IntelliVue MP2 Patient Monitor

IntelliVue MP2 Patient Monitor

I N ST R U C T I O N S F O R U S E

IntelliVue MP2

P at i e nt Mo n i t o r

R e l e a s e F . 0 w i t h S o f t w a r e R e v i s i o n F . 0 1 . x x

P a t i e n t M o n i t o r i n g

Printed in Germany 07/07

*M8102-9001A*

Part Number M8102-9001A

4512 610 21441

S

M8102-9001A

1

Table Of Contents

1 Installation

Installation Checklist

Unpacking and Checking the Shipment

Initial Inspection

Claims for Damage

Repacking

Mounting the Monitor

Mounting the External Power Supply (M8023A)

Connecting the Monitor to AC Mains

Checking Out the Monitor

Operating the Monitor

Setting the Date and Time

Checking Country-Specific Default Settings

Handing Over the Monitor

2 Basic Operation

Introducing the IntelliVue MP2

Controls, Indicators and Connectors

MP2 Overview

MP2 Controls and Indicators

MP2 Patient Connectors, Right Side

MP2 Left Side

Extending Measurements

Operating and Navigating

Using the Touchscreen

Measurement Setup Menus

Main Setup Menu

SmartKeys

Pop-Up Keys

Using the On-Screen Keyboard

Operating Modes

Understanding Screens

Switching to a Different Screen

Changing a Screen’s Content

Using the Visitor Screen

Understanding Profiles

Swapping a Complete Profile

Swapping a Settings Block

Default Profile

Locked Profiles

Understanding Settings

Changing Measurement Settings

2

2

2

1

2

7

7

6

7

3

5

3

3

1

9

11

12

12

13

16

10

10

10

18

18

19

19

21

21

22

23

23

23

24

24

25

26

26

26

26

26

i

ii

Switching a Measurement On and Off

Adjusting a Measurement Wave

Changing Wave Speeds

Changing the Wave Group Speed

Changing Wave Speed for a Channel

Using Labels

Changing Measurement Labels (e.g. Pressure)

Resolving Label Conflicts

Changing Monitor Settings

Adjusting the Screen Brightness

Adjusting Touch Tone Volume

Setting the Date and Time

Checking Your Monitor Revision

Getting Started

Inspecting the Monitor

Switching On

Power On/Power Off Behavior

Setting up the Measurements

Starting Monitoring

Disconnecting from AC Mains Power

Monitoring After a Power Failure

Networked Monitoring

3 Alarms

Visual Alarm Indicators

Audible Alarm Indicators

Alarm Tone Configuration

Changing the Alarm Tone Volume

Minimum Volume for No Central Monitoring INOP

Minimum Volume for Severe Yellow or Red INOPs

Acknowledging Alarms

Acknowledging Disconnect INOPs

Alarm Reminder (ReAlarm)

Pausing or Switching Off Alarms

To Pause All Alarms

To Switch All Alarms Off

To Switch Individual Measurement Alarms On or Off

While Alarms are Paused or Off

Restarting Paused Alarms

Resetting Arrhythmia Alarm Timeouts

Extending the Alarm Pause Time

Alarm Limits

Viewing Individual Alarm Limits

Viewing All Alarm Limits

Changing Alarm Limits

About Automatic Alarm Limits (AutoLimits)

28

28

28

27

27

27

27

27

30

30

30

29

30

30

30

31

31

31

31

32

32

32

36

36

37

34

34

35

35

36

36

38

38

38

38

37

37

37

37

38

39

39

40

41

33

Documenting Alarm Limits

Reviewing Alarms

Review Alarms Window

Latching Alarms

Viewing the Alarm Latching Settings

Alarm Latching Behavior

Testing Alarms

Alarm Behavior at On/Off

Alarm Recordings

4 Patient Alarms and INOPs

Patient Alarm Messages

Technical Alarm Messages (INOPs)

5 Managing Patients

Admitting a Patient

Patient Category and Paced Status

Admitting a Centrally-Monitored Patient

Quick Admitting a Patient

Editing Patient Information

Discharging a Patient

New Patient Check

Transferring Patients

Transferring a Centrally-Monitored Patient with the Monitor

Data Exchange Between Information Centers

Resolving Patient Information Mismatch

Manually Resolving Patient Mismatch

6 ECG, Arrhythmia, ST and QT Monitoring

Skin Preparation for Electrode Placement

Connecting ECG Cables

Selecting the Primary and Secondary ECG Leads

Checking Paced Status

Understanding the ECG Display

Monitoring Paced Patients

Setting the Paced Status (Pace Pulse Rejection)

Avoiding Pace Pulse Repolarization Tails

Changing the Size of the ECG Wave

To Change the Size of an Individual ECG Wave

To Change the Size of all the ECG Waves

Changing the Volume of the QRS Tone

Changing the ECG Filter Settings

Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)

Choosing EASI or Standard Lead Placement

About ECG Leads

ECG Leads Monitored

45

51

75

75

75

73

74

74

76

76

76

76

77

77

82

83

83

81

81

82

82

79

79

80

80

83

83

84

84

84

85

43

43

44

44

44

42

42

42

43

79

45

73

iii

Changing Lead Sets

ECG Lead Fallback

ECG Lead Placements

Standard 3-Lead Placement

Standard 5-Lead Placement

6-Lead Placement

Chest Electrode Placement

10-Lead Placement

Conventional 12-Lead ECG

Choosing Standard or Modified Electrode Placement

Capture 12-Lead

EASI ECG Lead Placement

ECG and Arrhythmia Alarm Overview

Using ECG Alarms

Extreme Alarm Limits

ECG Alarms Off Disabled

HR Alarms When Arrhythmia Analysis is Switched Off

Enhanced Asystole Detection

ECG Safety Information

About Arrhythmia Monitoring

Arrhythmia Options

Where Can I Find More Information?

Switching Arrhythmia Analysis On and Off

Choosing an ECG Lead for Arrhythmia Monitoring

Aberrantly-Conducted Beats

Atrial Fibrillation and Flutter

Intermittent Bundle Branch Block

Understanding the Arrhythmia Display

Viewing Arrhythmia Waves

Arrhythmia Beat Labels

Arrhythmia Status Messages

Arrhythmia Relearning

Initiating Arrhythmia Relearning Manually

Automatic Arrhythmia Relearn

Arrhythmia Alarms

Yellow Arrhythmia Alarms

Arrhythmia Alarms and Latching

Switching Individual Arrhythmia Alarms On and Off

Switching All Yellow Arrhythmia Alarms On or Off

Adjusting the Arrhythmia Alarm Limits

Arrhythmia Alarm Timeout Periods

How are Yellow Arrhythmia Alarms Indicated?

Understanding PVC-Related Alarms

About ST Monitoring

Switching ST On and Off

Selecting Leads for ST Analysis

iv

92

92

92

92

93

94

94

94

95

95

95

95

96

88

88

89

86

86

87

87

89

90

91

92

85

85

85

98

98

99

96

96

96

97

100

100

100

101

103

99

100

100

100

104

104

104

Understanding the ST Display and Windows

Updating ST Baseline Snippets

About the ST Measurement Points

Adjusting ST Measurement Points

ST Alarms

Single- or Multi-lead ST Alarming

Changing ST Alarm Limits

Viewing ST Maps

Current View

Trend View

Viewing an ST Map

Working in the ST Map Task Window

About QT/QTc Interval Monitoring

QT Measurement Algorithm

Indications For Use Of QT Interval Monitoring

Limitations For Use Of QT Interval Monitoring

Selecting The QT Leads

QT Alarms

Switching Individual QTc Alarms On and Off

Changing QTc Alarm Limits

Setting The QT Baseline

Switching QT Monitoring On and Off

7 Monitoring Pulse Rate

Entering the Setup Pulse Menu

System Pulse Source

Switching Pulse On and Off

Using Pulse Alarms

Selecting the Active Alarm Source: ECG or Pulse?

Alarm Source Selection Disabled

Changing HR/Pulse Alarm Limits

Extreme Alarm Limits

QRS Tone

8 Monitoring Respiration Rate (Resp)

Lead Placement for Monitoring Resp

Optimizing Lead Placement for Resp

Cardiac Overlay

Lateral Chest Expansion

Abdominal Breathing

Understanding the Resp Display

Changing Resp Detection Modes

Auto Detection Mode

Manual Detection Mode

Resp Detection Modes and Cardiac Overlay

Changing the Size of the Respiration Wave

121

121

121

122

122

122

122

122

123

123

123

119

119

119

119

117

117

118

118

118

109

109

109

109

111

112

112

105

106

106

107

109

114

114

115

115

115

116

116

116

116

116

117

121

v

Changing the Speed of the Respiration Wave

Using Resp Alarms

Changing the Apnea Alarm Delay

Resp Safety Information

9 Monitoring SpO

2

SpO

2

Sensors

Applying the Sensor

Connecting SpO

2

Cables

Measuring SpO

2

Assessing a Suspicious SpO

2

Understanding SpO

2

Alarms

Reading

Alarm Delays

Adjusting the Alarm Limits

Adjusting the Desat Limit Alarm

Pleth Wave

Perfusion Numeric

Perfusion Change indicator

Setting SpO

2

/Pleth as Pulse Source

Setting Up Tone Modulation

Setting the QRS Volume

10 Monitoring NBP

Introducing the Oscillometric NBP Measurement

Measurement Limitations

Measurement Methods

Reference Method

Preparing to Measure NBP

Correcting the Measurement if Limb is not at Heart Level

Understanding the NBP Numerics

Starting and Stopping Measurements

Enabling Automatic Mode and Setting Repetition Time

Enabling Sequence Mode and Setting Up The Sequence

Choosing the NBP Alarm Source

Switching Pulse from NBP On/Off

Assisting Venous Puncture

Calibrating NBP

11 Monitoring Temperature

Making a Temp Measurement

Selecting a Temperature for Monitoring

Extended Temperature Label Set

Calculating Temp Difference

12 Monitoring Invasive Pressure

Setting up the Pressure Measurement

vi

139

140

140

140

134

135

135

136

136

136

136

137

137

138

133

134

134

134

141

130

130

130

131

131

131

131

132

132

127

127

128

128

129

130

124

124

124

124

127

133

139

141

Selecting a Pressure for Monitoring

Extended Pressure Label Set

Zeroing the Pressure Transducer

Zeroing ICP (or IC1/IC2)

Determining a Pressure’s Most Recent Zero

Zeroing a Pressure Measurement

Zeroing All Pressures Simultaneously

Troubleshooting the Zero

Adjusting the Calibration Factor

Displaying a Mean Pressure Value Only

Changing the Pressure Wave Scale

Optimizing the Waveform

Non-Physiological Artifact Suppression

Choosing the Pressure Alarm Source

Extreme Alarm Limits

Calibrating Reusable Transducer CPJ840J6

Making the Pressure Calibration

Troubleshooting the Pressure Calibration

Calculating Cerebral Perfusion

13 Monitoring Carbon Dioxide

Measuring CO

2

using the CO

2

Option or M3014A

Preparing to Measure Mainstream CO

2

Preparing to Measure Sidestream CO

2

Measuring Mainstream CO

2

using M3016A

Preparing to Measure Mainstream CO

2

Checking Transducer Accuracy

Calibrating the Transducer

Attaching and Removing the CO

2

Transducer

Measuring Microstream CO

2

using M3015A

Preparing to Measure Microstream CO

2

Using Microstream Accessories

Using the FilterLine and Airway Adapter

Removing Exhaust Gases from the System

Suppressing Zero Calibration

Setting up Mainstream and Sidestream CO

2

Adjusting the CO

2

Wave Scale

Setting up CO

2

Corrections

Suppressing Sampling (not Mainstream CO

2

)

Changing CO

2

Alarms

Changing the Apnea Alarm Delay

Deriving Alarms From awRR

Changing awRR Alarm Limits

14 Trends

Viewing Trends

150

150

151

153

153

153

154

154

155

155

155

156

156

156

158

158

158

158

156

156

157

157

142

142

143

144

145

145

145

145

145

143

143

143

144

144

146

147

147

148

148

159

149

159

vii

Trends Pop-Up Keys

Viewing Graphic Trends

Viewing Vital Signs Trends

Setting Up Trends

Making Segment Settings

Trend Groups

Trend Interval

Trend Priority

Trend Parameter Scales

Graphical Trend Presentation

Documenting Trends

Trends Databases

Aperiodic Trends Database

Trending Multiple-Value Measurements

Screen Trends

Setting the Screen Trend Time

Changing the Selection of Screen Trends Displayed

Activating the Cursor for Screen Trends

Changing the Screen Trend View

15 Recording

Starting and Stopping Recordings

Recording Without a Template

Overview of Recording Types

Creating and Changing Recordings Templates

Maintaining Recording Strips

Recorder Status Messages

16 Printing Patient Reports

Starting Report Printouts

Stopping Reports Printouts

Setting Up Reports

Setting Up ECG Reports

Setting Up Vital Signs and Graphic Trend Reports

Setting Up Auto Reports

Setting Up Individual Print Jobs

Checking Printer Settings

Printing a Test Report

Switching Printers On Or Off for Reports

Dashed Lines on Reports

Unavailable Printer: Re-routing Reports

Checking Report Status

Printer Status Messages

Sample Report Printouts

Alarm Limits Report

Realtime Report

viii

171

171

172

172

173

173

179

179

179

180

181

177

178

178

178

175

176

176

176

176

177

182

182

164

164

165

165

165

167

167

167

167

159

160

161

161

161

162

163

163

163

163

171

175

ECG Reports

Other Reports

17 Care and Cleaning

General Points

Cleaning the Monitor

Disinfecting the Monitor

Sterilizing the Monitor

Cleaning, Sterilizing and Disinfecting Monitoring Accessories

18 Using Batteries

Battery Power Indicators

Battery LED

Battery Status on the Main Screen

Battery Status Window

Checking Battery Charge

Replacing a Battery

Optimizing Battery Performance

Display Brightness Setting

Charging a Battery

Conditioning a Battery

Storing a Battery

Battery Safety Information

19 Maintenance and Troubleshooting

Inspecting the Equipment and Accessories

Inspecting the Cables and Cords

Maintenance Task and Test Schedule

Troubleshooting

Disposing of the Monitor

Disposing of Empty Calibration Gas Cylinders

20 Accessories

ECG/Resp Accessories

Recommended Cables

Supported Cables

NBP Accessories

Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs

Reusable Cuff Kits

Adult/Pediatric Antimicrobial Coated Reusable cuffs

Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs

Neonatal/Infant Cuffs (Disposable, non-sterile)

Invasive Pressure Accessories

SpO

2

Accessories

Temperature Accessories

Mainstream CO

2

Accessories

192

193

193

194

194

194

194

195

190

190

190

191

197

197

198

199

199

199

201

201

203

205

205

205

205

206

206

206

206

210

211

183

183

185

186

186

186

187

185

189

197

201

ix

x

Sidestream CO

2

Accessories

Mainstream CO

2

Accessories (for M3016A)

Microstream CO

2

Battery Accessories

Accessories

21 Specifications

Intended Use

Indication for Use

Manufacturer’s Information

Trademark Acknowledgement

Symbols

Installation Safety Information

Connectors

Altitude Setting

Monitor Safety Specifications

EMC And Radio Regulatory Compliance

Out-Of-Hospital Transport - Standards Compliance

Physical Specifications

Environmental Specifications

Monitor Performance Specifications

M4607A Battery Specifications

Measurement Specifications

ECG/Arrhythmia/ST/QT

Respiration

SpO

2

NBP

Invasive Pressure and Pulse

Temp

CO

2

Safety and Performance Tests

Electromagnetic Compatibility (EMC) Specifications

Electromagnetic Emissions

Electromagnetic Immunity

Recommended Separation Distance

Recommended separation distances from portable and mobile RF communication equipment

22 Default Settings Appendix

Country-Specific Default Settings

Alarm and Measurement Default Settings

Alarm Default Settings

ECG, Arrhythmia, ST and QT Default Settings

Pulse Default Settings

Respiration Default Settings

SpO

2

Default Settings

NBP Default Settings

225

227

228

229

231

232

232

236

236

236

237

237

218

218

218

219

220

220

221

223

225

215

215

215

216

216

217

217

238

251

251

252

253

241

247

247

248

211

212

212

213

215

241

Temperature Default Settings

Invasive Pressure Default Settings

CO

2

Default Settings

253

253

256

xi

xii

1

1

Installation

Installation should be carried out by qualified service personnel, either by the hospital’s biomedical department, or by Philips Support.

If you have purchased a “customer-installable bundle”, it is assumed that your own hospital personnel will install and, if necessary, configure the monitor. You can contact Philips Support for assistance if required; any assistance will be associated with additional costs.

For mechanical and electrical installation, you need technically qualified personnel with a knowledge of english. Additionally, for monitor configuration, you need clinically qualified personnel with a knowledge of the use environment. For further information on Installation, refer to the Service Guide.

WARNING

• Monitor configuration settings must be specified by authorized hospital personnel.

• For installation of the device as part of a system, always refer to the Service Guide.

• As the first step in preparing the monitor for use, follow the installation instructions given in this chapter.

Installation Checklist

Use this checklist to document your installation.

Step

1

2

3

4

5

Task

Perform initial inspection of delivery, unpack and check the shipment

(see “Unpacking and Checking the Shipment” on page 2).

Mount the monitor as appropriate for your installation

(see “Mounting the Monitor” on page 3).

Insert the battery into the battery compartment (the battery must always be in the battery compartment during use). Connect the monitor to AC mains

via the external power supply using the supplied power cord (see “Connecting the Monitor to AC Mains” on page 3).

Perform Visual, Power On and Functional test blocks (see “Checking Out the

Monitor” on page 5).

Perform Safety Tests, if required by local laws and regulations (see “Checking

Out the Monitor” on page 5).

Check Box when Task

Done

1

2

1 Installation

Unpacking and Checking the Shipment

Step

6

7

8

Task

Check/set the time and date (see “Setting the Date and Time” on page 7).

Check that the country-specific default settings are appropriate (see

“Checking Country-Specific Default Settings” on page 7)

Perform System Test as necessary (see the Service Guide)

Check Box when Task

Done

Unpacking and Checking the Shipment

The monitor and any supporting options ordered are supplied packed in protective shipping cartons.

Initial Inspection

Before unpacking, check the packaging and ensure that there are no signs of mishandling or damage.

Open the package carefully and remove the monitor and accessories.

Check that the contents are complete and that the correct options and accessories have been delivered.

System Components, Accessories and Supplies

Monitor with options as ordered

ECG accessories

NBP accessories

SpO

2

accessories

Pressure accessories

Temperature accessories

CO

2

Accessories

External Power Supply including AC power cord and MSL cable

Rechargeable battery

Instructions for Use

Quick Guide

Documentation CD-ROM (includes Service Guide and Instructions for Use)

Comments

1 optional optional optional optional optional optional

1

1

1

1

1

Claims for Damage

If the shipping cartons are damaged, contact the carrier.

If any of the equipment is damaged, contact both the carrier and your local Philips service organization for repair or replacement arrangements.

Repacking

Retain the original packing carton and material, in case you need to return equipment to Philips for service. If you no longer have the original packing materials, Philips can advise you on alternatives.

Mounting the Monitor

1 Installation

Mounting the Monitor

The monitor can be rested on a flat, level surface, hung on the bed rail, or mounted on a wall or on a rollstand. See the Service Guide for details.

Mounting the External Power Supply (M8023A)

The external power supply (M8023A) can be rested on its rubber feet on a flat, level surface, or mounted as described in the Service Guide.

The following pictures show examples of correct ( power supply.

) and incorrect ( ) ways to mount the

Connecting the Monitor to AC Mains

The monitor is an electrical Class II device in which the protection against electric shock does not rely on basic insulation and a protective earth conductor but on double and/or reinforced insulation.

3

1 Installation

Connecting the Monitor to AC Mains

The monitor has a wide-range external power supply (M8023A) that allows you to operate the monitor from an AC (alternating current) power source of 100 V to 240 V (± 10%) and 50/60 Hz (± 5%). The external power supply also charges the monitor’s battery.

MSL Cable connects to power supply (M8023A)

1

2

4

3

4

1

2

3

4

AC power cord. Connect to AC mains socket.

Connect LAN cable here. For connection to a PC or Information Center.

Measurement Link (MSL) cable. Supplies AC input power to the monitor for AC operation and for battery charging. When there is a LAN connection to a PC or Information Center, the MSL cable also carries this data to and from the monitor.

Power-on LED. The green light is on when the external power supply is connected to AC mains.

WARNING

• Always use the supplied power cord with the earthed mains plug to connect the external power supply (M8023A) to an earthed AC mains socket. Never adapt the mains plug from the power supply to fit an unearthed AC mains socket.

Checking Out the Monitor

1 Installation

• Do not use AC mains extension cords or multiple portable socket-outlets. If a multiple portable socket-outlet without an approved isolation transformer is used, the interruption of its protective earthing may result in enclosure leakage currents equal to the sum of the individual earth leakage currents, so exceeding allowable limits.

• Do not connect any devices that are not supported as part of a system.

• Any non-medical device placed and operated in the patient’s vicinity must be powered via an approved isolation transformer that ensures mechanical fixing of the power cords and covering of any unused power outlets.

Checking Out the Monitor

The following table defines which tests and inspections need to be performed, and when they are required.

Visual

Power On

System

Test

Functionality Test

Safety Tests (1) to (4)

Test or Inspection to be Performed

Inspect the monitor, measurement accessories and cables for any damage.

Are they free of damage?

Power on the monitor. Does it start up successfully without errors? Do all alarm lamps light up during power up?

After start up, the monitor sounds a tone, and you can see the monitoring main screen (normally with measurement wave channels and numeric positions).

After power up, touch the battery status indicator in the bottom right of the screen. The battery status window should open. Press the blue Main Screen key to close the window and return to the main screen.

Perform safety tests (1) to (4), as described in the Service Guide, for standalone devices if required by local laws and regulations, and each time you combine equipment to form a system, or exchange system components. Details of the safety tests and procedures are described in the Service Guide. These safety tests are derived from international standards but may not always be sufficient to meet local requirements.

Perform the system test according to IEC 60601-1-1, if applicable, after combining equipment to form a system (see the Service Guide).

For test and inspection information regarding repairs, upgrades and all other service events, refer to the

Service Guide.

5

1 Installation

Operating the Monitor

Operating the Monitor

To complete installation you will need to operate the monitor to check basic functionality. Here is a quick introduction to the monitor.

1

Switch on the monitor. After start-up the monitor display will become active. You operate the monitor using the touch screen.

2

Touch something on the screen (numerics, waves, other screen items) to enter the corresponding menu. Touching the NBP numeric, for example, brings you to the

Setup NBP menu.

3

Touch again to select an item on the menu and work through the menu activities.

4

To access SmartKeys, press the SmartKeys key. Main Setup is one of the

SmartKeys.

6

5

If you cannot find a menu by touching the screen you can always use the Main Setup SmartKey which will get you to all menus on the monitor.

6

Press the Main Screen key to close all open menus/windows and return to the main screen. Press again to enter the Change

Screen

window, where you can choose from a number of pre-configured screens.

Setting the Date and Time

1 Installation

Setting the Date and Time

To set the date and time:

1

Press the SmartKeys key

to enter the SmartKeys window.

2

3

4

Select the Main Setup SmartKey to enter the Main Setup menu.

Select the Date, Time screen element from the monitor’s info line to enter the Date, Time menu.

Select, in turn, the

Year, Month, Day, Hour

(in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list.

5

Select Store Date, Time to change the date and time.

If your monitor is connected to an Information Center, the date and time are automatically taken from this.

Once it is set, the internal clock retains the setting even when you switch off the monitor.

Checking Country-Specific Default Settings

Some settings are made in the factory to match the typical requirements in a specific country. Line frequency, units for weight and height, and ECG cable colors (AAMI or IEC) have been set to appropriate values. If you suspect that these settings may not match your institution’s requirements, check the settings and change them if necessary as described in the Configuration Guide.

WARNING

Before starting monitoring, check that the current configuration meets your requirements, especially patient category, alarm limits and paced setting.

1

2

If you need to enter configuration mode:

In the Main Setup menu, select Operating Modes.

Select Config and enter the passcode.

The passcode for configuration mode is given in the monitor’s service documentation.

The monitor displays Config at the right hand side of the status line and in the center of the Screen while you are in configuration mode.

Before you leave configuration mode, always be sure to store any changes you made. You must store changes made to each Settings Block and to each Profile, individually. As it may be difficult to remember whether the settings you changed belong to a Monitor Settings block or a Measurement

Settings block, we recommend that you store each block before you leave configuration mode.

To leave configuration mode:

In the Main Setup menu, select Operating Modes and then select Monitoring.

Handing Over the Monitor

If you are handing over the monitor to the end-users directly after configuration, make sure that it is in

Monitoring mode.

7

8

1 Installation

Handing Over the Monitor

Users must be adequately trained to use the monitor before monitoring a patient. To achieve this, they should have access to, and read, the following documentation delivered with the monitor:

• Instructions for Use (this book) - for full operating instructions

• Quick Guide - for quick reminders during use

Additionally, we recommend working through the Training Guide for self-training on the monitor before use (not available in all languages).

2

2

Basic Operation

These Instructions for Use are for clinical professionals using the IntelliVue MP2 (M8102A) patient monitor.

This basic operation section gives you an overview of the device and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment.

Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients. Read and keep the Instructions for Use that come with any accessories, as these contain important information about care and cleaning that is not repeated here.

This guide describes all features and options. Your monitor may not have all of them; they are not all available in all geographies. Your monitor is highly configurable. What you see on the screen, how the menus appear and so forth, depends on the way it has been tailored for your hospital and may not be exactly as shown here.

In this guide:

• A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient.

• A caution alerts you to where special care is necessary for the safe and effective use of the product.

Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.

Monitor refers to the entire patient monitor. Display refers to the physical display unit. Display

Screen and Screen refer to everything you see on monitor’s display, such as measurements, alarms, patient data and so forth.

9

2 Basic Operation

Introducing the IntelliVue MP2

Introducing the IntelliVue MP2

The Philips IntelliVue MP2 monitor provides a comprehensive set of basic physiological measurements: ECG (including ST analysis and optional 10-lead ECG), NBP, SpO

2 invasive blood pressure, temperature and CO

, and optionally

2

. Through networking it provides information integration, documentation and information access. The MP2 can be used with adult, pediatric and neonatal patients in a hospital environment and during patient transport both inside and outside hospitals.

The monitor stores data in trend databases. You can see tabular trends (vital signs) and document them on a central printer. You can view measurement trend graphs, including horizon trends, to help you identify changes in the patient’s physiological condition.

The monitor can be powered by a rechargeable battery, or from AC mains using the external power

supply (M8023A). For battery charging, care and status information, refer to the chapter “Using

Batteries” on page 189.

Controls, Indicators and Connectors

MP2 Overview

3

4

2

1

4

5

6

7

8

3

4

1

2

5

6

7

8

6

5

9

9

On/Standby Switch

Power and battery indicators (see “MP2

Controls and Indicators” on page 11)

3.5-inch TFT LCD touchscreen QVGA display

Alarm lamps (see “MP2 Controls and

Indicators” on page 11)

Built-in carrying handle

Battery eject button

Keys (see “MP2 Controls and Indicators” on page 11)

Measurement connectors (see “MP2

Patient Connectors, Right Side” on page 12)

Battery

10

5

4

3

2

Controls, Indicators and Connectors

6

MP2 Controls and Indicators

7

2 Basic Operation

8

9

10

11

1

1

On/Standby switch

2

On/Standby LED. Green when monitor is on. Red indicates an error.

3

Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected.

4

External power LED. Green when monitor is powered from an external power source.

5

Alarms off indicator. When alarms are suspended, the lamp is red, and the

ALARMS OFF message appears on the screen.

6

Active INOP alarm lamp in light blue.

Stays lit until active INOP is acknowledged.

7

Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is acknowledged.

8

Silence key

9

Alarms key: turns alarms On/Off, or pauses them

10 SmartKeys key: brings up SmartKeys on the screen

11 Main Screen key: closes all open menus/windows and returns to the main screen, or selects current screen.

11

2 Basic Operation

Controls, Indicators and Connectors

6

MP2 Patient Connectors, Right Side

4

5

1

3

Symbols (International)

2

3

1

4

7

2

Text (English versions only)

1

2

3

4

5

6

7

1

2

3

4

5

6

5

6

Pressure (option)

Temperature (option)

Noninvasive blood pressure

SpO

2

ECG sync pulse output

(See page 222 for specifications)

ECG/Respiration

CO

2

(option)

MP2 Left Side

1

2

Loudspeaker

MSL Connector. Connects to the external power supply via the MSL cable for AC mains operation, battery charging, and communication with a network.

1

2

12

Extending Measurements

2 Basic Operation

Extending Measurements

Your monitor is compatible with Philips measurement extensions for use with other IntelliVue patient monitoring devices. These allow you to add specific measurements to those already integrated into your monitor. These measurement extensions are referred to as MMS extensions.

MMS Extension

M3014A attached to the MP2

The MMS extensions connect to the monitor and use the monitor’s settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the monitor.

WARNING

• Measurements from a MMS extension are only available when the extension is connected to the monitor, and the monitor is running on AC mains via the external power supply (M8023A).

Measurements from a MMS extension connected to the monitor are not available when the monitor is running on battery power.

• Any measurements on a MMS extension that conflict with those in the monitor cannot be used. For example, only one CO

2

measurement is supported.

To separate an extension from the monitor, press the release lever and push the extension forward.

13

2 Basic Operation

Extending Measurements

M3014A, M3015A and M3016A Measurement Extensions

The optional M3014A Capnography extension adds mainstream capnography, and optionally one pressure plus either a pressure or a temperature to the monitor. Cardiac Output and Continuous

Cardiac Output are not available when used with the MP2.

The optional M3015A Microstream CO

2

extension adds microstream capnography and optionally either pressure or temperature to the monitor. The optional M3016A Mainstream CO

2 mainstream capnography and optionally either pressure or temperature to the monitor.

extension adds

Only one CO

2

measurement at a time is supported.

M3015A Microstream

M3014A Capnography

1

1

4

3

M3016A Mainstream

2

1

7

6

1

2

3

4

3

Pressure connectors (red)

Temperature connector (brown)

Mainstream/sidestream connector CO

2

(optional)

Cardiac Output connector

2

5

6

7

Inlet

Microstream connector CO

2

Gas sample outlet

5

2

14

Extending Measurements

M3012A Hemodynamic MMS Extension

MSL Connector to MP2

2 Basic Operation

Pressure connectors

(red)

Cardiac Output (orange; optional)

Temperature connectors (brown)

When attached to the MP2 connected to the external power supply, the optional M3012A

Hemodynamic extension adds temperature, pressure, and an additional pressure or a temperature to the monitor.

Cardiac Output and Continuous Cardiac Output are not available when used with the MP2.

15

2 Basic Operation

Operating and Navigating

Operating and Navigating

The principle method of operating your monitor is via the touchscreen. Almost every element on the screen is interactive. Screen elements include measurement numerics, information fields, alarms fields, waveforms and menus.

There are also four keys to the right of the screen (see also “MP2 Controls and Indicators” on page 11).

These let you:

• Silence alarms: the Silence key acknowledges all active alarms by switching off audible alarm indicators and lamps.

• Switch alarms on or off, or pause alarms.

Key with symbol

(international)

Text replaces symbol (English versions only)

• Call up SmartKeys on the screen (see below).

• Close all open menus/windows and return to the main screen.

• If you are already in the main screen (no additional menus/ windows are open), then pressing this key opens the

Change Screen

window, where you can choose from a number of pre-configured screens.

• To temporarily disable the touchscreen operation, press and hold this key for 2 seconds. Press the key again to re-enable the touchscreen operation.

16

Operating and Navigating

A typical main screen looks like this:

HR

Bed9

3

Adult Doe, John

SpO

2

2

5

6

7

4

Sinus Rhythm

M

8

1mV

NBP

Sys.

9

All Settings reset to Profile Adult

2 Basic Operation

1

10

4

5

6

MP2 Screen Elements

Item

1

2

3

Description

Alarm volume off indicator

Patient name / alarm message field

Patient category and bed label / INOP message field

Network connection indicator

Measurement label

Paced status

Comments

is displayed when the alarm volume is set to zero (0).

Patient name can be covered by alarm messages or alarms On/Off/Paused message.

HR

Bed4 Adult

ST-I

ST-V6

SpO2 LOW

SpO

2

If red and yellow alarms are active at the same time, they rotate in the alarm field.

HR

Bed4 Adult

ST-I

ST-V6

APNEA

SpO

2

Patient category and bed label can be covered by INOP messages. If there are multiple red/ yellow/cyan INOPs active at the same time, they rotate in the INOP field.

HR

ALL ECG ALARMS OFF

ST-I

ST-V6

APNEA

SpO

2

Documented in Information Center

Instructions for Use.

Touch the measurement to enter the measurement setup menu.

Displayed below the HR label.

17

2 Basic Operation

Operating and Navigating

MP2 Screen Elements

Item

7

Description

Measurement numeric/values

8

9

10

Measurement wave

Status line

Battery status indicator

Comments

Touch the numeric to enter the measurement setup menu.

Touch the wave to enter the measurement setup menu.

Shows information and messages prompting you for action.

Gives information about remaining battery charge, estimated operating time, maintenance requirements and malfunctions. See the

chapter “Using Batteries” on page 189.

Using the Touchscreen

Touch a screen element to get to the actions linked to that element. For example, touch a measurement numeric and the setup menu for that measurement opens. Touch a wave to enter the setup menu for that wave.

Measurement Setup Menus

Each measurement has a setup menu where you can perform operations or change settings. Typically, the setup menu window covers the whole screen, with the exception of the INOP and alarm message fields, which are always displayed at the top. The following picture is for illustration purposes, and may not exactly represent what you see on the screen. We are using non invasive blood pressure as an example, but all measurement setup windows are similar and share the same basic layout and components.

Touch the measurement numeric on the screen to enter the setup menu.

HR

Main screen

Bed4

Adult

SpO

2

Doe, John

Pulse 60 Auto 15 min

Measurement setup menu

No Central Monit.

**

Setup NBP

NBPs HIGH

NBP

Pulse 60

Auto 08:28

1

2

3

NBP meas. + autom. cycle started

Alarms :

On

Sys.

Al. from :

Sys

Auto/Man. :

Auto

Repeat:

15 min

Start/

Stop

Stop

All

NBP

STAT

4

5

18

Operating and Navigating

2 Basic Operation

Key to measurement setup menu:

Item Description

1

2

INOP and alarm message field.

Wave/numerics window.

3

4

5

Status/prompt message.

Next page arrows.

Measurement menu buttons.

Comment

These are always displayed at the top of the screen.

The main measurement numeric and wave (if applicable) are shown in this window so that you do not lose sight of the current measurement while making changes in the menu.

Status/prompt messages related to the measurement menu are displayed below the wave/numerics. General status/prompt messages on the main screen are covered by the measurement setup menu.

The menu may have more than one page, as shown here. Move to another page by touching these arrows.

Each button has two lines of text. To perform an operation on a measurement, press one of the buttons. Some buttons lead directly to a task. For example, pressing the Start/Stop button for noninvasive blood pressure starts a measurement. Other buttons open a pop-up window, which can have more than one page, from which you make a selection. Again, using noninvasive blood pressure as an example, pressing the Repet.Time button for setting the repetition time opens a pop-up window from which you pick a time, scrolling if necessary.

Main Setup Menu

There is usually more than one way to enter a setup menu for a measurement, to change a setting or to execute a task. Some routes are more direct than others. You can use whichever method you find most convenient. Which routes are available to you, however, can vary depending on your monitor’s configuration.

For this reason, this book generally describes entry to a measurement’s setup menu via the Main Setup menu, as this route is always available and is not subject to configuration dependencies. You can get to all setup windows from the Main Setup menu. You enter the Main Setup menu by pressing the

SmartKeys key, then selecting the Main Setup Smartkey.

Main Setup

menu

From here you can get to all setup menus

SmartKeys

A SmartKey is a configurable graphical key on the screen allowing fast access to frequently used functions. Press the SmartKeys hard key to call up a set of SmartKeys on the screen. Although the selection of SmartKeys available on your monitor depends on the monitor configuration and on the options purchased, the SmartKeys window generally looks like this:

19

2 Basic Operation

Operating and Navigating

No Central Monit.

SmartKeys

**

NBPs HIGH

Start/

Stop

Alarm

Limits

Alarm

Volume

Measmt.

Select.

Admit/

Discharge

Vitals

Trend

Profiles

QRS

Volume

Monitor

Standby

Main Setup

is one of the SmartKeys.

enter Main Setup menu - you can get to all setup windows using this key enter profile menu, or revert to default profile previous Screen

Touch to view more

SmartKeys enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained.

change Screen, or revert to default screen quick admit a patient enter patient identification menu to admit/discharge/transfer lock touchscreen operation end case to discharge a patient change alarm volume change QRS volume set alarm limits change screen brightness (not for independent displays) change amplitude (size) of ECG wave review beat labels (annotate arrhythmia wave)

- start/stop manual NBP measurement

- start auto series

- stop current automatic measurement within series stop automatic or STAT NBP measurement and measurement series re-learn arrhythmia start NBP STAT measurement start NBP measurement and measurement series

20

Operating and Navigating

2 Basic Operation

start veni puncture (inflate cuff to subdiastolic pressure) set the NBP repeat time stop current NBP measurement access patient reports zero invasive pressure transducer switch CO

2

pump off new lead setup set standard or EASI lead placement review vital signs trend review graph trend unpair equipment and continue central monitoring with the monitor start 12-Lead Capture (only available if Information Center is connected) select measurement device unpair equipment and continue central monitoring with the telemetry device access ST Map application

Pop-Up Keys

Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the confirm pop-up key appears only when you need to confirm a change.

Using the On-Screen Keyboard

Use this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift key to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard.

Bed10 Adult

Last Name

Not Admitted

!

@ #

Q W

E

A S D

$

R

F

% ^

T

Y

G

H

&

U

J

*

I

(

O

K L

)

P

?

Z

X C

Shift Alt

V B

N

M < >

< >

Back

Clr

Enter

21

2 Basic Operation

Operating Modes

Operating Modes

When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:

1

Select the Main Setup menu.

2

Select Operating Modes and choose the mode you require.

Your monitor has four operating modes. Some are passcode protected.

Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them.

These are for your information and can be changed only in Configuration Mode.

Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend information is deleted from the monitor’s memory.

Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks.

These tasks are described in the Configuration Guide. During installation the monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on, the number of waves you see and so forth.

Service Mode: Passcode protected, this is for trained service personnel.

Config

When the monitor is in Demonstration Mode, Configuration Mode, or

Service Mode, this is indicated by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand corner. Select this field to change to a different mode.

Standby Mode

Standby mode can be used when you want to temporarily interrupt monitoring.

To enter Standby mode,

1

2

Press the SmartKeys key

.

Either select the Monitor Standby SmartKey

Or select the Main Setup SmartKey, then select Monitor Standby.

The Standby screen looks like this:

22

Understanding Screens

2 Basic Operation

STANDBY

Press any key or select any field on the screen to resume monitoring

The monitor enters Standby mode automatically after the End Case function is used to discharge a patient. Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed.

If a patient location is entered at the Information Center, this will also be displayed on the Standby screen (availability depends on Information Center revision).

To resume monitoring,

Select anything on the screen or press any key.

Understanding Screens

Your monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios. A Screen defines the overall selection, size and position of waves and numerics on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.

Switching to a Different Screen

To switch to a different Screen:

1

2

After closing any open menus or windows, press the Main Screen key to access the Change

Screens

menu.

Choose the new Screen from the Change Screens menu.

Changing a Screen’s Content

If you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, or trends. Be aware that these changes cannot be stored permanently in

Monitoring Mode.

To change the selection of elements on a Screen,

1

Select the element you want to change. For example, touch the wave menu to enter the wave setup menu, or touch the numeric to enter the numeric setup menu.

2

From the menu that appears, select

Change Wave

or Change Numeric, and then select the wave or numeric you want.

23

2 Basic Operation

Understanding Profiles

In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk.

Up to three modified Screens can be accessed via the Change Screen menu.

To recall Screens, select the name of the

Screen in the Change Screen menu

After a patient discharge, the monitor’s default Screen is shown. Modified Screens are still available in the

Change Screen

menu.

Change Screen

1 Wave B

1 Big Wave

Vital Signs B

2 Waves A

2 Waves B

If the monitor is switched off and then on again, modified Screens are erased from the monitor’s memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained (unless Automat. Default is set to Yes in Configuration Mode).

Using the Visitor Screen

If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and

Information Center. You can change the name of the visitor Screen in Configuration Mode.

To activate this Screen,

1

Press the Main Screen key to open the Change Screen menu.

2

Select the name of the visitor Screen configured for your monitor from the list of available Screens.

To select a Screen with waves and numerics again,

Touch the gray rectangle in the center of the screen showing the visitor Screen’s name, or press the

Main Screen

key, to open the Change Screen menu and then select a Screen from the list.

Understanding Profiles

Profiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings.

The settings that are defined by Profiles are grouped into three categories. Each category offers a choice of ‘settings blocks’ customized for specific monitoring situations. These categories are:

• Display (screens)

– Each profile can have a choice of many different predefined screens. When you change the profile, the screen selection configured for the new profile becomes active.

• Measurement Settings

– Each profile can have a choice of different predefined measurement settings. These relate directly to individual measurements, for example, measurement on/off, measurement color, alarms limits,

NBP alarm source, NBP repeat time, temperature unit ( o

F or o

C) pressure unit (mmHg or kPa).

24

Understanding Profiles

2 Basic Operation

• Monitor Settings

– Each profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.

PAP ZERO+CHECK CAL

Doe, John

PAP ZERO+CHECK CAL

Profiles

Doe, John

Profile : Profile Adult

Patient Category

Paced

: Adult

: No

Profile

Patient

Measmnt. Adult

Measmnt. Pedi

Please Confirm

To activate the highlighted settings block select confirm

Measmnt.Settings

: Measmt. Adult

Profiles Menu, showing current settings

Please Confirm Confirm Cancel

Available choices in measurement menu. Confirm your choice when prompted.

You can change from one complete profile to another or swap individual settings blocks (display screen/monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode.

Depending on your monitor configuration, when you switch on or discharge a patient the monitor either continues with the previous profile, or resets to the default profile configured for that monitor.

WARNING

If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be setup to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles.

When you leave Demonstration Mode, the monitor uses the default profile.

Swapping a Complete Profile

1

Press the SmartKeys key and

Either select Main Setup and then Profiles in the Setup menu.

Or select the Profiles SmartKey .

2

3

4

In the Profiles menu, select Profile.

Chose a profile from the pop-up list.

Confirm your selection.

25

2 Basic Operation

Understanding Settings

Swapping a Settings Block

3

4

1

2

Select the Main Setup SmartKey and then Profiles in the Main Setup menu, or select the Profiles SmartKey.

In the Profiles menu, select Display or

Measmnt. Settings

or

Monitor Settings

to call up a list of the settings blocks in each category.

Choose a settings block from the pop-up list.

Confirm your selection.

Default Profile

Your monitor has a default profile that it uses when you leave Demonstration, or Service modes, or when you discharge a patient. This profile is indicated by a diamond .

Locked Profiles

Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol.

Understanding Settings

Each aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including,

Screen Settings, to define the selection and appearance of elements on each individual Screen

Measurement settings, to define settings unique to each measurement, for example, high and low alarm limits

Monitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness.

You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitor’s Configuration Mode. All settings are reset to the stored defaults:

• when you discharge a patient

• when you load a Profile

• when the monitor is switched off for more than one minute (if Automat. Default is set to

Yes

).

Changing Measurement Settings

Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:

• via the measurement numeric - select the measurement numeric to enter its setup menu. For example, to enter the Setup ECG menu, select the HR (heart rate) numeric.

26

Switching a Measurement On and Off

2 Basic Operation

• via the Main Setup SmartKey - if you want to setup a measurement when the measurement is switched off, use the Main Setup SmartKey and select Measurements. Then select the measurement name from the popup list. With this permanent key you can access any setup menu in the monitor.

• via the Measurement Selection key.

Switching a Measurement On and Off

When a measurement is off, its waves and numerics are removed from the monitor’s screen. The monitor stops data acquisition and alarming for this measurement.

1

Enter the measurement’s setup menu and select the measurement.

2

Select the measurement name to toggle between on and off. The screen display indicates the active setting.

Adjusting a Measurement Wave

To quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement Wave menu, which has only wave-related measurement settings.

Changing Wave Speeds

Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.

The monitor distinguishes two groups of wave speed settings,

RespiratorySpeed, for CO

2

waves.

Global Speed, for all waves not included in the other group.

Changing the Wave Group Speed

The wave speed group setting defines the speed of all the waves in the group.

To change the wave speed of a wave speed group,

1

Select Main Setup -> User Interface

2

Select Global Speed or RespiratorySpeed, as required

3

Select a value from the list of available speeds.

Changing Wave Speed for a Channel

To change the wave speed of an individual wave channel,

1

2

Enter the

Wave

menu for a measurement by selecting its wave.

Select Change

Speed

.

3

To set the speed to the wave group speed, select RespiratorySpeed or Global Speed.

To set an individual channel speed, select a numeric value from the list of available speeds. This overrides the wave group speed setting and sets the speed for the individual wave channel on the

27

2 Basic Operation

Using Labels monitor Screen. The wave channel speed is independent of the wave (label) depicted in the channel, if you change the wave, the new wave will retain the set channel speed.

Using Labels

You can measure up to three invasive pressures and temperatures simultaneously. The monitor uses labels to distinguish between them. The default settings defined in the profile (such as measurement color, wave scale, and alarm settings) are stored within each label. When you assign a label to a measurement, the monitor automatically applies these default settings to the measurement. The labels assigned are used throughout the monitor, in reports, recordings, and in trends.

Changing Measurement Labels (e.g. Pressure)

To change a measurement label of a measurement with multiple labels (invasive pressure or temperature),

1

Enter the Wave menu of the measurement.

2

3

Select Label.

Choose a label from the list.

The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you select. You can change scale settings in Monitoring Mode, but color can only be changed in the monitor’s Configuration Mode.

Any labels already being used in the monitor are shown “grayed-out” in the list and cannot be selected.

Resolving Label Conflicts

Each label must be unique, that is, it can only be assigned once. If you have a MMS Extension equipped with a pressure measurement connected to the monitor, there is a potential conflict with, for example, the ABP label. If you manually enter measurement values these may also conflict with existing labels on the monitor.

Depending on your configuration, the monitor will either

• display the Measurement Selection window automatically for you to resolve the conflict

• take no action, you must enter the Measurement

Selection

window and resolve the conflict

measurement selection key

All the currently available measurements are depicted in the

Measurement Selection

window. Any measurement labels causing a label conflict are shown in red. If a measurement is connected but currently unavailable, for example, because it was deactivated due to a label conflict, that measurement is shown “grayed-out”. If a MMS Extension is not available, for example if monitor is running on battery power and not an external power source, the MMS Extension is not displayed.

28

Changing Monitor Settings

2 Basic Operation

PAP ZERO+CHECK CAL

*** APNEA

Measurement Selection

ABP

Tcore

Temp

NBP PAP

Unavailable measurements are grayed-out

SpO

2

ECG

Resp

CO

2

CPP

Temp

Change

Label

De-

Activate

Setup

SpO

2

More

A MMS Extension is only shown in the Measurement Selection window when the monitor is connected to the external power supply (M8023A) and running on AC mains power, and not when running on battery power.

To resolve a label conflict:

1

Press the SmartKeys key and

Either select Main Setup and then Meas. Selection

Or select the Meas. Select. SmartKey to display the Measurement Selection window.

2

Select the label to be corrected.

3

Use the measurement selection keys to resolve the conflict. Select either:

Change Label: to assign a different label to the conflicting label.

De-activate: to disable the conflicting measurement. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged.

Setup <Measurement label>: to enter the Setup menu for the measurement and change the conflicting device’s label to a different label.

4

Select the De-activate pop-up key to disable the conflicting measurement.

Changing Monitor Settings

To change monitor settings such as brightness, or QRS tone volume:

1

2

Press the SmartKeys key .

Either Enter the Main Setup menu by selecting the SmartKey . Select the setting you want to change, or select User Interface to enter a submenu where you can change user interface settings.

Or Select the appropriate SmartKey for the setting you want to change.

29

2 Basic Operation

Checking Your Monitor Revision

Adjusting the Screen Brightness

1

2

Select the

Brightness

SmartKey.

Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most situations.

Your monitor may be configured with a lower brightness for Standby mode and also for transport to conserve battery power. These settings can only be changed in the monitor’s Configuration Mode.

Adjusting Touch Tone Volume

The touch tone volume is the tone you hear when you select any field on the monitor screen. To adjust the touch tone volume,

1

In the Main Setup menu, select User Interface

2

Select TouchToneVolume, then select the appropriate setting for the touch tone volume: 10 is the loudest and 1 is the quietest. Selecting zero switches the touch tone volume off.

Setting the Date and Time

If your monitor is connected to an Information Center, the date and time are automatically taken from this.

Once it is set, the internal clock retains the setting even when you switch off the monitor.

1

In the Main Setup menu, select Date, Time.

2

3

Select, in turn, the

Year, Month, Day, Hour

(in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list.

Select Store Date, Time to change the date and time.

Checking Your Monitor Revision

1

2

3

Select Main Setup -> Revision to open the Monitor Revision menu.

Select the correct device from the device pop-up keys.

From the Monitor Revision menu, select the monitor component for which you need revision information.

Getting Started

Once you understand the basic operation principles, you can get ready for monitoring.

Inspecting the Monitor

WARNING

If the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel.

1

Before you start to make measurements, carry out the following checks on the monitor.

– Check for any mechanical damage.

30

Getting Started

2 Basic Operation

2

– Check all the external cables, plug-ins and accessories.

Always ensure that the battery is loaded in the battery compartment when monitoring a patient, even when the monitor is running on external power.

3

If you are using battery power, ensure that the battery has sufficient power for monitoring. Before using a battery for the first time, you must charge it, following the instructions given in the section on Charging Batteries.

4

5

Measurements from measurement extensions attached to the monitor are only available when the monitor is operating from AC mains power. The measurement extensions are not active when the monitor is operating from battery power.

Check all the functions of the instrument that you need to monitor the patient, and ensure that the instrument is in good working order.

Switching On

Press the on/off switch on the monitor for one second. The monitor performs a self test and is then ready to use. If you see a message such as CO2 Sensor Warmup wait until it disappears before starting to monitor that measurement.

Power On/Power Off Behavior

The general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows:

• A monitor that was switched on prior to a temporary power loss switches on again when power is restored.

• A monitor that was switched off prior to a temporary power loss remains off when power is restored.

• When AC mains power is lost, a battery powered monitor continues to run without interruption on battery power.

Setting up the Measurements

1

Decide which measurements you want to make.

2

Connect the required patient cables and sensors. The connectors are color-coded to the patient cables and sensors for easy identification.

Starting Monitoring

After you switch on the monitor,

1

2

3

Admit your patient to the monitor.

Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and so forth are appropriate for your patient. Change them if necessary.

Refer to the appropriate measurement section for details of how to perform the measurements you require.

31

2 Basic Operation

Disconnecting from AC Mains Power

Disconnecting from AC Mains Power

To disconnect the monitor from AC mains power, unplug the power cord for the external power supply (M8023A) from the mains socket.

Monitoring After a Power Failure

If external power is disconnected or there is a power failure, the monitor continues to run on its rechargeable battery.

If the monitor is without any power (no external power or the battery is empty) for less than one minute, monitoring will resume with all active settings unchanged. If the monitor is without power for

more than one minute, the behavior depends on your configuration. If Automat. Default is set to Yes, the default profile will be loaded when power is restored. If Automat. Default is set to

No

, all active settings are retained, if power is restored within 48 hours. The Automat. Default setting is made in Configuration Mode.

Networked Monitoring

You can connect your monitor to an Information Center on a network. This can be done using one of the optional interfaces:

• Standard wired LAN

• IntelliVue Instrument Telemetry System (IIT)

If your monitor is connected to a network, a network symbol is displayed in the upper left corner next to the bed label. To see details about the monitoring equipment and technical information about the network, select the Main Setup SmartKey to enter the Setup menu, then select

Bed Information

.

Be aware that some network-based functions may be limited for monitors on IIT wireless networks in comparison to those on wired networks.

32

3

3

Alarms

The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements.

The monitor has two different types of alarm: patient alarms and INOPs.

Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy).

INOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, LEADS OFF), the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded. INOPs without this audible indicator indicate that there may a problem with the reliability of the data, but that monitoring is not interrupted.

Most INOPs are light blue, however there are a small number of INOPS which are always yellow or red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be

configured as red or yellow INOPs to provide a severity indication:

• ECG Leads Off

• Cuff Overpress

• Cuff Not Deflated

All monitors in a unit should have the same severity configured for these INOPs.

Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the trigger delay time for the individual measurement. See the specifications section for details.

If more than one alarm is active, the alarm messages are shown in the alarm status area in succession. An arrow symbol next to the alarm message informs you that more than one message is active.

↑ ** HR HIGH

The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged.

33

3 Alarms

Visual Alarm Indicators

Visual Alarm Indicators

Alarm message: An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. There is a field for INOPs (light blue, red or yellow) and a field for patient alarms, which is shared for red and yellow alarms. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow ( ) at the side. If both red and yellow alarm conditions are active simultaneously, they alternate every two seconds in the patient alarms field. The background color of the alarm message matches the alarm priority: red for red alarms, yellow for yellow alarms, light blue for standard INOPs, red for red INOPs and yellow for yellow

INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms,

** for yellow alarms, * for short yellow alarms. Standard INOPs do not have a symbol, red and yellow

INOPs have exclamation marks beside the alarm message: !!! for red INOPs and !! for yellow INOPs.

Depending on how your monitor is configured, it may display alarm limit violation messages

• in text form, for example “**SpO2 LOW” or

• in numeric form, for example “**SpO2 94<96”, where the first number shows the maximum deviation from the alarm limit, and the second number shows the currently set limit.

Flashing numeric: The numeric of the measurement in alarm flashes.

Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if Show AlarmLimits is enabled and there is sufficient room on the screen.

Alarm lamp: A lamp on the monitor’s front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds. The color is yellow or red corresponding to the highest priority patient alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow or red INOPs as follows:

INOP Lamp

Color

Yellow

Red

Modulation (how long the lamp is on or off while flashing)

On

1.0 seconds

0.25 seconds

Off

1.0 seconds

0.25 seconds

If only patient alarms are present, and no INOPs, the patient alarms will use both left and right sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and right sections to flash but light blue INOPs will always light continuously in the left section only.

Audible Alarm Indicators

The audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to non-latching).

34

Audible Alarm Indicators

3 Alarms

WARNING

• Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.

Alarm Tone Configuration

The audible alarm indicators of your monitor are configurable. In the monitor’s Configuration Mode, you can:

• increase the alarm volume of unacknowledged alarms at regular intervals

• change the interval between alarm sounds (ISO/IEC Standard 9703-2 alarms only)

• change the base volume of the red and yellow alarm tones and the INOP tones

• change the alarm sound to suit the different alarm standards valid in different countries.

Traditional Audible Alarms (HP/Agilent/Philips/Carenet)

• Red alarms and red INOPs: A high pitched sound is repeated once a second.

• Two-star yellow alarms and yellow INOPs: A lower pitched sound is repeated every two seconds.

• One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration.

• Standard INOPs: an INOP tone is repeated every two seconds.

ISO/IEC Standard 9703-2 Audible Alarms

• Red alarms and red INOPs: A high pitched tone is repeated five times, followed by a configurable pause.

• Two-star yellow alarms and yellow INOPs: A lower pitched tone is repeated three times, followed by a configurable pause.

• One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration.

• Standard INOPs: a lower pitched tone is repeated twice, followed by a pause.

Changing the Alarm Tone Volume

If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, or change the setting, select the Alarm Volume SmartKey. The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale. Any settings that are inactive (“grayed out”) have been disabled in the monitor’s Configuration Mode.

Alarm

Volume

When the alarm volume is set to zero (off), the alarm volume symbol reflects this. If you switch the alarm volume off, you will not get any audible indication of alarm conditions.

35

3 Alarms

Acknowledging Alarms

Minimum Volume for No Central Monitoring INOP

If your monitor is connected to an Information Center, and the connection is interrupted, the INOP message No Central Monit. will appear within 30 seconds, accompanied by an INOP tone. To help ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the monitor alarm volume is set to zero.

Minimum Volume for Severe Yellow or Red INOPs

Severe yellow or red INOPs require action to ensure the well-being of the patient. Therefore the minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.

The severe INOPs for which this applies are:

Cuff Not Deflated (configurable to yellow or red)

NBP Cuff Overpress (configurable to yellow or red)

Insert Battery (yellow)

Acknowledging Alarms

To acknowledge all active alarms and INOPs, press the Silence key. This switches off the audible alarm indicators and alarm lamps.

A check mark beside the alarm message indicates that the alarm has been acknowledged. If the monitor is configured to re-alarm, a dashed check mark will be shown.

If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message

APNEA

stays on the screen with a check mark symbol beside it, except for NBP alarms. When an NBP alarm is acknowledged the alarm message disappears.

If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.

Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also stops alarm indication.

Acknowledging Disconnect INOPs

Acknowledging an INOP that results from a disconnected transducer switches off the associated measurement. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the

Information Center switches off the audible INOP indicator but does not switch off the measurement.

36

Pausing or Switching Off Alarms

3 Alarms

Alarm Reminder (ReAlarm)

If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). Alarm reminder is not available for standard, light blue INOPs but for yellow and red INOPs.

In Configuration Mode, you can set the interval between silencing the alarm and sounding the reminder tone to one, two, or three minutes.

The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the

Information Center Instructions for Use for further information.

Pausing or Switching Off Alarms

If you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely.

To view the alarm pause setting chosen for your unit,

1

Select Main Setup -> Alarms -> Alarm Settings

2

Check the Alarms Off setting.

This setting can only be changed in Configuration Mode.

To Pause All Alarms

Press the Alarms key.

If your monitor is configured to infinite pause time, the lamp next to the alarms off symbol is red, and pressing this key switches alarms off.

To Switch All Alarms Off

You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause.

Press the Alarms key.

Pausing alarms infinitely is the same as switching them off.

Alarms

Off

To Switch Individual Measurement Alarms On or Off

1

2

Select the measurement numeric to enter its setup menu.

Select Alarms to toggle between On and Off.

The alarms off symbol is shown beside the measurement numeric.

37

3 Alarms

Alarm Limits

While Alarms are Paused or Off

• The red Alarms Paused lamp on the monitor front panel is lit.

In the alarm

field, the monitor displays the message

Alarms Paused

or Alarms Off, together with the alarms paused symbol and the remaining pause time in minutes and seconds, or alarms off symbol.

ALARMS PAUSED 1:28

• No alarms are sounded and no alarm messages are shown.

ALARMS OFF

• INOP messages are shown but no INOP tones are sounded.

The only exceptions are the INOPs CUFF NOT DEFLATED, NBP Cuff Overpressure and INOPs relating to empty, missing and malfunctioning batteries.

These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or off. You need to remove the INOP condition first before you can switch the alarm tones off again.

If a NO SENSOR or NO TRANSDUCER INOP is present and alarms are paused or switched off, the measurement in question is switched off.

Restarting Paused Alarms

To manually switch on alarm indication again after a pause, press the Alarms key again.

Alarm indication starts again automatically after the pause period expires. If the monitor is configured to stay paused infinitely, you must select Alarms Off again to restart alarm indication.

Resetting Arrhythmia Alarm Timeouts

To reset the arrhythmia alarm timeout period, press the Alarms key and then press it again.

Extending the Alarm Pause Time

If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patient’s condition closely.

To extend the alarm pause time to five or 10 minutes,

1

Select one of the alarm fields. This calls up the Review Alarms window.

2

Select either the pop-up key Pause Al. 5 min or the pop-up key Pause Al. 10 min.

Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes.

Alarm Limits

The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO

2

), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off. In these cases, the alarms off symbol is not displayed.

38

Alarm Limits

3 Alarms

WARNING

Be aware that the monitors in your care area may each have different alarm settings, to suit different patients. Always check that the alarm settings are appropriate for your patient before you start monitoring.

Viewing Individual Alarm Limits

HR

120

50

85

Alarm limits

You can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen.

If your monitor is not configured to show the alarm limits next to the numeric, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits.

Viewing All Alarm Limits

The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an

Apnea alarm delay time is set, this is also shown. The Alarms Off symbol is shown beside the measurement label of any measurement whose alarm switched off.

To open the Alarm Limits window, either select one of the alarm fields then select the

Alarm Limits

pop-up key, or select the Alarm Limits SmartKey, if configured.

Graphic view of current yellow and red alarm limits and currently monitored measurement value

Off

indicates the measurement is switched off

Measurement labels, with alarms off symbol where appropriate

Δ

QTc

SpO

2

NBPs

Alarm Limits

Off

ABPs

All Lim. All Lim.

Narrow

Wide

Set narrow or wide alarm AutoLimits for all measurements

Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits.

Selecting Hide ST Limits hides the list again.

You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:

39

3 Alarms

Alarm Limits

All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all measurements.

These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window.

Changing Alarm Limits

To change individual measurement alarm limits using the measurement’s Setup Menu,

1

2

In the measurement’s setup menu, select the alarm limit you want to change. This calls up a list of available values for the alarm limit.

Select a value from the list to adjust the alarm limit.

For example, to change the alarm limits for SpO

2

:

• Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-up list that opens.

• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.

Alternatively, you can use the keys in the measurement Change Limits window, which you access by selecting the measurement label in the Alarm Limits window.

Parameter label

High red alarm (view only)

ABPs

Graphic view of alarm limits with currently measured value

Alarms

On/Off

High yellow alarm field

Select to open a pop-up list of high alarm limits

Alarms On/Off key - select to toggle between alarms on or off

Preview Alarm AutoLimits for a measurement before applying

Select to apply wide AutoLimits

Select to apply narrow AutoLimits

Low yellow alarm field

Select to open a pop-up list of low alarm limits

Low red alarm (view only)

40

Alarm Limits

3 Alarms

To change alarm limits,

1

Enter the Change Limits window.

2

To set the high alarm limit, select the high yellow alarm field to open a pop-up list of high alarm limits. Select a limit from the list. Repeat to set the low yellow alarm field.

If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically set the red alarm to the yellow alarm limit.

When an ST measurement is in the Change Limits window there are also two pop-up keys available labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST

Leads.

About Automatic Alarm Limits (AutoLimits)

The monitor can automatically set alarm limits suited to your individual patient, using the Automatic

Alarm Limits function. This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds.

The defined safe limits never exceed the non-pathological range.

Limits Narrow

sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patient’s vital signs.

Limits Wide

sets limits further away from the currently measured values for situations where small changes are not so critical.

Use the keys in the Change Limits window to apply AutoLimits for individual measurements.

These keys are not available if AutoLimits have been disabled for the measurement in the monitor’s

Configuration Mode.

High alarm limit, wide

High alarm limit, narrow

Alarm limits

Low alarm limit, narrow

Low alarm limit, wide

Measurement value

Lower limit clamps

Upper limit clamps

AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitor’s Configuration mode.

Use the Change Limits window to check AutoLimits before you apply them to ensure that they are appropriate for your individual patient and their clinical condition. Once applied, AutoLimits are shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not appropriate for your patient, you must set alarm limits manually. The limits remain unchanged until you set them again or change them manually.

41

3 Alarms

Reviewing Alarms

Documenting Alarm Limits

To print a list of all current alarm limit settings on an available printer:

1

2

Select the Main Setup SmartKey.

Select Reports from the Main Setup menu.

3

Select Alarm Limits.

Reviewing Alarms

You can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen.

To review the history of alarms and INOPs, select the alarms or INOPs field to open the Review

Alarms

window.

All alarms and INOPs are erased from the Review Alarms window when you discharge a patient, or if you change to Demonstration Mode.

Review Alarms Window

The Review Alarms window contains a list of the most recent alarms and INOPs with date and time information.

Review Alarms

23 Apr 14:08:30

***Apnea

23 Apr 14:08:30 Alarms Silenced

23 Apr 14:08:19 **AwRR LOW (14<15)

23 Apr 14:42:55

**SpO2 NON-PULSAT.

Alarm

Limits

PauseAl.

PauseAl.

5 MIn

10 MIn

If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit. The Review Alarms window also shows when the monitor was switched on (after being switched off for longer than 1 minute) and any changes made to the Alarms On/Off, Standby, Silence or ECG source changes.

When you select an item from the list, you can get additional information about that item. If you select a high or low limit alarm in the list, the Graphical Trends window will open to provide further data. If you select an alert other than a high or low alarm, a help text window opens with more information. Some items in the list are simply log items not related to a patient alert as such (for example, Alarms On or Alarms Off). You cannot see any further information if you select one of these items. When you close these windows you will return to the Review Alarms window.

The information in the Review Alarms window is deleted when a patient is discharged, and when you leave Demonstration Mode.

42

Latching Alarms

3 Alarms

The Review Alarms window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive.

Alarm

Limits

Pause Al.

5 Min.

Pause Al.

10 Min.

Latching Alarms

The alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed or announced by the monitor after the alarm condition ends. The indication lasts until you acknowledge the alarm.

Viewing the Alarm Latching Settings

To see the alarm latching setting for your monitor

1

2

In the monitor’s Main Setup menu, select Alarms.

Select Alarm Settings, and see the Visual Latching and Audible Latching settings.

This setting can only be changed in Configuration Mode. You should be aware of the settings chosen for your unit. There are three possible choices each for visual and audible latching, Red, Red and

Yellow, and Off. These choices can be combined to give the following settings:

Visual Latching

Audible latching

R&Y

R&Y

R = red alarms, Y = yellow alarms

Alarm Latching Behavior

R&Y

R

R&Y

Off

R

R

R

Off

Off

Off

Red and Yellow Measurement

Alarms

Non-latching alarms

Visual and audible latching

Visual latching, audible non-latching

Alarm has not been acknowledged.

Alarm has been acknowledged.

Alarm condition still present.

Alarm condition no longer present.

Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.

All audible and visual alarm indicators automatically stop.

Alarm tone on.

Alarm lamp on.

Alarm message.

Flashing numerics.

Alarm message. Flashing numerics.

Audible alarm indicators automatically stop.

Alarm condition still present.

Alarm condition no longer present.

Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).

Audible and visual alarm indicators automatically stop.

All INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 100 for information on one-star

yellow alarms latching behavior.

43

3 Alarms

Testing Alarms

Testing Alarms

When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO that appropriate alarm behavior is observed.

2

or CO

2

) or use a simulator. Adjust alarm limits and check

Alarm Behavior at On/Off

When you switch alarms on, the settings defined in the currently active Profile are used.

If the monitor is switched off for longer than one minute and then switched on again, or after a loss of power lasting longer than one minute, or when a patient is discharged, the monitor can be configured to restore either the alarm settings from the monitor's configured default Profile, or the most recently used alarm settings. After any of these situations, you should check that the alarm settings are appropriate for your patient, and if necessary, select the correct Profile and patient category.

If power is lost for less than one minute, the alarm settings prior to the power loss are restored.

Alarm Recordings

3

4

You can set up your monitor so that it automatically triggers alarm recordings at the Information

Center, or if configured, to a printer as a realtime report.

1

2

Press the Main Setup SmartKey.

Select Alarms from the Main Setup menu.

Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.

Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list.

5

For the desired measurement(s), choose the alarm condition to trigger an alarm recording:

Red Only

: an alarm recording will automatically be triggered when the measurement enters a red alarm condition.

Red&Yell

: both yellow and red alarms will trigger an alarm recording.

Off:

disables automatic alarm recording.

Refer to the chapter “Recording” for details of how to set up a recording.

44

4

4

Patient Alarms and INOPs

This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their

priority. INOPs start on page 51. All alarms and INOPs are listed here; the ones which can appear on

your monitor will depend on the model and the individual options.

Patient Alarm Messages

The measurement labels and abbreviations for pressure, temperature, SpO

2

, and anesthetic agent alarms are explained in the individual chapters.

Some alarms may be shown at the Information Center in shortened form, when transferred through

IntelliVue Instrument Telemetry. These shortened alarm texts are included in the list and identified with the note “at Information Center”.

Note that yellow arrhythmia alarms may be shown with one or with two stars, depending on your monitor configuration and the Information Center revision you are using.

Alarm Message

***APNEA

or

***APNEA xxx sec

***ASYSTOLE

**awRR HIGH

**awRR LOW

**BIS HIGH

**BIS LOW

***BRADY (Pulse) or

***BRADY xxx<yyy

From

CO

2

, Resp,

AGM

ECG

CO

2

, Resp,

AGM

CO

2

, Resp,

AGM

BIS

BIS

Press, SpO

2

Condition Indication

Respiration has stopped for longer than the preset apnea time. “xxx” denotes the

Apnea duration.

numeric flashes, red alarm lamp, alarm tone.

No QRS detected for a period greater than the asystole threshold (in the absence of Vfib or chaotic ECG).

The airway respiration rate has exceeded the high alarm limit.

numeric flashes, red alarm lamp, alarm tone.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

The airway respiration rate has dropped below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

The Bispectral Index value has exceeded the high alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

The Bispectral Index value has dropped below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit.

numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.

45

4 Patient Alarms and INOPs

Patient Alarm Messages

Alarm Message

**CCO/CCI HIGH

**CCO/CCI LOW

**CPP HIGH

**CPP LOW

***DESAT

or

***DESAT xxx<yyy

**etCO2 HIGH

**etCO2 LOW

**etO2 HIGH

**etO2 LOW

*/**/***

EVENT:<GRP>

*/**/*** EVENT

at Information center

***EXTREME BRADY

***EXTREME TACHY

**HR HIGH

**HR LOW

From

CCO

CCO

CPP

CPP

SpO

CO

2

, Resp,

AGM

CO

2

, Resp,

AGM

O

O

2

2

2

, AGM

, AGM

Event surveillance

Event surveillance

ECG

ECG

ECG

ECG

Condition Indication

Continuous Cardiac Output or CC

Index is above the high alarm limit.

Continuous Cardiac Output or CC

Index is below the low alarm limit.

The CPP value has exceeded the high alarm limit.

numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone

The CPP value has fallen below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

The SpO

2

value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. numeric flashes, red alarm lamp, alarm tone.

The end tidal CO

2 been exceeded.

high alarm limit has numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

The end tidal CO

2

value has fallen below the low alarm limit.

The end tidal O been exceeded.

2

high alarm limit has numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

The end tidal O

2

value has fallen below the low alarm limit. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone.

An event has occurred and the event notification is configured to alarm.

<GRP> is the event group event group name flashes, yellow or red alarm lamp and alarm tone

An event has occurred and the event notification is configured to alarm.

Check on the monitor for more details on event group.

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone

The bradycardia limit has been exceeded.

The tachycardia limit has been exceeded.

numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.

numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.

The heart rate high alarm limit has been exceeded.

The heart rate has fallen below the low alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. The sound switches off after 5 seconds if

Arrhythmia is On.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. The sound switches off after 5 seconds if

Arrhythmia is On.

46

Patient Alarm Messages

4 Patient Alarms and INOPs

Alarm Message From Condition Indication

*/**IRREGULAR HR

*/**MISSED BEAT

*/**MULTIFORM PVCs

**NBP HIGH

***<Pressure>

DISCONNECT

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

NBP

**NBP LOW

*/**NON-SUSTAIN VT

NBP

ECG/

Arrhythmia

The measured NBP value is below the low alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

A run of Vs having a ventricular

HR>V-Tach HR limit, but lasting for less than the V-Tach Run limit has been detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

*/**PACER NOT CAPT

ECG/

Arrhythmia

(paced patients only)

A missed beat with a pace pulse was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

*/**PACER NT PACING

ECG/

Arrhythmia

(paced patients only)

A missed beat without a pace pulse was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

*/**PAIR PVCs

ECG/

Arrhythmia

*/**PAUSE

ECG/

Arrhythmia

A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

No beat detected for a period greater than the pause threshold. numeric flashes, yellow alarm lamp, short yellow audible alarm.

PRESS

Consistently irregular heart rhythm.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only).

numeric flashes, yellow alarm lamp, short yellow audible alarm.

Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

The measured NBP value is above the high alarm limit.

s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

***<Pressure> HIGH

PRESS

The pressure is non-pulsatile and the mean pressure is continuously less than

10mmHg (1.3kPa). This alarm occurs only with arterial pressures (P, ABP,

ART, Ao, BAP, FAP, PAP, UAP, P1, P2,

P3, P4).

numeric flashes, red alarm lamp, alarm tone.

The measured pressure value is above the extreme high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes, high limit is highlighted, red alarm lamp, alarm tone.

47

4 Patient Alarms and INOPs

Patient Alarm Messages

Alarm Message

**<Pressure> HIGH

***<Pressure> LOW

**<Pressure> LOW

**PULSE HIGH

**PULSE LOW

*/**PVCs/min HIGH

**QTc HIGH

**

ΔQTc HIGH

*/**R-ON-T PVCs

**RR HIGH

**RR LOW

*/**RUN PVCs HIGH

**<SpO2 label> HIGH

**<SpO2 label> LOW

From

PRESS

PRESS

PRESS

PRESS

SpO

2

PRESS

SpO

2

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

RESP

RESP

ECG/

Arrhythmia

SpO

SpO

2

2

Condition Indication

The measured pressure value is above the high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone.

The measured pressure value is below the extreme low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes and low limit is highlighted, red alarm lamp, alarm tone.

The measured pressure value is below the low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

The pulse rate has exceeded the high alarm limit.

The pulse rate has dropped below the low alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

More premature ventricular contractions have been detected in a minute than the limit.

QTc value has exceeded the QTc high limit for more than 5 minutes

ΔQTc value has exceeded the ΔQTc high limit for more than 5 minutes numeric flashes, yellow alarm lamp, short yellow audible alarm.

numeric flashes, yellow alarm lamp, alarm tone.

numeric flashes, yellow alarm lamp, alarm tone.

For HR <100, a PVC with R-R interval

< 1/3 the average interval followed by a compensatory pause of 1.25 x average

R-R interval or two such Vs without compensatory pause occurring within 5 minutes of each other. (When HR

>100, 1/3 R-R interval is too short for detection.).

numeric flashes, yellow alarm lamp, short yellow audible alarm.

The respiration rate has exceeded the high alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

The respiration rate has dropped below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

A run of PVCs greater than 2 was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

The arterial oxygen saturation has exceeded the high alarm limit.

The arterial oxygen saturation has fallen below the low alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

48

Patient Alarm Messages

4 Patient Alarms and INOPs

Alarm Message

**ST<n> HIGH

**ST<n> LOW

**ST MULTI <n>,<n>

ECG/

Arrhythmia

**ST MULTI

at Information Center

**SvO2 HIGH

**SvO2 LOW

*/**SVT

**tcpO2 HIGH/

**tcpCO2 HIGH

**tcpO2 LOW/

**tcpCO2 LOW

**<Temperature label> HIGH

**<Temperature label> LOW

SvO

SvO

2

2

***TACHY (Pulse) or

***TACHY xxx>yyy

Press, SpO

2

**Tblood HIGH

**Tblood LOW

*/**/***TELE ALARM

From

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

ECG/

Arrhythmia

C.O.

C.O.

tcGas tcGas

Telemetry

TEMP

TEMP

Condition Indication

The ST elevation in lead <n> is higher than the limit.

The ST depression or elevation is outside of the limit in two or more leads <n> and <n> numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone.

The ST depression in lead <n> is lower than the limit.

numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, alarm tone

(on monitor) numeric flashes, yellow alarm lamp, alarm tone

The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor for more details about which leads are affected.

The SvO

2 limit.

value has exceeded the high

The SvO low limit.

2

value has fallen below the numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone.

A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the

SVT HR limit.

numeric flashes, yellow alarm lamp, alarm tone.

The heart rate from the Pulse signal has exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit.

numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone.

The blood temperature value has exceeded the high alarm limit.

numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone.

The blood temperature value has fallen below the low alarm limit.

numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone.

The tcpO exceeded the high alarm limit.

The tcpO

2

2

or tcpCO

or tcpCO

2

2

value has value has fallen below the low alarm limit.

numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone.

numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone.

This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window.

yellow or red alarm lamp and alarm tone

The temperature has exceeded the high alarm limit.

numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.

The temperature has fallen below the low alarm limit.

numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.

49

4 Patient Alarms and INOPs

Patient Alarm Messages

Alarm Message

*/**VENT BIGEMINY

***VENT FIB/TACH

*/**VENT RHYTHM

*/**VENT TRIGEMINY

ECG/

Arrhythmia

***VTACH

**/***VueLink ALARM

at Information Center

From

ECG/

Arrhythmia

ECG

ECG/

Arrhythmia

ECG,

Arrhythmia

VueLink

Condition Indication

A dominant rhythm of N, V, N, V (N = supraventricular beat, V = ventricular beat) was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

A fibrillatory waveform for 4 consecutive seconds was detected.

numeric flashes, red alarm lamp, alarm tone.

A dominant rhythm of adjacent Vs > vent rhythm limit and ventricular HR <

VTach HR limit was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

A dominant rhythm of N, N, V, N, N,

V (N = supraventricular beat, V = ventricular beat) was detected.

numeric flashes, yellow alarm lamp, short yellow audible alarm.

Ventricular tachycardia has been detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach

HR limit).

numeric flashes, yellow alarm lamp, short yellow audible alarm.

A yellow (**) or red (***) patient alarm is present on the VueLink module.

Check the monitor display for more detailed alarm information.

(on monitor) yellow or red alarm lamp, alarm tone

50

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ? appears next to the numeric.

INOP Message, Indication Source What to do

ABP

INOPS

ALL ECG ALARMS OFF

Ao INOPS

ART INOPS

AWF CHANGE SCALE

AWP CHANGE SCALE

AWV CHANGE SCALE

Bad Serverlink

INOP tone

BAP

INOPS

BATT EMPTY

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off.

PRESS

ECG/

Arrhythmia

See <Pressure label> INOPS (under Pressure).

All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch

ECG alarms on or select ECG as the alarms source.

See <Pressure label> INOPS (under Pressure).

PRESS

PRESS See <Pressure label> INOPS (under Pressure).

Spirometry Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave.

Spirometry Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave

Spirometry Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave.

Monitor 1) An MMS with an incompatible software revision is connected to the monitor. This combination does not allow monitoring, OR

2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact your service personnel.

PRESS See <Pressure label> INOPS (under Pressure).

Battery The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery immediately.

Battery

If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.

The battery cannot be used with this monitor. Replace with the correct battery

(M4607A)

.

BATT INCOMPAT

INOP tone

BATT LOW

INOP tone

BATT MALFUNCTION

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.

BATTERIES EMPTY

or BATT 1/

BATT 2 EMPTY

Batteries

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off.

BATTERIES INCOMP

or BATT

1/BATT 2 INCOMP

INOP tone

Battery

Battery

Batteries

The estimated battery-powered operating time remaining is less than 20 minutes.

The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery. If the condition persists and the monitor is not connected to mains power, this INOP is reissued two minutes after you acknowledge it.

Place the battery in a different monitor or in a battery charger.

If the same INOP is shown, contact your service personnel.

The estimated remaining battery-powered operating time of the indicated battery or batteries is less than 10 minutes.

Replace the batteries immediately.

If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.

The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book.

51

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

BATTERIES LOW

or BATT 1/

BATT 2 LOW

INOP tone

BATTERIES MALF

or BATT 1/

BATT 2 MALFUNCTION

INOP tone, battery LED flashes

During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.

BATTERY LOW T

Source

Batteries

Batteries The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this

INOP is re-issued two minutes after you acknowledge it.

Place the batteries in a different monitor or in a battery charger.

If the same INOP is shown, contact your service personnel.

Telemetry The battery in the Telemetry device is low and must be replaced soon.

Batteries The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately.

BATT 1/BATT 2 MISSING

INOP tone.

During this INOP, alarms cannot be paused or switched off.

BIS CABLE INCOMPAT

INOP tone.

BIS

What to do

The estimated battery-powered operating time remaining is less than 20 minutes.

BIS CABLE USAGE

INOP tone.

BIS DSC DISCONN

INOP tone

BIS DSC INCOMPT

INOP tone

BIS DSC MALFUNC

BIS DSC UPDATE

INOP tone

BIS ELECTR. DISC

INOP tone.

BIS ENGINE DISCONN

INOP tone

BIS ENGINE INCOMPT

INOP tone

BIS ENGINE MALFUNC

INOP tone

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philipssupported sensor cable.

The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.

DSC is not properly connected OR either DSC or BIS engine may be faulty.

Make sure that the DSC is properly connected to the BIS

Engine. If INOP persists, replace DSC with a known good one of the same type.

If INOP persists replace BIS engine.

Silencing this INOP switches the measurement off.

DSC is not supported by the BIS engine or new DSC connected to an old BIS engine. A software upgrade may be required. Contact your service personnel.

Electrocautery used during self-test OR malfunction in the

DSC hardware.

Make sure not to use electrocautery during the self-test procedure. Disconnect and reconnect the DSC to the BIS engine. If the INOP persists, replace the DSC or contact your service personnel.

DSC update currently being carried out. This INOP will disappear when the DSC update is finished. Do not disconnect the DSC during the update. No action is needed.

One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections.

BIS engine not connected OR Module Cable defective.

Make sure that the Module Cable is properly connected. If

INOP persists, replace the Module Cable.

Silencing this INOP switches the measurement off.

BIS engine software is not supported. A software upgrade may be required. Contact your service personnel.

MP20/30 - BIS engine not supported.

Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine.

52

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

BIS EQUIP MALF

INOP tone

BIS HIGH IMPEDANCE

INOP tone may sound

BIS IMPEDANCE CHCK

INOP tone may sound

BIS ISOELECTRC EEG

BIS LEAD OFF

INOP tone may sound

BIS OVERCURRENT

INOP tone

BIS SENSOR DISCONN

INOP tone

BIS SENSOR INCOMPT

INOP tone

BIS SENSOR MALFUNC

INOP tone

BIS SENSOR USAGE

INOP tone

Source

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

BIS

What to do

There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists, contact your service personnel.

Impedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question using correct skin preparation.

If INOP persists, contact your service personnel.

The Cyclic Impedance check is running. It will stop automatically if all impedances are within the valid range. If any electrodes do not pass the impedance test, check the sensor montage and press the electrode pads firmly.

To manually stop the Cyclic Impedance Check, select

Cyclic Check Off

in the

Setup BIS

menu.

No discernible EEG activity is detected for longer than one minute.

Check the patient. Check that the electrodes are properly connected.

One or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly.

If this INOP persists, replace the sensor(s) in question, using correct skin preparation.

Unplug and replug the BIS module or, f or the MP20/MP30, disconnect and reconnect the BISx from the Interface board. If the INOP persists, contact your service personnel.

The sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the

DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty.

Check all the connections.

Disconnect and reconnect the sensor, PIC, DSC, BISx.

If the INOP persists, replace the sensor.

If the INOP persists, replace PIC. If INOP persists, contact your service personnel.

Silencing this INOP switches the measurement off.

Unsupported sensor connected or sensor type unknown or not supported by your software revision. Replace the sensor, using only Philips supported sensors.

Malfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR patient interface cable (PIC) or DSC or BISx may be faulty.

Replace the sensor. Manually initiate a Cyclic Impedance

Check. Make sure all electrodes pass the test. Make sure that the both sides of the PIC connector (between PIC and sensor) are dry. If you are not sure that the connector is dry, replace the

PIC until it has dried. If this INOP persists, contact your service personnel.

Excessive sensor usage. Replace sensor.

A Cyclic Impedance Check will start automatically.

53

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

BIS SQI < 15%

(INOP tone)

OR

BIS SQI < 50%

(no INOP tone)

BIS UNPLUGGED

INOP tone

BISx DISCONNECTED

INOP tone

BISx INCOMPATIBLE

INOP tone

BISx MALFUNCTION

INOP tone

CANNOT ANALYZE ECG

CANNOT ANALYZE QT

CANNOT ANALYZE ST

CCI NO BSA

CCI numeric unavailable

INOP tone

CCO BAD PRESS SIGN

numeric is replaced by -?-

INOP tone

CCO NO <Pressure label>

numeric is replaced by -?-

INOP tone may sound

Source

BIS

BIS

What to do

If the signal quality is below 50%, BIS numerics cannot be reliably derived.

If the signal quality is below 15%, no BIS numerics can be derived.

This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices. Make sure the sensor is properly attached to the patient. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure the patient is completely relaxed (even small motions of the facial muscles affect the signal quality).

Plug in the BIS module. Silencing this INOP switches off the measurement.

BIS

BIS

BIS

ECG/

Arrhythmia

QT

ST

C.O.

C.O.

C.O.

The BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches the measurement off.

The BISx software is not compatible with the BIS module or with the MP20/MP30 monitor software. A software upgrade may be required. Contact your service personnel.

The BISx is faulty. Disconnect and reconnect it to the module or BIS interface board. If the INOP persists, replace the BISx.

MP20/MP30 - Malfunction on interface board. If the INOP persists, contact your service personnel.

The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.

If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off.

The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase.

The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points.

If the patient has a ventricular pacemaker, ST analysis is not possible.

CCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight and height to provide the BSA for CCI calculation.

The arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia.

CCO/CCI cannot be calculated. Make sure that the pressure chosen in the

Setup CCO

menu under

CCO From

matches the pressure measured with the arterial catheter for

CCO measurement. A VueLink pressure cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP.

54

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

CCO NO CALIBRATION

numeric is replaced by -?-

CCO NO PRESS

at Information Center

CCO NOT SUPPORTED

numeric is replaced by -?-

INOP tone

Source

C.O.

C.O.

C.O.

What to do

The CCO measurement is currently not calibrated.

CCO/CCI cannot be calculated. Make sure that the pressure chosen in the

Setup CCO

menu under

CCO From

matches the pressure measured with the arterial catheter for

CCO measurement. A VueLink pressure cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP.

A catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right Heart C.O. catheter, or the measurement mode has been changed manually. Silencing this INOP switches the measurement off.

The measured CCO or CCI value is not within the specified range for CCO/CCI measurement.

CCO/CCI OVERRANGE

numeric is replaced by -?-

INOP tone

CCO <Pressure label>

INVALID

numeric is replaced by -?-

INOP tone may sound

CCO PRESS INVALID

at Information Center

CCO PRESS OVERRANG

numeric is replaced by -?-

INOP tone

CCO PULSE OVERRANG

numeric is replaced by -?-

INOP tone

CCO/Tbl NO TRANSD

Numeric is replaced by -?-

INOP tone

CCO RECALIBRATE

numeric is replaced by -?-

C.O.

C.O.

C.O.

C.O.

C.O.

C.O.

The arterial pressure selected for pulse contour calculation for

CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.

The arterial pressure selected for pulse contour calculation for

CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.

The mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0 mmHg or above 300 mmHg.

The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm.

No transducer attached to the module or catheter disconnected.

Charge BATT1/BATT2 now

INOP tone

CHARGER MALFUNC

INOP tone, battery LED may flash

Check Alarm Lamps

INOP tone.

CHECK BATT TEMP

INOP tone

Check DrugSettings

INOP tone

Check ECG Settings

INOP tone

C.O.

Batteries

Batteries

Monitor

Battery

The most recent CCO or CCI calibration was made over 8 hours ago. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed.

Battery must be charged. Connect the monitor to mains power or exchange the battery.

There is a problem with the battery charger in the monitor.

Connect the monitor to mains power and contact your service personnel.

Perform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps.

The temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat.

Monitor There was a problem loading the drug settings. Check that the settings are complete and correct.

Telemetry Synchronization of ECG settings between the monitor and

Information Center has failed. Check that the ECG settings in use are appropriate.

55

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

!!CHECK ECG SOURCE

INOP tone

Check Flex Texts

INOP tone

CheckInternVoltage

at Information Center

Check Keyboard

INOP tone

Check Main Board 2

INOP tone.

Check Monitor Func

INOP tone.

Check Monitor Temp

INOP tone

Check Mouse Device

INOP tone.

Check MSL Voltage

INOP tone

Check Network Conf

INOP tone

Check Nurse Relay

INOP tone

!!Check Pairing

INOP tone

Check Screen Res

INOP tone

Check Settings

INOP tone

Check SpeedPoint

INOP tone.

Check SpO

2

T Settings

INOP tone

Source

Monitor

Monitor

Monitor

Monitor

What to do

The telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and the monitor if they are no longer used for the same patient.

Check the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel.

Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP will appear on the monitor as Check Monitor Func.

Perform a visual and functional check of the keyboard. Contact your service personnel.

Monitor

Monitor

There is a problem with the second main board in the monitor.

Contact your service personnel.

Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP may appear on the Information Center as

CheckInternVoltage

.

Monitor

Monitor

The temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed. If the situation continues, contact your service personnel.

Perform a visual and functional check of the mouse input device. Contact your service personnel.

There is a problem with the voltage of the Measurement Link

(MSL). Contact your service personnel.

Monitor/

Multi-

Measuremt

Module

Monitor

Monitor

Monitor

The monitor is receiving network topology information from more than one source, e.g. the Database Server and an

Application Server. Contact your service personnel.

There is a problem with the connection to the nurse relay.

Contact your service personnel.

There is a problem with device pairing. Check that the monitor and telemetry device are correctly paired.

Monitor The Screen you have selected uses a resolution which is not supported by the display. The monitor will show a generic

Screen instead until you select a different Screen.

Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.

Monitor If this INOP appears, check the monitor and patient settings before you resume monitoring. If the settings are unexpected, there may be a problem with the monitor software. Contact your service personnel.

Monitor Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel.

Telemetry Synchronization of SpO

2

T settings between the monitor and

Information Center has failed. Check that the SpO

2 in use are appropriate.

T settings

56

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

Check Touch Input

INOP tone

Check Waves

INOP tone

CHK ECG Sync Cable

INOP tone

Chk IndepDsp Cable

C.O.

DEACTIVATED

INOP tone.

C.O. EQUIP MALF

Numeric is replaced by a - ? -

INOP tone.

Source

Monitor

Monitor

Monitor

Monitor

CHK MSL Connection

INOP tone

C LEAD OFF

HR Numeric is replaced by -?- for 10 seconds. INOP tone.

Monitor

ECG

CO

2

AUTO ZERO

Numeric is replaced by a - ? if the Autozero lasts >15 sec, INOP tone sounds.

CO

2

CAL MODE

CO

2

numeric displays current CO value for accuracy check

2

CO

2

CAL RUNNING

Numeric is replaced by a - ? -

CO

2

CHANGE SCALE

CO

2

CO

2

CO

CO

2

2

CO

2

CO

2

CHECK ADAPTER

Numeric is replaced by a - ? -

INOP tone.

CO

2

CHECK CAL

Numeric is replaced by a - ? -

INOP tone.

CO

2

DEACTIVATED

INOP tone.

CO

CO

2

2

C.O.

C.O.

What to do

Perform a visual and functional check of the touch input device. Contact your service personnel.

The options purchased with this monitor may not support the number of waves required to show the selected Screen, so some waves or high resolution trends are missing from the Screen.

Select a different Screen with fewer waves.

Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.

The ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected.

The monitor cannot communicate with the D80 Intelligent

Display. Check the MSL coupling cable. The end with the grey connector must be connected to the Intelligent Display.

Check that the MSL connector or cable are properly connected. Check the cable and connector for damage.

The C electrode (AAMI: V electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO

2

values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring.

Currently no calibration is running. Accuracy can be checked by placing the transducer on the two cells of the calstick and starting calibration. To start monitoring, leave Cal. Mode.

Wait until calibration is finished.

The CO

2

wave is clipped. Select a more appropriate wave scale to display the whole wave.

Check that the sensor is connected to the airway adapter, clean the airway adapter, if necessary. Perform a zero calibration. If the INOP persists, contact your service personnel.

The CO

2

value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer.

The CO

2

measurement label in the measurement device has been deactivated by deactivating the label in the Measurement

Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.

The Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the

Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the

Measurement Selection window.

There is a problem with the C.O. hardware. Contact your service personnel.

57

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

CO

2

EQUIP MALF

Numeric is replaced by - ? -

INOP tone.

CO

2

FAILED CAL

Numeric is replaced by -?-

INOP tone.

CO

2

NO SENSOR

Numeric is replaced by - ? -

INOP tone.

CO

2

NO TRANSDUC

Numeric is replaced by - ? -

INOP tone.

CO

2

NO TUBING

Numeric is replaced by - ? -

INOP tone.

CO

2

OCCLUSION

Numeric is replaced by a - ? -

INOP tone.

CO

2

OVERRANGE

Numeric is replaced by - ? -

INOP tone.

CO

2

PUMP OFF

Numeric is replaced by a - ? -.

CO

2

PURGING

Numeric is replaced by a - ? -

INOP tone.

CO

2

SENSOR WARMUP

Numeric is displayed with a - ? -

Microstream CO

2

Mainstream CO

2

: INOP tone.

: no INOP tone

C.O. UNPLUGGED

numeric is replaced by -?-

INOP tone.

CO

2

UPDATE FW

Numeric is replaced by a - ? -

INOP tone.

CO

2

WAIT CAL2

Numeric is replaced by a - ? -

CO

2

ZERO FAILED

Numeric is replaced by a - ? -

INOP tone.

CO

2

ZERO REQUIRED

Numeric is replaced by a - ? -

INOP tone

C.O.

CO

2

CO

2

CO

2

CO

2

Source

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

CO

2

What to do

The Measurement Extension is faulty. Unplug and replug the

Multi-Measurement Module with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel.

Make sure that the Cal cell was changed between CAL1 and

CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel.

There is no CO

2 the CO

2 sensor connected. If you silence this INOP

measurement will be switched off.

There is no CO

2

transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO

2

measurement will be switched off.

Either the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories).

If you silence this INOP, the measurement will be switched off.

The sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line.

The CO

2

value is higher than the measurement range. If you suspect a false high value, contact your service personnel.

The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the Setup CO

2

menu.

The Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is removed, the INOP will disappear. If not, the INOP

CO2 OCCLUSION

is displayed.

Wait until the sensor reaches operating temperature and the

INOP disappears.

Plug in the C.O. module. Silencing this INOP switches off the measurement.

The software in the Measurement Extension does not match the software in the MMS. Contact your service personnel.

Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle.

An error occurred during the last zero calibration. Check the airway adapter and clean, if necessary. Perform another zero calibration. If the INOP persists, contact your service personnel.

Perform zero calibration for the CO

2

sensor. If the INOP persists, contact your service personnel.

58

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

CO

2

ZERO RUNNING

CPP CHK SOURCES

Numeric is replaced by a - ? -

CPP CHK UNITS

Numeric is replaced by a - ? -

!!/!!!CUFF NOT DEFLATED

Numeric is displayed with a - ? -

Severe yellow/red INOP tone.

During this INOP, alarms cannot be paused or switched off.

Source

CO

2

CPP

CPP

NBP

CVP

INOPS

ECG EQUIP MALF

Numeric is displayed with a - ? -

INOP tone.

ECG EQUIP MALF T

Numeric is displayed with a - ? -

INOP tone.

<ECG LEAD> LEAD OFF

Numeric is displayed with a - ? -

INOP tone.

PRESS

ECG

Monitor

ECG

ECG EL. NOISY <ECG LEAD>

ECG

ECG NOISY SIGN.

INOP tone.

EcgOut EQUIP MALF

INOP tone

EEG EQUIP MALFUNC

INOP tone

EEG IMPEDANCE HIGH

or

EEG1

and/or EEG2 IMPED.

HIGH

ECG

ECG

EEG

EEG

What to do

Wait until zero calibration is finished.

Not all measurements or values required to perform the calculation are available. Check the measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try repeating the measurement.

You can silence the INOP, but the INOP message remains visible until the next NBP measurement is started or the Stop

All

SmartKey is selected.

[Adult or pediatric patients: The NBP cuff pressure has exceeded

15mmHg (2kPa) for more than 3 minutes.

Neonatal patients: The NBP cuff pressure has exceeded 5mmHg

(0.7kPa) for more than 90 seconds.]

See <Pressure label> INOPS (under Pressure).

Contact your service personnel.

The ECG hardware is faulty.

Contact your service personnel.

The ECG in the Telemetry device is faulty.

Not all the required leads for ECG monitoring are connected.

Check the ECG connections and make sure that the electrode indicated by <ECG lead> [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected.

The ECG signal from the named ECG electrodes [RA, LA, LL,

RL, V (or C)] is noisy. Check the ECG connections and make sure that the electrode indicated is attached.

The ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient.

The ECG signal may be saturated or overloaded.

Check that the ECG out cable is securely connected. Contact your service personnel.

The EEG hardware is faulty. Contact your service personnel.

EEG<X> LEAD OFF <n>

[X = channel, n = electrode]

EEG<X> LEAD OFF

[X = channel] at Information Center

EEG

EEG

The signal electrode in one or both channels exceeds the userselected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines.If the INOP persists, contact your service personnel.

Reconnect specified electrode.

One or more electrodes are not connected. Check in the EEG

Impedance/Montage

window on the monitor which electrode(s) are affected and reconnect the electrodes.

59

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

EEG<X> LEADS OFF

[X = channel]

EEG LINE NOISE

EEG 1

or 2 LINE NOISE

EEG MUSCLE NOISE

EEG 1

or 2 MUSCLE NOISE

EEG NO TRANSDUCER

INOP tone

EEG UNPLUGGED

INOP tone

EEG OVERRANGE

, or

EEG<X> OVERRANGE

FAP

INOPS

FMS UNPLUGGED

INOP tone.

FMS UNSUPPORTED

INOP tone.

IC1

/IC2 INOPS

ICP

INOPs

Indep.Dsp Malfunc.

Indep.Dsp NotSupp.

Source

EEG

EEG

EEG

EEG

EEG

EEG

PRESS

FMS

FMS

PRESS

PRESS

Display

Display

!!INSERT BATTERY

Severe yellow INOP tone.

During this INOP, alarms cannot be paused or switched off.

Intell.Dsp Malf.

INOP tone

Intell.Dsp Missing

Battery

Display

Display

Intell.Dsp Unsupp.

Display

Monitor

Internal.Comm.Malf

INOP tone

INVALID LEADSET

Telemetry

What to do

Two or more electrodes are not connected. Check in the EEG

Impedance/Montage

window which electrodes are affected and reconnect the electrodes.

Excessive line noise has been detected in either channel EEG1 or EEG2, or in both EEG channels.

Keep all cables together and away from metallic bodies, other cables & radiated fields.

Too much power above 30 Hz has been detected in channel

EEG1 or EEG2, or both.

Check the Electrode-to-Skin Impedance and reposition the electrode away from possible muscle activity, if necessary.

The trunk cable is disconnected from the EEG plug-in module.

Reconnect the trunk cable.Silencing this INOP switches the measurement off.

Plug in module. Silencing this INOP switches off the measurement.

Input signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electrosurgery. X denotes the EEG channel.

See <Pressure label> INOPS (under Pressure).

Make sure that the Flexible Module Rack is connected to the monitor. All FMS measurements are off while the FMS is unplugged.

The Flexible Module Rack is not supported by your monitor.

Contact your service personnel.

See <Pressure label> INOPS (under Pressure).

See <Pressure label> INOPS (under Pressure).

A problem has occurred with the second main display. Contact your service personnel.

The monitor does not support a second main display. The monitor software is incompatible. Contact your service personnel.

X2/MP2 only: There is no battery in the battery compartment.

You cannot operate the monitor on AC mains while the battery compartment is open (not sealed with a battery). Load a battery immediately.

There is a problem with the Intelligent Display. Check the

MSL coupling cable then contact your service personnel.

The monitor has lost contact with the connected Intelligent

Display. Contact your service personnel.

The monitor does not support the connected Intelligent

Display. The monitor software is incompatible.

There is a problem with I2C Bus communication in the monitor. Contact your service personnel.

60

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

LA LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

LAP

INOPs

LEADSET UNPLUGGED

LEADS OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

LL LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

MCC Reversed

INOP tone

MCC Unsupported

INOP tone

Meas. DEACTIVATED

Measserv Unsupportd

INOP tone

MMS Ext. EQUIP MALF

INOP tone

MMS Ext. UNPLUGGED

INOP tone

MMS Ext. Unpowered

INOP tone

MMS Ext. Unsupported

INOP tone

MMS UNPLUGGED

INOP tone.

MMS UNSUPPORTED

INOP tone.

!!/!!!MORE BED ALARMS

At Information Center

MSL Power High

MSL Power Off

INOP tone.

Source What to do

ECG The LA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

See <Pressure label> INOPS (under Pressure).

PRESS

Telemetry The leadset has been unplugged from the telemetry device.

ECG Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced.

ECG

Monitor

Monitor

MMS

MMS

Extension

MMS

Extension

MMS

Extension

MMS

Extension

MMS

MMS

Monitor

Monitor

Monitor

The LL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

The MSL coupling cable is reversed. Connect the end with the grey connector to the Intelligent Display.

An MSL coupling cable has been connected to a device which does not support MSL coupling.

An X2 or MP5 has been connected to a host monitor

(companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor.

The Multi-Measurement module is not supported by the monitor. Contact your service personnel.

Loss of communication between the Multi-Measurement

Module and the MMS extension. Contact your service personnel.

The MMS extension has been disconnected from the Multi-

Measurement Module.

The MMS extension cannot operate while the Multi-

Measurement Module is running on battery power.

The MMS extensions not supported by your monitor. Contact your service personnel.

Make sure that the Multi-Measurement Module is connected to the monitor. All MMS measurements are off while the MMS is unplugged.

The Multi-measurement Module is not supported by your monitor. Contact your service personnel.

The monitor is associated with a telemetry device and is sending data to the Information Center via the telemetry device. There are currently more alarms at the bedside than can be transmitted to the Information Center.

The power consumption of the devices connected to the

Measurement Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel.

The power consumption of the devices connected to the

Measurement Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel.

61

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

MSL Power Overload

INOP tone.

!!/!!!NBP CUFF OVERPRESS

Numeric displayed with -?- ;

Severe yellow/red INOP tone.

During this INOP, alarms cannot be paused or switched off.

NBP Deactivated

INOP tone.

NBP EQUIP MALF

Numeric is replaced by -?-

INOP tone.

NBP INTERRUPTED

Numeric is replaced by -?-

INOP tone.

NBP MEASURE FAILED

Numeric may be displayed with a -?-

INOP tone.

No Central Monit.

INOP tone

NO ECG SOURCE

NO PPV FROM MeasSrv

at Information Center

NO PPV FROM <Device>

Source What to do

Monitor

NBP

NBP

The power consumption of the devices connected to the

Measurement Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off. Contact your service personnel.

The NBP cuff pressure exceeds the overpressure safety limits.

Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try restarting the measurement.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All

SmartKey is selected.

The NBP measurement label in the measurement device has been deactivated by deactivating the label in the Measurement

Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.

NBP

NBP

NBP

Monitor

Remove the cuff from the patient. The NBP hardware is faulty.

Contact your service personnel.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All

SmartKey is selected.

Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement.

If the INOP occurs repeatedly, contact your service personnel.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All

SmartKey is selected.

This INOP arises when the measurement needed longer than the maximum time for inflation, deflation or the total measurement.

Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement.

You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All

SmartKey is selected.

Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue measuring.

There is a problem with the communication to the network.

Central monitoring is currently not possible (no patient alarms or information). Check the connection. Contact your service personnel.

Telemetry A telemetry device is paired with the monitor but the

Information Center is not detecting a valid ECG signal from either of them.

MMS or

FMS

MMS or

FMS

The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.

The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.

62

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

No Tele Sett Sync

INOP tone

OUT OF AREA

P

/P1/P2/P3/P4 INOPS

PAP

INOPS

PPV BAD SIGNAL

at Information Center

Telemetry The MMS in use does not support synchronization of ECG and SpO

2

settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above.

Telemetry The telemetry device has left the access point coverage area.

PRESS

PRESS

PPV BAD <Pressure Label>

SIGNAL

PPV

PPV

See <Pressure label> INOPS (under Pressure).

See <Pressure label> INOPS (under Pressure).

The arterial pressure source selected for PPV is not providing a pulsatile signal.

The arterial pressure source selected for PPV is not providing a pulsatile signal.

PPV CHK SOURCES

PPV

<Pressure label> ARTIFACT

Numeric questionable

<Pressure label>

DEACTIVATED

INOP tone

<Pressure label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone.

PRESS

PRESS

PRESS

The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off.

A non-physiological event is detected (for example, a flush or blood sample). A resulting high limit alarm will be suppressed.

A Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either reconnect a

Pressure transducer or reactivate the measurement label in the

Measurement Selection window.

Contact your service personnel.

The pressure hardware is faulty.

<Pressure label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone.

PRESS Make sure that the pressure transducer is connected to the measurement device or module.

If you silence this INOP, the measurement will be switched off.

<Pressure label> NOISY

SIGNAL

Pulse numeric is replaced by -?-

INOP tone.

<Pressure label> NON-

PULSATILE

Pulse numeric is replaced by -?-

INOP tone.

<Pressure label>

OVERRANGE

Numeric is replaced by -?-

INOP tone.

<Pressure label> REDUCE

SIZE

PRESS

PRESS

PRESS

PRESS

This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse detector finds a pulse rate above 350bpm. This is usually caused by movement artifact or electrical interference.

This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate being measured is less than 25 beats per minute or the amplitude is less than three mmHg.

Check the catheter and connections to the patient.

Make sure that the measurement has been properly prepared and zeroed, and that the transducer is level with the heart. If this INOP persists, try another transducer.

Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the transducer.

Increase the scale for the pressure wave.

63

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

<Pressure label>

UNPLUGGED

INOP tone.

Source

PRESS

What to do

A Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement

Selection window.

Perform a zero and check the calibration of the transducer.

<Pressure label>

ZERO+CHECK CAL

Numeric is replaced by -?-

PRESS

<pTemp label> CHECK PROBE

Numeric is replaced by -?-

INOP tone.

Predictive

Temp

Check that the probe holder is correctly installed and that a compatible probe is in use. If the INOP does not clear, remove the probe from the holder then replace it. If the INOP still does not clear, disconnect and reconnect the probe.

The Predictive temperature has been deactivated.

<pTemp label> DEACTIVATED

INOP tone.

<pTemp label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

Predictive

Temp

Predictive

Temp

<pTemp label> INCOMPAT.

Predictive

Temp

<pTemp label> MEAS FAILED

Numeric is replaced by -?-

INOP tone.

Predictive

Temp

The Predictive Temperature hardware is defective. Contact your service personnel.

The Predictive Temperature version is not supported by the monitor.

The ambient temperature is outside the specified range (10 to

40 °C /50 to 104 °F). Bring the temperature into range to continue monitoring. If the INOP does not clear, disconnect and reconnect the probe.

Connect a probe to the Predictive temperature unit.

<pTemp label> NO PROBE

Numeric is replaced by -?-

INOP tone.

<pTemp label> OVERRANGE

Numeric is replaced by -?-

INOP tone.

<pTemp label> PROBE MALF

Numeric is replaced by -?-

INOP tone.

pTaxil INOPS pToral INOPS pTrect INOPS

(!!)PW:Action Required

Predictive

Temp

Predictive

Temp

Predictive

Temp

Predictive

Temp

Predictive

Temp

Predictive

Temp

Protocol

Watch

The temperature at the measurement site is out of range. Check that the probe is correctly located. If the INOP does not clear, disconnect and reconnect the probe.

The connected probe may be defective. Disconnect and reconnect the probe. If the INOP does not clear, try another probe.

See <pTemp label> INOPS

See <pTemp label> INOPS

See <pTemp label> INOPS

PW:Check Settings

PW in conflict

Protocol

Watch

Protocol

Watch

The protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response.

Contact your service personnel. Settings could not be loaded or interpreted correctly

There is a patient information mismatch which has not yet been resolved (>15 minutes).

64

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

RA LEAD OFF

Numeric is replaced by -?-

INOP tone.

RAP INOPS

Rem.Alarmdev.Malf

INOP tone

!!/!!! REPLACE BATTERY T

Severe yellow/red INOP tone.

During this INOP, alarms cannot be paused or switched off.

RESP EQUIP MALF

Numeric is replaced by -?-

INOP tone.

RESP ERRATIC

Numeric is replaced by -?-

RESP

RESP

RESP LEADS OFF

Numeric is replaced by -?-

INOP tone.

RL LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

Source What to do

ECG The RA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

See <Pressure label> INOPS (under Pressure).

PRESS

Monitor There is a problem with the connection to the remote alert device. Contact your service personnel to check the remote alert device and its connections.

Telemetry The battery in the telemetry device is almost empty and must be replaced.

RESP

Contact your service personnel. The RESP hardware is faulty.

The monitor has detected too many artifacts in the measured

Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out.

Not all the required leads for Resp monitoring are attached.

Make sure that the RA and LL leads are attached.

Settings Malfunc.

INOP tone.

SOME ECG ALARMS OFF

Speaker Malfunct.

INOP tone

SPIRO MALFUNCTION

SPIRO INCOMPATIBLE

SPIRO UPGRADE

SPIRO CANNOT MEAS

SPIRO PURGE FAILED

SPIRO UNKN. SENSOR

SPIRO ALARMS SUPPR

SPIRO PURGING

SPIRO NO SENSOR

ECG The RL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New

Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

Monitor The monitor cannot use the predefined settings for monitoring. Contact your service personnel.

Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current

Profile.

Monitor Contact your service personnel to check the speaker and the connection to the speaker.

Spirometry Module failure detected. Contact your service personnel.

Spirometry Module revision not compatible with the host monitor software revision. Contact your service personnel.

Spirometry The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring.

Spirometry Measurement is at its limit, e.g. ambient pressure out of range.

Spirometry The purge operation could not be completed successfully.

Check for kinked sensor tubings, hard occlusions and make sure that the pump is running and all valves are switching.

Spirometry An unknown sensor ID code was detected. Use only the sensors listed in the Accessories chapter.

Spirometry Alarming is suppressed for the spirometry module.

Spirometry A purge operation is in progress - no data update on the screen.

Wait until purge is complete.

Spirometry No sensor detected. Make sure the correct sensor is attached to the breathing circuit.

65

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

SPIRO NO BREATH

SPIRO GAS COMPENS?

SPIRO PATIENT CAT.

Δ

SpO

<SpO

2

2

CHK SOURCES

Numeric is replaced by -?-

Δ

SpO

2

CHK UNITS

Numeric is replaced by -?-

INOP tone

<SpO

2

label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

<SpO

2

label> ERRATIC

Numeric is replaced by -?-

INOP tone.

SpO

2

<SpO

2

label> EXTD. UPDATE

Label is displayed with a -?-

(questionable numeric)

SpO

2

<SpO

2

label> INTERFERNCE

Numeric is replaced by -?-

INOP tone.

SpO

2

<SpO

2

label> DEACTIVATED

Label is displayed with a -?-

(questionable numeric)

<SpO

2

Numeric is replaced by -?-

INOP tone.

<SpO

2

label> NON-PULSAT.

Numeric is replaced by -?-

INOP tone.

<SpO

2

Numeric is replaced by -?-

INOP tone.

<SpO

2

label> LOW PERF

label> NOISY SIGN.

label> NO SENSOR

LABEL> POOR SIGNAL

Label is displayed with a - ? -

(questionable numeric)

Spirometry No breath was detected for more than 25 seconds. Breath derived numerics are not available.

Spirometry Gas compensation is set to “gas analyzer” but not all gases necessary for compensation are measured by a gas monitor.

Some of the fall-back values provided by the user are used.

Measurement accuracy might be reduced.

Spirometry Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the Spirometry chapter.

SpO

2

Difference

SpO

2

Difference

SpO

2

Not all measurements or values required to perform the calculation are available. Check measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

SpO

2

The SpO

2

measurement label in the measurement device has been deactivated by deactivating the label in the Measurement

Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.

The MMS is faulty. Unplug and replug the MMS. If the INOP persists, contact your service personnel.

SpO

SpO

SpO

SpO

SpO

2

2

2

2

2

Check the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.

The update period of displayed values is extended due to an

NBP measurement on the same limb or an excessively noisy signal.

There is too much interference, caused by a high level of ambient light and/or electrical interference. Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is not damaged or positioned too close to power cables.

Accuracy may be compromised due to very low perfusion.

Stimulate circulation at sensor site. If INOP persists, change the measurement site.

Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce patient movement or to relieve the cable strain on the sensor.

Check the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the

NBP measurement is finished.

Make sure the SpO

2

sensor is connected. If the INOP persists, try another adapter cable and sensor. If you silence this INOP, the measurement will be switched off.

The signal condition of the SpO

2

measurement is poor and measurement accuracy may be compromised.

66

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

SvO

2

CAL REQUIRED

SvO

2

numeric is replaced by -?-.

INOP tone may sound

SvO

2

CONFIGURATION

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

CONNCT OPTMOD

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

EQUIP MALF

SvO

2

numeric is replaced by -?-.

INOP tone

Source

<SpO

2

LABEL> PULSE?

Numeric is replaced by -?-

INOP tone

SpO

2

<SpO

2

LABEL> SEARCHING

Numeric unavailable

<SpO

2

LABEL> UNKN.SENSOR

Numeric is replaced by a - ? -

SpO

2

<SpO

2

label> SENSOR MALF

Numeric is replaced by -?-

INOP tone.

SpO

2

SpO

2

<SpO

2

LABEL> SENSOR OFF

Numeric is replaced by -?-

INOP tone

SpO

2

SpO

2

<SpO

2

LABEL> UNPLUGGED

Numeric is replaced by -?-

INOP tone

SvO

SvO

SvO

2

2

2

What to do

The detectable pulsations of the SpO

2 specified pulse rate range.

signal are outside the

SpO

2

is analyzing the patient signal to derive Pulse, SpO

2

and

Perf values. Please wait until the search analysis is complete.

The SpO

2

sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.

The SpO

2

sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer.

The connected sensor or adapter cable is not supported by the

SpO

2

measurement. Use only specified sensors and cables.

An SpO

2

measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement

Selection window.

The SpO

2

measurement is currently in UPGRADE mode.

Monitoring is not possible in this mode.

<SpO

2

LABEL> UPGRADE

Label is displayed with a -?-, numeric is unavailable

SpO

2

Sp - vO

2

CHK SOURCES

Numeric is replaced by -?-

Sp - vO

2

Sp - vO

2

CHK UNITS

Numeric is replaced by -?-

Sp - vO

2

SvO

2

CAL FAILED

SvO

2

numeric is displayed with ?

SvO

2

SvO

SvO

2

2

CAL MODE

numeric is replaced by -?-

SvO

SvO

2

2

Not all measurements or values required to perform the calculation are available. Check measurement sources.

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

The calibration failed. Check the catheter-to-Optical-Module connection. Manually restart the calibration. Try another catheter and Optical Module. If the catheter is already inserted, perform an in-vivo calibration.

Pre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The catheter is now ready for insertion.

There is no valid calibration data in the Optical Module.

Perform either a pre-insertion or an in-vivo calibration.

The Optical Module has been configured to SaO

2

Change to SvO2

in the

Setup SvO2

menu to reconfigure to SvO

2

Mode.

Mode. Use

The Optical Module was disconnected during data storage.

Reconnect the Optical Module for at least 20 seconds.

The SvO

2

Module or Optical Module is faulty. Unplug and replug the Optical Module and SvO

2

module. Exchange the modules. If the INOP persists, contact your service personnel.

67

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

SvO

2

IN-VIVO CALIB

SvO

2

numeric is replaced by -?-.

SvO

2

LIGHT INTENS

SvO

2

numeric is replaced by -?- or numeric is displayed with ?

INOP tone with -?- display

SvO

2

LOW LIGHT

SvO

2

numeric is replaced by -?- or numeric is displayed with ?

INOP tone may sound

SvO

2

NO OPTMOD

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

OPTMOD DEFECT

SvO

2

OPTMOD WARMUP

SvO

2

numeric is displayed with ?

SvO

2

PRE-INS CALIB

SvO

2

numeric is replaced by -?-

INOP tone

SvO

2

UNABL TO MEAS

SvO

2

numeric is replaced by -?-.

INOP tone

SvO

2

UNPLUGGED

SvO

2

numeric is replaced by -?-.

INOP tone

SVR/SVRI CHK SOURCES

Numeric is replaced by -?-

SVR/SVRI CHK UNITS

Numeric is replaced by -?-

SVR/SVRI SET CVP USED

Numeric is replaced by -?-

T

/T1/T2/T3/T4 INOPs

Tamb

INOPs

Tart

INOPs

Tblood NO TRANSDUC

Numeric is replaced by -?-

INOP tone

Tblood OVERRANGE

Numeric is replaced by -?-

Tcereb

INOPS

Tcore

INOPs

Source What to do

SvO

SvO

SvO

SvO

SvO

SvO

SvO

SvO

2

2

2

2

2

2

2

2

The in-vivo calibration is not yet complete. Lab values must be stored to the Optical Module to complete the calibration.

Either continue with the next steps of the current calibration or recall the previous calibration.

The intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow.

Reposition the catheter and perform a light intensity calibration.

The optical signal levels are too low. Check that the catheter is either in the optical reference or inserted into the patient.

Check the catheter-to-Optical Module connection. If INOP persists, try another catheter and Optical Module.

Connect the Optical Module. If the INOP persists, try another

Optical Module. Silencing this INOP switches the measurement off.

The Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this feature is needed, use another Optical Module.

The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished.

The pre-insertion calibration is running. This typically takes one minute. During this time SvO

2

alarms are switched off.

Wait until the calibration is complete.

The signal is out of the normal range, and no SvO

2

value can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter.

SvO

2

Measurement switched on and SvO

2 the rack.

module unplugged from

The measurement automatically disappears from the display.

Silencing this INOP switches off the measurement.

SVR/SVRI Not all measurements or values required to perform the calculation are available. Check measurement sources.

SVR/SVRI The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

SVR/SVRI A CVP value is required for this calculation, but is not currently being measured. The monitor is using the CVP value preset in the

Setup SVR

menu.

TEMP See <Temp label> INOPs (under Temp)

TEMP

TEMP

C.O.

See <Temp label> INOPs (under Temp)

See <Temp label> INOPs (under Temp)

No transducer attached to the module or catheter disconnected.

C.O.

TEMP

TEMP

Tblood out of range 17°C - 43°C.

See <Temp label> INOPs (under Temp)

See <Temp label> INOPs (under Temp).

68

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication Source tcpO

2

(or tcpCO

2 or tcGas)

CAL FAILED

Numeric is replaced by -?-

INOP tone.

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

CAL REQUIRD

Numeric is replaced by -?-

INOP tone.

tcGas

What to do

A calibration failed. Check the cal. unit, gas pressure, and tubing connections, then restart the cal. If the cal. has failed more than once, remembrane the transducer and restart the calibration. If this INOP persists, contact your service personnel.

Calibration is required before applying the transducer to the patient.

Insert a membraned transducer into the cal. chamber on the module, connect the cal. unit to the cal. chamber, open the gas valve and start the calibration. If this INOP occurs during a calibration, there may be a module or transducer malfunction: contact your service personnel.

Wait until the tcpO

2

/tcpCO

2

calibration is finished.

tcpO

2

(or tcpCO

2 or tcGas)

CAL RUNNING

Numeric displays first -?- , then numeric is displayed with a ?

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

CHECK TIME

tcGas Site Timer due to time out in 15 minutes or less.

tcpO

2

(or tcpCO

2 or tcGas)

CHANGE SITE

If Heat Switch Off is configured to Yes, numeric is replaced by -?-

INOP tone. tcGas

tcpO

2

(or tcpCO

2 or tcGas)

EQUIP MALF

Numeric is replaced by -?-

INOP tone.

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

NO TRANSDUC

Numeric is replaced by -?-

INOP tone.

tcGas

Site Timer has timed out. Change the application site to avoid skin burns. To reset the Site Timer, either calibrate and change the measurement site, or change the measurement site and reset the Site Timer manually by selecting the appropriate site time from the

Setup TCGas

menu.

There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel.

No transducer is connected to the tcpO

2

/tcpCO

2

module.

Silencing the alarm switches off the measurement.

tcpO

2

(or tcpCO

2 or tcGas)

STABILIZING

Numeric is displayed with a ?

tcGas

tcpO

2

(or tcpCO

2 or tcGas)

UNPLUGGED

Numeric is replaced by -?-

INOP tone.

tcGas

TELE CONFIG UNSUPP

INOP tone

Monitor

TELE DISCONNECTED

INOP tone

TELE EQUIP MALF

INOP tone

The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes.

The measurement is switched on but the module is unplugged.

The measurement automatically disappears from the display.

Silencing this INOP switches off the measurement.

Telemetry device not supported (companion mode)

Telemetry The cable between the telemetry device and the monitor is disconnected

Monitor The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device.

!!/!!! TELE INOP

Severe yellow/red INOP tone.

Telemetry Check for further details at the Information Center or in the

Telemetry Data window on the monitor.

TELE UNSUPPORTED

INOP tone

<

Δ

Temp> CHK SOURCES

Numeric is replaced by -?-

Monitor

TEMP

Difference

This telemetry device is not supported for direct connection to the monitor.

Not all measurements or values required to perform the calculation are available. Check measurement sources.

69

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

INOP Message, Indication

<

Δ

Temp> CHK UNITS

Numeric is replaced by -?-

<Temp label> DEACTIVATED

INOP tone

Source

TEMP

Difference

TEMP

TEMP

What to do

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

A Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either reconnect a Temp transducer or reactivate the measurement label in the

Measurement Selection window.

Contact your service personnel.

The temperature hardware is faulty.

<Temp label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

<Temp label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone.

<Temp label> UNPLUGGED

INOP tone

TEMP

TEMP

Make sure the TEMP probe is connected to the MMS or module.

If you silence this INOP, the measurement will be switched off.

TEMP

A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement

Selection window.

Try changing the application site of the transducer.

[The temperature is less than -1

°

C, or greater than 45

°

C.]

<Temp label> OVERRANGE

Numeric is replaced by -?-

INOP tone.

Tesoph

INOPS

TimeExpired:<

timer label>

INOP tone

Tnaso

INOPS

Trect

INOPS

Tskin

INOPS

Ttymp

INOPS

Tven

INOPS

Tvesic

INOPS

UAP

INOPS

Unsupported LAN

INOP tone

User I/F Malfunct

.

INOP tone.

UVP

INOPS

V LEAD OFF

Numeric is replaced by -?- for 10 seconds; INOP tone.

TEMP

Monitor

TEMP

TEMP

TEMP

TEMP

TEMP

TEMP

PRESS

Monitor

Monitor

PRESS

ECG

See <Temp label> INOPs (under Temp).

The time has expired for the timer indicated in the INOP text.

Clearing the timer clears the INOP.

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp)

See <Temp label> INOPs (under Temp).

See <Temp label> INOPs (under Temp)

See <Pressure label> INOPS (under Pressure).

There is a problem with the communication to the network and central monitoring is currently not possible. Check the connection.If the INOP persists, switch off the monitor and contact your service personnel.

Perform a visual and functional check of all the monitor input devices. Contact your service personnel.

See <Pressure label> INOPS (under Pressure).

The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select

New Lead Setup

in the

Setup ECG

menu to confirm the new lead set.

70

Technical Alarm Messages (INOPs)

4 Patient Alarms and INOPs

INOP Message, Indication

<VueLink option> CHK

CABLE

INOP tone.

<VueLink option> CHK

CONF.

INOP tone.

VueLnk NO CONFIG

INOP tone.

VueLnk UNPLUGGED

INOP tone.

Source

VueLink

VueLink

<VueLink option> CHECK

SETUP

INOP tone.

VueLink

VueLnk EQUIP MALF

INOP tone.

VueLink

VueLink

VueLink

What to do

No cable or the wrong cable connected to the VueLink module, or incorrect device selected. Silencing this INOP switches the measurement off.

VueLink INOP abbreviations may differ slightly depending on the device category.

The wrong external device has been selected on the VueLink module, or the external device has not been correctly setup, or the wrong cable has been used to connect the device to the

VueLink module.

VueLink INOP abbreviations may differ slightly depending on the device category.

No information was received from the external device. The device may be switched off or disconnected.

VueLink INOP abbreviations may differ slightly depending on the device category.

Malfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.

VueLink INOP abbreviations may differ slightly depending on the device category.

The VueLink module has not been configured during installation. The installation process should be completed by either your biomedical engineering department or the Philips service engineer.

VueLink INOP abbreviations may differ slightly depending on the device category.

The VueLink module has been unplugged from the rack, or the whole rack has been disconnected. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.

VueLink INOP abbreviations may differ slightly depending on the device category.

71

4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

72

5

5

Managing Patients

Use the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer

(ADT) patients.

All patient demographic and ADT information is shared between the patient monitor and the

Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center.

Admitting a Patient

The monitor displays physiological data and stores it in the trends as soon as a patient is connected.

This lets you monitor a patient who is not yet admitted. It is however important to admit patients properly so that you can identify your patient on recordings, reports, and networked devices.

During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

To admit a patient,

1

Select the patient name field or select the

Patient Demographics

window.

Admit/Dischrge

SmartKey to open the

SBed10 Adult

Doe, John

Patient Demographics

Last Name : Doe

First Name : John

MRN : 12345678

Patient

Cat.

Admit

Patient

: Adult

Transfer

Discharge

Patient

End

Case

73

5 Managing Patients

Admitting a Patient

2

Clear any previous patient data by selecting the

Dischrge Patient

or

End Case

pop-up key and then

Confirm

.

If you do not discharge the previous patient, you will not be able to distinguish data from the previous and current patients, for example, in the trend database.

Select Admit Patient.

3

4

Enter the patient information: select each field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information.

Last name

: Enter the patient’s last name (family name), for example

Smith.

First name

: Enter the patient’s first name, for example

Joseph.

MRN

: Enter the patient’s medical record number (MRN), for example

12345678.

Patient Cat

: Choose the patient category, either Adult, Pediatric, or Neonatal.

Paced

: Choose Yes or No (You must use “Yes” if your patient has a pacemaker).

Height

: Enter the patient’s height.

Weight

: Enter the patient’s weight.

BSA

: The monitor calculates the body surface area automatically.

Date Of Birth

: Enter the patient’s date of birth. Enter this in the form dd/mm/yyyy.

Age

: The monitor calculates the patient age automatically.

Gender

: Choose Male or Female.

Notes

: Enter any extra information about the patient or treatment.

5

Select

Confirm.

The patient status changes to admitted.

Patient Category and Paced Status

The patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is set to No, pace pulses are filtered and therefore do not show in the ECG wave.

WARNING Patient Category

and Paced status will always contain a value, regardless of whether the patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the default settings from the current profile, which might not be correct for your patient.

Patient category Changing the patient category may change the arrhythmia and NBP alarm limits.

Always check alarm limits to make sure that they are appropriate for your patient.

Paced status For paced patients, you must set

Paced

to Yes. If it is incorrectly set to No, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole.

Admitting a Centrally-Monitored Patient

You can admit a patient at either the bedside or the Information Center. When you admit a patient, the patient’s name appears on the bedside monitor and the Information Center.

If you do not fill in all patient information required by the Information Center, the Information

Center may reject the admission. Complete all the required fields and try again to admit the patient.

74

Quick Admitting a Patient

5 Managing Patients

Quick Admitting a Patient

3

4

Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later.

1

2

Select the

Quick Admit

SmartKey.

Enter the required data (MRN or Last Name depending on configuration) with the keyboard.

Select Enter.

In the confirmation window, select

Confirm

to discharge the previous patient (if confirmation is configured).

5

Check that patient category and paced status are correct for the new patient.

If the monitor is connected to an Information Center and only the MRN is entered, the patient name is set to - - - at the Information Center. Complete the rest of the demographic details as soon as possible to fully identify the patient on the network, on the monitor and on printed reports. To complete the details, select Admit

Patient

again and complete all required fields.

Editing Patient Information

To edit the patient information after a patient has been admitted, select the patient name field on the

Main Screen to open the

Patient Demographics

window, and make the required changes.

Discharging a Patient

You should always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. A discharge:

– clears the information in the Patient Demographics window

– erases all patient data (including trend data) from the monitor and Information Center. This ensures that data from a previous patient are not mixed with data from the new patient.

– resets patient category and paced settings to the settings defined in the default Profile

– resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile

– discharges the patient from the Information Center.

When a patient is discharged from the monitor or from an Information Center, all patient data is deleted. Make sure that you have printed out any required reports before discharging. Check that a functioning central printer is available before you use End Case.

To discharge a patient,

1

Select the patient name field or select the

Admit/Dischrge

SmartKey to open the

Patient Demographics

window and associated pop-up keys.

2

Select the pop-up key for either:

End Case - to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an End Case SmartKey is configured for your monitor, you can also select this instead and then confirm.

To see which end case reports are set up for your monitor, select Main Setup -> Reports ->

Auto Reports

. For each auto report, if End Case Report is set to On, this report will

75

5 Managing Patients

Transferring Patients be printed when you select End Case. See the section on AutoReports for information on setting up end case reports.

Dischrge Patient - to discharge the patient without printing any reports.

New Patient Check

The monitor can be configured to ask you in certain situations:

• after a specified power-off period

• after a specified standby period

• when no basic vitals (HR, RR, Pulse, SpO

2

, NBP) have been measured for a specified period whether a new patient is now being monitored. The pop-up window is entitled Is this a new

Patient?

. The monitor offers a Yes key to discharge the previous patient and begin monitoring a new patient and a No key to continue monitoring with the current patient data and settings.

The time periods for the three conditions can be configured independently.

Transferring Patients

To save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, patient demographic information is shared between patient monitors and

Information Centers.

Transferring a Centrally-Monitored Patient with the Monitor

Scenario: A centrally-monitored patient is moved with the monitor to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information.

1

Select the patient name field or select the

Admit/Dischrge

SmartKey to open the

Patient Demographics

window, then select the Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive

(“grayed-out”).

This step preserves the patient’s demographic data during the transfer.

2

At the new location, connect the monitor to the network (only needed for wired networks). If the

monitor detects a patient conflict, the patient selection window will be displayed. See “Resolving

Patient Information Mismatch” on page 77.

Verify that the settings for patient category and paced mode are correct.

3

If you accidentally transfer a patient, use

Re-admit

to restore this patient’s data to the Information

Center. If you are not connected to the network, select

Clear Transfer

to leave transfer mode. The patient data remains in the monitor.

Data Exchange Between Information Centers

You can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors.

76

Transferring Patients

5 Managing Patients

Resolving Patient Information Mismatch

When you connect a monitor to the network, the monitor compares patient category, paced status, and a unique patient identification number that is internally stored in the monitor. The monitor indicates a mismatch if the information is not identical.

WARNING

When a monitor is connected to an Information Center by the wireless IntelliVue Instrument

Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary.

Manually Resolving Patient Mismatch

The source of the patient mismatch is indicated by question marks (???) and displayed in the status line at the bottom of the screen (Patient???, Patient Category??? or Paced???).

The Patient Selection window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, but the indicators remain until you do.

After you resolve the mismatch, the monitor displays a confirmation window that explains the consequences of your choice, telling you where the patient will be continued/discontinued. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.

Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the monitor. Always check the Patient

Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.

WARNING After resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient.

77

5 Managing Patients

Transferring Patients

Patient Mismatch - If One Set of Patient Data is Correct

If there is a mismatch between an

Information Center and a monitor, choose the data set you want to continue using for this patient, either:

Continue Central: to continue with the patient demographics from the

Information Center, discharge the patient in the monitor, and use the default monitor profile.

Continue Monitor: to continue with the patient in the monitor and discharge the patient in the

Information Center, permanently deleting all data in the Information

Center.

Patient Selection

Last name

First name

MRN

Patient Cat Adult

Paced

Central

DOE

JOHN

1234HG9556

No

Continue

Central

Continue

Monitor

New

Monitor

MILLER

Neo

Yes

Patient

Same

Patient

78

6

6

ECG, Arrhythmia, ST and QT

Monitoring

The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see

page 94), ST monitoring (see page 104) and QT monitoring (see page 114).

Skin Preparation for Electrode Placement

4

5

Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity.

1

2

Select sites with intact skin, without impairment of any kind.

Clip or shave hair from sites as necessary.

3

Wash sites thoroughly with soap and water, leaving no soap residue.

We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.

Dry skin thoroughly.

Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site.

Connecting ECG Cables

1

2

Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.

Place the electrodes on the patient according to the lead placement you have chosen.

79

6 ECG, Arrhythmia, ST and QT Monitoring

Selecting the Primary and Secondary ECG Leads

ECG Connector

CAUTION

3

4

Attach the electrode cable to the patient cable.

Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display.

To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips.

Selecting the Primary and Secondary ECG Leads

The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.

The secondary lead setting is used only if your monitor is configured for multi-lead (instead of singlelead) arrhythmia analysis. It determines which additional lead will be used for arrhythmia analysis.

You should choose a lead as primary or secondary lead that has the following characteristics:

• the QRS should be either completely above or below the baseline and it should not be biphasic

• the QRS should be tall and narrow

• the P-waves and T-waves should be less than 0.2 mV

To select a lead as primary or secondary lead:

In the

Setup ECG

menu, select

Primary

or

Secondary

, then select the appropriate lead. You can assign any available lead whether it is currently displayed or not.

Checking Paced Status

It is important to set the paced status correctly when you start monitoring ECG.

To change the paced status in the

Setup ECG

menu, select

Paced

to toggle between

Yes

or

No

.

WARNING

Pace pulse rejection must be switched on for paced patients by setting “Paced” to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient.

80

Understanding the ECG Display

6 ECG, Arrhythmia, ST and QT Monitoring

Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias.

Keep pacemaker patients under close observation.

Understanding the ECG Display

Your display may be configured to look slightly different.

1 mV calibration bar

Lead label

Pace pulse markers

Pacer spikes of the displayed wave

M

EASI

ECG Filter label

EASI lead placement label

Paced Rhythm

Current heart rate

Current heart rate alarm limits

HR bpm

ECG numeric: This is derived from the monitored ECG.

Pace pulse markers: These are shown if the

Paced

status has been set to

Yes

, the pacer spikes are not configured to have a fixed size, and the patient has a paced signal.

Pacer Spikes: The pacer spikes are shown in white, unless the ECG wave is white, then they will be green. If the pacer spikes have been configured to have a fixed size, they will be displayed in the background as a dotted line.

Pacer spikes configured to have a fixed size

Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave. The synchronization marks will be shown in yellow, unless the ECG wave is yellow, then they will be green.

ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the bottom left.

Monitoring Paced Patients

An ECG optimized for monitoring a paced patient should look like this:

Normal Beats Pace Pulses/Beats

81

6 ECG, Arrhythmia, ST and QT Monitoring

Changing the Size of the ECG Wave

You should choose a lead as primary or secondary lead that has these characteristics:

• the normal QRS should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.

• the QRS should be tall and narrow

• the P-waves and the T-waves should be less than 0.2 mV.

For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They are then shown in the background as a dotted lines. The length of the dotted line is fixed to the wave channel height and is independent of the actual pacer amplitude.

Setting the Paced Status (Pace Pulse Rejection)

In the

Setup ECG

menu, select

Paced

to toggle between

Yes

and

No

.

You can also change the paced status in the Patient Demographics window.

Paced

When

Paced

is set to

Yes

:

– Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes.

Non-Paced

– pace pulse marks are shown on the ECG wave as a small dash (only when the pacer spikes are not configured to have a fixed size)

– the paced symbol is displayed under the HR label.

When

Paced

is set to

No

, pacer spikes are not shown in the ECG wave. Be aware that switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected.

Avoiding Pace Pulse Repolarization Tails

Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as

QRSs in the event of cardiac arrest or other arrhythmias.

If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.

Repolarization tail

(note width)

Changing the Size of the ECG Wave

If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the

ECG waves on the screen.

Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor.

82

Changing the Volume of the QRS Tone

6 ECG, Arrhythmia, ST and QT Monitoring

Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose AutoSize, the calibration bar may be a different size for each wave.

To Change the Size of an Individual ECG Wave

1

Select the wave segment you want to change. This calls up the lead menu for this segment.

2

In the lead menu, select

Size Up

to increase wave size or

Size Down

to decrease the size.

Selecting

AutoSize

lets the monitor choose the optimal adjustment factor for all displayed ECG waves.

To Change the Size of all the ECG Waves

To change the size of all the ECG waves on the screen by a fixed adjustment factor,

1

In the

Setup ECG

menu, select

Adjust Size

.

2

Select the required adjustment factor from the line of pop-up keys.

Size x0.5

to halve the wave size

Size x1

to display the wave without zoom

Size x2

to double the wave size

Size x4:

to multiply the wave size by four

Changing the Volume of the QRS Tone

The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off).

To change the QRS volume, in the

Setup ECG

appropriate volume from the pop-up list.

menu select

QRS Volume

and then select the

Changing the ECG Filter Settings

The ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.

To change the filter setting, in the appropriate setting.

Setup ECG

menu, select

Filter

and then select the

Monitor

: Use under normal measurement conditions.

Filter

: The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electro-surgical units. Under normal measurement conditions, selecting

Filter

may suppress the QRS complexes too much and thus interfere with the clinical

83

6 ECG, Arrhythmia, ST and QT Monitoring

Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor.

If

AutoFilter

is set to

On

in Configuration Mode, the filter setting will automatically be set to

Filter

if electromagnetic interference is detected.

Diag

(Diagnostic): Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible.

The setting

Diag

selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the

Adult, Pedi and Neo patient category. The term “diagnostic” relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/AAMI standard

EC11-1991.

Selecting Positions of Va and Vb Chest Leads (for 6lead placement)

The two chest leads for the 6-lead placement can be positioned at any two of the V1 to V6 positions.

Select the positions you have used in the

Setup ECG

menu, so that the chest leads will be correctly labeled.

1

2

In the

Setup ECG

menu, select

Va Lead

.

Select the position used from the list.

3

Select

Vb Lead

and select the position used from the list

Choosing EASI or Standard Lead Placement

You must enable either standard lead placement or EASI lead placement.

In the

Setup ECG

menu, select

Placement

and then

Standard

or

EASI

.

EASI

is shown beside the 1mV calibration bar on the ECG wave on the display, and

EASI

is marked on any printouts.

See the section on EASI ECG Lead Placement for electrode placement diagrams.

About ECG Leads

To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called “leads.” To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor.

When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis.

Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location.

84

ECG Lead Fallback

6 ECG, Arrhythmia, ST and QT Monitoring

ECG Leads Monitored

If you are using these leads are available:

I, II, III

I, II, III, aVR, aVL, aVF, V and MCL

I, II, III, aVR, aVL, aVF, Va, Vb

Resp is measured between electrodes:

RA and LL a 3-electrode set a 5-electrode set a 6-electrode set

RA and LL

RA and LL a 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A

Changing Lead Sets

To change the ECG lead set,

1

2

Remove the electrodes and then replace them as required.

If the new lead set has more leads than the previous, the monitor automatically recognizes the new lead placement. If the new lead set has fewer leads, then you must select

New Lead Setup

in the

Setup ECG

menu. If you remove electrodes and do not select

New Lead Setup

, the monitor will issue a Lead Off INOP message. Select

New Lead Setup

and the INOP message will disappear.

ECG Lead Fallback

If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback.

When the Leads Off condition is corrected, the leads are automatically switched back.

This setting can only be changed in Configuration Mode.

ECG Lead Placements

The labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.

Electrode labels

AAMI EASI IEC

RA I

LA S

LL A

RL N

V E

V1

V2

C

C1

C2

R

L

F

N

Electrode colors

AAMI

White

Black

Red

Green

Brown

Brown/Red

Brown/Yellow

IEC

Red

Yellow

Green

Black

White

White/Red

White/Yellow

85

6 ECG, Arrhythmia, ST and QT Monitoring

ECG Lead Placements

Electrode labels

AAMI

V3

V4

V5

V6

EASI IEC

C3

C4

C5

C6

Standard 3-Lead Placement

Electrode colors

AAMI

Brown/Green

Brown/Blue

Brown/Orange

Brown/Violet

RA

LA

IEC

White/Green

White/Brown

White/Black

White/Violet

RA placement: directly below the clavicle and near the right shoulder

LA placement: directly below the clavicle and near the left shoulder

LL placement: on the left lower abdomen

LL

Standard 5-Lead Placement

RA

II aVR

V

I aV

L aV

F

III

LA

RA placement:

directly below the clavicle and near the right shoulder

LA placement:

directly below the clavicle and near the left shoulder

RL placement:

on the right lower abdomen

LL placement:

on the left lower abdomen

V placement:

on the chest, the position depends on your required lead selection

RL

LL

86

ECG Lead Placements

6 ECG, Arrhythmia, ST and QT Monitoring

6-Lead Placement

For a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and Vb, can be positioned at any two of the V1 to V6 positions shown in the chest electrode diagram below. The Va and Vb lead positions chosen must be selected in the ECG Setup

Menu to ensure correct labeling.

Chest Electrode Placement

For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space.

1

2

Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.

Palpate and count down the chest until you locate the fourth intercostal space.

Angle of

Lewis

2

3

4

V4R

V3R

V1

VE

V2

V3

V4

V5

V6

V7

V1 placement: on the fourth intercostal space at the right sternal border

V2 placement: on the fourth intercostal space at the left sternal border

V3 placement: midway between the

V2 and V4 electrode positions

V4 placement: on the fifth intercostal space at the left midclavicular line

V5 placement: on the left anterior axillary line, horizontal with the V4 electrode position

V6 placement: on the left midaxillary line, horizontal with the V4 electrode position

V3R to V6R placement: on the right side of the chest in positions corresponding to those on the left

VE placement: over the xiphoid process

V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal space

V7R placement: on posterior chest at the right posterior axillary line in the fifth intercostal space

87

6 ECG, Arrhythmia, ST and QT Monitoring

ECG Lead Placements

10-Lead Placement

When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement.

Conventional 12-Lead ECG

RA

V1 - V6

LA

In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.

Limb electrodes:

– Place arm electrodes on the inside of each arm, between the wrist and the elbow.

– Place leg electrodes inside of each calf, between the knee and the ankle.

Chest electrodes:

V1 - on the 4th intercostal space at the right sternal border

V2 - on the 4th intercostal space at the left sternal border

V3 - midway between the V2 and V4 electrode positions

V4 - on the 5th intercostal space at the left midclavicular line

V5 - on the left anterior axillary line, horizontal with the V4 electrode position

V6 - on the left midaxillary line, horizontal with the V4 electrode position

RL

LL

88

Capture 12-Lead

Modified 12-Lead ECG

Angle of Lewis

RA

6 ECG, Arrhythmia, ST and QT Monitoring

LA

V1 - V6

If your institution uses modified 10

Lead ECG electrode placement (the

Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen.

The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.

RL LL

Choosing Standard or Modified Electrode Placement

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch

ModLdPlcmt

to

On

in the monitor. To do this,

♦ in the

Setup ECG

menu, select

ModLdPlcmt

to toggle between

On

and

Off

.

– When

ModLdPlcmt

is set to

On

, 12 Lead ECG Reports will be labelled

12 Lead ECG Report

(Mason-Likar)

, and captured 12-lead ECGs will be labelled

Mason-Likar

to the right of the bandwidth annotation at the Information Center.

– When

ModLdPlcmt

is set to

Off

, 12 Lead ECG Reports will be labelled

12 Lead ECG

Report

, and captured 12-lead ECGs will not be annotated at the Information Center.

WARNING Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead

ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and

ST slope.

Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.

Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label.

Capture 12-Lead

If the monitor is connected to an Information Center via a wired network, the

Capture 12-Lead

SmartKey may be configured. Selecting this exports 12-Lead ECG information to the Information

Center for analysis. For details see the Instructions for Use supplied with the Information Center.

89

6 ECG, Arrhythmia, ST and QT Monitoring

EASI ECG Lead Placement

EASI ECG Lead Placement

Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia.

WARNING

EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead

ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional

ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.

Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I and A electrodes.

Place the electrodes as accurately as possible to obtain the best quality EASI measurements.

When EASI lead placement is selected,

EASI

is shown beside the 1mV calibration bar on the ECG wave on the display, and

EASI

is marked on any recorder strips and printouts.

When EASI lead placement is selected,

EASI

is shown beside the 1mV calibration bar on the ECG wave on the display, and

EASI

is marked on any printouts.

EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP condition (for example,

LEAD OFF

), a flat line is displayed. After 10 seconds, the directly acquired

EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn.

4

3

1

2

EASI Electrode Placement

1

E (V) on the lower sternum at the level of the fifth intercostal space

2

A (LL)

3

S (LA) on the left midaxillary line at the same level as the E electrode on the upper sternum

4

I (RA)

5

N on the right midaxillary line at the same level as the E electrode reference electrode - can be anywhere, usually below the sixth rib on the right hip

5

90

ECG and Arrhythmia Alarm Overview

6 ECG, Arrhythmia, ST and QT Monitoring

ECG and Arrhythmia Alarm Overview

The ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.

• Cardiotach alarms are available when HR is on and the active alarm source is ECG, but arrhythmia is switched off

• Basic arrhythmia alarms are available when Arrhythmia is switched on

• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced

Arrhythmia option has been enabled for your monitor

Cardiotach Alarms

***Asystole

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**High heart rate

**Low heart rate

Additional Alarms with Basic

Arrhythmia Option

Additional Alarms with

Enhanced Arrhythmia

Option

***Ventricular Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**Frequent PVCs (PVC > limit/ min)

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Nonsustained V-Tach

**Multiform PVCs

91

6 ECG, Arrhythmia, ST and QT Monitoring

Using ECG Alarms

Using ECG Alarms

ECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to

ECG are described here.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value (the

Δ value) to the high and low alarm limits.

Extreme

Brady Limit

Low

Limit

High

Limit

Extreme

Tachy Limit

Δ Extreme Brady

Δ Extreme Tachy

You need to know which value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the extreme rate alarms set for your monitor, in the

Setup ECG

menu, see the menu items

Δ

ExtrTachy

and

Δ

ExtrBrady

.

ECG Alarms Off Disabled

Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitor’s Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring

Mode. If you try to switch off the HR alarms, you will see the message

To activate enter

Config and enable Alarms Off

.

HR Alarms When Arrhythmia Analysis is Switched Off

When arrhythmia analysis is switched off, only these HR-related alarms will be detected:

• the asystole alarm

• the ventricular fibrillation/tachycardia alarm

• the extreme tachycardia and extreme bradycardia alarms

• the high heart rate and low heart rate alarms.

Enhanced Asystole Detection

In order to improve alarming on asystole under certain conditions, you can set

Asystole

Detection

in Configuration Mode to

Enhanced

. In enhanced mode an asystole alarm will be suppressed for up to five seconds if a valid beat-to-beat Pulse is detected from a Pressure.

92

ECG Safety Information

ECG Safety Information

6 ECG, Arrhythmia, ST and QT Monitoring

CAUTION

Interference from instruments near the patient and ESU interference can cause problems with the

ECG wave. See the monitor specifications for more information.

WARNING

Defibrillation and Electrosurgery: Do not touch the patient, or table, or instruments, during defibrillation.

After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions.

ECG cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again.

According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your

ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.

When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal.

General: When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth.

During surgery: Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.

Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves

(greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest.

Patients exhibiting intrinsic rhythm: When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest.

The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patient’s heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined.

Filtered ECG signal from external instruments: Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance.

93

6 ECG, Arrhythmia, ST and QT Monitoring

About Arrhythmia Monitoring

External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse.

This may result in the arrhythmia algorithm’s failure to detect pacemaker noncapture or asystole.

Fusion beat pacemakers: Pacemakers that create fusion beats (pace pulse on top of the QRS complex) cannot be detected by the monitor’s QRS detector.

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.

About Arrhythmia Monitoring

Arrhythmia analysis provides information on your patient’s condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously

• optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.

• detects beats, for example, QRS complexes, identifying them for further analysis.

• measures signal features such as R-wave height, width, and timing.

• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.

• examines the ECG signal for ventricular fibrillation, asystole, and noise.

Arrhythmia Options

Your monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labelling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different

options are listed in the section “ECG and Arrhythmia Alarm Overview” on page 91, the rhythm and

ectopic messages detected are listed in “Arrhythmia Status Messages” on page 97.

Where Can I Find More Information?

See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed information on the arrhythmia algorithm and its clinical application.

94

Switching Arrhythmia Analysis On and Off

6 ECG, Arrhythmia, ST and QT Monitoring

Switching Arrhythmia Analysis On and Off

1

2

In the

Setup Arrhy

menu, select

Arrhythmia

to toggle between

On

and

Off

.

Select the

Confirm

pop-up key which appears at the bottom of the screen.

Be aware that when arrhythmia analysis is switched off,

– the message

Arrhythmia Off

appears beside the ECG wave, if configured to do so

– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/ tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate and low heart rate alarms)

– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.

Choosing an ECG Lead for Arrhythmia Monitoring

It is important to select a suitable lead for arrhythmia monitoring.

Guidelines for non-paced patients are:

– QRS should be tall and narrow (recommended amplitude > 0.5 mV)

– R-Wave should be above or below the baseline (but not bi-phasic)

– T-wave should be smaller than 1/3 R-wave height

– the P-wave should be smaller than 1/5 R-wave height.

For paced patients, in addition to the above, the pace pulse should be:

– not wider than the normal QRS

– the QRS complexes should be at least twice the height of pace pulses

– large enough to be detected, with no re-polarization.

To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for

QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.

Aberrantly-Conducted Beats

As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.

Atrial Fibrillation and Flutter

Since P-waves are not analyzed, it is not possible to discriminate atrial rhythms. If there is constant variance in the R-R interval, the rhythm is classified as Irregular. It is extremely important for accurate analysis of the rhythm to have p-waves with an amplitude of less than 1/5 the height of the R-wave or

< 0.15 mV. If the p-waves are larger than this, they may be counted as QRS complexes.

95

96

6 ECG, Arrhythmia, ST and QT Monitoring

Understanding the Arrhythmia Display

Intermittent Bundle Branch Block

Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the

QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.

Understanding the Arrhythmia Display

Your monitor screen may look slightly different from the illustration.

II

M

Beat label

P

1mV

P

Pace pulse marks

P

Delayed

Rhythm status message

Paced Rhythm

Pair PVCs

PVC Numeric

HR Numeric

PVC

HR

2

75

Ectopic status message

Delayed arrhythmia wave

Viewing Arrhythmia Waves

To review arrhythmia beat labels, in the

Setup Arrhy

menu, select

Annotate Arrhy

.

The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey background. Beat labels will be annotated above the ECG wave and

Delayed

will be written beside it.

To return to the normal ECG primary lead display, select

Annotate Arrhy

again.

Arrhythmia Beat Labels

Arrhythmia beat labels tell you how the monitor is classifying beats.

N

= Normal

V

= Ventricular Ectopic

S

= Supra-ventricular Premature

P

= Paced

'

= Pacer spike

“ = Biventricular Pacer Spike

L

= Learning patient's ECG

A

= Artifact (noisy episode)

?

= Insufficient information to classify beats

I

= Inoperative condition (e.g., LEADS OFF)

M

= Pause or missed beat

Understanding the Arrhythmia Display

6 ECG, Arrhythmia, ST and QT Monitoring

Arrhythmia Status Messages

The monitor displays two types of status messages:

• Rhythm Status Messages -- to indicate the patient’s rhythm.

• Ectopic Status Messages -- to indicate the presence of ectopic beats.

These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.

The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats.

If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level.

Rhythm Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Rhythm Status Message Description B or E

ASYSTOLE

VENT FIB/TACH

V-TACH

SUST V-TACH

VENT RHYTHM

VENT BIGEMINY

VENT TRIGEMINY

PACED RHYTHM

IRREGULAR HR

No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal

A fibrillatory wave for 4 consecutive seconds

B, E

B, E

A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart

Rate Limit

B, E

Ventricular tachycardia rhythm for more than 15 seconds

A dominant rhythm of adjacent PVCs and a HR

the V-Tach HR

Limit

E

E

A dominant rhythm of N, V, N, V

A dominant rhythm of N, N, V, N, N, V

A dominant rhythm of paced beats

Consistently irregular rhythm

A dominant rhythm of SV beats preceded by P-waves

E

E

B, E

E

B, E

SINUS BRADY

SINUS RHYTHM

SINUS TACHY

SV BRADY

SV RHYTHM

SV TACHY

A dominant rhythm of SV beats not preceded by P-waves

UNKNOWN ECG RHYTHM

Rhythm cannot be determined

LEARNING ECG

Algorithm is learning the ECG beat morphology

LEARNING RHYTHM

Algorithm is learning the rhythm of the classified beats

CANNOT ANALYZE ECG

ECG signal is predominantly invalid and therefore cannot be analyzed

B, E

B, E

B, E

B, E

B, E

97

6 ECG, Arrhythmia, ST and QT Monitoring

Arrhythmia Relearning

Ectopic Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Ectopic Status Message Explanation B or E

(No message displayed) No ectopic activity within the last minute

RUN PVCs

PAIR PVCs

More than 2 consecutive PVCs within the last minute

Pair PVCs within the last minute

PACER NOT CAPT

PACER NOT PACE

PAUSE

Pause with pace pulse (paced patient only) within the last minute

E

E

B, E

Pause without pace pulse (paced patient only) within the last minute B, E

No beat detected for 1.75 x average R-R interval for HR <120, or

No beat for 1 second with HR >120 (non-paced patient only), or

No beat detected for more than the set pause threshold.

E

R-ON-T PVCs

MULTIFORM PVCs

FREQUENT SVPBs

SVPBs

SV BEATS

PACED BEATS

R-ON-T detected within the last minute

Multiform PVCs detected within the last minute

SVPB count within last minute is greater than 5

1-5 SVPBs in the last minute with a sinus rhythm and no Vs

SV count within last minute and rhythm status is PACED

Paced beat count within last minute and rhythm status is NOT

PACED

E

E

E

E

B, E

B, E

Arrhythmia Relearning

During a learning phase:

• Alarm timeout periods are cleared

• Stored arrhythmia templates are cleared

Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.

Initiating Arrhythmia Relearning Manually

1

To initiate relearning manually, in the

Setup Arrhy

menu, select

Relearn Arrhy

.

– While the monitor is learning, the delayed arrhythmia wave displays the beat label

L

and the rhythm status message

LEARNING ECG

.

– Next, the monitor determines the dominant rhythm. The beats are labeled

N

, and the rhythm status message changes to

LEARNING RHYTHM

.

2

3

After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly.

If beats are still not classified correctly, check that the ECG is optimized for arrhythmia monitoring. You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves.

98

Arrhythmia Alarms

6 ECG, Arrhythmia, ST and QT Monitoring

Automatic Arrhythmia Relearn

Arrhythmia relearning is initiated automatically whenever:

• ECG monitoring is switched on

• The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs

• A

Leads Off

INOP condition (that has been active for > 60 seconds) ends.

If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled

L

and there is no

LEARNING ECG

rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active.

Arrhythmia Relearn and Lead Fallback

Lead fallback triggers an automatic arrhythmia relearn.

WARNING

If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-

Fib.

For this reason you should:

• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free

• be aware that arrhythmia relearning can happen automatically

• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)

• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads

• always ensure that the arrhythmia algorithm is labeling beats correctly.

Arrhythmia Alarms

Arrhythmia alarms can be switched on and off and the settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here.

The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter.

The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).

99

6 ECG, Arrhythmia, ST and QT Monitoring

Arrhythmia Alarms

Yellow Arrhythmia Alarms

Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions.

Depending on your monitor and Information Center configuration, they may be shown with one or two stars.

WARNING

When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This means that the yellow alarm lamp and the tones are active for a six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. Red alarms behave as usual.

Arrhythmia Alarms and Latching

When using arrhythmia analysis,

Visual Latching

and

Audible Latching

should be on for red alarms, or at least

Visual Latching

should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in Configuration Mode.

Switching Individual Arrhythmia Alarms On and Off

Some arrhythmia alarms can be individually switched on or off. They are:

Pacer not capture, Pacer not pace, Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T

PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, Irregular HR, Missed Beat, PVCs/min.

To switch individual alarms on or off, in the

Setup Arrhythmia

menu, select the alarm from the list to toggle between

On

and

Off

. The monitor displays the INOP message SOME ECG

ALRMS OFF if configured.

Switching All Yellow Arrhythmia Alarms On or Off

All yellow arrhythmia alarms can be switched on and off together. To do this,

In the

Setup Arrhythmia

menu, select

All Yellow Off

or

All Yellow On

.

Adjusting the Arrhythmia Alarm Limits

Some arrhythmia alarms have limits which can be individually adjusted. They are:

1

2

Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause

Threshold.

To adjust alarm limits, in the

Setup Arrhythmia

menu, select the alarm to be adjusted.

Select the appropriate setting from the pop-up list.

Arrhythmia Alarm Timeout Periods

Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:

• if a more serious alarm condition is active in the same chain

• if a timeout period is in effect for a particular alarm

• if a timeout period is in effect for a higher alarm in that chain.

100

Arrhythmia Alarms

6 ECG, Arrhythmia, ST and QT Monitoring

What is a Timeout Period?

Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm. Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see

“Arrhythmia Alarm Chaining” on page 102).

This setting can only be changed in Configuration Mode.

To view the timeout period configured for your monitor, in the the menu items

TimeOut 1st

and

TimeOut 2nd

.

Setup Arrhythmia

menu, see

To reset the timeout period, press the

Alarms

key and then reselect it.

Resetting the Timeout Period

Switching alarms off and then on again cancels all visual and audible indicators and resets the timeout periods.

Silencing an alarm cancels all visual and audible indicators, if the alarm condition is no longer present.

How are Yellow Arrhythmia Alarms Indicated?

When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators. Yellow arrhythmia alarms are always set to latch visually for three minutes. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:

Alarm Condition

Single alarm instance Non-sustained

V-tach

Continuous alarm condition HR LOW

Same intermittent alarm condition

Example

Pair of PVCs

Audible Indicators

Short yellow alarm tone sounds ...

Visual Indicators

Alarm message displayed ...

when alarm condition is initially detected when alarm condition is initially detected and - as an alarm reminder - every time the configured time out period has expired each time the alarm condition is detected, provided that the configured timeout period has expired for 3 minutes (latching time) until the alarm condition stops, plus a maximum of three minutes latching time

If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will get an alarm reminder e very time the configured time out period has expired.

If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared. Silencing an alarm does not reset its time out period, so you will not get a realarm for the same condition or lower on the chain until the time out expires.

101

6 ECG, Arrhythmia, ST and QT Monitoring

Arrhythmia Alarms

Arrhythmia Alarm Chaining

When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm “chains”: PVC Alarms; Beat Detection Alarms, and Rate Alarms.

Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are occurring.

See “ECG and Arrhythmia Alarm Overview” on page 91 for information on which alarms are included

in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 100 for an

explanation of how alarm timeouts work.

Red Arrhythmia Alarms

Asystole

PVC Alarms Chain

Non-sustain VT/

Vent Rhythm

Run PVCs

Pair PVCs

R-on-T PVCs

Vent Bigeminy

Vent Trigeminy

PVCs > xx/min

Multiform PVCs

Vent Fib/Tach

V-Tach

Extreme Tachy/Extreme Brady

Yellow Arrhythmia Alarms

Beat Detection Alarms Chain

Rate Alarms Chain

Pause

Pacer Not Captured/

Pacer Not Pacing/

Missed Beat

SVT

HR High/ HR Low

Irregular HR

(occurs only if no other arrhythmia alarms are present)

First level timeout period

(

TimeOut

1st

)

Second level timeout period

(

TimeOut

2nd

)

– If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain.

– Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated.

102

Arrhythmia Alarms

6 ECG, Arrhythmia, ST and QT Monitoring

Understanding PVC-Related Alarms

PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). Changing one alarm limit automatically changes linked alarm limits.

Example: This diagram illustrates the conditions under which PVC alarms would be generated if the

Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to eight, and the V-Tach HR Limit is set to 100.

V-Tach Run Limit

100

**Pair

PVCs

PVC =

2

** Non-Sustain

VT

PVC Run < 8

HR > 100

***V-Tach

PVC Run

HR > 100

8

V-Tach Heart

Rate Limit

** Run PVCs

PVC Run > 2 but

12

HR

100

** Vent Rhythm

PVC Run > 12

HR

100

1 2 3 4 5 6 7 8 9 10 11 12

Number of Consecutive PVCs (PVC Run)

Ventricular Rhythm

Run Limit

You will see that

• if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated

• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated.

103

6 ECG, Arrhythmia, ST and QT Monitoring

About ST Monitoring

About ST Monitoring

The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor.

All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the monitor for ST Segment analysis.

ST analysis is always performed using a dedicated filter which ensures diagnostic quality. If you are monitoring ECG using an ECG filter mode other than Diagnostic, the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave. For diagnostic evaluation of the ST segment, always switch to Diagnostic filter mode or use the ST snippet.

WARNING

Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example:

• if you are unable to get a lead that is not noisy

• if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline

• if the patient is continuously ventricularly paced

• if the patient has left bundle branch block.

You should consider switching ST monitoring off if these conditions are present.

This monitor provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.

ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for

ST monitoring in neonatal and pediatric modes is

ST Analysis: Off

.

Switching ST On and Off

To switch all ST monitoring on or off, in the

Setup ST Analysis

menu, select

ST Analysis

to toggle between

On

and

Off

.

Selecting Leads for ST Analysis

You select which leads to use for ST analysis in the

Setup ST Analysis

menu.

To see the current list of leads selected for ST analysis:

1

Enter the

Setup ST Analysis

menu.

2

Select

Setup ST Leads

. This opens the

Setup ST Leads

pop-up window. Leads chosen for

ST monitoring are listed here. There are two pop-up keys at the bottom of the screen:

Add Delete

If all leads are already selected, the

Add

pop-up key is disabled.

To choose a lead for ST monitoring:

1

Select the

Add

key at the bottom of the

Setup ST Leads

window. This opens the

Choices

pop-up window.

104

Understanding the ST Display and Windows

6 ECG, Arrhythmia, ST and QT Monitoring

2

Choose a lead from the list for ST monitoring. This closes the

Choices

window and adds the selected lead to the list of chosen leads.

To disable ST monitoring for a lead:

1

2

Choose a lead from the list in the

Setup ST Leads

window.

Select the

Delete

key. This removes this lead from the list.

Understanding the ST Display and Windows

Your monitor screen may be configured to look slightly different from the illustrations.

ST Numerics Up to 12 ST numerics plus the

ST index can be displayed on the monitor

Current HR alarm limits

Current heart rate screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet.

A positive ST value indicates ST segment elevation; a negative value indicates depression.

ST numerics

ST-II 1.2

ST-V 2.5

ST-aVR -3.0

ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the

Setup ST Analysis

->

Setup ST Leads

list. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric.

ST Index The ST index numeric (

STindx

) is the sum of the absolute values for the ST leads V2, V5, aVF. Because it is based on absolute values, it is always a positive number. If you haven’t selected one of the leads V2, V5, and aVF for ST analysis, the STindx numeric will display a question mark “?”.

To switch the ST index numeric on or off for display, in the

ST-Index

to toggle between

On

and

Off

.

Setup ST Analysis

menu, select

ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient.

The information is updated once per minute.

You can see ST snippets in the

Adjust ST Points

window or the

ST Baseline

window.

ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid. The current

ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between these two numerics.

A “?” in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored.

To view the

ST Baseline

window, select the ST numerics, then

ST Baseline

.

105

6 ECG, Arrhythmia, ST and QT Monitoring

Updating ST Baseline Snippets

ST label and numeric

Baseline ST numeric and difference since baseline was stored

1mV calibration bar

Current snippet

ST baseline

ST-II

-0.3

0.8

?-1.1

1mv

ST Baseline

ST Baseline from 04 Apr 07 9:38

Timestamp of most recently stored baseline snippet

1sec

Updating ST Baseline Snippets

ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear.

The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines,

1

Select the ST numerics then

ST Baseline

to open the

ST Baseline

window.

2

In the

ST Baseline

window, select

Update Baseline

to store all current snippets as baselines.

This deletes all previously-stored baselines.

About the ST Measurement Points

The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.

106

About the ST Measurement Points

6 ECG, Arrhythmia, ST and QT Monitoring

R-wave peak at 0 msec

J point, for example, 48 msec

T

P

Difference = ST value

Isoelectric point set to -80 msec

Q

S

ST measurement point, for example, J + 60 msec

CAUTION

The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus the placement of the ST point. Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set.

Always ensure that ST measurement points are appropriate for your patient.

Adjusting ST Measurement Points

Depending on your monitor’s configuration, the ST point can be positioned either

• relative to the J-point.

In the

Adjust ST Points

window, the pop-up keys ISO Point, J Point and ST Point are visible and can be adjusted. or

• directly by selecting a numeric value for the ST point.

In the

Adjust ST Points

window, you can adjust the ISO and ST point.

The

ST Uses

setting can only be changed in Configuration Mode.

To adjust the ST measurement points,

1

2

In the

Setup ST Analysis

menu, select

Adjust ST Points

to open the

Adjust ST

Points

window. Alternatively, you can use the

Adjust ST Points

pop-up key in the

ST

Baseline

window.

Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads.

3

Select the ST point you need to adjust by touching the appropriate point on the screen. The current choice is highlighted (ISO point -80 in the screen example).

107

6 ECG, Arrhythmia, ST and QT Monitoring

ST label and the ST numeric that would apply using the current points

1mV calibration bar

ST-I

0.1

Cursors for adjusting ST points

About the ST Measurement Points

Adjust ST Points

1mv

ST Points adjusted at 04 Apr 07 11:38

1sec

Highlighted ST point

Update

Apply

Changes

ISO

The ISO-point cursor positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds. Position the

ISO-point in the middle of the flattest part of the baseline (between the P and

Q waves or in front of the P wave).

The J-point cursor positions the J-point relative to the R-wave peak. It helps you to correctly position the ST-point. Position the J-point at the end of the

QRS complex and the beginning of the ST segment.

The J-point cursor is not available if your monitor is configured to let you set the ST point directly.

4

5

To position the ST-point relative to the J-point: select either

J + 60

or

J + 80

. Select

J Point

and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment.

To position the ST-point directly: select

ST Point

and use the left and right arrow keys to position the ST point at the midpoint of the ST segment.

Select the

Apply Changes

pop-up key to activate the new ST measurement points and recalculate all ST values.

The most recent ST Points adjustment time is displayed in the

Adjust ST Points

window.

This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor.

To update the ST snippet shown in the

Adjust ST Points

window, select the

Update

pop-up key.

108

ST Alarms

6 ECG, Arrhythmia, ST and QT Monitoring

ST Alarms

ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads.

If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits.

Single- or Multi-lead ST Alarming

Be aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead will be announced.

To choose individual or multi-lead ST alarming,

In the

Setup ST Analysis

Multi ST

.

menu, select

ST Alarm Mode

and select either

Single ST

or

Changing ST Alarm Limits

The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.

1

2

In the

Setup ST Analysis

menu, select

ST Alarm Mode

and select

Single ST

or

Multi

ST

.

Select the alarm to be adjusted.

3

Select the appropriate setting.

Viewing ST Maps

The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in

ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the

ECG parameter.

Current View

In current view, the monitor displays an ST map that corresponds to the current ST values. Three or more leads per plane are necessary to display a map.

The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads.

109

6 ECG, Arrhythmia, ST and QT Monitoring

SBed10 Adult

ST-II HIGH

ST Map (Current)

Limb Leads Chest Leads

Size

Up

Size

Down

Show

Baseline

Show

Values

Trend

View

Select

Interval

Print

If an ST lead is switched off, its axis is not shown in the map.

Viewing ST Maps

ST map

ST label and polarity of corresponding lead

Scroll to view more pop-up keys

If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is unplugged), the area formed by the remaining ST leads is left open.

If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.

Limb Leads

ST-I

ST-II

ST-aVR

ST-aVL

ST-aVF

110

Viewing ST Maps

6 ECG, Arrhythmia, ST and QT Monitoring

Additionally, when both ST maps are displayed, you can view the currently available ST values in the

ST Map window (Current or Trend) at any time. To do this, select the

Show Values

pop-up key.

The ST values are shown in place of the second ST map, and the pop-up key text changes to

Hide

Values

. Select the

Hide Values

pop-up key and the display shows both ST maps again.

SBed10

Adult

ST-II HIGH

ST Map (Current)

Limb Leads

ST-I

ST-II

ST-VI

ST-V2

ST-V3

ST-V4

ST-V5

ST-V6

ST-aVF

Size

Up

Size

Down

Show

Baseline

Hide

Values

ST values are shown where the

STmap for the chest leads is normally displayed.

Select the

Show Values

pop-up key to see the current ST values.

Select

Hide Values

and the display shows both ST maps again.

Trend View

In trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old.

The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values on the diagrams show the current ST values.

If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off 20 seconds ago. The current ST values and the first trended value reflect this change in the lead setup. All other maps are displayed the way in which they were recorded.

SBed10

Adult

ST-II HIGH

ST Map (Trend)

Limb Leads

Chest Leads

5 min

Size

Up

Size

Down

Show

Baseline

Show

Values

Current

View

Select

Interval

Print

trending interval

Scroll to view more pop-up keys

111

6 ECG, Arrhythmia, ST and QT Monitoring

Viewing ST Maps

In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed.

Viewing an ST Map

To display an ST map,

In the

Setup ST Analysis

menu, select

ST Map

.

Working in the ST Map Task Window

You may need to activate the ST map task window to see all the data, and to access the pop-up keys.

Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here.

Switching Between ST Map Views

To switch between views,

Select

Current View

or

Trend View

to toggle between views.

If your trend view is empty, you need to adjust the priority of this measurement in the trending

priority list. See “Trend Priority” on page 163.

Displaying an ST Reference Baseline

You can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request.

Select

Show Baseline

/

Hide Baseline

to toggle between baseline display on and off.

Updating an ST Map Reference Baseline

To update the baseline,

In the

Setup ST Analysis

menu, select

ST Baseline -> Update baseline

.

Changing the Scale of the ST Map

To change scale,

Select

Size Up

or

Size Down

to alter the size at which monitor displays the map.

Changing the Trending Interval

To determine how frequently the monitor displays a trended sample,

112

Viewing ST Maps

6 ECG, Arrhythmia, ST and QT Monitoring

1

2

In Trend view, select

Select Interval

.

Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.

Printing an ST Map Report

To print the most recently viewed (current or trend) window,

1

2

Select

Main Setup

- >

Reports

.

Select

ST Map

.

3

Press

Print

.

113

6 ECG, Arrhythmia, ST and QT Monitoring

About QT/QTc Interval Monitoring

About QT/QTc Interval Monitoring

The QT interval is defined as the time between the beginning of the Q-wave and the end of the

T-wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome.

R

T

P

Q

S

QT interval

The QT interval has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in

Configuration Mode.

For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned on.

QT Measurement Algorithm

The QT values are updated every five minutes except in the initial phase (first five minutes) where they are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing. Normal beats followed by a premature QRS will be excluded from the measurements to prevent the premature beat from obscuring the end of the T-wave. If the algorithm cannot form a representative waveform, for example because the morphology of the beats is too varied, a

Cannot Analyze QT

INOP will be generated after 10 minutes. This is also the case if normal beats have been falsely labelled so that the algorithm does not have enough valid beats to make QT measurements. No QT value is calculated if the QT-HR is

>150 bpm (Adult) or >180 bpm (Pedi/Neo).

Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor.

Where Can I Find More Information?

See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick

Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance.

114

About QT/QTc Interval Monitoring

6 ECG, Arrhythmia, ST and QT Monitoring

Indications For Use Of QT Interval Monitoring

Of special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category.

Limitations For Use Of QT Interval Monitoring

Some conditions may make it difficult to achieve reliable QT monitoring, for example:

• the T-wave is very flat

• T-waves are not well defined due to atrial flutter or atrial fibrillation

• the end of the T-wave is difficult to define because of the presence of U-waves

• a high heart rate causes the P-wave to encroach on the end of the previous T-wave

• noise or high QRS morphology variation

For these cases you should select a lead with a good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave.

Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.

Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm.

If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured.

When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable

QTc calculation it is important to avoid a region where the heart rate is changing.

WARNING

QT/QTc measurements should always be verified by a qualified clinician.

Selecting The QT Leads

For QT Monitoring you can select one of the following three modes:

• All Leads mode - all available leads (I, II, III, V, MCL, V1 - V6) are used to produce a global QT measurement. For EASI lead placement, directly acquired AI, AS and ES leads are used.

• Primary-Lead mode - the primary lead will be used for QT measurement. If the original primary lead becomes unavailable or is changed, QT measurement will continue with the new primary lead.

• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable.

To select the mode,

1

Select the QT numeric to enter the

Setup QT Analysis

window.

2

Select QT Lead and select

All

,

Primary Lead

or one of the available single leads.

When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads.

115

6 ECG, Arrhythmia, ST and QT Monitoring

QT Alarms

Changing the lead(s) used for QT measurements will not cause the baseline to be reset.

QT Alarms

There are two QT alarms, QTc high limit alarm and

ΔQTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The

ΔQTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes.

The

Cannot Analyze QT

INOP and the

?

will be displayed when no QT measurement could be calculated for 10 minutes. Up to this time the previous valid value will be displayed.

Switching Individual QTc Alarms On and Off

Each QTc alarm can be switched off individually.

To switch an alarm on or off, in the

Setup QT Analysis

menu, select

QTc Alarm

or

Δ

QTc

Alarm

to toggle between

On

and

Off

.

Changing QTc Alarm Limits

Set the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits.

1

2

3

In the

Setup QT Analysis

menu, select

High Limit

.

Select the appropriate setting.

Select

Δ

High Limit

.

4

Select the appropriate setting.

Setting The QT Baseline

In order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the effect of medication on the QT interval you can set the current value as the baseline before you begin medication. This baseline will then be used to calculate the

ΔQTc value.

To set the baseline,

In the

Setup QT Analysis

menu, select

Set QT Baseline

and set the value.

If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the

ΔQTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a

ΔQTc alarm from being generated. Discharging a patient clears the baseline.

Switching QT Monitoring On and Off

To switch all QT monitoring on or off, in the

Setup QT Analysis

menu, select

QT Analys.

to switch between On and Off.

116

7

7

Monitoring Pulse Rate

The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO

2

signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the

Setup Pulse

menu to check whether it is switched on.

Entering the Setup Pulse Menu

If a pulse numeric is displayed on the screen, select it to enter the

Setup Pulse (Pulse Source)

menu. If no pulse numeric is visible, in the

Setup SpO

2

menu or a

Setup

arterial pressure menu, select

Pulse

(Pulse Source).

System Pulse Source

The currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:

• is monitored as system pulse and generates alarms when you select pulse as the active alarm source

• is sent via the network to the Information Center, if available

• is trended in the HighRes Trends and stored in the monitor’s databases.

To define which pulse rate is used as system pulse,

1

In the

Setup Pulse

menu, select

SystemPulse

.

2

Select one of the SpO

2

or arterial pressure labels from the pop-up list, or select Auto.

If you select Auto, the monitor automatically chooses a pulse rate to be used as system pulse. It looks through the list from top to bottom and activates the first pulse rate that is switched on and available.

If your selected pulse source measurement becomes unavailable or is switched off, the monitor will use the next measurement from the list as system pulse until the selected pulse source measurement becomes available again.

117

7 Monitoring Pulse Rate

Switching Pulse On and Off

Switching Pulse On and Off

To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO

2

pulse numeric on or off,

1

Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the

Setup SpO2

menu.

2

In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and

Off

.

Using Pulse Alarms

You can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the Setup Pulse menu or the Setup ECG menu by selecting AlarmSrc (xxx) where xxx is the current alarm source. Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms.

Pulse alarms are only generated when the active alarm source is set to Pulse, a pulse source is set as system pulse and pulse alarms are switched on.

Selecting the Active Alarm Source: ECG or Pulse?

In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the monitor uses either ECG or Pulse as its active alarm source. To change the alarm source, select

AlarmSrc

in the

ECG/Pulse

Alarms menu, then select

ECG: if you want the HR to be the alarm source for HR/Pulse.

Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off.

Auto: If the AlarmSrc is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and at least one

ECG lead can be measured without an INOP condition.

The monitor will automatically switch to Pulse as the alarm source if:

– a valid ECG lead can no longer be measured and

– a Pulse source is switched on and available,

The monitor then uses the pulse rate from the measurement currently active as system pulse. While

Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source.

Note: If ECG is switched off, the monitor will always change to Pulse as alarm source, if a Pulse is available. One exception to this rule can arise when you have a telemetry device paired with your monitor. The monitor ECG is then deactivated but the monitor may be configured to allow only ECG as the active alarm source. In this case the monitor will not switch to Pulse as alarm source and Pulse will not be available as a selection in the

ECG/Pulse

Alarms menu.

118

Using Pulse Alarms

7 Monitoring Pulse Rate

WARNING

Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the

section “ECG and Arrhythmia Alarm Overview” on page 91, and the heart rate alarms. This is

indicated by the message All ECG Alarms Off (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.

High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.

Alarm Source Selection Disabled

If Alarm Source Selection is disabled, you cannot change the alarm source. If you try to change the source, the monitor displays the message

To activate enter Config and enable

AlarmSourceSel

. This setting can only be changed in Configuration Mode.

Changing HR/Pulse Alarm Limits

As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the

Setup Pulse

menu, the high or low alarm limits for HR in the

Setup ECG

menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO

2

Pressure 25 bpm.

is 30 bpm; for HR 15 bpm, and for

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm limits. You need to know what value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the values added to the high and low limit alarms to create the extreme rate alarms for your monitor, in the Setup ECG menu, see the menu items Extr.Tachy and Extr.Brady.

QRS Tone

The active alarm source is also used as a source for the QRS tone. You can change the tone volume in the

Setup SpO2

and

Setup ECG

menus and the QRS tone modulation in the

Setup SpO2

menu.

119

7 Monitoring Pulse Rate

Using Pulse Alarms

120

8

8

Monitoring Respiration Rate

(Resp)

For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two

ECG electrodes on the patient’s chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).

Lead Placement for Monitoring Resp

Correct patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG.

The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI™ placement - to measure Resp, as long as you use ICU ECG cables.

The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI™

ECG electrode placement, Resp is measured between the I and A electrodes.

Optimizing Lead Placement for Resp

If you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients. Repositioning

ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation.

Cardiac Overlay

Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is particularly important for neonates.

121

Understanding the Resp Display

8 Monitoring Respiration Rate (Resp)

Lateral Chest Expansion

Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient’s maximum point of breathing movement to optimize the respiratory wave.

Abdominal Breathing

Some patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave.

Understanding the Resp Display

The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text

HR = RR

next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration.

1 Ohm calibration bar

Manually-set Resp detection level

Resp numeric and label

Resp

RR

22

1 Ohm

Changing Resp Detection Modes

The Resp detection level can be set either automatically or manually.

To change the resp detection mode, in the between the settings.

Setup Resp

menu, select

Auto/Man

to toggle

Auto Detection Mode

In Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode,

• the detection level (a dotted line) is not displayed on the waveform,

122

Changing the Size of the Respiration Wave

8 Monitoring Respiration Rate (Resp)

• the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.

Use Auto Detection Mode for situations where:

• the respiration rate is not close to the heart rate

• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)

• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).

Manual Detection Mode

In Manual Detection Mode you must set the Resp detection level.

In the

Setup Resp

menu, select

Manual Up

or

Manual Down

. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached.

Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.

Use Manual Detection Mode for situations where:

• the respiration rate and the heart rate are close.

• patients have Intermittent Mandatory Ventilation.

• respiration is weak. Try repositioning the electrodes to improve the signal.

Resp Detection Modes and Cardiac Overlay

In Auto Detection Mode: If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration.

In Manual Detection Mode: Cardiac overlay can in certain situations trigger the respiration counter.

This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you

may need to optimize the electrode placement as described in the section ”Lateral Chest Expansion”.

Changing the Size of the Respiration Wave

WARNING

When monitoring in Manual Detection Mode, make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave.

In the

Setup Resp

menu, select

Size Up

to increase the size of the wave or

Size Down

to decrease it.

123

8 Monitoring Respiration Rate (Resp)

Changing the Speed of the Respiration Wave

Changing the Speed of the Respiration Wave

Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.

Select the Resp wave to enter the

Resp Wave

menu, then select

Change Speed

. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).

Using Resp Alarms

Resp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter.

Changing the Apnea Alarm Delay

The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm.

1

2

In the

Setup Resp

menu, select

Select the appropriate setting.

Apnea

Time

.

Resp Safety Information

WARNING

Respiration detection level If you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of apnea.

Apnea The respiration measurement does not recognize obstructive and mixed apneas — it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.

The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

Interference If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated

Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit.

Resp Accessories To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electro-surgery is being performed.

124

Resp Safety Information

8 Monitoring Respiration Rate (Resp)

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.

125

8 Monitoring Respiration Rate (Resp)

Resp Safety Information

126

9

9

Monitoring SpO

2

Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact suppression technology (FAST). It provides four measurements:

• Oxygen saturation of arterial blood (SpO

2

) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).

• Pleth waveform - visual indication of patient’s pulse.

• Pulse rate (derived from pleth wave) - detected pulsations per minute.

• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation.

The monitors are also compatible with SpO

2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information.

SpO

2

Sensors

Familiarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site.

CAUTION

Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors on patients who have allergic reactions to the adhesive.

Applying the Sensor

1

2

3

Follow the SpO

2

sensor’s instructions for use, adhering to all warnings and cautions.

Remove colored nail polish from the application site.

Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7 and 8 mm (0.27” and 0.31”). When applying a

M1193A neonatal sensor do not overtighten the strap.

127

9 Monitoring SpO

2

Connecting SpO

2

Cables

4

Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient’s tissue.

WARNING

Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site at least every four hours.

Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.

Ambient Temperature: At elevated ambient temperatures be careful with measurement sites that are not well perfused, because this can cause severe burns after prolonged application. All listed sensors operate without risk of exceeding 41

°

C on the skin if the initial skin temperature does not exceed

35

°

C.

Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line.

Connecting SpO

2

Cables

Connect the sensor cable to the color-coded socket on the monitor. You can connect some Philips sensors directly to the monitor. For other sensors, use the corresponding adapter cable.

CAUTION

Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “long” cable version).

Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.

Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.

Measuring SpO

2

1

2

Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO

2

and pulse numerics.

During measurement, ensure that the application site:

– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.

– has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.

128

Assessing a Suspicious SpO

2

Reading

9 Monitoring SpO

2

WARNING

Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours.

CAUTION

Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.

Interference can be caused by:

• High levels of ambient light or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.)

• Electromagnetic interference.

• Excessive patient movement and vibration.

Assessing a Suspicious SpO

2

Reading

Traditionally, pulse rate from SpO

2

was compared with heart rate from ECG to confirm the validity of the SpO

2

reading. With newer algorithms, such as FAST-SpO because the correct calculation of SpO

2

2

, this is no longer a valid criteria

is not directly linked to the correct detection of each pulse.

When pulse rate is very low, or strong arrhythmia is present, the SpO

2

/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO

2

value.

If you doubt the measured SpO

2

, use the pleth wave and perfusion indicator instead to assess the signal quality.

N O T E

With pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or electromagnetic interference can give unexpected intermittent readings when the sensor is not attached to a patient. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling.

129

9 Monitoring SpO

2

Understanding SpO

2

Alarms

Understanding SpO

2

Alarms

This refers to SpO

2

specific alarms. See the Alarms section for general alarm information. SpO

2

offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit.

CAUTION

If you measure SpO

2

on a limb that has an inflated NBP cuff, a non-pulsatile SpO

2

INOP can occur.

If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating critical patient status, such as sudden pulse loss or hypoxia.

Alarm Delays

There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components:

• The time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and the configured averaging time. The longer the averaging time configured, the longer the time needed until the numerical values reflect the physiological event.

• The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the combination of the configured alarm delay time plus the general

system delay time (see “Monitor Performance Specifications” on page 221).

Adjusting the Alarm Limits

In the Setup SpO

2

menu:

• Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the popup list that opens.

• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.

WARNING

High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off.

Adjusting the Desat Limit Alarm

The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation.

1

2

In the

Setup SpO

2

menu, select

DesatLimit

.

Adjust the limit.

130

Pleth Wave

9 Monitoring SpO

2

Pleth Wave

The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.

minimum size for reliable SpO

2

value

Perfusion Numeric

The perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow.

As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO

2

measurement. Above 1 is optimal, between 0.3-1 is acceptable.

Below 0.3 is marginal; reposition the sensor or find a better site.

Perfusion Change indicator

The perfusion change indicator is a graphic symbol which shows the change in the perfusion value, relative to a reference value which you can set.

To set the current perfusion value as the reference value:

In the Setup SpO2 menu, select Set Perf Ref..

When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric.

Perfusion change indicator

Setting SpO

2

/Pleth as Pulse Source

1

2

In the

Setup SpO2

menu, select

Pulse (SpO

2

)

to enter the

Setup Pulse

menu.

In the

Setup Pulse

menu, select

SystemPls

and select

SpO

2

from the pop-up list.

131

9 Monitoring SpO

2

Setting Up Tone Modulation

Setting Up Tone Modulation

If tone modulation is on, the QRS tone pitch lowers when the SpO

2

level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.

In the

Setup SpO

2

menu

,

select

Tone Mod.

to toggle between

Yes

(for on) and

No

(for off ).

Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett

Incorporated, a Tyco Healthcare company.

Setting the QRS Volume

In the

Setup SpO

2

menu, select

QRS Volume

and set the appropriate QRS tone volume.

132

10

10

Monitoring NBP

This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National

Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements

(depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure.

In neonatal mode, the blood pressure measurements determined with this device comply with the

American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-

1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.

The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.

A physician must determine the clinical significance of the NBP information.

Introducing the Oscillometric NBP Measurement

Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish.

Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques.

WARNING

Patient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients.

Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.

Skin Damage: Do not measure NBP on patients with sickle-cell disease or any condition where skin damage has occurred or is expected.

Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff.

133

10 Monitoring NBP

Preparing to Measure NBP

CAUTION

If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.

Measurement Limitations

Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine.

The measurement may be inaccurate or impossible:

• if a regular arterial pressure pulse is hard to detect

• with cardiac arrhythmias

• with excessive and continuous patient movement such as shivering or convulsions

• with rapid blood pressure changes

• with severe shock or hypothermia that reduces blood flow to the peripheries

• with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery

• on an edematous extremity.

Measurement Methods

There are three methods of measuring NBP:

Manual - measurement on demand.

Auto - continually repeated measurements (between one and 120 minute adjustable interval).

Sequence - up to four measurement cycles which will run consecutively, with number of measurements and interval between them configurable for each cycle.

STAT - rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients.

Reference Method

The NBP measurement reference method can be Auscultatory (manual cuff) or Invasive (intraarterial). For further information, see the Application Note on NBP supplied on the monitor documentation CD-ROM.

In Adult and Pediatric mode to check the current setting, select Main Setup -> Measurements

-> NBP, and check whether the Reference setting is set to Auscult. or Invasive. This setting can only be changed in Configuration Mode.

In Neonatal mode, to comply with safety standards, invasive is always used as the reference method.

This setting cannot be changed and is not visible in any operating mode.

Preparing to Measure NBP

1

Connect the cuff to the air tubing.

134

Preparing to Measure NBP

10 Monitoring NBP

2

3

4

Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes.

Air must pass unrestricted through the tubing.

Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted.

A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb.

Apply the cuff to a limb at the same level as the patient’s heart. If it is not, you must use the measurement correction formula to correct the measurement.

The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements.

Correcting the Measurement if Limb is not at Heart Level

To correct the measurement if the limb is not at heart level, to the displayed value add 0.75mmHg (0.10kPa) for each centimeter higher or add 1.9mmHg (0.25kPa) for each inch higher.

deduct 0.75mmHg (0.10kPa) for each centimeter lower or deduct 1.9mmHg (0.25kPa) for each inch lower.

Understanding the NBP Numerics

Alarm source

Measurement Mode

Sys.

NBP mmHg

Auto

Auto

60min

17:15

Mean

120

90

Timestamp/

Timer

Alarm limits Systolic

Diastolic

Mean pressure

Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values.

Alarm Sources if you have parallel alarm sources, the sources are displayed instead of the alarm limits.

NBP Timestamp depending on the configured NBP Time setting, the time shown beside the NBP numeric can be:

Meas Time: the time of the most recent NBP measurement, or

Next Meas: the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here.

135

10 Monitoring NBP

Starting and Stopping Measurements

During measurements the cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement.

Starting and Stopping Measurements

Use the Setup menu or SmartKeys to start and stop measurements.

CAUTION

Use clinical judgement to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff.

Enabling Automatic Mode and Setting Repetition

Time

1

2

In the

Setup NBP

menu, select

Auto/Man

and select

Auto

from the pop-up menu.

For an automatic measurement, select

Repeat

and set the time interval between two measurements.

Enabling Sequence Mode and Setting Up The

Sequence

1

2

3

4

In the

Setup NBP

menu, select

Auto/Man

and select

Sequence

from the pop-up menu.

Select Setup Sequence to open the Setup NBP Sequence window.

Up to four measurement cycles can be setup which will run consecutively. For each cycle you can set the number of measurements and the interval between them. If you want to run less than four cycles in a sequence, you can set the number of measurements for one or more cycles to Off.

Select each sequence in turn and select the number of measurements and the time interval between the measurements.

To have measurements continue after the sequence, set the number of measurements for your last cycle to Continuous and this cycle will run indefinitely.

CAUTION

Be aware that, if none of the cycles are set to Continuous, NBP monitoring will end after the last measurement of the cycle.

When the NBP measurement mode is set to Sequence, the repetition time for Auto mode cannot be changed.

Choosing the NBP Alarm Source

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic.

In the

Setup NBP

menu, select

Al. from

and choose from:

136

Switching Pulse from NBP On/Off

10 Monitoring NBP

Menu option Pressure value monitored

Sys.

Dia.

Mean

Sys&Dia

Dia&Mean

Sys&Mean

S&D&M systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel

If mean is not selected as alarm source (Sys, Dia, or Sys&Dia selected), but the monitor can only derive a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits.

When no value can be derived an NBP MEASURE FAILED INOP will be displayed.

Switching Pulse from NBP On/Off

In the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse value is displayed together with the time the measurement was made. After one hour the value becomes invalid. There are no alarms associated with pulse from NBP.

To switch the display of the pulse value on or off:

In the

NBP Setup

menu select Pulse (NBP).

Pulse from NBP

NBP

Sys.

Pulse Auto

Assisting Venous Puncture

You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.

1

2

In the

NBP Setup

menu select

VeniPuncture

.

Puncture vein and draw blood sample.

3

Reselect

VeniPuncture

to deflate the cuff.

During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode.

137

10 Monitoring NBP

Calibrating NBP

Cuff pressure

NBP

Venous puncture measurement mode

Time left in venous puncture mode

(60)

VP

01:45

Calibrating NBP

NBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at least once every two years by a qualified service professional. See the Service Guide for details.

138

11

11

Monitoring Temperature

WARNING

Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A).

You can measure temperature using the built-in temperature measurement (optional), or one of the

MMS extensions.

Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.

Making a Temp Measurement

1

2

3

Select the correct type and size of probe for your patient.

If you are using a disposable probe, connect the probe to the temperature cable.

Plug the probe or temperature cable into the temperature connector socket.

Temp connector socket

4

5

6

Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.

Select an appropriate temperature label.

Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement.

139

11 Monitoring Temperature

Calculating Temp Difference

WARNING

Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.

Selecting a Temperature for Monitoring

Tell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that label’s stored color and alarm settings.

1

2

In the

Setup <Temp>

menu, select

Label.

Select the appropriate label from the list.

Temp

Tart

Tcore

Tesoph non-specific temperature label.

arterial temperature core temperature esophageal temperature

Trect

Tskin

Tven

Tnaso rectal temperature skin temperature venous temperature nasopharyngeal temperature

Extended Temperature Label Set

The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.

T1, T2, T3, T4

Tamb

Tcereb

Ttymp

Tvesic

Non-specific temperature labels ambient temperature cerebral temperature tympanic temperature vesical temperature

Calculating Temp Difference

The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled

Δ

Temp

.

1

2

In the

Setup Main

menu, select

Measurements

.

In the

Setup

Δ

Temp

menu, select

First Temp

.

3

Label the measurement source as appropriate.

4

5

Select

Second Temp

.

Label the measurement source as appropriate.

140

12

12

Monitoring Invasive Pressure

WARNING

Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A).

CAUTION

Do not use the MP2 in combination with other monitors using an M1006A pressure module and the

HP1290A pressure transducer. This may cause interference on the respiration or invasive pressure signals.

You can measure pressure using the monitor’s built-in pressure measurement (optional), or one of the

MMS extensions.

Setting up the Pressure Measurement

1

Plug in the pressure cable.

Pressure connector

2

3

Prepare the flush solution.

Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.

141

12 Monitoring Invasive Pressure

Setting up the Pressure Measurement

WARNING

If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading.

4

5

6

Connect the pressure line to the patient catheter.

If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.

Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.

WARNING

If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient’s ear. Incorrect leveling may give incorrect values.

Selecting a Pressure for Monitoring

Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that label’s stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values.

1

2

In the

Setup

<

Press>

menu, select

Label

.

Select the appropriate label from the list.

Label

ABP

ART

Ao

CVP

ICP

LAP

Description

Arterial blood pressure

Arterial blood pressure (alternative)

Aortic pressure

Central venous pressure

Intracranial pressure

Left atrial pressure

Label Description

P

PAP

RAP

UAP

UVP

Non-specific pressure label

Pulmonary artery pressure

Right atrial pressure

Umbilical arterial pressure

Umbilical venous pressure

Extended Pressure Label Set

The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.

142

Zeroing the Pressure Transducer

12 Monitoring Invasive Pressure

Label Description

BAP

FAP

Brachial arterial pressure

Femoral arterial pressure

IC1, IC2

Alternative intracranial pressures

P1, P2, P3, P4

Alternative non-specific pressure labels

Zeroing the Pressure Transducer

To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy (at least once per day). You must perform a zero:

• when you use a new transducer or tubing

• every time you reconnect the transducer cable to the monitor

• if you think the monitor’s pressure readings are not correct.

Zeroing ICP (or IC1/IC2)

Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values are automatically stored and you will not be prompted to repeat the zero procedure.

If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the monitor while zeroing. Reconnecting the transducer recalls the stored values.

WARNING

If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero.

Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturer’s instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient.

Determining a Pressure’s Most Recent Zero

The monitor displays the most recent zero on the status line. If this has “timed-out” after you have performed a zero, redisplay the information in the status line by entering the pressure’s setup menu.

Zeroing a Pressure Measurement

WARNING

Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing.

1

2

3

Turn off the stopcock to the patient.

Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer.

In the setup menu for the pressure, select

Zero <Press>

.

143

12 Monitoring Invasive Pressure

Adjusting the Calibration Factor

4

When you see the message <

Press> zero done at <date and time>

on the status line,

(for example,

ABP zero done at 13 Mar 02 23.35

) close the stopcock to atmospheric pressure, and open the stopcock to the patient.

Zeroing All Pressures Simultaneously

WARNING

Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.

If you are measuring pressures with more than one measuring device, using the

Zero

SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select

All Press

to zero all pressures simultaneously.

Troubleshooting the Zero

The status line lists the probable cause of an unsuccessful zero:

Message Corrective Action can’t zero; equipment malf.

The hardware is faulty. Contact your service personnel.

can’t zero; excessive offset

Make sure the transducer is vented to air and try again. If this fails, the hardware may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel.

can’t zero - unstable signal can’t zero - no transducer

Make sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer.

Make sure that the transducer is vented to air, not to the patient, and try again.

can’t zero; pulsat. pressure unable to zero - timed out

Try pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel.

switch <Press> on first

Pressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressure’s label.

Adjusting the Calibration Factor

Each time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same.

1

2

In the

Setup <Press>

menu, select

Cal. Factor

.

If the value here does

not

match that on the transducer, select the corresponding value from the list now in accordance with your hospital’s procedure.

To confirm you want to use the new calibration factor, select the Confirm popup.

144

Displaying a Mean Pressure Value Only

12 Monitoring Invasive Pressure

Displaying a Mean Pressure Value Only

Use this when you want to see only the mean pressure.

In the pressure’s setup menu, select

Mean Only

.

Toggle between

On

to display mean pressure value only, and

Off

to display all pressure values (systolic, diastolic and mean).

Changing the Pressure Wave Scale

1

2

Select the label of the pressure wave whose scale you want to set to enter the Setup menu.

In the Setup

<Press>

menu, (for example

ABP

) select

Scale

.

3

Select a value from the pop-up list:

– a positive value sets the top gridline. The bottom gridline is set at zero.

– a negative value sets the bottom gridline. The middle gridline is set at zero.

Optimizing the Waveform

In the

Setup <Press>

menu, select

Optimum Scale

to let the monitor select the best minimum and maximum scales for the current wave.

Non-Physiological Artifact Suppression

Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample.

Your monitor may be configured to suppress these non-physiological artifacts for a specified duration

(Artifact Suppression is configured to 30, 60, or 90 seconds). During artifact suppression, the monitor shows the INOP message <Pressure label> ARTIFACT, and a question mark is shown beside the pressure numerics. Pressure alarms and the Pulse Non-Pulsatile INOP are suppressed during the configured period. The CPP high alarm is not suppressed.

Choosing the Pressure Alarm Source

WARNING

Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.

In the

Setup <Press>

menu, select

Al. from

and choose the source.

Menu option

Sys.

Dia.

Mean

Pressure value monitored

systolic diastolic mean

145

12 Monitoring Invasive Pressure

Choosing the Pressure Alarm Source

Menu option

Sys&Dia

Dia&Mean

Sys&Mean

Sys&Dia&Mean

Select and set the

Pressure value monitored

systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel

High Limit

and

Low Limit

for the pressure(s) you have selected.

Extreme Alarm Limits

The extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the

Δ value) to the high and low alarm limits. This value can be set for each pressure label individually.

Extreme

Low Limit

Low

Limit

High

Limit

Extreme

High Limit

Δ Extreme Low Δ Extreme High

You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the extreme pressure alarms set for your monitor, in the

Setup <Press>

menu, see the menu items

Δ

Extr. High

and

Δ

Extr. Low

.

The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message.

146

Calibrating Reusable Transducer CPJ840J6

12 Monitoring Invasive Pressure

Calibrating Reusable Transducer CPJ840J6

Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:

• standard sphygmomanometer.

• sterile 10cc syringe with heparinised solution.

• 3-way stopcock.

• approximately 25cm of tubing.

Making the Pressure Calibration

WARNING

Never perform the invasive pressure calibration while a patient is being monitored.

1

2

Zero the transducer.

Connect the syringe and manometer.

a. Attach the tubing to the manometer.

b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient.

c. Attach the syringe to one port and the manometer tubing to the other port.

d. Open the port to the manometer.

tubing to manometer

Syringe with heparinised solution

Patient connection stoppered

Off

PRESS M1006A

T

PRESS ZERO

Pressure connector

12

PIN on monitor

3

4

Move the syringe barrel in and raise the mercury to 200mmHg (30kPa). 200mmHg is the recommended calibration pressure.

In the

Setup Pressure

menu, select

Cal. Press

.

147

12 Monitoring Invasive Pressure

Calculating Cerebral Perfusion

5

6

7

8

9

Select the calibration pressure from the list, for example 200 mmHg.

Select

Confirm

to recalculate the calibration factor using the applied pressure.

When the monitor displays <

Press> calibration done at <date and time>

, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones.

Label the transducer with the calibration factor shown in the

Cal. Factor

field in the pressure’s setup menu.

Reconnect the patient and start measuring again.

Troubleshooting the Pressure Calibration

The status line lists the probable cause of an unsuccessful calibration.

Message can’t calibr.; equipmt malfunction can’t calibrate;out of range can’t calibr.; no transd.

can’t cal.; unstable signal can’t calibr.;do zero first

Corrective Action

Contact your service department. The pressure hardware is faulty.

Make sure that you have selected the value for Cal. Press that you are applying to the transducer, and repeat the calibration.

Make sure that the transducer is connected and try again.

Make sure there are no disturbances to the transducer, and repeat the calibration.

No valid zero. Zero the transducer.

Calculating Cerebral Perfusion

The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.

The difference is labeled CPP.

1

2

In the

Main Setup

menu, select

Measurements

.

In the

Setup CPP

menu, select

ABP

,

ART

,

Ao

,

BAP

or

FAP

as the arterial pressure source.

148

13

13

Monitoring Carbon Dioxide

WARNING

• Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A).

• Only one CO

2

measurement at a time is supported.

Use the CO

2 measurement to monitor the patient’s respiratory status and to control patient ventilation.

There are two methods for measuring carbon dioxide in the patient’s airway:

• Mainstream measurement uses a CO

2 sensor attached to an airway adapter directly inserted into the patient’s breathing system. This method is available using the monitor’s built-in CO

2

measurement

(optional), the M3014A Capnography Extension or the M3016A Mainstream Extension.

• Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient’s airway and analyzes it with a remote CO

2 sensor. You can measure sidestream CO

2

using the monitor’s built-in CO

2

measurement (optional) or using the M3014A Capnography Extension, or the M3015A Microstream CO

2

Extension.

In both cases, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO

2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO

2

.

When using a wet ventilator circuit, monitor mainstream CO

2

if available, in preference to sidestream

CO

2

.

The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure.

The measurement provides:

• a CO

2

waveform.

• an end tidal CO

2

(etCO

2

) value: the CO

2

value measured at the end of the expiration phase.

• an inspired minimum CO

2

(imCO

2

): the smallest value measured during inspiration.

• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO

2 waveform.

149

13 Monitoring Carbon Dioxide

Measuring CO

2

using the CO

2

Option or M3014A

Depending on the

Max Hold

setting configured for your monitor, the etCO

2 the highest CO

2

numeric shows either

value measured within the configured time period (

Max Hold

set to

10 sec

or

20 sec

) or the etCO

2

numeric shows breath-to-breath value (

Max Hold

set to

Off

).

Refer to your Gas Module Instructions for Use, if you are using a Gas Module to monitor CO

2

.

WARNING

Correlation: The etCO

2

readings do not always correlate closely with paCO

2

, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.

Pharmaceuticals in aerosols: Do not measure CO

2

in the presence of pharmaceuticals in aerosols.

Explosion Hazard: Do not use in the presence of flammable anesthetics, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide.Use of the devices in such an environment may present an explosion hazard.

Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel.

Low etCO

2

values: Leakages in the breathing system or sampling system may cause the displayed etCO

2

values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO

2

readings. Even with combined nasal oral cannulas, the etCO readings may be slightly lower than actual in patients breathing through the mouth only.

2

Measuring CO

2

using the CO

2

Option or M3014A

The monitor (with the CO

2

option) or the M3014A Capnography Extension measures partial pressure of carbon dioxide in a patient’s expired gas using the mainstream method or the sidestream method.

The mainstream CO

2

measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO

2

measurement can be used, with appropriate accessories, with intubated and nonintubated adult, pediatric, infant and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patient’s breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.

WARNING

Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation.

Before the CO

2

measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO

2

readings. The CO

2

readings will typically deviate

5% for every 1000m difference.

Electrical Shock Hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor, monitor or measurement device. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel.

Preparing to Measure Mainstream CO

2

You must perform a zero as described in this procedure each time you use a new airway adapter.

1

Attach the sensor connector to the CO

2

connector on the monitor (when the optional CO

2 measurement is integrated) or on the extension.

150

Measuring CO

2

using the CO

2

Option or M3014A

13 Monitoring Carbon Dioxide

2

Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition.

3

Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly.

4

To zero the sensor:

– expose the sensor to room air and keep it away from all sources of CO

2 including the ventilator, the patient’s breath and your own.

– in the setup menu for the CO

2

, select

Start Zero

Cal

.

– When you see the message

Zero done at <date and time>

on the status line, the zero calibration is finished and you can begin monitoring.

5

Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section.

WARNING

To prevent stress on the endotrachial tube, support the sensor and airway adapter.

Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable.

Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the CO

2 waveform changes unexpectedly without a change in patient status.

To avoid infection, use only sterilized, disinfected or disposable airway adapters.

Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population.

Preparing to Measure Sidestream CO

2

You must perform a zero as described in this procedure each time the ambient temperature changes more than 10 °C (for example during transport).

1

Plug the sensor cable into the monitor’s CO

2 two minutes warm up time

input connector. Allow the sensor

151

13 Monitoring Carbon Dioxide

Measuring CO

2

using the CO

2

Option or M3014A

2

Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly.

3

To zero the sensor:

– expose the sensor to room air and keep it away from all sources of CO

2 including the ventilator, the patient’s breath and your own.

– In the setup menu for the CO

2

, select

Start Zero Cal

.

– When you see the message

Zero done at <date and time>

on the status line, the zero calibration is finished and you can begin monitoring.

4

For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection.

For intubated patients with an integrated airway adapter in the breathing

circuit.: Connect the male luer connector on the straight sample line to the female port on the airway adapter.

For non-intubated patients: Place the nasal cannula onto the patient.

For patients prone to mouth breathing use an oral-nasal cannula. Trim the oral sampling tip if necessary to fit the patient. It should extend down past the teeth and be positioned in the mouth opening. Remove the cannula from the patient if the tip needs to be trimmed.

For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow.

WARNING

Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor.

CAUTION

Always disconnect the cannula, airway adapter or sample line from the sensor when not in use.

152

Measuring Mainstream CO

2 using M3016A

13 Monitoring Carbon Dioxide

Using the Sidestream Sensor Holder

The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.

1

2

Push the sensor into the holder until it clicks into position.

Clamp the holder onto an IV pole, a shelf or another appropriate location.

To remove the sensor from the holder, release the clip and pull the sensor out of the holder.

clip

Removing Exhaust Gases from the System

WARNING

Anesthetics: When using the sidestream CO

2

measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.

Measuring Mainstream CO

2

using M3016A

The M3016A Mainstream CO

2

Extension measures partial pressure of carbon dioxide in a patient’s expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO

2

measurement with ventilated adults, pediatric and neonatal patients.

WARNING

Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation during use. This may cause incorrect readings.

Preparing to Measure Mainstream CO

2

1

2

Attach the transducer connector to the CO

2

connector on the M3016A extension.

Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition.

3

Perform an accuracy check and then, if necessary, calibrate the transducer.

Checking Transducer Accuracy

WARNING

Check transducer accuracy at least once a week or if you doubt the CO

2

readings.

1

2

In

Setup CO2

menu, select

Cal. Mode

to switch on calibration mode.

Look at the calibration value displayed in the

Setup CO2

menu next to Start Cal 1:. Is it the same as the value on the calstick? If not, calibrate the transducer now.

153

13 Monitoring Carbon Dioxide

Measuring Mainstream CO

2 using M3016A

3

4

5

Place the transducer on the low cell of the calstick (labelled 0.0 mmHg or “ZERO”). The reading on the screen should be zero within ±1 mmHg within one minute.

Place the transducer on the high cell of the calstick. The reading on the screen should be within ±1 mmHg of the value on the calstick within one minute.

If both readings are in range, you can leave calibration mode and begin monitoring. If either of the readings is out of range, calibrate the transducer.

Calibrating the Transducer

1

Check that the windows on the calstick are clean and clear.

2

Place the transducer on one of the calstick cells and select Start Cal 1.

3

4

5

6

Enter the calibration value printed on the calstick then press

Confirm

to start calibration.

When the message CO2 CAL 1 done;Start CAL 2 cal appears, put the transducer on the other cell and select Start Cal 2 then press

Confirm

.

When you see the message CO2 cal done; leave Cal. Mode, calibration is complete.

Select

Cal Mode

to switch calibration mode off. You cannot monitor in calibration mode.

Attaching and Removing the CO

2

Transducer

Airway Adapter

1

Open the latch and place the transducer onto the airway adapter.

Place the airway adapter in the patient’s breathing circuit between the endotracheal tube and the Ypiece. You may see the

CO2 SENSOR

WARM UP

message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement.

CO

2

Transducer

154

Measuring Microstream CO

2

using M3015A

2

To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.

13 Monitoring Carbon Dioxide

WARNING

To prevent stress on the endotrachial tube, support the transducer and airway adapter.

To avoid infection, use only sterilized airway adapters.

Measuring Microstream CO

2

using M3015A

The M3015A Microstream CO

2

Extension measures the partial pressure of carbon dioxide in a patient’s expired gas using Microstream technology.

In intubated patients, a sample of the respiratory gas is drawn from the patient’s breathing circuit through an airway adapter and a gas sampling tube. In non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.

When using the appropriate accessories, you can use the Microstream CO

2

measurement with adult, pediatric, and neonatal patients.

The M3015A is equipped with an automatic barometric pressure compensation.

Preparing to Measure Microstream CO

2

Use appropriate accessories for:

• the patient type (adult, pediatric or neonatal),

• the ventilation situation (including humidification)

• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).

All accessories are for single patient use only.

Using Microstream Accessories

M3015A can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory.

155

13 Monitoring Carbon Dioxide

Setting up Mainstream and Sidestream CO

2

For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set.

For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine

(which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO

2

, oxygen (O

2

) may be delivered to the patient to support gas exchange. This is done by using an O

2 or a Smart CapnoLine O

2

(a combined oral-nasal O

2

/CO

2

FilterLine).

/CO

2

FilterLine,

Using the FilterLine and Airway Adapter

1

Attach the female Luer connector to the CO

2

inlet connector on the extension by pushing the socket cover down and screwing the connector into place.

2

3

Check that the FilterLine is not kinked.

Change the FilterLine if a “CO

2

OCCLUSION” INOP appears on the monitor or if the readings become extremely erratic.

Disconnect the FilterLine during suctioning and nebulizing therapies.

Check the table in the Microstream CO

2

Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories.

CO

2

values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blocked

Removing Exhaust Gases from the System

WARNING

Anesthetics: When using the Microstream CO

2

measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ ventilator, to avoid exposing medical staff to anesthetics.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector.

Suppressing Zero Calibration

To prevent an automatic zero calibration from being started in the next five minutes,

♦ in the

Setup CO

2

menu, select

SmartKey, if configured.

No Zero for 5 Min

, or select the

Suppress CO2 Zero

Selecting

No Zero for 5 Min

or selecting the

Suppress CO2 Zero

SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.

Setting up Mainstream and Sidestream CO

2

These tasks are common to all CO

2

measurements except where otherwise noted.

Adjusting the CO

2

Wave Scale

1

In the

CO

2

Wave

menu or the

Setup CO

2

menu, select

Scale

.

156

Setting up Mainstream and Sidestream CO

2

13 Monitoring Carbon Dioxide

2

Choose a suitable scale range from the pop-up list.

Setting up CO

2

Corrections

Temperature, water vapor in the patient’s breath, barometric pressure, and the proportions of O

2,

N

2

O and Helium in the mixture all influence CO

2

absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections.

Correction

Altitude

(M3014A only)

O

2

(M3014A only)

Humidity

Altitude is set during installation. The monitor automatically applies an appropriate correction.

In the

Setup CO2

menu, select

Oxy. Corr.

and select a value between 0% and

100%, the default value is 16% (expired O

2

). If you are not measuring the expired O

2 estimate it by subtracting

5% from the inspired O

2

.

,

At installation, the monitor is configured to automatically apply either

Body Temperature

Pressure Saturated (BTPS) or Standard Temperature Pressure Dry (STPD). To see which, go to the

Setup CO2

menu, and scroll down to look at

HUM Corr..

N

2

O

(M3016A mainstream and M3015A microstream only)

In the

Setup CO2

menu, select

N2O Corr.

and turn on or off. If N

2 the ventilation gas mixture, you must turn this on.

O is present in

If the N

2

O correction is not available in the

Setup CO2

measurement in your MMS Extension does not require N with

Gas Corr.

(see below).

2 menu, the CO

2

O correction or it is setup

Gas

(M3014A only)

In the

Setup CO2

menu, select

Gas Corr.

and select Helium, N2O or turn off. If

Helium or N

2

O is present in the ventilation gas mixture, you must make the appropriate selection.

Agent

(M3014A only)

If the Gas correction is not available in the

Setup CO2

menu, the CO

2 in your MMS Extension does not require N

2 correction is setup with

N2O Corr.

(see above).

measurement

O or Helium correction or the N

2

O

In the

Setup CO2

menu, select

Agt. Corr.

and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration.

Suppressing Sampling (not Mainstream CO

2

)

To temporarily stop sampling,

♦ in the

Setup CO

available.

2

menu, select

Pump 15min Off

or use the

CO2 Pump Off

SmartKey if

Selecting

Pump 15Min Off

again before fifteen minutes have passed resets the timer to fifteen minutes.

To re-start the pump,

♦ in the

Setup CO

2

menu, select

Pump On

.

157

13 Monitoring Carbon Dioxide

Setting up Mainstream and Sidestream CO

2

Changing CO

2

Alarms

This refers to CO

2

specific alarms. See the Alarms section for general alarm information.

You change CO

2

alarm settings in the

Setup CO

2

menu.

To switch

etCO

2

alarms on and off:

Select

etCO

2

Alarms

and toggle between

On

and

Off

.

To change the

etCO

2

alarm limits:

• Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the popup list that opens.

• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.

To change the imCO

2

high limit:

Select

imCO

2

High

and choose the high alarm limit from the pop-up list that opens.

Changing the Apnea Alarm Delay

This determines the time limit after which the monitor alarms if the patient stops breathing.

1

2

In the

Setup CO

2

menu, select

awRR

.

In

Setup awRR

menu, select

Apnea

.

3

Choose the apnea alarm delay time.

WARNING

Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.

Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A) measurement only.

Deriving Alarms From awRR

1

In the

Setup CO

2

menu, select

awRR

.

2

In the

Setup awRR

menu, select

Alarms

.

3

Choose

On

to derive alarms from the airway respiration signal or

Off

to disable them.

Changing awRR Alarm Limits

1

In the

Setup CO

2

menu, select

awRR

.

2

Select

High Limit

to set the upper alarm limit.

Select

Low Limit

to set the lower alarm limit.

3

Select the appropriate setting.

158

14

14

Trends

Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient’s condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodicallymeasured parameters, such as Cardiac Output.

Viewing Trends

Trend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.

To view trends embedded as a screen element, enter the

Screen designed to show an embedded trend window.

Change Screen

window, then select a

To open the tabular trends window, select

Main Setup

>

Trends

>

Vitals Trend

, or select the

Vitals Trend

SmartKey.

Vitals

Trend

To open the graphic trends window over the current Screen, select

Main

Setup

>

Trends

>

Graph Trend

, or select the

Graph Trend

SmartKey.

The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the

Graph

Trend

latest available measurement value. The preview column is updated every five minutes or whenever an

NBP or other aperiodic measurement is completed.

A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement.

Your monitor screen may look slightly different to the examples shown in this chapter.

Trends Pop-Up Keys

When you open the trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks.

159

14 Trends

Viewing Trends

Pop-Up Keys Selecting this pop-up key lets you....

Select

Group

see a pop-up list of trend groups and select a group for viewing.

Select

Interval

Print

see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.

print a graphic trends report of the data in the current window. The report will use the current trend interval settings.

move the cursor one step to the left or right to navigate through the trends database timeline.

Vital

Signs

Graph

Trend

move the cursor one page to the left or right to navigate through the trends database timeline.

scroll up and down the screen to see measurement trends that do not fit in the current view.

open the current trend view in tabular form. The displayed time period and resolution stay the same.

open the current trend view in graphic form. The displayed time period and resolution stay the same.

Viewing Graphic Trends

Graphical Trends: Standard

HR

SpO

2

RR

4 Apr

Select

Interval

Scroll to view more pop-up keys

Select

Group

Vital

Signs

Print

1

2

A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column.

In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.

To use the trend cursor to navigate in time through the trends database,

Select the graphical trend or the arrow pop-up keys to activate the cursor.

Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or

160

Setting Up Trends

3

Place the cursor at a specific time by touching the graph.

Viewing Vital Signs Trends

14 Trends

HR

SpO

2 etCO

2 imCO

2

RR awRR

Vital Signs: Standard

Aperiodic values are shown with a timestamp

Select

Interval

Scroll to view more pop-up keys

Select

Group

Graph

Trend

Print

The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.

Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets.

If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow.

Setting Up Trends

Trends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under

Main Setup

->

Trends.

Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu.

Making Segment Settings

The

Graphical Trends

window is divided into measurement segments, each of which has its own settings.

To enter the segment menu,

♦ select the left hand column of the segment, where the measurement label is displayed.

Expanded View

To expand the segment to fill the

Graphical Trends

window,

♦ in the

Segment

menu, select

Expand

to have that segment enlarged to fill the window.

161

14 Trends

Setting Up Trends

In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement,

♦ in the

Segment

measurement.

menu, select

Highlight

repeatedly until the highlight is on the required

To return the segment to its original size,

♦ in the

Segment

menu, select

Expand

again.

Trend Scales for Segment Measurements

To change the trend scales for a measurement in the current segment:

1

2

In the segment menu, select the measurement label

Select

Upper

to change the upper limit of the scale or

Lower

to change the lower limit of the scale.

Optimum Scale

To have the monitor automatically select an optimum scale for viewing, based on current values,

♦ in the

Segment

menu, select

Optimum Scale

.

This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in

Parameter Scales

.

To switch off automatic optimum scaling,

♦ in the

Segment

menu, select

Optimum Scale

again.

Trend Group

To add or remove measurements for this trend group or change the order of the existing measurements:

1

2

In the

Segment

menu, select

Change Group

Use the

Add

,

Change

,

Sort Up

and

Sort Down

popup keys to change or re-order the group as required.

No. of Segments

In an embedded graphical trend window, you can select the number of segments to be displayed in the

Segment

menu:

In the

Segment

menu, select

No. of Segments

Trend Groups

The measurements grouped in trend groups define the trends displayed together in the Vital Signs or

Graphics Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group

All

contains all available measurements, you cannot change the order or selection of this group.

To change the selection of measurements in a trend group, either use the

Change Group

setting in the

Segment

menu or:

162

Setting Up Trends

14 Trends

1

2

Select

Main Setup

->

Trends

->

Trend Groups

Select the Trend Group you want to change and use the pop-up keys to

Add

,

Change

, or

Delete

the selection of measurements trended.

To temporarily change the order in which the measurements are displayed in a group,

1

Select

Main Setup

->

Trends

->

Trend Groups

2

Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort

Down pop-up keys.

Trend Interval

The trend interval defines the resolution of trend data shown on the Screen.

To set the trend resolution, in the Vital Signs or Graphical Trends window,

Select the

Select Interval

pop-up key and then select the required interval from the list.

Trend Priority

The monitor stores trend information for all monitored measurements, if configured to do so. If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements.

To see the measurement priority list for trending,

1

2

In the

Main Setup

menu, select

Trends

.

Select

Trend Priority

.

To add measurements to the priority list,

1

Select the pop-up key

Add

and choose from the pop-up list of available measurements.

2

Use the

Sort Up

and

Sort Down

pop-up keys to change the priority order.

Trend Parameter Scales

Parameter scales define how the trend waveform will appear on the screen and in trend reports.

Separate scales can be set for adult, pediatric, and neonatal patient trends.

To change the trend parameter scales settings, either use the

Scale

setting in the

Segment

menu or:

1

In the

Main Setup

menu, select

Trends

.

2

3

Select

Parameter Scales

.

Select the measurement or parameter you want to change from the list.

4

5

Select the pop-up key

Change

to call up the

Scale

menu.

In the

Scale

menu, select the parameter label you want to define settings for. Select

Adult

,

Pedi

, and

Neo

and use the pop-up keypad to enter new upper and lower scale definitions.

Graphical Trend Presentation

Graphical trends and screen trends for measurements with compound values (for example ABP or

CO

2

) can be viewed in line or band form.

To change the presentation style,

1

Select

Main Setup

->

Trends

163

14 Trends

Documenting Trends

2

Select

Global Style

and choose

Line

to display the trends as a continuous line

Band

to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.

240

This sample ABP trend shows the continuouslymeasured values for the systolic, diastolic and mean pressures displayed in band form.

ABP

50

Documenting Trends

To print a Vital Signs or Graphical Trends report,

♦ in the

Vital Signs

or

Graph Trends

window, select the pop-up key for the trend group currently on the monitor screen.

Print

to print a report

Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor’s configuration. Trends reports can be printed on central or local printers.

Trends Databases

The trend databases store information for up to 16 measurements for up to 48 hours.

The values in the trends database are stored as measured by the monitor, they are not averaged values.

The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown.

Example database configuration In this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution.

“4 hours @ 12 second resolution” means that the monitor stores trend data every 12 seconds, for the most recent four hours.

164

Screen Trends

14 Trends

- 48 hours

- 24 hours

- 4 hours now time

4 hours @12 second resolution

24 hours @ 1 minute resolution

48 hours @ 5 minute resolution

Aperiodic Trends Database

Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time.

Trending Multiple-Value Measurements

Some measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements.

Screen Trends

Trends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, or horizon format.

If you do not see screen trends on the monitor Screen, select a different Screen, one that is configured to show screen trends. Screen trends are only available on specially designed Screens.

Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended.

165

14 Trends

Screen Trends

Measurement wave

HR

SBed9 Adult

SpO

2

ALARMS OFF

Perf

Arrhythmia Off

M

NBP

Sys.

NBPs

1mV

Auto 15 min

Temp

65 -60min

-30min

Measurement numerics

NBPs

65

-60min -30min

NBP graphical screen trend

ABP

240

50

Example of other graphical screen trends: ABP

Measurement wave

HR

SBed9 Adult

Pulse

ALARMS OFF

SpO

2

Arrhythmia Off

M

NBP

1mV

Auto 15 min

Temp

NBP

Sys.

Measurement numerics

Tabular trend

166

Screen Trends

14 Trends

Setting the Screen Trend Time

To set the

ScreenTrend Time

for all graphical and horizon screen trends (“global” trend time),

1

2

Select a screen trend then select

Setup Trend

, or select

Main Setup

->

Trends

.

Select

ScreenTrend Time

and select the required time: 30 minutes, one, two, four, eight, or twelve hours.

This is now the Global screen trend time and defines the period of trend information shown for all screen trends.

To set a different

ScreenTrend Time

for a screen trends or a group of aligned screen trends,

1

2

Select a screen trend

Select

Change TrendTime

3

Select the required trend time.

Selecting

Global

leaves the trend time set to the global screen trend time.

Changing the Selection of Screen Trends Displayed

1

Select the screen trend.

2

Select

Change Trend

and select the required trend from the list of available trends.

Select

Blank

to remove the selected trend from the Screen.

If you do not see

Change Trend

in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend.

To display two or more screen trends overlapping,

1

Select the screen trend to open the screen trend menu,

2

Select

Change Trend

->

Add Trend

and select a screen trend from the pop-up list.

Activating the Cursor for Screen Trends

To activate the cursor for Screen Trends:

1

2

Select the screen trend.

Select

Activate Cursor

You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor.

To de-activate the cursor,

Press the

Main Screen

key.

Changing the Screen Trend View

To switch between tabular, graphic and horizon views, select the screen trend then select

Change

View

and select the required view.

Tabular View

Aperiodic measurements such as NBP, can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label.

167

14 Trends

Screen Trends

NBP

Sys.

Horizon View

The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient’s condition since the baseline was set.

The horizon view is made up of:

• a horizon, drawn in white, as a reference point or baseline to help you visualize

1 2

changes in your patient’s condition. The horizon can be set to represent your patient’s current

3

condition, or a target condition and can be a single value or a range.

• a graphical trend, displaying patient data for the set TrendTime (1).

• a trend indicator arrow, indicating how the patient trend has developed in the set time period

(10 minutes, 5 minutes or 2 minutes) (2).

• a deviation bar, showing how the currently measured value deviates from the set horizon (3). The height of the deviation bar is an indication of the extent of the change in your patient’s condition relative to the (horizon) baseline.

Your monitor may not be configured to show all elements of the screen trend horizon view.

Setting the Horizon

The horizon is the reference value to which deviations in the measurements are compared.

1

To set the horizon, select the horizon trend

2

Select

– Set High Horizon

to select the upper horizon value. If the high and low horizon values are the same, the horizon is a baseline - if the values are different the horizon is a range.

– Set Low Horizon

to select the lower horizon value.

Auto Horizon

to set the horizon for the selected horizon trend to the currently-measured value

Auto All

to reset the horizon for all horizon screen trends to the currently-measured values

Set Horizon

to set the horizon to a specific value from a pop-up list.

Setting the Horizon Trend Scale

The horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.

To set the horizon trend scale delta,

1

Select the horizon trend.

168

Screen Trends

14 Trends

2

Select

Set Scale Delta

and select a value to define the distance between the horizon and the upper and lower scale limits.

Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient’s condition having changed.

If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.

Setting the Time Period for the Trend Indicator Arrow

The time period for which the trend indicator arrow can be set in the Trends window.

1

2

Select

Main Setup

>

Trends

Select

HorizonArrowTime

.

3

Select 10, 5 or 2 minutes.

169

14 Trends

Screen Trends

170

15

15

Recording

Central

Recording

For central recording from the bedside, your monitor must be connected via a network to an

Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A

4-Channel Recorder. See the documentation supplied with the Information Center for information on the 4-Channel Recorder.

Starting and Stopping Recordings

The recordings pop-up keys let you start and stop recordings. Select the

Main Setup

SmartKey then select

Recordings

to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.

Delayed

Recordng

RT A

Recordng

RT B

Recordng

Select

Waves

Setup

Recordng

Stop all

Recordng

Recording Without a Template

To record without a preconfigured template, selecting the waves you require,

1

2

Select the

Main Setup

SmartKey then select

Recordings.

Select the pop-up key

Select Waves

,

3

4

Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the

Continue

pop-up key.

Select one of the recording speed pop-up keys to set the required recording speed.

5

Select the

Start

pop-up key to start the recording.

Select Waves

recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping.

171

15 Recording

Overview of Recording Types

Overview of Recording Types

Delayed

Type of recording manual

Recording

Destination

central

Information recorded

from the start trigger minus the delay time

Number of waves

up to 2

Speed

50, 25, 6.25 mm/sec

Runtime

N/A

Stops

automatically

Delay Time

10, 15 seconds

Overlap

N/A = not applicable

Off

On (up to 2 waves)

Alarm

automatic, triggered by defined alarm conditions central printer

Realtime (RT)

manual central from the start trigger minus the delay time up to 2

25 mm/sec

N/A automatically

10, 15 seconds

Off

On (up to 2 waves)

N/A

N/A

N/A

N/A

N/A

N/A

N/A from the start trigger up to 2

50, 25, 6.25 mm/sec continuously manually none

Off

On (up to 2 waves)

Creating and Changing Recordings Templates

1

2

To save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the

Setup Recording

menu. You can create templates for one delayed recording, one alarm recording and two realtime recordings (

Realtime A

and

Realtime B

).

Changing recordings templates changes the settings that will be used each time a recording of this name is triggered.

Select the

Main Setup

SmartKey to call up the Main Setup menu.

Select

Recordings.

3

4

Select the

Setup Recording

pop-up key to enter the Setup Recordings menu.

Select the name of the template you want to create or change. Each recording name is linked to a recording type: delayed, alarm, and realtime. Recording names can be changed in the monitor’s

Configuration Mode.

5

Design the template by selecting each menu item and entering the information for the template.

Recorder

: choose which recorder the recording will print to (Central 2-Ch. or Central 4-Ch. recorder, or a printer (for realtime reports in alarm recording only)).

Channels 1 - 4

: choose which waveform to record in each channel.

In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:

Alarm Par

will always record the measurement in alarm in the chosen recorder channel

Primary Lead

will always record the current primary lead in the chosen recorder channel

172

Recorder Status Messages

15 Recording

Secondary Lead

will always record the current secondary lead in the chosen recorder channel

Overlap

: define whether the recorded waveforms will be printed overlapping or beside each other.

Speed

: choose the recording print speed.

Delay Time

: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the “Delay Time” and can be set as specified in

the table on page 172. This setting can only be changed in Configuration Mode.

Runtime

: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely.

Central Config

- if available in the

General

menu, select this setting to use the recording settings made for the centrally-connected recorder.

Maintaining Recording Strips

Recording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation.

Recorder Status Messages

CAUTION

If no central recorder is available, alarm recordings may be lost. The message

no alarm recording available

will be displayed. This message is not shown if

Printer

is configured as the alarm recording destination.

Recorder Status Messages

<Recording name> running

Explanation

The named recording is currently running.

No alarm recording available

Central recorder out of paper

Central recorder door open

No recorder available. Alarm recordings will be lost.

Try configuring Printer as the alarm recording destination.

The named recorder is out of paper.

The door of the specified recorder is open.

173

15 Recording

Recorder Status Messages

174

16

16

Printing Patient Reports

Starting Report Printouts

Most patient reports can be printed by selecting Main Setup - > Reports (or the Reports

SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up.

Data from the time of the print request is printed, even if the print job is delayed in the printer queue.

Depending on availability, reports can be printed on printers connected to the Information Center, an external PC-based print server or into the print database. Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available.

Print jobs in the print database are not deleted after a patient discharge. Always admit your patient so that reports can be clearly assigned to a patient.

Report types Report contents How to start printing reports

Vital Signs Report

Graphic Trends Report

ECG Reports

ST Map Report depends on selected trend group, data resolution, and period.

Depends on format selected

ST data in a transversal and/or horizontal multiaxis diagram,

In the Vital Signs window, select

Print

In the Graphic Trends window, select

Select the

Print

ECG Report

SmartKeys, if configured

In the ST Map window, select

Print

.

Alarm Limits Report Graphic and numeric report of all current alarm limits

Realtime Reports

Battery Report

Patient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT waves

Battery serial number, information on the currently-measured and potential charge status of the battery

In the

Alarm Limits

window, select

Print

Limits

Select the configured

In the

Realtime Reports

SmartKey, if

Battery Status

window, select

Print Status

.

175

16 Printing Patient Reports

Stopping Reports Printouts

Stopping Reports Printouts

To stop Reports printing, in the Reports menu, select

Stop Report to stop the current print job

Stop All Reports to cancel all queued report printouts

Scheduled Rep. to toggle to Off and switch off scheduled reports.

Setting Up Reports

ECG report layout and Auto Reports settings must be defined in Configuration Mode.

The content you define in the individual Setup Reports menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report will be printed at this speed, irrespective of format.

Setting Up ECG Reports

The settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up

ECG Reports,

1

Select Main Setup -> Reports -> ECG Reports. Note the report layout configured for your monitor, either Internat. or Cabrera. This setting is inactive (“grayed-out”) in Monitoring Mode and can only be changed in Configuration Mode.

2

Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the

ECG report printouts.

3

4

Select Speed and select the report print speed.

Select Annotation and toggle to On if the printed ECG wave should be annotated with beat labels or not. See the chapter on ECG for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.

Setting Up Vital Signs and Graphic Trend Reports

The settings you choose in the Setup Vital Signs Report and Graphical Trend

Report

menus apply for all Vital Signs and Graphic Trend reports printed.

To set up Vital Signs and Graphic Trend reports,

1

2

Select Main Setup -> Reports -> Vital Signs Rep. or Graph Trend Rep.

Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor’s trend configuration.

3

4

Select Period and select the period of time for which trend data should be printed on the report. If

Automatic Period

is configured to

On

, all trend data for the current patient will be printed, irrespective which trend period is selected.

Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report,

176

Setting Up Individual Print Jobs

16 Printing Patient Reports

Setting Up Auto Reports

Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports:

Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report.

To set up Auto Reports,

1

2

Select Main Setup -> Reports -> Auto Reports and select the Auto Report you want to set up (A, B,

C, or D).

Select Report and assign a report type to the Auto Report.

3

Select End Case Report and toggle to On if you want the selected report to print automatically when you select End Case to discharge a patient.

Toggle End Case Report to Off if the report is a Scheduled Report only.

4

Select Scheduled Rep. and toggle to On if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day.

For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on.

– To set the time of day at which you want the report to print every day: select Start Hour and

Start Minute

and select the required time from the pop-up list

– To set the time interval in minutes between two scheduled reports: select Rep. Freq. (Hr) and Rep. Freq. (Min) and select the time interval from the pop-up list.

If you are setting up an end case report, these settings will be inactive (“grayed-out”).

Toggle Scheduled Rep. to Off if the report is an End Case Report only.

5

Repeat the procedure for all Auto Reports you want to set up.

All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger.

Be aware that the monitor’s memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost.

Setting Up Individual Print Jobs

To adjust the appearance of individual print jobs, in the Reports menu,

1

2

Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu.

Select Report and then select the report you want to set up.

177

16 Printing Patient Reports

Checking Printer Settings

3

4

5

Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected.

Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:

Visible Waves:

all waves currently visible, in the order they appear on the screen.

All Waves

: all measured waves,

RT Waves

: all currently measured realtime waves, according to the monitor’s priority list.

Vital Signs

: trend information in tabular form.

Graph Trend

: trend information in graphic form.

ECG3X4

, ECG6X2, ECG12X1, ECG4X2, ECG8X1, ECG12X1(2P): ECG reports.

Alarm Limits

: a list of all currently set alarm limits.

Select Report Size to set the paper size to be used for the report: Unspecified to use the default size for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or

Ledger

. The list of available sizes depends on the report type selected.

Select Orientation to set the orientation of the report printout: Unspec. to use the default size for the template chosen, Landscape or Portrait.

6

Select Target Device and choose which printer the print job will be sent to: Unspec. to use the default printer, or choose from the list of printer names defined at the Information Center or in the monitor’s Configuration Mode (for example, Remote 1 or Database).

Some settings may be inactive (“grayed-out”) in this menu for reports that can only be started in a special window.

Checking Printer Settings

The printer settings for your monitor are defined in Configuration Mode. The printer settings Paper

Size

, Resolution, Color Support, and Duplex Option for the active printer are visible but inactive (“grayed-out”) in the Setup Printers menu. When Print Database is selected as active printer only the Paper Size setting will be shown.

To enter the Setup Printers menu, in the Reports menu, select Setup Printers.

Printing a Test Report

A test report can be printed in Configuration mode, refer to the Service Guide for details.

Switching Printers On Or Off for Reports

You can enable or disable printer status to switch individual printers on or off for report printouts.

1

In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.

2

Select Printer Status to toggle between the settings Enable and Disable. If you set this to Disable, no reports will be printed to the named printer.

If the monitor detects that no printer of a particular type is available, the Enable/Disable setting will automatically be set to Disable and “grayed out”.

178

Dashed Lines on Reports

Dashed Lines on Reports

16 Printing Patient Reports

If a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing.

For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place.

Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/ mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.

To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.

Unavailable Printer: Re-routing Reports

If you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitor’s memory.

If the target device of this print job was set to Unspecified, the monitor will periodically try to resend the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and that has paper of the correct size.

To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-route a print job,

Enable the new target printer by selecting it in the Setup Printers menu and toggling to

Enabled

. As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.

If the target device of the print job was set to a specific printer, re-routing is not possible.

Checking Report Status

A list of all print requests which are waiting, printing or stored can be viewed in the Reports Job List.

To view the list,

♦ in the Reports menu, select Reports Job List.

The following information is displayed for each print request:

• Report title

• Patient name (except for system reports such as the battery status report)

• Request date and time

• Report paper format

• Job status: Preparing, Printing, Waiting, In Database, Retry, Cancelling, Error

179

16 Printing Patient Reports

Printer Status Messages

Individual reports can be deleted from the list with the Stop Report key, and all reports with the

Stop All Reports

key.

Printer Status Messages

Printer Status Message

Print job queued

<Printer name>

Print job can’t queue;queue full

Cancelling all print jobs

Possible causes and suggested action

The report has been placed in the queue for the named printer.

The printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again,

OR

A report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request.

Stop All Reports

has been selected in the

Report

menu, OR

The Operating Mode has been changed from Monitoring Mode to

Demonstration or Service Mode.

The current report is being cancelled as the result of a user request.

Cancelling the active print job

Deleted N print jobs;discharge

Deleted N print jobs; hotstart

Print failed;No report configurd

Printing on

<Printer name>

When a patient is discharged, all queued reports are cancelled except those stored in the print database. “

N

” is the number of reports cancelled.

The monitor has restarted and all report requests have been cancelled except those stored in the print database. “

N

” is the number of reports cancelled.

A report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report.

A report is in progress, or the monitor is waiting for the central printer to accept the print job.

180

Sample Report Printouts

16 Printing Patient Reports

Printer Status Message Possible causes and suggested action

NoPrinter <Printer name>;job susp

The chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available.

Print Database full->job suspnd.

The requested report does not fit into the print database. You can select

another printer to print the report (see “Unavailable Printer: Re-routing

Reports” on page 179). Alternatively you can delete another report from

the Reports Job List (using the Stop report key) to create space for your report.

Job <Printer name> fail;

A report cannot be started on the requested printer.

One of three reasons will also be shown in the status message:

• data requisition error (data error) - an internal error has caused data required for the report to be unavailable, try starting the report again.

• printer unavailable (no printer)- make sure the printer is plugged in, switched on, and has paper loaded.

• data unavailable (no data) - the connected X2 or MP5 has been removed before the data for the report was transferred.

The report has been printed.

Print job on

<Printer name> done

Sample Report Printouts

Each report header contains the patient’s bed label, last name and first name, the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end.

The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the Addressograph and it can only be changed in the monitor’s Configuration Mode.

181

16 Printing Patient Reports

Sample Report Printouts

Alarm Limits Report

NBed6

Alarm Limits

HR

ST-I

ST-II

ST-III

ST-aVR

ST-aVL

Measurement labels, with alarms off symbol where alarms are switched off

ST-aVF

ST-V1

ST-V2

ST-V3

ST-V4

ST-V5

Doe, John

ST-V6

SpO2

NBPs

ABPs

RR

Apnea Time 20 sec

123456789-P1

19 Apr 07 15:59:37

Graphic view of current alarm limits in relation to currently monitored measurement value

Realtime Report

Patient demographic information, time stamp

NBed6

Realtime Report

Patient Cat.: Adult

Paced: No

Gender: Male

Active Alarms and INOPs, followed by vital signs

**ABPs HIGH

SpO2 NON-PULSAT.

HR

PVC

ST-I

ST-II

ST-III

60 bpm

0 /m

0.0 mm

0.0 mm

0.0 mm

Measurement waves section

Doe, John

Date of Birth: 19 Nov 1963

Age: 43 years

Height: 69 in

ST-aVR

ST-aVL

ST-aVF

ST-V1

ST-V2

ST-V3

ST-V4

ST-V5

0.0 mm

0.0 mm

0.0 mm

0.0 mm

0.0 mm

0.0 mm

-0.1 mm

0.0 mm

Patient Cat.: Adult

Paced: No

123456789-P1

19 Apr 07 15:59:54

ST-V6

SpO2

Pulse

Perf

NBP

Pulse

ABP

ST-V5

0.0 mm

-?- %

-?- bpm

-?-

119/81 (93) mmHg

0.0 mm

Bandwidth 0.5-40 Hz Non-Paced 10mm/mV 25mm/sec

182

Sample Report Printouts

ECG Reports

Patient information

Numeric block

Wave area

16 Printing Patient Reports

Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values.

The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patient’s paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.

ECG Report type

12-Lead ECG

Multi-lead ECG

Available Formats

3X4 landscape

6X2 landscape

12X1 portrait

12X1 landscape

12X1 (2P) landscape

2X4 landscape

8X1 portrait

8X1 landscape

Other Reports

See the sections on Trends for other example reports.

Available Paper Sizes

A4, letter, A3, ledger

A4, letter, A3, ledger

A4 and letter only

A4, letter, A3, ledger

A4, letter (2 pages)

A4, letter, A3, ledger

A4 and letter only

A4, letter, A3, ledger

183

16 Printing Patient Reports

Sample Report Printouts

184

17

17

Care and Cleaning

Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods.

Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to “Guidelines for Prevention of

Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-

Safety Workers” issued by the U.S. Department of Health and Human Services, Public Health Service,

Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country.

General Points

Keep your monitor, cables and accessories free of dust and dirt. After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first.

Observe the following general precautions:

• Always dilute according to the manufacturer’s instructions or use lowest possible concentration.

• Do not allow liquid to enter the case.

• Do not immerse any part of the equipment or any accessories in liquid.

• Do not pour liquid onto the system.

• Never use abrasive material (such as steel wool or silver polish).

• Never use bleach.

WARNING

If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.

185

17 Care and Cleaning

Cleaning the Monitor

Cleaning the Monitor

Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene.

Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement connectors. Wipe around, not over, connector sockets.

CAUTION

To clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by pressing and holding the Main Screen key for two seconds. Press the

Main Screen key again to re-enable touch operation.

Recommended cleaning agents are:

Tensides (dishwasher detergents)

Ammonias

Alcohol

Disinfecting the Monitor

Edisonite Schnellreiniger

®

, Alconox

®

Dilution of Ammonia <3%, Window cleaner

Ethanol 70%, Isopropanol 70%, Window cleaner

CAUTION

Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.

Hospital policy: Disinfect the product as determined by your hospital’s policy, to avoid long term damage to the product.

Clean equipment before disinfecting. Recommended types of disinfecting agents are:

Base

Alcohol

Aldehyde

Approved Agents

Ethanol up to 70%

1- and 2- Propanol up to 70%

Glutaraldehyde up to 3.6%

Sterilizing the Monitor

Sterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies.

186

Cleaning, Sterilizing and Disinfecting Monitoring Accessories

17 Care and Cleaning

Cleaning, Sterilizing and Disinfecting Monitoring

Accessories

To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory.

187

17 Care and Cleaning

Cleaning, Sterilizing and Disinfecting Monitoring Accessories

188

18

18

Using Batteries

When monitoring a patient, one Philips M4607A rechargeable Lithium Ion battery must always be inserted into the battery compartment on the right side of the monitor. This applies even when you are running the monitor from the external power supply. The battery seals the battery compartment, thereby preventing the ingress of fluids or foreign bodies. A severe yellow INOP (!!INSERT

BATTERY

) will be issued if the monitor is connected to AC mains without a battery fully inserted in the battery compartment. This INOP will persist until a battery is loaded.

Battery compartment

To use the monitor with battery power, disconnect the MSL cable (connecting the external power supply) from the monitor.

You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring.

The battery recharges automatically when the monitor is connected to the external power supply

(M8023A).

189

18 Using Batteries

Battery Power Indicators

Battery Power Indicators

The battery LED and battery status information on the Main Screen, in combination with INOP messages and prompts, help you keep track of the battery power status. The indicators always show the remaining capacity in relation to the battery’s actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window.

Battery LED

The battery LED on the front panel of the monitor is indicated by a battery symbol.

Battery LED

Battery LED Colors If the monitor is connected to the external power supply

(M8023A), this means

battery charging

If the monitor is running on battery power, this means

Yellow

Red, flashing

less than 10 minutes power remaining battery malfunction

Red, flashes intermittently

battery or charger malfunction

The battery LED is yellow during charging and switches off when the battery is charged.

Battery Status on the Main Screen

Battery status information can be configured to display permanently on all

Screens. It shows the status of the battery, with the battery power remaining and, when the battery is not charging, an estimate of the monitoring time this represents.

Battery power gauge: This shows the remaining battery power. It is divided into sections, each representing 20% of the total power. If three sections are filled, as in this example, this indicates that 60% battery power remains. If no battery is detected, a blank battery gauge marked with a flashing red X is displayed. If no data is available from the battery, a question mark is shown in the gauge.

190

Battery Power Indicators

18 Using Batteries

Battery status/malfunction indicator: Normal battery function is indicated by the battery power gauge, together with the remaining operating time, on the Main Screen. You are informed of problems or changes in the status of the battery by the battery status/malfunction indicator. This consists of a blank battery gauge containing a symbol. If the symbol is red, this indicates a critical situation. You can check the specific cause of the problem by looking at the symbol(s) displayed in the Battery

Status

window (see page 191).

Battery status indicator

!

Alternates with the battery gauge on the

Main Screen.

Check in the Battery Status window to see which status symbol is displayed to identify the cause.

Battery malfunction indicator

X

!

The red

!

flashes. Critical battery situation or malfunction. Check in the Battery Status window to see which malfunction indicator is displayed, or refer to the INOP, to identify the cause.

Indicator for missing battery

(flashing red X). An INOP is issued when the battery compartment is empty, and the monitor is connected to AC mains via the external power supply. This !!INSERT

BATTERY

INOP is suppressed for 15 seconds while the monitor is connected to AC mains power, allowing you sufficient time to load a new battery. After silencing, the INOP cycles every

10 seconds until a battery is loaded.

Monitoring Time Available: While the monitor is running on battery power, a time is displayed below the battery power gauge. No time is displayed when the monitor is running on AC mains power via the external power supply (M8023A). This is the estimated monitoring time available with the current battery power. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery.

Battery Status Window

To access the Battery Status window and its associated pop-up keys, select the battery status information on the Screen, or select Main Setup -> Battery.

Battery Status

2:33 hrs

TimeToEmpty:

Capacity remaining fullCharge

[mAh]

[mAh]

Capacity, Remaining

tells you how much power is left in the battery.

Capacity, Full Charge

tells you how much power the battery can hold when fully charged.

191

18 Using Batteries

Checking Battery Charge

Time To Empty

tells you approximately how long you can continue to use the monitor with this battery. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery.

Time To Full

is shown in place of Time To Empty if the monitor is connected to mains power via the M8023A external power supply, and tells you how much time is left until the battery is charged to 90%. You can use the M8043A Smart Battery Charger to charge the batteries externally.

Battery status/malfunction symbols: If a problem is detected with the battery, an INOP may be issued, and the following symbols are displayed in the Battery Status window, where they may be accompanied by a battery status message providing more details. Messages appear in the line where

Time To Full/Time to Empty

is shown. Symbols indicating critical situations are colored red.

Battery status symbols

battery is empty

Battery malfunction symbols

(red) incompatible battery battery not charging as the temperature is above or below the specified range battery requires maintenance

(red) battery malfunction

(red) battery has no power left charging stopped to protect the battery (red) battery temperature too high

Printing Battery Reports

To print the information in the Battery Status window on a connected printer,

1

2

Select the battery status information on the Screen to open the Battery Status window

Select the Print Status pop-up key.

Checking Battery Charge

To check the charge status of a battery in a monitor, see the battery power gauge on the Screen or select Main Setup -> Battery to enter the Battery Status window.

To check the charge status of a battery that is not connected to a monitor or battery charger, press the black dot marked “PUSH” on the labeled side of the battery. The remaining charge is indicated by four LEDs on the electronic fuel gauge directly above the dot. Each LED represents 25% of charge. If all LEDs are lit, the battery is fully charged, if only one LED is lit, 25% or less charge is left.

192

Replacing a Battery

Replacing a Battery

To replace the battery,

1

Press the battery eject button. This releases the battery.

18 Using Batteries

Battery eject button

2

3

The INOP !!INSERT BATTERY is suppressed for 15 seconds, allowing you sufficient time to load a new battery.

Remove the battery from the compartment.

Slide the new battery into position with the contacts facing downwards. It should ‘click’ into position when it is fully inserted.

Click!

Optimizing Battery Performance

The performance of rechargeable batteries may deteriorate over time. Battery maintenance as recommended here can help to slow down this process.

193

18 Using Batteries

Optimizing Battery Performance

Display Brightness Setting

In the Main Setup menu, select User Interface -> Brightness - > Optimum.

This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings.

Satisfy yourself that this level of brightness is suitable for your monitoring location.

Note that your monitor may be configured to dim or brighten the display brightness automatically when you disconnect from power, to suit the most common transport scenario

(“TransportBrightn” setting).

Charging a Battery

A battery can be charged in a monitor during monitoring. You can also use the M8043A Smart Battery

Charger to charge batteries.

1

2

Insert the battery into a monitor connected to the external power supply (M8023A).

Charge the battery until it is full, the battery LED goes out, and the battery power gauge is filled.

In certain situations, internal temperature conditions may mean that the battery will not charge. This is sometimes necessary to protect the battery from damage, and does not indicate a malfunction. In this case you must use the M8043A Smart Battery Charger to charge the battery.

Conditioning a Battery

You must condition a battery when its “battery requires maintenance” symbol shows on the Screen. Do not interrupt the charge or discharge cycle during conditioning.

CAUTION

Do not use a monitor being used to monitor patients to condition batteries. The monitor switches off automatically when there is no battery power left.

You can also use the M8043A Smart Battery Charger for external battery conditioning (requires adapter, order number 4512 610 17451). For details please see the Instructions for Use for the Smart

Battery Charger. Do not use any other battery chargers or conditioners.

To condition a battery using a monitor,

1

Insert the battery into a monitor connected to the external power supply.

2

Charge the battery until it is completely full. Open the Battery Status window and check that the Batt fully charged message is displayed.

3

4

Disconnect the monitor from mains power, and let the monitor run until there is no battery power left and the monitor switches itself off.

Reconnect the monitor to mains power and charge the battery until it is full for use or charge to

50% for storage.

Storing a Battery

A battery should not remain inside the monitor if it is not used for a longer period of time. Batteries should be charged to a maximum of 50% for storage.

194

Battery Safety Information

18 Using Batteries

N O T E

The battery will discharge over time if it is stored inside the monitor when not connected to AC power via the external power supply (M8023A). The reported values for “remaining capacity” and “runtime” will become less accurate when the battery is stored in this way for a longer period of time (that is, several weeks).

Battery Safety Information

WARNING

Use only Philips batteries part number M4607A. Use of a different battery may present a risk of fire or explosion.

Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury.

Dispose of used batteries promptly and in an environmentally-responsible manner. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements.

CAUTION

Do not disassemble, heat above 100

°

C (212

°

F) or incinerate the batteries, to avoid the risk of fire and burns. Keep batteries out of the reach of children and in their original package until you are ready to use them.

If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Refer to qualified service personnel.

195

18 Using Batteries

Battery Safety Information

196

19

19

Maintenance and

Troubleshooting

WARNING

Schedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.

Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.

Inspecting the Equipment and Accessories

You should perform a visual inspection before every use, and in accordance with your hospital’s policy.

With the monitor switched off:

1

Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse.

2

Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use.

3

Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier.

Inspecting the Cables and Cords

1

2

3

Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.

Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.

Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.

197

19 Maintenance and Troubleshooting

Maintenance Task and Test Schedule

Maintenance Task and Test Schedule

The following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation CD.

Ensure that these tasks are carried out as indicated by the monitor’s maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.

Maintenance and Test Schedule Frequency

Monitor Tests

Safety checks. Selected tests on the basis of IEC 60601-1

At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped.

Monitor Maintenance

Check ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation)

Measurement Tests

Performance assurance for all measurements not listed below.

Measurement Maintenance

NBP calibration

Microstream CO

2 performance test

calibration and

Mainstream and sidestream CO

2 calibration check

Battery Maintenance

Battery

At least once every two years, or as needed.

At least once every two years, or if you suspect the measurement values are incorrect.

At least once every two years, or as specified by local laws.

At least once a year or after 4000 operating hours.

At least once a year, or if you suspect the measurement values are incorrect.

See the section on Maintaining Batteries

198

Troubleshooting

19 Maintenance and Troubleshooting

Troubleshooting

If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly.

If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log,

1

2

In the

Main Setup

menu, select Revision.

View the status log by selecting the Stat Log pop-up key.

3

View the status log by selecting Status Log from the Monitor Revision window.

Disposing of the Monitor

WARNING

To avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your country’s laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste.

You can disassemble the monitor as described in the Service Guide.

– There is no metal molded into the plastic case, and there are no metal sprays on the plastic.

– All plastic parts with a weight greater than 10g (0.35 ounces) are marked with the ISO code for identification.

– The sheet metal card cage uses only one kind of steel.

– The screen has a touch resistor laminate.

– You can recycle the paper Instructions for Use.

The battery can be easily removed (see “Replacing a Battery” on page 193),

and can be returned, free of charge, to the worldwide-recycling program run by the battery manufacturer (contact your local supplier).

This product consists of devices that may contain mercury, which must be recycled or disposed of in accordance with local, state, or federal laws. Within this system, the backlight lamps in the monitor display contain mercury.

Do not dispose of waste electrical and electronic equipment as unsorted municipal waste.

Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered.

Disposing of Empty Calibration Gas Cylinders

1

2

3

Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.

When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.

Write “Empty” on the cylinder and dispose of it appropriately for scrap metal.

199

19 Maintenance and Troubleshooting

Disposing of Empty Calibration Gas Cylinders

WARNING

Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.

200

20

20

Accessories

You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details.

WARNING

Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard.

Philips’ approval: Use only Philips-approved accessories.Using non-Philips-approved accessories may compromise device functionality and system performance and cause a potential hazard

Packaging: Do not use a sterilized accessory if its packaging is damaged.

ECG/Resp Accessories

This symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.

The following cables may not all be available in all countries. Please check availability with your local

Philips supplier.

Recommended Cables

Trunk Cables

3-Electrode

Cable Set

5-Electrode

Cable Set

Part No. M1669A

Length 2.7m

M1668A

2.7m

6-Electrode

Cable Set

M1667A

2.7m

10-Electrode

Cable set

(5+5)

10-Electrode

Cable set

(6+4)

M1663A

2.0m

M1665A

2.7m

201

20 Accessories

ECG/Resp Accessories

3-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU snap shielded

ICU Clip non-shielded

ICU Clip non-shielded

5-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU Snap shielded

ICU Miniclip non-shielded

Length

1.0m

1.0m

1.0m

0.45m

0.7m

Length

1.0m/1.6m

1.0m/1.6m

1.0m/1.6m

0.7m/1.3m

AAMI Part No.

M1675A

M1671A

M1673A

M1622A

M1624A

IEC Part No.

M1678A

M1672A

M1674A

--

M1626A

AAMI Part No.

M1973A

M1968A

M1644A

M1647A

IEC Part No.

M1974A

M1971A

M1645A

M1648A

6-Electrode Cable Sets

Description

OR Grabber

ICU Grabber

ICU Snap

Length

1.0m/1.6m

1.0m/1.6m

1.0m/1.6m

10-Electrode (5+5)Cable Sets

Description Length

ICU Grabber, chest, shielded 1.0m

ICU Snap, chest, shielded 1.0m

OR Grabber, chest, shielded 1.0m

For Limb Leads see 5-electrode cable sets

AAMI Part No. IEC Part No.

M1684A M1685A

M1680A M1681A

M1682A M1683A

AAMI Part No.

M1976A

M1602A

M1979A

IEC Part No.

M1978A

M1604A

M1984A

10-Electrode (6+4)Cable Sets

Description Length

ICU Grabber, chest, shielded 1.0m

ICU Snap, chest, shielded 1.0m

OR Grabber, chest, shielded 1.0m

For Limb Leads see 6-electrode cable sets

AAMI Part No.

M1532A

M1537A

M1557A

IEC Part No.

M1533A

M1538A

M1558A

202

ECG/Resp Accessories

One-piece Cables

20 Accessories

Description

3-lead Grabber, ICU

5-lead Grabber, ICU

Length

1.0m

1.0m

AAMI Part No.

989803143181

989803143201

Radio-translucent Cables

Pack of five single wires, radio-translucent, 0.9m, M1649A

Set Combiners and Organizers

Set combiners and organizers

Set combiner

Set organizer for shielded leadsets - grabber and snap

Set organizer for nonshielded lead sets - miniclip

3-electrode

5-electrode

3-electrode

4-electrode

5-electrode

6-electrode

3-electrode

5-electrode

Bedsheet clip

Replacement red cover for trunk cable (for 5-electrode cable sets)

Supported Cables

Part No.

M1501A

M1502A

M1503A

M1664A

M1504A

M1679A

M1636A

M1638A

M1509A

989808148861

Trunk Cables

Length

0.9m

2.7m

3-Electrode Cable Set

AAMI

Part No.

M1540C

M1500A

IEC

Part No.

M1550C

M1510A

5-Electrode Cable Set

AAMI

Part No.

M1560C

M1520A

IEC

Part No.

M1570C

M1530A

IEC Part No.

989803143171

989803143191

203

20 Accessories

ECG/Resp Accessories

3-Electrode Cable Sets

Description Length

OR 1.0m

ICU Grabber shielded 1.0m

ICU snap shielded

ICU Clip non-shielded

ICU Clip non-shielded

1.0m

0.45m

0.7m

5-Electrode Cable Sets

Description

OR Grabber shielded

ICU Grabber shielded

ICU Snap shielded

ICU Clip non-shielded

Length

1.0m/1.6m

1.0m/1.6m

1.0m/1.6m

0.7m/1.3m

AAMI Part No.

M1601A

M1603A

M1605A

M1608A

M1609A

IEC Part No.

M1611A

M1613A

M1615A

M1618A

M1619A

AAMI Part No.

M1621A

M1623A

M1625A

M1629A

IEC Part No.

M1631A

M1633A

M1635A

M1639A

3-Electrode One Piece Cables

AAMI 3-Electrode

One Piece Cables

OR Grabber

ICU Snap

Length

1.9m

1.9m

AAMI

Part No.

IEC 3-electrode One

Piece Cables

IEC

Part No.

M1970A OR Grabber M1980A

M1972A ICU M1981A

5-Electrode One Piece Cables

AAMI 5-electrode

One Piece Cables

OR Grabber

ICU Snap

Length

2.5m

2.5m

AAMI

Part No.

M1975A

M1977A

Set Combiners and Organizers

Set combiners and organizers

Set combiner

Set organizer

3-electrode

5-electrode

Shielded 3-electrode

Shielded 5-electrode

Bedsheet clip

IEC 5-electrode One

Piece Cables

OR Grabber

ICU Grabber

IEC

Part No.

M1985A

M1986A

Part No.

M1501A

M1502A

M1503A

M1504A

M1509A

204

NBP Accessories

20 Accessories

NBP Accessories

These cuffs and tubings are designed to have special protection against electric shocks

(particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery.

Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs

Patient Category Limb

Circumference

Bladder

Width

Adult (Thigh)

Large Adult

Adult

Small Adult

Pediatric

Infant

42 to 54 cm

34 to 43 cm

20 cm

16 cm

27 to 35 cm 13 cm

20.5 to 28 cm 10.5 cm

14 to 21.5 cm 8 cm

10 to 15 cm 5.5 cm

Disposable cuff

Part No.

M1879A

M1878A

M1877A

M1876A

M1875A

M1874A

Reusable Cuff Kits

Reusable cuff

Part No.

Tubing

M1576A

M1575A

M1574A

M1573A

M1572A

M1571A

M1598B (1.5m) or

M1599B (3m)

Cuff Kits Part No.

Infant, pediatric, small adult, adult

Small adult, adult, large adult, thigh

M1577A

M1578A

Infant, pediatric, small adult, adult, large adult, thigh M1579A

Adult/Pediatric Antimicrobial Coated Reusable cuffs

Patient Category (color) Limb

Circumference

(cm)

Adult Thigh (grey) 45 - 56.5

Large Adult X-Long (burgundy) 35.5 - 46.0

Large Adult (burgundy)

Adult X-Long (navy blue)

35.5 - 46.0

27.5 - 36.5

Adult (navy blue)

Small Adult (royal blue)

Pediatric (green)

Infant (orange)

27.5 - 36.5

20.5 - 28.5

13.8 - 21.5

9 - 14.8

Bladder Width Part No.

21.0 cm

17.0 cm

17.0 cm

13.5 cm

13.5 cm

10.6 cm

8.0 cm

5.4 cm

M4559A

M4558A

M4557A

M4556A

M4555A

M4554A

M4553A

M4552A

Tubing

M1598B

(1.5m) or

M1599B (3m)

205

20 Accessories

Invasive Pressure Accessories

Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs

Tubing Patient Category

Adult (Thigh)

Large Adult X-Long

Large Adult

Adult X-Long

Adult

Small Adult

Pediatric

Infant

Limb Circumference

(cm)

Bladder

Width

45 - 56.5 cm

35.5 - 46 cm

35.5 - 46 cm

27.5 - 36.5

27.5 - 36.5 cm

20.5 - 28.5 cm

15.0 - 21.5 cm

9 - 15 cm

20.4 cm

16.4 cm

16.4 cm

13.1 cm

13.1 cm

10.4 cm

8.0 cm

5.6 cm

Neonatal/Infant Cuffs (Disposable, non-sterile)

Part No.

M4579A

M4578A

M4577A

M4576A

M4575A

M4574A

M4573A

M4572A

M1598B (1.5m) or

M1599B (3m)

Cuffs

Size 1

Size 2

Size 3

Size 4

Limb Circumference

(cm)

3.1 to 5.7 cm

4.3 to 8.0 cm

5.8 to 10.9 cm

7.1 to 13.1 cm

Bladder Width Part No.

2.2 cm

2.8 cm

3.9 cm

4.7 cm

M1866A

M1868A

M1870A

M1872A

Tubing

M1596B (1.5m) or

M1597B (3m)

Invasive Pressure Accessories

These transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.

SpO

2

Accessories

Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the

Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare.

Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “Long” version).

All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.

Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result.

206

SpO

2

Accessories

Product

Number

Description Comments

Philips reusable sensors.

M1191A/B Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb.

M1191A/B with longer cable (3 m) M1191AL/

BL

M1192A

M1193A

Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and

50 kg. Any finger except thumb.

Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot.

M1194A

M1195A

Ear sensor (1.5m cable) for patients more than 40 kg.

Infant sensor (1.5m cable) for patients between 4kg and 15 kg. Any finger except thumb.

No adapter cable required.

M1196A

M1191T

Adult clip sensor (3m cable) for patients over 40 kg. Any finger except thumb.

No adapter cable required.

Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb.

Requires M1943

(1 m) or M1943AL

(3 m) adapter cable

M1192T

M1193T

Small adult, pediatric sensor (0.45m cable) for patients between 15 kg and

50 kg. Any finger except thumb.

Neonatal sensor (0.9m cable) for patients between 1kg and 4 kg. Hand or foot.

M1196T Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb.

M1191ANL Special Edition (SE) No adapter cable required.

Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb.

M1192AN Special Edition (SE)

Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and

50 kg. Any finger except thumb.

M1193AN Special Edition (SE)

Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot.

20 Accessories

207

20 Accessories

Product

Number

Description Comments

M1194AN Special Edition (SE)

Ear sensor (1.5m cable) for patients more than 40 kg.

M1195AN Special Edition (SE)

Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb.

No adapter cable required.

Philips disposable sensors. Not available in the USA.

M1904B

M1903B

M1902B

M1901B

Identical to OxiMax MAX-A

Identical to OxiMax MAX-P

Identical to OxiMax MAX-I

Identical to OxiMax MAX-N

Use adapter cable

M1943A or

M1943AL.

Philips disposable sensors. Available worldwide.

M1131A

M1132A

M1133A

Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg)

Use adapter cable

M1943A or

M1943AL.

Infant finger or toe sensor, 0.9m cable

(patient size 3 - 10 kg)

Use adapter cable

M1943A or

M1943AL.

Adult/Infant/Neonatal, 0.9m cable

Foot or hand for neonates < 3 kg

Big toe or thumb for patients between

10kg and 20kg

Any finger except thumb for patients

> 40kg

Use adapter cable

M1943A or

M1943AL.

SpO

2

Accessories

NELLCOR disposable sensors (must be ordered from Nellcor)

OxiMax

MAX-A

OxiMax

MAX-AL

OxiMax

MAX-P

OxiMax

MAX-I

OxiMax

MAX-N

Adult finger sensor (patient size kg)

OxiMax MAX-A with long cable

>30

Pediatric foot/hand sensor (patient size

10-50 kg)

Infant foot/hand sensor (patient size

3-20 kg)

Adult finger or neonatal foot/hand sensor (patient size

>40 kg or <3 kg)

Use adapter cable

M1943A or

M1943AL.

208

SpO

2

Accessories

Product

Number

Description Comments

Oxisensor II

D-25

Oxisensor II

D-20

Adult sensor (patient size

>30kg)

Pediatric sensor (patient size 10-50 kg)

Oxisensor II

I-20

Oxisensor II

N-25

Infant sensor (patient size 3-20 kg)

Neonatal sensor (patient size

>40 kg)

OxiCliq A See OxiMax MAX-A

OxiCliq P See OxiMax MAX-P

OxiCliq I See OxiMax MAX-I

OxiCliq N See OxiMax MAX-N

<3 kg or

Use adapter cable

M1943A or

M1943AL

Use adapter cable

M1943A or

M1943AL together with OC-3 adapter cable.

Extension / Adapter Cables for Philips and Nellcor Sensors

M1941A

M1943A

M1943AL

OC-3

Extension cable (2 m)

Adapter cable (1.1 m cable)

Adapter cable (3 m cable)

Adapter Cable for OxiCliq sensors

For use with Philips reusable sensors and adapter cables.

Adapter cable for

Philips/Nellcor disposable sensors.

Available from

Nellcor only.

20 Accessories

Product

Number

Description

MASIMO LNOP

®

reusable sensors.

LNOP DC-I Adult Finger Sensor (> 30 kg)

LNOP DC-IP Pediatric Finger Sensor (10 - 50 kg)

LNOP YI Multi-site Sensor (> 1 kg)

LNOP TC-I Ear Sensor (> 30 kg)

MASIMO LNCS

®

reusable sensors.

Philips Part

Number

989803140321

989803140331 n/a

989803140341

LNCS DC-I Adult reusable Sensor (> 30 kg) 989803148281

LNCS DC-IP Pediatric reusable Sensor (10 - 50 kg) 989803148291

LNCS TC-I Reusable ear Sensor (> 30 kg) 989803148301

LNCS TF-I Reusable forehead Sensor (> 30 kg)

MASIMO LNOP

®

disposable adhesive sensors.

989803148311

LNOP Adt

LNOP Adtx

LNOP Pdt

LNOP Pdtx

Adult Sensor (> 30 kg)

Adult Sensor (> 30 kg)

Pediatric Sensor (10 - 50 kg)

Pediatric Sensor (10 - 50 kg)

989803140231 n/a

989803140261 n/a

209

20 Accessories

Temperature Accessories

Product

Number

Description

LNOP Inf-L Infant Toe Sensor (3 - 20 kg)

LNOP Neo-L Neonatal Sensor (<3kg) or Adult adhesive Sensor (> 40 kg)

LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin

Sensors (<1kg)

MASIMO LNCS

®

disposable adhesive sensors.

Philips Part

Number

989803140311

989803140291

989803140301

LNCS Adtx

LNCS Pdtx

Adult Finger Sensor (> 30 kg)

Pediatric Finger Sensor (10 - 50 kg)

LNCS Inf-L

LNCS Neo-L

Infant Toe Sensor (3 - 20 kg)

Neonatal Foot Sensor (< 3 kg) or Adult Finger Sensor (> 40 kg)

LNCS NeoPt-L Neonatal pre-term sensitive skin Sensor

(< 1 kg)

Adapter Cable for MASIMO sensors.

989803148231

989803148241

989803148251

989803148271

989803148261

LNOP MP12 LNOP MP Series Patient Cable (3.6 m)

Adapter Cable for Masimo LNOP

Sensors

LNC MP10 LNCS MP Series Patient Cable (3.0 m)

Adapter Cable for Masimo LNCS

Sensors

451261000761

989803148221

The monitor uses Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo

Temperature Accessories

Temperature Probes

Reusable

General purpose probe

Small flexible vinyl probe (Infant/Pediatric)

Attachable surface probe

Disposable

General purpose probe

Skin probe

Esophageal/Stethoscope Probe (12 French)

Esophageal/Stethoscope Probe (French 18)

Esophageal/Stethoscope Probe (French 24)

Foley Catheter Probe (12 French)

210

Part No.

21075A

21076A

21078A

M1837A

21091A

21093A

21094A

21095A

M2255A

Minimum measurement time for accurate readings

90 sec

60 sec

60 sec

90 sec

60 sec

180 sec

210 sec

310 sec

180 sec

Mainstream CO

2

Accessories

Temperature Probes Part No.

Foley Catheter Probe (16 French)

Foley Catheter Probe (18 French)

Adapter cable 1.5m

Adapter cable 3.0m

Mainstream CO

2

Accessories

21096A

21097A

21082B

21082A

Description Part No.

CO

2

Sensor M2501A

Adult/Pediatric Airway Adapter (reusable) M2513A

Infant Airway Adapter (reusable)

Adult Airway Adapter (single-patient use)

Infant Airway Adapter (single-patient use)

M2516A

M2533A

M2536A

Sidestream CO

2

Accessories

Description

CO

2

Sensor

Nasal and Oral-Nasal Cannulas

CO

2

Nasal Cannula, Adult

CO

2

Nasal Cannula, Pediatric

CO

2

Nasal Cannula, Infant

CO

2

/ O

2

Nasal Cannula, Adult

CO

2

/ O

2

Nasal Cannula, Pediatric

CO

2

Oral-Nasal Cannula, Adult

CO

2

Oral-Nasal Cannula, Pediatric

CO

2

/ O

2

Oral-Nasal Cannula, Adult

CO

2

/ O

2

Oral-Nasal Cannula, Pediatric

Airway Adapters

Airway Adapter Set, ET > 4.0 mm

Airway Adapter Set H, ET > 4.0 mm

Airway Adapter Set H, ET =< 4.0 mm

Straight Sample Lines

Straight Sample Line

Straight Sample Line H

Part No.

M2741A

M2744A

M2745A

M2746A

M2750A

M2751A

M2756A

M2757A

M2760A

M2761A

M2768A

M2772A

M2773A

M2776A

M2777A

20 Accessories

Minimum measurement time for accurate readings

180 sec

180 sec

211

20 Accessories

Mainstream CO

2

Accessories (for M3016A)

Mainstream CO

2

Accessories (for M3016A)

Description

CO

2

Sensor

Standard Airway Adapter (reusable)

Small Airway Adapter (reusable)

Part No.

M1460A

M1465A

14363A

Microstream CO

2

Accessories

• “FilterLine Set” is a combination of a FilterLine with an Airway Adapter.

• “H” in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.

• “Smart CapnoLine” is a combined oral-nasal FilterLine.

• “Smart CapnoLine O

2

” is a combined oral-nasal-O

2

-CO

2

FilterLine.

• “NIV Line” is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).

• “Single purpose” means CO

2

measurement only, “dual purpose” means CO

2

measurement and O

2 delivery.

• The accessories are supplied in packs of 25.

Microstream accessory selection flowchart

Is the patient intubated?

Yes No

Short-term

(up to 6 hours)

Long-term

(up to 72 hours)

Does the patient need oxygen?

Short term

(up to 8 hours)

Oral/Nasal

Yes

Long term

(up to 24 hours)

Nasal

No

Long-term

(up to 24 hours)

Short term

(up to 8 hours)

Short term

(up to 8 hours)

Nasal Oral/Nasal Nasal

Key Applications

Critical Care OR, EMS, ED Procedural

Sedation, Critical

Care, EMS, ED

Critical Care,

Sleep Lab, Longterm Pain

Management

Critical Care,

Sleep Lab

Procedural

Sedation,

Critical Care,

EMS, ED

EMS, ED

Philips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate)

FilterLine Set:

A/P: M1920A

FilterLine:

M1925A*

FilterLine H Set:

A/P: M1921A

I/N: M1923A

Smart

CapnoLine O

2

:

A: M2522A

FilterLine H:

P: M2520A

M1926A*

*Not available in all geographies.

CapnoLine HO

2

:

A: M4680A

P: M4681A

CapnoLine H:

A: M4689A

P: M4690A

I/N: M4691A

Smart

CapnoLine:

A: M2526A

P: M2524A

NIV Line:

A: 4686A

P: M4687A

212

Battery Accessories

Battery Accessories

Description

Battery Charger and Conditioner (requires size adapter 4512 610

17451 to charge M4607A battery)

Size adapter for M4607A battery

Part No.

M8043A

4512 610 17451

20 Accessories

213

20 Accessories

Battery Accessories

214

21

21

Specifications

Intended Use

The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in a hospital environment and during patient transport inside and outside of the hospital environment. The monitor is intended for use by health care professionals.

The monitor is only for use on one patient at a time. It is not intended for home use. Not a therapeutic device.

Rx only: U.S. Federal Law restricts this device to sale by or on the order of a physician.

ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients.

The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11).

N O T E Hospital Environment

The monitor is suitable for use in all medically used rooms which fulfil the requirements regarding electrical installation according to IEC60364-7-710 “Requirements for special installations or locations

- Medical locations”, or corresponding local regulations.

Indication for Use

The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.

Manufacturer’s Information

You can write to Philips at this address

Philips Medizin Systeme Boeblingen GmbH

Hewlett-Packard-Str. 2

71034 Boeblingen

Germany

Visit our website at: www.philips.com.

© Copyright 2002 - 2007. Koninklijke Philips Electronics N.V. All Rights Reserved.

215

21 Specifications

Symbols

Trademark Acknowledgement

The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor

®

, Durasensor

Y

®

, Oxiband

®

, Oxicliq

®

, OxiMax

®

. MAX-FAST

®

is a trademark of Mallinckrodt Inc.

®

, Dura-

Microstream

®

, FilterLine

®

, and Smart CapnoLine

®

are trademarks or registered trademarks of Oridion

Systems Ltd.

Masimo

®

, Masimo SET

®

, and LNOP are federally registered trademarks of the Masimo Corporation.

Other product and company names mentioned in this book may be trademarks of their respective owners.

Symbols

These symbols can appear on the monitor and its associated equipment.

‘These symbols can appear on the monitor and its associated equipment (depending on options).

Symbols

Refer to accompanying documents

DC power source

On/Off/Standby

Battery symbol

Main Screen

Battery Eject

SmartKeys

Pressure connector

ECG Sync Pulse Output indicator

Temperature connector

Connection direction indicator

Connector has special protection against electric shocks and is defibrillator proof

216

Installation Safety Information

Symbols

NBP connector

21 Specifications

Silence Alarms

SpO

2

connector

Alarms

Uses FAST SpO

2 algorithm

Alarms Off

ECG connector

LAN connection indicator for connection to a wired network

Error LED

IntelliVue

Instrument

Telemetry wireless network

2002-

06

Identifies year and month of manufacture

Always use separate collection for waste electrical and electronic equipment (WEEE)

Installation Safety Information

WARNING

If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1, IEC60601-1-1, UL60601-1. Consult your service personnel.

Earthing The monitor must be earthed during operation. The earthing is for functional purposes and does not provide protection against electric shock. The protection against electric shock in this device is provided by double and/or reinforced insulation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to twowire adapter.

Combining equipment Combinations of medical equipment with non-medical equipment must comply with

IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment.

Network Cables All network cables must be unshielded.

Connectors

The actual placement of boards and configuration of connections for your monitor depends on how

your hardware has been configured. See the symbols table on page 216 to see which symbols are used

to mark the connections.

WARNING

• Connect only medical devices to the ECG output connector socket.

• Connecting the ECG sync out to external equipment should only be done by a qualified user. Do not touch the patient when you have contact to the ECG output connector socket.

217

21 Specifications

Altitude Setting

• Always connect the ECG sync cable first to the external device and then to the monitor. Wherever possible, pre-install the cable before the patient is brought into the vicinity of the equipment.

Altitude Setting

Altitude affects CO

2 altitude.

measurements. The monitor must be configured at installation to the correct

Monitor Safety Specifications

0366

The monitor complies with the Medical Device Directive 93/42/EEC.

In addition, the product complies with:

IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 60601-

1:2003; CAN/CSA C22.2#601.1-M90; JIS T 0601-1:1999; IEC 60601-1-1:2001; EN 60601-1-

1:2001; IEC 60601-1-2:2001; EN 60601-1-2:2001.

Classification (according to IEC 60601-1): Class II, Type CF, Continuous Operation.

The possibility of hazards arising from software errors was minimized in compliance with ISO

14971:2000, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999.

EMC And Radio Regulatory Compliance

This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-

001 du Canada.

The MP2 including IntelliVue Instrument Telemetry WMTS (US only)

complies with part 15 of the

FCC Rules. Operation is subject to the condition that this device does not cause harmful interference

.

Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.

The MP2 including IntelliVue Instrument Telemetry ISM (2.4 GHz) - FCC and Industry Canada

Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry

Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by

Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.

The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and

Telecommunications Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market.

This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.

218

Out-Of-Hospital Transport - Standards Compliance

21 Specifications

Out-Of-Hospital Transport - Standards Compliance

The MP2 patient monitor, with the following measurements and interfaces:

– ECG/Respiration, NBP, SpO

2

, Pressure, Temperature, CO

2

(only Mainstream Sensor M2501A)

– LAN, Battery can be used in a transport environment such as a road ambulance, airplane or helicopter. For this purpose the monitor fulfils the following additional mechanical, EMC and environmental requirements:

Shock Tests according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN

60068-2-27 (peak acceleration up to 100 g).

Random Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/

EN 60068-2-64 (RMS acceleration 5 g).

Sinusoidal Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to

IEC/EN 60068-2-6 (acceleration up to amplitude 2 g).

Bump Test according to IEC/EN60068-2-29 (peak acceleration 15 g, 1000 bumps).

Free Fall Test according to EN1789 (covers also IEC TR 60721-4-7 and Class 7M3). Test procedure according to EN 60068-2-32 (height 0.75 m).

• Specification for degrees of protection provided by enclosures according to IEC/EN 60529: IP 32

EN 1789 +A1:2003 Medical vehicles and their equipment - Road ambulances (chapter 6 - Medical

Devices).

Radiated susceptibility 20 V/m according to EN ISO 9919 (SpO

2

) and EN ISO 21647 (CO

2

).

Altitude Range from -500 to 3000 m operating and -500 to 4600 m storage and transportation.

Extended radiated susceptibility tests

The MP2 patient monitor with its out-of-hospital parameter set provides a general immunity level of

20 V/m with only few restrictions. Details are as listed below:

– GSM 900: Immunity at 900 MHz (uplink mobile phone), 20 V/m (ECG:10V/m), duty cycle

1:8

– GSM 1800: Immunity at 1800 MHz (uplink mobile phone), 20 V/m, duty cycle 1:8.

– DECT: Immunity at 1800 MHz (digital cordless phone), 20 V/m, duty cycle 1:24

– AM: 1 kHz Immunity from 80 MHz to 1.0 GHz (any radio communication unit, broadcasting and TV transmitter), 20 V/m, modulation factor 80 %.

(ECG: 20 V/m except 600-950 MHz where it is 10 V/m and Temperature which holds 3 V/m over the full range).

CAUTION

Temperature measurement accuracy may be compromised in the presence of strong electromagnetic fields (>3 V/m) in certain small frequency bands.

Magnetic Field emission according to MIL STD 461E, Chapter RE101: Radiated emissions, magnetic field, 30 Hz to 100 kHz. Limit class: Army.

Magnetic Field susceptibility: Radiated susceptibility, magnetic field, 50, 60 and 400 Hz,

18 µT(15 A/m)

Operating ambient temperature testing over the range from 0 to 40°C (32 to 100°F).

219

21 Specifications

Out-Of-Hospital Transport - Standards Compliance

Operating ambient humidity testing up to 95 % RH at 40°C (100°F), non condensing.

EN 13718-1: Patient transport in air, on water and in difficult terrain - Part 1: Special requirements on interfaces of medical products for continuous care of patients.

N O T E

Additional requirements can be necessary for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU.

Physical Specifications

Specification

Maximum Weight

1.5 kg

(3.3 lb)

Size (W x H x D)

188 x 99 x 86 mm

7.4 x 3.9 x 3.4 in

Comments

including battery, without options without handle and options

M8023A External Power Supply Weight and Dimensions

Maximum Weight

680 g ± 10%

(1.5 lb ± 10%)

Size (W x H x D)

207 x 70 x 113 mm

8.1 x 2.8 x 4.4 in

Environmental Specifications

The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges.

The monitor is protected against ingress of objects and fluids according to IEC 60529 IP32 (applies to all options intended for out-of-hospital use). However, do not expose the monitor directly to heavy rain.

When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.

Item Condition

Temperature Range

Operating

Storage including transportation

Temperature Range when charging the battery

Operating

Humidity Range

Operating

Storage including transportation

Range

0 to 40°C (32 to 104°F)

-20 to 60°C (-4 to 140°F)

0 to 40°C (32 to 95°F)

15 % to 95 % Relative Humidity (RH)

5 % to 95 % Relative Humidity (RH)

220

Monitor Performance Specifications

21 Specifications

Item Condition Range

Altitude Range

Operating

Storage including transportation

-500 m to 3000 m (10000 ft)

-500 m to 4600 m

1

(15000 ft)

Ingress Protection

Monitor (when specified for out-ofhospital use)

IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°)

Monitor (when not specified for out-ofhospital use)

IPX1 (protection against ingress of water when the water is dripping vertically)

1.Sufficient for flight altitudes up to 12,000 m with pressurized cabins.

Monitor Performance Specifications

Performance Specifications

Power Specifications

Power consumption

Operating Voltage

Battery Specifications

Operating Time

(with new, fully charged battery at

25°C)

Charge Time

Indicators

<12 W average

<30 W while battery is loading

36 to 60 V DC floating

Basic monitoring configuration: 2.5 hours

(Brightness set to Optimum, ECG/Resp, SpO

2 measurements in use, NBP measurement every 15 minutes)

When monitor is off: 2 hours

When monitor is in use, and connected to the external power supply (M8023A), without MMS extensions: 12 hours approx.

Alarms Off

Alarms red (crossed-out alarm symbol) LED red/yellow/cyan LED

On/Standby / Error green / red LED

AC Power green LED

Sounds

Trends

Alarm signal

Battery

External Power yellow (charging)/red blinking (empty) LED green LED

Audible feedback for user input

Prompt tone

QRS tone, or SpO

2

modulation tone

4 different alarm sounds

Resolution

Information

12 or 16 numerics @ 12 sec, 1 minute, 5 minute resolution.

Multiple choices of number of numerics, resolution and duration depending on trend option and application area.

For example:

For neonatal, you can choose between 12 and 16 numerics.

less than 3 seconds System delay

Pause duration 1,2,3 minutes or infinite, depending on configuration

Extended alarm pause 5 or 10 minutes

221

21 Specifications

Monitor Performance Specifications

Performance Specifications

Review Alarms

Information

Real Time Clock

Buffered Memory

Capacity

Range

Accuracy

Hold Time

Hold Time

Contents all alarms / inops, main alarms on/off, alarm silence and time of occurrence

500 items from: January 1, 1997, 00:00 to: December 31, 2080, 23:59

<4 seconds per day (typically) infinite if powered by external power supply; otherwise at least

48 hours if powered by external power supply: infinite without power: at least 48 hours

Active settings, trends, patient data, realtime reports, review alarms

M8023A External Power Supply Performance Specifications

Power Specifications

Indicators

Power consumption

Line Voltage

Current

Frequency

AC Power

<12 W average

<30 W peak

100 to 240 V ~

0.7 to 0.4 A

50/60 Hz ~ green LED

Monitor Interface Specifications

Measurement Link

(MSL)

Connectors

Power

Power Sync.

LAN signals

Serial signals

Local signals

ECG Sync Pulse

Output

Cable detection

Marker In

(See “Connectors” on page 217 for safety-

related information)

Wave Output

Connector

Output levels

Isolation

Pulse Width

Delay from R-wave peak to start of pulse

Minimum required Rwave amplitude

0.5 V

Female ODU (Proprietary)

30 V to 60 V input

RS-422 compliant input 78.125k Hz (typical)

IEEE 802.3 10-Base-T compliant

RS-422 compliant

Provided for connecting measurement extensions

Yes

No

No

Binder Series 709/719

Output low <0.8 V @ I = -4 mA

Output high >2.4 V @ I = 4 mA

None

100 +/-10 ms (high)

20 ms maximum per AAMI EC13

222

M4607A Battery Specifications

21 Specifications

M8023A External Power Supply Interface Specifications

Measurement Link

(MSL)

Connectors

Power

Power Sync.

LAN signals

Serial signals

Local signals

Male ODU (Proprietary)

48 V output

RS-422 compliant output 78.125 kHz (typical)

IEEE 802.3 10-Base-T compliant

RS-422 compliant output 78.125 kHz (typical)

Not connected

Display Specifications

Integrated QVGA

Display

Sweep Speeds

Resolution

Refresh frequency

Useful screen

Pixel size

6.25, 12.5, 25 and 50 mm/s;

320 x 240

60 Hz

72 x 54 mm (2.8 x 2.1 in)

0.22 x 0.22 mm

Compatible Devices

IntelliVue Instrument Telemetry Wireless Network (USA only)

Internal WMTS Adapter Technology compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure

Frequency Band WMTS, 1395-1400 MHz and 1427-1432 MHz

IntelliVue Instrument Telemetry Wireless Network (except USA, MP20/30/40/50 only)

Internal ISM Adapter Technology compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure

Frequency Band 2.4 GHz ISM

M4607A Battery Specifications

One battery is required for battery operation of the monitor.

M4607A Battery Specifications

Physical Specifications

W x D x H

Performance Specifications

Nominal Voltage

Rated Capacity at discharge C/5

Environmental Specifications

Temperature Range

Humidity Range

66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in)

10.8 Volt

1000 mAh (typical)

Discharge 0 to 60

°C (32 to 122°F)

Charge 0 to 60

°C (32 to 122°F)

Storage and Transportation: -20 to 65

°C (-4 to 140°F)

Operating: 15 % to 95 % Relative Humidity (RH)

Storage and Transportation: 5 % to 95 % Relative Humidity (RH)

223

21 Specifications

M4607A Battery Specifications

Battery Type

Safety

Electromagnetic Compatibility (EMC)

Communication Standard

M4607A Battery Specifications

Lithium Ion Mangan, 10.8 V, 1000 mAh, complies with UL 1642 (UL Recognized) complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2 complies with the SMBus specification v1.1

224

Measurement Specifications

21 Specifications

Measurement Specifications

See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.

ECG/Arrhythmia/ST/QT

Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-

27:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/

EC13:1991/2002.

ECG/Arrhythmia/ST Performance Specifications

Cardiotach

PVC Rate

ST Numeric

QT Numeric

QTc Numeric

Range

Accuracy

Resolution

Sensitivity

Range

Resolution

Range

Accuracy

Resolution

Range

Accuracy

Resolution

Range

Adult/pedi: 15 to 300 bpm

Neo range: 15 to 350 bpm

±1 % of range

1 bpm

≥200 µV peak

0 to 300 bpm

1 bpm

-20 to +20 mm

±0.5 mm or 15 %, whichever is greater

0.1 mm

200 to 800 ms

±30 ms

8 ms

200 to 800 ms

ΔQTc Numeric

QT-HR Numeric

Resolution

Range

Resolution

Range - adult

1 ms

-600 to +600 ms

1 ms

15 to 300 bpm

15 to 350 bpm

Sinus and SV Rhythm

Ranges

Bandwidth

Range - pediatric and neonatal

Brady

Normal

Adult: 15 to 60 bpm

Pedi: 15 to 80 bpm

Neo: 15 to 90 bpm

Adult: 60 to 100 bpm

Pedi: 80 to 160 bpm

Neo: 90 to 180 bpm

Tachy Adult: >100 bpm

Pedi: >160 bpm

Neo: >180 bpm

Diagnostic Mode Adult/neo/pedi: 0.05 to 150 Hz

Extended

Monitoring Mode

Neo/pedi: 0.5 to 150 Hz

Monitoring Mode Adult: 0.5 to 40 Hz

Neo/pedi: 0.5 to 55 Hz

Filter Mode Adult/neo/pedi: 0.5 to 20 Hz

225

21 Specifications

Measurement Specifications

ECG/Arrhythmia/ST Performance Specifications

Differential Input Impedance

Common Mode Rejection Ratio

Electrode Offset Potential Tolerance

>2 M

Ω RA-LL leads (Resp)

>5 M

Ω at all other leads (at 10 Hz including patient cable)

Diagnostic mode: >86 dB (with a 51 k

Ω/47 nF imbalance).

Filter mode: >106 dB (with a 51 k

Ω/47 nF imbalance).

±500 mV

Auxiliary Current

(Leads off Detection)

Input Signal Range

Active electrode: <100 nA

Reference electrode: <900 nA

±5 mV

ECG/Arrhythmia/ST/QT

Alarm Specifications

HR

Extreme Tachy

Extreme Brady

Run PVCs

PVCs Rate

Vent Tach HR

Vent Tach Run

Vent Rhythm Run

SVT HR

SVT Run

ST High

ST Low

QTc High

ΔQTc High

Range

15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard

Adjustment

Adult:1 bpm steps (15 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:1 bpm steps (15 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm 5 bpm steps

Difference to low limit 0 to 50 bpm

Clamping at 15 to 100 bpm

5 bpm steps

5 bpm steps

2 PVCs

1 to 99 PVCs/minute

20 to 300 bpm

3 to 99 PVCs/minute

2 to 99 PVCs/minute

120 to 300 bpm

3 to 99 SV beats

-19.8 to +20 mm

-20 to +19.8 mm

200 ms to 800 ms

30 ms to 200 ms

Not adjustable by user

1 PVC

5 bpm

1 PVC

1 PVC

5 bpm

1 SV beat

0.2 mm

0.2 mm

10 ms steps

10 ms steps

ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13

Respiration Excitation Waveform

Noise Suppression

Time to Alarm for

Tachycardia

Vent Tachycardia

1 mV pp

,206 bpm

Sinusoidal signal, 260

μA, 39 kHz

RL drive gain 44 dB max., max. voltage 1.8 Vrms

Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds

Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds

Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds

Vent Tachycardia

2 mV pp

,195 bpm

Tall T-Wave Rejection Capability

Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds

Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds

Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds

Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitude

226

Measurement Specifications

21 Specifications

ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13

Heart Rate Averaging Method

Three different methods are used:

Normally, heart rate is computed by averaging the 12 most recent RR intervals.

For runs of PVCs, up to 8 RR intervals are averaged to compute the HR.

If each of 3 consecutive RR intervals is greater than 1200 ms

(that is, rate less than 50 bpm), then the 4 most recent RR intervals are averaged to compute the HR.

Response Time of Heart Rate Meter to Change in

Heart Rate

HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds

Heart Rate Meter Accuracy and Response to

Irregular Rhythm

Accuracy of Input Signal Reproduction

Pacemaker Pulse Rejection Performance

HR change from 80 to 40 bpm:

Range: [5.6 to 6.4 sec] Average: 6.0 seconds

Ventricular bigeminy: 80 bpm

Slow alternating ventricular bigeminy: 60 bpm

Rapid alternating ventricular bigeminy: 120 bpm

Bidirectional systoles: 90 bpm

Methods A and D were used to establish overall system error and frequency response.

Rejection of pacemaker pulses with amplitudes from ±2 mV to

±700 mV and widths from 0.1 ms to 2.0 ms (Method A)

Respiration

Respiration Performance Specifications

Respiration Rate

Range

Bandwidth

Noise

Accuracy

Resolution

Adult/pedi: 0 to 120 rpm

Neo: 0 to 170 rpm at 0 to 120 rpm ±1 rpm at 120 to 170 rpm ±2 rpm

1 rpm

0.3 to 2.5 Hz (–6 dB)

Less than 25 m

Ω (rms) referred to the input

Respiration Alarm

Specifications Range

High

Low

Adult/pedi: 10 to 100 rpm

Neo: 30 to 150 rpm

Adult/pedi: 0 to 95 rpm

Neo: 0 to 145 rpm

Apnea Alarm

10 to 40 seconds

Adjustment

under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps

Delay

max. 14 seconds for limits from 0 to 20 rpm: max.

4 seconds for limits above 20 rpm: max.

14 seconds

5 second steps

227

21 Specifications

SpO

2

Measurement Specifications

Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-

49:2001).

Measurement Validation: The SpO

2

accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements. Display Update Period: Typical: 2 seconds,

Maximum: 30 seconds. Max. with NBP INOP suppression on

: 60 seconds.

SpO

2

Performance Specifications

SpO

2

The specified accuracy is the root-meansquare (RMS) difference between the measured values and the reference values

Range

Accuracy

Pulse

Sensors

Resolution

Range

Accuracy

Resolution

Pulse Oximeter Calibration Range

0 to 100 %

Philips Reusable Sensors:

M1191A, M1191AL, M1191ANL, M1191B, M1191BL, M1192A,

M1192AN = 2 % (70 % to 100 %)

M1193A, M1193AN, M1194A, M1194AN, M1195A, M1195AN,

M1196A = 3 % (70 % to 100 %)

M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%)

M1193T (Neonate) = 4 % (70 % to 100 %)

Philips Disposable Sensors with M1943A(L):

M1132A, M1133A (adult/infant) = 2 %

M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate)

= 3 % (70 % to 100 %)

NellcorPB

®

Sensors with M1943A(L):

MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-

25, OxiCliq A, P, I, N = 3 % (70 % to 100 %)

Masimo Reusable Sensors

®

with LNOP MP12 or LNC MP10:

LNOP DC-I, LNOP DC-IP, LNOP YI, LNCS DC-1, LNCS DC-IP,

LNCS TF-I: 2 % (70 % to 100 %)

LNOP TC-I, LNCS TC-I: 3.5 % (70 % to 100 %)

Masimo Disposable Sensors

®

with LNOP MP12 or LNC MP10:

LNOP Adt, LNOP Adtx, LNOP Pdt, LNOP Pdtx, LNOP Inf-L,

LNCS Adtx, LNCS Pdtx, LNCS Inf-L: 2 % (70 % to 100 %)

LNOP Neo-L, LNOP NeoPt-L, LNCS Neo-L, LNCS NeoPt-L: 3 %

(70 % to 100 %)

1 %

30 to 300 bpm

±2 % or 1 bpm, whichever is greater

1 bpm

Wavelength range: 500 to 1000 nm

Emitted Light Energy:

≤15 mW

Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)

70 % to 100 %

228

Measurement Specifications

21 Specifications

NBP

SpO

2

Alarm

Specifications

SpO

2

Desat

Pulse

Tachycardia

Bradycardia

Range Adjustment

Adult: 50 to 100 %

Pedi/Neo: 30 to 100 %

Adult: 50 to Low alarm limit

Pedi/Neo: 30 to Low alarm limit

30 to 300 bpm

1 % steps

1 % steps

Adult:

1 bpm steps (30 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:

1 bpm steps (30 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Difference to high limit 0 to 50 bpm 5 bpm steps

Clamping at 150 to 300 bpm 5 bpm steps

Difference to low limit 0 to 50 bpm 5 bpm steps

Clamping at 30 to 100 bpm 5 bpm steps

Delay

(0, 1, 2, 3,... 30)

+4 seconds max. 14 seconds max. 14 seconds max. 14 seconds

Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.

NBP Performance Specifications

Measurement Ranges Systolic

Accuracy

Pulse Rate Range

Measurement Time

Diastolic

Mean

Pulse Rate

Pulse Rate Measurement Accuracy

Adult: 30 to 270 mmHg (4 to 36 kPa)

Pedi: 30 to 180 mmHg (4 to 24 kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Adult: 10 to 245 mmHg (1.5 to 32 kPa)

Pedi: 10 to 150 mmHg (1.5 to 20 kPa)

Neo: 10 to 100 mmHg (1.5 to 13 kPa)

Adult: 20 to 255 mmHg (2.5 to 34 kPa)

Pedi: 20 to 160 mmHg (2.5 to 21 kPa)

Neo: 20 to 120 mmHg (2.5 to 16 kPa)

Adult: 40 to 300

Pedi: 40 to 300

Neo: 40 to 300

Max. Std. Deviation: 8 mmHg (1.1 kPa)

Max. Mean Error: ±5 mmHg (±0.7 kPa)

40 to 100 bpm:

±

5 bpm

101 to 200 bpm:

±

5 % of reading

201 to 300 bpm:

±10 % of reading

(average over NBP measurement cycle)

40 to 300 bpm

Typical at HR >60 bpm

Auto/manual/sequence: 30 seconds (adult)

25 seconds (neonatal)

Stat: 20 seconds

Maximum time: 180 seconds (adult/pediatric)

90 seconds (neonates)

229

21 Specifications

Measurement Specifications

NBP Performance Specifications

Cuff Inflation Time

Initial Cuff Inflation Pressure

Typical for normal adult cuff: Less than 10 seconds

Typical for neonatal cuff: Less than 2 seconds

Adult: 165 ±15 mmHg

Pedi: 130 ±15 mmHg

Neo: 100 ±15 mmHg

1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutes

5 minutes

Auto Mode Repetition Times

STAT Mode Cycle Time

Venipuncture Mode Inflation

Inflation Pressure Adult

Automatic deflation after

Pediatric

Neonatal

Adult/pediatric

Neonatal

20 to 120 mmHg (3 to 16 kPa)

20 to 80 mmHg (3 to 11 kPa)

20 to 50 mmHg (3 to 7 kPa)

170 seconds

85 seconds

Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated

Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure.

In neonatal mode, the blood pressure measurements determined with this device comply with the

American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 -

1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.

NBP Alarm Specifications Range

Systolic

Adult: 30 to 270 mmHg (4 to 36 kPa)

Pedi: 30 to 180 mmHg (4 to 24 kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Diastolic

Mean

Adult: 10 to 245 mmHg (1.5 to 32 kPa)

Pedi: 10 to 150 mmHg (1.5 to 20 kPa)

Neo: 10 to 100 mmHg (1.5 to 13 kPa)

Adult: 20 to 255 mmHg (2.5 to 34 kPa)

Pedi: 20 to 160 mmHg (2.5 to 21 kPa)

Neo: 20 to 120 mmHg (2.5 to 16 kPa)

Adjustment

10 to 30 mmHg: 2 mmHg (0.5 kPa)

>30 mmHg: 5 mmHg (1 kPa)

NBP Overpressure Settings

Adult >300 mmHg (40 kPa) >2 sec

Pedi

Neo

>300 mmHg (40 kPa) >2 sec

>150 mmHg (20 kPa) >2 sec not user adjustable

230

Measurement Specifications

21 Specifications

Invasive Pressure and Pulse

Complies with IEC 60601-2-34:2000/EN60601-2-34:2000.

Invasive Pressure Performance Specifications

Measurement Range

Pulse Rate

Input Sensitivity

Transducer

Range

Accuracy

Resolution

Frequency Response

Zero Adjustment

Gain Accuracy

Range:

Accuracy

Drift

Accuracy

Drift

Non linearity and Hysteresis

Overall Accuracy

(including transducer)

Volume displacement of CPJ840J6

–40 to 360 mmHg

25 to 350 bpm

±1 % Full Range

1 bpm

Sensitivity:5 µV/V/mmHg (37.5 µV/V/kPa)

Adjustment range:±10 %

Load Impedance:200 to 2000

Ω (resistive)

Output Impedance:

≤3000 Ω (resistive) dc to 12.5 Hz or 40 Hz

±200 mmHg (±26 kPa)

±1 mmHg (±0.1 kPa)

Less than 0.1 mmHg/°C (0.013 kPa/°C)

±1 %

Less than 0.05 %/°C

Error of

≤0.4 % FS (@CAL 200 mmHg)

±4 % of reading or ±4 mmHg (±0.5 kPa), whichever is greater

0.1 mm

3

/100 mmHg

Invasive Pressure Alarm Specifications Range

Pressure

–40 to 360 mmHg

(–5.0 to 48 kPa)

Extreme High

Extreme Low

Pulse

Adjustment

-40 to 50 mmHg

2 mmHg (0.5 kPa)

>50 mmHg

5 mmHg (1 kPa)

Difference to high limit 0 to

25 mmHg

5 mmHg steps (0.5 kPa)

5 mmHg steps (1.0 kPa) Clamping at -40 to

360 mmHg

Difference to low limit 0 to

25 mmHg

5 mmHg steps (0.5 kPa)

Clamping at -40 to

360 mmHg

25 to 300 bpm

5 mmHg steps (1.0 kPa)

Adult:

1 bpm steps (25 to 40 bpm)

5 bpm steps (40 to 300 bpm)

Pedi/Neo:

1 bpm steps (25 to 50 bpm)

5 bpm steps (50 to 300 bpm)

Delay

max.

12 seconds

231

21 Specifications

Measurement Specifications

Invasive Pressure Alarm Specifications Range

Tachycardia

Difference to high limit 0 to

50 bpm

Clamping at 150 to

300 bpm

Bradycardia

Difference to low limit 0 to

50 bpm

Adjustment

5 bpm steps

5 bpm steps

5 bpm steps

Clamping at 25 to 100 bpm 5 bpm steps

Delay

max.

14 seconds max.

14 seconds

Temp

Complies with EN 12470-4:2000

Temp Performance Specifications

Temp

Range

Average Time Constant

Resolution

Accuracy

–1 to 45

°C (30 to 113°F)

0.1

°C (0.2°F)

±0.1

°C (±0.2°F)

Less than 10 seconds

Temp Alarm Specifications Range

–1 to 45ºC (30 to 113ºF)

Temp High/Low Alarms

Adjustment

-1 to 35

°C (30 to 95°F), 0.5°C (1.0°F) steps

35 to 45

°C (95 to 113°F), 0.1°C (0.2°F) steps

CO

2

The CO

2

measurement in the monitor, M3014A and M3015A complies with EN ISO 21647:2004 +

Cor.1:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001).

M3015A Microstream CO

2

Performance Specifications

CO

2

Range

Accuracy

0 to 98 mmHg (0 to 13 kPa), or 13 % CO

2

, whichever is lower

Up to 5 minutes during warmup: ±4 mmHg or 12 %, whichever is greater

After 5 minutes warmup:

0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)

Above 40 mmHg (5.3 kPa):±(5.5 % + (0.08 %/mmHg above 40 mmHg)) of reading

These specifications are valid for 21 % O

2

and N

2

balance, up to 35

°C ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode.

Outside of these conditions the accuracy reaches at a minimum

±4 mmHg or ±12 % of the reading, whichever is greater.

Resolution

Stability

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

Included in Accuracy specifications

awRR

Warm-up Time

Range

Accuracy

0 to 150 rpm

0 to 40 rpm: ±1 rpm

41 to 70 rpm: ±2 rpm

71 to 100 rpm: ±3 rpm

>100 rpm: ±5 % of reading

5 minutes for full accuracy specification

232

Measurement Specifications

21 Specifications

M3015A Microstream CO

2

Performance Specifications

Rise Time

190 ms for neonatal mode

(measured with FilterLine H for neonatal)

Sample Flow Rate

240 ms for adult mode

(measured with FilterLine H for adult)

50 + 15/-7.5 ml/minute

Gas Sampling Delay Time

Sound Pressure

Total System Response Time

Typical:2.3 seconds

Maximum:3 seconds

Acoustic noise: <45 dBA

The total system response time is the sum of the delay time and the rise time.

M3014A Mainstream CO

2

Performance Specifications

CO

2

Range 0 to 150 mmHg (0 to 20.0 kPa)

Accuracy

Resolution after 2 minutes warmup:

For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)

For values from 41 to 70 mmHg: ±5 % of reading

For values from 71 to 100 mmHg: ±8 % of reading

The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, P abs

= 760 mmHg, flow rate = 2 l/min.

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

awRR

Warm-up Time

Response Time

Stability:

Short term drift

Long term drift

Range

Accuracy

±0.8 mmHg over four hours

Accuracy specification will be maintained over a 120 hour period

2 to 150 rpm

±1 rpm

2 minutes with CO

2

transducer attached for full accuracy specification

Less than 60 ms (with adult or infant reusable or disposable adapter)

M3014A Sidestream CO

2

Performance Specifications

CO

2

Range 0 to 150 mmHg (0 to 20.0 kPa)

Accuracy after 2 minutes warmup:

For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)

For values from 41 to 70 mmHg: ±5 % of reading

For values from 71 to 100 mmHg: ±8 % of reading

For values from 101 to 150 mmHg: ±10 % of reading

At respiration rates above 80 rpm, all ranges are ±12 % of actual. The specifications are valid for gas mixtures of CO

2

, balance N

760 mmHg within specified operating temperature range.

2

, dry gas at

Resolution Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

awRR

Stability:

Short term drift

Long term drift

Range

Accuracy

±0.8 mmHg over four hours

Accuracy specification will be maintained over a 120 hour period

2 to 150 rpm

±1 rpm

233

21 Specifications

Measurement Specifications

M3014A Sidestream CO

2

Performance Specifications

Warm-up Time

Sample Flow Rate

2 minutes with CO

2

sensor attached for full accuracy specification

50 ±10 ml/minute

Total System Response Time

3 seconds

Operating Temperature

0 to 40°C (32 to 100°F)

M8102A/M3014A Mainstream and Sidestream CO

2

Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the CO

2 formula for the correction calculation is:

readings. The

P

STPD

= P

B TPS

P

-----------------------------

P a bs

– P

H2O

Where p = partial pressure, P abs

= absolute pressure, and P

H2O

= 42 mmHg @35°C and 100 % RH.

M3016A Mainstream CO

2

Performance Specifications

CO

2

Range –4 to 150 mmHg (-0.5 to 20.0 kPa)

Accuracy after 20 minutes warmup and calibration:

For values between 0 and 40 mmHg: ±2.2 mmHg (±0.29 kPa)

For values between 40 and 76 mmHg: ±5.5 % of reading

The specifications are valid for 45 % O

2

and N

2

or N

2

O balance. Outside these conditions the accuracy reaches at a minimum the requirements of

EN864/ISO9918.

Resolution

Stability

Numeric: 1.0 mmHg (0.1 kPa)

Wave: 0.1 mmHg (0.01 kPa)

±1.0 mmHg over a 7 day period

awRR

Warm-up Time

Response Time

Range

Accuracy

0 to 150 rpm

±2 rpm

20 minutes with CO

2

transducer attached for full accuracy specification

Less than 125 ms (for step from 10 % to 90 %)

Mainstream CO

2

Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO

2 readings. The formula for the correction calculation is:

P

STPD

= P

B TPS

P

-----------------------------

P a bs

– P

H2O

Where p = partial pressure, P abs

= absolute pressure, and P

H2O

= 47 mmHg @37

°C

and 100 % RH.

234

Measurement Specifications

21 Specifications

CO

2

Alarm

Specifications Range etCO

2

High etCO

2

Low imCO

2

High awRR High awRR Low

Apnea delay

20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa)

10 to 90 mHg (1 to 12 kPa)

2 to 20 mmHg

(0.3 to 3.0 kPa)

Adult/pedi: 10 to 100 rpm

Neo: 30 to 150 rpm

Adult/pedi: 0 to 95 rpm

Neo: 0 to 145 rpm

10 to 40 seconds

Adjustment

steps of 1 mmHg

(0.1 kPa) under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps

5 second steps

Delay

M8102A/M3014A/M3016A: less than

14 seconds

M3015A: less than18 seconds.

M8102A/M3014A/M3016A: less than

14 seconds

M3015A: less than18 seconds.

M8102A/M3014A/M3016A: less than

14 seconds

M3015A: less than18 seconds.

M3015A: settings <20 rpm: less than 8 seconds

>20 rpm: less than 18 seconds

M8102A/M3014A/M3016A settings <20 rpm: less than 4 seconds

>20 rpm: less than 14 seconds set apnea delay time +4 seconds

(M8102A/M3014A/M3016A) or

8 seconds (M3015A)

Interfering Gas and Vapor Effects On CO

2

Measurement Values

The specified deviations for M8102A/M3014A are valid when the appropriate corrections are switched on and set correctly.

Gas or Vapor

Nitrous Oxide

Halothane

Enflurane

Isoflurane

Sevoflurane

Xenon

Helium

Metered dose inhaler propellants

Desflurane

Ethanol

Isopropanol

Acetone

Methane

15

0.1

0.1

0.1

1.0

5

5

5

80

Gas Level

(% volume fraction)

60

4

-

50

M8102A/M3014A M3015A

Additional deviation due to gas interfence, measured at

0 - 40 mmHg CO

2

±1 mmHg ±5 %

±2 mmHg ±5 %

±2 mmHg

±2 mmHg

±2 mmHg

-5 mmHg

±1 mmHg not specified for use

±5 %

±5 %

±5 %

±5 %

±5 %

+5 mmHg

±1 mmHg

±1 mmHg

±1 mmHg

±1 mmHg

±5 %

±5 %

±5 %

±5 %

±5 %

235

21 Specifications

Safety and Performance Tests

Safety and Performance Tests

You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications are described in the Installation and Service guide.

Electromagnetic Compatibility (EMC) Specifications

Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radio frequency (RF) communications equipment can affect medical electrical equipment.

Accessories Compliant with EMC Standards

All accessories listed in the accessories section comply, in combination with the monitor, with the requirements of IEC 60601-1-2:2001 + A1:2004.

WARNING

Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment.

Electromagnetic Emissions

The monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environment

Emissions test

Radio Frequency (RF) emissions

RF emissions CISPR 11

Compliance Avoiding Electromagnetic Interference

Group 1 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

Class A The monitor is suitable for use in all establishments other than those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.

Avoiding Electromagnetic Interference (Resp)

The respiration (Resp) measurement is a very sensitive measurement that measures a very small signal.

Technological limitations do not allow higher immunity levels than 1 V/m for radiated RF electromagnetic fields and 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of this measurement.

WARNING

The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients.

236

Safety and Performance Tests

21 Specifications

Electromagnetic Immunity

The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below.

Immunity test

Electrostatic discharge (ESD)

IEC 61000-4-2

Electrical fast transient/burst

IEC 61000-4-4

Surge

IEC 61000-4-5

IEC 60601-1-2 test level

±

6 kV contact

±8 kV air

±2 kV for power supply lines

±1 kV for input/output lines

±1 kV differential mode

±2 kV common mode

Compliance level

±

6 kV contact

±8 kV air

Electromagnetic environment guidance

Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30 %.

±2 kV for power supply lines

±1 kV for input/output lines

±1 kV differential mode

±2 kV common mode

Mains power quality should be that of a typical commercial and/or hospital environment

Mains power quality should be that of a typical commercial and/or hospital environment

Voltage dips, short interruptions and voltage variations on power supply input lines

IEC 61000-4-

11

<5 %

U

T

(>95 % dip in

U

T

0.5 cycles

) for

<5 %

U

T

(>95 % dip in

U

0.5 cycles

T

) for

40 %

U

T

(60 % dip in

U

T

) for 5 cycles

70 %

U

T

(30 % dip in

U

T

) for 25 cycles

<5 %

U

T

(>95 % dip in

U

T

) for 5 sec

40 %

U

T

(60 % dip in

U

T

) for

5 cycles

70 %

U

T

(30 % dip in

U

T

) for

25 cycles

<5 %

U

T

(>95 % dip in

U

T

) for 5 sec

3 A/m Power frequency

(50/60 Hz) magnetic field

IEC 61000-4-8

3 A/m

Mains power quality should be that of a typical commercial and/or hospital environment. If the user of the monitor requires continued operation during power mains interruptions, it is recommended that the monitor is equipped with an internal battery or is powered from an uninterruptible power supply.

Power frequency magnetic fields should be a t levels characteristic of a typical location in a typical commercial and/or hospital environment

In this table, U

T

is the a.c. mains voltage prior to application of the test level.

Recommended Separation Distance

WARNING

The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that other equipment complies with CISPR emission requirements.

In the following table, 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 metres

(m). The values given in brackets are for respiration.

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 appropriate for the frequency of the transmitter.

Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range (over the frequency range 150 kHz to 80 MHz, field strengths should be less than 1 V/m for respiration and 3 V/m for all other functions).

237

21 Specifications

Safety and Performance Tests

Interference may occur in the vicinity of equipment marked with this symbol:

Immunity test

Conducted RF

IEC 61000-4-6

IEC 60601-1-2 test level

3 V

RMS

150 kHz to

80 MHz

Radiated RF

IEC 61000-4-3

3 V/m

80 MHz to

2.5 GHz

Compliance level

3 V

RMS

(1 V

RMS

for respiration)

Electromagnetic environment guidance

Recommended separation distance: d = 1.2 P for respiration:

:

3 V/m

(1 V/m for respiration) d = 3.5 P

:

Recommended separation distance:

80 MHz to 800 MHz d = 1.2 P

80 MHz to 800 MHz for respiration d = 3.5 P :

800 MHz to 2,5 GHz d = 2.3 P

800 MHz to 2,5 GHz for respiration d = 7.0 P

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.

These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.

Recommended separation distances from portable and mobile RF communication equipment

The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment.

In the following table, 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 metres

(m). The values given in brackets are for respiration.

238

Safety and Performance Tests

21 Specifications

Frequency of transmitter 150 kHz to 80 MHz 150 kHz to 800 MHz 800 MHz to 2,5 GHz

d = 1.2 P d = 1.2 P d = 2.3 P

Equation

Rated max. output power of transmitter (W) for respiration:

d = 3.5 p

for respiration:

d = 3.5 P

for respiration:

d = 7.0 P

Separation distance (m) Separation distance (m) Separation distance (m)

0.01

0.1

1

10

100

0.1 (0.4)

0.4 (1.1)

1.3 (3.5)

3.8 (11.1)

12.0 (35.0)

0.1 (0.4)

0.4 (1.1)

1.3 (3.5)

3.8 (11.1)

12.0 (35.0)

0.2 (0.7)

0.7 (2.2)

2.3 (7.0)

7.3 (22.1)

23.0 (70.0)

Electrosurgery Interference/Defibrillation/Electrostatic Discharge

The equipment returns to the previous operating mode within 10 seconds without loss of any stored data. Measurement accuracy may be temporarily decreased while performing electro-surgery or defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magnetic fields (MRI).

Fast Transients/Bursts

The equipment will return to the previous operating mode within 10 seconds without loss of any stored data. If any user interaction is required, the monitor indicates with a technical alarm (INOP).

Restart time

After power interruption, an ECG wave will be shown on the display after 30 seconds maximum.

239

21 Specifications

Safety and Performance Tests

240

22

22

Default Settings Appendix

This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor’s default settings can be permanently changed in

Configuration Mode.

Note: If your monitor has been ordered preconfigured to your requirements, the settings at delivery will be different from those listed here.

Country-Specific Default Settings

Certain default settings are specific to a particular country. These are listed here for all countries alphabetically.

Country-Description

Afghanistan

Åland Islands

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antarctica

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

Bahamas, The

Bahrain

Bangladesh

Barbados

Belarus

Belgium

50

50

60

50

50

50

60

50

60

50

50

50

50

60

60

50

50

50

60

60

Line Frequency Units

Weight

50/60 [Hz]

50

50 kg, lb kg kg

Units

Height

ECG Cable Color

in, cm IEC, AAMI cm cm

AAMI

IEC kg kg lb lb kg lb lb kg kg kg kg kg kg kg kg kg lb kg kg kg cm cm in in cm in in cm cm cm cm cm cm cm cm cm in cm cm cm

IEC

IEC

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

IEC

IEC

241

22 Default Settings Appendix

60

50

60

50

60

50

50

60

50

60

50

50

50

60

60

50

50

50

50

60

60

60

60

60

60

50

60

50

50

60

60

60

60

50

50

50

50

50

60

50

50

50

50

50

60

60

60

60

60

60

50

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Bouvet Island

Brazil

British Indian Ocean Territory

Brunei Darussalam

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Islands

Cocos Keeling Islands

Colombia

Comoros

Congo

Congo, Democratic Republic of the

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands, Malvinas

Faroe Islands

Fiji

242

Country-Specific Default Settings

AAMI

IEC

AAMI

AAMI

AAMI

IEC

AAMI

IEC

IEC

AAMI

AAMI

IEC

IEC

IEC

IEC

IEC

IEC

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

IEC

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

IEC

IEC cm cm cm cm in cm cm cm cm cm cm cm cm in cm cm cm cm cm in in in in cm in cm in cm cm in cm in cm cm cm cm cm cm in cm cm cm cm cm in cm in in cm in cm kg kg kg kg lb kg kg kg kg kg kg kg kg lb kg kg kg kg kg lb lb lb lb kg lb kg lb kg kg lb kg lb kg kg kg kg kg kg lb kg kg kg kg kg lb kg lb lb kg lb kg

Country-Specific Default Settings

Finland

France

French Guiana

French Polynesia

French Southern Territories

Gabon

Gambia, The

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Heard Island and McDonald Islands

Holy See, Vatican City State

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran, Islamic Republic of

Iraq

Ireland

Isle of Man

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

50

60

Korea, Democratic People’s Republic of 60

Korea, Republic of 60

60

50

50

50

50

50

50

50

50

50

50

50

Kuweit

Kyrgyzstan

Lao People’s Democratic Republics

Latvia

Lebanon

Lesotho

50

60

50

50

50

50

50

50

50

50

60

60

60

60

50

60

60

60

50

50

60

60

50

60

50

60

50

50

60

50

50

50

50

60

60

22 Default Settings Appendix

cm in in cm cm cm cm cm cm cm cm cm cm cm cm cm cm in cm cm cm cm cm cm cm cm cm in in cm cm in in cm cm cm in cm cm in cm in cm cm in cm cm cm cm in in

IEC

IEC

AAMI

IEC

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

IEC

IEC

IEC

IEC

AAMI

AAMI

AAMI

IEC

IEC

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

IEC

AAMI

IEC

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

IEC

IEC

AAMI

IEC

IEC

AAMI

IEC

AAMI kg lb lb kg kg kg kg kg kg kg kg kg kg kg kg kg kg lb kg kg kg kg kg kg kg kg kg lb lb kg kg lb lb kg kg kg lb kg kg lb kg lb kg kg lb kg kg kg kg lb lb

243

22 Default Settings Appendix

Liberia

Libyan Arab. Jamahiriya

Liechtenstein

Lithuania

Luxembourg

Macao 60

Macedonia, The former Yugoslav. Rep. of 50

Madagascar

Malawi

50

50

Malaysia

Maldives

Mali

Malta

50

60

50

50

50

60

60

50

50

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia, Fed. States of

Moldova, Republic of

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Namibia

50

50

60

50

60

60

50

50

60

60

60

60

60

60

50

60

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Islands

Northern Mariana Islands

Norway

Oman

Pakistan

Palau

Palestinian Territory

Panama

Papua New Guinea

Paraguay

Peru

Philippines

50

50

50

60

50

60

60

60

60

50

60

50

60

60

50

50

50

60

60

50

60

60

244

Country-Specific Default Settings

IEC

AAMI

AAMI

AAMI

IEC

AAMI

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

IEC

IEC

AAMI

IEC

AAMI

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

IEC

IEC

AAMI

IEC

IEC

IEC

IEC

AAMI

IEC

IEC cm cm cm in cm in in in in cm in cm in in cm cm cm in in cm cm cm cm cm in cm in in cm cm in cm in in in cm cm in cm in cm cm in cm cm cm cm in in cm cm kg kg kg lb kg lb lb lb lb kg kg kg lb lb kg kg kg lb lb kg kg kg kg kg lb kg lb lb kg kg lb kg lb lb lb kg kg lb kg lb kg kg lb kg kg kg kg lb lb kg kg

Country-Specific Default Settings

Pitcairn

Poland

Portugal

Puerto Rico

Qatar

Reunion

Romania

Russian Federation

Rwanda

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Serbia & Montenegro

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Georgia and the South Sandwich

Islands

Spain

Sri Lanka

Sudan

Suriname

Svalbard and Jan Mayen

Swaziland

Sweden

Switzerland

Syrian Arab Rep

Taiwan, Province of China

Tajikistan

Tanzania, United Republic of

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Trinidad and Tobago

Tunisia

Turkey

50

60

60

60

50

60

60

60

60

60

50

50

60

60

50

50

50

60

50

60

50

60

50

60

60

50

50

50

50

50

50

50

50

60

60

60

60

60

60

50

60

60

50

50

50

60

50

50

60

50

22 Default Settings Appendix

cm in cm in in cm cm cm cm cm cm cm cm in in in in in cm cm in in cm cm cm in cm cm in cm cm in in in cm cm in in in in cm cm in in cm cm cm in cm cm

AAMI

IEC

IEC

IEC

IEC

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

IEC

IEC

AAMI

AAMI

AAMI

IEC

IEC

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

IEC

AAMI

AAMI

AAMI

IEC

IEC

AAMI

AAMI

IEC

IEC kg lb kg lb lb kg kg kg kg kg kg kg kg lb lb lb lb lb kg kg lb lb kg kg kg lb kg kg lb kg kg lb lb lb kg kg lb lb lb lb kg kg lb lb kg kg kg lb kg kg

245

22 Default Settings Appendix

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

UK

United Arab Emirates

United Kingdom

United States

United States Minor Outlying Islands 60

Uruguay 50

Uzbekistan

Vanuatu

60

60

50

50

50

60

60

60

60

60

60

Venezuela

Viet Nam

Virgin Islands (British)

Virgin Islands (US)

Wallis and Futuna Islands

Western Sahara

Yemen

Zambia

Zimbabwe

60

50

50

60

60

50

50

60

60 lb kg kg lb lb kg kg lb lb lb kg lb lb kg kg kg lb lb kg lb lb lb

Country-Specific Default Settings

AAMI

IEC

AAMI

AAMI

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

AAMI

IEC

AAMI

IEC

AAMI

AAMI

AAMI

AAMI

AAMI in cm cm in in cm cm in in in cm in in cm cm cm in in cm in in in

246

Alarm and Measurement Default Settings

22 Default Settings Appendix

Alarm and Measurement Default Settings

Settings are only entered once per table row if they are the same for all patient categories

1

.

Alarm Default Settings

Alarm Settings

Alarm Volume

Alarms Off

Pause Al. 5min

Pause Al. 10min

Auto Alarms Off

Alarm Off Reminder

Visual Latching

Audible Latching

Alarm Reminder

Reminder Time

Alarm Sounds

Red Alarm Interval

Yel. Al. Interval

Alarm Low

Red Alarm Volume

Yell. Alarm Volume

Inop Volume

Auto Increase Vol.

Increase Vol Delay

Keep Blinking

Relay 1 Sensitiv.

Relay 2 Sensitiv.

Relay 3 Sensitiv.

Inop Relay Latency

Yel. Relay Latency

Alarm Text

No Centr Mon Min Vol

Factory Default

AlarmVol +0

2 Steps

20 sec

No

R & Y & I

Red & Yell

Red

5 sec

2 sec

Standard

4

5

2 min.

Enabled

Enabled

Off

Off

Red & Yell

Red & Yell

On

3 min

Traditional

10 sec

20 sec

4

AlarmVol +2

AlarmVol +0

1.A profile “Outdoor” exists for use in typical outdoor conditions (bright sunlight, higher ambient noise). See the Configuration

Guide for details.

247

22 Default Settings Appendix

ECG, Arrhythmia, ST and QT Default Settings

ECG, Arrhythmia, ST and QT Default Settings

ECG Settings

High Limit

Low Limit

Alarms

Alarm Source

ECG

QRS Volume

Primary Lead

Secondary Lead

Analysis Mode

Lead Placement

Mod. Lead Placment

Filter

Speed

Auto Filter

Default ECG Size

Color

Asystole Thresh

Δ ExtrTachy

Tachy Clamp

Δ ExtrBrady

Brady Clamp

ALL ECG IN.

Fallback

Alarms Off

Alarm Source Sel.

Arrhythmia Settings

Arrhythmia

Pause Threshold

VTach HR

VTach Run

Vent Rhythm

SVT HR

SVT Run

PVCs/min

Non-Sustain

Factory Defaults

Adult

II

V

On

1

120 bpm

50 bpm

On

Auto

Multi-lead

Standard

Off

Monitor

25 mm/s

Off x1

Green

4.0 sec

20 bpm

200 bpm

20 bpm

40 bpm

On

On

Enabled

Enabled

Pedi

160 bpm

75 bpm

220 bpm

Neo

200 bpm

100 bpm

3.0 sec

240 bpm

50 bpm

Factory Defaults

Adult Pedi Neo

On Off

2.0 sec

100 120

1.5 sec

150

5

14

180

5

10

On

200

5

210

5

248

ECG, Arrhythmia, ST and QT Default Settings

Arrhythmia Settings

Vent Rhythm

Run PVCs

Pair PVCs

R-On-T PVCs

V.Bigeminy

V.Trigeminy

PVCs/min

Multif. PVCs

Pacer N. Cap

Pacer N. Pac

Pause

Missed Beat

SVT

IrregularHR

TimeOut 1st

TimeOut 2nd

Arrhy Off Message

SOME ECG IN

Factory Defaults

Adult

On

On

On

On

On

On

On

On

On

On

On

On

On

On

3 min

10 min

Yes

On

Pedi

22 Default Settings Appendix

Neo

249

22 Default Settings Appendix

ECG, Arrhythmia, ST and QT Default Settings

Lead-independent ST Settings

ST Alarm Mode

Alarms

ST Analysis

ST-Index

ISO Point

J Point

ST Point

Factory Defaults

Adult

Single ST

On

On

On

-80 ms

48 ms

J+60

Pedi

Off

Lead I, II, III, V, aVR, aVL, aVF, V1-6,

MCL Settings

Factory Defaults

Factory Adult

ST

(Label)

For Alarm Mode = Single-ST

On

ST

(Label)

High +2.0 mm

ST

(Label)

Low -2.0 mm

For Alarm Mode = Multi-ST

ST

(Label)

High +1.0 mm

ST

(Label)

Low -1.0 mm

Factory Pedi

Off

QT Settings

QT Lead

QTc High Limit

ΔQTc Limit

QTc High Alarm On/Off

ΔQTc High Alarm On/Off

QT Analysis

QTc Formula

Factory Defaults

Factory Adult

All

500 ms

60 ms

On

On

Off

Bazett

Factory Pedi

480 ms

Neo

Factory Neo

Factory Neo

460 ms

250

Pulse Default Settings

Pulse Default Settings

Respiration Settings

High Limit

Low Limit

Apnea Time

Alarms

Resp

Auto/Manual

Resp Speed

Color

Factory Defaults

Adult

30 rpm

8 rpm

20 sec

On

On

Auto (Trigger Mode)

6.25 mm/s

Yellow

Pedi

22 Default Settings Appendix

Pulse Settings

Alarms Source

Pulse (Label)

System Pulse

Alarms Off

Alarm Source Sel.

Factory Defaults

Adult

Auto

On

SpO2

Enabled

Enabled

Pedi Neo

Pulse Alarm Settings

Pulse (SpO2)

Pulse Alarms

High Limit

Low Limit

Δ Extr Brady

Brady Clamp

Δ Extr Tachy

Tachy Clamp

Factory Defaults

Adult

On

Off

120 bpm

50 bpm

20 bpm

40 bpm

20 bpm

200 bpm

Pedi

160 bpm

75 bpm

40 bpm

220 bpm

Pulse alarms use the settings of the currently selected Pulse alarm source.

Respiration Default Settings

Neo

200 bpm

100 bpm

50 bpm

240 bpm

Neo

100 rpm

30 rpm

251

22 Default Settings Appendix

SpO

2

Default Settings

SpO

2

Settings

Alarms

QRS Volume

Tone Modulation

Tone Mod. Type

Speed

Perfusion

Average

NBP Alarm Suppr.

Extd. Auto OnOff

Color

SpO

2

Alarm Default Settings

Setting

Desat Limit

Low Limit

High Limit

Desat delay

High Alarm delay

Low Alarm delay

Parameter Alarms On/Off

Label

Pulse Settings

Pulse (SpO2) On/Off

Pulse Alarms On/Off

Pulse High Limit

Pulse Low Limit

Δ Extr Brady

Brady Clamp

Δ ExtrTachy

Tachy Clamp

Adult

80

90

100

20 sec

10 sec

10 sec on

SpO

2 on on

120 bpm

50 bpm

20 bpm

40 bpm

20 bpm

200 bpm

Factory Defaults

Adult

On

1

Yes

Enhanced

25 mm/s

On

10 sec

On

Disabled

Cyan

Pedi

Pediatric

80

90

100

20 sec

10 sec

10 sec on

SpO

2 on on

160 bpm

75 bpm

20 bpm

40 bpm

20 bpm

220 bpm

Neo

SpO

2

Default Settings

Neonatal

80

85

95

20 sec

10 sec

10 sec on

SpO

2 on on

200 bpm

100 bpm

20 bpm

50 bpm

20 bpm

240 bpm

252

NBP Default Settings

NBP Default Settings

22 Default Settings Appendix

NBP Settings

Auto/Manual

Alarms from

High Alarm Limit

Low Alarm Limit

Alarms

NBP

Repetition Time

Pulse (NBP)

Unit

Done Tone

Start Time

VP Pressure

Reference

Color

Temperature Default Settings

Factory Defaults

Adult

Auto

Sys.

160/90 (110)

90/50 (60)

On

On

10 min

On mmHg

Off

Synchronized

60 mmHg

Auscultatory

Red

Pedi

120/70 (90)

70/40 (50)

40 mmHg

Temp Settings

Low Limit

High Limit

Alarms

Unit

Range

Color

Factory Defaults

Adult

36

39

On

0

C

35...43

Green

Pedi

Invasive Pressure Default Settings

Neo

Manual

90/60 (70)

40/20 (24)

30 mmHg

Invasive

Neo

ABP, ART, Ao, BAP, FAP, P, P1, P2, P3,

P4, UAP Settings

Factory Defaults

Adult

Alarms from

High Limit

Low Limit

Alarms

Extreme Alarms

Sys.

160/90 (110)

90/50 (70)

On

Enabled

Pedi

120/70 (90)

70/40 (50)

Neo

90/60 (70)

55/20 (36)

253

22 Default Settings Appendix

Invasive Pressure Default Settings

Pedi

10

10

140/80 (100)

60/35 (45)

100

Neo

5

5

105/75 (75)

45/15 (30)

100

Pedi

10/2 (4)

2/-4 (0)

5

5

15/5 (10)

0/-5 (-5)

Neo

10/2 (4)

2/-4 (0)

5

5

15/5 (10)

0/-5 (-5)

254

Invasive Pressure Default Settings

ICP, IC1, IC2 Settings

Alarms from

High Limit

Low Limit

Alarms

Extreme Alarms

ΔExtreme High

ΔExtreme Low

Low Clamp

High Clamp

Scale

Speed

Mean Only

Filter

Mercury Cal.

Artifact Suppr.

Unit

Color

PAP Settings

Alarms from

High Limit

Low Limit

Alarms

Extreme Alarms

ΔExtreme High

ΔExtreme Low

High Clamp

Low Clamp

Scale

Speed

Mean Only

Filter

Mercury Cal.

Artifact Suppr.

Unit

Color

22 Default Settings Appendix

Factory Defaults

Adult

Dia.

34/16 (20)

10/0 (0)

On

Enabled

5

5

45/20 (25)

5/-5 (-5)

30

25 mm/s

No

12 Hz

Yes

60 sec mmHg

Yellow

Factory Defaults

Adult

Mean

14/6 (10)

6/-4 (0)

On

Enabled

10

10

20/10 (-5)

0/-5 (0)

30

25 mm/s

Yes

12 Hz

Yes

60 sec mmHg

Magenta

Pedi

10/2 (4)

2/-4 (0)

Enabled

10

10

15/5 (-5)

0/-5 (0)

Pedi

60/4 (26)

24/-4 (12)

Enabled

5

5

65/5 (35)

15/-5 (5)

Neo

10/2 (4)

2/-4 (0)

Enabled

10

10

15/5 (-5)

0/-5 (0)

Neo

60/4 (26)

24/-4 (12)

Enabled

5

5

65/5 (35)

15/-5 (5)

255

22 Default Settings Appendix

CO

2

Default Settings

Factory Defaults

CO

2

Settings

etCO

2

low etCO

2

high imCO

2

high

CO

2

Alarms

Unit

Adult

30

50

4

Scale

ImCO

2

N

2

O Corr (only M3015A/M3016A)

Oxygen Corr (only M3014A) on mmHg

40 mmHg on

Gas Corr (only M3014A)

Humidity Corr

Max Hold Off

AwRR On

Off

16 %

Off

BTPS

AwRR Alarms

AwRR high limit

AwRR low limit

Apnea time

Color

On

30

8

20 secs

Yellow

Pedi

CO

2

Default Settings

Neo

100

30

256

1

Index

#

10-lead placement (ECG)

88

12-lead placement (ECG)

88

3-lead placement (ECG)

86

5-lead placement (ECG)

86

A

AAMI ECG lead labels

85

abdominal breathing and Resp electrode placement

122

aberrantly conducted beats

95

accessories

10-electrode cable sets

202

3-electrode cable sets

202

,

204

5-electrode cable sets

202

,

204

5-electrode one piece cables

204

6-electrode cable sets

202

CO2

155

CO2 (mainstream)

211

,

212

CO2 (microstream)

212

ECG

201

NBP adult cuffs

206

comfort cuffs

205

disposable cuffs

205

multi-patient comfort cuff kits

205

neonatal/infant cuffs

(disposable)

206

reusable cuffs

205

single-hose disposable cuffs

206

Nellcor

206

pressure

206

Pulsion

206

resp

201

set combiners and organizers

203

,

204

SpO2

206

Nellcor adhesive sensors

(disposable)

206

Philips sensors (disposable)

206

Philips sensors (reusable)

206

temperature

210

trunk cables

201

,

203

active alarms

33

address, Philips

215

addressograph (printer configuration setting)

181

adjusting ST measurement points

106

adjusting wave scale (pressure)

145

adjusting wave size (CO2)

156

admit editing information

75

quick admit

75

admitting a patient

73

airway adapter

CO2, microstream accessory

156

alarm latching

43

,

100

alarm limits changing

40

checking

39

manually adjusting

40

narrow

41

report

182

ST

109

switching auto limits on/off

41

using automatic limits

41

wide

41

window

39

alarm recording choosing recorded measurements

172

alarm source selection, disabled

119

alarms acknowledging

36

active

33

active SpO2 source

132

alphabetical listing

45

apnea delay

158

apnea delay time (Resp)

124

arrhythmia

33

audible indicators

34

awrr limits

158

chaining

102

CO2 specific

158

CO2, apnea delay

158

CO2, awRR

158

desat, SpO2

130

effect on pressure alarms during zero

143

extending pause time

38

high priority

33

INOP

33

ISO/IEC standard 9703-2

35

key

16

limit, SpO2

229

message field

17

NBP source

136

off indicator

17

patient messages

45

pausing

37

physiological

45

pleth as source

131

recordings

44

red

33

reminder

37

restarting

38

reviewing window

42

selftest

44

silencing

36

SpO2 high and low limits

130

SpO2 specific

130

ST

109

suspended symbol

38

switching on and off

37

temperature

139

testing

44

tone configuration

35

traditional

35

visual indicators

34

volume, changing

35

yellow

33

alarms key

16

alphabetical listing of alarms

45

analog output

ECG

217

apnea alarm delay

CO2

158

apnea alarm delay time (RESP)

124

apnea alarms and Resp detection modes

124

arrhythmia aberrantly conducted beats

95

analysis, how it works

94

atrial fibrillation and flutter

95

beat labels

96

initiating learning

98

,

99

intermittent bundle branch block

96

learning during ventricular rhythm

99

levels of analysis

91

,

94

monitoring non-paced patients

95

monitoring paced patients

95

options

94

relearning

98

relearning and lead fallback

99

status messages

97

switching on/off

95

understanding the display

96

arrhythmia alarms

33

,

99

adjusting alarm limits

100

all yellow on/off

100

i

chaining

102

latching

100

multiple

102

pvc-related alarms

103

sinus and SV rhythm ranges

227

,

229

switching on/off

100

timeout periods

100

arrhythmia monitoring and defibrillation

93

arrhythmia options

91

arrhythmia relearning with EASI INOP

90

arterial pressure source

148

arterial pulsation

127

artifact suppression (pressure)

145

atrial fibrillation and flutter

95

audlatching (arrhythmia alarms)

100

auto alarm limits switching on/off

41

using

41

auto detection mode (Resp)

122

autofilter

83

automatic arrhythmia relearn

99

automatic default setting

26

automatic NBP repeat time

136

autosize

ECG wave

83

awRR alarm limits

158

awRR alarms

CO2

158

B

baseline

ST map, updating

112

ST, updating

106

basic arrhythmia option

91

,

94

battery and display brightness

194

battery reports

192

battery status window

191

charge status

192

compartment

189

conditioning

194

conserving power

194

indicators

190

LED

190

malfunction indicator

191

malfunction symbols

190

monitoring time

191

power gauge

190

recharging

189

replacing

193

safety information

195

ii

status indicator

18

,

191

symbol

216

time to empty

192

time to full

192

battery eject symbol

216

battery performance optimizing

193

battery status indicator

18

beat labels arrhythmia

96

bed information

32

blood pressure. See also NBP (non-invasive) or PRESS (invasive)

Brightness SmartKey

30

brightness, adjusting

30

C

calculating cerebral perfusion

148

calculating temperature difference

140

calibrating

CO2 transducer

154

calibration interval, NBP

198

NBP

138

pressure

147

pressure transducer

147

capnography mainstream

14

Microstream

14

carbon dioxide, see CO2

149

cardiac overlay and Resp detection modes

123

when measuring Resp

121

cardiotach alarms

91

cautions

9

central recorder choosing

172

cerebral perfusion

148

chaining

102

change screen menu

23

change screen window

16

,

24

Changing

23

changing ECG lead sets

85

changing Resp detection mode

122

changing Resp wave size

123

changing Resp wave speed

124

changing screen content

23

channels recorder

172

checking battery charge

192

checking paced status

80

checklist delivery

2

installation

1

cleaning infection control

185

method

186

monitoring accessories

187

recommended substances

186

CO2 airway adapter

156

alarms, apnea delay

158

alarms, awRR

158

alarms, specific

158

awRR alarm limits

158

checking transducer accuracy

153

correction, humidity

157

correction, N2O

157

corrections

157

FilterLine

156

measuring mainstream

150

,

153

measuring microstream

155

method, mainstream

149

method, microstream

149

method, sidestream

149

microstream accessories

155

microstream extension

155

removing exhaust gases

153

,

156

transducer, calibrating

154

transducer, using

154

wave scale, adjusting

156

CO2 (mainstream).

accessories

211

,

212

CO2 (microstream).

accessories

212

conditioning batteries

194

configuration mode

22

entering

7

conflict label

28

connecting power

4

connecting temperature probe

139

connection direction symbol

216

connectors

217

ECG

80

temp

139

conventional 12-lead ECG

88

correcting the NBP measurement

135

CPAP (RESP)

123

cuff pressure, NBP

136

selection, NBP

135

current view

ST map

109

D

damage mechanical

30

damage claims

2

date, setting

7

,

30

DC power symbol

216

default profile

26

default settings

241

checking country-specific

7

defibrillation and arrhythmia monitoring

93

and ECG monitoring

93

synchronization marks

81

defibrillator proof symbol

216

defibrillator synch maintenance interval

198

delay time recording

173

demonstration mode

22

desat alarm, SpO2

130

detection modes (Resp)

122

diagnostic (ECG filter setting)

84

discharging a patient

75

disconnect INOPs silencing

36

disinfecting infection control

185

recommended substances

186

display arrhythmia

96

ECG

81

NBP

135

Resp

122

ST

105

display brightness

194

display settings

24

disposal gas cylinder

199

parts and accessories

199

dual Temp measurement

140

dyshemoglobins intravascular (SpO2)

129

E

early systolic blood pressure, NBP

136

EASI activating

84

ECG monitoring

90

lead placement

90

EASI ECG lead labels

85

ECG

79

accessories

201

alarms off (Config Mode)

92

changing lead sets

85

choosing electrode sites

84

conventional 12-lead

88

external pacing electrodes

94

filter settings

83

fusion beat pacemakers

94

intrinsic rhythm

93

modified 12-lead

88

New Lead Setup

85

pacemaker failure

93

rate adaptive pacemakers

94

unfiltered

84

wave size

82

ECG analog output

217

ECG cable for operating room

93

ECG cables, connecting

80

ECG connector

80

ECG display

81

ECG electrode colors

85

ECG electrode placement during electro-surgery

93

ECG gain in reports

176

ECG lead labels

85

ECG lead placement choosing EASI/Standard

84

ECG leads monitored

85

ECG report

183

lead layout

176

ECG safety information

93

ECG wave autosize

83

calibration bar

83

ectopic status messages (arrhythmia monitoring)

98

electrical output symbol

216

electrode placement (ECG)

79

conventional 12-lead

88

modified 12-lead

88

electrode placement (Resp)

121

with abdominal breathing

122

with lateral chest expansion

122

electro-surgery and ECG

93

EMC interference

Resp

124

EMI filter for ECG

83

end case discharging a patient

75

report, printing

75

end case reports setup

177

enhanced arrhythmia option

91

,

94

exclamation mark symbol

216

exhaust gases, removing

153

,

156

extension cable for SpO2

128

external pacing electrodes and ECG monitoring

94

extreme bradycardia alarm

92

,

119

extreme pressure alarms

146

extreme rate alarms

92

,

119

extreme tachycardia alarm

92

,

119

F

fallback (ECG)

85

FAST

Fourier artefact suppression technology

127

filter (ECG filter setting)

83

filter (ECG)

83

FilterLine

CO2, microstream accessory

156

flushing invasive pressure accessories

142

functional arterial oxygen saturation

127

fusion beat pacemakers and ECG monitoring

94

G

gas cylinder empty, disposing of

199

getting started

30

global trend time

167

graphic trends

160

graphic trends report

164

H

hemodynamic measurement extension

15

hemodynamic MMS extension

15

horizon trend trend time

167

HR = RR (Resp)

122

HR alarms when arrhythmia off

92

HR alarms off (Config Mode)

92

HR and pulse alarm source selection

119

HR from (heart rate source)

118

humidity correction

CO2

157

I

IEC ECG lead labels

85

IIT

32

IMV (Resp)

123

indicators battery malfunction

191

battery status

18

,

191

infection control cleaning

185

disinfecting

185

iii

sterilizing

185

Information Center central recording

171

transferring patients

76

INOPs indicators

33

message field

17

silencing

36

installation checklist

1

connectors

217

personnel

1

Instructions for Use intended audience

9

IntelliVue Instrument Telemetry System

(IIT)

32

intermittent bundle branch block

96

intermittent mandatory ventilation

(Resp)

123

interruption symbol

217

intravascular dyshemoglobins (SpO2)

129

intrinsic rhythm

93

ISO point (ST)

107

J

J point (ST)

107

K

keyboard, on screen

21

keys alarms

16

main screen

16

pop-up

21

silence

16

SmartKeys

16

L

label conflict resolution

28

label conflicts,resolving

28

labels

28

changing

28

LAN connection

4

latching alarms

43

alarms, behavior

43

latching arrhythmia alarms

100

lateral chest expansion (neonates) monitoring Resp

122

lead fallback and arrhythmia relearning

99

lead fallback (ECG)

85

lead labels (ECG)

85

lead placement activating EASI/Standard

84

iv

for Resp measurement

121

leads monitored (ECG)

85

Leads Off INOP (ECG)

85

levels of arrhythmia analysis

94

M

main screen key

16

main setup

19

mains power connecting to

3

mainstream capnography

14

mainstream CO2 measuring

150

,

153

maintenance cables

197

cords

197

measurements, schedule

198

microstream CO2, calibration

198

schedule

197

visual inspection

197

malfunction symbols battery

190

manual detection mode (Resp)

123

and apnea alarms

124

manufacture date symbol

217

manufacturer’s information

215

map

ST

109

Mason-Likar lead system

88

max hold setting (CO2)

150

measurement adjusting a wave

27

preparation

30

setting up

26

wave speed, changing

27

measurement extension

M3012A

15

M3015A

14

M3016A

14

measurement label

17

measurement labels

28

changing

28

measurement points, ST

106

measurement server

ECG connector

80

measurement settings

24

measurement setup menu

18

measurements setting up

31

switching on and off

27

mechanical damage

30

menu main setup

19

measurement setup

18

messages alarm

17

INOP

17

status and prompt

18

methemoglobin (SpO2)

129

Microstream capnography

14

microstream CO2

155

accessories

155

maintenance, calibration

198

measuring

155

mismatch patient data, resolving

77

MMS extensions

14

modified 12-lead ECG

88

modifying screens

23

monitor inspecting before use

30

quick operating giude

6

starting monitoring

31

switching on

31

monitor (ECG filter setting)

83

monitor defaults

241

monitor revision how to find

30

monitor settings

24

changing

29

monitoring preparation

30

starting

30

monitoring mode

22

mounting power supply

3

mounting information

3

MSL cable

4

multi-lead ST alarming

109

N

N2O correction

CO2

157

narrow alarm limits

41

NBP adult cuffs

206

alarm source

136

ANSI/AAMI SP10-1992

133

automatic mode, enabling

136

calibrating

138

calibration interval

198

comfort cuff kits

205

comfort cuffs

205

cuff pressure

136

cuff, applying

135

cuff, selecting

135

cuff, tightness

135

disposable cuffs

205

how the measurement works

133

measurement correction

135

measurement limitations

134

measurement methods, auto

134

measurement methods, manual

134

measurement methods, sequence

134

measurement methods, stat

134

measurement, starting

136

measurement, stopping

136

neonatal cuffs (disposable)

206

numerics

135

oscillometric method

133

pediatric cuffs

206

preparing to measure

134

repeat time

135

repeat time for automatic

136

repetition time, setting

136

reusable cuffs

205

single-hose disposable cuffs

206

site inspection

135

time of last measurement

135

units

135

venous puncture

137

neonates

Resp electrode placement

122

network connection indicator

17

networked monitoring

32

non-invasive blood pressure. See NBP

non-paced patients arrhythmia monitoring

95

numerics explanation of NBP display

135

O

on-screen keyboard

21

operating modes

22

configuration

22

demonstration

22

monitoring

22

passcode protection

22

service

22

operating room ECG cable

93

orange ECG cable

93

organizers

203

,

204

Oridion Systems Ltd

216

oscillometric NBP measurement method

133

overlap in recordings

173

overlapping screen trends

167

P

pace pulse rejection (ECG) about

80

switching on/off

82

paced patients arrhythmia monitoring

95

repolarization tails

82

safety information

93

setting status

93

paced status

17

checking

80

pacemaker failure

93

paper size for reports

178

parameter scales trends

163

passcode protection

22

patient admit

73

category, NBP

133

discharge

75

end case

75

patient alarm messages

45

patient category field

17

patient demographics window

73

patient mismatch

77

patient name field

17

patient reports contents

181

patient trends viewing

159

paused alarms

37

extending time

38

restarting

38

performance specifications pressure

225

,

231

performance test

236

perfusion indicator

127

,

128

,

131

Philips contact information

215

physiological alarms

33

pleth alarm source

131

pleth wave

131

pleth waveform

127

Pop

21

pop-up keys

21

power connecting

4

connection

3

disconnecting from mains power disconnecting from

32

power supply

4

mounting

3

power-on LED

4

preparing skin for ECG

79

pressure alarms during zero

143

arterial source

148

calibration pressure

147

cerebral perfusion, calculating

148

performance specifications

225

,

231

wave scale

145

wave size

145

zeroing the transducer

143

pressure accessories

206

pressure artifact suppression

145

pressure of NBP cuff

136

pressure transducer calibration

147

zeroing

143

primary lead (ECG) selecting

80

print job suspended

179

printer disabling

178

settings

178

status messages

180

unavailable

179

printing

ST map reports

113

status log

199

trends reports

164

priority list for trends

163

probes disposable temperature

139

profiles

24

default profile

26

patient category

25

swapping a complete profile

25

swapping setting block

26

prompts

18

pulse alarms

118

system pulse source

117

pulse numerics for SpO2

128

PVC-related alarms

103

Q

QRS tone

119

changing volume

29

QRS tone pitch, SpO2

132

QRS volume, changing

83

QT alarms

116

QT baseline

116

QT measurement algorithm

114

QT monitoring limitations

115

QT/QTc monitoring

114

quick admit

75

v

R

radiated field immunity

Resp

124

rate adaptive pacemakers and ECG monitoring

94

realtime report

182

realtime reports content

178

recorder status messages

173

recording central

171

changing recording type

172

channels

172

choosing central recorder

172

choosing recording speed

173

creating templates

172

preventing fading ink

173

runtime

173

setting the runtime

173

setup menu

172

starting and stopping

171

wave overlap

173

recording alarms

44

recording delay time

173

recycling

199

rejecting pace pulses

80

relearning arrhythmia

98

reminder, alarm

37

replacing batteries

193

repolarization tails

82

reports alarm limits

182

battery reports

192

choosing paper size

178

contents

181

ECG

183

end case

177

patient trends

164

realtime report

182

re-routing

179

scheduled

177

setting up

176

ST map

113

stopping printouts

176

re-routing reports

179

resolution trends

163

resolving patient mismatch

77

resp accessories

201

Resp alarms apnea alarm delay time

124

Resp detection level and apnea detection

124

Resp detection modes

vi

and cardiac overlay

123

changing

122

Resp display

122

Resp monitoring and cardiac overlay

121

Resp safety information

124

Resp wave changing size

123

changing speed

124

restarting paused alarms

38

retrolental fibroplasia (SpO2)

130

reviewing alarms window

42

rhythm status messages (arrhythmia monitoring)

97

runtime setting recording runtime

173

S

safety maintenance interval

198

monitor

218

safety information batteries

195

ECG

93

Resp

124

safety test

236

safety tests performance tests

5

power on test

5

system

5

visual inspection

5

scale

ECG wave

82

Resp wave

123

scales for trends waveforms

163

scheduled reports

177

screen adjusting brightness

30

screen trend trend time

167

screen trends

165

screens changing content

23

switching

23

understanding

23

visitor screen

24

secondary lead (ECG) selecting

80

selecting the primary lead (ECG)

80

selecting the secondary lead (ECG)

80

selftest alarms

44

sensor disposable SpO2

127

sequence mode

136

service mode

22

set combiners

203

,

204

setting up trends

161

setting up reports

176

setting up the sepuence

136

settings

26

about

26

default

241

measurement settings

26

monitor settings

26

screen settings

26

settings blocks

24

Setup Recording menu

172

short yellow alarms on/off

100

signal quality of SpO2

129

silence key

16

sinus and SV rhythm ranges

227

,

229

skin preparation

ECG

79

SmartKeys

19

key

16

SmartKeys key

16

SmartKeys symbol

216

specifications

215

arrhythmia

225

speed recording

173

wave speed, changing

27

SpO2 accessories

206

active alarm source

132

alarms specific to

130

arterial pulsation

127

assessing suspicious reading

129

connecting the cables

128

disposable sensors

127

extension cable

128

FAST technology

127

Nellcor adhesive sensors

(disposable)

206

perfusion indicator

127

,

128

,

131

Philips sensors (disposable)

206

Philips sensors (reusable)

206

pleth as alarm source

131

pleth wave

131

pleth waveform

127

pulse numerics

128

QRS tone

132

signal quality

129

site inspection

129

site selection

127

tone modulation

132

SpO2 desat alarm

130

SpO2 limit alarms

130

ST adjusting alarm limits

109

alarms

91

,

109

baseline, updating

106

ensuring diagnostic quality

104

filtering

104

measurement points, adjusting adjusting

106

multi-lead alarms

109

numerics in ECG wave

81

snippets

105

ST display

105

ST map baseline, updating

112

current view

109

report, printing printing

ST map report

113

scale, changing scale

ST map

112

task window

112

trend view

111

trending interval, changing

112

trending priority

112

ST maps

109

ST point

107

standard 10-lead placement

88

standard 3-lead placement

86

standard 5-lead placement (ECG)

86

standby mode

22

Standby screen

22

standby symbol

216

starting monitoring

31

status line

18

status log printing

199

status messages printer

180

recorder

173

status messages (arrhythmia)

97

ectopic

98

rhythm

97

sterilizing infection control

185

stopping reports printouts

176

surgical ECG cable

93

suspended alarm

38

suspicious SpO2 reading

129

switching on monitor

31

switching screens

23

symbols

216

battery

190

synchronization marks (defibrillator)

81

system pulse

117

systolic blood pressure, NBP, early

136

T

tabular trends

161

Tamb

140

task window for ST map

112

Tcereb

140

temperature

139

accessories

210

alarm settings

139

connecting probe to monitor

139

difference, calculating

140

dual Temp measurement

140

extended label set

140

first

140

label

140

making a measurement

139

probe, disposable

139

probe, selecting

139

second

140

temperature probe connecting

139

templates creating for recordings

172

test blocks, how to perform

5

testing alarms

44

time, setting

7

,

30

tone configuration, alarm

35

tone mod (SpO2)

132

tone modulation

132

touch tone volume

30

touchscreen disable/re-enable

16

using

18

transducer

CO2, accuracy

153

CO2, calibrating

154

pressure, zeroing

143

transferring centrally-monitored patients

76

transport brightness setting

194

trend time

167

global

167

trend view

ST map

111

trending interval

ST map

112

trends resolution

163

screen trends

165

setting parameter scales

163

setup

161

viewing

159

trends pop-up keys

159

trends priority list

163

ST map

112

trunk cables accessories

201

,

203

Ttymp

140

Tvesic

140

U

Understanding

24

unfiltered ECG signal

84

unpacking

2

user interface settings changing

29

V

V electrode placement (ECG)

87

venous puncture

137

viewing arrhythmia waves

96

viewing trends

159

visible waves report

178

visitor screen

24

vislatching (arrhythmia alarms)

100

vital signs report

164

voltage setting

4

volume alarm

35

touch tone volume

30

W

warnings

9

wave adjusting

27

changing speed

27

scale (CO2)

156

scale (pressure)

145

size (CO2)

156

size (pressure)

145

wave channel speed

27

wave group speed

27

wave size

Resp

123

wave size (ECG) changing

82

wave speed eeg speed wave speed global speed

27

respiratory speed

27

wave speed (Resp)

124

vii

wide alarms limits

41

wired network connection symbol

217

Z

zero effect on pressure alarms

143

zeroing pressure transducer

143

viii

Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertisement

Table of contents