduces IBP measurement, maintenance and cleaning of relevant
accessories.
The Monitor measures direct blood pressure (SYS, DIA and MAP) of one selected blood
vessel through two channels, and displays two BP waveforms measures direct blood pressure
(SYS, DIA and MAP).
The available pressure labels are:
Label
16.2
Definition
ART
Arterial Blood Pressure
PA
Pulmonary Arterial Pressure
CVP
Center Venous Pressure
RAP
Right Atrial Pressure
LAP
Left Atrial Pressure
ICP
Intracranial Pressure (ICT/B
information Refer to 16.7)
P1-P2
Expand Pressure
Transducer
Precautions during IBP Monitoring
Warning
Parts and accessories used must meet the safety requirements of the medical
electrical equipment standards.
Warning
Do not contact the metal part connected to the electrical appliance when connecting or
using the accessory.
Warning
When the monitor is used with HF surgical equipment, do not let the transducer and
cable contact the HF surgical equipment to prevent the patient from burning caused by
leakage current.
Patient Monitor user’s manual (V 5.4)
16-1
IBP Monitoring
Warning
Disposable IBP transducer or domes should not be reused.
Note
Use only the pressure transducer specified in this operation manual.
The specified transducer(except for ICT/B transducer) has the function of protecting against
the electric shock (especially the leakage current) and the influence of cardiac defibrillator. It
can be used in surgical operation. When the patient is in the defibrillation, the pressure
waveform may become temporarily distorted. However the monitor will work normally after
defibrillation with the operation mode and user configuration being not affected.
Warning
Inspect the transducer cable is in normal condition before monitoring. Unplug the
transducer of the channel 1, the monitor should display the error message “IBP:
SENSOR 1 OFF” and trigger audible alarm. The other channel should act the same.
Note
Periodically calibrate the transducer either new or used according to the Hospital
Regulation.
Warning
If any kind of liquid, other than the solution to be infused in the pressure line or
transducer, is splashed on the equipment or its accessories, especially enters the
transducer or the monitor, contact the Service Center of the Hospital immediately.
16.3
Monitoring Procedure
Preparation before IBP measurement:
1.Plug the pressure cable into corresponding socket and check that the monitor is switched
on.
2.Any entrapped air should be removed from the pressure system (pressure line and
transducer) by filling with normal saline.
3.Connect the arterial catheter to the pressure line, ensure any entrapped air removed.
Warning
If any entrapped air in pressure system, re-fill system with normal saline.
16-2
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
4.Position the transducer at the same level of the patient’s heart, approximately mid-axillary
line.
5.Ensure the correct label name has been selected, Refer to the next section for details.
6.Zero the transducer. Refer to the next section for details.
Figure 16-1
16.4
IBP Monitoring
IBP Menu
Rotate the knob to move the cursor onto IBP hot key in the parameter area; press the knob to
popup “IBP(1,2) SELECT” menu shown as below: Pick the IBP SETUP to popup “IBP(1,2)
SETUP” menu shown as below:
Figure 16-2
IBP SELECT Menu
Patient Monitor user’s manual (V 5.4)
16-3
IBP Monitoring
Figure 16-3 IBP SETUP Menu
Options that could be set up are:
■
ALM: Select “ON” to enable alarm and data storage during IBP alarm. Select “OFF”
to disable physiological alarm and display the
symbol beside “IBP” numeric.
■ ALM LEV: Set up the alarm level. Three levels are available: HIGH, MED, LOW.
■
ALM REC: Select “ON” to enable recording once IBP alarm occurs. Select ”OFF” to
disable recording function.
■ AMP ADJUST: adjust waveform amplitude. Two selections are available: MANUAL,
AUTO. Set it to AUTO, the pressure names of IBP become P1 and P2, and the IBP
scale is adjusted by system automatically. Set it to MANUAL, the pressure names
of IBP can choose one of ART, PA, CVP, RAP, LAP, ICP, P1, P2, and the IBP scale
is adjusted by the user via SCALE ADJUST item.
■ SWEEP: Select the scanning speed of the IBP wave. Two selections are available:
12.5 mm/s or 25 mm/s.
■ UNIT: Select the pressure unit (mmHg or kPa).
■
FILTER: Select filtering mode of system. Three selections are available: NORMAL
(filter the waveform at the frequency of 16Hz), SMOOTH (filter the waveform at the
frequency of 8Hz) and NO FILTER (display the original waveform). The default is
NO FILTER.
■
ALM LIMIT SETUP: Access the sub-menu of IBP ALM LIMIT SETUP, in which user
may set up the upper and lower alarm limit of systolic pressure, diastolic pressure
and mean pressure respectively for channel 1 and channel 2.
■ SCALE ADJUST: Access the sub-menu of IBP SCALE ADJUST, in which user
may adjust the position of the high, reference and low scales for the two waveforms
displayed on the screen.
■ EXPAND PRESSURE: Access the sub-menu of IBP EXPAND PRESSURE, user
could select the pressure type to be represented by P1 and P2.
■ DEFAULT: Access the IBP DEFAULT CONFIG dialog, in which user could select
FACTORY DEFAULT CONFIG or USER DEFAULT CONFIG. After selecting an
option and exiting the dialog, the system will pop up a dialog asking for
confirmation.
■ EXIT: Exit the menu and return to the upper menu
16-4
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
Warning
Before setting the alarm limits, confirm to choose the correct label.
Figure 16-4
IBP ALM LIMIT SETUP
When the value exceeds the alarm limits, an alarm will occur.
IBP alarm limits:
ART
Max. Alarm High
(mmHg)
300
Min. Alarm Low
(mmHg)
0
Step
(mmHg)
1
PA
120
-6
1
CVP
40
-10
1
RAP
40
-10
1
LAP
40
-10
1
ICP
40
-10
1
P1
300
-50
1
P2
300
-50
1
Pressure Label
IBP Zeroing
Press the IBP PRESSURE ZERO button on the IBP SELECT menu to call up IBP
PRESSURE ZERO menu as shown below:
Figure 16-5 IBP PRESSURE ZERO
Note
User should ensure that the transducer has been zeroed before measurement;
Patient Monitor user’s manual (V 5.4)
16-5
IBP Monitoring
otherwise the device does not have valid zero value, which may result in
inaccurate measuring data.
Zero Transducer
Select “CH1 ZERO”, IBP1 is zeroed, Select “CH2 ZERO”, IBP2 is zeroed
Cautions:
Close the transducer stopcock to the patient before zeroing.
Open the venting stopcock to atmosphere.
The transducer should be placed at the same level of the patient’s heart, approximately
mid-axillary line.
Zero procedure should be performed before starting the monitoring or at least once a day
(or each time after connecting/disconnecting the cable).
Information related to zero; (For this example, CH1 is used)
■ “SUCCESSFUL ZERO”
Indicate the zero procedure has finished, open the transducer stopcock to the patient
and close the venting stopcock to atmosphere.
■ “SENSOR OFF, FAIL”
Verify that the transducer for CH1 does not fall off, then execute zeroing. If problem
still exists, contact the serviceman.
■ “IN DEMO FAIL”
Ensure that the monitor is not in DEMO mode. Contact the serviceman if necessary.
■ “PRESSURE OVER RANGE, FALL”
Ensure that the venting stopcock is opened to atmosphere, then execute zeroing. If
the problem still exists, replace the transducer and contact the serviceman.
■ “PULSATILE PRESSURE, FALL”
Ensure that the transducer is not opened to the patient and the stopcock is vented to
atmosphere. Then execute zeroing. If the problem still exists, contact the serviceman.
IBP Calibration
Pick IBP PRESSURE CALIBRATE in the IBP (1,2) SELECT menu to popup IBP PRESSURE
CALIBRATE menu as shown below:
Figure 16-6
IBP Calibration Menu
Calibrate the transducer:
Turn the knob to select the item CH1 CAL VALUE, press and turn the knob to select the
16-6
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
pressure value to be calibrated for channel 1. Then turn the knob to select CALIBRATE to
start calibrating channel 1.
Turn the knob to select the item CH2 CAL VALUE, press and turn the knob to select the
pressure value to be calibrated for channel 2. Then turn the knob to select CALIBRATE to
start calibrating channel 2.
The pressure calibration of the monitor
Figure 16-7
IBP Calibration
Caution:
Mercury calibration should be performed by the biomedical engineering department
either whenever a new transducer is used or as periodically as requested by your
Hospital regulation.
The purpose of the calibration is to ensure that the system gives you accurate
measurements.
Before starting a mercury calibration, a zero procedure must be performed.
If you need to perform this procedure yourself you will need the following pieces of
equipment:
•
•
•
Standard sphygmomanometer
3-way stopcock
Tubing approximately 25 cm long
The Calibration Procedure: (SEE Figure 16-7)
Warning
You must never perform this procedure while patient is being monitored.
Patient Monitor user’s manual (V 5.4)
16-7
IBP Monitoring
1.
Disconnect transducer with patient.(when patient is monitored)
2.
By using of tube, one end of T-type connector links to 3-way stopcock of transducer,
another end links to inflation orb and the third end links to sphygmomanometer.
3.
Vent the stopcock of transducer to atmosphere and run zeroing procedure. Open the
stopcock to the sphygmomanometer side after successful zeroing.
4.
Select the calibrated channel in “IBP calibration” menu and preset the calibration
pressure of this channel.
5.
6.
Inflate sphygmomanometer and obtain the value of pressure to preset value in menu.
Repeatedly adjust the calibrating pressure value in the menu or the pressure value of
sphygmomanometer until they are equal.
7.
Push CALIBRATION button, the monitor starts calibrating process.
8.
9.
Wait for the result of calibration; determine the action according to the prompt message.
After calibration, disconnect the tube of sphygmomanometer and the T-type connector;
then connect the transducer to the patient by following specified steps.
Related information to calibration ( for this example,CH1 is used)
• “SUCCESSFUL CALIBRATION”
CH1 work properly, User could perform IBP monitoring via CH1.
• “SENSOR OFF , FALL”
Check the connection of CH1 transducer, Ensure no “SENSOR OFF, FALL” message
prompts, and Execute calibration. If problem still exists, contact serviceman.
• “IN DEMO, FAIL”
Ensure that the monitor is not in DEMO mode, Execute calibration. If problem still
exists, contact serviceman.
• “PRESSURE OVER RANGE, FAIL”
Make sure that you have selected transducer value in IBP CAL, then proceed
calibration.
• “PULSATILE PRESSURE, FALL”
Ensure that the pressure value of the sphygmomanometer is constant. Execute
calibration. If problem still exists, contact serviceman.
IBP SCALE ADJUST submenu:
Figure 16-8
16-8
IBP SCALE ADJUST Menu
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
The waveform and corresponding scale appears in the IBP Waveform Area with 3 dotted lines
representing Higher Scale, Reference Scale, and Lower Scale from the top to the bottom.
Values of the three scales can be set according to the instruction given below.
■ IBP label: Selectable from ART, PA, CVP, RAP, LAP, ICP, P1, P2;
■ HI: IBP value of Higher scale , the range of which is the measurable range of current
pressure.
Note
The HI value must be higher than the LO value.
■ LO: IBP value of Lower scale , the range of which is the measurable range of current
pressure.
Note
The LO value must be lower than the HI value.
■ VAL: IBP value of Reference scale (between HI and LO).
.
Note
HI scale, LO scale, Reference scale and IBP waveform are displayed simultaneously on
the screen, user could obviously view the change of the waveform after the scale has
been adjusted.
16.5
Alarm Information and Prompts
Alarm Messages
Physiological alarm, caused by the parameter value exceeds the limits, will activate the
recorder to automatically outputting the parameters and related measuring waveforms once
the alarm occur while ALARM REC in related menu switch ON.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during IBP measurement.
Physiological alarms:
Message
IS1 TOO HIGH
IS1 TOO LOW
ID1 TOO HIGH
ID1 TOO LOW
Cause
SYS measuring value
upper alarm limit.
SYS measuring value
lower alarm limit.
DIA measuring value
upper alarm limit.
DIA measuring value
lower alarm limit.
of channel 1 is above
of channel 1 is below
of channel 1 is above
of channel 1 is below
Patient Monitor user’s manual (V 5.4)
Alarm Level
User-selectable
User-selectable
User-selectable
User-selectable
16-9
IBP Monitoring
IM1 TOO HIGH
IM1 TOO LOW
IS2 TOO HIGH
IS2 TOO LOW
ID2 TOO HIGH
ID2 TOO LOW
IM2 TOO HIGH
IM2 TOO LOW
MAP measuring value of channel
upper alarm limit.
MAP measuring value of channel
lower alarm limit.
SYS measuring value of channel
upper alarm limit.
SYS measuring value of channel
lower alarm limit.
DIA measuring value of channel
upper alarm limit.
DIA measuring value of channel
lower alarm limit.
MAP measuring value of channel
upper alarm limit.
MAP measuring value of channel
lower alarm limit.
1 is above
1 is below
2 is above
2 is below
2 is above
2 is below
2 is above
2 is below
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
User-selectable
Technical alarms:
Message
Cause
Alarm
Level
IBP1 SENSOR OFF
IBP cable of channel
1 falls off from
monitor.
LOW
IBP2 SENSOR OFF
IBP cable of channel
2 falls off from
monitor.
LOW
Make sure that cable is properly
connected.
IBP module failure
HIGH
Stop using measuring function of
IBP module, notify biomedical
engineer or Our service staff.
IBP(1,2) COMM
STOP
IBP(1,2)
module
failure
or
communication
failure
HIGH
Stop using ALARM function of IBP
module, notify biomedical engineer
or Our service staff.
IBP(1,2) COMM ERR
IBP(1,2)
communication error
HIGH
IBP1 ALM LMT ERR
Functional
failure
safety
HIGH
IBP2 ALM LMT ERR
Functional
failure
safety
Remedy
Make sure that cable is properly
connected.
IBP(1,2) INIT ERR
IBP(1,2) INIT ERR1
IBP(1,2) INIT ERR2
IBP(1,2) INIT ERR3
IBP(1,2) INIT ERR4
IBP(1,2) INIT ERR5
IBP(1,2) INIT ERR6
IBP(1,2) INIT ERR7
IBP(1,2) INIT ERR8
16-10
HIGH
Stop using ALARM function of IBP
module, notify biomedical engineer
or Our service staff.
Stop using ALARM function of IBP
module, notify biomedical engineer
or Our service staff.
Stop using ALARM function of IBP
module, notify biomedical engineer
or Our service staff.
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
Prompt message:
Message
Cause
Systolic value of channel 1 is beyond
measurement range.
Diastolic measuring value of channel 1 is
beyond measurement range.
Mean measuring value of channel 1 is
beyond measurement range.
Systolic value of channel 2 is beyond
measurement range.
Diastolic measuring value of channel 2 is
beyond measurement range.
Mean measuring value of channel 2 is
beyond measurement range.
IBP1 SYS EXCEED
IBP1 DIA EXCEED
IBP1 MEAN EXCEED
IBP2 SYS EXCEED
IBP2 DIA EXCEED
IBP2 MEAN EXCEED
Alarm
Level
HIGH
HIGH
HIGH
HIGH
HIGH
HIGH
IBP1 NEED ZERO-CAL
IBP channel 1 has not been zeroed.
LOW
IBP2 NEED ZERO-CAL
IBP channel 2 has not been zeroed.
LOW
16.6
Maintenance and Cleaning
16.6.1
Care and cleaning
Warning
Before cleaning the monitor or the transducer, turn off the power and disconnect
from power line.
Cleaning of IBP Transducer (Reusable)
After the IBP monitoring operation is completed, remove the tubing and the dome from the
transducer and wipe the transducer diaphragm with water. To clean the transducer and the
cable, soak or wipe them by using soap or the detergents listed below:
Cetylcide
Wavicide-01
Wescodyne
Cidex
Lysol
Vesphene
Do not immerse the connector in any liquid. After cleaning, dry the transducer thoroughly
before storing. Slight discoloration or temporary increase of surface stickiness of the cable
should not be considered abnormal If adhesive tape residue must be removed from the
transducer cable, double seal tape remover is effective and will cause a minimum of damage
to the cable if used sparingly. Acetone, Alcohol, Ammonia and Chloroform, or other strong
solvents are not recommended because over time the vinyl cabling will be damaged by these
Patient Monitor user’s manual (V 5.4)
16-11
IBP Monitoring
agents.
Note
The disposable transducers or domes must not be re-sterilized or re-used.
Note
For protecting environment, the disposable transducers or domes must be reclaimed
or disposed properly
Sterilization
■
Chemical solution Sterilization
Remove obvious contamination by using the cleaning procedure described previously.
Select a sterilant that has been found effective to your hospital or institution for chemical
solution sterilization of operating room equipment. Buffered glutaraldehyde (e.g. Cidex or
Hospisept) has been found to be effective. Do not use quaternary cationic detergents
such as zephiran chloride. If the whole unit is to be sterilized, immerse the transducer but
not the electrical connector into the sterilant for the recommended sterilizing period.
Ensure that the dome has been removed. Then rinse all transducer parts except the
electrical connector with sterilized water or saline. The transducer must be thoroughly
dried before storing.
■ Gas Sterilization
For more complete asepsis, use gas sterilization.
Remove obvious contamination by using the cleaning procedure described previously. To
inhibit the formation of ethylene glycol when ethylene oxide gas is used as the
disinfectant, the transducer should be completely dry.
Follow the operating instructions provided by the manufacturer of the gas disinfectant.
Warning
The sterilize temperature must not exceed 70°C (158°F). Plastics in the pressure
transducer may deform or melt above this temperature.
16.7
ICP Transducer ICT/B (Optional Accessory)
16.7.1
Introduction
The ICT/B is one of catheter tip transducers manufactured by Gaeltec. It is designed for
measuring intracranial pressure by the epidural method. There are many advantages of
catheter tip measurement including simplicity of use and excellent frequency response
without artefacts.
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IBP Monitoring
The ICT/B has an atmospheric reference pressure channel that connects the back of the
sensing area to the ambient air pressure via the luer fitting on the connector. All
measurements are differential with respect to ambient air pressure.
Measured
pressure
Calibration
sleeve
Luer fitting for
zero check by
balloon inflation
sensor
Reference channel to
ambient air pressure
Extension
cable
Temperature compensation and
bridge balance network
Figure 16-9
Transducer drive
Output signal
ICT/B transducer
A significant feature of the ICT/B is the ability to check the zero drift of the ICT/B and pressure
monitor in-vivo. Not only does this allow for accurate measurements, but also allow moving
the patient with the ICT/B in the epidural space and reconnection to another monitor quickly
and easily.
There is a flat silicone rubber membrane, or balloon, covering the pressure sensing
diaphragm. Two internal tubes connect the two sides of the diaphragm to a female luer fitting
on the connector shell. By introducing approximately 0.2 to 0.3ml of air from a 1ml syringe the
pressure in these tubes will be greater than the ICP being measured. The exact amount of air
is not critical, subject to the permitted maximum. When this air is injected, the pressure will
cause the balloon to be lifted from the surface of the sensor and the same pressure will be
applied to the back of the sensor. The strain gauge senses equal pressure above and below
which is equivalent to having zero pressure applied. Thus by injecting a small volume of air,
one undeflects the pressure sensor and checks the zero of the transducer and amplifier.
16.7.2
Cautions
Note
Gaeltec catheter tip pressure transducers are designed for use by trained physicians
practicing a specialized branch of medicine. Use of the transducers should be
restricted to those trained to perform the procedures.
Note
All pressure transducers must be used with patient monitors which meet the current
safety standards for the country in which they are used and which are intended for use
with strain gauge pressure transducers. The PATIENT MONITOR must provide
electrical isolation between the transducer and any mains powered equipment to which
the monitor is connected.
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16-13
IBP Monitoring
Warning
Disconnect the catheter from the monitor before defibrillation or electrosurgery.
Warning
Do not plug the female luer on the proximal end of the catheter during ethylene oxide
sterilization or damage to the transducer may result.
Warning
Do not immerse or soak the electrical connector end in any kind of fluid or liquid.
Warning
The total volume of air injected to check the zero or baseline must not exceed 0.5ml or
the membrane over the sensor may be ruptured.
Warning
Do not press with thumb and forefinger on the tip of the ICT/B. Enormous pressures
will be generated this way and the device will be subject to possible damage. To see if
the ICT/B is operating, gently touch the sensor tip.
Note
Carefully check for cuts on the silicone of the catheter and sensor tip before use.
PLACING THE ICT/B
Note
Burr hole edges must be rounded where the catheter makes an ''S'' bend into the
epidural space. Evacuate all bone chips.
Note
The catheter should be protected by suitable means where sutures are placed. This will
prevent damage to the catheter when pulling sutures tight.
Warning
Do not use haemostats or forceps as these will damage the device.
Note
When removing the catheter, care should be taken not to nick the device while cutting
16-14
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IBP Monitoring
sutures. Pull slowly on the catheter to remove the ICT/B.
16.7.3
Connection to the pressure monitor
Note
Although the catheter tip pressure transducer sensor is electrically isolated from the
patient, it is recommended that pressure monitors with patient isolation be used for
safety. Consult the manufacturer of the monitoring equipment for questions relating to
monitor safety.
Calibration
The ICT/B is supplied with minimal zero offset and the sensitivity is set at 5 uV/V/mmHg. In
order to set up the amplifier and recorder accurately the controls should be zeroed at ambient
pressure and then a known pressure applied, for instance using the calibration tube, syringe
and manometer, or immersion to a known depth in a water column. The gain of the system is
then set to the required level. The procedure should be repeated to check that the zero
baseline has not changed due to the change in gain.
Figure 16-10
ICT/B calibration
Tightening the collet on calibration tube over the sliding calibration sleeve will seal around the
ICT/B catheter. Using the male luer fitting a connection can be made to a reference pressure,
such as a syringe and manometer. The output of the transducer and amplifier system can be
reliably and quickly confirmed.
Zeroing
Checking the Zero when the ICT/B is in the Epidural Space
Patient Monitor user’s manual (V 5.4)
16-15
IBP Monitoring
Using a 1ml syringe, inject approximately 0.3cc of air into the female luer connector on the
proximal end of the ICT/B. Leave the syringe attached and note the value on the pressure
monitor or scope. The ICP will decrease to zero or a value very close to it. If the
monitor/transducer combination has drifted from zero, reset the zero control to zero value on
the meter. Remove the syringe and the monitor will immediately begin to measure intracranial
pressure.
Warning
The total volume of air injected from a 1ml syringe to check the zero must not exceed
0.5ml or the membrane over the sensor may be ruptured.
Connecting to a new monitor when the ICT/B is in the Epidural Space
Set correct pressure range on monitor.
Inject 0.3cc of air from a 1ml syringe.
Adjust the monitor for zero reading.
With the air still injected, set the calibration number on the monitor, if applicable.
Remove the syringe and the ICP will be displayed immediately.
Note
Always leave the luer fitting open to ambient pressure during measurement.
Warning
Disconnect the catheter from the monitor before defibrillation or electrosurgery.
16.7.4
Practicing with the ICT/B
It is a good idea to obtain experience using the ICT/B and monitor combination before actually
using the device with a patient.
Set up the monitor and the ICT/B as already described. Use either a water column or the
calibration tube to apply a known pressure of from 10 to 25mmHg to the ICT/B. Recall that
13.6cm of water is about equal to 10mmHg.
With the known pressure applied to the ICT/B, inject approximately 0.3cc of air into the female
luer using a 1ml syringe and note that the monitor does indeed immediately go to zero. Also
note that if the ICT/B is moved rapidly up and down in a column of water pressure waves of
high fidelity are seen. The ICT/B has a very high frequency response and you will observe
excellent pressure waves in actual practice. It can also be confirmed that the exact amount of
air injected to check the zero is not important.
16.7.5
Note to the neurosuregeon
The ICT/B is intended for the measurement of epidural pressures. Use of the transducer for
the measurement of intraventricular pressures is not recommended. The ICT/B is designed
for the measurement of positive pressures only.
16-16
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
Note
Catheter Tip Pressure Transducers must be used under the supervision of a suitably
qualified Physician.
Method of Application of the ICT/B
The application of the ICT/B may be accomplished through a variety of surgical techniques.
Therefore, the surgeon is best advised to use the method which his own practice and
discretion dictate to be best for the patient. The following are some general guidelines.
The ICT/B may be inserted during surgery or through a burr hole. When in place, the catheter
tip transducer should have its pressure sensing surface facing against the dura, under the
cranium. There are 2.5cm marks on the back of the catheter and these are visible when the
sensor is facing in the proper direction.
The site of placement should be away from any craniotomy flap, preferably via a contralateral
burr hole.
The dura mater should be carefully stripped at least 2cm under the skull and 180° in arc
before insertion. Failure to do this will result in wedging of the pressure sensor and inaccurate
readings.
Protect the catheter :Use thick sutures and put tape around the catheter before
suturing. Remove all bone chips. Use bone wax.
Use of a tunnel is recommended. A short length
of a large bore catheter can be passed first to act
as a guide for the sensor tip. Remove the guide
from the burr hole end after the ICT/B has been
passed to the burr hole from the tunnel entrance.
Note that both edges are smoothed.
This will help to prevent damage to
the catheter.
Strip the dura at least 2 cm under the inner table
of the skull. Strip in an arc of at least 180°
Figure 16-11
ICT/B application
Reseat the transducer tip after a few days since the dura may rapidly tighten and change its
physical characteristics.
If possible, round the bone at the point where the catheter makes its first bend into the burr
hole and round the bone where the catheter makes the second bend under the cranium. This
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16-17
IBP Monitoring
will help to prevent tearing the catheter or tip during insertion or removal. A tear will require
the device to be returned for repair, an inconvenience that may be avoided by smoothing
areas of bone in contact with the catheter transducer.
The catheter is led out through the wound in the manner of a drain. It may make sharp bends
without disturbing the operation of the ICT/B. Care should be taken though, not to pinch the
catheter by bending onto itself at acute angles for this will seal and possibly damage the
internal lumens required for proper operation.
The catheter should be restrained from moving once the tip is in place. It may be fixed to the
scalp by encircling sutures or with a silicone rubber suture collar available from manufacturers
of such items as peritoneal shunt systems. The latter method is preferred as it will help
prevent damage to the catheter by sutures or during removal of sutures.
Another method is by first approaching the burr hole through a tunnel under the skin (entering
the tunnel from a point distal to the burr hole by making a small incision in the skin). The
ICT/B can be guided in the tunnel by using a disposable tube removable from the burr hole
side.
This latter method is to be preferred from both a mechanical stability point of view and from
the reported low incidence of infection. The catheter can then be led out in the manner of a
drain and the burr hole incision sutured.
The physician is urged to examine the ICT/B for physical damage to the silicone rubber
covering anywhere on the tip or catheter before use. If damage is suspected, do not use the
catheter and return it to Manufactory for repair.
Proper function before insertion into the epidural space should be confirmed by gently
touching the tip of the transducer and observing a deflection on the operating room pressure
monitor.
Once the ICT/B has been inserted into the epidural space, the physician should check the
proper function again, by injecting 0.3cc of air to check the zero of the ICT/B. The monitor
should respond correctly as previously described.
Review of techniques to prevent damage to the catheter.
1. In preparing the burr hole, it is imperative that the hole be rounded at the edges where
the catheter makes an "S" bend into the epidural space.
2. Evacuate all bone chips.
3. A small pledgelet of woven bandage should be placed around the catheter where
sutures will be placed. This will prevent damage to the catheter when pulling sutures
tight. Otherwise you may cut the catheter.
4. Use some bone wax on the edges of bone where the catheter and tip make contact
with bone.
5. When removing the catheter, care should be taken not to cut the device while cutting
sutures. Remove the ICT/B by pulling slowly on the catheter.
6. The dura mater should be stripped sufficiently so that the tip of the sensor is not forced
or wedged into place.
7. Do not use haemostats or forceps, they will damage the device. Do not squeeze the
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IBP Monitoring
sensor between thumb and forefinger.
16.7.6
Cleaning and sterilization
Warning
Do not autoclave
Warning
Do not use radiation sterilization
Warning
Do not use ultrasonic cleaning
Warning
Do not use chlorinated hydrocarbons
Warning
Do not use toluene
Warning
Do not use sodium hypochlorite solution
Note
The ICT/B is supplied non-sterile. It must be cleaned and sterilised before each use.
Inspect for cuts or damage to silicone coating before immersing in any liquid. Be careful not to
get liquid on the connector pins or inside the connector via the luer fitting
Wash the catheter with soap solution being careful not to poke the sensing area. Do not use
synthetic detergents or oil based soaps as this may result in a foreign body reaction.
Transducers may be cleaned gently with alcohol wipes. Do not soak in alcohol.
Sterilisation is by means of cold aqueous solutions of detergicide (e.g. Cidex), formalin or by
ethylene oxide gas.
Warning
Do not use the sterilizing cap during ETO gas sterilizing.
Note
Immediately after removal of the catheter from the patient, Checking for cuts in the
silicone rubber.
Use a 1ml syringe to inject 0.5cc of air into the luer and immerse the catheter in water. If small
bubbles are seen from any part of the catheter or tip, wipe dry and sterilize. Return to
Patient Monitor user’s manual (V 5.4)
16-19
IBP Monitoring
Manufactory for repair.
Note
It is recommended that each institution establish the efficacy of its sterilization
procedure by a method which includes the sterilization of an intentionally
contaminated product.
Note
There are only two chemical sterilization techniques recognized by the U.S.
Department of Agriculture as effective and truly sporicidal, gas sterilization by ethylene
oxide and liquid sterilization by a glutaraldehyde.
Ethylene oxide (ETO) Procedure
Unplug the female luer on the proximal connector before the ETO sterilization cycle. Failure to
do this will result in damage to the ICT/B and render it unusable. The luer must be open to
allow free passage of ETO gas both internally and externally.
Package the ICT/B in a coil in disposable ETO packaging. Include an approved
sterilization indicator.
Sterilize - "Normal Cycle" in an accepted commercially available hospital sterilizer. Follow
the manufacturer's instructions for the sterilizer.
Use the following as a guide only. In an actual hospital sterilization facility, the following
parameters were found to provide acceptable sterilization via ETO:
Sterilizer make and model
- AMSCO Eagle 2000
Prevacuum
- 15 minutes, 24 inches Hg
Relative humidity
- 40%
Temperature
- 140°F
ETO mix
- 12:88
Gas pressure
- 8 psi
Exposure time
- 1 hour 45 minutes
Post Vacuum
- 15 minutes, 24 inches Hg
Aeration Cycle
- 12 hours
Calculated ETO Concentration
- 600 mg/l
Liquid Sterilization Procedure
Prevent liquids from entering the female luer on the electrical connector. A male plug may be
used to do this. This plug must be removed during normal use and ETO sterilization.
1.
Rinse and cold soak the catheter transducer in a solution of glutaraldehyde such as
Cidex, following the chemical manufacturer's instructions. Note that disinfecting does not
equal sterilisation and the strength of the glutaraldehyde must be confirmed by the
chemical manufacturer's instructions.
2.
After sterilisation of the catheter and just before use, rinse the device with pyrogen-free,
sterile distilled water or saline solution as recommended by the manufacturer of the
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IBP Monitoring
sterilising agent.
Care of the ICT/B
The metal sensor is very robust and can withstand severe shocks and vibrations. It can be
irreversibly damaged by contact with sharp objects or overpressure, for instance by squeezing
the tip between finger and thumb.
The silicone coating on the sensing area allows a small amount of water absorption. During
this process, which may take an hour or more, the baseline may drift a few mmHg. The device
should be allowed to stabilize in water or saline before use for a few hours.
Liquids entering the back of the sensor will cause damage to the sensor. Cuts to the outer
coating should be avoided and repaired immediately if any are found. Return to manufactory
or apply a temporary repair using a suitable silicone sealant to the damage.
The most common reason for failure of the ICT/B pressure transducer is physical damage to
the device's silicone catheter and/or tip. The cuts are usually caused by sharp bone segments
and are not always visible to the naked eye. If such damage remains undetected fluids may
enter the device and damage the sensing element. Check for damage as described in the
Cleaning section of this manual.
16.7.7 SOME COMMONLY ASKED QUESTIONS
QUESTION
Is the ICT/B a single use device?
ANSWER
No, it is designed to be reused many times.
If it is damaged, what shall we do?
Sterilize first. Then, obtain a purchase order
for repair and send it back to Manufactory for
repair.
Does the air used for checking the zero get
into the patient?
No. Air used for checking the zero stays in
the fine lumens and tip of the ICT/B until the
syringe is removed.
What happens if we autoclave the ICT/B?
It will have to be returned to Manufactory for
repair.
We inject air to check the zero but the
baseline on the scope always returns to ICP
even if we leave the syringe attached. What
is wrong?
There is a leak in the catheter or sensor tip.
Remove, wipe clean with alcohol and then
sterilize. Return the device to Manufactory for
repair.
Readings were taken with the syringe left
attached until we noticed it. Can we rely on
these readings?
No. They are incorrect. All pressure readings
must be made with the proximal female luer
open to atmosphere.
Someone new on the staff began injecting
water into the luer but we caught it just as a
little went into the ICT/B. Is the device
ruined?
Probably not. Return to Manufactory for
repair.
Why will the ICT/B be damaged if we ETO
sterilize it with the luer plugged?
When you plug the luer you are sealing the
internal lumens at normal atmospheric
pressure. Part of the ETO cycle is a partial
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16-21
IBP Monitoring
vacuum. Thus, the trapped air at atmospheric
pressure will expand and rupture the balloon.
16.7.8
TROUBLE-SHOOTING
TROUBLE
CAUSE
REMEDY
You inject air to
check the zero and
cal
but
the
baseline reappears
with the waveform
showing.
The catheter or tip is cut and
cannot hold zero long enough.
Readings cannot be trusted.
Remove the ICT/B and use a
spare. The waveforms will be
accurate if that is all you need.
The
monitor
indicates
‘damaged gauge’
or ‘over range’ and
if you inject air or
not, you cannot
see the waveform.
Either the tip is ‘wedged’ or the
tip sensor was overpressured
against
the
dura
during
insertion. Therefore the monitor
is seeing a transducer that has
a very high initial zero and finds
this zero out of its range.
If the tip is wedged, pull back a few
millimeters to free it. This will allow
the monitor to be zeroed. If this
does not help, the transducer has
been strained and must come out
and be returned for repair.
Everything
was
alright for several
hours and then the
‘damaged gauge’
or
‘over-range’
light came on.
Although overpressured or
wedged, the sensor zero must
have been just within the range
of the monitor. As conditions
changed, the total pressure
(=zero amount+ICP), pushed
the
monitor
beyond
its
capabilities.
Try raising the pressure scale to
90, 120 or 300mmHg and then
setting zero.
The
transducer
can be zeroed and
we have
good
pressure
waves
but the ICP reads
constantly
near
zero mmHg.
The sensor face must be flat
(planar) against the dura. If its
facing the inner table of the
skull for example, then you will
get pressure waves and be
able to zero it but not obtain
actual ICP readings.
It is important that the transducer
face be placed against an intact
section of dura.
Sometimes raising the scale on the
monitor will allow it to manage a
transducer with a high zero offset.
Try raising the pressure scale to
90, 120 or 300mmHg and then
setting zero. If this works, the only
thing that you will sacrifice is the
waveform resolution. Return the
catheter for repair when the
measurement is finished.
If required, use a contralateral burr
hole.
If indeed placed properly, the
brain may have moved away
from the skull substantially
enough so that there is poor
contact between the skull,
transducer and the dura. This
may happen soon after the
transducer is placed but may
correct itself in a short time.
We read negative
ICP but get good
16-22
Not proper zeroing.
The ICT/B cannot read negative
pressure. Rezero the monitor
Patient Monitor user’s manual (V 5.4)
IBP Monitoring
/transducer combination. Make
sure that you are not plugging the
female luer during readings.
waveforms on the
monitor
The waveform on
the monitor makes
large
cyclical
swings
If you are using a respirator or
some device that applies
pressure even indirectly it may
affect ICP. The transducer is
responding
normally
by
showing this accurately.
/
Patient Monitor user’s manual (V 5.4)
16-23
Chapter 17 CO Measuring
17.1 General
■ The Cardiac Output(CO) measurement is performed by using thermodilution method.
■
The PM-9000 Portable Patient Monitor can determine blood temperature, measure
cardiac output, and perform hemodynamic calculations.
■ You can have iced injectate using either the flow through system or individual syringes of
injectate.
■ You can perform up to six measurements before editing the average cardiac output (C.O.)
and cardiac index (C.I.).
■ Prompt message on the screen will tell you when to inject.
17.2 Monitoring Procedure
17.2.1
C.O. Measurement Procedure
1.Plug the C.O. interface cable into the C.O. socket in the front panel.
2.Attach the injectate probe connector and catheter thermistor connector to the appropriate
parts of the cardiac output interface cable. (see the following figure).
3.Pick the CO hot key in the parameter area on the screen to call up the C.O SELECT menu
and if necessary change the computation constant to the one appropriate to the catheter
and volume of fluid used.
Note
If to replace the Catheter thermistor, please enter the catheter computation coefficient
into the CO.CONST item according to the instruction.
4.Pick C.O. MEASURE item in the C.O.SELECT menu to access the WINDOW FOR CO
MEASUREMENT.
Note
You should appropriately set the injectate switch, because the CO calculation will be
according to the ON or OFF of the injectate switch at the completion of measurement.
No change shall be made after the switch is set off.
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CO Measuring
Figure 17-1
CO sensor connection
5.You can perform more than one measurement as required.
6.After completion of the measurement(s), access the WINDOW FOR C.O. EDIT to edit
measured data.
The procedure in detail is described in the following pages.
Warning
Make sure that the computational constant for the measurement is appropriate to the
catheter used.
Note
The blood temperature alarm will not function during CO measurement. It will resume
automatically when the measurement is over.
17.2.2
CO Measuring
Warning
Make sure that appurtenance applied is in conformity with relevant Medical Device
Safety Requirements.
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CO Measuring
Warning
Appurtenance should be avoided from contact with conductive metal body when being
connected or applied.
C.O. Measurement Window
Enter WINDOW FOR C.O. MEASUREMET and start C.O. measurement. If CO transducer is
not connected, the monitor will prompt “No Sensor, unable to measure C.O.!” on the screen
④
⑤
①
⑥
⑦
⑧
②
⑨
③
Figure 17-2
Contents in C.O. Measurement Window
Contents displayed in the C.O. Window:
① Measurement curve
② Prompt message ,refer to Measuring the Cardiac Ouput for details
③ Start time of the measurement
④ CO: Cardiac Output
⑤ CI: Cardiac Index
⑥ BSA: Body Surface Area
⑦ TB: Blood Temperature
⑧ TI: Injectate Temperature. If necessary, change can be performed in the “C.O.
SETUP” menu.
⑨ Function keys:
START
STOP
Start a measurement.
If the blood temperature cannot resume in a considerably long time,
the measurement could not stop automatically. Use this button to
stop the measurement and display the C.O. C.I. calculation result.
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CO Measuring
CANCEL
Cancel the processing measurement or cancel the result after
measurement.
REC
Print out the curve.
Scale Y
Scale X
Change the scale Y (temperature) value. Three modes are
available: 0 - 0.5℃, 0 - 1.0℃, and 0 - 2.0℃. Adjust the scale by the
temperature differences. A smaller scale results in a larger curve.
Change the scale X (time) value. Two modes are available: 0 - 30s
and 0 - 60s. If you start measurement in the 0 - 30s mode, it will be
switched to 0 - 60s mode automatically if the measurement can not
finish within 30 seconds. After the switch, no further adjustment can
be made to the Scale X.
Edit
Enter the WINDOW FOR C.O. EDIT.
Exit
Press to exit the WINDOW FOR C.O. MEASUREMENT.
Measuring the Cardiac Output
Measurement should be taken when the message “Ready for new measurement” appears on
the screen (② in the Figure 17-2). Press the START button, and then start injection. The
thermodilution curve, current blood temperature and the injectate temperature are displayed
during the measurement. Curve drawing will stop automatically when the measurement
completes, and then the C.O. (Cardiac output) and the C.I. (Cardiac Index) (④ and ⑤ in the
Figure 17-2) will be calculated and displayed on the screen. The monitor will also display the
CO in the Parameter Area, as well as the remaining time to the next measurement (② in the
Figure 17-2).
To ensure the accuracy of the measurement, it is suggested that a reasonable interval should
take place between two consecutive measurements. The length of the interval can be set in
the C.O. SETUP menu (Time unit: second). The interval time counter (② in the Figure 17-2)
is displayed on the screen. The next measurement can not be performed until the time
reduces to zero and a prompt message “Ready for new measurement” appears.
Note
It is strongly recommended that the user must push the injector within four seconds
after pressing the START button.
Note
It is strongly recommended that you wait at least 1 minute (or longer depending on the
patient’s clinical condition) before starting the next measurement.
Continue to repeat this procedure until you have completed the measurements you want to
perform.
You can perform a maximum of 6 measurements before editing. If you perform additional
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CO Measuring
measurements the oldest measurement each time will be deleted. If any of the curves in the
editing window is not selected for calculation (excluded from the averaging calculations), the
place will be taken by the new measurement.
Editing the CO measurement
Pick the “EDIT” button to access the WINDOWS FOR C.O. EDIT as shown below:
①
②
④
③
Figure 17-3
CO Edit Windows
Contents displayed in the window:
①Six curves of the six measurements and C.O. value
②Average value of cardiac output
③Average value of cardiac index
④Function button in the edit window
Editing operation:
Values of selected measurements can be averaged and stored in the CO item in the
HEMOD menu as the basis for Hemodynamic calculations.
When first enter the EDIT Window, curves and CO values of valid measurements
are highlighted, indicating these values are to be averaged. You can move the
cursor to the curve of questionable measurements and press the rotary knob,
dis-highlighted waveforms and CO values will be excluded from the averaging
calculation..
Note
Dis-highlighted curves can be picked and included into the averaging calculation.
17.2.3
Blood Temperature Monitoring
■ Blood temperature monitoring can function when C.O. measurement is not taken. The
blood temperature is measured by the thermistor situated in the distal end of the flotation
catheter in the pulmonary artery. (See the diagram below).
■ The blood temperature alarm function will not work during the C.O. measurement. When
the measurement ends, the function will automatically resume.
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CO Measuring
■ The current blood temperature is displayed in the CO Parameter Area.
Thermodilutio
Cathetern
Pulmonary
Artery
Balloon
Thermister
Right Atrium
Right Ventricle
Figure 17-4
Thermodilutio Cathetern Site
17.3 C.O. SETUP Menu
C.O. Setup and Adjustment
Pick the CO hot key on the screen to call up the C.O. SELECT menu as shown below:
Figure 17-5
C.O. SELECT Menu
Pick the C.O.SETUP button to access the submenu as shown below:
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CO Measuring
Figure 17-6
C.O. SETUP Menu
TB Alarm setup
ALM: Select “ON” to enable alarm prompt and data storage during TB alarm. Select
“OFF” to disable audio alarm and prompt the
symbol beside TB numeric.
Warning
During the cardiac output measurement procedure the blood temperature alarms will
be inactive.
ALM REC: Select “ON” to enable recording during the TB alarm.
ALM LEV: selectable from level HIGH, level MED to level LOW. Level HIGH
represents the most serious case.
TB ALM HI and TB ALM LO: used to set up the upper and lower alarm limit for TB.
Alarm occurs when the measured TB exceeds set alarm high limit or falls below
alarm low limit.
TB alarm limits:
TB
Max. Alarm High
43℃
Min. Alarm Low
23℃
Step
0.1℃
CO.CONST
It represents the computation constant related to the catheter and injectate volume. After
replacing the catheter, you should adjust this constant according to the instruction.
Warning
Make sure that the computational constant for the measurement is appropriate to the
catheter used.
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CO Measuring
INT TIME(s)
It refers to the minimum time interval between two measurements.
It is in second unit. The adjustment range is 5 to 300 seconds with
the increment being 5 seconds.
INJ. TEMP FROM
Pick “ON” or “OFF” to select from two ways of obtaining the
injectate temperature.
ON: the system obtains the injectate temperature through
sampling.
OFF: directly display the injectate temperature obtains from the
INJ.TEMP item.
INJ. TEMP
When the INJ. TEMP FROM is OFF, the user can set the injectate
temperature between 0 – 27℃ with the increment being 0.1℃.
“℃” for Celsius degree, “℉” for Fahrenheit degree.
TEMP UNIT
■ DEFAULT: pick this item to access the CO DEFAULT CONFIG dialog box, in which the
user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT
CONFIG is to be used. After selecting any of the items and exiting the dialog box, the
system will pop up the dialog box asking for the user’s confirmation.
■ EXIT: used to exit the menu and return to the main screen.
17.4 Hemodynamic Calculation
Hemocalculation
Pick the “HEMO CALCULATE” in the WINDOWS FOR C.O.EDIT Window to display input
parameter value and list calculation results.
Figure 17-7
HEMOD Windows
Turn the rotary knob, you can change the value of the parameter that the cursor appears on
by picking it. Pick “CALCULATE” after input of all parameter values, the calculation results will
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CO Measuring
be displayed in the window. Pick “REC” can print out all the calculation results.
Input parameter value:
PAWP:
Pulmonary Artery Wedge Pressure
CVP:
Central Venous Pressure
CO:
Cardiac Output
HR:
Heart Rate
AP MAP:
Mean Artery Pressure
LV_D:
Left Ventricular Diameter
PA MAP:
Mean Pulmonary Artery Pressure
HT:
Height
WT:
Weight
17.5 Alarm Information and Prompt
CO Alarm Message
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during co measurement.
Physiological alarms:
Message
TB TOO HIGH
TB TOO LOW
Cause
Alarm Level
TB measuring value is above upper alarm
limit.
TB measuring value is below lower alarm
limit.
User-selectable
User-selectable
Technical alarms:
Message
Cause
Alarm
Level
TB SENSOR
OFF
TB measuring cable
falls off the monitor.
LOW
CO INIT ERR
CO module failure
HIGH
CO INIT ERR1
Remedy
Make sure that cable is properly
connected.
Stop using measuring function of CO
module, notify biomedical engineer or
Mindray service staff.
CO INIT ERR2
CO INIT ERR3
CO INIT ERR4
CO INIT ERR5
CO INIT ERR6
CO INIT ERR7
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CO Measuring
CO INIT ERR8
CO COMM
STOP
CO COMM ERR
TB ALM LMT
ERR
CO module failure or
communication
failure
CO module failure or
communication
failure
Functional
failure
safety
HIGH
HIGH
HIGH
Stop using measuring function of CO
module, notify biomedical engineer or
Mindray service staff.
Stop using measuring function of CO
module, notify biomedical engineer or
Mindray service staff.
Stop using TB alarming function, notify
biomedical engineer or Mindray service
staff.
Prompt message (general alerts):
Message
TB EXCEED
Cause
TB measuring value
beyond measuring range.
Alarm Level
is
HIGH
17.6 Maintenance and Cleaning
Care and Maintenance
Warning
Before cleaning the monitor or the transducer, make sure that the equipment is
switched off and disconnected from the power line.
CO Cable Cleaning
1.
If adhesive tape residue must be removed from the transducer cable, double seal tape
remover is effective and will cause a minimum of damage to the cable if used sparingly.
Acetone, Alcohol, Ammonia, Chloroform, or other strong solvents are not recommended
because they will eventually damage the vinyl cabling.
2.
Sponge the cable with warm water and soap, or another suitable cleaning solution, and
dry. Do not immerse them in water.
3.
Check each cable for corrosion, cracks and deterioration.
4.
Gas Sterilization
For more complete asepsis, use gas sterilization.
Remove obvious contamination by using the cleaning procedure described
previously. To inhibit the formation of ethylene glycol when ethylene oxide gas is
used as the disinfectant, the transducer should be completely dry.
Follow the operating instructions provided by the manufacturer of the gas
disinfectant.
Warning
Do not autoclave the cable or heat it above 75℃ (167℉). The cable should be stored in
an environmental temperature between -20℃ to 75 ℃ (-68℉ to 167℉). It should be
hung up or laid flat to prevent damage to the cable.
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Chapter 18 CO2 Measuring
18.1 General
This chapter offers some relevant data concerning CO2 monitoring.
PM-9000 provides two kinds of CO2 measuring methods as per the requirements of users,
which are MainStream and SideStream.
This module can be applied in operation room, monitor units etc, it can measure the CO2
partial pressure or concentration of patient Air Way, obtain EtCO2, Inspired Maximum CO2
(InsCO2), Air Way Respiration Rate (AwRR), and display CO2 concentration waveforms. The
parameter symbols displayed on the screen are defined as following:
CO2:EtCO2
INS: InsCO2。
AWRR: Air Way Respiration (AwRR)(Resp. times/MIN)。
Note
Don’t use the device in the environment with flammable anesthetic gas.
The device can only be operated by personnel having taken professional training and
familiar with this manual.
Warning
CO2 module shall be avoided from crash and vibration.
18.2 Monitoring Procedure
Principle of CO2 measurement is primarily based on the fact that CO2 molecule can absorb
4.3um infrared ray. Absorption intensity is proportional to CO2 concentration of patient sample,
the CO2 concentration will compute from the detecting CO2 absorption intensity of patient
sample. The relation between partial pressure and percentage of CO2 concentration is given
below : P(mmHg) = Percentage(%) * Pamp( ambient pressure )
Of CO2 MainStream and CO2 SideStream modules, whichever is selected by the user,
Autorun measuring mode is adopted. Rate for waveform sampling is 31 msec/time. The
operating series for the two modules are respectively:
MainStream work sequence: After the system is powered on, CO2 module automatically
begins warming-up for about 45S to 90S. Then the sensor motor is activated. After 5S to 10S,
the light source of infrared ray is opened. After 10S, the system enters the normal measuring
status.
SideStream work sequence: Except the procedures that after being powered on, the system
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CO2 Monitoring
needs not warming-up and the air pump should be activated, other procedures are the same
as those in MainStream sequence.
CO2 measurement setups:
1. Verify the type of the configured CO2 module (MainStream or SideStream);
2. For MainStream, connect the sensor to the receptacle of CO2 module. For SideStream,
plug the water trap onto its fixing chassis. Add a permanently used nafion tube between the
sampling line and the watertrap to further remove the influence of water vapor.
3. Power on the system. For MainStream, technical prompt information of “CO2 WARM UP” is
always displayed on the screen until the sensor reaches to the operating temperature.
4. After CO2 module is activated and enters the normal status, for MainStream, “MAIN” is
displayed following CO2 waveform identifier, and for SideStream, the “SIDE” is displayed
following CO2 waveform identifier.
Mainstream
Sensor
Airway
Adapter
Figure 18-1 Sidestream Connection
Figure 18-2
Mainstram Connection
Do not use the sterile supplied CO2 Water trap set (for side stream including water trap
and sample line and cannula) and Air adapter (for main stream) if the packaging or the
sensor is damaged and return them to the vendor.
“CO2 WARM UP” or “CO2 SENSOR START UP” displayed on the screen indicates that
the sensor is in warm-up or starting-up. After the information disappears from the screen,
the standard measurement can then be generated.
Monitor has water trap beside it, which is used to prevent the moisture or water drops
produced by patient’s respiration from entering the module. The sample line and the
water trap are one-off consumables that can not be repeatedly used by different patients.
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CO2 Monitoring
18.3 CO2 Menu
18.3.1
Parameter Setup and Adjustment
Turn the knob to select and press CO2 hot key on the screen to activate “CO2 Setup” menu
as shown below:
Figure 18-3
CO2 Setup Menu
Following functions can be realized via CO2 SETUP menu.
■
ALM: select “ON” to enable and store alarm prompt when CO2 parameters have alarms.
Select “OFF” to disable alarm and display
■
beside CO2. The default is “ON”.
ALM REC: select “ON” to generate output from the recorder ever since CO2 parameter
alarm occurs. The default is “OFF”.
■
ALM LEV: select from HIGH, MED and LOW. Level HIGH represents the most serious
alarm, followed by Level MED and Level LOW with a decrease of seriousness. Change in
“ALM LEV” can only affect the physiological alarm levels of CO2 parameters including
EtCO2 upper limit, EtCO2 lower limit, InsCO2 upper limit, AwRR upper limit and AwRR
lower limit. The default alarm level is “MED”.
■
CO2 ALM HI: to adjust the upper alarm limit of EtCO2. If the measuring value is larger
than CO2 upper alarm limit, “CO2 TOO HIGH” appears on the screen.
After the
measuring value returns to the normal one, the information disappears.
■
CO2 ALM LO: to adjust the lower alarm limit of EtCO2. If the measuring value is smaller
than CO2 lower alarm limit, “CO2 TOO LOW” appears on the screen. After the measuring
value returns to the normal one, the information disappears.
■
INS ALM HI: to adjust the upper alarm limit of InsCO2. If the measuring value is larger
than InsCO2 upper alarm limit, “INS TOO HIGH” appears on the screen. After the
measuring value returns to the normal one, the information disappears.
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CO2 Monitoring
■
AWRR ALM HI: to adjust the upper alarm limit of AwRR. If the measuring value is larger
than the upper alarm limit of AwRR, “AWRR TOO HIGH” appears on the screen. After the
measuring value returns to the normal one, the information disappears.
■
AWRR ALM LO: to adjust the lower alarm limit of AwRR. If the measuring value is smaller
than the lower alarm limit of AwRR, “AWRR TOO LOW” appears on the screen. After the
measuring value returns to the normal one, the information disappears.
■
UNIT: to change the display units of CO2 and InsCO2 parameters. “mmHg” and “kPa” are
available for selection.
■
APNEA ALM: After selecting the alarm time for APNEA alarm (having 7 levels, which are
10S, 15S, 20S, 25S, 30S, 35S, and 40S), the “CO2 APNEA” information will appear on
the screen after the corresponding selected time. The alarm level is HIGH.
■
SWEEP: to adjust the display rate of CO2 waveforms with “6.25 mm/s”, “12.5 mm/s”, or
“25.0 mm/s” selectable.
■
Exit: to close CO2 SETUP menu.
Note
“APNEA ALM” cannot be closed.
When various alarms occur simultaneously, the alarm information of highest level will be
displayed on the screen.
OTHER SETUP: pick this item in the menu to call up CO2 more setup sub-menu.
Figure 18-4
CO2 More Setups Menu
Now we introduce you to the functions of each item in CO2 SETUP submenu.
WAVE SCALE: to adjust full scale size of CO2 waveform display area with “LOW” or
“HIGH” selectable. The default value is “LOW”.
PUMP RATE: to adjust the pump rate of the air pump of CO2 module with “100ml/min”,
“150ml/min”, or “200ml/min” selectable. The default value is “100ml/min”.
NOTE: This menu only functions to “SideStream”.
WORK MODE: to change the work mode of CO2 with “MEASURE” mode or “STANDBY”
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CO2 Monitoring
mode selectable. The default is “STANDBY” mode. When it is required to monitor CO2,
select “MEASURE” mode. “STANDBY” mode disables the air pump in SideStream module,
the sensor and the IR (infrared ray) source in MainStream module, thus decreases the
power consumption and extends the life cycles of IR source and the whole CO2 module.
Note
When not using CO2 monitoring function, it is suggested not to connect MainStream
sensor or SideStream water trap and to adjust to “STANDBY” mode.
COMPENSATE: to perform different compensate operations as per the selection of the
user. The selections are GENERAL, O2, N2O/DES and ALL. Work conditions for
calculating compensate are shown in following table. Here is the operation method. First,
select the gas compensates to be used, including general compensate, O2 compensate,
Desf compensate and full compensates. Then, determine whether to make VA
compensate and BTPS compensate.
Work Conditions for CO2 Calculation Compensate:
Calculation
Compensate Method
General
O2
O2
Modification
Desflurance
OFF
ON
OFF
N2O/Desflurane
Modification
OFF
OFF
ON
Full
ON
ON
Work Conditions
O2≤60%,no N2O
O2>50%,no N2O
O2≤60%,&N2O 或
Desflurane≥12%
O2>60%,& N2O
WATERVAPOR: determine whether to make watervapor compensate.
Water vapor compensation accounts for the effect of water vapor on the CO2
IR(Infra-Red) absorption characteristics. It is used in both mainstream and sidestream
measurement modes. The user may disable this compensation under certain situations.
During normal sidestream operation, CO2 measurements are adjusted mathematically
to compensation for this effect.
The host may choose to disable this compensation when performing dry gas
meaasurements in which the gas does not contain water vapor.Dry gas procedures may
include
steady
state
measurements
and
calibration
procedures.Steady
state
measurements are performed only when background CO2,or CO2 present in the
immediate environment,is measured. An example of a steady state measurement is
measuring the CO2 content inside an incubator. Calibration procedures use calibrated
gas which is free of water vapor,or dry,as well.
The water vapor compensation is ON by default and may be enabled or disabled via a
host system command.
BTPS:The end user may want choose whether to correct values for gas that is at body
temperature, ambient pressure and is saturated with water vapor (BTPS) or has that is at
ambient temperature and pressure and is dry (ATPD). BTPS compensation (Body
Temperature and Pressure, Saturated) is a user selectable compensation that accounts
for the differences between the airway sample and “deep lung” CO2. Since the intent is to
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CO2 Monitoring
report “deep lung” CO2, where the sample is at 37 ℃ and fully saturated, BTPS
compensates for the variance of water vapor content due to temperature. The BTPS
compensation of CO2 module is on by default.
Note
1. If Compensate item is not correctly set as per the operation conditions, the result
will be far from the actual value, thus leading to severe misdiagnosis.
2. The default of Water Vapor Compensate is on. Turn it off when measuring dry gas,
such as when performing regular maintenance or measurement validation by using
dry calibrated gas.
3. The default of BTPS is on. Turn it on when measuring the VA saturated “damp” gas
under the body temperature and ambient pressure and turn it off when measuring
the “dry” gas under the ambient temperature and pressure.
4. Operate by strictly observing the Compensate operation method.
DEFAULT: pick this item to access the CO2 DEFAULT CONFIG dialog box, in which the
user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT
CONFIG is to be used. After selecting any of the items and exiting the dialog box, the
system will pop up the dialog box asking for the user’s confirmation.
EtCO2 upper alarm limit: when parameter value exceeds this limit, there will be alarm for
exceeding the upper limit.
Default:
Adult:
50 mmHg
Pediatric: 50 mmHg
Neonatal: 45 mmHg
EtCO2 lower alarm limit: when parameter value is smaller than the lower limit, there will be
alarm for exceeding lower limit.
Default:
Adult:
15 mmHg
Pediatric: 20 mmHg
Neonatal: 30 mmHg
InsCO2 upper alarm limit: when parameter value exceeds this limit, there will be alarm for
exceeding upper limit.
Default:
Adult:
4 mmHg
Pediatric: 4 mmHg
Neonatal: 4 mmHg
AwRR upper alarm limit: when parameter value exceeds this limit, there will be alarm for
exceeding upper limit.
Default:
Adult:
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CO2 Monitoring
Pediatric: 30 rpm
Neonatal: 100 rpm
AwRR lower alarm limit: when parameter value is smaller than the limit, there will be alarm for
exceeding lower limit.
Default:
Adult:
8 rpm
Pediatric: 8 rpm
Neonatal: 30 rpm
APNEA Time: Selections are 10S to 40S,
Default: 20S.
Work Mode: MainStream: Standby, Measurement;
SideStream: Standby, Measurement.
Default: Measurement
Compensate Method:
MainStream: General/O2/N2O/DES/ALL
SideStream: General/O2/N2O/DES/ALL
Default Methods: General.
Pump Rate: 100 – 200 ml/min.
Default: 100 ml/min
Unit: mmHg/kPa.
Default: mmHg
Waveform Sweep: 25.0/12.5/6.25 (mm/s)
Default: 25.0 mm/s
Waveform Scale: LOW/HIGH
Default: LOW
Besides, for alarm function of CO2 module, refer to Chapter Alarm, for its recording function,
refer to Chapter Recording, and for information about alarm event review, graphic and tabular
trend of CO2 parameters, refer to Chapter Trend and Event.
18.4 Alarm Information and Prompt
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch in
the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during CO2 measurement.
Physiological alarms:
Message
CO2 TOO HIGH
CO2 TOO LOW
Cause
EtCO2 measuring value is above upper
alarm limit.
EtCO2 measuring value is below lower
alarm limit.
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Alarm Level
User-selectable
User-selectable
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CO2 Monitoring
INS TOO HIGH
AWRR TOO HIGH
AWRR TOO LOW
CO2 APNEA
InsCO2 measuring value is above alarm
limits.
AwRR measuring value is above upper
alarm limit.
AwRR measuring value is below lower
alarm limit.
In specific time interval, no RESP can be
detected using CO2 module.
User-selectable
User-selectable
User-selectable
HIGH
Technical alarms:
Message
CO2 SENSOR OFF
CO2 NO
WATERTRAP
Alarm
Level
Cause
Mainstream sensor is not
properly connected or has
fallen off.
Sidestream water trap is not
properly connected or has
fallen off.
CO2 WATERTRAP
OCCLUDE
Sidestream
occluded.
CO2 SIGNAL LOW
Measuring module technical
failure
CO2 SIGNAL TOO
LOW
CO2 BAROMTRC
TOO LARGE
CO2 PNEUMATIC
LEAK
CO2 SIGNAL NOISY
CO2 SIGNAL
SATURATE
CO2 CALCULATION
ERR
CO2 SENSOR FAULT
CO2 SENSOR TEMP
HIGH
CO2 SENSOR TEMP
LOW
CO2 WATCHDOG
TIMEOUT
CO2 INT COMM ERR
CO2 SYSTEM ROM
ERR
CO2 FLASH CRC
ERR
water
trap
is
LOW
LOW
LOW
LOW
LOW
MED
MED
LOW
LOW
HIGH
HIGH
HIGH
HIGH
HIGH
HIGH
HIGH
HIGH
CO2 INT RAM ERR
HIGH
CO2 FLASH CHECK
ERR
HIGH
CO2 EXT RAM ERR
HIGH
CO2 STACK OVER
HIGH
CO2 PUMP FAULT
HIGH
CO2 REVERSE
FLOW
HIGH
18-8
Patient Monitor user’s manual (V 5.4)
Remedy
Make
sure
that
mainstream sensor is
properly connected.
Make
sure
that
sidestream water trap
is soundly connected.
Make
sure
that
sidestream water trap
functions smoothly.
If necessary, re-start
the monitor. If failure
persists, stop using
measuring function of
CO2 module, notify
biomedical engineer
or Mindray service
staff.
CO2 Monitoring
CO2 FORWARD
FLOW
HIGH
CO2 MALFUNCTION
HIGH
CO2 BAROMETRIC
HIGH
CO2 BAROMETRIC
LOW
HIGH
HIGH
CO2 COMM ERR
CO2 module communication
failure
HIGH
CO2 INIT ERR
CO2 module is not properly
connected or failed.
HIGH
CO2 COMM STOP
Measuring module failure or
communication failure.
HIGH
CO2 ALM LMT ERR
Functional safety failure
HIGH
INS ALM LMT ERR
Functional safety failure
HIGH
AWRR ALM LMT ERR
Functional safety failure
HIGH
Stop using measuring
function
of
CO2
module,
notify
biomedical engineer
or Mindray service
staff.
Stop using measuring
function
of
CO2
module,
notify
biomedical engineer
or Mindray service
staff.
Stop using measuring
function
of
CO2
module,
notify
biomedical engineer
or Mindray service
staff.
Prompt message:
Message
CO2 STANDBY STATUS
CO2 WARM UP
CO2 SENSOR START UP
Cause
Turn from measuring mode to
standby mode, making the module
in energy-saving status.
Shows that the sensor is in
warming-up stage.
Shows that the sensor has just
entering start-up stage.
Alarm Level
No alarm
No alarm
No alarm
18.5 Maintenance and Cleaning
Care and Maintenance
1. Sample line is for one-off use in SideStream module. Do not sterilize or clean for reuse on
another patient.
2. Airway adapter is for one-off use in MainStream module. Do not sterilize or clean for reuse
on another patient.
3. When the sample system of Sidestream module occurring occlusion, first check kinks for
sampling line. If no kinks are found, then check water trap after disconnecting sample line
from the Watertrap. If the occlusion message on the screen disappears, the sampling line
must be replaced. If the occlusion message on the screen remains, the Watertrap must be
replaced.
4. No routine calibration required in both Mainstream and Sidestream CO2 module.
Patient Monitor user’s manual (V 5.4)
18-9
Chapter 19 Anesthetic Gas
Measurement
19.1 General
AG module is used to measure respiratory and anesthetic gases of a patient during
anesthesia. This module provides et (end tidal) values and inspired values of various gases
listed below.
„ CO2
--- here it represents the measured EtCO2 value (maximum expired gas
value---maximum expired gas value tested during expiring period)
„ N2O ---
nitrous oxide
„ O2
optional function
---
„ AwRR
---
respiring time per minute
The system can simultaneously display the waveforms of 4 anesthetic gases: CO2, N2O, O2
and an anesthetic waveform. The default is to display CO2 waveform.
Parameters that can be displayed simultaneously are CO2, N2O, O2 and AA (it refers to
anesthetic: DES, ISO, ENF, SEV, HAL). In addition, inspired and expired values are displayed
at the same time plus MAC (Minimal Alveolar Concentration) or BAL (Balance gas) and
AwRR.
Definitions of parameter:
CO2
: carbon dioxide
N2O
: nitrous oxide
O2
: oxygen
AwRR
: air way respiration rate (respiring time per minute)
MAC
: minimum alveolar concentration
Halothame
: HAL
Isoflurane
: ISO
Enflurane
: ENF
Sevoflurane
: SEV
Desflurane
: DES
Patient Monitor user’s manual (V 5.4)
19-1
Anesthetic Gas Measurement
AwRR
AG value
MAC
Figure 19-1
AG measurement display
Note
The system can only display the waveform and value of one anesthetic agent at one
time.
19.2 Measuring principle and operating process
Principle for measuring anesthetic gas:
Anesthetic gas can absorb infrared ray. By using this principle, we can measure the
concentration of anesthetic gas.
Gases that can be measured using “AG module” are all able to absorb infrared ray. Besides,
each gas has it own absorption characteristic. First the gas to be measured is driven into a
sample cell. Then optic infrared filter selects the infrared ray with special wavelength to
penetrate this gas. For a given volume, the higher the gas concentration is, the more infrared
rays are absorbed. This means that the higher the concentration of the absorbed infrared is,
the fewer infrared rays there are to have penetrated the gas. We may first measure the
quantity of the infrared rays that have penetrated the gas and then calculate the gas
concentration via specialized formula. If you desire to measure multiple gases, you should
install various infrared filters in the AG module.
Principle for measuring oxygen:
Within the range of wavelengths mentioned above, oxygen does not absorb infrared rays.
Therefore we have to measure oxygen concentration by taking advantage of its paramagnetic
characteristic. Inside the sensor of the oxygen module, there are two glass balls filled up with
19-2
Patient Monitor user’s manual (V 5.4)
Anesthetic Gas Measurement
Nitrogen. These two glass balls are suspended into symmetric non-uniform magnetic field,
pointing into the direction away from the most intensive part of the field. This device is
surrounded by oxygen having paramagnetic characteristic. By this means, this device is
actually further pushed out of the field by the oxygen having relatively more intensive
paramagnetic characteristic. The force moment acted on this device is proportional to the
paramagnetic intensity of the surrounding gas, and therefore also proportional to oxygen
concentration.
Figure 19-2
connection diagram for measuring AG gas
Warning
Ensure tight connection when installing the filter. Any leakage in the system will result
in incorrect reading because this leakage will make the surrounding environmental air
mix up with patient gas.
Warning
To protect the module against contamination, always use bacteria filter because
without it, bacteria and liquid may directly enter the AG module and lead to system
contamination, clog or incorrect reading. In order to prevent clog, dispose the filter
each time after it is used on a patient. Do not try to disinfect or clean a used filter.
Only use the sample line recommended especially for the system. Using other sample
line may reduce the performance and reliability of the AG module.
If the sample line is tangled up, do not use it because the line in this condition may
have clog or leakage.
19.3 Menus
Patient Monitor user’s manual (V 5.4)
19-3
Anesthetic Gas Measurement
19.3.1
AG SETUP menu
Use the rotary knob to select the “GAS” hot key in the Parameter area to call out the “AG
SETUP” menu.
Figure 19-3
AG SETUP menu
Detailed information about each item in the AG SETUP menu is:
„
AGENT: used to select the name of the anesthetic to be monitored.
„
CO2 UNIT: used to select the display unit of CO2.
„
O2 UNIT: used to select the display unit of O2.
„
N2O UNIT: used to select the display unit of N2O.
„
AA UNIT: used to select the display unit of anesthetic.
„
PUMP RATE: used to select the appropriate pump rate.
„
O2 COMPEN: O2 compensation switch. When the O2 concentration is larger than
60% and O2 is not being monitored, turn on this switch.
„
SWEEP: used to select the speed to scan the screen waveforms.
„
WORK MODE: to monitor the anesthetic gas, select the “MEASURE” option.
Otherwise, select the “STANDBY” option.
„
ALARM SETUP>>: used to enter the ALARM SETUP submenu.
„
CALIBRATE>>: used to enter the CALIBRATE submenu.
„
O2 calibrate>>: used to enter the “O2 CALIBRATE” submenu.
„
ADJUST WAVE AMP>>: used to enter the “ADJUST WAVE AMP” submenu, in
which you may select the appropriate waveform amplitude for display.
„
DEFAULT>>: used to enter the “AG DEFAULT CONFIG” submenu. You can use
the information in this submenu to initialize all menus.
19-4
Patient Monitor user’s manual (V 5.4)
Anesthetic Gas Measurement
19.3.2
ALARM SETUP menu
In the ALARM SETUP menu, select the “ALARM” item to pop up the “ALARM SETUP” menu.
Figure 19-4
„
ALARM SETUP menu
ALM: when this switch is “ON”, if anesthetic gas has alarm, the system will give
alarm prompt and save the alarm information. When this switch is “OFF”, the
system will not trigger alarm. Instead it will display
beside GAS in the
Parameter area.
„
ALM LEV: there are three options: “HIGH”, “MED” and “LOW”. “HIGH” refers to
the most serious alarm, followed by “MED” and “LOW” in the order of descending
seriousness. The default alarm level is “MED”.
„
ALM REC: if it is “ON”, when anesthetic gas parameter has alarm, the recorder
will output the alarm information. The default is “OFF”.
„
EtCO2 ALM HI: used to adjust the upper alarm limit of EtCO2. When the measured
value is larger than EtCO2 upper alarm limit, the “EtCO2 HIGH” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is below the upper alarm limit.
„
EtCO2 ALM LO: used to adjust the lower alarm limit of EtCO2. When the
measured value is smaller than EtCO2 lower alarm limit, the “EtCO2 LOW”
message is displayed on the screen. In the UNLATCH mode, this message
disappears when the measured value is above the lower alarm limit.
„
FiCO2 ALM HI: used to adjust the upper alarm limit of FiCO2. When the measured
value is larger than FiCO2 upper alarm limit, the “FiCO2 HIGH” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is below the upper alarm limit.
„
FiCO2 ALM LO: used to adjust the lower alarm limit of FiCO2. When the measured
Patient Monitor user’s manual (V 5.4)
19-5
Anesthetic Gas Measurement
value is smaller than FiCO2 lower alarm limit, the “FiCO2 LOW” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is above the lower alarm limit.
„
EtO2 ALM HI: used to adjust the upper alarm limit of EtO2. When the measured
value is larger than EtO2 upper alarm limit, the “EtO2 HIGH” message is displayed
on the screen. In the UNLATCH mode, this message disappears when the
measured value is below the upper alarm limit.
„
EtO2 ALM LO: used to adjust the lower alarm limit of EtO2. When the measured
value is smaller than EtO2 lower alarm limit, the “EtO2 LOW” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is above the lower alarm limit.
„
FiO2 ALM HI: used to adjust the upper alarm limit of FiO2. When the measured
value is larger than FiO2 upper alarm limit, the “FiO2 HIGH” message is displayed
on the screen. In the UNLATCH mode, this message disappears when the
measured value is below the upper alarm limit.
„
FiCO2 ALM LO: used to adjust the lower alarm limit of FiO2. When the measured
value is smaller than EiO2 lower alarm limit, the “FiO2 LOW” message is displayed
on the screen. In the UNLATCH mode, this message disappears when the
measured value is above the lower alarm limit.
„
AwRR ALM HI: used to adjust the upper alarm limit of AwRR. When the measured
value is larger than AwRR upper alarm limit, the “AwRR HIGH” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is below the upper alarm limit.
„
AwRR ALM LO: used to adjust the lower alarm limit of AwRR. When the
measured value is smaller than AwRR lower alarm limit, the “AwRR LOW”
message is displayed on the screen. In the UNLATCH mode, this message
disappears when the measured value is above the lower alarm limit.
„
OTHER SETUP>>: used to enter the other ALARM SETUP menus.
„
EXIT: used to close this “ALARM SETUP” menu.
After selecting “OTHER SETUP>>” item in the ALARM SETUP menu, the following ALARM
SETUP menu pops up.
19-6
Patient Monitor user’s manual (V 5.4)
Anesthetic Gas Measurement
Figure 19-5
„
ALARM SETUP menu for other parameters
EtN2O ALM HI: used to adjust the upper alarm limit of EtN2O. When the measured
value is larger than EtN2O upper alarm limit, the “EtN2O HIGH” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is below the upper alarm limit.
„
EtN2O ALM LO: used to adjust the lower alarm limit of EtN2O. When the
measured value is smaller than EtN2O lower alarm limit, the “EtN2O LOW”
message is displayed on the screen. In the UNLATCH mode, this message
disappears when the measured value is above the lower alarm limit.
„
FiN2O ALM HI: used to adjust the upper alarm limit of FiN2O. When the measured
value is larger than FiN2O upper alarm limit, the “FiN2O HIGH” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is below the upper alarm limit.
„
FiN2O ALM LO: used to adjust the lower alarm limit of FiN2O. When the measured
value is smaller than FiN2O lower alarm limit, the “FiN2O LOW” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is above the lower alarm limit.
„
EtAA ALM HI: used to adjust the upper alarm limit of EtAA. When the measured
value is larger than EtAA upper alarm limit, the “EtAA HIGH” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is below the upper alarm limit.
„
EtAA ALM LO: used to adjust the lower alarm limit of EtAA. When the measured
value is smaller than EtAA lower alarm limit, the “EtAA LOW” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is above the lower alarm limit.
„
FiAA ALM HI: used to adjust the upper alarm limit of FiAA. When the measured
value is larger than FiAA upper alarm limit, the “FiAA HIGH” message is displayed
on the screen. In the UNLATCH mode, this message disappears when the
Patient Monitor user’s manual (V 5.4)
19-7
Anesthetic Gas Measurement
measured value is below the upper alarm limit.
„
FiAA ALM LO: used to adjust the lower alarm limit of FiAA. When the measured
value is smaller than FiAA lower alarm limit, the “FiAA LOW” message is
displayed on the screen. In the UNLATCH mode, this message disappears when
the measured value is above the lower alarm limit.
„
APNEA ALM: used to set up the apnea alarm time.
Note
Never turn off APNEA alarm.
When various alarms happen together, the screen only displays the alarm message of
the highest alarm level.
19.3.3
ADJUST WAVE AMP menu
In the “AG SETUP” menu, select the “ADJUST WAVE AMP>>” item to pop up the “ADJUST
WAVE AMP” menu as shown in the figure below:
Figure 19-6 ADJUST WAVE AMP menu
„
„
„
„
„
19.3.4
CO2 WAVE AMP: used to adjust the display amplitude of CO2 waveform.
N2O WAVE AMP: used to adjust the display amplitude of N2O waveform.
O2 WAVE AMP: used to adjust the display amplitude of O2 waveform.
AA WAVE AMP: used to adjust the display amplitude of anesthetic waveform.
EXIT: used to exit this menu.
DEFAULT menu
In the “AG SETUP” menu, select the “DEFAULT” item to pop up the “AG DEFAULT CONFIG”
menu as shown in the figure below:
19-8
Patient Monitor user’s manual (V 5.4)
Anesthetic Gas Measurement
Figure 19-7 AG DEFAULT CONFIG
„
FACTORY DEFAULT CONFIG: use the factory default configuration to initialize
menu items.
„
USER DEFAULT CONFIG: use the user default configuration to initialize menu
items.
„
EXIT: used to exit this menu.
19.4 Alarm information and prompts
When the alarm record switch in a related menu is on, those physiological alarms caused by
the parameter value exceeding the alarm limits will trigger the recorder to automatically output
this parameter value and its related measured waveforms.
Physiological and technical alarms and prompts that may appear during AG monitoring are
listed in following tables:
Physiological alarms:
Message
Cause
Alarm level
FiCO2 HIGH
The measured FiCO2 value exceeds
the setup upper alarm limit.
User selectable
FiCO2 LOW
The measured FiCO2 value is below
the setup lower alarm limit.
User selectable
EtCO2 HIGH
The measured EtCO2 value exceeds
the setup upper alarm limit.
User selectable
EtCO2 LOW
The measured EtCO2 value is below
the setup lower alarm limit.
User selectable
FiO2 HIGH
The measured FiO2 value exceeds the
setup upper alarm limit.
User selectable
FiO2 LOW
The measured FiO2 value is below the
setup lower alarm limit.
User selectable
EtO2 HIGH
The measured EtCO2 value exceeds
the setup upper alarm limit.
User selectable
EtO2 LOW
The measured EtCO2 value is below
the setup lower alarm limit.
User selectable
FiN2O HIGH
The measured FiN2O value exceeds
User selectable
Patient Monitor user’s manual (V 5.4)
19-9
Anesthetic Gas Measurement
the setup upper alarm limit.
FiN2O LOW
The measured FiN2O value is below
the setup lower alarm limit.
User selectable
EtN2O HIGH
The measured EtN2O value exceeds
the setup upper alarm limit.
User selectable
EtN2O LOW
The measured EtN2O value is below
the setup lower alarm limit.
User selectable
FiDES HIGH
The measured FiDES value exceeds
the setup upper alarm limit.
User selectable
FiDES LOW
The measured FiDES value is below
the setup lower alarm limit.
User selectable
EtDES HIGH
The measured EtDES value exceeds
the setup upper alarm limit.
User selectable
EtDES LOW
The measured EtDES value is below
the setup lower alarm limit.
User selectable
FiHAL HIGH
The measured FiHAL value exceeds
the setup upper alarm limit.
User selectable
FiHAL LOW
The measured FiHAL value is below
the setup lower alarm limit.
User selectable
EtHAL HIGH
The measured EtHAL value exceeds
the setup upper alarm limit.
User selectable
EtHAL LOW
The measured EtHAL value is below
the setup lower alarm limit.
User selectable
FiISO HIGH
The measured FiISO value exceeds
the setup upper alarm limit.
User selectable
FiISO LOW
The measured FiISO value is below the
setup lower alarm limit.
User selectable
EtISO HIGH
The measured EtISO value exceeds
the setup upper alarm limit.
User selectable
EtISO LOW
The measured EtISO value is below
the setup lower alarm limit.
User selectable
FiSEV HIGH
The measured FiSEV value exceeds
the setup upper alarm limit.
User selectable
FiSEV LOW
The measured FiSEV value is below
the setup lower alarm limit.
User selectable
EtSEV HIGH
The measured EtSEV value exceeds
the setup upper alarm limit.
User selectable
EtSEV LOW
The measured EtSEV value is below
the setup lower alarm limit.
User selectable
FiENF HIGH
The measured FiENF value exceeds
the setup upper alarm limit.
User selectable
FiENF LOW
The measured FiENF value is below
the setup lower alarm limit.
User selectable
EtENF HIGH
The measured EtENF value exceeds
the setup upper alarm limit.
User selectable
EtENF LOW
The measured EtENF value is below
the setup lower alarm limit.
User selectable
19-10
Patient Monitor user’s manual (V 5.4)
Anesthetic Gas Measurement
AwRR HIGH
The measured AwRR value exceeds
the setup upper alarm limit.
User selectable
AwRR LOW
The measured AwRR value is below
the setup lower alarm limit.
User selectable
GAS APNEA ALM
Respiration cannot be detected during
specified time interval.
HIGH
Technical alarms:
Message
Cause
AG NO WATERTRAP
The AG watertrap falls off from the monitor. Medium
CHANGE AG WATERTRAP
Replace the AG watertrap
AG WATERTRAP
WRONG
The type of the AG watertrap being used is
Medium
not suitable.
TYPE
Alarm Level
Medium
AG INIT FAIL
AG module has failure.
High
AG COMM STOP
AG module failure or
failure
AG OCCLUSION
The actual PUMP rate of the AG module is
High
<20ml/min, which exceeds 1 second.
AG COMM ERROR
AG module has communication failure.
High
AG HARDWARE ERROR
AG module has hardware failure.
High
AG DATA LIMIT ERROR
AG module failure
High
AG USA ERROR
AG module failure
High
AG ZREF FAIL
AG module fails to zero.
High
AG CAL FAIL
AG module fails to calibrate.
High
FiCO2 ALM LMT ERR
Functional safety failure
High
EtCO2 ALM LMT ERR
Functional safety failure
High
FiO2 ALM LMT ERR
Functional safety failure
High
EtO2 ALM LMT ERR
Functional safety failure
High
FiN2O ALM LMT ERR
Functional safety failure
High
EtN2O ALM LMT ERR
Functional safety failure
High
FiAA ALM LMT ERR
Functional safety failure
High
EtAA ALM LMT ERR
Functional safety failure
High
AwRR ALM LMT ERR
Functional safety failure
High
communication
High
Prompt:
Message
Cause
Alarm level
AG IS STARTING
Loading the AG module
No alarm
AG WARM UP
AG module is operating in the Warm-up
status.
No alarm
AG STANDBY
The AG module is operating in the Standby
status.
No alarm
Patient Monitor user’s manual (V 5.4)
19-11
Anesthetic Gas Measurement
19.5 Maintenance and cleaning
„
AG module
For detailed cleaning information about “AG Module”, refer to the chapter of
“Maintenance and Cleaning” in this operation manual.
„
Bacteria filter
The bacteria filter is one-off type, i.e., one bacteria filter can only be used by one patient.
„
Sample line
The sample line is one-off type.
„
Gas exhaust outlet
The gas exhaust outlet is reusable. You need to replace it only when it is damaged or
becomes loosely connected. This tube can be cleaned and disinfected.
Cleaning: use cloth moistened with warm soap water to clean the tube. Do not immerse
the tube into the liquid.
Disinfection: use cloth moistened with cool chemical disinfector (ramification mainly
containing aldehyde, ethanol or ramification mainly containing ethanol) to clean the tube.
Do not immerse the tube into the liquid. After cleaning, use wet cloth to wipe off the
disinfector and then use dry cloth to wipe the tube.
„
Occlusion handling
If the AG module passage is occluded, the screen will display the message “AG
OCCLUSION”. Following are a few examples of occlusion, which you may remove one
by one until this message disappears.
Entrance Occlusion
If the part at the entrance such as filter, sample line or airway connector is occluded by
condensed water, the screen will display the message telling that the airway is occluded.
The optimal method to remove clogs of this kind is:
check for clogs in entrance parts:
a. replace the bacteria filter at the entrance;
b. check the sample pipe for clogs and/or entangle. If necessary, replace it.
c. Check the airway connector for water. If necessary, drain off the water and install
the connector again.
Internal Occlusion
If the interior of the AG module is contaminated by condensed water, the screen will also
display the message telling that the airway is occluded.
The optimal method to remove clogs of this kind is:
19-12
Patient Monitor user’s manual (V 5.4)
Anesthetic Gas Measurement
Step 1: as usual, check the entrance or the exit for clogs and remove them.
Step 2: if occlusion still persist after step 1, you should consider the existence of interior
occlusion. In this situation, contact Mindray service engineer.
Patient Monitor user’s manual (V 5.4)
19-13
Chapter 20 Accessories and Ordering
Information
This chapter lists the recommendation accessories used in this device.
Warning
The accessories list below are specified to be used in this device of Shenzhen Mindray
Bio-Medical Electronics Co., Ltd. The device will be possibly damaged or lead some
harm if any other accessories are used.
20.1
ECG Accessories
Cables
6PIN 3-core ECG cable (LL-2325TRONOMEDINC)
P/N:0509-10-00093
5-lead ECG lead wire (LL-22305TRONOMED)
P/N:6000-10-02006
6PIN 5-lead ECG cable (LL-2514TRONOM ED)
P/N:6000-10-02007
6PIN 5-lead ECG cable (LL-2540AAMI)
P/N:9000-10-05163
6PIN 5-lead ECG cable, EURO (KENDALL)
P/N:9000-30-07339
6PIN 5-lead ECG cable and lead wires assembly, A
P/N:0010-30-12240
6PIN 5-lead ECG cable and lead wires assembly, IEC (Mindray)
P/N:0010-30-12241
6PIN 3-lead ECG cable and lead wires assembly, AHA (Mindray)
P/N:0010-30-12242
6PIN 3-lead ECG cable and lead wires assembly, IEC(Mindray)
P/N:0010-30-12243
6PIN 5-lead ECG cable and lead wires assembly, Deffibrilation,
AHA (Mindray)
P/N:0010-30-12244
6PIN 5-lead ECG cable and lead wires assembly, Deffibrilation,
IEC (Mindray)
P/N:0010-30-12245
6PIN 3-lead ECG cable and lead wires assembly, Deffibrilation,
AHA (Mindray)
P/N:0010-30-12246
6PIN 3-lead ECG cable and lead wires assembly, Deffibrilation,
IEC (Mindray)
P/N:0010-30-12247
6PIN separable ECG trunk cable assembly (Mindray)
P/N:0010-30-12256
6PIN separable ECG trunk cable assembly, Defibrillation,(Mindray)
P/N:0010-30-12257
Lead wires
3-lead ECG lead wire LL-22363
P/N:9000-10-07445
EURO 5-lead ECG lead wire (KENDALL)
P/N:9000-30-07338
Patient Monitor user’s manual (V 5.4)
20-1
Accessories and Ordering Information
3-lead ECG lead wire, EURO (KENDALL)
P/N:9000-30-07470
5-lead separable ECG lead wire, AHA, PINCH (Mindray)
P/N:0010-30-12262
3-lead separable ECG lead wire, AHA, PINCH (Mindray)
P/N:0010-30-12263
5-lead separable ECG lead wire, IEC, PINCH (Mindray)
P/N:0010-30-12264
3-lead separable ECG lead wire, IEC, PINCH (Mindray)
P/N:0010-30-12265
5-lead separable ECG lead wire, AHA, SNAP (Mindray)
P/N:0010-30-12266
3-lead separable ECG lead wire, AHA, SNAP (Mindray)
P/N:0010-30-12267
5-lead separable ECG lead wire, IEC, SNAP (Mindray)
P/N:0010-30-12268
3-lead separable ECG lead wire, IEC, SNAP (Mindray)
P/N:0010-30-12269
Electrodes
ECG electrode (Medi-Trace 230)
P/N:0010-10-12080
ECG electrode (Medi Trace 210’KENDALL’)
P/N:0010-10-12304
ECG electrode (2249 3M)
P/N:0509-10-00094
Pediatric ECG electrode (2248 3M)
P/N:900E-10-04879
Pediatric electrode (2258-3 3M)
P/N:900E-10-04880
20.2
SpO2 Accessories
MASIMO ACCESSORIES:
1269 LNOP-DCI ADULT SENSOR(KIT)
P/N:0010-10-12274
1269 LNOP-DCI ADULT REUSABLE SENSOR
P/N:0010-10-12101
6PIN SPO2 cable
P/N:9200-30-10682
6PIN SPO2 trunk cable (KIT)
P/N:9200-30-10707
NELLCO ACCESSORIES:
DS-100A finger sensor
P/N:9000-10-05161
OXI-P/I pediatric sensor
P/N:9000-10-07308
NELLCO Adult/Neonate wrapping SPO2 sensor (OXI-A/N)
P/N:9000-10-07336
MINDRAY ACCESSORIES:
512B finger SPO2 sensor
P/N:512B-30-90134
Finger SPO2 sensor
P/N:512D-30-90200
518A multi-function SPO2 sensor
P/N:518A-30-90226
6PIN SPO2 sensor trunk cable
P/N:0513-30-11220
6PIN SPO2 sensor trunk cable
P/N:512D-30-16752
20-2
Patient Monitor user’s manual (V 5.4)
Accessories and Ordering Information
20.3
NIBP Accessories
Reusable cuff
Patient Type
Limb perimeter
PN
Factory PN
Infant
10-19 cm
0010-30-12157
CM1201
Child
18-26 cm
0010-30-12158
CM1202
Adult
25-35 cm
0010-30-12159
CM1203
Large Adult
33-47 cm
0010-30-12160
CM1204
Thigh
46-66 cm
0010-30-12161
CM1205
Adult
25-35 cm
0010-30-12059
W.A.BAUM
Child
18-26 cm
0010-30-12060
W.A.BAUM
Infant
10-19 cm
0010-30-12061
W.A.BAUM
Pediatric
6-11 cm
0010-30-12067
W.A.BAUM
Adult
25-35 cm
509B-30-08845
CM1203-1
Disposable cuff
20.4
Size No.
Limb perimeter
PN
Factory PN.
1
3.1~5.7 cm
900E-10-04876
Pediatric PHILIPS M1866A
2
4.3 ~ 8.0 cm
900E-10-04875
Pediatric PHILIPS M1868A
3
5.8 ~ 10.9 cm
900E-10-04874
Pediatric PHILIPS M1870A
4
7.1 ~ 13.1 cm
900E-10-04873
Pediatric PHILIPS M1872A
TEMP Accessories
NAME
Temperature Probe
YSI PN
YSI 401
PN
0509-10-00095
Temperature Probe
YSI 402
6000-10-01969
Skin TEMP probe
(Adult)
Skin TEMP probe
(Pediatric)
YSI 409B
900E-10-04881
YSI-427
0010-10-12124
20.5
Application
Adult esophageal and rectal
temperature measurements
Pediatric esophageal and rectal
temperature measurements
Can easily be taped to the skin to
give surface temperature readings
Can easily be taped to the skin to
give surface temperature readings
IBP Accessories
ICP encephalic pressure transducer ICT/B’’GADTEC”
P/N:0010-10-12151
6PIN ICP cable assembly, ver. A
P/N:0010-21-12154
IBP cable PX1800/896019021/EDWARDS
P/N:0010-10-12177
IBP cable TC-VTK 'OHMEDA' or 'BD'
P/N:6000-10-02106
Patient Monitor user’s manual (V 5.4)
20-3
Accessories and Ordering Information
Disposable IBP transducer DT-4812'OHMEDA' or 'BD'
P/N:6000-10-02107
Reusable IBP transducer P23XL`OHMEDA`
P/N:900E-10-04882
Disposable IBP pressure transducer PX260/EDWARDS
P/N:0010-10-12176
Edwards two disposable IBP pressure transducer PX2X2
P/N:0010-10-12208
20.6
CO Accessories
IT sensor OHMEDA P /N: SP4042 'BD'
P/N:6000-10-02079
IT sensor cap OHMEDA P/N: SP5045 'BD'
P/N:6000-10-02080
Anti-pressure three-circles injector 12CC
P/N:6000-10-02081
6PIN CO trunk cable assembly
P/N:900E-30-04952
20.7
CO2 Accessories
008-0781-00/EtCO2 DryerSample Line with TEE(HH)
P/N:0010-10-12082
008-0784-00/EtCO2 DryerSample Line (HH)(No TEE)
P/N:0010-10-12083
008-0780-00/EtCO2 DryerSample Line with TEE(LH)
P/N:0010-10-12084
008-0782-00/EtCO2 Dryer
P/N:0010-10-12085
008-0789-00/Adult Nasal Sampling Line (soft)
P/N:0010-10-12086
008-0786-00/Adult O2 Delivery Sampling Line
P/N:0010-10-12087
008-0790-00/Pediatric Nasal Sampling Line,Soft
P/N:0010-10-12088
008-0785-00/Pediatric O2 Deliver Nasal SampleLine
P/N:0010-10-12089
008-0788-00/Infant EtCO2 Nasal Sampling Line,Soft
P/N:0010-10-12090
008-0783-00/Infant O2 Deliver Nasal SampleLine
P/N:0010-10-12091
2.5mm,008-0766-00/InfantConnecter with Sideport
P/N:0010-10-12092
008-0779-00/Adult/Pediatric Sampling TEE
P/N:0010-10-12093
Sampling LineNeonate2.5m purchase No:60-15300-00
P/N:9200-10-10555
Sampling ELBOW (BOX OF 50) (P/N 000.91167)
P/N:9000-10-07297
Sampling SATRAIGHT CTEE connector
P/N:9200-10-10593
DRYLINE WATER TRAP NEONATER(60-13200-00)
P/N:9200-10-10574
MAINSTREAM SENSOR II (P/N 000.59000)
P/N:9000-10-07299
AIRWAY ADAPTER,ADULT (BOX OF 10)(P/N 000.91060)
P/N:9000-10-07301
AIRWAY ADAPTER,LDS(BOX OF 10)(P/N 000.91070)
P/N:9000-10-07302
20-4
Patient Monitor user’s manual (V 5.4)
Accessories and Ordering Information
20.8
Anesthetic Gas Accessories
DRYLINE Airway Adapter,Straight P/N:60-14100-00
P/N:9000-10-07486
DRYLINE Airway Adapter,Elbow P/N:60-14200-00
P/N:9000-10-07487
Aion DRYLINE Water Trap, Adult, purchase No:60-13100-00
P/N:9200-10-10530
Sampling Line,Adult 2.5m, Adult, purchase No:60-15200-00
P/N:9200-10-10533
Patient Monitor user’s manual (V 5.4)
20-5
Appendix I
EC Declaration of Conformance
Manufacturer
Shenzhen Mindray Bio-Medical Electronics
Co., Ltd.
Address
Mindray Building, Keji 12th Road South, Hi-tech Industrial Park,
Nanshan, Shenzhen, 518057, P. R. China.
European
Shanghai International Holding Corp. GmbH (Europe)
Representative
Eiffestrasse 80 D-20537 Hamburg Germany
Product
Patient Monitor
Model Code
PM-9000
Standard Configuration including:
ECG/RESP, NIBP, SpO2, Battery
Options:
1. Thermal Recorder
2. 2-channel Temp
3. 2-channel IBP
4. EtCO2(Sidestream)
5. EtCO2(Mainstream)
6. Cardiac Output
7. Anaesthetic Gases
8. 12.1 (in.) Color TFT
9. 10.4 (in.) Color TFT
Classification(MDD, Annex IX): IIb
We herewith declare that the above mentioned products meet the provisions of the
following EC Council Directives and Standards. All supporting documentations are
retained under the premises of the manufacturer and the notified body.
Patient Monitor user’s manual (V 5.4)
1
EC Declaration of Conformance
DIRECTIVES
General applicable directives:
Medical Device Directive: COUNCIL DIRECTIVE 93/42/EEC of 14 June 1993 concerning
medical devices (MDD 93/42/EEC).
Standards:
Harmonized Standards (published in the Official Journal of the European Communities)
applicable to this product are:
ISO14971:2000+A1:2003,
EN1041:1998,
ISO1000:1992+A1:1998,
ISO10993-1:2003,
EN980:2003,
IEC60878:2003,
ISO3744:1994,
EN540:1993,
EN60601-1:1990+A1:1993+A2:1995+A13:1996, EN60601-1-1:2001, EN60601-1-2:2001,
EN60601-1-4:2000,
EN475:1995,
EN60601-2-27:1994,
EN865:1997,
EN60601-2-30:2000,
EN864:1996,
EN60601-2-34:2000,
EN12470-4:2000,
EN1060-1:1995,
EN1060-3:1997, IEC60601-2-49:2001, ANSI/AAMI SP-10:1996.
Notified Body:
2
TÜV Product Service GmbH, Ridlerstrasse 65 D- 80339 Münich, Germany.
Patient Monitor user’s manual (V 5.4)
Appendix II
Product Specification
1
Classification
Anti-electroshock type
Class I equipment with internal power supply
Anti-electroshock degree
ECG(RESP), SpO2, NIBP, IBP, TEMP, CO, CO2
CF
AG
BF
EMC
Class A
Harmful liquid proof degree
Ordinary equipment (sealed equipment without liquid
proof)
Disinfection/sterilizing method
Refer to Operation manual for details.
Working system
Continuous running equipment
2
Specifications
2.1
Size and Weight
Size
Monitor
318 x 144 x 264 mm
Weight
Monitor
5.5 kg
2.2
Environment
Temperature
Working
0 ~ 40 (°C)
Welch Allyn Sidestream CO2
+5ºC ~ +35ºC
Welch Allyn Mainstream CO2
+10ºC ~ +40ºC
Artema AION Anesthesia Gases +10ºC ~ +40ºC
Storage
-20 ~ 60 (°C)
Humidiity
Working
15%~ 85 %
Storage
10%~ 93 %(noncomdensing)
Altitude
Working
-500 to 4,600m(-1,600 to 15,000ft)
Storage
-500 to 13,100m(-1,600 to 43,000ft)
Patient Monitor user’s manual (V 5.4)
1
Production Specification
Power Supply
100~250 (V) AC, 50/60 (Hz)
Pmax=110VA
FUSE T 1.6
2.3
Display
Device
12.1 (in.) Color TFT, 800 x 600 Resolution, 3 LED
Messages
8 Waveforms Maximum
1 Alarm LED (Yellow/Red)
1 Power LED (Green)
1 Charge LED (Green)
3 Sound Mode corresponding Alarm Mode
2.4
Signal Interface
External display:
Standard VGA
ECG Output
BNC
Amplitude
1V
Accuracy
<5%
Impedance
100 (ohm)
Signal Delay
< 20 (ms)
NURSE CALL output
NURSE CALL function is realized through external NURSE CALL cable.
Output signal type:
NORMAL OPEN/NORMAL CLOSE is software controlled
Max. voltage:
36V DC OR 25V AC
Max. load current:
1A
On resistance
<1Ω
Isolation voltage:
1500VAC
2.5
Battery
Rechargeable Lead-Acid
2.3Ah 12V
Operating time under the normal condition
100 minutes (2 batteries)
Operating time after the first alarm of low battery
>5 minutes
Maximum charging time of single battery is 4 hours. Maximum charging time of two batteries
is 8 hours.
2.6
Recorder (Option)
Record Width
48 (mm)
Paper Speed
25/50(mm/s)
Trace
2
Recording types:
Continuous real-time recording
8 second real-time recording
Auto 8 second recording
Parameter alarm recording
2
Patient Monitor user’s manual (V 5.4)
Production Specification
Waveform freeze recording
Trend graph/table recording
ARR events review recording
Alarm event review recording
NIBP review recording
CO2 Measurement review recording
AG Measurement review recording
CO Measurement curve recording
Hemodynamic Calculation result recording
Drug Calculation and titration table recording
Monitor information recording
OxyCRG review recording
2.7
Recall
Trend Recall
Short
1 hour, 1 second or 5 second Resolution
Long
72 (hrs), 1 min, 5min or 10 min Resolution
Alarm Event Recall
60 alarm events of all parameters and 8,16 or 32
seconds of corresponding waveform.
NIBP Measurement Recall
2.8
400 NIBP measurement data.
ECG
Lead Mode
5 Leads ( R, L, F, N, C or RA, LA, LL, RL, V )
Lead selection
I, II, III, avR, avL, avF, V, CAL
Waveform
2 ch
Lead mode
3 Leads ( R, L, F or RA, LA, LL)
Lead selection
I, II, III, CAL
Waveform
1 ch
Gain
×0.25, ×0.5, ×1, ×2, auto
HR and Alarm
Range
Adult
15 ~ 300 (bpm)
Neo/Ped
15 ~ 350 (bpm)
Accuracy
± 1% or ± 1bpm, use the greater
Resolution
1 (bpm)
Sensitivity
> 200 (uV) P-P
Differential Input Impedance
> 5 (Mohm)
CMRR
Monitor
> 105 dB
Surgery
> 105 dB
Diagnostic
> 90 dB
Electrode offset potential
±300mV
Leakage Current
< 10 (uA)
Patient Monitor user’s manual (V 5.4)
3
Production Specification
Baseline Recovery
< 3 (S) After Defi.
ECG Signal Range
± 8 (mV) p-p
Bandwidth
Surgery
1 ~ 15 Hz
Monitor
0.5 ~ 35 Hz
Diagnostic
0.05 ~ 100 Hz
1 (mV) p-p, ±5% Accuracy
Calibration Signal
ST Segment Monitoring Range
Measure and Alarm
-2.0 ~ +2.0 (mV)
ARR Detecting
Type
ASYSTOLE,
VFIB/VTAC,
COUPLET,
BIGEMINY,
TRIGEMINY, R ON T, VT>2, PVC, TACHY, BRADY,
MISSED BEATS, PNP, PNC
Alarm
Available
Review
Available
2.9
RESPARATION
Method
Impedance between RA-LL
Differential input Impedance:
>2.5 MOhm
Measuring Impedance Range:
0.3~5.0Ω
Base line Impedance Range:
200Ω - 2500Ω(use 1kΩ of ECG cable)
Bandwidth
0.2 ~ 2Hz (-3 dB)
Resp.Rate
Measuring and Alarm Range
Adult
0 ~ 120 (rpm)
Neo/Ped
0 ~ 150 (rpm)
Resolution
1 (rpm)
Accuracy
±2 (rpm)
Apean Alarm
2.10
10 ~ 40 (s)
NIBP
Method
Oscillometric
Mode
Manual, Auto, STAT
Measuring Interval in AUTO Mode
1, 2, 3, 4, 5, 10, 15, 30, 60, 90, 120, 180, 240, 480 min
Measuring Period in STAT Mode
5 (Min)
Pulse Rate Range
40 ~ 240 (bpm)
Alarm
Type
4
SYS, DIA, MEAN
Patient Monitor user’s manual (V 5.4)
Production Specification
Measuring and alarm range
Adult Mode
SYS
40 ~ 270 mmHg
DIA
10 ~ 210 mmHg
MEAN
20 ~ 230 mmHg
Pediatric Mode
SYS
40 ~ 200 mmHg
DIA
10 ~ 150 mmHg
MEAN
20 ~ 165 mmHg
Neonatal Mode
SYS
40 ~ 135 mmHg
DIA
10 ~ 95 mmHg
MEAN
20 ~ 105 mmHg
Resolution
Pressure
1mmHg
Accuracy
Pressure
Maximum Mean error
±5mmHg
Maximum Standard deviation
8mmHg
Overpressure Protection
2.11
Adult Mode
297±3 mmHg
Pediatric Mode
240±3 mmHg
Neonatal Mode
147±3 mmHg
SpO2
Measuring Range
0 ~ 100 %
Alarm Range
0 ~ 100 %
Resolution
1%
Accuracy
70% ~ 100%
±2 %
0% ~ 69%
unspecified
Actualization interval
about 1(Sec.)
Alarm Delay
10 (Sec.)
Pulse Rate
Measuring and Alarm Range
0~254bpm
Resolution
1bpm
Accuracy
±2bpm or ±2%, use the greater
MASIMO Specification:
Range
Saturation(%SpO2)
1%~100%
Pulse Rate(bmp)
25~240
Patient Monitor user’s manual (V 5.4)
5
Production Specification
Accuracy
Saturation(%SpO2) - During No Motion Conditions
Adults/pediatric
70%~100%±2%
0%~69% unspecified
Neonates
70%~100%±3%
0%~69% unspecified
Saturation(%SpO2) - During Motion Conditions
Adults/ pediatric/ Neonates 70%~100%±3%
0%~69% unspecified
Pulse(bpm) - During No Motion Condition
25 to 240 ± 3BPM
Pulse(bpm) - During Motion Condition
25 to 240 ± 5BPM
Resolution
Saturation(%SpO2)
1%
Pulse Rate(bpm)
1
2.12
TEMPERATURE
Channel
2
Measuring and Alarm Range
0 ~ 50 °C
Resolution
0.1°C
Accuracy
±0.1°C (0 ~ 50 °C exclusive of probe errors)
Actualization interval
about 1(Sec.)
Average Time Constant
< 10 (Sec.)
2.13
IBP
Channel
2
Label
ART, PA, CVP, RAP, LAP, ICP, P1, P2
Measuring and alarm range
ART
0 ~ 300 mmHg
PA
-6 ~ 120 mmHg
CVP/RAP/LAP/ICP
-10 ~ 40 mmHg
P1/P2
-50 ~ 300 mmHg
Press Sensor
Sensitivity
5 (uV/V/mmHg)
Impedance
300 ~ 3000 (Ohm)
Resolution
1 mmHg
Accuracy
±2% or ±1mmHg, use the greater
Actualization interval
about 1(Sec.)
2.14
CO
Method
Thermodilution Technique
Measuring range
6
Patient Monitor user’s manual (V 5.4)
Production Specification
CO
0.1 ~ 20 (L/min)
TB
23 ~ 43 (°C)
TI
0 ~ 27 (°C)
Resolution
CO
0.1 (L/min)
TB,TI
0.1 (°C)
Accuracy
CO
±5% or ± 0.1L/min
TB
±0.1 (°C)
TI
±0.1 (°C)
Calculation
CO, Hemodynamic Calculation
Alarm Range
23-43 (°C)
2.15
CO2
Method
Infra-red Absorbation Technique
Measuring mode
Sidestream or Mainstream (optional)
Side-stream mode sampling gas flow rate
100, 150, 200 ml/min (option)
Measuring range
CO2
0~99 mmHg
INS CO2
0-99 mmHg
AwRR
0~150 bpm
Resolution
CO2
1 mmHg
INS CO2
1mmHg
AwRR
1 bpm
Accuracy
CO2
AwRR
Actualization interval
±2 mmHg,
0 ~ 40 mmHg
±5% of reading,
41 ~ 76 mmHg
±10% of reading,
77 ~ 99 mmHg
±2 bpm
about 1(Sec.)
Start-up Time
< 30 sec typical in sidestream mode
< 80 seconds in mainstream mode from 25°C ambient,
5W supplied to sensor heater
(Mainstream sensor temperature controlled to 42°C)
Mainstream Response Time
100 msec (10% to 90 %)
Sidestream Rise Time
240 msec (10% to 90 %)
Sidestream Delay Time
1.12 seconds maximum with 7-feet length, 0.055-inch ID.
Sampling line at 175 ml/min
Alarm range
Patient Monitor user’s manual (V 5.4)
7
Production Specification
CO2
0 – 99 mmHg
Ins CO2
0 – 99 mmHg
AwRR
0 – 150 rpm
Suffocation Alarm Delay
AwRR
2.16
10 ~ 40 Sec.
AG
Method
Infrared Absorption Technique
Measuring mode
Side-stream
Warm-up time
30 Sec
Iso accuracy mode
10 Min
Full accuracy mode
Side-stream mode sampling gas flow rate
Adult:
100,150,200 ml/min (option)
Neonate:
70,90,120 ml/min (option)
Gas Sort
CO2, N2O, O2 (Option), Des. , Iso., Enf., Sev., Hal.
Measuring range
CO2
0- 10% ( 0-76 mmHg)
N2O
0-100%
Des
0- 18%
Sev
0- 8%
Enf, Iso, Hal
0- 5%
O2
0- 100%(Option)
awRR
2-100 rpm
Resolution
CO2
1 mmHg
awRR
1 rpm
Accuracy
CO2
N2O
Des
Sev
8
Accuracy
range
±0.1%
0 – 1%
±0.2%
1 – 5%
±0.3
5 – 7%
±0.4
7 – 10%
Unspecified
> 10%
±2%
0 - 20%
±3%
20 - 100%
±0.15%
0 – 1%
±0.2%
1- 5%
±0.4%
5 - 10%
±0.6%
10 - 18%
Unspecified
>18%
±0.15%
0 – 1%
±0.2%
1- 5%
Patient Monitor user’s manual (V 5.4)
Production Specification
Enf, Iso, Hal
O2 (Option)
awRR
±0.4%
5 - 8%
Unspecified
> 8%
±0.15%
0-1%
±0.2%
1-5%
Unspecified
>5%
±1%
0- 25%
±2%
25-80%
±3%
80-100%
±1 rpm
Alarm range
CO2
0-10% (0-76 mmHg)
awRR
2-100 rpm
Suffocation Alarm Delay
awRR
20-40 Sec.
Updating frequency:
once per second
Calibrate:
no specified calibrate regulations
AG calibrate stability:
after being used for consecutive 12 months, the
deviation from precision is < 1%
Rising time:
Delay time:
240ms (10% - 90 %)
1.12 seconds maximum with 7-feet long sampling line
and ID 0.055 inch ,Sample rate is 175 ml/min
Patient Monitor user’s manual (V 5.4)
9
Appendix III
EMC
The monitor meets the requirements of EN 60601-1-2:2001
Note
The monitor needs special precautions regarding EMC and needs to be installed and
put into service according to the EMC information provided below.
Note
Portable and mobile RF communications equipment can affect this monitor. See tables
1,2,3, and 4 below.
TABLE 1
Guidance and manufacturer’s declaration — electromagnetic emmissions
The monitor is intended for use in the electromagnetic environment specified below. The
customer or the user of the monitor should assure that it is used in such an environment.
Emissions test
Compliance
RF emissions
CISPR 11
Group1
RF emissions
CISPR 11
Class A
Harmonic
Emissions IEC
Voltage
Fluctuations/
Flicker
Emissions IEC
61000-3-3
Class A
Electromagnetic environment — guidance
The MONITOR uses RF energy only for its internal
function. Therefore, its RF emissions are very low and
are not likely to cause any interference in nearby
electronic equipment.
The MONITOR is suitable for use in all establishments
other than domestic and those directly connected to
the public low-voltage power supply network that
supplies buildings used for domestic purposes
Class A
TABLE 2
Guidance and manufacturer’s declaration — electromagnetic immunity
The monitor is intended for use in the electromagnetic environment specified below. The
customer or the user of the monitor should assure that it is used in such an environment.
Immunity test
IEC 60601
Compliance level
Electromagnetic
Test level
environment — guidance
Patient Monitor user’s manual (V 5.4)
1
EMC
± 2KV, ± 4KV,
±6KV contact
Electrostatic
Discharge (ESD)
IEC 61000-4-2
Electrical
fast
Transient/burst
IEC 61000-4-4
± 2kV, ± 4KV,
± 6KV, ± 8KV
air
±2kV, ±4KV, ±
6KV, ±8KV air
±2 kV for power
supply lines
±2 kV
±
1
kV
differential mode
±2 kV common
mode
<5% UT (>95%
dip in UT ) for 0.5
cycle
Surge
IEC 61000-4-5
Voltage dips, Short
interruptions and
voltage
variation
on power supply
input lines
IEC 61000-4-11
40% UT (60% dip
in UT ) for 5 cycle
70% UT (30% dip
in UT ) for 25
cycle
<5% UT (>95%
dip in UT ) for 5
sec
Power frequency
(50/60
HZ)
magnetic field IEC
61000-4-8
±2KV, ±4KV, ±
6KV contact
3 A/m
±1 kV
Mains power quality should be
that of a typical commercial or
hospital environment.
±2 kV
<5% UT (>95% dip
in UT ) for 0.5
cycle
40% UT (60% dip
in UT ) for 5 cycle
70% UT (30% dip
in UT ) for 25 cycle
<5% UT (>95% dip
in UT ) for 5 sec
3 A/m
Floors
should
be
wood,
concrete or ceramic tile. If
floors
are
covered
with
synthetic material, the relative
humidity should be at least
30%.
Mains power quality should be
that of a typical commercial or
hospital environment.
Mains power quality should be
that of a typical commercial or
hospital environment. If the
user of the monitor requires
continued operation during
power mains interruptions, it is
recommended that the monitor
be
powered
from
an
uninterruptible power supply or
a battery.
Power frequency magnetic
fields should be at levels
characteristic of a typical
location in a typical commercial
of hospital environment.
NOTE — UT is the a.c. mains voltage prior to application of the test level.
TABLE 3
Guidance and manufacturer’s declaration — electromagnetic immunity
Portable and mobile RF communications equipment should be used no closer to any part of the monitor,
including cables, than the recommended separation distance calculated from the equation applicable to
the frequency of the transmitter.
NOTE 1 — At 80 MHz and 800 MHz, the higher frequency range applies.
NOTE 2 — These guidelines may not apply in all situations. Electromagnetic propagation is affected
by absorption and reflection from structures, objects and people.
The monitor is intended for use in the electromagnetic environment specified below. The customer or
the user of the monitor should assure that it is used in such an environment.
Immunity test
IEC 60601
Test level
Conducted RF
IEC 61000-4-6
3 Vrms 150kHz
to 80MHz
2
Compliance
level
3 Vrms
Electromagnetic environment —
guidance
Recommended separation distance:
d = 1.2 x P
Patient Monitor user’s manual (V 5.4)
EMC
Radiated
RF
IEC 61000-4-3
3 V/m 80MHz
to 2.5 GHz
3 V/m
Recommended separation distance:
d = 1.2 x P 80MHz to 800MHz
d = 2.3 x P 800MHz to 2.5GHz
Where P is the maximum output power
rating of the transmitter in watts (W) according to
the transmitter manufacturer and d is the
recommended separation distance in meters
(m).
Field strengths from fixed RF transmitters,
as determined by an electromagnetic site survey,
a
should be less than the compliance level in
each frequency range. b
Interference may occur in the vicinity of
equipment marked with the following symbol:
a
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones
and land mobile radios, amateur radio, AM and FM radio broadcast, and TV broadcast cannot be
predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF
transmitters, an electromagnetic site survey should be considered. If the measured field strength in the
location in which the monitor is used exceeds the applicable RF compliance level above, the monitor
should be observed to verify normal operation. If abnormal performance is observed, additional
measures may be necessary, such as reorienting or relocating the monitor.
b
Over the frequency range 150kHz to 80 MHz, field strengths should be less than 3V/m.
TABLE 4
Recommended separation distances between portable and mobile RF
communications equipment and the monitor
The monitor is intended for user in an electromagnetic environment in which radiated RF disturbance
are controlled. The customer or the user of the monitor can help prevent electromagnetic interference
by maintain a minimum distance between portable and mobile RF communication equipment
(transmitters) and the monitor as recommended below, according to the maximum output power of the
communication equipment.
Rated maximum output
power of transmitter
W
Separation distance according to frequency of transmitter
m
800 MHz to 2.5
150 kHz to 80 MHz 80 MHz to 800 MHz
GHz
d = 1.2 x P
d = 1.2 x P
0.01
0.12
0.12
0.23
0.1
0.38
0.38
0.73
1
1.2
1.2
2.3
d = 2.3 x
P
10
3.8
3.8
7.3
100
12
12
23
For transmitters rated at a maximum output power not listed above, the recommended
separation distanced d in meters (m) can be estimated using the equation applicable to the
frequency of the transmitter, where P is the maximum output power rating of the transmitter in
watts (W) according to the transmitter manufacturer.
NOTE 1 — At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
NOTE 2 — These guidelines may not apply in all situations. Electromagnetic propagation is affected
by absorption and reflection from structures, objects and people.
Patient Monitor user’s manual (V 5.4)
3
Appendix IV
System Alarm Prompt
PROMPT
CAUSE
"XX TOO HIGH"
XX value exceeds the higher
alarm limit.
"XX TOO LOW"
XX value is below the lower
alarm limit.
MEASURE
Check if the alarm limits are
appropriate and the current
situation of the patient.
XX represents the value of parameter such as HR, ST1, ST2, RR, SpO2, IBP, NIBP, etc in the system.
"ECG WEAK SIGNAL"
“NO PULSE”
"RESP APNEA"
"CO2 APNEA"
The ECG signal of the patient
is too small so that the system
can not perform ECG analysis.
The pulse signal of the patient
is too small so that the system
can not perform pulse analysis.
The respiration signal of the
patient is too small so that the
system cannot perform RESP
analysis.
The respiration signal of the
patient is too small so that the
system cannot perform RESP
analysis.
"ASYSTOLE"
Patient suffers from Arr. Of
ASYSTOLE.
"VFIB/VTAC"
Patient suffers from Arr. of
VFIB/VTAC.
"COUPLET"
Patient suffers from Arr. of
COUPLET.
"BIGEMINY"
Patient suffers from Arr. Of
BIGEMINY.
"TRIGEMINY"
Patient suffers from Arr. of
TRIGEMINY.
"R ON T"
Patient suffers from Arr. of R
Check if the electrodes and
lead wires are connected
correctly and the current
situation of the patient.
Check the connection of the
sensor and the current
situation of the patient.
Check the connection of the
linking wire and the current
situation of the patient.
Check the connection of CO2
sensor and the current
situation of the patient.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
Patient Monitor user’s manual (V 5.4)
1
System Alarm Prompt
ON T.
"PVC"
Patient suffers from Arr. of
PVC.
"TACHY"
Patient suffers from TACHY.
" BRADY"
Patient suffers from BRADY.
"VT>2"
Patient suffers from Arr. of
VT>2.
“MISSED BEATS”
Patient suffers from Arr. of
MISSED BEATS.
"PNP"
The pacemaker is not paced.
"PNC"
No pacemaker
captured.
"ECG LEAD OFF"
"ECG V LEAD OFF";
"ECG LL LEAD OFF";
"ECG LA LEAD OFF";
"ECG RA LEAD OFF";
"ECG C LEAD OFF";
"ECG F LEAD OFF";
"ECG L LEAD OFF";
"ECG R LEAD OFF";
SPO2 SENSOR OFF
2
signal
is
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the current situation of
the
patient.
Check
the
connection of the electrodes
and lead wires.
Check the connection of the
pacemaker.
Check the connection of
electrodes and lead wires.
Check the current situation of
the patient.
Check the connection of the
pacemaker.
Check the connection of
electrodes and lead wires.
Check the current situation of
the patient.
ECG lead is not connected
correctly.
The V lead wire of ECG is not
connected correctly.
The LL lead wire of ECG is not
connected correctly.
The LA lead wire of ECG is not
connected correctly.
The RA lead wire of ECG is not
connected correctly.
Check the connection of ECG
lead wire.
Check the connection of V
lead wire.
Check the connection of LL
lead wire.
Check the connection of LA
lead wire.
Check the connection of RA
lead wire.
The C lead wire of ECG
connected correctly.
The F lead wire of ECG
connected correctly.
The L lead wire of ECG
connected correctly.
The R lead wire of ECG
connected correctly.
Check the
lead wire.
Check the
lead wire.
Check the
lead wire.
Check the
lead wire.
SpO2 sensor may
disconnected
from
patient or the monitor.
is not
is not
is not
is not
be
the
connection of C
connection of F
connection of L
connection of R
Make sure that the monitor
and the patient are in correct
connection with the cables.
Patient Monitor user’s manual (V 5.4)
System Alarm Prompt
SPO2 INIT ERR
SPO2 INIT ERR 1
SPO2 INIT ERR 2
SPO2 INIT ERR 3
SPO2 INIT ERR 4
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
Our service staff.
SpO2 module failure
SPO2 INIT ERR 5
SPO2 INIT ERR 6
SPO2 INIT ERR 7
SPO2 INIT ERR 8
SPO2 COMM STOP
SpO2 module failure
communication error
or
SPO2 COMM ERR
SpO2 module failure
communication error
or
SPO2 ALM LMT ERR
PR ALM LMT ERR
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
Our service staff.
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
Our service staff.
Functional safety failure
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
Our service staff.
Functional safety failure
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
Our service staff.
Sensor not fully inserted into
the connector.
May be an incorrect sensor,
or a defective sensor or cable.
Insert
sensor
into
the
connector. Disconnect and
reconnect sensor. Refer to the
instructions for the sensor
being used.
Sensor inserted upside down.
Disconnect and reconnect he
sensor
with
the
logos
matching.
MASIMO Alarm information:
SpO2 NO SENSOR
SpO2 SENSOR
OFF
SpO2
sensor
may
be
disconnected from the patient
or the monitor.
Disconnect and reconnect the
sensor.
Reattach sensor.
This message appears when
the sensor is faulty
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
SpO2
UNRECOGNIZED
SENSOR
Masimo board does
recognize the sensor.
Make sure that the monitor
and the patient are in correct
connection with the cables.
SpO2
This
SpO2
FAULT
SENSOR
message
is
not
displayed
Make sure that the monitor
Patient Monitor user’s manual (V 5.4)
3
System Alarm Prompt
INCOMPATIBLE
SENSOR
when the masimo sensor is
finding incompatible sensor.
SpO2
INTERFERENCE
Outside signal or
preventing reading.
SpO2
SEARCH
PULSE
SpO2
LOW
PERFUSTION
SpO2 TOO
MUCH LIGHT
Unit is searching
patients pulse.
energy
for
the
Signal too small.
Too
much
light
on
patient(sensor).
Inadequate
tissue
covering
sensor
detector.
SpO2 LOW
SIGNAL IQ
Low signal quality.
SpO2
BOARD FAULT
This message appears when
the
Masimo
Set
board
malfunctions.
SpO2 COMMUNICATION
ERROR
This message is displayed
when the front end module is
having
problems
communicating ( ie: framing
errors or bad checksums) with
the Masimo board.
SpO2 COMMUNICATION
STOP
This message is displayed
when the host can not receive
the data from Masimo board
for 5 seconds
SpO2 INIT ERR
This message is displayed
when the SpO2 module
initialization error happened.
"TEMP1 SENSOR OFF"
"TEMP2 SENSOR OFF"
"IBP1 LEAD OFF"
"IBP2 LEAD OFF"
"IBP1 NEED ZERO-CAL"
"IBP2 NEED ZERO-CAL"
"TB SENSOR OFF"
"CO2 SENSOR OFF"
4
TEMP1
sensor
is
not
connected correctly.
TEMP2
sensor
is
not
connected correctly.
IBP1 sensor is not connected
correctly.
IBP2 sensor is not connected
correctly.
Zero calibrating must be done
before measuring in IBP1
Zero calibrating must be done
before measuring in IBP2
TB sensor is not connected
correctly.
CO2 sensor is not connected
correctly.
use incompatible sensor.
Remove outside interference.
If values are not displayed
within 30 seconds, disconnect
and reconnect sensor. If pulse
search continues, remove
sensor and replace on a
better perfused site.
Move
sensor
perfused site.
to
better
Remove or reduce lighting.
Cover sensor from light.
Reposition sensor.
Ensure
proper
sensor
application. Mover sensor to a
better perfused site.
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
Stop using the measuring
function of SpO2 module,
notify biomedical engineer or
our service staff.
Check the connection of
TEMP1 sensor.
Check the connection of
TEMP2 sensor.
Check the connection of IBP1
sensor.
Check the connection of IBP2
sensor.
Do zero calibrating for IBP1
Do zero calibrating for IBP2
Check the connection of TB
sensor.
Check the connection of CO2
sensor.
Patient Monitor user’s manual (V 5.4)
System Alarm Prompt
"ECG NOISE"
Rather
large
interference
signals appear in the ECG
signals.
"XX INIT ERR X"
XX has error
initialization.
"XX COMM STOP"
XX cannot communicate with
the host.
"XX COMM ERR"
XX
cannot
communicate
normally with the host.
X
Check the connection of ECG
lead wire. Check the current
situation of the patient. Check
if the patient moves a lot.
during
Re-start up the monitor or
re-plug in/out the module. If
the error still exists, contact
the manufacturer.
XX represents all the parameter modules in the system such as ECG, NIBP, SpO2, IBP, CO module, etc.
"XX ALM LMT ERR"
"XX RANGE EXCEEDED"
The alarm limit of
parameter is modified
chance.
The measured value of
parameter has exceeded
measuring range of
system.
XX
by
XX
the
the
Contact the manufacturer for
repair.
Contact the manufacturer for
repair.
XX represents the parameter name in the system such as HR, ST1, ST2, RR, SpO2, IBP, NIBP, etc.
"CO2 NO WATERTRAP"
CO2
watertrap
connected correctly.
"CO2
WATERTRAP
OCCLUDE"
CO2 watertrap is clogged.
"CO2 SIGNAL LOW"
CO2 signals are poor.
"CO2 SIGNAL TOO LOW"
CO2 signals are too poor.
"CO2 BAROMETRIC TOO
LARGE"
"CO2 PNEUMATIC LEAK"
"CO2 SIGNAL NOISY"
"CO2
SIGNAL
SATURATE"
"CO2
CALCULATION
ERR"
"CO2 PUMP FAULT"
"CO2REVERSE FLOW"
"CO2 FORWARD FLOW"
"CO2 MALNUFUNCTION"
"CO2
BAROMETRIC
HIGH"
"CO2
BAROMETRIC
LOW"
"CO2
WATCHDOG
ERROR"
"CO2 INT COMM ERR"
“CO2
SYSTEM
ROM
ERR”
is
CO2 modules has failure.
not
Check the connection of CO2
watertrap.
Replace the filter net or CO2
air hose. Check if the water in
the CO2 watertrap is too
much.
Check for leaks in the airway.
Check if the airway is
clogged.
Check
if
the
watertrap is too old. After
excluding
the
above
problems, replace another
CO2 air hose or watertrap. If it
still cannot work normally,
contact the manufacturer for
repair.
Contact the manufacturer for
repair.
Patient Monitor user’s manual (V 5.4)
5
System Alarm Prompt
“CO2 FLASH CRC ERR”
“CO2 EXT RAM ERR”
“CO2 INT RAM ERR”
“CO2 FLASH CHECK
ERR”
“CO2 STACK OVER”
"CO2 SENSOR FAULT"
"CO2 SENSOR TEMP
HIGH"
"CO2 SENSOR TEMP
LOW"
"REAL
NEEDSET"
"REAL
EXIST"
CLOCK
CLOCK
NOT
"SYSTEM WD FAILURE"
"SYSTEM
SOFTWARE
ERR"
"SYSTEM CMOS FULL"
"SYSTEM CMOS ERR"
"SYSTEM
EPGA
FAILURE"
"SYSTEM FAILURE2"
"SYSTEM FAILURE3"
"SYSTEM FAILURE4"
"SYSTEM FAILURE5"
"SYSTEM FAILURE6"
"SYSTEM FAILURE7"
"SYSTEM FAILURE8"
"SYSTEM FAILURE9"
"SYSTEM FAILURE10"
"SYSTEM FAILURE11"
"SYSTEM FAILURE12"
When the system displays
2000-1-1, the system gives this
prompt reminding the user that
the current system time is not
right.
Re-set up the system time. It
is better to set up the time just
after the start-up and prior to
monitoring the patient. After
modifying the time, the user
had better re-start up the
monitor to avoid storing error
time.
The system has no cell battery
or the battery has run out of
the capacity.
Install
or
replace
rechargeable battery.
the
The system has serious error.
Re-start up the system. If the
failure still exists, contact the
manufacturer.
The keys on the keyboard
cannot be used.
Check the keys to see
whether
it
is
pressed
manually or by other object. If
the key is not pressed
abnormally,
contact
the
manufacturer for repair.
"KEYBOARD
COMM
ERR";
"KEBOARD ERROR";
"KEYBOARD ERR1";
"KEYBOARD ERR2";
The keyboard has failure,
which cannot be used.
Contact the manufacturer for
repair.
"NET INIT ERR(G.)"
"NET INIT ERR(Ram)"
"NET INIT ERR(Reg)"
The network part in the system
has failure. The system cannot
be linked to the net.
Contact the manufacturer for
repair.
"KEYBOARD
AVAILABLE";
6
NOT
Patient Monitor user’s manual (V 5.4)
System Alarm Prompt
"NET INIT ERR(Mii)"
"NET INIT ERR(Loop)"
"NET ERR(Run1)"
"NET ERR(Run2)"
"NET ERR(Run3)"
"5V TOO HIGH"
"5V TOO LOW"
"POWER ERR3"
"POWER ERR4"
"12V TOO HIGH"
"12V TOO LOW"
"POWER ERR7"
"POWER ERR8"
"3.3V TOO HIGH"
"3.3V TOO LOW"
"CELL BAT TOO HIGH"
"CELL BAT TOO LOW"
The power part of the system
has failure.
If
the
prompt
appears
repeatedly,
contact
the
manufacturer for repair.
Cell battery has problem.
The cell battery has low
capacity or the cell battery is
not installed or the connection
is loose.
Replace the battery. If the
failure still exists, contact the
manufacturer.
"RECORDER SELFTEST
ERR"
During the selftest, the system
fails connecting with the
recorder module.
"RECORDER VLT HIGH"
"RECORDER VLT LOW"
The recorder
voltage failure.
"RECORDER HEAD HOT"
The continuous recording time
may be too long.
"REC HEAD IN WRONG
POSITION"
"RECORDER OUT OF
PAPER"
"RECORDER
PAPER
JAM"
"RECORDER
ERR"
has
The handle for pressing the
paper is not pressed down.
No paper is in the recorder.
The paper in the recorder is
jammed.
COMM
"RECORDER S. COMM
ERR"
"RECORDER
W.P."
module
PAPER
"REC NOT AVAILABLE"
The communication
recorder is abnormal.
of
the
Execute ‘Clear Record Task’
function in the recorder setup
menu to re-connect the host
and the recorder. If the failure
still
exists,
contact
the
manufacturer for repair.
Contact the manufacturer for
repair.
After the recorder becomes
cool, use the recorder for
output again. If the failure still
exists,
contact
the
manufacturer for repair.
Press down the recorder
handle for pressing the paper.
Place the paper into the
recorder.
Place the recorder correctly
and try again.
In the recorder setup menu,
execute the function of
clearing record task. The
function can make the host
and the recorder connect
again. If the failure still exists,
contact the manufacturer for
repair.
The paper roll of the recorder
is not placed in the correction
position.
Place the paper roll in the
correct position.
Cannot communicate with the
recorder.
In the recorder setup menu,
execute the function of
clearing record task. The
function can make the host
and the recorder connect
again. If the failure still exists,
contact the manufacturer for
Patient Monitor user’s manual (V 5.4)
7
System Alarm Prompt
repair.
"NIBP INIT ERR"
NIBP initialization error
"NIBP SELFTEST ERR"
"NIBP
RESET"
ILLEGALLY
During NIBP measurement,
illegal reset occurs.
"NIBP COMM ERR"
The NIBP communication part
has problem.
"LOOSE CUFF"
The NIBP cuff is not connected
correctly.
"AIR LEAK"
The NIBP cuff is not connected
correctly or there are leaks in
the airway.
"AIR
ERROR"
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
PRESSURE
"WEAK SIGNAL"
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
"RANGE EXCEEDED"
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
"EXCESSIVE MOTION"
The patient arm moves.
"OVER PRESSURE"
Perhaps folds exist in the
airway.
"SIGNAL SATURATED"
"NIBP TIME OUT"
8
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
Execute the reset program in
the NIBP menu. If the failure
still
exists,
contact
the
manufacturer for repair.
Check the airway of NIBP to
see if there are clogs. Then
measure again, if the failure
still
exists,
contact
the
manufacturer for repair.
Execute the reset program in
the NIBP menu. If the failure
still
exists,
contact
the
manufacturer for repair.
Re-connect the NIBP cuff.
Check the connection of each
part or replace with a new
cuff. If the failure still exists,
contact the manufacturer for
repair.
Check the connection of each
part or replace with a new
cuff. If the failure still exists,
contact the manufacturer for
repair.
Check if the setup of patient
type is correct. Check the
connection of each part or
replace with a new cuff. If the
failure still exists, contact the
manufacturer for repair
Check the connection of each
part or replace with a new
cuff. If the failure still exists,
contact the manufacturer for
repair.
Check the connection of each
part and the patient situation.
Measure again, if the failure
still
exists,
contact
the
manufacturer for repair.
Check for the smoothness in
the airway and patient
situation. Measure again, if
the failure still exists, contact
the manufacturer for repair.
Check the connection of each
part and the patient situation.
Measure again, if the failure
still
exists,
contact
the
manufacturer for repair.
Check the connection of each
part and the patient situation.
Measure again, if the failure
still
exists,
contact
the
manufacturer for repair.
Patient Monitor user’s manual (V 5.4)
System Alarm Prompt
"CUFF TYPE ERR"
Perhaps the used cuff does not
fit the setup patient type.
"PNEUMATIC LEAK"
NIBP airway has leaks.
"MEASURE FAIL"
"NIBP SYSTEM FAILURE"
AG NO WATERTRAP
CHANGE
WATERTRAP
AG WATERTRAP
WRONG
AG
TYPE
AG INIT FAIL
AG COMM STOP
AG OCCLUSION
AG COMM ERROR
AG HARDWARE ERROR
AG DATA LIMIT ERROR
AG USA ERROR
AG ZREF FAIL
AG CAL FAIL
FiCO2 ALM LMT ERR
EtCO2 ALM LMT ERR
FiO2 ALM LMT ERR
EtO2 ALM LMT ERR
FiN2O ALM LMT ERR
EtN2O ALM LMT ERR
FiAA ALM LMT ERR
EtAA ALM LMT ERR
AwRR ALM LMT ERR
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
Problem
happens
when
measuring the curve. The
system
cannot
perform
measurement,
analysis
or
calculation.
Check if the patient type is set
up correctly. Check the
connection of each part or
replace with a new cuff. If the
failure still exists, contact the
manufacturer for repair.
Check the connection of each
part or replace with a new
cuff. If the failure still exists,
contact the manufacturer for
repair.
Check the connection of each
part and the patient situation.
Measure again, if the failure
still
exists,
contact
the
manufacturer for repair.
Check the connection of each
part and the patient situation.
Measure again, if the failure
still
exists,
contact
the
manufacturer for repair.
The AG watertrap falls off Check the connection of AG
from the monitor.
watertrap sensor.
Check if the watertrap type is
Replace the AG watertrap
correct. Check the connection
of each part or replace with a
The type of the AG watertrap new watertrap. If the failure still
exists,
contact
the
being used is not suitable.
manufacturer for repair.
AG module has failure.
Check the connection of each
part and the patient situation.
AG
module
failure
or Measure again, if the failure
still
exists,
contact
the
communication failure
manufacturer for repair.
Refer to the chapter of
The actual PUMP rate of the “Maintenance and Cleaning” of
“Anesthetic
Gas
AG module is <20ml/min, the
which exceeds 1 second.
Measurement” in this operation
manual.
AG
module
has
communication failure.
AG module has hardware
failure.
AG module failure
AG module failure
AG module fails to zero.
Check the connection of each
AG module fails to calibrate. part and the patient situation.
Functional safety failure
Measure again, if the failure
still
exists,
contact
the
Functional safety failure
manufacturer for repair.
Functional safety failure
Functional safety failure
Functional safety failure
Functional safety failure
Functional safety failure
Functional safety failure
Functional safety failure
Patient Monitor user’s manual (V 5.4)
9
P/N: 9200-20-10499
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