FCC ID: PQC-SRRBV1 Dual SRR Module

 

Instructions for Use IntelliVue Patient Monitor MX600/MX700/MX800 Release H.0 with Software Revision H.1x.xx Patient Monitoring Part Number 453564260091 Printed in Germany 05/11

*453564260091*

1Table of Contents 1 Introduction Introducing the Monitor Devices for Acquiring Measurements Operating and Navigating Operating Modes Understanding Screens Connecting Additional Displays to the Monitor Using the XDS Remote Display Using the Visitor Screen Understanding Profiles Understanding Settings Changing Wave Speeds Freezing Waves Using Labels Entering Measurements Manually Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from Power Networked Monitoring Using the Integrated PC Using the X2 or MP5 with a Host Monitor 2 Alarms Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at Power On Alarm Recordings 3 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 13 13 15 24 31 32 33 34 34 34 36 37 38 39 42 42 43 43 45 45 46 47 49 50 51 53 54 56 60 61 62 62 63 65 65 70 3 4 Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients Data Upload from an MMS Care Groups 5 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 Changing the Size of the ECG Wave 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 Lead Fallback ECG Lead Placements Capture 12-Lead EASI ECG Lead Placement ECG and Arrhythmia Alarm Overview Using ECG Alarms ECG Safety Information About Arrhythmia Monitoring Switching Arrhythmia Analysis On and Off Choosing an ECG Lead for Arrhythmia Monitoring Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring Switching ST On and Off Understanding the ST Display Updating ST Baseline Snippets Recording ST Segments About the ST Measurement Points ST Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 4 95 95 96 97 97 98 102 105 111 111 111 112 112 112 113 114 115 115 116 116 116 117 117 123 125 126 127 128 129 130 130 132 134 135 139 140 141 142 142 143 145 146 149 152 153 6 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 7 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Display Changing Resp Detection Modes Changing the Size of the Respiration Wave Changing the Speed of the Respiration Wave Using Resp Alarms Changing the Apnea Alarm Delay Resp Safety Information 8 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 SpO2 Signal Quality Indicator (Fast SpO2 only) Assessing a Suspicious SpO2 Reading Changing the Averaging Time Understanding SpO2 Alarms Pleth Wave Perfusion Numeric Perfusion Change Indicator Setting SpO2/Pleth as Pulse Source Setting Up Tone Modulation Setting the QRS Volume Calculating SpO2 Difference 9 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP 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 10 Monitoring Temperature Making a Temp Measurement 155 155 155 156 156 159 159 160 160 161 162 162 162 162 165 165 165 166 166 167 168 168 168 171 171 171 172 172 172 172 173 173 175 176 178 178 178 179 179 179 181 181 5 Calculating Temp Difference 11 Monitoring Invasive Pressure Setting up the Pressure Measurement Zeroing the Pressure Transducer Adjusting the Calibration Factor Displaying a Mean Pressure Value Only Changing the Pressure Wave Scale Optimizing the Waveform Using the Wave Cursor Non-Physiological Artifact Suppression Choosing the Pressure Alarm Source Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion Pressure Calculating Pulse Pressure Variation Measuring Pulmonary Artery Wedge Pressure Editing the Wedge Identifying the Pressure Analog Output Connector 12 Monitoring Cardiac Output Hemodynamic Parameters Using the C.O. Procedure Window Accessing the Setup C.O. and Setup CCO Menus Entering the HemoCalc Window Measuring C. O. Using the PiCCO Method Measuring C.O. Using the Right Heart Thermodilution Method Documenting C.O. Measurements C.O. Injectate Guidelines C.O./CCO Curve Alert Messages C.O./CCO Prompt Messages C.O./CCO Warning Messages C.O./CCO Safety Information 13 Monitoring Carbon Dioxide Measurement Principles Measuring CO2 using M3014A or X2 Measuring Mainstream CO2 using M3016A Measuring Microstream CO2 using M3015A/B Setting up all CO2 Measurements 14 Monitoring Airway Flow, Volume and Pressure Attaching the Flow Sensor Zero Calibration Automatic Purging Manual Purging Gas Compensation 6 182 183 183 184 186 187 187 187 187 188 188 189 191 191 192 193 193 195 195 196 197 198 198 203 206 206 207 209 209 210 213 214 214 218 220 222 225 226 228 228 229 229 Setting up Spirometry 15 Monitoring tcGas Identifying tcGas Module Components Setting the tcGas Sensor Temperature Using the tcGas Site Timer Setting the tcGas Barometric Pressure Remembraning the tcGas Transducer Calibrating the tcGas Transducer Applying the tcGas Transducer Finishing tcGas Monitoring TcGas Corrections 16 Monitoring Intravascular Oxygen Saturation Selecting a Measurement Label Preparing to Monitor with the M1021A Wide Module Preparing to Monitor with the M1011A Narrow Module Further Information for Both Modules 17 Monitoring EEG EEG Monitoring Setup Using the EEG Impedance/Montage Window About Compressed Spectral Arrays (CSA) Changing EEG Settings EEG Reports EEG Safety Information EEG and Electrical Interference 18 Monitoring BIS BIS Monitoring Setup BIS Continuous Impedance Check BIS Cyclic Impedance Check BIS Window Changing the BIS Smoothing Rate Switching BIS and Individual Numerics On and Off Changing the Scale of the EEG Wave Switching BIS Filters On or Off BIS Safety Information 19 Assigning a Telemetry Device and a Monitor to One Patient How Can You Combine Devices?

Functions Available When the Telemetry Data Window is Displayed General Telemetry-related Functions Use Models With Telemetry 230 233 233 233 234 235 235 235 237 238 238 241 242 242 246 247 249 249 250 252 253 254 254 255 257 257 259 260 260 261 262 262 262 262 265 265 267 268 269 7 20 Trends Viewing Trends Setting Up Trends Documenting Trends Trends Databases Screen Trends 21 Calculations Viewing Calculations Reviewing Calculations Performing Calculations Entering Values for Calculations Documenting Calculations 22 High Resolution Trend Waves Changing the Hi-Res Trend Waves Displayed Hi-Res Trend Wave Scales Hi-Res Trend Waves and OxyCRG Printing Hi-Res Trend Wave Reports Hi-Res Trend Wave Recordings 23 Event Surveillance Levels of Event Surveillance Event Groups Event Episodes Events Pop-Up Keys Event Triggers The Events Database Viewing Events Annotating Events Documenting Events 24 ProtocolWatch SSC Sepsis Protocol 25 Recording Central Recording Starting and Stopping Recordings Overview of Recording Types All ECG Waves Recordings Creating and Changing Recordings Templates Changing ECG Wave Gain Recording Priorities Recording Strip Reloading Paper Recorder Status Messages 8 271 271 274 278 278 279 283 284 285 285 286 287 289 289 289 289 290 290 291 291 292 292 293 294 298 298 301 301 309 309 317 317 317 319 319 320 321 321 321 323 323 26 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up 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 and Printing Manually Printer Status Messages Sample Report Printouts 27 Using the Drug Calculator Accessing the Drug Calculator Performing Drug Calculations Charting Infusion Progress Using the Titration Table Documenting Drug Calculations 28 IntelliBridge EC10 Module Connecting an External Device Changing Waves and Numerics Displayed Viewing the IntelliBridge Device Data Window Using Screens with External Device Data Alarms/INOPs from External Devices Language Conflict with External Device Drivers 29 VueLink Modules Connecting an External Device Changing VueLink Waves and Numerics Displayed Viewing the VueLink Device Data Window Using VueLink Screens Switching VueLink On and Off Alarms/INOPs From External Devices Language Conflict with External Device Drivers 30 Using Timers Viewing Timers Timer Setup Pop-up Keys Setting Up Timers Displaying a Timer On The Main Screen Displaying A Clock On The Main Screen 325 325 326 327 328 329 329 329 329 330 330 331 332 337 338 338 340 341 341 343 343 344 344 344 345 345 347 348 348 349 349 349 350 350 351 351 352 352 353 354 9 31 Respiratory Loops Viewing Loops Capturing and Deleting Loops Showing/Hiding Loops Changing Loops Display Size Using the Loops Cursor Changing Loops Type Setting Up Source Device Documenting Loops 32 Laboratory Data Viewing Received Data 33 Care and Cleaning General Points Cleaning the Monitor Disinfecting the Monitor Sterilizing the Monitor Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning the SO2 Optical Module Cleaning the Recorder Printhead (M1116B only) 34 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 35 Accessories ECG/Resp Accessories NBP Accessories Invasive Pressure Accessories SpO2 Accessories Temperature Accessories Cardiac Output (C.O.) Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Mainstream CO2 Accessories (for M3016A) Microstream CO2 Accessories Spirometry Accessories tcGas Accessories EEG Accessories BIS Accessories SO2 Accessories for M1021A 10 355 355 356 356 356 356 357 357 357 359 359 361 361 362 362 363 363 363 363 365 365 366 366 367 367 367 369 369 372 375 376 380 381 382 382 383 383 384 385 385 385 386 SO2 Accessories for M1011A Recorder Accessories Battery Accessories 36 Specifications Intended Use Manufacturer's Information Symbols Installation Safety Information Monitor Mounting Precautions Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Physical Specifications Environmental Specifications Performance Specifications Interface Specifications Measurement Specifications Safety and Performance Tests 37 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 SpO2 Default Settings NBP Default Settings Temperature Default Settings Invasive Pressure Default Settings Cardiac Output Default Settings CO2 Default Settings Spirometry Default Settings tcGas Default Settings Intravascular Oxygen Saturation SvO2 Default Settings ScvO2 Default Settings EEG Default Settings BIS Default Settings VueLink Default Settings Index 386 386 386 387 387 387 389 390 393 393 393 393 395 397 399 401 405 424 429 429 436 436 437 438 439 439 440 440 441 443 444 444 445 445 446 446 446 447 447 449 11 12 1 1Introduction These Instructions for Use are for clinical professionals using the IntelliVue MX600/MX700/MX800 patient monitor. This basic operation section gives you an overview of the monitor 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. Introducing the Monitor The IntelliVue MX600/MX700/MX800 patient monitor offers a monitoring solution optimized for the high-end surgical, cardiac, medical and neonatal care environments. Combining patient surveillance and data management, it allows multi-measurement monitoring by linking separate modules. The MX600 uses the navigation knob as primary input device and the MX700/MX800 use the touch screen as primary input device. All monitors have a remote control for convenient access to the five main keys and numeric data input. 13 1 Introduction The monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital signs) and document them on a printer. You can view measurement trend graphs, with up to three measurements combined in each graph, to help you identify changes in the patient's physiological condition. You can view fast-changing measurement trends with beat to beat resolution and see up to four high resolution trend segments. Event surveillance enhances documentation and review of physiologically significant events by automatically detecting and storing up to 50 user-defined clinical events over a 24 hour period. With the optional Integrated PC, you have computer functionality directly in the monitor. You can use standard applications (e.g. Web browsers), connect to the hospital network or intranet, and run a second independent display with content from the patient monitor. An IntelliVue X2 or MP5 can be connected to your monitor, where it acts as a multi-measurement module, acquiring measurements for the host monitor. When the X2 or MP5 is disconnected from the the original host monitor, it continues to monitor the patient as a fully independent, battery powered patient monitor, eliminating the need for a separate transport monitor. On connection to a new host monitor, the X2 or MP5 resumes its role as multi-measurement module, ensuring fully continuous monitoring. Major Parts and Keys MX600/700:

1 Color coded alarm lamps 2 Alarms Off lamp 3 Power on/Standby switch with integrated LED: Green - On/

Standby, Red - Error 4 AC power LED 5 Mounting quick-release lever

(when this is pressed the monitor is not fixed on the mounting) Part number and serial number 6 7 Hardkeys (Silence, Alarms Off, Main Screen) 8 Navigation knob 14 MX800:

1 Introduction 1 Color coded alarm lamps 2 Alarms Off lamp 3 Power on/Standby switch with integrated LED: Green - On/

Standby, Red - Error 4 AC power LED 5 Mounting quick-release lever

(when this is pressed the monitor is not fixed on the mounting) Part number and serial number 6 Devices for Acquiring Measurements The patient monitor acquires patient measurements using the devices described in this section. You can also extend the measurement capabilities of your monitor with such devices. Of these measurement devices, only the X2 has its own power on/standby switch, and can be powered from an external power supply or a rechargeable battery when not directly connected to the monitor (refer to the IntelliVue X2 Instructions for Use for details). All the rest take their power exclusively from the monitor, and switch on automatically when you turn on the monitor. A green power-on LED indicates when they are drawing power from the monitor. A permanently illuminated, or flashing, red LED indicates a problem with the unit that requires the attention of qualified service personnel. All symbols used on the front panels are explained in Symbols on page 389. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Flexible Module Rack (M8048A) The 8-slot flexible module rack (FMS-8) lets you use up to eight plug-in physiological measurement modules. For the MX800, you can connect two FMSs to use up to 10 measurement modules. The maximum number of specific module types that can be used simultaneously in an FMS-8 is: five pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any combination). 15 1 Introduction Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side to connect an additional MMS. Use the connector on the right to connect to the monitor. 1 X1 Multi-Measurement Module 2 Multi-Measurement Module mount Flexible Module Rack FMS-8 Power on LED Interruption indicator 3 4 5 4-Slot Flexible Module Rack (FMS-4) The 4-Slot flexible module rack (FMS-4) lets you use up to four plug-in physiological measurement modules. The maximum number of specific module types that can be used simultaneously in an FMS-4 is: four pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any combination). Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side (if you have the appropriate option) to connect an additional MMS. Use the connector on the back to connect to the monitor. Measurement Modules Invasive blood pressure (M1006B) Temperature (M1029A) You can use up to eight measurement modules with the Flexible Module Rack (M8048A). Available modules are:

Oxygen saturation of arterial blood (SpO2) (M1020B) Cardiac output (M1012A), and Continuous cardiac output with M1012A Option #C10 Mixed venous oxygen saturation - SvO2 (M1021A) Intravascular Oxygen Saturation - ScvO2 or SvO2 (M1011A) Transcutaneous gas (M1018A) 16 1 Introduction IntelliBridge EC10 Recorder (M1116B) Bispectral Index - BIS (M1034A) Spirometry (M1014A) VueLink device interface (M1032A) EEG (M1027A) You can plug in and unplug modules during monitoring. Insert the module until the lever on the module clicks into place. Remove a module by pressing the lever upwards and pulling the module out. A measurement automatically switches on when you plug the module in, and switches off when you unplug it. Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label. The connector socket on the front of each module is the same color as the corresponding connector plug on the transducer or patient cable. Press the Setup key on the module's front to display the measurement's setup menu on the monitor screen. When the setup menu is open, a light appears above the key. Some modules have a second key. On the pressure module, for example, it initiates a zeroing procedure. Example Module (SpO2) 1 Module name Setup key LED 2 Setup key to enter setup menu of measurement modules or external device data window. Some modules have a second module-specific key next to this one, for example Zero. 3 4 Connector socket for patient cable/transducer X1 Multi-Measurement Module (M3001A) The X1 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG

(including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure or temperature. You can connect it to the monitor via a cable or mount it on the left side of the FMS. 17 1 Introduction X1 Connectors and Symbols 1 White ECG/Resp connector 2 Blue SpO2 connector 3 Red NBP connector 4 Combined pressure (red) and temperature

(brown) connector - connect either invasive pressure transducer or temperature probe. You might have a version of the MMS that does not have this connector. 5 NBP STAT key - starts NBP STAT series of measurements OR Zero key - initiates a zero procedure for the connected pressure transducer when pressed and held for a second 6 NBP Start/Stop key - starts or stops NBP measurements Silence: acknowledges all active alarms by switching off audible alarm indicators and lamps 7 X2 Multi-Measurement Module (M3002A) The X2 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG

(including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure and temperature, or CO2. It has a color touchscreen display. 18 1 Introduction The X2 has the added capability to operate as a stand-alone monitor, and can be powered by a rechargeable battery. This makes it particularly suited to transport situations. When the X2 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor running on battery power, eliminating the need for a separate transport monitor. When the X2 is connected to a new host monitor, it resumes its role as MMS, ensuring fully continuous monitoring. For details of using the X2 as a stand-alone monitor, refer to the IntelliVue X2 Instructions for Use. When connected to a host monitor (Companion Mode is indicated), the X2 takes power from the host, including that required for battery charging. The X2 can also be powered by AC mains when not connected to a host monitor using the optionally available external power supply (M8023A). See the IntelliVue X2 Instructions for Use for details. X2 Overview 1 On/Standby switch 2 Power and battery indicators (see X2 Controls and Indicators on page 20) 3.5-inch TFT LCD touchscreen QVGA display 3 4 Alarm lamps (see X2 Controls and Indicators on page 20) 5 Battery eject button 6 Hard keys (see X2 Controls and Indicators on page 20) 7 Measurement connectors (see X2 Patient Connectors, Right Side on page 21) 8 Battery compartment 19 1 Introduction X2 Controls and Indicators 1 External power LED. Green when monitor is powered from an external power source. 2 Battery status LED. Yellow when charging. Flashing red when battery is empty. 3 On/Standby LED. Green when monitor is on. Red indicates an error. 4 On/Standby switch. Disabled when X2 is connected to a host monitor 5 Main Screen key: closes all open menus/windows and returns to the main screen. SmartKeys key: brings up SmartKeys on the screen. 6 7 Alarms key: turns alarms On/Off, or pauses them. 8 9 Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is Silence key acknowledged. 10 Active INOP alarm lamp in light blue. Blinks until active INOP is acknowledged. 11 Alarms off indicator. When alarms are suspended, the lamp is red, and the alarms off symbol is shown. 20 X2 Patient Connectors, Right Side Showing symbols version (international) - English version has text labels 1 Introduction Pressure (option) 1 2 Temperature (option) 3 Noninvasive blood pressure 4 5 ECG sync pulse output 6 ECG/Respiration 7 CO2 (option in place of Pressure and Temperature) SpO2 X2 Left Side Loudspeaker 1 2 MSL Connector. Connects to the external power supply or a host monitor via the MSL cable for AC mains operation, battery charging, and communication with a network. MMS Extensions The MMS extensions connect to the X1 and X2 MMS and use the MMS settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the MMS. WARNING The MMS extensions can only function when they are connected to an MMS. If the MMS is removed during monitoring, the measurements from both the MMS and the extension are lost. Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered from AC mains, when connected to a host monitor or the external power supply (M8023A), or from the Battery Extension. To separate an extension from the MMS, press the release lever down, and push the MMS forward. 21 1 Introduction M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions The optional M3014A Capnography extension adds mainstream capnography or sidestream capnography, and optionally one pressure plus either a pressure or a temperature, Cardiac Output and Continuous Cardiac Output to the MMS. M3014A Pressure connectors (red) 1 2 Temperature connector (brown) 3 Mainstream/sidestream connector CO2 4 Cardiac Output connector 22 1 Introduction The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the MMS. The optional M3015B Microstream CO2 extension adds microstream capnography, two pressures and a temperature to the MMS. M3015A M3015B Pressure connectors (red) - M3015A optional 1 2 Temperature connector (brown) - M3015A optional 3 4 Microstream connector CO2 5 Gas sample outlet Inlet The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the MMS. M3016A Pressure connectors (red) 1 2 Temperature connector (brown) 3 Mainstream/sidestream connector CO2

(optional) When a capnography extension is connected to an X2 MMS with CO2, the CO2 from the extension will be automatically deactivated in favor of the one in the X2. If you prefer to use the CO2 measurement on the extension, you can activate it via the measurement selection key (see Resolving Label Conflicts on page 40). 23 1 Introduction The cardiac output measurement in the M3014A is deactivated when the extension is used with an X2 MMS, even if the X2 is connected to an external power supply. The cardiac output measurement is only available when the X2 is connected to a host monitor. M3012A Hemodynamic MMS Extension 1 Cardiac Output (orange; optional) 2 Connection to MMS 3 4 Temperature connectors (brown) Pressure connectors (red) The M3012A Hemodynamic extension can be connected to the M3001A Multi-Measurement Module to provide the following additional measurements: Temperature, Pressure, an additional Pressure or Temperature, and C.O. and CCO measurements. The cardiac output measurement is deactivated when the extension is used with an X2 MMS unless the X2 is connected to a host monitor. Operating and Navigating Everything you need to operate the monitor is contained on its screen. Almost every element on the screen is interactive. Screen elements include measurement numerics, waveforms, screen keys, information fields, alarms fields and menus. The configurability of the monitor means that often you can access the same element in different ways. For example, you might be able to access an item through its on-screen setup menu, via a hard key, or via a SmartKey. 24 1 Introduction Other screen elements 10 alarm status area - shows active alarm messages 11 12 13 14 15 16 17 18 status line - shows information messages and prompting you for action close all open menus and windows and return to main screen enter Main Setup menu scroll right to display more SmartKeys SmartKeys - these change according to your monitor's configuration scroll left to display more SmartKeys Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to immediately re-enable alarm indicators. Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on. Monitor information line 1 network connection indicator

(documented in Information Center Instructions for Use) bed label patient identification patient category paced status date and time access the Profiles menu current screen name/enter Change Screen menu adjust alarm volume/level indicator 2 3 4 5 6 7 8 9 Selecting Screen Elements Select a screen element to tell the monitor to carry out the actions linked to the element. For example, select the Patient Identification element to call up the Patient Demographics window, or select the HR numeric to call up the Setup ECG menu. Select the ECG wave segment to call up the ECG Lead menu. Note that the space between each line of a menu may be configured to wide or narrow to facilitate your most common method of operation, either touch, remote control or a pointing device such as a mouse. 25 1 Introduction Using the Touchscreen Select screen elements by pressing them directly on the monitor's screen. Disabling Touchscreen Operation To temporarily disable touchscreen operation of the monitor, press and hold the Main Screen permanent key. A padlock will appear on the Main Screen permanent key. Press and hold the Main Screen permanent key again to re-enable the touchscreen operation. Using a Mouse or Trackball If you are using a mouse or trackball, select screen elements by clicking on them (press and release the left mouse button). While you are moving the mouse, a cursor appears and a highlight shows your current position. Moving Windows Select the title of the window and keep your finger on the title, or the mouse button pressed. You can move windows and menus using the Touchscreen or a mouse. To move a window, 1 2 Move your finger on the Touchscreen, or move the mouse, to move the window. 3 Take your finger off the screen, or release the mouse button, to place the window in the final position. The new position is only active until the window or menu is closed. Not all locations on the screen can be a target position, a window cannot overlap the monitor info line, the alarms and INOPs or the status line. Using Keys The monitor has four different types of keys:

Permanent Keys A permanent key is a graphical key that remains on the screen all the time to give you fast access to functions. Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to immediately re-enable alarm indicators. Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Main Screen - close all open menus and windows and return to the main screen. Main Setup - enter main setup menu. 26 SmartKeys 1 Introduction A SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased. If you have an integrated PC (iPC) you may also see Smartkeys generated by applications on the iPC. enter profile menu, or revert to default profile change Screen, or revert to default screen show BIS Sensor previous Screen freeze waves set alarm limits quick admit a patient enter patient identification menu to admit/discharge/transfer change alarm volume end case to discharge a patient change QRS volume enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained. review beat labels (annotate arrhythmia wave) change amplitude (size) of ECG wave

- start/stop manual NBP measurement

- start auto series

- stop current automatic measurement within series start NBP measurement and measurement series start veni puncture (inflate cuff to subdiastolic pressure) view information for patients in other beds change screen brightness (not for independent displays) re-learn arrhythmia enter cardiac output procedure start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series stop current NBP measurement set the NBP repeat time access patient reports zero invasive pressure transducer 27 1 Introduction 28 start a delayed recording access pop-up recording keys access Vital Signs recording function access Select Waves recording function set wide automatic alarm limits set narrow automatic alarm limits access wedge procedure window access the Loops window review vital signs trend review graph trend access event surveillance access calculations access the calculator access the Drug Calculator gas analyzer - exit standby mode unpair equipment and continue central monitoring with the monitor suppress zero for all gas measurements unpair equipment and continue central monitoring with the telemetry device access the spirometry data window access ST Map application start 12-Lead Capture (only available if Information Center is connected) access remote applications (if Application Server is connected) access EEG CSA access the EEG montage display external device information access timers access ProtocolWatch set standard or EASI lead placement switch CO2 pump off new lead setup enter data manually start/stop car seat assessment record open the Histogram window open Unit Conversion window 1 Introduction Hardkeys A hardkey is a physical key on a monitoring device, such as the zero pressure key on the MMS or a setup key on a module. 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 Remote Control The remote control provides you with direct access to five hard keys, a navigation knob and a numeric keypad:

Hardkeys 1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior follows the Silence permanent key configuration. 2 Alarms Off/Pause Alarms - pauses alarm indicators. Behavior follows the Pause Alarms permanent key configuration. 3 Main Screen - close all open menus and windows and return to the main screen. 4 5 Back - go back one step to the previous menu. SmartKeys - display a block of SmartKeys specially configured for remote tasks (see below) 29 1 Introduction Keypad 6 Type numeric data on the keypad and press the Enter key to enter the data on the monitor. Navigation knob 7 Rotate the knob to highlight screen elements, then press to select the highlighted element. The remote control can be used with a USB cable connection to the monitor or without a cable using short range radio. When used without a cable, the remote control must be assigned to the monitor. The assignment is made in Configuration or Service mode. CAUTION When using a remote control without a cable, it is important that the user knows which remote control is assigned to which monitor. Use the tethering cable delivered with the remote control to attach it to a bed rail or IV pole, or label the remote control with the bed or monitor ID. Using the SmartKeys Key The SmartKeys hard key on the remote control displays a block of SmartKeys on the monitor screen. Nine SmartKeys appear in a 3 by 3 matrix which corresponds to the layout of the numeric pad on the remote control. Pressing the 1 key on the remote control selects the top left SmartKey, pressing the 8 key selects the bottom center SmartKey. The . and the key can be used to select the arrow keys to page up and down in the available SmartKeys. The SmartKeys which appear can be configured so that you have the functions available which you most often need when using the remote control. If no list of SmartKeys has been configured, the standard SmartKeys will be displayed and you can page through to the key you want. 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 and capital Lock keys 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. If a conventional keyboard is connected to the monitor, you can use this instead of or in combination with the on-screen keyboard. 30 1 Introduction Using the On-Screen Calculator You can use the on-screen calculator to perform any of the standard operations for which you would normally use a handheld calculator. To access the on-screen calculator, select the Calculator SmartKey, or select Main Setup then Calculations followed by Calculator. 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. Select Operating Modes and choose the mode you require. 2 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 monitors 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. 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 the mode box in the center of the screen to change to a different mode. When an X2 or MP5 is connected to a host monitor (Companion Mode is indicated):

You cannot change the operating mode at the monitor in companion mode. The monitor in companion mode will adopt the operating mode of the host monitor. Standby Mode Standby mode can be used when you want to temporarily interrupt monitoring. To enter Standby mode, The monitor enters Standby mode automatically after the End Case function is used to discharge a patient. select the Monitor Standby SmartKey or select Main Setup, followed by Monitor Standby. 31 1 Introduction 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. This can be configured to a moving image or a blank screen. 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, If you connect an X2 or MP5 that is powered on (and not in Standby) to a host monitor in Standby mode, the host will leave Standby mode. When connected to a host monitor, with both the host and the monitor in companion mode in Standby mode, leaving Standby on the monitor in companion mode will also make the host leave Standby. 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 such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and other elements 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. When you switch from a complex to a less complex Screen layout, some measurements may not be visible but are still monitored in the background. If you switch to a more complex Screen with, for example, four invasive pressure waves but you have only two pressures connected to the monitor, the

"missing" two pressures are either left blank or the available space is filled by another measurement. Switching to a Different Screen 1 To switch to a different Screen, select the current Screen name in the monitor info line, or select the Change Screen SmartKey. 2 Choose the new Screen from the pop-up list. 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, high-res waves, 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. From the menu that appears, select Change Wave, Change Numeric, or ChangeHiResTrend, and then select the wave or numeric you want, or select the high-resolution trend wave you want from the list of available waves. If you do not see Change Numeric in the menu, this Screen may be configured to always display the numeric beside its wave. Changing the wave will automatically change the numeric. 2 The changed Screen is shown with an asterisk in the monitor info line. In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk. 32 1 Introduction Up to three modified Screens can be accessed via the Change Screen menu. To recall Screens, either or select the name of the Screen in the Change Screen menu use the previous/next arrows at the top of the Change Screen menu to move back and forth in the Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed. After a patient discharge, the monitor's default Screen is shown. Modified Screens are still available in the Change Screen menu. 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 configured to Yes). Connecting Additional Displays to the Monitor You can connect a second display, showing the same Screen as the main display, to your monitor, for viewing only. If you have the optional independent display interface, you can connect a second display which can be configured and operated individually using standard input devices. For monitors with multiple displays and multiple input devices, the usage and behavior can be configured according to specific requirements at installation (for example, use for two independent operators or tracking of mouse input across two displays). For details refer to the Service Guide. When two operators are using two displays, the scope of an action depends on the type of operation:

Patient monitoring operations such as Silence or Pause alarms take effect for the monitor as a whole, the results will be seen on both displays. Display operations such as the Main Screen key and Back hardkey will take effect only on the display being operated. If you are operating two displays with one remote control, to navigate from one display to another:

1 Move the highlight to the Main Screen key and then turn one click further. The highlighting moves to a special "jump" field at the edge of the Screen. Press the navigation knob on the remote control to confirm; the highlighting will automatically move to the other display. 2 The content of each Screen can be changed individually as described in the previous section. If you are operating two displays, you can choose Screens for both displays from one location:

1 Select Profiles in the monitor info line of the first display, Select Display 1, or Display 2, then select the Screen you want to appear on that display from the list of available Screens. 2 When two displays are mounted next to each other or one above the other, a special Screen can be assigned which spans across both displays. The Screen content for these Tall and Wide Screens can then use the increased area available with two displays. These Screens appear in the Screen list with a special Tall Screen or Wide Screen symbol. 33 1 Introduction Certain windows (for example: cardiac output procedure) can only be shown on one display at a time. If you try to open one of these windows when it is already shown on another display, you will see a blank gray window with a cross through it. Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. 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, select the Screen name in the monitor info line to open the Change Screen menu, then 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 box in the center of the screen, showing the visitor Screen's name, to open the Change Screen menu and select a different Screen to show waves and numerics again. 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. If you are using a second display, each display can have its own individual screen selection. 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 (F or C), pressure unit (mmHg or kPa). 34 1 Introduction 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. You can change from one complete profile to another or swap individual settings blocks (display/

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 set up 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 Select Profiles in the monitor info line, or select the Profiles SmartKey. In the Profiles menu, select Profile. 2 3 Chose a profile from the pop-up list. 4 Confirm your selection. Swapping a Settings Block 1 2 Select Profiles in the monitor info line, 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. 3 Choose a settings block from the pop-up list. 4 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 shaped symbol. 35 1 Introduction 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. via the Setup hardkey (on plug-in modules) - press the Setup hardkey on the module front. via the Main Setup permanent key - if you want to setup a measurement when the measurement is switched off, use the Main Setup permanent key and select Measurements. Then select the measurement name from the pop-up list. With this permanent key you can access any setup menu in the monitor. via the Measurement Selection key. This guide always describes the entry method using the setup menu. But you can use any method you prefer. 36 1 Introduction 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. A measurement automatically switches off if you disconnect its module or MMS. If you disconnect a transducer, the monitor replaces the measurement numeric with question marks. If in this situation alarms are paused or switched off, the measurement in question may be switched off completely, depending on monitor configuration. 1 Enter the measurement's setup menu and select the measurement. 2 Select the measurement name to switch between on and off. The screen display indicates the active setting. Switching Numerics On and Off For some measurements, such as EEG, you can choose which numerics to view on the screen. In the measurement's setup menu, select the numeric name to toggle between on and off. For example in the Setup EEG menu, select the EEG numeric name to toggle between on and off. 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 three groups of wave speed settings, RespiratorySpeed, for all respiratory waves: CO2, anesthetic agents and O2 EEG Speed, for all EEG and BIS waves Global Speed, for all waves not included in the other two groups. 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, Select Main Setup, then select User Interface 1 Select Global Speed, RespiratorySpeed, or EEG Speed as required Select a value from the list of available speeds. Changing Wave Speed for a Channel 2 3 To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 Select Change Speed. 37 1 Introduction 3 To set the speed to the wave group speed, select RespiratorySpeed, EEG Speed, 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 set the speed for the individual wave channel on the 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. Freezing Waves You can freeze waves on the screen and measure parts of the wave using cursors. The waves are frozen with a history of 20 seconds so that you can go back and measure what you have seen. Freezing An Individual Wave To freeze a wave, 1 Enter the Wave menu for the measurement by selecting the wave on the screen. 2 The realtime wave is replaced with the frozen wave. Select Freeze Wave. Freezing All Waves To freeze all waves on the screen, 1 Select the Freeze Waves SmartKey. All realtime waves are replaced with frozen waves. Measuring Frozen Waves To measure a frozen wave, Select the frozen wave. 1 If you are using touch, this automatically positions the vertical cursor. The cursor can be repositioned by touching the required point on the wave, or 2 Using the SpeedPoint or another pointing device or touch: use the right/left arrow keys to move the vertical cursor. The vertical cursor moves through the time axis and the current value is displayed next to the cursor. 3 Use the up/down arrow keys to activate and move the horizontal cursor. The horizontal cursor measures the wave value, which is displayed above the cursor line. If the wave is a pressure wave, the cursor value can be stored as a systolic, diastolic or mean pressure value; if the pressure wave is a PAP wave it can also be stored as a PAWP value; for pressure waves P, P1 to P8 it can also be stored as an IAP value. The stored value appears in the trend database as a manually entered value. Changing The Wave Speed 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. 38 1 Introduction To change the wave speed:

Select the frozen wave. 1 Select Change Speed. Select a speed from the list. Updating The Frozen Wave 2 3 To update the wave, that is freeze the current wave:

1 2 Select the frozen wave. Select Freeze Again. Releasing Frozen Waves To release frozen waves, Select a frozen wave. 1 Select Unfreeze Waves. 2 All frozen waves are released. Using Labels You may have more than one instance of some measurements, for example pressure, being used 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) Select Label. To change a measurement label of a measurement with multiple labels (e.g. invasive pressure or temperature), 1 Enter the wave menu of the measurement. 2 3 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. About Label Sets Your monitor may be configured to use a Restricted or Full label set. The Full label set provides extra labels for Pressure and Temp. See the sections on Pressure and Temperature in these Instructions for Use for more information. If you connect an MMS from a monitor using a Full label set to an IntelliVue monitor using a Restricted label set or an M3/M4 monitor, any additional labels switch to labels available in the target monitor. This may cause a label conflict with other monitored measurements. 39 1 Introduction Be aware that connecting a monitor using the Full label set to an Information Center with certain software revisions may affect the availability of measurement information from the additional labels on the Information Center. See the Information Center documentation and your monitor's Configuration Guide for information on label set compatibility. Resolving Label Conflicts Each label must be unique, that is, it can only be assigned once. You cannot monitor two pressures labeled "ICP" at the same time. If you need to use two identical pressures, you must assign different labels to them, for example, P and ICP. Measurement labels are stored in the measurement device (module or MMS). If you try to use two measurement devices that have identical labels, this causes a label conflict in the monitor. Measurement selection key with question marks indicating a label conflict. Depending on your configuration, the monitor will either resolve the conflict automatically, by assigning a new, generic label to the most recently connected conflicting label (e.g. a second FAP label could be changed to ABP) 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. All the currently available measurement devices, for example MMSs, MMS extensions, measurement modules, Gas analyzers, devices connected to a host monitor and manually entered measurements

(marked

), are depicted in the Measurement Selection window. De-activated devices are grayed-out (here the Temp measurement on the left) Any measurement labels causing a label conflict are shown in red. If a measurement device is connected but currently unavailable, for example, because it was deactivated due to a label conflict, the device is shown "grayed-out". 40 When an X2 or MP5 is connected to a host monitor, the measurement selection window looks like this:

1 Introduction X2 connected to host monitor MP5 connected to host monitor WARNING When an X2 or MP5 with an active measurement, say SpO2, is connected to a host monitor with the same measurement already active, the SpO2 measurement on the X2 or MP5 is deactivated and the Meas. DEACTIVATED INOP is displayed. The measurement can only be reactivated if the X2 or MP5 is disconnected from the host monitor. The label conflict can be resolved on the host monitor like any other label conflict. To resolve a label conflict:

1 Select the measurement selection key or select Main Setup, then Meas. Selection to display the Measurement Selection window. Select the device whose label you want to correct. 2 3 Use the measurement selection pop-up keys to resolve the conflict. Select either:

Change Label: to assign a different label to the conflicting label De- Activate: to disable the conflicting device. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged. When the device has been deactivated the question marks under the measurement selection key will be replaced by XXX. Setup <Measurement Label>: to enter the Setup menu for the measurement and change the conflicting device's label to a different label. Modify Driver (VueLink/IntelliBridge only): - to modify the device driver setup to disable the conflicting device's label. Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used. 41 1 Introduction If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. Entering Measurements Manually 2 3 4 5 6 You can enter values into the monitor that have been measured with other equipment or manually (for example, manual temperatures, lab values). These values are then stored in the database, included in trends and reports, and passed on to the Information Center and central charting systems. There is no alarm functionality for manually entered measurements. To enter values, 1 Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues. Select the measurement you want to enter values for. The Edit window will open. If the measurement is switched off, switch it on by selecting the label. Select Value and enter the value. Select Date/Time to enter the date and time for the value. The default is always the current date and time. For compound labels, for example ABPs, ABPd and ABPm, select the Format field to select whether all values are required or a single value. Select Save. 7 When a manually entered value has been configured to display as a numeric on the screen, you can also enter a new value for this measurement by selecting the numeric, then selecting Enter MeasValues. Manually entered measurement values are marked with a * on the display, in trends, and so forth. Each measurement has a defined measurement interval after which a value becomes invalid (no value is then displayed). Values can be entered up to two hours after they have been measured or up to the measurement interval, if this is shorter. The list of measurement labels which appears in the Enter Measurement Values window is set in Configuration Mode. No values can be entered manually on a monitor in companion mode when it is connected to a host monitor. Switching Manually Entered Measurements On and Off To switch a manually entered measurement on or off, 1 Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues. Select the measurement you want to switch on or off. Select the measurement label field to switch between On and Off. 2 3 Changing Monitor Settings To change monitor settings such as brightness, or QRS tone volume, select the Main Setup permanent key and then select User Interface to enter a submenu where you can change these settings. 42 1 Introduction 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 monitoring locations and optimizes power usage for battery powered monitors. Your monitor may be configured with a lower brightness for Standby mode and also (for battery powered monitors) for transport to conserve battery power. These settings can only be changed in the monitor's Configuration Mode. If you are using a monitor with an external display, the Brightness SmartKey does not adjust the brightness of this display. See the instructions supplied with the external display for instructions. Setting the Date and Time 1 2 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. Select Store Date, Time to change the date and time. 3 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. WARNING Changing the date or time will affect the storage of trends and events. Checking Your Monitor Revision 1 2 3 Select Main Setup then select Revisions 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. We also recommend working through the CBT for self-training before using the monitor (not available in all languages). 43 1 Introduction 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 including all connected MMSs, modules, or MMS extensions. Check for any mechanical damage. Check all the external cables, plug-ins and accessories. Plug the power cord into the AC power source. 2 3 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 power on/standby switch on the monitor for one second. The monitor performs a self test during which all lamps will light up and a tone will be sounded, and is then ready to use. If you see a message such as CO SENS.WARMUP wait until it disappears before starting to monitor that measurement. Connected devices usually take their power from the monitor. External devices such as gas monitors and those connected via VueLink/IntelliBridge have their own power switches. 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. An X2 or MP5 switches on automatically when connected to a running host monitor. When an X2 or MP5 is disconnected from a running host monitor, the X2 or MP5 continues to run without interruption on battery power. Setting up the Modules 1 Decide which measurements you want to make. 2 Connect the required modules, MMSs, or MMS extensions. 3 Check that you have the correct patient cables and transducers plugged in. The connectors are color-coded to the patient cables and transducers for easy identification. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor. 2 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. 44 1 Introduction 3 Refer to the appropriate measurement chapter for further details of how to perform the measurements you require. WARNING During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns. Disconnecting from Power The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect, unplug the power cable. Monitoring After a Power Failure If the monitor is without power 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, using one of the optional interfaces:

Wireless LAN IntelliVue Instrument Telemetry System (IIT). Standard wired LAN WARNING Do not connect patient monitors to the standard hospital network. Additionally, when an IntelliVue X2 or MP5 is equipped with IIT and declared at the Information Center as a telemetry device, it allows data continuity when paired to a host monitor. After disconnection from the host monitor, it continues to monitor the patient during transport and provides continuous data to the same sector on the Information Center. (See Assigning a Telemetry Device and a Monitor to One Patient on page 265.) 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 Care Group, the monitoring equipment, and technical information about the network, Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks. Printout functionality and data export are not guaranteed when using a standard hospital network. in the monitor info line, select the bed label. 45 1 Introduction Using the Integrated PC If your monitor has the optional integrated PC (iPC), you can run applications on the iPC. The applications display data on the monitor's display (or on a second independent display) that is generated on and retrieved from the iPC or externally. For details about applications, refer to the XDS/iPC Instructions for Use. The monitor runs independently of the iPC, and vice versa. WARNING Some clinical applications may show data from another patient. Be aware that some of the data on your patient monitor display may not always be from your patient. Applications running on the iPC cannot act as a primary alarming device and cannot be relied upon for alarm notification. There may be no audible or visible indications apart from what is shown on the screen and any data shown may be delayed. Starting the iPC Your monitor may be configured to have the iPC start up automatically when the monitor is switched on. If not:

1 Select Main Setup then Internal PC. In the Internal PC menu, select Switch PC On to start the iPC. Viewing the iPC Desktop on the Monitor Display 2 If the Desktop is not displayed on the monitor display:

1 Select the iPC key Select Main Setup, Internal PC, then Show PC Window. 2 To hide the Desktop again, select Main Screen.

, or Adjusting the iPC Audio Volume The Audio from the iPC is normally configured to be off. However, your monitor may have the iPC audio configured on for use with specific PC applications. WARNING Always minimize the iPC audio volume or mute it completely when it is not needed for an iPC application. This will avoid iPC tones distracting from or masking tones from the monitor. 46 1 Introduction Using Input Devices with the iPC and Monitor You can connect input devices such as a mouse, trackball and keyboard to the rear of the patient monitor (using the left hand row of USB connectors) and use them for input to the monitor. Correspondingly you can connect input devices to the rear of the patient monitor (using the right hand row of USB connectors) or to the front USB connector and use them for the iPC. Input devices connected to the iPC can also be shared with the patient monitor. Sharing input devices and touchscreen input requires a specific software application; refer to the IntelliVue XDS Application Instructions for Use for details. If the iPC is switched off when input devices are shared, any input devices connected to it will not be available for use with the monitor. Shutting the iPC Down The iPC will be shut down automatically when the monitor is switched off. If you want to shut down the iPC when the monitor is on, 1 Select Main Setup then Internal PC. In the Internal PC menu, select Switch PC Off. 2 If there is a problem with the shutdown, and you need to switch off the iPC manually, 1 Select Main Setup then Internal PC. In the Internal PC menu, select Force PC Off to force the iPC to power down. 2 Special Situations at Shutdown If you switch the monitor off and then on again immediately, the iPC will continue running and will not be shut down. In some situations, shutting down the iPC can take a little time. The monitor will go into Standby mode until the shutdown is complete. By touching the touchscreen, you can bring the monitor back into operating mode. If you do this, the iPC will restart when the shutdown is complete. If the shutdown cannot be completed within a certain time, a window will open giving the reason:

for example, that a file has not been saved, or that updates are being installed. You can then decide whether to wait (for example, in the case of the updates) or to take action (for example by saving the unsaved file). You will also have the option to force shutdown, if necessary. Using the X2 or MP5 with a Host Monitor When you connect an X2 or MP5 in companion mode to a host monitor, an integrated system is formed for monitoring a single patient. The following general observations and considerations apply to such a system:

The host monitor is the "master" of the system, and you have full control over all the system's operation only via the host monitor. Functions you can operate on a monitor in companion mode are restricted to measurements originating in that device. If you try to operate controls that are disabled, you are prompted by the message Not available in Companion Mode. 47 1 Introduction Depending on how it is configured, your host monitor can determine whether the user interface of a connected monitor in companion mode is completely disabled or not, and what is displayed on the screen (a standard main screen, or a blank screen indicating Companion Mode). This is controlled by two monitor settings that are applied to the monitor in companion mode on connection. You can change the settings in Configuration Mode. Global settings such as line frequency, QRS sound and ECG lead colors from the host monitor, are applied to the monitor in companion mode on connection. When disconnected from the host, the monitor in companion mode re-applies its own global settings. No audible alarms are available on a monitor in companion mode when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps which are controlled by the host monitor. Alarms become active again as soon as the monitor in companion mode is disconnected from the host monitor. The host monitor is the master of all ADT information. ADT operations on the monitor in companion mode are disabled, and any pending actions on the monitor in companion mode (for example, admit or end case) are canceled. The date and time of the monitor in companion mode is synchronized with that of the host monitor. Event surveillance in the monitor in companion mode is disabled. Main Setup menu operations and SmartKeys are disabled. While connected to a host monitor, no new events are detected in the monitor in companion mode, and no events are deleted. There is no transfer of stored events from the monitor in companion mode to the host monitor. After disconnection from the host monitor, event surveillance is enabled again in the monitor in companion mode, and new events are detected. 48 2 2Alarms 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 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 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 be 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:

OCCLUSION 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. ECG LEADS OFF NBP CUFF OVERPRESS CUFF NOT DEFLATED TELE DISCONNECTED Replace TeleBatt 49 2 Alarms 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. Visual Alarm Indicators WARNING No alarms are available on an X2 or MP5 when connected to a host monitor (Companion Mode is indicated). Alarms become active again as soon as the X2 or MP5 is disconnected from the host monitor. Alarm fields and other visual alarm indicators are disabled on an X2 or MP5 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps, which are controlled by the host monitor. Alarm Message An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow (

) at the side. 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 ** SpO LOW or in numeric form, for example **Pulse xxx>yyy 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:

50 2 Alarms INOP Lamp Color Yellow Red 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. Nurse Call Systems If configured to do so, red, yellow and light blue alarms are indicated on any device connected to the nurse call relay. 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). 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. No audible alarm indicators are available on an X2 or MP5 when connected to a host monitor

(Companion Mode is indicated). Alarms become active again as soon as the X2 or MP5 is disconnected from the host monitor. 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 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. 51 2 Alarms Standard INOPs: an INOP tone is repeated every two seconds. ISO/IEC Standard 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 The alarm volume symbol at the top right of the monitor screen gives you an indication of the current volume. To change the volume, select the volume symbol and then select the required volume from the pop-up selection. 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. 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. There is no alarm volume indication on the screen of an X2 or MP5 when connected to a host monitor

(Companion Mode is indicated). 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. 52 2 Alarms 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 - X2 (yellow) Power Loss Tone When power is lost - no power is available via the power cable - a buzzer will sound, if so configured. The tone can be silenced by pressing the On/Off power switch. Acknowledging Alarms To acknowledge all active alarms and INOPs, select the Silence permanent key. This switches off the audible alarm indicators and alarm lamps. Alternatively, you can acknowledge alarms by pressing the Silence hardkey on the MMS or on the SpeedPoint. The hardkeys follow the behavior configured for the permanent key. 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 stays on the screen with a check mark symbol beside it, except for NBP alarms and alarms from other intermittent measurements. When such an 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, unless the monitor is configured to not allow this. 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. Unplugging an MMS or a plug-in module automatically switches off its measurements. 53 2 Alarms Alarm Reminder 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, Select Main Setup, Alarms, then Alarm Settings 1 2 Check the Alarms Off setting. This setting can only be changed in Configuration Mode. To Pause All Alarms Select the Pause Alarms permanent key. If your monitor is configured to infinite pause time, the permanent key is labeled Alarms Off, and selecting it switches alarms off. Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key. Depending on the configuration, you may need to select Confirm to complete the change. To Switch All Alarms Off You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause and the permanent key is labeled Alarms Off. Select the Alarms Off permanent key. Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key. Depending on the configuration, you may need to select Confirm to complete the change. Pausing alarms infinitely is the same as switching them off. 54 To Switch Individual Measurement Alarms On or Off 1 2 Select the measurement numeric to enter its setup menu. Select Alarms to switch between on and off. 2 Alarms The alarms off symbol is shown beside the measurement numeric. 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 1:28 or ALARMS OFF, together with the alarms paused symbol or the alarms off symbol. Alarms Paused Alarms Off No alarms are sounded and no alarm messages are shown. INOP messages are shown but no INOP tones are sounded. The only exceptions are the INOPs CUFF NOT DEFLATED, NBP CUFF OVERPRESS 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. The nurse call relay is not active. If a disconnect INOP is present and alarms are paused or switched off, the measurement in question may be switched off, depending on monitor configuration. Restarting Paused Alarms To manually switch on alarm indication again after a pause, select the permanent key Pause Alarms (or Alarms Off) 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, select the Alarms Off or Pause Alarms permanent key and then reselect it. 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. 55 2 Alarms To extend the alarm pause time to five or 10 minutes, 1 Select one of the alarm fields. This calls up the Alarm Messages window. Select either the pop-up key PauseAl. 5 Min or the pop-up key PauseAl. 10 Min. Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes. 2 Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, BIS and SpO2), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off, or setting the low alarm limit to 0 switches it off. In these cases, the alarms off symbol is not displayed. 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 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 any alarm field to open the Alarm Messages window, then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured. 56 2 Alarms 1 Measurement labels, with alarms off symbol where appropriate 2 Current alarm limits 3 Graphic view of current yellow and red alarm limits and currently monitored measurement value. Off indicates the measurement is switched off 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:

All Al. On/All Al. Off All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all measurements. Print Limits/Record Limits to print a list of all current alarm limit settings on a connected printer or recorder. 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 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. 2 Alternatively, you can use the keys in the measurement alarm limits window, which you access by selecting the measurement label in the Alarm Limits window. 57 2 Alarms T Parameter label High red alarm (view only) High yellow alarm field. Select to open a pop-up list of high alarm limits Alarms On/Off key - select to switch 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) Graphic view of alarm limits with currently measured value 15-min trend, showing alarm limits and monitored measurement values 1 2 3 4 5 6 7 8 9 10 11 To change alarm limits, 1 Enter the Alarm Limits window. 2 Using touch: 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. Using a SpeedPoint or Navigation Point: position the cursor in the high yellow alarm field, then press the knob inwards. Rotate the knob to the left or right to adjust the limit. Press the knob again to set the displayed limit. Repeat to set the low yellow alarm limit. If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically adapt the red alarm limit. When an ST measurement is in the alarm 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. 58 2 Alarms About Automatic Alarm Limits The monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function (AutoLimits). 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 wide and narrow limits have a fixed relationship to the measured value within the non-

pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinician's judgment about the specific patient. 1 Wide alarm limits 2 Narrow alarm limits 3 Alarm Limits 4 Measurement value 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 measurement alarm 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. 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 measurement alarm 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. About Smart Alarm Delays The monitor can be configured to apply a delay before announcing limit alarms. The delay is calculated using an intelligent algorithm. This capability can be used to suppress alarms which occur because a limit is exceeded for a short time or by a small amount. Currently, Smart Alarm Delays are available only for SpO2 limit alarms and are not available in the U.S.A. or in clinical environments under FDA control. See the Monitoring SpO2 chapter for details. 59 2 Alarms WARNING Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are. Documenting Alarm Limits The alarm limits pop-up keys appear with the Alarm Limits and measurement alarm limits windows. Select the Print Limits pop-up key to print an overview of all alarm limits on a connected printer. Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder. 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 see the currently active alarms and INOPs listed in one place, select any of the alarm status areas on the monitor screen. The Alarm Messages window pops up. All alarms and INOPs are erased from the Alarm Messages window when you discharge a patient, or if you change to Demonstration Mode. Alarm Messages Window The Alarm Messages window shows all the currently active alarms and INOPs sorted by priority, beginning at the top with the most recent. INOPs are shown on the left hand side and patient alarms are shown on the right hand side. Any active red alarms are shown first, followed by yellow alarms. Acknowledged alarms or INOPs are shown with the check mark symbol. The Alarm Messages window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive ("grayed-out"). Selecting the Review Alarms pop-up key opens the Review Alarms window. If you do not immediately understand an INOP or alarm message, refer to its help text. In the Alarm Messages window, select the INOP message. This calls up a help window with an explanation of the INOP message and, where appropriate, a suggested solution for the problem. If the alarm or INOP was generated in a device other than the monitor (for instance, in an MMS or FMS), this source is specified at the end of the help text. Review Alarms Window The Review Alarms window contains a list of the most recent alarms and INOPs with date and time information. 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 actions related to switching alarms on and off, entering or leaving Standby mode, silencing alarms or changing the ECG source. 60 2 Alarms 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 alarm resulting from an event alarm notification, the Event Episode window for that event will open. If you select an alert other than a high or low alarm, a help text window opens with more information. This is the same as the help text window that opens in the Alarm Messages window. 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. 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. Selecting the Active Alarms pop-up key opens the Alarm Messages window. 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 In the monitor's Main Setup menu, select Alarms. Select Alarm Settings, and see the Visual Latching and Audible Latching settings. 2 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 Red&Yellow Red&Yellow Red&Yellow Red Only Red Only Off Audible Latching Red&Yellow Red Only Off Red Only Off Off 61 2 Alarms Alarm Latching Behavior Red & Yellow Measurement Alarms Non-latching alarms Alarm has not 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 has been acknowledged. 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. Visual and audible latching Visual latching, audible non-latching Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured). 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 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 136 for information on one-

star yellow alarms latching behavior. 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 SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed. Alarm Behavior at Power On restore the alarm settings from the monitor's configured default Profile, restore the most recently used alarm settings, or switch the alarms off. 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:

After any of these situations, you should check that the alarm settings are appropriate for your patient and monitoring situation, and if necessary, select the correct Profile and patient category. If power is lost for less than one minute, the alarm on/off condition prior to the power loss is restored. 62 Alarm Recordings 2 Alarms 2 3 4 5 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 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. 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&Yellow: both yellow and red alarms will trigger an alarm recording. Off: disables automatic alarm recording. Refer to the Recording chapter for details of how to set up a recording. 63 2 Alarms 64 3 3Patient Alarms and INOPs This chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here;

the ones which can appear on your monitor will depend on the model and the individual options. For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for Use. Patient Alarm Messages The measurement labels and abbreviations for pressure, temperature, SpO2, 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. Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices. Refer to your Gas Module Instructions for Use for patient alarms and INOPs from the gas modules. Alarm Message

* AFIB

** AFIB

*** APNEA

*** APNEA x:yy

*** APNEA >10min

*** ASYSTOLE

** awRR HIGH

** awRR LOW From ECG/Arrhythmia Atrial fibrillation waveform detected Condition CO2, Resp, Spirometry ECG Respiration has stopped for longer than the preset apnea time. "x:yy" denotes the Apnea duration in minutes and seconds No QRS detected for a period greater than the asystole threshold (in the absence of Vfib or chaotic ECG) CO2, Resp, AGM The airway respiration rate has exceeded the high alarm limit. CO2, Resp, AGM The airway respiration rate has dropped below the low alarm limit. Indication yellow alarm lamp, short yellow audible alarm numeric flashes, red alarm lamp, alarm tone numeric flashes, red alarm lamp, alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone 65 3 Patient Alarms and INOPs Alarm Message

** BIS HIGH

** BIS LOW

** CCO HIGH

** CCI HIGH

** CCO LOW

** CCI LOW

** CPP HIGH

** CPP LOW

*** DESAT

*** DESAT xx < yy

** EC10 ALARM

*** EC10 ALARM at Information Center

** etCO HIGH From BIS BIS CCO CCO CPP CPP SpO2 Condition The Bispectral Index value has exceeded the high alarm limit. The Bispectral Index value has dropped below the low alarm limit. 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. The CPP value has fallen below the low alarm limit. The SpO2 value has fallen below the desaturation alarm limit. xx denotes the lowest measured value, and yy is the desaturation limit. Indication numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone 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 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, red alarm lamp, alarm tone EC10 Intellibridge A yellow (**) or red (***) patient alarm is present on the IntelliBridge module. Check the monitor display for more detailed alarm information. CO2, Resp, AGM The end tidal CO2 high alarm limit has been exceeded.

** etCO LOW CO2, Resp, AGM The end tidal CO2 value has fallen below the low alarm limit.

** etO HIGH O2, AGM The end tidal O2 high alarm limit has been exceeded.

** etO LOW O2, AGM The end tidal O2 value has fallen below the low alarm limit. Event surveillance An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group.

(on monitor) yellow or red alarm lamp; the alarm text is defined by the Intellibridge device driver numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone Event surveillance An event has occurred and the event notification is configured to alarm. event group name flashes, yellow or red alarm lamp and alarm tone ECG The bradycardia limit has been exceeded. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone

* EVENT

** EVENT

*** EVENT at Information center

* EVENT:<Event Group>

** EVENT:<Event Group>

*** EVENT:<Event Group>

*** EXTREME BRADY 66 Alarm Message

** HR LOW From ECG Condition The heart rate has fallen below the low alarm limit.

* IRREGULAR HR

** IRREGULAR HR

* MISSED BEAT

** MISSED BEAT

* MULTIFORM PVCs

** MULTIFORM PVCs

** NBP HIGH

** NBP LOW

* NON-SUSTAIN VT

** NON-SUSTAIN VT

* PACER NOT CAPT

** PACER NOT CAPT

* PACER NT PACING

** PACER NT PACING

* PAIR PVCs

** PAIR PVCs ECG/Arrhythmia Consistently irregular heart rhythm. ECG/Arrhythmia No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second

(non-paced patients only). ECG/Arrhythmia Two differently shaped Vs detected, each NBP NBP occurring at least twice within the last 300 beats and at least once within the last 60 beats. 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. 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. ECG/Arrhythmia 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. A missed beat with a pace pulse was detected. ECG/Arrhythmia

(paced patients only) ECG/Arrhythmia

(paced patients only) ECG/Arrhythmia A non-ventricular contraction, followed by two A missed beat without a pace pulse was detected. ventricular contractions, followed by a non-

ventricular contraction has been detected. ECG/Arrhythmia No beat detected for a period greater than the

* PAUSE

** PAUSE

*** <Press Label> HIGH PRESS

** <Press Label> HIGH PRESS pause threshold. 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. 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. 3 Patient Alarms and INOPs Indication numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is switched on. numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, high limit is highlighted, red alarm lamp, alarm tone numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone 67 3 Patient Alarms and INOPs Alarm Message From

*** <Press Label> LOW PRESS

** <Press Label> LOW PRESS

** Pulse HIGH PRESS, SpO2 Condition 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. 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. The pulse rate has exceeded the high alarm limit.

** Pulse LOW PRESS, SpO2 The pulse rate has dropped below the low alarm limit. ECG/Arrhythmia More premature ventricular contractions have

* PVCs/min HIGH

** PVCs/min HIGH

** QTc HIGH

* R-ON-T PVCs

** R-ON-T PVCs ECG/QT ECG/Arrhythmia been detected in a minute than the limit. QTc value has exceeded the QTc high limit for more than 5 minutes 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.). The respiration rate has exceeded the high alarm limit. The respiration rate has dropped below the low alarm limit.

** RR HIGH

** RR LOW RESP RESP

* RUN PVCs HIGH

** RUN PVCs HIGH

** <SO Label> HIGH ECG/Arrhythmia A run of PVCs greater than 2 was detected. SvO2/SO2 The the measured intravascular oxygen saturation has exceeded the high limit.

** <SO Label> LOW SvO2/SO2 The measured intravascular oxygen saturation has fallen below the low limit.

** <SpO Label> HIGH SpO2

** <SpO Label> LOW SpO2

** ST-<n> HIGH ECG/ST The arterial oxygen saturation has exceeded the high alarm limit. The arterial oxygen saturation has fallen below the low alarm limit. The ST elevation in lead <n> is higher than the limit. 68 Indication numeric flashes and low limit is highlighted, red alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm 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 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone Alarm Message

** ST-<n> LOW From ECG/ST Condition The ST depression in lead <n> is lower than the limit. ECG/Arrhythmia A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit. The blood temperature value has exceeded the high alarm limit. The blood temperature value has fallen below the low alarm limit. The tcpO2 or tcpCO2 value has exceeded the high alarm limit. The tcpO2 or tcpCO2 value has fallen below the low alarm limit. This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window. The temperature has exceeded the high alarm limit. The temperature has fallen below the low alarm limit.

* SVT

** SVT

** Tblood HIGH

** Tblood LOW

** tcpO HIGH

** tcpCO HIGH

** tcpO LOW

** tcpCO LOW

* TELE ALARM

** TELE ALARM

*** TELE ALARM C.O. C.O. tcGas tcGas Telemetry

** <Temp Label> HIGH TEMP

** <Temp Label> LOW TEMP

* VENT BIGEMINY

** VENT BIGEMINY

*** VENT FIB/TACH ECG

* VENT RHYTHM

** VENT RHYTHM

* VENT TRIGEMINY

** VENT TRIGEMINY

*** VTACH

** VueLink ALARM

*** VueLink ALARM at Information Center VueLink

** QTc HIGH ECG/QT ECG/Arrhythmia A dominant rhythm of N, V, N, V (N =

supraventricular beat, V = ventricular beat) was detected. A fibrillatory waveform for 4 consecutive seconds was detected. ECG/Arrhythmia A dominant rhythm of adjacent Vs > vent rhythm limit and ventricular HR < VTach HR limit was detected. ECG/Arrhythmia 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 ECG, Arrhythmia Ventricular tachycardia has been detected

(Consecutive PVCs exceed V-Tach Run limit and HR exceeds V-Tach HR limit). A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information. QTc value has exceeded the QTc high limit for more than 5 minutes 3 Patient Alarms and INOPs Indication numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone yellow or red alarm lamp and alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, red alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm numeric flashes, red alarm lamp, alarm tone

(on monitor) yellow or red alarm lamp; the alarm text is defined by the VueLink device driver numeric flashes, yellow alarm lamp, alarm tone 69 3 Patient Alarms and INOPs Alarm Message

***BRADY/P xxx<yyy

***BRADY xxx < yyy From Press, SpO2

***<Pressure>

DISCONNECT PRESS

**ST MULTI <n>,<n>

ECG/ST

**ST MULTI at Information Center ECG/ST

***TACHY xxx > yy ECG Condition The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit. 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). The ST depression or elevation is outside of the limit in two or more leads <n> and <n>. The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor The tachycardia limit has been exceeded

***TACHY/P xxx>yy or

***TACHY xxx > yy Press, SpO2, ECG The tachycardia limit has been exceeded. xxx denotes the highest measured value; yy is the tachycardia limit. Technical Alarm Messages (INOPs) Indication numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes, red alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone

(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone 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. The measurement labels and abbreviations for pressure, temperature, SpO2, and VueLink INOP messages are explained in the individual measurement chapters. Monitor INOPs INOP Message, Indication

!! CHECK PAIRING INOP tone Bad Server Link INOP tone CENTRAL: TELE ONLY INOP tone Check Alarm Lamps INOP tone Check DrugSettings INOP tone

!!CHECK ECG SOURCE INOP tone 70 What to do There is a problem with device pairing. Check that the monitor and telemetry device are correctly paired. 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. System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station. 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. There was a problem loading the drug settings. Check that the settings are complete and correct. 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. 3 Patient Alarms and INOPs INOP Message, Indication Check Flex Texts INOP tone 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 Screen Res. INOP tone Check Settings INOP tone Check SpeedPoint INOP tone Check Touch Input INOP tone Check Waves INOP tone CHK ECG Sync Cable INOP tone Chk IndepDsp Cable Chk MSL Connection INOP tone ECG EQUIP MALF T Numeric is displayed with a -?-

INOP tone Internal.Comm.Malf INOP tone MCC Reversed INOP tone MCC Unsupported INOP tone What to do 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. Perform a visual and functional check of the keyboard. Contact your service personnel. 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. 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. 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. 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. 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. Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel. 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 gray connector must be connected to the Intelligent Display. Check that the MSL cable is properly connected. If this is the case, try using another MSL cable, to check if your cable is defective. If this does not help, the device connected via the MSL cable may be defective, contact your service personnel. Contact your service personnel. The ECG in the Telemetry device is faulty. There is a problem with I2C Bus communication in the monitor. Contact your service personnel. The MSL coupling cable is reversed. Connect the end with the gray connector to the Intelligent Display. An MSL coupling cable has been connected to a device which does not support MSL coupling. 71 3 Patient Alarms and INOPs What to do 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 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. 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. There is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. In case the connection is via a telemetry device, the current telemetry use model does not support central monitoring. Contact your service personnel. The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device. 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. The monitor cannot use the predefined settings for monitoring. Contact your service personnel. Contact your service personnel to check the speaker and the connection to the speaker. The short range radio connection has interference from another device. Try using another channel. The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration. Malfunction in the short range radio device. If the INOP persists contact your service personnel. The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor. Telemetry device not supported (companion mode) The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device. SRR-enabled telemetry device is not supported by this central software revision. Please check configuration. This telemetry device is not supported for direct connection to the monitor. The time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP. 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. INOP Message, Indication Meas. DEACTIVATED

!!MORE BED ALARMS

!!!MORE BED ALARMS at Information Center MSL Power High MSL Power Off INOP tone MSL Power Overload INOP tone No Central Monit. INOP tone NO ECG AT CENTRAL Rem.AlarmDev.Malf. INOP tone Settings Malfunc. INOP tone Speaker Malfunct. SRR INTERFERENCE INOP tone SRR INVALID CHAN INOP tone SRR MALFUNCTION TAAP DISABLED INOP tone TELE CONFIG UNSUPP INOP tone TELE EQUIP MALF INOP tone TELE INCOMPATIBLE TELE UNSUPPORTED INOP tone TimeExpired:<Timer Label>

INOP tone Unsupported LAN INOP tone User I/F Malfunct. INOP tone 72 3 Patient Alarms and INOPs Battery INOPs INOP Message, Indication Batt 1 MISSING Batt 2 MISSING INOP tone During this INOP, alarms cannot be paused or switched off. Batt EMPTY INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. BATT EXTENSN MALF INOP tone 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 Batt 1 EMPTY Batt 2 EMPTY INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. BATTERIES INCOMPAT Batt 1 INCOMPAT. Batt 2 INCOMPAT. INOP tone BATTERIES LOW Batt 1 LOW Batt 2 LOW INOP tone BATTERIES MALFUNC. Batt 1 MALFUNCTION 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. Charge Batt 1 Now Charge Batt 2 Now INOP tone CHARGER MALFUNC. INOP tone, battery LED may flash What to do The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately. The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery 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. There is a hardware error in the Battery Extension. Contact your service personnel. The battery cannot be used with this monitor. Replace with the correct battery (M4607A). 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 re-issued 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. 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 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. 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. 73 3 Patient Alarms and INOPs INOP Message, Indication CHECK BATT TEMP INOP tone Chk MSL Connection ExtBat EMPTY ExtBat INCOMPAT. ExtBat LOW ExtBat MALFUNCTION ExtBat MISSING

!!INSERT BATTERY Severe yellow INOP tone During this INOP, alarms cannot be paused or switched off. MSL Power High MSL Power Off What to do 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. Check the MSL connection between X2/MP2 and the battery extension for damage or loose connections. Check also if a second X1 or X2 has been connected accidentally (e.g. in companion mode). The estimated battery-powered operating remaining time is less than 10 minutes. Replace the battery in the battery extension immediately. The battery in the battery extension cannot be used. The estimated battery-powered operating time remaining is less than 20 minutes. The monitor cannot determine the status of the battery in the battery extension. If this INOP persists, replace the faulty battery in the battery extension. If the condition persists and the monitor is not connected to mains power or a host monitor, this INOP is re-issued two minutes after you acknowledge it. There is no battery in the Battery Extension 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. The power consumption of the devices connected to the Battery Extension is too high. If this situation continues, the Battery Extension will be switched off. Contact your service personnel. The power consumption of the devices connected to the Battery Extension was too high for too long. The Battery Extension has been switched off. Contact your service personnel. MMS, MMS Extensions and FMS INOPs INOP Message, Indication FMS UNPLUGGED INOP tone FMS UNSUPPORTED INOP tone MEASSRV UNSUPPORTD INOP tone MMS Ext. UNPLUGGED INOP tone MMS Ext. Unpowered INOP tone MMS Ext.EQUIP MALF INOP tone MMS UNPLUGGED INOP tone What to do 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. The Multi-Measurement module is not supported by the monitor. 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. Loss of communication between the Multi-Measurement Module and the MMS extension. 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. 74 INOP Message, Indication MMS UNSUPPORTED INOP tone MMSExt.Unsupported INOP tone NO PPV FROM FMS NO PPV FROM MMS Display INOPs INOP Message, Indication Indep.Dsp Malfunc. Indep.Dsp NotSupp. Intell.Dsp Malf. Intell.Dsp Missing Intell.Dsp Unsupp. 3 Patient Alarms and INOPs What to do The Multi-measurement Module is not supported by your monitor. Contact your service personnel. The MMS extensions not supported by your monitor. Contact your service personnel. 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. What to do There is a problem with the Independent Display. Check the MSL coupling cable then contact your service personnel. The monitor does not support a second main display. The monitor software is incompatible. Contact your service personnel. 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. ECG, Arrhythmia, QT and ST INOPs INOP Message, Indication C LEAD OFF HR Numeric is replaced by -?-

for 10 seconds. INOP tone CANNOT ANALYZE ECG CANNOT ANALYZE QT CANNOT ANALYZE ST ECG EL. NOISY <ECG Lead>

ECG EQUIP MALF Numeric is replaced by -?-

INOP tone What to do 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 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. 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. Contact your service personnel. The ECG hardware is faulty. 75 3 Patient Alarms and INOPs What to do 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. Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. 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. 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 alarm source. 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 alarm source. There is a problem with the device connected to the ECG Out connector. Contact your service personnel. 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. 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 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. 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. This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile. 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. What to do Pulse has no alarming because the system pulse is measured by an external device. Select another pulse source to enable pulse alarming. INOP Message, Indication

<ECG Lead> LEAD OFF

!! <ECG Lead> LEAD OFF

!!! <ECG Lead> LEAD OFF Numeric is replaced by -?-

INOP tone ECG LEADS OFF

!! ECG LEADS OFF

!!!ECG LEADS OFF ECG NOISY SIGNAL INOP tone

!!ECG/AR ALARM OFF ECG/ARRH ALARM OFF

!!ECG/AR ALARM OFF EcgOut EQUIP MALF INOP tone LA LEAD OFF Numeric is replaced by -?- for 10 seconds. INOP tone LL LEAD OFF Numeric is replaced by -?- for 10 seconds. INOP tone RA LEAD OFF Numeric is replaced by -?-

INOP tone RL LEAD OFF Numeric is replaced by -?- for 10 seconds. INOP tone SOME ECG ALRMS OFF V LEAD OFF Numeric is replaced by -?- for 10 seconds. INOP tone Pulse INOPs INOP Message, Indication PULSE NO ALARMING Numeric is replaced by -?-

INOP tone 76 Resp INOPs INOP Message, Indication Resp EQUIP MALF Numeric is replaced by -?-

INOP tone Resp ERRATIC Numeric is replaced by -?-

Resp LEADS OFF Numeric is replaced by -?-

INOP tone NBP INOPs INOP Message, Indication

!! CUFF NOT DEFLAT

!!!CUFF NOT DEFLAT Numeric is displayed with a -?-

Severe yellow/red INOP tone During this INOP, alarms cannot be paused or switched off.

!! CUFF OVERPRESS

!!!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 3 Patient Alarms and INOPs What to do 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. What to do 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 15 mmHg (2kPa) for more than 3 minutes. Neonatal patients: The NBP cuff pressure has exceeded 5mmHg (0.7kPa) for more than 90 seconds.]

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. 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. 77 3 Patient Alarms and INOPs Temperature INOPs INOP Message, Indication T1, T2, T3, T4 INOPs Tamb INOPs Tart INOPs Tcereb INOPs Tcore INOPs

<Temp Label>

DEACTIVATED INOP tone

<Temp Label> EQUIP MALF Numeric is replaced by -?-

INOP tone

<Temp Label> NO TRANSDUC Numeric is replaced by -?-

INOP tone

<Temp Label>

OVERRANGE Numeric is replaced by -?-

INOP tone

<Temp Label>

UNPLUGGED INOP tone Tesoph INOPs Tnaso INOPs Trect INOPs Tskin INOPs Ttymp INOPs Tven INOPs Tvesic INOPs What to do See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs 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. Make sure the TEMP probe is connected to the MMS or module. If you silence this INOP, the measurement will be switched off. Try changing the application site of the transducer.

[The temperature is less than -1C, or greater than 45C.]

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. See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs See <Temp Label> INOPs 78 3 Patient Alarms and INOPs What to do The SpO2 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 or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel. 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. Make sure the SpO2 sensor is connected. If the INOP persists, try another adapter cable and sensor. If you silence this INOP, the measurement will be switched off. 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. The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised. The detectable pulsations of the SpO2 signal are outside the specified pulse rate range. SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. SpO2 INOPs INOP Message, Indication

<SpO Label>

DEACTIVATED INOP tone

<SpO Label> EQUIP MALF Numeric is replaced by -?-

INOP tone

<SpO Label> ERRATIC Numeric is replaced by -?-

INOP tone

<SpO Label>

EXTD.UPDATE Numeric is replaced by -?-

(questionable numeric)

<SpO Label>

INTERFERNCE Numeric is replaced by -?-

INOP tone

<SpO Label> LOW PERF Numeric is replaced by -?-

(questionable numeric)

<SpO Label> NO SENSOR Numeric is replaced by -?-

INOP tone

<SpO Label> NOISY SIGN. Numeric is replaced by -?-

INOP tone

<SpO Label> NON-

PULSAT. Numeric is replaced by -?-

INOP tone

<SpO Label> POOR SIGNAL Numeric is replaced by -?-

(questionable numeric)

<SpO Label> PULSE?

Numeric is replaced by -?-

INOP tone

<SpO Label> SEARCHING Numeric unavailable

<SpO Label> SENSOR MALF Numeric is replaced by -?-

INOP tone 79 3 Patient Alarms and INOPs INOP Message, Indication

<SpO Label> SENSOR OFF Numeric is replaced by -?-

INOP tone

<SpO Label>

UNKN.SENSOR Numeric is replaced by -?-

<SpO Label>

UNPLUGGED Numeric is replaced by -?-

INOP tone

<SpO Label> UPGRADE Numeric is replaced by -?-

Numeric is unavailable Pressure INOPs INOP Message, Indication ABP INOPs Ao INOPs ART INOPs BAP INOPs CPP CHK SOURCES Numeric is replaced by -?-

INOP tone CPP CHK UNITS Numeric is replaced by -?-

CPP UNPLUGGED CVP INOPs FAP INOPs IC1 / IC2 INOPs ICP INOPs LAP INOPs P / P1 / P2 / P3 / P4 INOPs PAP INOPs PPV BAD <Press Label>

SIGNAL PPV BAD SIGNAL at Information Center PPV CHK SOURCES

<Press Label> ARTIFACT Numeric questionable 80 What to do The SpO2 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 SpO2 measurement. Use only specified sensors and cables. An SpO2 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 SpO2 measurement is currently in upgrade mode. Monitoring is not possible in this mode. What to do See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs 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. With the default profile settings, the CPP measurement is disabled in the adult profile and enabled in the pediatric and neonatal profiles. When changing from a pediatric or neonatal profile to an adult profile, this INOP can occur. Enable CPP in the adult profile to clear the INOP. See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs 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. 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 (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile INOP will be suppressed. 3 Patient Alarms and INOPs What to do 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. 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. 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. 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. See <Press Label> INOPs See <Press Label> INOPs See <Press Label> INOPs INOP Message, Indication

<Press Label>

DEACTIVATED INOP tone

<Press Label> EQUIP MALF Numeric is replaced by -?-

INOP tone

<Press Label> NO TRANSDUCER Numeric is replaced by -?-

INOP tone

<Press Label> NOISY SIGNAL Pulse numeric is replaced by -?-

INOP tone

<Press Label> NON-

PULSATILE Pulse numeric is replaced by -?-

INOP tone

<Press Label>

OVERRANGE Numeric is replaced by -?-

INOP tone

<Press Label> REDUCE SIZE

<Press Label>

UNPLUGGED INOP tone

<Press Label>

ZERO+CHECK CAL Numeric is replaced by -?-

RAP INOPs UAP INOPs UVP INOPs 81 3 Patient Alarms and INOPs CO2 INOPs INOP Message, Indication

!! CO OCCLUSION

!!! CO OCCLUSION Numeric is replaced by -?-

INOP tone CO AUTO ZERO Numeric is replaced by -?-

if the Autozero lasts >15 sec, INOP tone sounds. CO CAL MODE CO2 numeric displays current CO2 value for accuracy check CO2 CAL RUNNING Numeric is replaced by -?-

CO CHECK CAL Numeric is replaced by -?-

INOP tone CO CHK ADAPTER Numeric is replaced by -?-

INOP tone CO DEACTIVATED INOP tone CO EQUIP MALF Numeric is replaced by -?-

INOP tone CO FAILED CAL Numeric is replaced by -?-

INOP tone CO NO SENSOR from M3014A Numeric is replaced by -?-

INOP tone CO NO TRANSDUC from mainstream CO2 (except M3014A) Numeric is replaced by -?-

INOP tone CO NO TUBING Numeric is replaced by -?-

INOP tone CO OVERRANGE Numeric is replaced by -?-

INOP tone CO PUMP OFF Numeric is replaced by -?-. CO PURGING Numeric is replaced by -?-

INOP tone 82 What to do 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 automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO2 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 CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. 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 CO2 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 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 CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off. There is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 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 CO2 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 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 CO OCCLUSION is displayed. 3 Patient Alarms and INOPs What to do Wait until the sensor reaches operating temperature and the INOP disappears. 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 CO2 sensor. If the INOP persists, contact your service personnel. The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave. Wait until zero calibration is finished. INOP Message, Indication CO SENS.WARMUP Numeric is replaced by -?-

Microstream CO2: INOP tone Mainstream CO2: no INOP tone CO UPDATE FW Numeric is replaced by -?-

INOP tone CO WAIT CAL2 Numeric is replaced by -?-

CO ZERO FAILED Numeric is replaced by -?-

INOP tone CO ZERO REQU'D Numeric is replaced by -?-

INOP tone COCHANGE SCALE COZERO RUNNING SO2 INOPs Pre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The catheter is now ready for insertion. The signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter. What to do 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. INOP Message, Indication

<SO Label> CAL FAILED Numeric is replaced by -?-

INOP tone

<SO Label> CAL MODE Numeric is replaced by -?-

INOP tone

<SO Label> CANNOT MEAS Numeric is replaced by -?-

INOP tone

<SO Label> CONN OPTMOD Numeric is replaced by -?-

INOP tone

<SO Label> EQUIP MALF Numeric is replaced by -?-

INOP tone

<SO Label> INCOMPAT. INOP tone

<SO Label> IN-VIVO CAL The in-vivo calibration is not yet complete. Lab values must be stored to the Optical Module to The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/

SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel. The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds. The SO2 Module or Optical Module is not supported. Contact your service personnel.

<SO Label> LOW LIGHT Numeric is replaced by -?-

INOP tone

<SO Label> NO OPTMOD Numeric is replaced by -?-

INOP tone complete the calibration. Either continue with the next steps of the current calibration or recall the previous 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. 83 3 Patient Alarms and INOPs INOP Message, Indication

<SO Label> OPTMOD MALF

<SO Label> PRE-INS CAL Numeric is replaced by -?-

INOP tone

<SO Label> UNPLUGGED Numeric is replaced by -?-

INOP tone

<SO Label> UPGRADE INOP tone

<SO Label> WARMUP Numeric is replaced by -?-

<SO Label>CAL REQUIRED Numeric is replaced by -?-

INOP tone

<SO Label>CONFIG ERROR Numeric is replaced by -?-

INOP tone

<SO Label>LIGHT INTENS Numeric is replaced by -?-

INOP tone C.O. INOPs INOP Message, Indication C.O. DEACTIVATED INOP tone C.O. EQUIP MALF Numeric is replaced by -?-

INOP tone C.O. UNPLUGGED Numeric is replaced by -?-

INOP tone CCI NO BSA CCI numeric unavailable INOP tone CCO BAD PRESS SIGN Numeric is replaced by -?-

INOP tone CCO NO CALIBRATION Numeric is replaced by -?-

CCO NO <Press Label>

Numeric is replaced by -?-

INOP tone may sound 84 What to do The Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this capability is needed, use another Optical Module. The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete. Measurement switched on and SO2/SvO2 module unplugged from the rack. The SO2 module is currently in upgrade mode. Monitoring is not possible in this mode. The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished. 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 SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode. 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). What to do 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. Plug in the C.O. module. Silencing this INOP switches off the measurement. 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. 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 pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. 3 Patient Alarms and INOPs What to do 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 pressure from an external device 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. 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. The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. 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. The pressure measurement must be zeroed before a CCO calibration. No transducer attached to the module or catheter disconnected. No transducer attached to the module or catheter disconnected. Tblood out of range 17C - 43C. INOP Message, Indication CCO NO PRESS at Information Center CCO NOT SUPPORTED Numeric is replaced by -?-

INOP tone CCO OVERRANGE CCI OVERRANGE Numeric is replaced by -?-

INOP tone CCO PRESS INVALID at Information Center CCO <Press Label>

INVALID Numeric is replaced by -?-

INOP tone may sound CCO PRESS OVERRANG Numeric is replaced by -?-

INOP tone CCO PULSE OVERRANG Numeric is replaced by -?-

INOP tone CCO RECALIBRATE Numeric is replaced by -?-

CCO/Tbl NO TRANSD. Numeric is replaced by -?-

INOP tone Tblood NO TRANSDUC Numeric is replaced by -?-

INOP tone Tblood OVERRANGE Numeric is replaced by -?-

85 3 Patient Alarms and INOPs tcGas INOPs INOP Message, Indication

<tcGas Label> CAL FAILED Numeric is replaced by -?-

INOP tone

<tcGas Label> CAL REQUIRD Numeric is replaced by -?-

INOP tone

<tcGas Label> CAL RUNNING Numeric displays first -?-, then numeric is displayed with a ?

<tcGas Label> CHANGE SITE If Heat Switch Off is configured to Yes, numeric is replaced by -?-

INOP tone

<tcGas Label> CHECK TIME

<tcGas Label> EQUIP MALF Numeric is replaced by -?-

INOP tone

<tcGas Label> NO TRANSDUC Numeric is replaced by -?-

INOP tone

<tcGas Label>

STABILIZING Numeric is replaced by ?

<tcGas Label>

UNPLUGGED Numeric is replaced by -?-

INOP tone What to do A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration 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 calibration chamber on the module, connect the calibration unit to the calibration 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 tcpO2/tcpCO2 calibration is finished. 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. Site Timer due to time out in 15 minutes or less. 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 tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement. 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. 86 EEG INOPs INOP Message, Indication EEG EQUIP MALF INOP tone EEG IMPEDANCE HIGH EEG1 IMPED. HIGH EEG2 IMPED. HIGH EEG LINE NOISE EEG1 LINE NOISE EEG2 LINE NOISE EEG MUSCLE NOISE EEG1MUSCLE NOISE EEG2MUSCLE NOISE EEG NO TRANSDUC INOP tone EEG UNPLUGGED INOP tone EEG1 LEAD OFF <n>

EEG2 LEAD OFF <n>

[n = electrode]

EEG1 LEAD OFF EEG2 LEAD OFF at Information Center EEG1 LEADS OFF EEG2 LEADS OFF EEG1 OVERRANGE EEG2 OVERRANGE BIS INOPs INOP Message, Indication BIS CABLE INCOMPAT INOP tone BIS CABLE USAGE INOP tone BIS DSC DISCONN INOP tone BIS DSC INCOMPT INOP tone BIS DSC MALFUNC BIS DSC UPDATE INOP tone 3 Patient Alarms and INOPs What to do The EEG hardware is faulty. Contact your service personnel. The signal electrode in one or both channels exceeds the user-selected 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. 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. 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. Two or more electrodes are not connected. Check in the EEG Impedance / Montage window which electrodes are affected and reconnect the electrodes. Input signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electrosurgery. What to do The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philips-supported 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. 87 3 Patient Alarms and INOPs What to do 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. 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. 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). INOP Message, Indication BIS ELECTR. DISC. INOP tone BIS ENGINE DISCONN INOP tone BIS ENGINE INCOMPT INOP tone BIS ENGINE MALFUNC INOP tone 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 BIS SQI < 15% (INOP tone) OR BIS SQI < 50% (no INOP tone) 88 3 Patient Alarms and INOPs INOP Message, Indication BIS UNPLUGGED INOP tone BISx DISCONNECTED INOP tone BISx INCOMPATIBLE INOP tone BISx MALFUNCTION INOP tone What to do Plug in the BIS module. Silencing this INOP switches off the measurement. 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. Spirometry INOPs INOP Message, Indication AWFCHANGE SCALE AWPCHANGE SCALE AWVCHANGE SCALE SPIRO ALARMS SUPPR SPIRO CANNOT MEAS SPIRO GAS COMPENS?

SPIRO INCOMPATIBLE SPIRO MALFUNCTION SPIRO NO BREATH SPIRO NO SENSOR SPIRO PATIENT CAT. SPIRO PURGE FAILED SPIRO PURGING SPIRO UNKN. SENSOR SPIRO UPGRADE What to do Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave. Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave. Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave. Alarming is suppressed for the spirometry module. Measurement is at its limit, e.g. ambient pressure out of range. 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. Module revision not compatible with the host monitor software revision. Contact your service personnel. Module failure detected. Contact your service personnel. No breath was detected for more than 25 seconds. Breath derived numerics are not available. No sensor detected. Make sure the correct sensor is attached to the breathing circuit. 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 chapter on 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. A purge operation is in progress - no data update on the screen. Wait until purge is complete. An unknown sensor ID code was detected. Use only the sensors listed in the Accessories chapter. The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring. 89 3 Patient Alarms and INOPs VueLink INOPs INOP Message, Indication VueLink ALARM at Information Center

<VueLink Option> CHECK SETUP INOP tone

<VueLink Option> CHK CABLE INOP tone

<VueLink Option> CHK CONF. INOP tone

<VueLink Option> EQUIP MALF INOP tone

<VueLink Option> NO CONFIG INOP tone

<VueLink Option>

UNPLUGGED INOP tone What to do A technical alarm is present on the VueLink module. The INOP text on the monitor is defined by the VueLink device driver. 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. 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. 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. IntelliBridge INOPs INOP Message, Indication DEVICE CHECK CONF. INOP tone DEVICE CHECK SETUP INOP tone DEVICE DEMO DATA INOP tone DEVICE REAL DATA INOP tone DEVICE UNSUPPORTED INOP tone

<EC10 / EC40> EQUIP MALF INOP tone What to do Device identification completed, but communication could not be established due to error. IntelliBridge INOP abbreviations may differ slightly depending on the device category. Device identification completed, but communication could not be established due to timeout. IntelliBridge INOP abbreviations may differ slightly depending on the device category. The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode. The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. Device identification completed, but no appropriate device driver installed. IntelliBridge INOP abbreviations may differ slightly depending on the device category. Malfunction in the IntelliBridge module. If this message appears repeatedly, the module must be replaced. Contact your service personnel. 90 3 Patient Alarms and INOPs INOP Message, Indication EC10 INOP

!! EC10 INOP

!!! EC10 INOP at Information Center

<External Device>

UNPLUGGED INOP tone NO DEVICE DATA TEXT UPLOAD FAILED INOP tone What to do A technical alarm is present on the IntelliBridge EC10 module. On the monitor the indication is a red (!!!), yellow (!!) or cyan alarm lamp (as appropriate) and an INOP text that is defined by the IntelliBridge EC10 device driver. The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement. IntelliBridge INOP abbreviations may differ slightly depending on the device category. Communication with connected device has been lost. Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary. Telemetry INOPs INOP Message, Indication

!! REPLACE BATT. T

!!!REPLACE BATT. T Severe yellow/red INOP tone During this INOP, alarms cannot be paused or switched off.

!! TELE INOP

!!! TELE INOP Severe yellow/red INOP tone BATTERY LOW T Check ECG Settings INOP tone

!!CHECK ECG SOURCE Chk SpOT Settings INOP tone INVALID LEADSET LEADSET UNPLUGGED NO ECG SOURCE

!!TELE DISCONNECT

!!!TELE DISCONNECT INOP tone Tele Sync Unsupp. INOP tone What to do The battery in the telemetry device is almost empty and must be replaced. Check for further details at the Information Center or in the Telemetry Data window on the monitor. The battery in the Telemetry device is low and must be replaced soon. Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate. Both the telemetry device and the monitor have valid ECG signals Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate. The leadset plugged in cannot be used with the telemetry device. The leadset has been unplugged from the telemetry device. A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup. For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.). If this INOP persists, ask your service personnel to survey the interference sources. The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above. 91 3 Patient Alarms and INOPs ProtocolWatch INOPs INOP Message, Indication PW In Conflict PW: Check Settings PW:Action Required What to do There is a patient information mismatch which has not yet been resolved (>15 minutes). Contact your service personnel. Settings could not be loaded or interpreted correctly. The protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response. Calculated Values INOPs INOP Message, Indication Sp-vO CHK SOURCES Numeric is replaced by -?-

Sp-vO CHK UNITS Numeric is replaced by -?-

SVR CHK SOURCES SVRI CHK SOURCES Numeric is replaced by -?-

SVR CHK UNITS SVRI CHK UNITS Numeric is replaced by -?-

SVR SET CVP USED SVRISET CVP USED SpO CHK SOURCES Numeric is replaced by -?-

SpO CHK UNITS Numeric is replaced by -?-

Temp CHK SOURCES Numeric is replaced by -?-

Temp CHK UNITS Numeric is replaced by -?-

What to do 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. 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. 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. 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. 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. Cableless Measurement Device INOPs INOP Message, Indication cl NBP Batt Empty cl NBP Batt Incomp cl NBP Batt Low cl NBP Batt Malf cl NBP Batt Temp cl NBP Check Batt cl NBP Disconnect 92 What to do The remaining battery time of the NBP Pod is below 30 minutes. Change the battery. The battery in use with the NBP Pod is incompatible. Replace it with one approved for use with the NBP Pod. The remaining battery time of the NBP Pod is below 2 hours. There is a malfunction in the NBP Pod's battery system. Contact your service personnel. The temperature of the battery in the NBP Pod is critically high. Check that the Pod is not covered or exposed to a heat source. If the INOP persists, remove the Pod from the patient and contact your service personnel. The battery in the NBP Pod is nearing the end of its useful life. Only 50 charge/discharge cycles remain. Contact your service personnel to replace the battery. The NBP Pod has lost the connection to the monitor. 3 Patient Alarms and INOPs INOP Message, Indication cl NBP No Cradle cl NBP Remove cl NBP Serv Batt cl SpO Batt Empty cl SpO Batt Incmp cl SpO Batt Low cl SpO Batt Malf cl SpO Batt Temp cl SpO Check Batt cl SpO Disconnect cl SpO No Cradle cl SpO Remove cl SpO Serv Batt What to do The NBP Pod is not in its cradle. The temperature of the battery in the NBP Pod is too high. Remove the Cableless Measurement Device from the patient and contact service personnel. The battery in the NBP Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the battery. The remaining battery time of the SpO2 Pod is below 30 minutes. Change the battery. The battery in use with the SpO2 Pod is incompatible. Replace it with one approved for use with the SpO2 Pod. The remaining battery time of the SpO2 Pod is below 2 hours. There is a malfunction in the SpO2 Pod's battery system. Contact your service personnel. The temperature of the battery in the SpO2 Pod is critically high. Check that the Pod is not covered or exposed to a heat source. If the INOP persists, remove the Pod from the patient and contact your service personnel. The battery in the SpO2 Pod is nearing the end of its useful life. Only 50 charge/discharge cycles remain. Contact your service personnel to replace the battery. The SpO2 Pod has lost the connection to the monitor. The SpO2 Pod is not in its cradle. The temperature of the battery in the SpO2 Pod is too high. Remove the SpO2 Pod from the patient and contact service personnel. The battery in the SpO2 Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the battery. 93 3 Patient Alarms and INOPs 94 4 4Managing 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. Note that when an X2 or MP5 monitor is connected to a host monitor, its ability to admit or discharge a patient is disabled, and the host monitor controls patient demographic and ADT information. 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. NOTE It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center. To admit a patient, 1 Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient Demographics window. 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. If a conventional keyboard or a barcode scanner is connected to the monitor you can use this to enter patient information. Last Name: Enter the patient's last name (family name), for example Doe. First Name: Enter the patient's first name, for example Doe, John. 95 4 Managing Patients Middle Name (if configured to appear): Enter the patient's middle name. Lifetime Id, Encounter Id: Whether these fields appear and how they are labeled can be configured for your hospital. One or both fields may be displayed and the labels may read:

MRN, Case Id, Visit Id, or other alternatives. Enter the appropriate data for the fields displayed. Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo. 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. 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 (1) / Notes (2): Enter any extra information about the patient or treatment. BSA: The monitor calculates the body surface area automatically. Select Confirm. The patient's name appears on the monitor info line at the top of the screen. 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 Cat. 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. Quick Admitting a Patient 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. 96 4 Managing Patients Select the Quick Admit SmartKey. 1 2 Enter the required data (ID fields or last name depending on configuration) with the keyboard or a barcode scanner. Select Enter. In the confirmation window, select Confirm to discharge the previous patient (if confirmation is configured). 3 4 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 ID field 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 WARNING Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient. A discharge:

clears the information in the Patient Demographics window erases all patient data (such as trend, event, and calculation data) from the monitor, measurement modules 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 local or central printer is available before you use End Case. To Discharge a Patient 1 2 Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient Demographics window and associated pop-up keys. Select the pop-up key for either:

97 4 Managing Patients 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, then Auto Reports. For each auto report, if End Case Report is set to On, this report will be printed when you select End Case. See Setting Up Auto Reports on page 327 for information on setting up end case reports. Dischrge Patient - to discharge the patient without printing any reports. New Patient Check after a specified power-off period after a specified standby period The monitor can be configured to ask you in certain situations:

when no basic vitals (HR, RR, Pulse, SpO2, 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, information can be shared between Multi-Measurement Modules (MMS), patient monitors, and Information Centers. patient demographic information is shared between connected MMSs, patient monitors, and Information Centers measurement settings and calibration data can be uploaded from an MMS to a patient monitor, if configured trend information can be uploaded from an MMS to a patient monitor, if configured. Different sets of patient and measurement-related data are stored in the monitor and the Multi-

Measurement Module. Understanding this will help you to understand what happens to patient data when you transfer patients. 98 Patient Information Stored in Monitor Patient demographics (name, DOB, patient IDs) Monitor settings (alarm pause time, alarm volume) Measurement settings for all measurements (alarm limits, measurement on/off, etc.) yes yes yes Trend data Calculation data (HemoCalc data) yes, for all MMS and extensions measurements (up to a maximum of 16 or 32, depending on your database configuration) yes Events data yes 4 Managing Patients Stored in MMS and extensions yes no yes, for all MMS and extensions measurements most recent 8 hours of information, for all MMS and extensions measurements no no WARNING If the monitor is not battery-powered, you cannot monitor during transport. Transferring a Centrally-Monitored Patient Scenario: A centrally-monitored patient is moved to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. 1 Before you disconnect the MMS from the monitor, 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 Remove the MMS and any connected extensions from the monitor. 3 Connect the MMS to the transfer monitor and monitor your patient during the move. 4 At the new location, connect the MMS to the monitor. If the monitor detects a patient mismatch, a window will open showing your patient's data and asking whether to Complete Transfer Of This Patient?. Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MMS to the receiving monitor. 5 6 Verify that the settings for patient category and paced mode are correct. 99 4 Managing Patients Transferring a Centrally-Monitored Patient with X2 or MP5 WARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A). Scenario: A centrally-monitored patient is moved to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. 1 Before you disconnect the X2/MP5 from the host monitor, 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 Remove the X2/MP5 and any connected extensions from the monitor. 3 Move the patient using the X2/MP5 as the transport monitor. 4 At the new location, connect the X2/MP5 to the new host monitor. If the monitor detects a patient mismatch, a window will open showing your patient's data and asking Complete Transfer Of This Patient?. Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor. 5 6 Verify that the settings for patient category and paced mode are correct. Transferring a Centrally-Monitored Patient with X2 or MP5 using IIT WARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A). Scenario: A centrally-monitored patient is moved with an X2 or MP5 to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. The X2/MP5 has an IntelliVue Instrument Telemetry interface (IIT), is connected to a host monitor, and is declared as a telemetry device at the Information Center. NOTE The Transfer key is not available while the X2/MP5 is connected to a host monitor (Companion Mode is indicated). 1 Remove the X2/MP5 and any connected extensions from the host monitor. 2 Move the patient using the X2/MP5 as the transport monitor. 3 At the new location, just before connecting the X2/MP5 to the new host monitor:

open the Patient Demographics window. select the Transfer pop-up key. 100 4 Managing Patients wait until the transfer has completed. 4 Connect the X2/MP5 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patient's data and asking Complete Transfer Of This Patient?. Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor. 5 6 Verify that the settings for patient category and paced mode are correct. 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. Transferring a Patient with an X1 (no Information Center) Scenario: A patient is moved to another monitoring location using a transport monitor and re-admitted at the new monitor. 1 Disconnect the X1 from the original monitor and silence the resulting UNPLUGGED INOP. If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient's data. 2 Connect the X1 to the transport monitor and move the patient. 3 At the new monitoring location, remove the X1 from the transport monitor and connect it to the new monitor. If prompted, re-admit the patient to the new monitor: in the Select Patient window, select the patient in the X1 to retain the data in the X1. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X1 to the monitor. Verify that the settings for patient category and paced mode are correct. 4 Transferring a Patient with an X2 or MP5 (no Information Center) WARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A). Scenario: A patient is moved to another monitoring location using the X2 or MP5 and re-admitted at the new monitor. 1 Disconnect the X2/MP5 from the original host monitor and silence the resulting UNPLUGGED INOP. If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient's data. 2 Move the patient using the X2/MP5 as the transport monitor. 3 At the new monitoring location, connect the X2/MP5 to the new host monitor. 4 If prompted, re-admit the patient to the new monitor: in the Select Patient window of the new monitor, select the patient in the X2/MP5 to retain the data in the X2/MP5. This will upload the 101 4 Managing Patients patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the monitor. Verify that the settings for patient category and paced mode are correct. Data Upload from an MMS The Multi-Measurement Module stores eight hours of patient trend data at one-minute resolution. It also stores patient demographic information and the measurement settings (including the ST baseline) and calibration data for the measurements carried out by the MMS and any connected extensions. This data can be uploaded to an IntelliVue patient monitor, if your monitor is configured to do so and if at least five minutes of trend information is stored in the MMS. Your monitor's data upload settings are defined in Configuration Mode to suit your patient transfer use model. How data is uploaded to the host monitor depends on the configuration mode settings MMS Trend Upload and MMS Sett. Upload. If there is a patient mismatch and you select Continue Monitor, no data will be uploaded from the MMS. 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. Resolving Patient Information Mismatch an MMS and a monitor, an X2 or MP5 and a host monitor, a monitor and an Information Center, When you connect together devices which store patient demographic data, for example:

the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical. Depending on your monitor's configuration, this mismatch may be automatically resolved or you may have to resolve it manually. If your monitor is configured to resolve mismatches automatically, depending on the configuration, either the monitor or the Multi-Measurement Module data is automatically retained. WARNING 1 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. It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Cat., may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in 2 102 4 Managing Patients the case of asystole. It is important that the patient category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set. In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a

"telemetry device" at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center. Manually Resolving Patient Mismatch The patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor Info Line and in the Select Patient window. The monitor displays a message such as Different patients in Central and Monitor. The Select Patient 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. For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patient's data and ask Complete Transfer Of This Patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window. There can be up to three sets of demographic data in the Select Patient window if the patient is different in the Information Center, monitor, and MMS. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. 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 MMS. 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. Patient Mismatch - If One Set of Patient Data is Correct If there is a mismatch between an Information Center and a monitor, or a monitor and an MMS, choose the data set you want to continue using for this patient by selecting one of the sectors in the Select Patient window. 103 4 Managing Patients 1 2 Patient demographics Patient category and paced status Same Patient - see Patient Mismatch - If Both Patient Data Sets Are Correct on page 104. 3 4 New Patient - see Patient Mismatch - If Neither Patient Data Set is Correct on page 104. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. Patient Mismatch - If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient. Patient Mismatch - If Both Patient Data Sets Are Correct A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor. Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor. Patient Information Patient name Patient IDs Screen Notes This information is taken from... the monitor, if the patient was admitted there. For centrally-admitted patients, this information is taken from the Information Center. 104 Patient Information Patient Category Date of Birth Height Weight Gender Paced Status Trend data 4 Managing Patients This information is taken from... the Multi-Measurement Module, if connected, otherwise the data is taken from the monitor. Paced status is always set to Yes where there is a mismatch in patient information. if there is newer trend data stored in the MMS, it is uploaded to the monitor. Automatically Resolving Patient Mismatch Your monitor can be configured to automatically resolve mismatches in one of two ways. continue using the patient in the MMS, and delete the old data in the monitor. This is suitable for transport monitors. continue with the patient in the monitor, and delete the data in the MMS. Care Groups If your monitor is connected to an Information Center, you can group bedside monitors into Care Groups. This lets you:

view information on the monitor screen from another bed in the same or in a different Care Group. be notified of yellow or red alarm conditions at the other beds in the Care Group. see the alarm status of all the beds in the Care Group on each monitor screen. There are two main types of Care Groups:

standard care group (Bed-based Care Group) - up to 12 patients monitored by up to 4 Information Centers unit group (Unit-based Care Group) - for a complete unit with up to 64 patients monitored by up to 4 Information Centers Monitors must be assigned to these Care Groups at the Information Center. There is a third care group which can be assigned locally at the bedside. This is the My Central care group which includes all beds (up to 16) from the Information Center your bed is connected to. This care group setting is typically used in facilities with only one Information center. The selection of beds is automatic and cannot be changed. The functions available with Care Groups depend on the Information Center revision your monitors are connected to. See your Information Center Instructions for Use for further details. 105 4 Managing Patients Understanding the Care Group Overview Bar The Care Group monitors' status is shown in symbol form in the Care Group overview bar. Flashing symbols indicate active alarms, symbols that are not flashing indicate alarms that have been acknowledged. Selecting a bed symbol calls up the window for that bed or a setup window to select this. The Care Group overview bar must be configured to display on the monitor Screen. If it is not visible on your monitor, select a Screen which has been configured to show the bar. Some screens may show the Care Group monitors grouped together in a tabular format on the right hand side of the screen. Care Group Symbols (four alternative display possibilities depending on space available) No data from this bed The alarms are on but there are no currently active alarms at this monitor The highest priority alarm at this monitor is a standard INOP The highest priority alarm at this monitor is a short yellow alarm The highest priority alarm at this monitor is a yellow alarm The highest priority alarm at this monitor is a red alarm The highest priority alarm at this bed is a yellow INOP The highest priority alarm at this bed is a red INOP 106 Care Group Symbols (four alternative display possibilities depending on space available) Care Group Symbols (used in the Care Group overview bar and the My Care Group window) 4 Managing Patients The alarms at this monitor are suspended The monitor is in standby mode The monitor is in Demonstration mode The current monitor This is a telemetry bed This bed is on a wireless network. This bed is on a wired network. This is a "paired" bed, with a bedside monitor and a telemetry transmitter assigned. Viewing the My Care Group Window This window shows the alarm status, bed name, and patient name for every bed in the Care Group. The window for the Unit group shows first the beds of the Information Center this bed is connected to. By selecting the Information Center name at the top of the list, you can display a list of all Information Centers associated with the Unit group, and select another Information Center to view. To enter the My Care Group window, select the Other Patients SmartKey, if configured, or in the Main Setup menu, select My Care Group. 107 4 Managing Patients Use the My Care Group pop-up keys to navigate through the Care Groups:

My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed. Other Units lets you view a list of all the Care Units in your Care Domain. Select any Care Unit to view a list of the Information Centers connected to it. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Bed window for that bed. Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity. Viewing the Other Bed Window The Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network. Waves and numeric information from another bed are delayed. If configured, Other Bed information is displayed in color, using the colors defined by the Information Center. The Other Bed window can be configured to pop-up automatically when an alarm occurs at another bed. To avoid too many windows appearing (for example, in large care groups) and covering the monitor's own bed data on the screen, you can temporarily disable this automatic pop-up:

1 Select Main Setup then Network followed by Auto Window Select Disabled 2 When automatic pop-up is disabled in this way, an icon will appear as a reminder in the Care Group Overview Bar next to the monitor's own bed label automatic pop-up is disabled for five minutes or until you set it to Enabled again. To open the Other Bed window, select the required bed label or patient name in the Care Group Overview Bar. If you are in a Unit Group with many beds, the My Care Group window may open for you to select the bed. Depending on the configuration, the The Other Bed window may be configured to display embedded in a specially designed Screen. To display the embedded Other Bed screen element, in the Change Screen menu, select a Screen designed to show the Other Bed information permanently. 108 4 Managing Patients Note that a Screen with an embedded Other Bed screen element cannot be displayed on the D80 Intelligent Display. Changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check that the correct other bed is displayed. Other Bed Pop-Up Keys Select the Other Patients SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys:

Next Wave lets you view waveforms not currently shown in the other bed window. More Vitals lets you view more numerics not currently shown in the other bed window. Next Bed lets you view waveforms and numerics from the next available bed in the Care Group. My Care Group lets you call up the Care Group window to select another bed. Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity. Silence Bed lets you silence active alarms at the other bed. (Whether you see this key depends on the revision and configuration of the Information Center your monitors are connected to.) WARNING The Silence Bed pop-up key in the Other Bed window silences alarms at a remote bed. Be aware that accidental use of this key could silence alarms for the wrong patient. To silence own bed alarms use the Silence permanent key on screen. Visual Alarm Status Information in the Other Bed Window If individual alarms are switched off at the other bed, this is indicated by the crossed alarm symbol beside the measurement numeric. If alarms are switched off at the other bed, the message Alarms Off is shown in the other bed window. In the embedded Other Bed window, the crossed speaker symbol in the upper right hand indicates that the volume of the audible alarm status change notification for the other beds in the care group is set to zero at the overview monitor. 109 4 Managing Patients Care Group Alarms Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group. The visual and audible indicators used depend on the monitor and Information Center configuration. When an alarm is detected at another bed in the Care Group, the alarm status is shown in the Care Group overview bar as an icon. a message informing you about the care group alarm is shown in the monitor status line. if configured, the Other Bed window, the Alarming Beds window or the My Care Group window may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at the Information Center). The automatic alarm notification is suppressed when a window, menu or pop-up keys are active. if configured, an audible status change notification is issued. The tone type and volume can be configured. Automatic alarm notification can be switched off permanently in the monitor's Configuration Mode or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode:

1 Select the network symbol on the monitor screen to call up the Network menu. Select Auto Window to toggle between the settings Enabled and Disabled. 2 This setting resets to the default at discharge and when the monitor is switched on. Always re-enable the Auto Window as soon as possible. 110 5 5ECG, 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 About Arrhythmia Monitoring on page 129), ST monitoring (see About ST Monitoring on page 139) and QT monitoring (see About QT/QTc Interval Monitoring on page 149). Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor conductor of electricity. 1 2 Clip or shave hair from sites as necessary. 3 Wash sites thoroughly with soap and water, leaving no soap residue. Select sites with intact skin, without impairment of any kind. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance. 4 Dry skin thoroughly. 5 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 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. 2 3 Attach the electrode cable to the patient cable. 4 Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on the monitor display. 111 5 ECG, Arrhythmia, ST and QT Monitoring CAUTION 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 is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis. You should choose a lead as primary or secondary lead that has the following characteristics:

the QRS complex should be either completely above or below the baseline and it should not be biphasic the QRS complex should be tall and narrow the P-waves and T-waves should be less than 0.2 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. 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. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation. Understanding the ECG Display Your display may be configured to look slightly different. 112 5 ECG, Arrhythmia, ST and QT Monitoring 1 3 2 Lead label of the displayed wave 1 mV calibration bar Pacer spikes Pace pulse markers 4 5 Current heart rate 6 Current heart rate alarm limits 7 EASI lead placement label (located here when present) 8 ECG Filter label ECG HR numeric: This is the heart rate 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. 1 Pacer spikes configured to have a fixed size Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, or the 2nd Sync Out channel is configured to ECG SyncPuls and a sync cable is plugged in, 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 left side. Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this:

1 Normal Beats 2 Pace Pulses/Pace Beats You should choose a lead as primary or secondary lead that has these characteristics:

113 5 ECG, Arrhythmia, ST and QT Monitoring the normal QRS complex 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 complex 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. When Paced is set to Yes:

Paced Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes. 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). Non-Paced The paced symbol is displayed on the main screen. 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. 1 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. 114 5 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 Auto Size, or an individual size using the Size Up/Size Down keys, the calibration bar may be a different size for each wave. To Change the Size of an Individual ECG Wave 1 2 Select the wave segment you want to change. This calls up the lead menu for this segment. In the lead menu, select Size Up to increase wave size or Size Down to decrease the size. Selecting Auto Size lets the monitor choose the optimal adjustment factor for all available ECG waves. To Change the Size of all the ECG Waves 2 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. Select the required adjustment factor from the line of pop-up keys. Auto Size: to let the monitor choose the optimal adjustment factor for all the ECG waves. 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 Previous Size: to return one step to the previous size 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 menu select QRS Volume and then select the appropriate volume from the pop-up list. 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 Setup ECG menu, select Filter and then select the appropriate setting. Monitor: Use under normal measurement conditions. Ext. Monitor: Use when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting. 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 electrosurgical units. Under normal measurement conditions, 115 5 ECG, Arrhythmia, ST and QT Monitoring selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical 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: 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 6-lead 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 In the Setup ECG menu, select Va Lead. Select the position used from the list. Select Vb Lead and select the position used from the list. 2 3 Choosing EASI or Standard Lead Placement In the Setup ECG menu, select Lead Placement and then Standard or EASI. You must enable either standard lead placement or EASI lead placement. EASI is shown beside the 1 mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts. See the section on EASI ECG Lead Placement on page 125 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. 116 5 ECG, Arrhythmia, ST and QT Monitoring ECG Leads Monitored If you are using a 3-electrode set a 5-electrode set a 6-electrode set a 10-electrode set an EASI 5-electrode set these leads are available:

Resp is measured between electrodes:

RA and LL I, II, III RA and LL I, II, III, aVR, aVL, aVF, V and MCL I, II, III, aVR, aVL, aVF, Va, Vb RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Changing Lead Sets To change the ECG lead set, When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement. When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a LEAD OFF INOP message; select New Lead Setup in the Setup ECG menu 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 Electrode colors EASI I S A N E AAMI RA LA LL RL V V1 V2 IEC R L F N C C1 C2 AAMI White Black Red Green Brown Brown/Red Brown/Yellow IEC Red Yellow Green Black White White/Red White/Yellow 117 5 ECG, Arrhythmia, ST and QT Monitoring Electrode labels Electrode colors EASI AAMI V3 V4 V5 V6 IEC C3 C4 C5 C6 AAMI Brown/Green Brown/Blue Brown/Orange Brown/Violet IEC White/Green White/Brown White/Black White/Violet Standard 3-Lead Placement 1 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 2 3 118 Standard 5-Lead Placement 5 ECG, Arrhythmia, ST and QT Monitoring 1 RA placement: directly below the clavicle and near the right shoulder LA placement: directly below the clavicle and near the left shoulder 2 3 RL placement: on the right lower abdomen LL placement: on the left lower abdomen 4 5 V placement: on the chest, the position depends on your required lead selection 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 Setup ECG Menu to ensure correct labeling. 119 5 ECG, Arrhythmia, ST and QT Monitoring Chest Electrode Placement A - Angle of Lewis V1 on the fourth intercostal space at the right sternal border V2 on the fourth intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the fifth 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 V3R -V6R on the right side of the chest in positions corresponding to those on the left VE over the xiphoid process V7 on posterior chest at the left posterior axillary line in the fifth intercostal space V7R on posterior chest at the right posterior axillary line in the fifth intercostal space For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space. 1 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. 2 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. 120 Conventional 12-Lead ECG 5 ECG, Arrhythmia, ST and QT Monitoring 1 V1 - V6 LA 2 3 RA 4 RL LL 5 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 121 5 ECG, Arrhythmia, ST and QT Monitoring Modified 12-Lead ECG LA 1 2 V1-V6 LL 3 4 RL 5 RA 6 Angle of Lewis 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. Choosing Standard or Modified Electrode Placement If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch Mod.LeadPlacment to On in the monitor. To do this, in the Setup ECG menu, select Mod.LeadPlacment to toggle between On and Off. When Mod.LeadPlacment is set to On, 12 Lead ECG Reports will be labeled 12 Lead ECG Report (Mason-Likar), and captured 12-lead ECGs will be labeled Mason-Likar to the right of the bandwidth annotation at the Information Center. When Mod.LeadPlacment is set to Off, 12 Lead ECG Reports will be labeled 12 Lead ECG Report (Standard), 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. 122 5 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead You can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured ECG data and then store it and send it to a connected Information Center for analysis. You can also print a 12-Lead report. The monitor can store one 12-Lead ECG episode at any time. Viewing the Realtime 12-Lead ECG Select the Capture 12 Lead SmartKey, or Select Main Screen, then Capture 12 Lead. To open the 12-Lead ECG window and view the realtime ECG waves, If a previously viewed 12-Lead ECG was not stored, a window will pop up asking whether you want to keep it or not. The title bar of the window shows the date and time when this 12-Lead ECG was captured. If you do not need the ECG, select No to discard it, otherwise, select Yes and then select Store & Send to store that 12-Lead ECG and send it to an Information Center (if one is connected). If your patient is not admitted, you will be prompted to enter at least the age and gender of the patient. This information is needed for analysis of the 12-Lead ECG at the Information Center but is not essential if you only want to capture the 12-Lead ECG without sending it for analysis. To enter this information:

1 2 Enter the information in the Patient Demographics window. 3 Open the 12-Lead ECG window again as described above. Select the Admit Patient pop-up key, then The age and gender will now be displayed in the title bar of the pop-up keys. To change the way the realtime waves are displayed, select the Change View pop-up key or select the wave area. You can switch between a one or two column display. The two column display lets you see a larger representation of the waves. While the realtime 12-Lead waves are being viewed in the window, the ECG filter mode (see Changing the ECG Filter Settings on page 115) is changed to the 12-Lead filter setting (see Setting Up the 12-Lead ECG on page 124). Capturing the 12-Lead ECG To capture the last 10 seconds of ECG data, select the Capture Waves pop-up key. The pop-up key is active as soon as enough wave data is available; until then a progress bar is displayed in the title bar of the pop-up keys. A preview of the captured data appears on the screen (unless your monitor is connected to an Information Center with software release earlier than Revision M then the captured data is automatically stored and sent to the Information Center). The title bar of the pop-up keys will now show the current filter setting and, if you are using EASI lead placement, an EASI indicator (see EASI ECG Lead Placement on page 125). You can at any time return to the realtime 12-Lead ECG view by selecting the Show Waves pop-up key. From there, you return to the preview window by selecting the Show Preview pop-up key. 123 5 ECG, Arrhythmia, ST and QT Monitoring Setting Up the 12-Lead ECG In the Preview window, select the Setup 12 Lead pop-up key to choose settings for filter, gain, etc., if changes are needed. All changes apply to both the display and the printed 12-Lead report. Filter Applies a filter to the waveforms. Choices are 0.05-150Hz D, 0.5-150Hz eM, 0.5-40Hz M (or 0.5-55Hz M for pediatric and neonatal patient categories), 0.5-20Hz F. The selected filter will be displayed in the title bar of the pop-up keys. Defines the gain used for the waveforms. Choices are 2.5 mm/mV, 5 mm/mV, 10 mm/mV and 20 mm/mV. Defines the gain for the chest leads relative to the standard gain setting. Choices are Full and Half. Defines the waveform speed. Choices are 25 mm/sec and 50 mm/sec. Defines the page layout. Choices are 12X1, 6X2, 3X4, 3X4 1R and 3X4 3R. 1R and 3R refer to 1 or 3 rhythm leads. Defines whether all leads show simultaneous or sequential intervals of time, when displaying or printing 2 or more columns. Choices are Sequential and Simultaneous. Defines which lead will be used as rhythm lead 1, 2 or 3. Choices are Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V, MCL. This setting is only relevant when 3X4 1R or 3X4 3R is selected as Format. Defines the sequence in which the leads are presented. Choices are Cabrera and Internat. Gain Chest Gain Paper Speed Format Time Rhythm Lead 1 Rhythm Lead 2 Rhythm Lead 3 Lead Sequence Storing and Sending the 12-Lead ECG You can enter an order number that will then be associated with the 12-Lead ECG. To enter an order number, select the Enter OrderNo. pop-up key. The order number will be displayed in the title bar of the pop-up keys. To store the previewed data on the monitor and send it to a connected Information Center for storage and analysis, select the Store & Send pop-up key. If the monitor is connected to an Information Center, use the Store & Send function before patient transport to store the 12-Lead ECG centrally, as the 12-Lead ECG data will not be uploaded from the MMS to another monitor after transport. If the connection to the Information Center is not active while storing, the 12-Lead ECG will be automatically sent as soon as the connection is established or restored. If a previously stored 12-Lead ECG is waiting to be sent to the Information Center, it will be overwritten when a new 12-Lead ECG is stored and can then not be sent to the Information Center. Printing the 12-Lead ECG Print a dedicated 12-Lead ECG report by selecting the Print Report pop-up key. 124 Capture 12-Lead Pop-up Keys Here is a summary of all the pop-up keys available during 12-Lead ECG procedure:

5 ECG, Arrhythmia, ST and QT Monitoring Pop-up Keys Admit Patient Change View Capture Waves Show Waves Show Preview Setup 12 Lead Enter OrderNo. Print Report Store & Send Show Stored Selecting this pop-up key lets you enter the age and gender for the patient in the Patient Demographics window, to allow analysis of the 12-Lead ECG. switch between the single column and two-column display of the realtime wave data. capture the current ECG waves and open the preview window. return to the realtime 12-Lead ECG view. show the preview of the captured 12-Lead wave data. choose settings for filter, gain, display layout, etc. enter an order number that is stored with the capture and displayed in the title bar of the pop-up keys. print a 12-Lead report. store the captured 12-Lead ECG in the monitor and send it to the Information Center. view a previously stored 12-Lead ECG, allowing a visual comparison between the current and the stored data. 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. 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. 125 5 ECG, Arrhythmia, ST and QT Monitoring EASI Electrode Placement 1 E (V) - on the lower sternum at the level of the fifth intercostal space 2 A (LL) - on the left midaxillary line at the same level as the E electrode S (LA) - on the upper sternum I (RA) - on the right midaxillary line at the same level as the E electrode 3 4 5 N - reference electrode - can be anywhere, usually below the sixth rib on the right hip 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 126 5 ECG, Arrhythmia, ST and QT Monitoring Cardiotach Alarms

***Asystole

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**High heart rate

**Low heart rate Additional Alarms with Basic Arrhythmia Option

***Ventricular Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**PVCs/min HIGH (PVC >

limit/min) Additional Alarms with Enhanced Arrhythmia Option

**Afib

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs 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 chapter. Special alarm features which apply only to ECG are described here. Extreme Alarm Limits for Heart Rate 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 value) to the high and low alarm limits. 1 Extreme Brady Limit Low Limit 2 3 High Limit 4 Extreme Tachy Limit 5 Extreme Brady 6 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 ExtrTachy and ExtrBrady. 127 5 ECG, Arrhythmia, ST and QT Monitoring ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the Alarms Off setting for ECG 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 Detect. 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. ECG Safety Information 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. 128 5 ECG, Arrhythmia, ST and QT Monitoring 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. 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 Ventilation rate 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 single-

lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously 129 5 ECG, Arrhythmia, ST and QT Monitoring 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 labeling. 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 126, the rhythm and ectopic messages detected are listed in Arrhythmia Status Messages on page 132. 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. Switching Arrhythmia Analysis On and Off In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off. Select the Confirm pop-up key which appears at the bottom of the screen. 1 2 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 complex 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. 130 5 ECG, Arrhythmia, ST and QT Monitoring 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 Alarm normal beat RR intervals must be irregular PR interval deviation must be large P-wave region must not match well The monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability. In order to generate an Afib alarm the following criteria must be detected for 1 minute:

Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm. An Afib alarm can be falsely detected in the presence of:

sinus arrhythmia, muscle noise, or If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations. See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis. electrode motion artifact. 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. 131 5 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display Your monitor screen may look slightly different from the illustration. 1 Beat label Pace pulse marks 2 3 Rhythm status message PVC Numeric 4 5 HR Numeric 6 Ectopic status message 7 Delayed arrhythmia wave Viewing Arrhythmia Waves To review arrhythmia beat labels, in the Setup Arrhythmia menu, select Annotate Arrhy. The wave showing the primary ECG lead will be delayed by six seconds and shown on a gray 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 Arrhythmia Status Messages The monitor displays two types of status messages:

132 5 ECG, Arrhythmia, ST and QT Monitoring 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 Asystole Vent Fib/Tach Vtach Sustained VT Vent Rhythm No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal A fibrillatory wave for 4 consecutive seconds A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate Limit Ventricular tachycardia rhythm for more than 15 seconds A dominant rhythm of adjacent PVCs and a HR the V-Tach HR Limit 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 Vent Bigeminy Vent Trigeminy Paced Rhythm Irregular HR Sinus Brady Sinus Rhythm Sinus Tach SV Brady SV Rhythm SV Tach Unknown ECG Rhythm Rhythm cannot be determined Learning ECG Learning Rhythm CANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be Algorithm is learning the ECG beat morphology Algorithm is learning the rhythm of the classified beats A dominant rhythm of SV beats not preceded by P-waves analyzed Ectopic Status Messages The label B or E indicates basic (B) or enhanced (E) arrhythmia capability. B or E B, E B, E B, E E E E E B, E E B, E B, E B, E B, E B, E B, E 133 5 ECG, Arrhythmia, ST and QT Monitoring Ectopic Status Message Explanation

(No message displayed) Run PVCs Pair PVCs Pacer Not Capt No ectopic activity within the last minute More than 2 consecutive PVCs within the last minute Pair PVCs within the last minute Pause with pace pulse (paced patient only) within the last minute Pause without pace pulse (paced patient only) within the last minute 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. 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 B or E E E B, E B, E E E E E E B, E B, E Pacer Nt Pacing Pause R-On-T PVCs Multiform PVCs Frequent SVPBs SVPBs SV Beats Paced Beats Arrhythmia Relearning During a learning phase:

Alarm timeout periods are cleared Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No Stored arrhythmia templates are cleared other alarms are active. Initiating Arrhythmia Relearning Manually To initiate relearning manually, in the Setup Arrhythmia 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. 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. 134 5 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 alarm 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). 135 5 ECG, Arrhythmia, ST and QT Monitoring 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. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply. WARNING When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-

star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. 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:

Non-Sustain, Vent Rhythm, Run PVCs, Pair PVCs, R-On-T PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, IrregularHR, Missed Beat, PVCs/min and Afib. 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, when more alarms are switched off than configured in your active profile. 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:

VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold 1 To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted. Select the appropriate setting from the pop-up list. 2 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:

136 5 ECG, Arrhythmia, ST and QT Monitoring 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. See Arrhythmia Alarm Chaining on page 138 for more details on alarm chains. 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 138. To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd. This setting can only be changed in Configuration Mode. Resetting the Timeout Period To reset the timeout period, select the Alarms Off or Pause Alarms permanent key and then reselect it. 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 except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:

Alarm Condition Example Short yellow alarm tone sounds Alarm message Single alarm instance Continuous alarm condition Non-sustained V-

tach PVCs/min HIGH when alarm condition is initially when alarm condition is initially detected detected and - as an alarm reminder - every time the configured timeout period has expired each time the alarm condition is detected, provided that the configured timeout period has expired Same intermittent alarm condition Pair of PVCs displayed 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 every time the configured timeout 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 timeout period, so you will not get a realarm for the same condition or lower on the chain until the timeout expires. 137 5 ECG, Arrhythmia, ST and QT Monitoring 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 126 for information on which alarms are included in the different arrhythmia options. See Arrhythmia Alarm Timeout Periods on page 136 for an explanation of how alarm timeouts work. 138 5 ECG, Arrhythmia, ST and QT Monitoring 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. 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). 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 8, and the V-Tach HR Limit is set to 100. 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. 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. 139 5 ECG, Arrhythmia, ST and QT Monitoring 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. WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example:

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 and 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. 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 Choose a lead from the list in the Setup ST Leads window. Select the Delete key. This removes this lead from the list. 2 NOTE The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen. To change the order in which ST leads are displayed, 1 In the Setup ST Leads menu, choose a lead from the list. Select the Sort Up or Sort Down key to move the lead up or down in the list. 2 140 5 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display Your monitor screen may be configured to look slightly different from the illustrations. ST numerics 1 2 Current HR alarm limits 3 Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor 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 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 list in Setup ST Leads, in the Setup ST Analysis menu. 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 ST index numeric will display a question mark "?". To switch the ST index numeric on or off for display, in the Setup ST Analysis menu, select ST-Index to toggle between On and Off. 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. If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select a Screen configured to show snippets from the pop-up list of available Screens. 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. The Baseline Window opens with the ST pop-up keys Update Baseline, Record ST, Change ST Lead, Adjust ST Points, ST Map and arrow keys for scrolling through the available leads. To view the ST Baseline window, select any snippet on the Screen. 141 5 ECG, Arrhythmia, ST and QT Monitoring ST label and numeric 1 2 Baseline ST numeric 3 Difference between current values and baseline values 4 5 Current snippet 6 7 Timestamp of most recently stored baseline snippet 1 mV calibration bar ST baseline 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 an ST snippet to open the ST Baseline window. In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines. 2 An ST baseline copy is also stored in the MMS, for transport purposes. Recording ST Segments To record all currently available ST snippets and baselines, in the ST Baseline window, select the pop-

up key Record ST. 142 5 ECG, Arrhythmia, ST and QT Monitoring 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. J point, for example, 48 msec 1 R-wave peak at 0 msec 2 3 Difference = ST value 4 ST measurement point, for example, J + 60 msec Isoelectric point set to -80 msec 5 P 6 7 Q S 8 9 T 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 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. 2 143 5 ECG, Arrhythmia, ST and QT Monitoring 3 Use the Select Point pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active. 1 ST label and the ST numeric that would apply using the current points 2 1mV calibration bar 3 Cursors for adjusting ST points 4 Timestamp of most recent ST point adjustment 5 Highlighted ST point The ISO-point cursor (1) 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 (2) 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. 144 5 ECG, Arrhythmia, ST and QT Monitoring To position the ST-point (3) 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. 4 5 To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key. 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 menu, select ST Alarm Mode and select either Single ST or Multi ST. 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 In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST. Select the alarm to be adjusted. Select the appropriate setting. 2 3 145 5 ECG, Arrhythmia, ST and QT Monitoring 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. 1 Alarm status indicator 2 3 4 5 EASI Limb Leads EASI Chest Leads ST index (for EASI) ST label, value and polarity of corresponding lead ST map 6 If an ST lead is switched off, its axis is not shown in the map. 146 5 ECG, Arrhythmia, ST and QT Monitoring If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is off), 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. 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. Limb Leads 1 2 Chest Leads 3 current ST values trending interval 4 147 5 ECG, Arrhythmia, ST and QT Monitoring 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 Main Setup 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 Select Current View or Trend View to toggle between views. To switch 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 276. 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 then select 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. 148 Changing the Trending Interval 5 ECG, Arrhythmia, ST and QT Monitoring To determine how frequently the monitor displays a trended sample, 1 In Trend view, select Select Interval. Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. 2 Printing an ST Map Report To print the most recently viewed (current or trend) window, 1 Select Main Setup then select Reports. Select ST Map. Press Print. 2 3 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. The QT interval (1) 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 labeled 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). 149 5 ECG, Arrhythmia, ST and QT Monitoring 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. 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 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 Some conditions may make it difficult to achieve reliable QT monitoring, for example:

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. 150 5 ECG, Arrhythmia, ST and QT Monitoring 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. Select QT Lead and select All, Primary Lead or one of the available single leads. 2 When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads. Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT View In the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads. Changing The View To A Single Wave Set To view one set of waves in a larger scale, you can cycle through the different views, 1 Select Current view to see the set of current waves. Select Baseline view to see the set of baseline waves. Select Split view to return to the combined view with current and baseline waves. 2 3 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 QTc value. 151 5 ECG, Arrhythmia, ST and QT Monitoring Select Set Baseline and set the value. To set the baseline, 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 QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a QTc alarm from being generated. Discharging a patient clears the baseline. Printing The QT Waves To start a printout, Select Print QT. Recording The QT Waves To start a recording, Select Record QT. QT Alarms There are two QT alarms, QTc high limit alarm and QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The QTc 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. The following additional messages on the cause of the invalid measurements may also be displayed. Additional Message QT Startup Asystole or Leads Off Insufficient Valid Leads Invalid Rhythm for QTc High QT-HR Small R Wave Small T Wave Cause of Invalid QT Measurement QT monitoring was just turned on or has been reset 1 Not all specified leads needed to perform QT analysis are available, or 2 Asystole condition is detected Not enough valid QRS complexes to generate a QT measurement Not enough valid RR intervals to generate QT-HR, the averaged HR used for QTc calculation QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics) R-wave of the signal is too small T-wave of the signal is too small 152 5 ECG, Arrhythmia, ST and QT Monitoring Additional Message End of T not Detected QT out of Range QTc out of Range QTc Erratic Cause of Invalid QT Measurement End of the T-Wave cannot be accurately detected QT measurement is outside the specified range of valid QT values

(200-800 msec) QTc measurement is outside the specified range of valid QTc values

(200-800 msec) QTc measurements are not stable 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 High Alarm or QTc High 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 In the Setup QT Analysis menu, select QTc High Limit. Select the appropriate setting. Select QTc High Limit. Select the appropriate setting. 2 3 4 Switching QT Monitoring On and Off To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analysis to switch between On and Off. 153 5 ECG, Arrhythmia, ST and QT Monitoring 154 6 6Monitoring 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 SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the Monitoring Invasive Pressure chapter 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 menu for that pulse source. If no pulse numeric is visible, in the Setup SpO menu or the setup menu from an arterial pressure, select pulse with the correct source, e.g. Pulse (HR). System Pulse Source 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. The currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:

To define which pulse rate is used as system pulse, In the Setup Pulse menu, select System Pulse. 1 Select one of the SpO2 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. 2 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. 155 6 Monitoring Pulse Rate 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 SpO2 pulse numeric on or off, 1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO menu. In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO), to toggle between On and Off. 2 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 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 Alarm Source in the ECG/Pulse Alarms menu, then select ECG/Arrhythm: 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 alarm source 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. 156 6 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 126, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow

(medium severity) INOP after a fixed number of hours. High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active. Alarm Source Selection Disabled If you cannot change the alarm source, selection of the alarm source may be disabled. If you try to change the source, the monitor displays the message To activate enter Config and enable Alarm Source Selection. 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 SpO2 is 30 bpm; from HR 15 bpm, and from Pressure 25 bpm. Extreme Alarm Limits for Heart Rate 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 ExtrTachy and ExtrBrady. 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 SpO and Setup ECG menus and the QRS tone modulation in the Setup SpO menu. WARNING The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis. If arrhythmia detection is needed, do not rely on the audible QRS tone. 157 6 Monitoring Pulse Rate 158 7 7Monitoring 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. 159 7 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 Resp wave label 2 One Ohm calibration bar 3 Manually-set Resp detection level 4 Resp numeric and label Changing Resp Detection Modes The Resp detection level can be set either automatically or manually. To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings. 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, 160 7 Monitoring Respiration Rate (Resp) the detection level (a dotted line) is not displayed on the waveform, 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 on page 160. 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. 161 7 Monitoring Respiration Rate (Resp) 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 In the Setup Resp menu, select Apnea Time. Select the appropriate setting. 2 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 162 7 Monitoring Respiration Rate (Resp) 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 electrosurgery is being performed. Rate adaptive pacemakers Implanted pacemakers which can adapt to the Minute Ventilation rate 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. 163 7 Monitoring Respiration Rate (Resp) 164 8 8Monitoring SpO2 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements:

Oxygen saturation of arterial blood (SpO2) - 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 SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information. SpO2 Sensors Depending on the purchased SpO2 option, different sensors and adapter cables can be used. The sensors for the different options are color-coded to match the connectors. See the Accessories chapter for a compatibility table. 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 when there is a known allergic reaction to the adhesive. Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor. Applying the Sensor Follow the SpO2 sensor's instructions for use, adhering to all warnings and cautions. 1 2 Remove colored nail polish from the application site. 165 8 Monitoring SpO2 3 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. 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 Proper Sensor Fit: 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 regularly. 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 41C on the skin if the initial skin temperature does not exceed 35C. Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, an NBP cuff or an intravascular venous infusion line. Connecting SpO2 Cables Connect the sensor cable to the color-coded socket on the measurement device (MMS or module). You can connect some Philips sensors directly to the measurement device. 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 SpO2 1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 166 8 Monitoring SpO2 2 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. WARNING For fully conscious pediatric or adult patients, who have a normal function of perfusion and sensory perception at the measurement site:

To ensure skin quality and correct optical alignment of the sensor, inspect the application site when the measurement results are suspicious or when the patient complains about pressure at the application site, but at least every 24 hours. Correct the sensor alignment if necessary. Move the sensor to another site, if the skin quality changes. For all other patients:

Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. Correct the sensor alignment if necessary. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours. Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements. Inaccurate measurements may result when the application site for the sensor is deeply pigmented or deeply colored, for example, with nail polish, artificial nails, dye or pigmented cream. Interference can be caused by:

High levels of ambient light (including IR warmers) or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.) Another SpO2 sensor in close proximity (e.g. when more than one SpO2 measurement is performed on the same patient). Always cover both sensors with opaque material to reduce cross-interference. Electromagnetic interference, especially at perfusion indicator values below 1.0 or signal quality indicator below medium. Excessive patient movement and vibration. SpO2 Signal Quality Indicator (Fast SpO2 only) The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the displayed values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled. 167 8 Monitoring SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse. When pulse rate is very low, or strong arrhythmia is present, the SpO2 pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value. If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality. WARNING 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. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling. Changing the Averaging Time Depending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high. 1 In the Setup SpO menu, select Average. Select the required averaging time from the list. 2 Understanding SpO2 Alarms This refers to SpO2 specific alarms. See the Alarms chapter for general alarm information. SpO2 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 SpO2 on a limb that has an inflated noninvasive blood pressure cuff, a non-pulsatile SpO2 INOP can occur. If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating a critical status, such as sudden pulse loss or hypoxia. 168 Alarm Delays 8 Monitoring SpO2 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 general system delay time is 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 alarm signal delay time. The alarm delay time can be configured to a fixed value (between 0 and 30 seconds) or the monitor can be configured to apply a delay based on an intelligent algorithm. See About Smart Alarm Delays on page 169 for details on how this works. See Performance Specifications on page 399 for delay specifications. About Smart Alarm Delays The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control. The monitor can be configured to apply a delay before announcing SpO2 limit alarms. The delay is calculated using an intelligent algorithm. This capability can be used to suppress alarms which occur because a limit is exceeded for a short time or by a small amount. WARNING Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are. the amount by which a limit is exceeded the time it is exceeded for, and hence the speed with which the values change when a limit is exceeded The following factors are considered when calculating the delay:

If the measured value rises, or falls, very quickly, an alarm will be announced with only a short delay. If the value changes slowly, the delay will be longer before an alarm is announced. And if the value changes slowly and only for a short time, an alarm may not be announced at all. Here are some specific examples to illustrate this. Examples In the examples, the SpO2 low alarm limit is set to 90%, and the Smart Alarm Delay is configured on. The measured SpO2 signal is represented by the dotted curve. The vertical axis (V) shows the change in the SpO2 value and the horizontal axis (T) shows the time. 169 8 Monitoring SpO2 In example 1, the SpO2 value is dropping quickly and goes below the low alarm limit at the point marked a. At the point marked b it also crosses into the shaded area which represents the Smart Alarm Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between a and b, is short. In example 2, the SpO2 value is dropping more slowly and goes below the low alarm limit at the point marked c. At the point marked d it also crosses into the shaded area which represents the Smart Alarm Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between c and d, is this time longer. In example 3, the SpO2 value drops slowly below the low alarm limit and after a short time increases again above the limit. As the value never crosses into the shaded area which represents the Smart Alarm Delay criteria, no alarm is announced. However, if a limit is exceeded by a small amount for a very long time, an alarm will be announced. For this case there is a maximum delay time after which an alarm will always be announced. Configuration To accommodate different levels of patient stability, there are three different Smart Alarm Delay settings: Short, Medium and Long, which correspond to three different sets of criteria (three different shaded areas). The appropriate setting for the treatment area where the monitor is to be used is decided during monitor configuration. The Short setting ensures a quick response to changing conditions for less stable patients. The Medium and Long settings extend the delay to avoid unnecessary alarms for more stable patients. For detailed numeric information about the different settings, see the SpO2 section in the Specifications chapter. For background information as a basis for the decision for a specific setting, see the Configuration Guide. Adjusting the Alarm Limits In the Setup SpO menu:

Select High Limit then choose the high alarm limit. Select Low Limit then choose the low alarm limit. 170 8 Monitoring SpO2 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 high 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 Adjust the limit. In the Setup SpO menu, select Desat Limit. 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. 1 Minimum size for reliable SpO2 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 SpO2 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:

When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric. In the Setup SpO menu, select Set Perf Ref.. 171 8 Monitoring SpO2 Setting SpO2/Pleth as Pulse Source 1 2 In the Setup SpO menu, select Pulse (SpO) to enter the Setup Pulse menu. In the Setup Pulse menu, select System Pulseand select the correct SpO2 label from the pop-up list. Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 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 menu, select Tone Modulation to switch between Yes (for on) and No (for off). Tone modulation is licensed under US patent US 4.653.498 from Nellcor Puritan Bennett Incorporated. Setting the QRS Volume In the Setup SpO menu, select QRS Volume and set the appropriate QRS tone volume. Calculating SpO2 Difference When a second SpO2 measurement is present (either through the SpO2 module or through an external device), the monitor displays both SpO2 values, and calculates the difference between them. The second value is subtracted from the first. 1 From the Main Setup menu, select Measurements. From the Setup SpOmenu, select First SpO. 2 3 Choose the first measurement source. 4 5 Choose the second measurement source. Select Second SpO. 172 9 9Monitoring 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 in cases of sickle-cell disease or any condition where skin damage has occurred or is expected. 173 9 Monitoring NBP Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements in cases of severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff. 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:

with excessive and continuous patient movement such as shivering or convulsions with cardiac arrhythmias 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 if a regular arterial pressure pulse is hard to detect the artery on an edematous extremity. The effectiveness of this sphygmomanometer has not been established in pregnant, including pre-

eclamptic patients. Measurement Modes There are four modes for measuring NBP:

Manual - measurement on demand. Auto - continually repeated measurements (between one minute and 24 hours 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 measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-arterial). For further information, see the Application Note supplied on the monitor documentation DVD. 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. In Adult and Pediatric mode, to check the current setting, select Main Setup then Measurements followed by NBP, and check whether the Reference setting is set to Auscultatory or Invasive. This setting can only be changed in Configuration Mode. 174 Preparing to Measure NBP 9 Monitoring NBP 1 Connect the cuff to the air tubing. 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 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. 4 Apply the cuff to a limb at the same level as the 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 0.75 mmHg (0.10 kPa) for each centimeter higher or deduct 0.75 mmHg (0.10 kPa) for each centimeter lower or add 1.9 mmHg (0.25 kPa) for each inch higher. deduct 1.9 mmHg (0.25 kPa) for each inch lower. Understanding the NBP Numerics 1 Alarm source 2 Measurement Mode 3 Timestamp/Timer 4 Mean pressure 5 Diastolic Systolic 6 7 Alarm limits 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. 175 9 Monitoring NBP The measured NBP value, together with the corresponding pulse rate if this is switched on, will be displayed for one hour. After that the values are regarded as invalid and are no longer displayed. In Auto mode the measurement values may disappear more quickly (to be replaced by new measurement values), if the repeat time is set to less than one hour. Alarm Sources If you have parallel alarm sources, the sources are displayed instead of the alarm limits. NBP Timestamp Depending on your configuration, the time shown beside the NBP numeric can be:

the time of the most recent NBP measurement, also known as the "timestamp", or the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here. The NBP timestamp will normally show the completion time of the NBP measurement. Only under the following conditions the timestamp shows the beginning of the measurement:

when in Auto or Sequence mode, and the monitor is configured to synchronize the measurements in a measurement series to an "easy-

to-document" time. For example, if you start the first measurement at 08:23, and the Repeat Time is set to 10 minutes, the monitor automatically performs the next measurement at 8:30, then 8:40 and so on. 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, SmartKeys or the MMS hardkey to start and stop measurements. 176 9 Monitoring NBP Action to be performed Start manual measurement Start Auto series NBP Setup menu Start/Stop SmartKeys MMS hardkey Start/Stop Start/ Stop

Start STAT measurement NBP STAT Stop Manual measurements Start/Stop Stop current Auto measurement Start/Stop Stop current STAT measurement and end series Start/Stop NBP STAT Stop Auto, Manual or STAT measurement AND series Stop All Start NBP NBP STAT Start STAT Start/ Stop Stop NBP Start/ Stop Stop NBP Start/ Stop NBP STAT Stop NBP Stop All STAT (for MMS without Pressure/Temp measurement) Start/Stop Start/Stop Start/Stop STAT (for MMS without Pressure/Temp measurement) 177 9 Monitoring NBP CAUTION Use clinical judgment 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 Mode and select Auto from the pop-up menu. For an automatic measurement, select Repeat Time and set the time interval between two measurements. Enabling Sequence Mode and Setting Up The Sequence 1 2 3 In the Setup NBP menu, select Mode and select Sequence from the pop-up menu. Select Setup Sequence to open the Setup 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. 4 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 Alarms from and choose from:

178 9 Monitoring NBP Menu option Sys. Dia. Mean Sys & Dia Dia & Mean Sys & Mean Sys&Dia&Mean Pressure value monitored 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. Check that the mean alarm limits are appropriate for the patient, even when not using mean as the alarm source. 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 Setup NBP menu select Pulse (NBP). 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 In the Setup NBP menu select VeniPuncture. Puncture vein and draw blood sample. 2 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. NOTE Performing a venous puncture while automatic or sequence NBP measurements are being made suspends the measurement series for the duration of the venous puncture inflation and for three minutes afterwards. Calibrating NBP NBP is not user-calibrated. Cuff-pressure transducers must be verified at least once every two years by a qualified service professional, and calibrated, if necessary. See the Service Guide for details. 179 9 Monitoring NBP 180 10 10Monitoring Temperature WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension

(865297). You can measure temperature using an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions, or the temperature plug-in module. Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually. Making a Temp Measurement 1 2 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. 3 4 Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes. 5 6 Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and Select an appropriate temperature label. this type of temperature measurement. 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 In the Setup <Temp Label> menu, select Label. 181 10 Monitoring Temperature 2 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 TEMP. 1 In the Main Setup menu, select Measurements. In the Setup Temp menu, select First Temp. Label the measurement source as appropriate. Select Second Temp. Label the measurement source as appropriate. 2 3 4 5 182 11 11Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension

(865297). CAUTION Do not use the X2 in combination with 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 an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions or the pressure plug-in module. With the plug-in module you may see a wave channel before the pressure cable is plugged in - with the MMS this will not be the case. Setting up the Pressure Measurement 1 2 3 Plug in the pressure cable. 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. 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. 1 Connect the pressure line to the patient catheter. 2 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. 3 183 11 Monitoring Invasive Pressure 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 In the Setup <Press Label> menu, select Label. Select the appropriate label from the list. 2 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 P PAP RAP UAP UVP Description 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. Label BAP FAP IC1, IC2 P1, P2, P3, P4 Description Brachial arterial pressure Femoral arterial pressure Alternative intracranial pressures 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. You must perform a zero:

when you use a new transducer or tubing every time you reconnect the transducer cable to the monitor 184 11 Monitoring Invasive Pressure if you think the monitor's pressure readings are not correct. When using a pressure module, the zero information is stored in the module. When a pressure module, with the transducer connected, is plugged into the monitor, the monitor will use the Zero stored in the module. 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 Multi-Measurement module or pressure module 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. Turn off the stopcock to the patient. 1 2 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 Label>. 3 4 When you see the message <Press Label> zero done at <date and time> on the status line, close the stopcock to atmospheric pressure, and open the stopcock to the patient. CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. 185 11 Monitoring Invasive Pressure Using the Zero Hardkey Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module. Pressing the Zero hardkey for two seconds on the M3001A Multi-Measurement module zeros the pressure being measured by the Multi-Measurement module and the pressures from any connected MMS extensions. 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 Press 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 unable to zero -

equipment malfunction unable to zero -

excessive offset unable to zero -

unstable signal unable to zero - no transducer unable to zero -

pulsatile pressure unable to zero - timed out Switch on first Corrective Action The hardware is faulty. Contact your service personnel. 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. 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. Try pressing the Zero hardkey or Zero <Press Label> key again. If this fails, replace the transducer and adapter cable and contact your service personnel. Pressure measurement is switched off. To switch it on, in the Setup <Press Label> 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. 186 11 Monitoring Invasive Pressure 1 In the Setup <Press Label> 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. 2 To confirm you want to use the new calibration factor, select the Confirm pop-up key. 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 3 Select the label of the pressure wave whose scale you want to set to enter the Setup <Press Label> menu. In the Setup <Press Label> menu, (for example ABP) select Scale. 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 Label> menu, select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave. Using the Wave Cursor When the pressure wave is selected, you can display a cursor in the wave. It appears as a white horizontal line in the wave. Using the pop-up keys you can move the cursor up or down to the required position and store the corresponding value. The cursor value can be stored as a systolic, diastolic or mean pressure value, as an IAP (intra-abdominal pressure) value - for the waves P, P1 to P8, if IAP is configured as a measurement which can be manually entered as a PAWP value - if the pressure wave is a PAP wave The stored value appears in the trend database as a manually entered value. To display and position the cursor 1 2 3 Use the pop-up arrow keys to position the cursor. Using the pop-up keys you can also change the scale or the speed for the wave, freeze the wave or start a printout or recording. Select the pressure wave. Select Activate Cursor. 187 11 Monitoring Invasive Pressure 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 Suppr. is configured to 30 sec, 60 sec, or 90 sec). During artifact suppression, the monitor shows the INOP message <Press Label> ARTIFACT, and a question mark is shown beside the pressure numerics. Pressure alarms and the <Press Label> NON-PULSATILE INOP are suppressed during the configured period. The CPP alarms are 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 Label> menu, select Alarms from and choose the source. Menu option Sys. Dia. Mean Sys & Dia Dia & Mean Sys & Mean Sys&Dia&Mean Pressure value monitored systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel Select and set the High Limit and Low Limit for the pressure(s) you have selected. Extreme Alarm Limits for Pressure 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 value) to the high and low alarm limits. This value can be set for each pressure label individually. 188 11 Monitoring Invasive Pressure 1 Extreme Low Limit Low Limit 2 3 High Limit 4 Extreme High Limit 5 Extreme Low 6 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 Label> menu, see the menu items Extreme High and Extreme Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message. 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 Zero the transducer. 2 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. 189 11 Monitoring Invasive Pressure d. Open the port to the manometer. 1 Tubing to manometer 2 Syringe with heparinised solution 3 To pressure connector on monitor 4 Patient connection stoppered 5 Off 3 Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the recommended calibration pressure. In the Setup <Press Label> menu, select Cal. Press. Select the calibration pressure from the list, for example 200 mmHg. Select Confirm to recalculate the calibration factor using the applied pressure. 6 7 When the monitor displays <Press Label> mercury calibr. 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. 4 5 8 9 Reconnect the patient and start measuring again. Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration. Message unable to calibrate - equipment malfunction Corrective Action Contact your service department. The pressure hardware is faulty. 190 11 Monitoring Invasive Pressure Message unable to calibrate - out of range 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. Corrective Action unable to calibrate - no transducer unable to calibrate - unstable signal unable to calibrate - perform zero first Make sure there are no disturbances to the transducer, and repeat the calibration. No valid zero. Zero the transducer. Calculating Cerebral Perfusion Pressure The monitor can calculate the difference between mean arterial pressure and the intracranial pressure. The difference is labeled CPP. 1 In the Main Setup menu, select Measurements. In the Setup CPP menu, select one of the listed pressures as the arterial pressure source. 2 Calculating Pulse Pressure Variation Note: Pulse Pressure Variation can be calculated in two different ways on this monitor - directly from the pressure measurement or in conjunction with the CCO measurement. Refer to the Cardiac Output chapter for information on PPV from CCO. Only one PPV can be active at a time. Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pulse pressure less the minimum pulse pressure divided by the average of the two. The average variation in pulse pressure is calculated over periods of 32 seconds. WARNING This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician. The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. PPV calculation may lead to inaccurate values in the following situations:

The PPV measurement has been validated only for adult patients at respiration rates below 8 rpm during ventilation with tidal volumes lower than 8 ml/kg for patients with acute right ventricular dysfunction ("cor pulmonale"). To select an arterial pressure as PPV source:

1 In the Main Setup menu, select Measurements. In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source. 2 191 11 Monitoring Invasive Pressure CAUTION Older Multi-Measurement modules cannot supply a beat-to-beat arterial pressure value. In this case the monitor shows a NO PPV FROM MMS or NO PPV FROM FMS INOP. Measuring Pulmonary Artery Wedge Pressure Fluid status Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:

Myocardial contractility Valve and pulmonary circulation integrity Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the inflated balloon occludes the artery allowing the monitor to record changes in the intrathoracic pressures that occur throughout the respiration cycle. The pulmonary wedge pressure is the left ventricular end diastolic pressure (preload). The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoracic pressure is fairly constant. You can use the respiration waveform as a reference when assessing the PAWP waveform, to ensure constant measurement timing relative to the respiratory cycle. The monitor displays the PAWP value for up to 24 hours or until you admit a new patient. WARNING The pressure receptor in the catheter records pressure changes that occur only in front of the occlusion. Even though the catheter tip is in the pulmonary artery, the receptor records pressure changes transmitted back through the pulmonary circulation from the left side of the heart. While performing the wedge procedure, the monitor switches off the pressure alarms for pulmonary artery pressure (PAP). Due to a slight measurement delay, you should not use sidestream CO2 as a direct reference for determining the end expiratory point in the pressure curve. To start the Wedge procedure, 1 In the Main Setup menu, select Wedge to display the wedge procedure window. Prepare and check the pressure line according to your hospital policy. 2 3 Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory wave as reference waves. Select Change Speed if you want to change the speed of the displayed wave. The speed can also be changed in the screen for editing the wedge. Select Change Scale to change the wave scale of the PAP. The same scale will be used in the screen for editing the wedge. If the setting Optimum Scale is used, the wave scale will be optimized when a wedging waveform is recognized and will revert to the previous scale when the wedge procedure window is closed. Inflate the balloon when the monitor prompts you: Ready for balloon inflation. The waveform changes from the PAP to the PAWP wave. The measurement takes approximately 12 seconds. On 4 5 6 192 11 Monitoring Invasive Pressure completion, the monitor stores the PAWP waveform display and prompts you to deflate the balloon. If the monitor cannot detect a wedging waveform you must use Store Trace to store the wedge and two reference waves manually. 7 Deflate the balloon when the monitor prompts you: Ready for balloon deflation and verify that the waveform returns to pulmonary artery shape. If you need to start a new measurement, select Restart Wedge. 8 Editing the Wedge Select the Edit Wedge pop-up key to see the stored waveforms. 1 2 The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any previously stored value and the time it was stored. Select Change Speed if you want to change the speed (resolution) of the displayed wave. 3 4 Move the cursors up, down, right and left to set them on the correct wedge position. 5 Select Store Wedge to store the PAWP value. Select Print Wedge to print the PAWP waveform and any reference waves or Record Wedge to record them. While recording or printing, you cannot perform any more Wedge tasks. 6 WARNING Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the minimum time necessary to get an accurate measurement. If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon, the pulmonary artery pressure waveform assumes a wedged appearance. Take appropriate action, in accordance with standard procedures, to correct the situation. If the PAWP (mean) is greater than the PAP (systolic), deflate the balloon and report the incident in accordance with hospital policy, because the pulmonary artery could be accidentally ruptured, and the wedge value derived will not reflect the patient's hemodynamic state, but will merely reflect the pressure in the catheter or balloon. Identifying the Pressure Analog Output Connector 1 Analog output (module M1006B, option C01 only) 193 11 Monitoring Invasive Pressure 194 12 12Monitoring Cardiac Output The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window, and the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to the area under the curve. As cardiac output varies continuously, a series of measurements must be carried out to achieve a reliable C.O. average value. Always use the average of multiple thermodilution measurements for therapy decisions. The measurements can be carried out using the right heart thermodilution method or the PiCCO method (transpulmonary thermodilution). The right heart method is available with C.O. module M1012A, standard and option #C10 M3012A Hemodynamic Measurement Extension Module, options #C05 and #C10 M3014A Capnography Measurement Extension Module, option #C05 and #C10 The PiCCO method is available with C.O. module M1012A, option #C10 M3012A Hemodynamic Measurement Extension Module, option #C10 M3014A Capnography Measurement Extension Module, option #C10 The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing pulse contour analysis on the blood pressure waveform. Hemodynamic Parameters This table illustrates the hemodynamic parameters available with each method, whether they are measured continuously, and whether they can be shown on the monitor's main screen or in the Hemodynamic Calculations window. 195 PiCCO Method (Transpulmonary Thermodilution) Right Heart Thermodilution 12 Monitoring Cardiac Output Measured and Calculated Hemodynamic Parameters and Indexes Blood Temperature (Tblood) C.O./C.I.: Cardiac Output CCO/CCI: Continuous Cardiac Output Y N Y Continuous?

Main Screen Y Y Y N and Y SVR/SVRI: Systemic Vascular Resistance N and Y SV/SI: Stroke Volume/SV Index Y SVV: Stroke Volume Variation Y

*dPmax: Left Ventricular Contractility Index N CFI: Cardiac Function Index Y PPV: Pulse Pressure Variation N ITBV/ITBVI: Intrathoracic Blood Volume EVLW/EVLWI: Extravascular Lung Water N GEDV/GEDVI: Global End-Diastolic Volume N

*PVPI: Pulmonary Vascular Permeability Index N N

*GEF: Global Ejection Fraction N

*RLShnt: Right-Left-Shunt Fraction PVR/PVRI: Pulmonary Vascular Resistance Not available N LCW/LCWI: Left Cardiac Work RCW/RCWI: Right Cardiac Work Not available RVSW/RVSWI: Right Ventricular Stroke Work Not available Y Y Y Y Y Y Y Y Y Y Y N N HemoCalc Window N Y Y (in the C.O. field) Y Y Y Y Y Y Y Y Y Y Y N Y Main Screen Y Y Continuous?

Y N Not available HemoCalc Window N Y N N Not available Not available Not available Not available Not available Not available Not available Not available Not available Not available N N N N N N N N N N Y Y Y Y Y Y

* currently not available in the U.S.A. or in clinical environments under FDA control. Using the C.O. Procedure Window The procedure window displays up to six trials (measurement curves) with the trial number and the C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys automatically appears to let you carry out C.O.-related tasks. This example shows the procedure window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly different on your monitor. To open the procedure window, Select Cardiac Output in the Setup C.O. or Setup CCO menu, or Select the Cardiac Output SmartKey on the Screen, if configured, or Press the START hardkey on the front of the C.O. plug-in module, if available, or Press a remote start switch, if you are using one. 196 12 Monitoring Cardiac Output Prompt message field Average - column of averaged values 1 2 Unit column 3 Continuously measured numeric 4 5 Thermodilution curve of current trial 6 Curve alert message field 7 Current trial number 8 Setup information Trial numbers for the trial curves 9 10 Trial curves 11 Results table of current trial 12 Trial curve scale To change the measurement parameters shown in the results table of the procedure window, select the Table Contents pop-up key and choose from the list of available parameters. To view the currently-used temperature unit, see the "grayed-out" setting Temperature Unit in the Setup C.O. menu. This setting can only be changed in Configuration Mode. The Cardiac Output screen element may be configured to display permanently on a specially designed Screen. Selecting the screen element opens the cardiac output pop-up keys. Accessing the Setup C.O. and Setup CCO Menus C.O. settings can be changed in the Setup C.O. menu. To access this menu, press the C.O. hard key on the C.O. module, or select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen. 197 12 Monitoring Cardiac Output CCO/CCI settings can be changed in the Setup CCO menu. To access this menu, select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen. Entering the HemoCalc Window From the procedure window, select the pop-up key Hemo Calc to open the Hemo Calculations window. Measuring C. O. Using the PiCCO Method The PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the blood pressure waveform. A fluid with a known volume and temperature is injected into the right atrium through a CVP catheter. The injectate bolus mixes with the blood in the heart and the change in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery. The PiCCO Method requires a pressure measurement made using either the M1006B Pressure module, or a M3001A/M3002A MMS, or a measurement extension module M3015A, M3014A, or M3012A. (A pressure from an external device may not be used.) You will also need a conventional central venous (CVP) line and an arterial catheter from PULSION Medical Systems. You must use the approved catheters and puncture locations. Measuring Continuous Cardiac Output Every time C.O. is measured with the PiCCO method, the monitor uses this C.O. value and the result of the pulse contour analysis to calculate a patient-specific calibration factor. The monitor uses this value to compute CCO and the other continuous hemodynamic parameters. CCO values are calculated on a beat-to-beat basis and then averaged over a 12-second time frame. The calculated values are displayed as numerics on the monitor screen. Measuring Systemic Vascular Resistance The monitor uses CCO, an arterial pressure, and CVP to calculate a continuous SVR value. If a continuously measured CVP value is not available, the monitor uses a preset, static CVP value to calculate the SVR (you will see the INOP message SVR SET CVP USED). If the BSA is available, the monitor uses the CCI to calculate the SVRI. A CCO or CCI from an external device can also be used for the SVR/SVRI calculation. SVR/SVRI settings can be changed in the corresponding setup menu. To enter the menu, select Main Setup then Measurements followed by SVR or SVRI. To display a SVR/SVRI numeric on the Screen, select any numeric, then select Change Numeric and select SVR or SVRI from the list of available numerics. Measuring Pulse Pressure Variation Note: Pulse Pressure Variation can be calculated in two different ways on this monitor - in conjunction with CCO or directly from the pressure measurement. Refer to the Invasive Pressure chapter for information on PPV from pressure. Only one PPV can be active at a time. 198 12 Monitoring Cardiac Output Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures. WARNING The monitor calculates PPV from beat-to-beat values of the arterial pressure selected for CCO. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician. The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. PPV calculation may lead to inaccurate values in the following situations:

The PPV measurement has been validated only for adult patients at respiration rates below 8 rpm during ventilation with tidal volumes lower than 8 ml/kg for patients with acute right ventricular dysfunction ("cor pulmonale"). 199 12 Monitoring Cardiac Output Setting Up the PiCCO C.O. Measurement PULSION Pressure Transducer Press Module Pressure Adapter Cable 1 C.O. Module 2 C.O. Interface Cable 3 4 5 6 Thermistor Connection Cable 7 Thermistor Connection 8 9 CVP Line 10 Injectate Temperature Probe PULSION Arterial Catheter Housing 11 Injectate Syringe 12 Injectate Temperature Probe 13 Remote Switch 1 Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit from PULSION Medical Systems. It must be placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery. You must use the approved catheters and puncture locations. Set up the central venous line. 2 3 Connect the injectate temperature probe housing to the venous line. 4 Injectate temperature probe Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices to the C.O. interface cable:

Thermistor connector Remote start switch (if used). Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin. 200 12 Monitoring Cardiac Output 5 If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories. 6 Check that the correct measurement method is selected. If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the Setup C.O. menu, select Method and then select Transpulmnry. 7 Check that you are using the correct probe - the M1646. This is the only probe supported for use;

it can be used with room temperature injectate or with cold injectate. 8 Check that the correct arterial catheter constant is selected. If the catheter is recognized by the monitor, the catheter constant is automatically displayed and cannot be changed manually. If it is not recognized, in the procedure window, select CathCt and use the pop-up keypad to enter the correct value. The catheter constant is usually written either on the catheter or on the catheter packaging. 9 Make sure that the injectate volume setting matches the injectate volume you will use. To change the volume, in the procedure window, select InjVol and select the correct injectate volume from the pop-up list. If there is a problem with the volume or temperature you have chosen, the monitor will issue a curve alert message to inform you of this. 10 If you are measuring CCO or CCI, check that the correct pressure source is selected in the Setup CCO menu. The pressure label under CCO From must match the pressure measured with the arterial catheter. To change the pressure source, select CCO From to call up a list of available pressure labels and select the correct label. If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item Alarms From. To change the alarm source, select Alarms From and choose either CCO or CCI. 11 Performing PiCCO C.O. Measurements Always wait for the monitor to indicate readiness for the next step before proceeding. If you are measuring CCO, all measurements should be conducted within 15 minutes. Older measurements "expire" for CCO calibration. 1 Enter the procedure window. 2 When you see the message Ready for new measurement, start the measurement by selecting the pop-up key Start C.O. or pressing the Start hardkey on the C.O. module, or pressing the remote start switch. If the measuring mode is set to Auto the Start C.O. key will also enable the automatic start of consecutive measurements. 3 When you hear the ready tone and see the message Stable baseline, inject now!, inject the solution into the CVP catheter. At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and EVLW values and any curve alerts are displayed and a message will appear Wait before starting new measurement or in Auto mode Prepare for next injection or press Stop. 4 When you see the Stable baseline, inject now! message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of 6 measurements before editing. If you perform more than 6 measurements without rejecting any, the oldest will automatically be deleted when a 7th curve is stored. 201 12 Monitoring Cardiac Output Editing PiCCO C.O. Measurements It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output. 1 Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak. 2 Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the Accept Reject pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials. If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia. Saving and Calibrating PiCCO C.O. Measurements When you have finished editing the trials, you must save the results. This closes the measurement series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases. Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the same direction over 15 minutes, or if there are large or sudden changes in the patient's condition. The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO. To save and calibrate, In the procedure window, select the pop-up key SaveC.O. &Cal CCO to use the averaged C.O. value to calibrate Continuous Cardiac Output (CCO). Your monitor may be configured to have two separate pop-up keys, Save C.O. and Cal CCO, instead of the combined SaveC.O. &Cal CCO. WARNING CCO calibration is patient-specific. When the C.O. module or measurement extension module is plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in doubt perform a new CCO calibration first. CCO Calibration Status Indicators Each measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial's validity to be used in a CCO calibration. 202 12 Monitoring Cardiac Output For a trial to be eligible for calibration, the pressure signal must be continuously available and undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the pressure measurement, change the pressure label, or disturb the pressure signal in any other way during this time. Cal

?Cal N/A Exp A pressure signal for CCO was available during the measurement (valid for calibration) A disturbed pressure signal for CCO was available during the measurement (valid for calibration) No adequate pressure signal for CCO was available during the measurement (no valid calibration data) This trial is more than 15 minutes older than the most recent trial and has expired for CCO calibration (no valid calibration data) Measuring C.O. Using the Right Heart Thermodilution Method In the right heart thermodilution method, a fluid of known volume and temperature is injected into the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter. The injectate bolus mixes with the blood in the right ventricle and the change in blood temperature is measured with a thermistor at the distal end of the catheter in the pulmonary artery. 203 12 Monitoring Cardiac Output Setting up RH C.O. Measurements 1 C.O. Module 2 C.O. Interface Cable 3 Remote Start Switch 4 Thermistor Connector 5 Thermistor Connection Cable 6 7 PA Catheter Injectate Temperature Probe Housing Injectate Syringe Injectate Temperature Probe 8 9 Set up the PA line using a PA catheter. 1 2 Attach the injectate temperature probe housing to the PA line. 3 injectate temperature probe remote start switch (if used). Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices into the C.O. interface cable:

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin. Plug the thermistor connection cable of the PA catheter into the thermistor connector. 4 5 Connect the injectate temperature probe to the injectate temperature probe housing. 6 Check that the correct measurement method is selected. If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the Setup C.O. menu, select Method and then select Right Heart. 204 12 Monitoring Cardiac Output Ice-Bath Setup for RH Thermodilution C.O. Measurements If you are using the flow-through method illustrated above, the injectate temperature is measured at the time of injection by the temperature probe in the injectate temperature probe housing. If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in an ice-bath and the probe measures the temperature of the contents of the ice bucket. Setting the Computation Constant Check that the correct Computation Constant is entered in the procedure window. This can be found in the documentation supplied with the catheter and is based on the injectate volume, injectate temperature and catheter type. To change the value, in the procedure window, select Computation Constant and use the pop-up keypad to enter the correct value. Performing RH C.O. Measurements 1 Enter the procedure window. 2 When you see the message Ready for new measurement, select the pop-up key Start C.O.. If the measuring mode is set to Auto the Start C.O. key will also enable the automatic start of consecutive measurements. 3 When you hear a ready tone and see the message Inject now!, inject the solution into the right atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second. At the end of the measurement the thermodilution curve, cardiac output, index values and curve alerts (if necessary) are displayed and a message will appear Wait before starting new measurement or in Auto mode Prepare for next injection or press Stop. 4 When you see the Inject now! message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of six measurements before editing. If you perform more than six measurements without rejecting any, the oldest will automatically be deleted when a seventh curve is stored. Editing and Saving RH C.O. Measurements It is important to identify and reject erroneous measurements (called "trials"), as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output. 1 Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak. 2 Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the Accept Reject pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials. If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia. Save average C.O. values. To close a measurement series, you must save the average values by selecting the pop-up key Save C.O.. This sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases. 3 205 12 Monitoring Cardiac Output Documenting C.O. Measurements 2 You can document C.O. measurements on the default printer or recorder. 1 In the procedure window, select the pop-up key Print/ Record. From the pop-up list, choose:

Print Results to print the contents of the procedure window Record Results to record the contents of the procedure window Record Trial to send an individual trial curve to the recorder. C.O. Injectate Guidelines The greater the injectate volume and the colder the temperature, the more accurate the measurement. Reduced injectate volume or higher injectate temperature may reduce the specified accuracy. For adult patients, to ensure the greatest measurement accuracy, use a cold injectate (< 8C) of 10 ml volume, if not contra-indicated by the patient's condition. Your choice of injectate volume should be based on the injectate temperature and the patient's cardiac output. Guidelines for Right Heart Thermodilution C.O. Injectate If you are using the right heart thermodilution method, the use of injectate with a temperature less than 8C lower than the blood temperature may cause incorrect values for the thermodilution. Guidelines for PiCCO C.O. Injectate If you are using the PiCCO method, the use of injectate with a temperature that is not at least 12C lower than the blood temperature may cause incorrect values for the thermodilution and CCO calibration. Injectate Volume, Patient Weight and ETVI Values (PiCCO Only) When deciding on an injectate volume and temperature, you must consider your patient's weight and extra-vascular thermal volume index (ETVI). The dilution of injectate is influenced by extravascular tissue and fluid. The accuracy of the PiCCO method may be reduced in patients with high extra-vascular thermal volume index (ETVI) values. Use the table below as a guide in selecting the correct injectate temperature. As shown in the table, if your patient has an ETVI > 10, you must use cold injectate. Use the table below as a guide in choosing an injectate volume appropriate for the patient weight. High ETVI Weight 206 Patient Weight

< 3 kg

< 10 kg

< 25 kg

< 50 kg

< 100 kg 100 kg Cold Injectate ETVI < 10 2 ml 2 ml 3 ml 5 ml 10 ml 15 ml 12 Monitoring Cardiac Output Room Temperature Injectate ETVI 10 Use cold injectate ETVI 10 2 ml 3 ml 5 ml 10 ml 15 ml 20 ml ETVI < 10 3 ml 3 ml 5 ml 10 ml 15 ml 20 ml C.O./CCO Curve Alert Messages After each measurement trial, the monitor analyzes the thermodilution curve. If the curve appears abnormal, a curve alert message appears in the procedure window. A question mark symbol ("?") may appear next to the cardiac output numeric if any of these messages appear. The curve alert messages are not error messages and do not necessarily mean that the measured values are invalid. 207 12 Monitoring Cardiac Output C.O./CCO Curve Alert Messages Tinj off scale Noisy baseline Temperature baseline drift Small signal, more indicator required Possible Causes The Tinjectate is out of the range -1C and 30C. Cool down or heat up the injectate or change the injectate solution and repeat the measurement. A blood temperature baseline drift that could not be compensated was detected during the C.O. measurement. Possible causes are:

- Interference may be caused by a ventilator.

- Interference may be caused by an infusion pump: infusions of significant volume through the central line should be paused at least 30 seconds before the first thermodilution measurement in a series and should not recommence until the measurement series is completed.

- Do not administer injections through the central line during a measurement series.

- Electrical devices in the vicinity can cause interference: check for infusion pumps connected to the central catheter, cables parallel to the thermodilution cable, electrocautery. Make sure all devices are properly grounded.

- Wait until measurement results are displayed before moving the patient or catheter.

- Close the stopcock to the injectate syringe after the injection.

- Do not rinse the catheter during measurement, to avoid temperature fluctuations. May occur if patient is recovering from open heart surgery, or if patient was cooled down for surgery and is in the process of regaining normal body temperature when the measurement is made. The peak of the transpulmonary thermodilution curve was below 0.1C. Increase injectate volume and/or lower injectate temperature. Injectate temperature too high The difference between the blood and injectate temperatures is too High ETVI, use cold injectate or greater inj. volume Disturbed injection Check Injectate Temperature Probe Type 208 small. The calculated value for C.O. may not be accurate. The ETVI value is too high. The accuracy of the transpulmonary thermodilution measurement may be reduced. Increase injectate volume and/or lower injectate temperature following the guidelines given in the section Guidelines for PiCCO C.O. Injectate

(Guidelines for PiCCO C.O. Injectate on page 206). The injection should be performed quickly and with a steady pressure. Shaking, unsteady pressure, or injections that take longer than six seconds may cause this message to appear; you should bear this in mind if you are using a large injectate volume (> 10 ml). The recorded Tinj signal is uncharacteristic for the M1646 injectate temperature probe. An incorrect probe type may have been used. 12 Monitoring Cardiac Output C.O./CCO Curve Alert Messages Unsteady baseline Multiple peaks Abnormal decay time Very long curve Very short curve Irregular curve Delayed injection Possible Causes There is a noisy baseline, and thermal baseline drift. Caused by faulty injection technique. May be caused by low cardiac output. Calculated value for C.O. may not be accurate. The decay time of the curve is longer than 15 seconds. Decay time of the curve is less than 0.5 seconds. If there is a noisy baseline, part of the baseline may have been mistaken for a thermodilution curve. Calculated value for C.O. may not be accurate. Any combination of curve alert messages. Injection is given more than 15 seconds after Start C.O. is selected. Calculated value for C.O. may not be accurate. If you have followed all of these guidelines, your measurement values should be valid, even if you still see a curve alert message. Ensure that at least three subsequent measurements within the current series do no differ by more than 15%. If the difference exceeds 15%, use your clinical judgment to determine the appropriate intervention. C.O./CCO Prompt Messages Prompt messages appear in the procedure window if a C.O. measurement trial must be terminated. C.O./CCO Prompt Messages Curve below baseline, measurement terminated Excessive curve height, measurement terminated Unstable baseline, injection not recommended!

Excessive baseline drift, don't inject now!

Possible Causes May be caused by thermal baseline drift. No C.O. value calculated. The curve exceeds the upper limit. This may be caused by an injectate that was too cold. No C.O. value calculated. The baseline is unstable. Wait until the baseline is stable before injecting. If this does not occur within a reasonable time, injection is possible but the accuracy of the measured values may be reduced. No measurement is possible. Measured values are incorrect. C.O./CCO Warning Messages Warning messages contain important information about the C.O. measurement. 209 12 Monitoring Cardiac Output C.O./CCO Warning Messages Next measurement erases older curve Possible Causes Six curves are stored, this is the maximum possible. If another measurement is stored, the oldest thermodilution curve will be erased. Verify C.O. setup data Previous C.O. setup data replaced A C.O. module or measurement extension module has been plugged in with different C.O. setup data from the previous data. The new C.O. setup data is read from the new C.O. device, and replaces the current data. The message disappears when the Start C.O. pop-up key is pressed. A new transpulmonary thermodilution catheter has been connected to the C.O. Interface Cable. Poor or invalid pressure signal, for example if pressure was not zeroed. Check arterial pressure, CCO cal currently not possible Verify the Computation Constant A new catheter has been plugged in, or the computation constant has been changed and Start C.O. has not been selected. A new C.O. module or measurement extension module with a different computation constant from the current one has been connected. The new computation constant is read from the new C.O. device, and replaces the current one. The message disappears when Start C.O. is selected. Previous Comp. Constant replaced C.O./CCO Safety Information WARNING Catheter constant - Make sure that the arterial catheter constant for the measurement is appropriate to the catheter used. Computation Constant - Make sure that the computation constant for the measurement is appropriate to the injectate volume, injectate temperature and catheter type used. IABP - Do not perform transpulmonary thermodilution measurements on patients undergoing IABP treatment. CCO accuracy - Accuracy of the CCO measurement and all the derived values may be influenced by patients with valve diseases or artificial valves. C.O. and MRI - Do not use the Cardiac Output Interface Cable in Magnetic Resonance Imaging

(MRI) Applications. Aortic graft patients - Do not use an arterial catheter in the arteria femoralis when it is contra indicated, for example, with patients who have an aortic graft. 210 12 Monitoring Cardiac Output CAUTION During the cardiac output measurement procedure the blood temperature alarms are inactive. This is indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive during this procedure prevents false alarms. The alarms are automatically reactivated when you have completed the measurement procedure. 211 12 Monitoring Cardiac Output 212 13 13Monitoring Carbon Dioxide WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension

(865297). Only one CO2 measurement at a time is supported. Use the CO2 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 CO2 sensor attached to an airway adapter directly inserted into the patient's breathing system. This method is available using the M3014A Capnography Extension and the M3016A Mainstream CO2 Extension, or the X2 with the optional CO2 measurement. 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 CO2 sensor built into the measurement system. Philips offers the sidestream CO2 measurement in the M3014A Capnography Extension or the X2 with the optional CO2 measurement, and the Microstream method of sidestream CO2 measurement in the M3015A/B Microstream CO2 Extension. Refer to your Gas Module Instructions for Use, if you are using a Gas Module to monitor CO2. WARNING Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation. Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols. Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, 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. 213 13 Monitoring Carbon Dioxide Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 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 etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only. Measurement Principles For both mainstream and sidestream measurements, 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 CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2. When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2. The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure. The measurement provides:

a CO2 waveform. an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase. an inspired minimum CO2 (imCO2): the smallest value measured during inspiration. an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform. Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off). Measuring CO2 using M3014A or X2 The M3014A Capnography Extension or the X2 with the CO2 option measures partial pressure of carbon dioxide in a patient's expired gas using the mainstream method or the sidestream method. The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 measurement can be used, with appropriate accessories, with intubated and non-intubated 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. 214 13 Monitoring Carbon Dioxide WARNING Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference. CAUTION Use the CO2 measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory. Preparing to Measure Mainstream CO2 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 CO2 connector on the MMS extension, or on the X2 (when the optional CO2 measurement is integrated). 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. To zero the sensor:

expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own. in the setup menu for the CO2, select Start Zero Cal. 215 13 Monitoring Carbon Dioxide When you see the message CO calibration done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring. 4 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 endotracheal 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 CO2 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 CO2 1 Plug the sensor cable into the monitor's CO2 input connector. Allow the sensor two minutes warm up time 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:

216 13 Monitoring Carbon Dioxide expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own. in the setup menu for the CO2, select Start Zero Cal. when you see the message CO calibration 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 Y-section. 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. 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. Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity. 217 13 Monitoring Carbon Dioxide CAUTION Always disconnect the cannula, airway adapter or sample line from the sensor when not in use. 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. Push the sensor into the holder until it clicks into position. 1 2 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. Removing Exhaust Gases from the System WARNING Anesthetics: When using the sidestream CO2 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 CO2 using M3016A The M3016A Mainstream CO2 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 CO2 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 CO2 1 Attach the transducer connector to the CO2 connector on the M3016A extension. 218 13 Monitoring Carbon Dioxide 2 Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition. Perform an accuracy check and then, if necessary, calibrate the transducer. 3 Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings. 1 2 3 4 5 In Setup CO menu, select Cal. Mode to switch on calibration mode. Look at the calibration value displayed in the Setup CO menu next to Start CAL1. Is it the same as the value on the calstick? If not, calibrate the transducer now. Place the transducer on the low cell of the calstick (labeled 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 Place the transducer on one of the calstick cells and select Start CAL1. 1 Check that the windows on the calstick are clean and clear. 2 3 Enter the calibration value printed on the calstick then press Confirm to start calibration. 4 When the message CO CAL1 calibration done -- Start CAL2 calibration appears, put the transducer on the other cell and select Start CAL2 then press Confirm. 5 When you see the message CO calibration completed - leave Cal. Mode, calibration is complete. Select Cal. Mode to switch calibration mode off. You cannot monitor in calibration mode. 6 Attaching and Removing the CO2 Transducer 1 Open the latch and place the transducer (B) onto the airway adapter (A). Place the airway adapter in the patient's breathing circuit between the endotracheal tube and the Y-piece. You may see the 219 13 Monitoring Carbon Dioxide CO SENS.WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. 2 To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. WARNING To prevent stress on the endotracheal tube, support the transducer and airway adapter. To avoid infection, use only sterilized airway adapters. Measuring Microstream CO2 using M3015A/B The M3015A/B Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patient's expired gas using Microstream technology. The measurement is equipped with an automatic barometric pressure compensation. 220 13 Monitoring Carbon Dioxide Preparing to Measure Microstream CO2 Use appropriate accessories for:

All accessories are for single patient use only. 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). Using Microstream Accessories The Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory. 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 CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine). Using the FilterLine and Airway Adapter WARNING Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity. 1 Attach the female Luer connector to the CO2 inlet connector by pushing the socket cover aside and screwing the connector into place. 2 Check that the FilterLine is not kinked. 3 Change the FilterLine if a CO OCCLUSION INOP appears on the monitor or if the readings become extremely erratic. Disconnect the FilterLine during suctioning and nebulizing therapies or suppress sampling by turning off the pump as described in Suppressing Sampling (Suppressing Sampling (not Mainstream CO2) on page 223). Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. CO2 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. 221 13 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the Microstream CO2 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 menu, select No Zero For 5Min, or select the Suppress CO Zero SmartKey, if configured. Selecting No Zero For 5Min or selecting the Suppress CO 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 all CO2 Measurements These tasks are common to all CO2 measurements except where otherwise noted. Adjusting the CO2 Wave Scale In the CO Wave menu or the Setup CO menu, select Scale. 1 2 Choose a suitable scale range from the pop-up list. Setting up CO2 Corrections Temperature, water vapor in the patient's breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections. 222 13 Monitoring Carbon Dioxide Correction Altitude

(M3014A only) O2

(M3014A only) Humidity N2O

(M3016A mainstream and M3015A/B microstream only) Gas

(M3014A only) Agent

(M3014A only) Altitude is set during installation. The monitor automatically applies an appropriate correction. In the Setup CO menu, select Oxy. Corr and select a value between 20%

and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list. At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO menu, and scroll down to look at Hum. Corr or Humidity Corr.. In the Setup CO menu, select NO Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on. If the N2O correction is not available in the Setup CO menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below). In the Setup CO menu, select Gas Corr. and select Helium, NO or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection. If the Gas correction is not available in the Setup CO menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with NO Corr. (see above). In the Setup CO 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 CO2) To temporarily stop sampling, in the Setup CO menu, select Pump 15Min Off or use the CO Pump Off SmartKey if available. 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 menu, select Pump On. Changing CO2 Alarms This refers to CO2 specific alarms. See theAlarms section for general alarm information. 1 In the Setup CO menu, select etCO High or imCO High and choose the high alarm limit. Select etCO Low and choose the low alarm limit. 2 Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. 1 In the Setup CO menu, select awRR. In Setup awRR menu, select Apnea Time. 2 3 Choose the apnea alarm delay time. 223 13 Monitoring Carbon Dioxide 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/B) measurement only. Deriving Alarms From awRR 1 In the Setup CO menu, select awRR. In the Setup awRR menu, select Alarms. 2 3 Choose On to derive alarms from the airway respiration signal or Off to disable them. Changing awRR Alarm Limits 1 2 3 In the Setup CO menu, select awRR. Select High Limit to set the upper alarm limit. Select Low Limit to set the lower alarm limit. Select the appropriate setting. 224 14 14Monitoring Airway Flow, Volume and Pressure The M1014A Spirometry Module is designed to be used in combination with Philips-branded airway flow sensors and combined CO2/airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics. The measurement provides:

Airway flow, airway volume and airway pressure waveform. Numerics for:

respiratory rate tidal volume minute volume PEEP (positive end-expiratory pressure) PIP (peak inspiration pressure) dynamic compliance airway resistance Numerics for: (only visible in SpirometryValues Window, no alarming, no trending) peak inspiratory flow peak expiratory flow negative inspiratory pressure mean airway pressure plateau pressure numeric I:E ratio The measurement also provides pressure-volume loops, flow-volume loops and pressure-flow loops. Please see Respiratory Loops on page 355 for details on loops. When using combined CO2/Flow sensors you can also perform mainstream capnography with intubated adult, pediatric and neonatal patients. See the Monitoring Carbon Dioxide chapter for details on the CO2 measurement and the Accessories chapter for a list of compatible accessories. 225 14 Monitoring Airway Flow, Volume and Pressure WARNING Electrical Shock Hazard: Do not open the module. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the module. Refer servicing to qualified service personnel. Attaching the Flow Sensor CAUTION Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory. 1 Select the appropriate flow sensor. Make sure that you are using the correct sensor for the respective patient category. Otherwise accuracy may be reduced. Pediatric/Adult Flow Sensor (M2785A). Color: clear For intubated patients with endotracheal tube diameters >4 mm. Adds approximately 6.5 cc of deadspace. Infant/Neonatal Flow Sensor (M2786A) Color: violet For intubated patients with endotracheal tube diameters 4 mm. Adds less than 1 cc of deadspace. You can also use combined CO2/flow sensors. Note that the M3014A Capnography Extension is required to measure CO2. Pediatric/Adult Combined CO2/Flow Sensor (M2781A). Color: clear For intubated patients with endotracheal tube diameters >5.5 mm. Adds 8 cc of deadspace. Pediatric Combined CO2/Flow Sensor (M2783A): Color: green For intubated patients with endotracheal tube diameters of 3.5 - 6 mm. Adds less than 4 cc of deadspace. Infant/Neonatal Combined CO2/Flow Sensor (M2782A). Color: violet For intubated patients with endotracheal tube diameters of 2.5 -4 mm. Adds less than 1 cc of deadspace. 1 If you are using a combined CO2/Flow sensor, connect it to the CO2 sensor head first. The airway adapter clicks into place when seated correctly. 2 Click the connector into place in the flow sensor receptacle on the monitor before connecting to the breathing circuit. 226 14 Monitoring Airway Flow, Volume and Pressure 3 Install the flow sensor or the combined CO2/Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y-piece. Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards. The correct position is also indicated by an arrow on some of the sensors. (Graphic shows combined CO2/Flow Sensors). 1 Pediatric/adult sensor 2 Pediatric sensor 3 Infant/Neonatal sensor WARNING To prevent stress on the endotracheal 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 or tubing. Replace the sensor, if excessive moisture or secretions are observed in the tubing and cannot be removed by a purge cycle. Reuse poses a patient hazard. Do not disassemble, clean, disinfect or sterilize the sensor. A system leak may significantly affect readings of flow, volume, pressure and other respiratory mechanics parameters. Do not leave the sensor in the patient circuit when not connected to the monitor. NOTE Do NOT place the airway adapter between the endotracheal tube and the elbow (pediatric/adult circuit), as this may allow patient secretions to block adapter windows. The striped tubing of the flow sensor should always be proximal to the patient. Position the airway adapter with the spirometry tubing pointing upwards. To prevent "rain-out" and moisture from draining into the airway adapter, do NOT place the airway adapter in a gravity dependent position. Periodically check the flow sensor and tubing for excessive moisture or secretion build up. Perform a purge cycle if droplets are visible within the sensor or tubing. Repeat if necessary. If purging does not remove the droplets, replace the sensor. 227 14 Monitoring Airway Flow, Volume and Pressure For routine performance of airway care, separate the system between the endotracheal tube and the airway adapter (neonatal circuit), or between the endotracheal tube and elbow (pediatric/adult circuit). Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows. Measurement values provided by a ventilator may differ significantly from the values provided by the spirometry module, due to different locations of the flow sensor. Incorrect entry of gas compensation parameters (i.e. temperature, gas composition) may reduce the accuracy of the measured values. An abnormal volume waveform as displayed below may be an indicator of an air leak:

In general, if MVexp or TVexp are significantly smaller than MVin or TVin, the tubing should be checked for leaks. Zero Calibration The zero calibration maintains the accuracy of the spirometry waves and numerics by regularly compensating for drifts within the measurement section. It is performed automatically without user interaction and takes about 2 seconds to complete. The automatic zero calibration is normally carried out every ten minutes. During warm-up or when the ambient pressure changes, this interval may be reduced to two minutes. During the zero calibration the waveform is flat but the numerics remain on the screen. Typically, a zero calibration is started at the beginning of a respiration cycle, therefore a waveform may begin normally and then immediately become flat for the time of the zero calibration. 1 Zero Calibration Automatic Purging A double lumen connecting line (tubing) connects the flow sensors to the patient monitor. The M1014A Spirometry Module includes an automatic and manual purge feature which provides a flush of room air to keep the sensor tubing free from water condensation and patient secretions. This feature is available for the adult, pediatric, and neonatal modes. The purge will begin with the exhalation portion of the ventilator cycle. 228 14 Monitoring Airway Flow, Volume and Pressure NOTE During the purge cycle the pump will be heard With each purge cycle, a zero calibration is automatically performed If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced Adult Mode The system automatically purges the sensor tubing every ten minutes or less, depending on system conditions. In adult mode, the system will purge both sides of the line, one at a time, during each purge cycle. The higher the pressure, the more frequent the purging. This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure. Neonatal and Pediatric Modes The automatic purge cycles used in the neonatal or pediatric mode is fixed at every three minutes regardless of circuit pressure. Only one side of the sensor tubing will be purged during each purge cycle. Unlike the adult purge mode, the neonatal or pediatric purge mode does not use the full force of the internal pump, but rather pressurizes an internal reservoir which is used for the purge. This minimizes the pressure delivered to the ventilator circuit, but does deliver a sufficient pressure to purge the sensor tubing. Manual Purging Occasionally, purging may be required in between the automatic purge cycles. The manual purge may be used as often as needed. Check the orientation of the flow sensor if repeated manual purge cycles become necessary. To manually purge, press the Purge button on the module (marked by on international versions of the module) or select Purge in the Setup Spirometry window to initiate a combined purge and zero cycle. Gas Compensation Temperature and the proportions of individual gases influence the flow measurement. If values seem inaccurately high or low, check that the monitor is using the appropriate gas compensation. Gas compensation can be done using either manually entered gas concentrations or gas concentrations from the gas analyzer. NOTE If you unintentionally switch the gas compensation to the incorrect setting, the accuracy of the measured flow and volume values may be significantly reduced. The tables below show examples of incorrect gas compensation settings and the resulting inaccuracies:

229 14 Monitoring Airway Flow, Volume and Pressure N2 O2 N2O Agent Actual Gas Composition 60 Gas Compensation Setting 40 40 60 Incorrect Balance Gas Setting (N2O instead of N2) Difference between measured and actual values 15%

N2 O2 N2O Agent Difference between measured and actual values Actual Gas Composition Gas Compensation Setting 55 60 40 40 5 0 15%

Incorrect Agent Percentage Setting Setting up Spirometry The following settings can be accessed through the Setup Spirometry menu. Optimizing Scale Settings In the Setup Spirometry menu, select Optimize Scales. The scale settings for all three spirometry waves (AWF, AWP, AWV) will be optimized. Spirometry Values Window You can view all spirometry measurement data in the spirometry data window. In the Setup Spirometry menu, select Show All Values. Alarms and Alarm Limits Alarms can be derived from PEEP, PIP, MV and RRspir. In the Setup Spirometry menu you can set the alarm limits. Please refer to the Alarms chapter of this manual for details on alarm settings. Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. 1 In the Setup Spirometry menu, select RRspir. In Setup RRspir menu, select Apnea Time. 2 3 Choose the apnea alarm delay time. 230 14 Monitoring Airway Flow, Volume and Pressure 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. WARNING If an apnea occurs during a zero calibration or purge, the time delay between the start of apnea and the activation of the apnea alarm could be up to 10 seconds plus the configured apnea delay time. Automatic Alarm Suppression If the automatic alarm suppression is switched on, all spirometry alarms are suppressed until breathing activity has been detected. This setting must be made in configuration mode. Choosing Measured AWV Components 1 2 In the Setup Spirometry menu, select AWV. Select MV to choose the measured components for Minute Volume (inspiratory and/or expiratory or off). Select TV to choose the measured components for Tidal Volume (inspiratory and/or expiratory or off). NOTE If MV and TV are set to off, there will be no alarming for these parameters. Setting the Gas Compensation Mode 1 2 In the Setup Spirometry menu, select Gas Compensation. Select Mode to choose the Gas Compensation mode:

select Manual for manually entered gas concentrations or select Gas Analyzer for gas concentrations from the gas analyzer. NOTE Gas concentrations from the gas analyzer are only available for Philips gas analyzers, not for devices connected via a Vuelink/IntelliBridge module. If gas concentrations from the gas analyzer are selected but not all data is available, the missing data is taken from manually entered values. In case of invalid data or no data at all, the INOP message SPIRO GAS COMPENS? is displayed. Changing the Type of Balance Gas 1 2 3 In the Setup Spirometry menu, select Gas Compensation. Select Balance Gas to change the type of balance gas. Select the appropriate setting (N2 or N2O). 231 14 Monitoring Airway Flow, Volume and Pressure Changing the Concentration of Inspired O2 and the Inspired Agents 1 2 3 In the Setup Spirometry menu, select Gas Compensation. Select Inspired O to change the concentration of inspired O2. Select Inspired Agent to change the concentration of the inspired agent(s). Select the appropriate setting. Changing the Temperature of the Inspired Gas Depending on the type of ventilator environment (e.g. if you are using a Heat Moisture Exchanger) you may want to change the temperature setting of the inspired gas:

1 In the Setup Spirometry menu, select Gas Compensation. Select Inspired Temp to change the temperature of the inspired gas. Select the appropriate temperature setting. 2 3 NOTE Changing the temperature setting unintentionally will result in approximately 3% reduced accuracy per 10C (18F) temperature setting change. 232 15 15Monitoring tcGas The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood. The monitor's settings for altitude and barometric pressure influence the measurement. The tcpO2/

tcpCO2 measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as halothane, can cause incorrect or drifting readings. Transcutaneous measurements cannot replace arterial blood gas monitoring. However, you can use transcutaneous monitoring to reduce the frequency of arterial sampling. The values at tissue level will not be the same as those measured arterially because the measurement is transcutaneous. They correlate with (track closely) the arterial values. For example, a drop in transcutaneous values usually indicates a corresponding drop in arterial values. Transcutaneous values will not always correlate with blood samples taken from the capillary blood of the heel (heelsticks or astrups). Identifying tcGas Module Components 1 Press to enter Setup tcGas menu Press to start calibration 2 3 Calibration chamber 4 Transducer connector Setting the tcGas Sensor Temperature 1 In the Setup tcGas menu, select Transducer Temp.. 233 15 Monitoring tcGas 2 Choose a temperature value appropriate for your patient's age, weight and physical condition in accordance with your hospital policy. Usually, a higher transducer temperature gives a better correlation and a quicker response time. However, higher temperatures also increase the risk of skin burns. Most physicians prefer a temperature between 42C (107F) and 44C (111F), and a site time of four hours or less. Usually, the higher the transducer temperature, the less the site time should be. Whenever you change the temperature setting, the monitor forces you to make a new calibration. Using the tcGas Site Timer Availability and behavior of the site timer depend on your monitor's configuration. WARNING Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics, such as irritation, reddening, blistering or burns. If the site timer is disabled, the transducer will heat indefinitely while on a patient. Change the site regularly, in accordance with medical procedures in your hospital. Setting the tcGas Site Timer The site timer helps reduce the risk of skin burn by ensuring that the transducer is used at one site for no longer than a predefined period. It reminds you when this period expires. 1 2 Choose the time you want the transducer to remain on the measurement site. The optimum time In the Setup tcGas menu, select Site Time. depends on the transducer temperature and your patient's skin sensitivity. The site timer starts automatically when you remove the calibrated transducer from the calibration chamber. If you return the transducer to the chamber and then remove it again, the site time continues to count down the remaining time; it does not start a new time period. The time remaining before the site timer expires appears in the status line which is visible as long as the Setup tcGas menu is open. When the time expires, the monitor sounds a tone and a displays a change site INOP. The monitor either switches off the transducer heating or continues monitoring, depending on its configuration. Although you can reuse the transducer for up to two hours after the heating is switched off, without making a new calibration, you are recommended to recalibrate before applying it to a patient. After two hours without heat, you must recalibrate. During the initial few minutes of use, the monitor eliminates false alarms by temporarily suppressing tcGas alarms. It displays the <tcGas Label> STABILIZING INOP. After you apply the transducer to the skin, the instrument reading slowly assumes a steady value. The reading stabilizes when the measurement site is warm and local hyperemization is complete. This takes 10 to 20 minutes for the tcpO2 reading and three to seven minutes for tcpCO2. Restarting the tcGas SiteTimer To restart the site timer without recalibration (for example, after the site time has elapsed):

1 2 Enter and confirm your desired time. In the Setup tcGas menu, select Site Time. 234 Disabling the tcGas Site Timer 15 Monitoring tcGas Depending on your monitor's configuration, you might be able to disable the site timer. Remember, this means that the transducer heats indefinitely while on a patient. 1 In Setup tcGas menu, select Site Timer and switch this to Disabled. Select the Confirm pop-up key. 2 Setting the tcGas Barometric Pressure Altitude and barometric pressure affect tcGas values. The monitor derives barometric pressure from its altitude setting. If you want to set the true barometric pressure you must do this before starting a calibration - changes after calibration do not influence tcGas values. The monitor remembers this pressure setting until you enter a new one. 1 2 Enter the current barometric pressure reading indicated by your barometer. 3 In the Setup tcGas menu, select Ambient Pressure. Select the Confirm pop-up key. Remembraning the tcGas Transducer Follow the instructions supplied with the transducer. New/Dried Out Transducers Remembrane all new or dried out transducers twice before using. After the first remembraning, unplug the transducer from the module and leave it for 24 hours with the cap on. Remembrane again before calibrating. Storing tcGas Transducers If you need to store a sensor for more than 24 hours, protect it for up to 28 days by putting two drops of electrolyte solution into the cap. Screw the cap on the sensor. Remembrane if it dries out or after 28 days. Calibrating the tcGas Transducer You can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the 'out-of-gas' zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not prompt you to do so. You MUST calibrate when:

you remembrane the transducer you change the transducer heat setting you doubt the measurement accuracy you start a new monitoring period or use a new site the monitor displays the Calibration required INOP message. 235 15 Monitoring tcGas 1 Connect the calibration unit to the inlet on the side of the module's calibration chamber using the recommended gas tubing. Different tubing will cause inaccurate measurements. 2 Plug the transducer cable into the module. Swing the calibration chamber cover open and insert the transducer into the chamber. Close the cover to secure the transducer. Set the transducer temperature at the monitor now. 3 On the 15210B calibration unit, turn the timer control clockwise as far as you can. On the Radiometer calibration unit, press the button with the green arrow once. 4 Press CAL on the module until the light above the key comes on and wait (three - 20 minutes) for the completion message to appear on the monitor. Alternatively, in the Setup tcGas menu, select StartCalibration. To save gas on 15210B, if the timer control dial is not in the start position when the monitor displays the completion message, turn the dial counter-clockwise to the start position. For TCC3, if the green light is still flashing when INOP <tcGas Label> CAL RUNNING disappears, press the green arrow button again. Calibration Failure If calibration fails, the monitor displays <tcGas Label> transducer or cal. unit malfunction and the

<tcGas Label> CAL FAILED INOP for the measurement. 236 Troubleshooting tcGas Calibration 15 Monitoring tcGas Perform each of the following steps, in order, until calibration is successful. 1 Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the calibration unit. If the pressure indicator reading is in the out of gas zone, there is insufficient gas in the cylinder. Connect the gas tubing firmly to the calibration unit and to the module's calibration chamber. If Step 1 fails, check whether you need to activate the transducer (necessary if the electrolyte has dried out or if you have a new transducer). Remembrane the transducer, removing the old membranes, and cleaning the transducer head thoroughly. 2 3 Calibrate a second time. 4 If Step 2 is unsuccessful, calibrate again. This calibration may be required to stabilize the electrochemical system in the transducer. 5 Only if the above steps are unsuccessful (you have activated and remembraned the transducer and calibration has still failed twice), replace the transducer. Applying the tcGas Transducer 1 Peel protection film from fixation ring. Using a finger, press the sticky side of the ring on to clean, dry skin. Press around the outside to ensure a good seal. Apply three to five drops of contact fluid in the ring's center. Remove transducer from chamber. 2 Align the arrow on the transducer with the tab on the ring and fasten by turning a quarter-turn clockwise. Wait 10-20 minutes for readings to stabilize. 3 Apply the transducer as soon as possible after you see the message indicating that calibration is complete. If you wait longer than 30 minutes, the heat supply to the transducer switches off to prevent the electrolyte from drying out and a new calibration is necessary. Optimize the measurement by selecting a site with high capillary density and blood flow, thin epidermis and no cardiovascular disorders. Most physicians use the abdomen, chest and back. 237 15 Monitoring tcGas WARNING You must either remove the transducer before defibrillating, or remembrane and calibrate the transducer after defibrillating. CAUTION To avoid transducer damage, remove it from the patient during high frequency surgical procedures. Selecting the tcGas HeatPowerDisplay Mode The heat power display gives an indication of the skin's perfusion below the transducer and of the transducer's contact with the skin. If the transducer loses contact, the heat power value drops significantly. When perfusion is poor you need less heat power to maintain the transducer temperature. In the Setup tcGas menu, select HeatPowerDisplay and then Relative or Absolute. Choose Relative when the skin temperature is stable (the <tcGas Label> STABILIZING INOP disappears). This indicates subsequent changes in the relative heat power (and therefore changes in perfusion or transducer contact) since the last zeroing. Zeroing the tcGas Relative Heat Power When you start a calibration, the HeatPowerDisplay is set to Absolute. When you switch to Relative, it automatically zeros. Zero again if you change application site. Finishing tcGas Monitoring Replace the transducer in the calibration chamber. When changing the application site after a measuring period, some users leave the fixation rings in position to allow them to quickly move the transducer from site to site. Always unscrew the transducer from the fixation ring before removing the fixation ring from the skin. TcGas Corrections Transcutaneous pCO2 values tend to be higher than arterial values due to the metabolic processes of the skin and the effect of heating on the blood under the transducer. Depending on your monitor's configuration, one or both of these corrections may automatically apply. Temperature Correction for tcpCO2 The transducer temperature causes an increase in partial CO2 pressure. Your monitor may be configured to correct this. In the Setup tcGas menu, look at the menu item CO Correction. If correction is enabled, it is set to On. 238 15 Monitoring tcGas Metabolism Correction for tcpCO2 CO2 production in the epidermis increases the CO2 value. Your monitor may be configured to automatically deduct a metabolism factor (only applies when CO Correction is on). In the Setup tcGas menu, look at the value shown for the menu item MetabolismFactor. This is deducted from the CO2 value. 239 15 Monitoring tcGas 240 16 16Monitoring Intravascular Oxygen Saturation Depending on the probe or catheter used and the measurement location, the two modules, M1011A and M1021A, measure the central venous oxygen saturation or mixed venous oxygen saturation continuously and invasively. The two modules can be differentiated by their size and their labeling. The M1011A is a single-width module (narrow) and is labeled SO2. The M1021A is a double-width module (wide) and is labeled SvO2. 1 M1011A 2 M1021A WARNING Injected dyes, such as methylene blue, or intravascular dyshemoglobin may lead to inaccurate measurements. Do not monitor oxygen saturation during infusion of I.V. fat emulsion or other turbid substances through the distal lumen of the OptiCath catheter. These liquids might temporarily modify the blood scattering and absorption characteristics at the catheter tip. This interferes with the optical measurement of oxygen saturation. After infusion is complete, you can again monitor oxygen saturation accurately. During injection of the bolus for thermodilution cardiac output measurements, the SvO2 measurement might be disturbed. Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, 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. 241 16 Monitoring Intravascular Oxygen Saturation Do not use probes/catheters when they, or the packaging, are damaged. Always select the correct label for the measurement location and the catheter/probe in use. This is especially important when Protocol Watch is in use, to ensure that the correct limits are used for the criteria applied. CAUTION Use the modules with Philips approved accessories only. Refer to the instructions for use provided with the accessory. Selecting a Measurement Label Always select a measurement label before inserting a catheter/probe. Use the SvO2 label when the catheter/probe will be located in the pulmonary artery (measuring mixed venous oxygen saturation). This is the only label which allows the measurement value to be used to calculate oxygen extraction (see Calculating Oxygen Extraction on page 247) and in the standard oxygen calculations. Use the ScvO2 label when the catheter/probe will be located in a central vein (measuring central venous oxygen saturation. Use the SO2 label in all other cases. To select a measurement label:

1 Select Main Setup then Measurements followed by <SO Label>

Select Label. Select the appropriate label for the catheter/probe location. 2 3 Preparing to Monitor with the M1021A Wide Module In addition to the measurement module, you need a Hospira OptiCath catheter, and 50131 Optical Module. Use only the Hospira accessories listed in the Accessories section. 242 16 Monitoring Intravascular Oxygen Saturation 1 Optical module 2 Balloon inflation stopcock 3 Hospira fiber optic catheter 4 Optical reference 5 Enter setup/calibration Connect the optical module (Hospira 50131) to the measurement module. Allow the optical module to warm up before you perform a calibration. Although the warm up message disappears from the screen after one minute, Hospira recommends letting the optical module warm up for 15 minutes for best accuracy. Please refer to the instructions for the optical module. To avoid false alarms during the pre-insertion calibration and insertion of the catheter into the patient, the monitor automatically suspends alarms during the pre-insertion calibration, for up to three minutes after you remove the catheter tip from the optical reference. After light intensity calibration, or after three minutes (whichever comes first), the monitor returns to the alarm state it was in prior to pre-

insertion calibration. Carrying out a Pre-insertion Calibration WARNING It is strongly recommended to carry out a pre-insertion calibration prior to all insertions. If this is not possible, you must perform an in-vivo calibration after insertion. Refer to the instructions for use that accompany the catheter. Do not use the catheter if the packaging is damaged. If you have to disconnect the monitor from the patient (for example, when transferring the patient from one location to another), you must disconnect at the SvO2 module. The catheter should remain in the optical module, otherwise you need to recalibrate. 1 Remove outer wrapping from catheter tray to uncover optical connector. 2 Place the optical module on the catheter tray in the space provided and open the lid. Place the optical connector into the optical module (with the label "TOP" facing upwards) and close the lid. In the Setup <SO Label> menu, select Start Pre-InsCal. Ensure that the tip of the catheter is still in the optical reference. Insert the catheter when you see the message <SO Label> calibration completed - catheter ready for insertion. If the calibration fails, repeat the calibration before inserting the catheter. If it fails a second time, replace the optical module. 3 4 5 243 16 Monitoring Intravascular Oxygen Saturation Inserting the Catheter 1 Remove the inner cover of the catheter tray. 2 Remove the catheter tip from the optical reference. Check the catheter's proper operation (for example: the balloon tip). Prepare and insert the catheter in accordance with standard hospital practice. 3 The SvO2 catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and sudden decrease in intensity readings. Refer to the documentation provided with the fiber-optic catheter, paying special attention to any precautions, warnings or contraindications. Secure the optical module directly or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient. Position the optical module to avoid contact with liquids, because fluid entering the catheter-optical module connection may impair light transmission. If you place the catheter in the patient without performing the pre-insertion calibration, you must perform an in-vivo calibration once the catheter is in place. Performing a Light Intensity Calibration Perform a light intensity calibration after the catheter is in its proper position. When the catheter is positioned properly, the light intensity indicator must cover at least two small divisions above the midpoint. In the Setup <SO Label> menu, select Start Light Cal. Calibration is complete after a few seconds. If you doubt existing light intensity readings, recalibrate. Performing In-Vivo Calibration if you place the catheter in a patient without performing a pre-insertion calibration. if the catheter was disconnected from the optical module. Perform an in-vivo calibration:

when the catheter has been in the patient for 24 hours. if any significant change in light intensity occurs that the monitor cannot correct automatically. Setting Up the In-Vivo Calibration Check for:

proper positioning of the catheter in the patient. relatively stable oxygen saturation in patient. that the SvO2 light intensity indicator covers at least two divisions above the midpoint. 244 Making the In-Vivo Calibration 16 Monitoring Intravascular Oxygen Saturation 1 Be prepared to draw a blood sample from the patient. In the Setup <SO Label> menu, select Start In-VivoCal. 2 3 To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample. 4 Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice. 5 Obtain laboratory analysis of the sample using direct measurements. 6 7 Complete the calibration by selecting Store In-VivoCal (even if the stored calibration value did not Select CalibrationValue and select from the list the value received from the lab. change) and select Confirm. This updates the data stored in the optical module. Selecting Recall Last Cal recalls the previously stored calibration value. If the calibration fails, check that the light intensity indicator is indicating a stable medium to high level. Repeat the calibration. Setting Up the In-Vivo Calibration proper positioning of the probe/catheter in the patient. relatively stable oxygen saturation in patient. that the light intensity indicator is indicating a stable medium to high level. Check for:

Depending on the probe/catheter in use you may need to enter a catheter correction factor. This will be indicated in the table in the Accessories chapter or in the catheter documentation. 1 2 Enter the correction factor. In the Setup <SO Label> menu, select Catheter Factor. Making the In-Vivo Calibration 1 Be prepared to draw a blood sample from the patient. In the Setup <SO Label> menu, select Start In-VivoCal. 2 3 To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample. 4 Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice. 7 5 Obtain laboratory analysis of the sample using direct measurements. 6 Select CalibrationValue and select from the list the value received from the lab. Select Hct [%] (or Hb [mmol/l] or Hb [g/dl] depending on the set up) and enter the corresponding value from the laboratory analysis. To change the setup for entering the Hb/Hct, see Changing the Lab Value Required for Entry on page 246 below. 8 Complete the calibration by selecting Store In-VivoCal (even if the stored calibration value did not change) and select Confirm. This updates the data stored in the optical module. Selecting Recall Last Cal recalls the previously stored calibration value. If the calibration fails, check that the light intensity indicator is indicating a stable medium to high level. Repeat the calibration. 245 16 Monitoring Intravascular Oxygen Saturation Changing the Lab Value Required for Entry You can change the lab value required to be entered: Hb [g/dl], Hb [mmol/l] or Hct [%]. 1 In the Setup <SO Label> menu, select Hb/Hct Entry. Select your preferred lab value and unit. 2 Preparing to Monitor with the M1011A Narrow Module In addition to the module, you need a Philips SO2 Optical Module and a compatible fiber optic probe or catheter. Use only the accessories listed as applicable for the intended measurement location in the Accessories section. Connecting the Optical Module 1 Connect the optical module to the SO2 module. Allow the optical module to warm up before you insert the probe/catheter and perform a calibration. Although the warmup message disappears from the screen after one minute, it is preferable to let the optical module warm up for 10 minutes for best accuracy. Position the optical module to avoid contact with liquids. Fluid entering the catheter-optical module connection will impair measurement performance. Place the optical module on the catheter tray in the space provided and open the lid. For instructions on the placement of fiber optic catheters/probes, refer to the documentation provided with the accessory. 2 3 4 After Insertion The SO2 probe/catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the probe/catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and a sudden decrease in intensity readings. Refer to the documentation provided with the fibre-optic probe/catheter, paying special attention to any precautions, warnings or contraindications. Secure the optical module directly attached or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient. You must perform an in-vivo calibration once the probe/catheter is in place. The probe/catheter should be replaced after it has been in place for 72 hours. 246 16 Monitoring Intravascular Oxygen Saturation CAUTION Do not apply excessive tension to any sensor cable or part of the catheter. Performing In-Vivo Calibration Perform an in-vivo calibration:

when you place the catheter in a patient. when the catheter has been in the patient for 24 hours. if the catheter was disconnected from the optical module. if any significant change in light intensity occurs that the monitor cannot correct automatically. Further Information for Both Modules Checking Suspicious Values If you have any doubts about the correctness of the measurement value, take a blood sample and have it analyzed using standard laboratory procedures. Calculating Oxygen Extraction Oxygen extraction is the difference between the measured SpO2 and SvO2 values. If you are monitoring SpO2 and SvO2, the monitor can calculate this value and display it as a numeric. To switch oxygen extraction calculation on or off, in the Setup Sp-vO menu, select Sp-vO and toggle between On and Off. If more than one SpO2 value is available, you must choose which value is used in the calculation. In the Setup Sp-vO menu, select SpO Source and select the required source. If one of the calculation sources becomes unavailable, the monitor displays the INOP Sp-vO CHK SOURCES for one minute. After this time, the calculation automatically switches off. If the missing source becomes available again, the calculation automatically switches on again. 247 16 Monitoring Intravascular Oxygen Saturation 248 17 17Monitoring EEG The Electroencephalograph (EEG) module monitors the patient's cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics:

Spectral Edge Frequency - The SEF is the frequency below which a defined percentage of the Total Power lies. The percentage is set in Configuration Mode. Mean Dominant Frequency (MDF) - The MDF is the mean value of the frequency which dominates the measured EEG. Peak Power Frequency (PPF) - The PPF is the frequency with the highest measured amplitude. Total Power (TP) - The TP numeric indicates the power in the measured frequency band. Percentage of total power in each frequency band:

Alpha waves (8 to 13 Hz) Beta waves (13 to 30 Hz) Theta waves (4 to 8 Hz) Delta waves (0.5 to 4 Hz). EEG Monitoring Setup 1 2 3 Plug the trunk cable into the EEG module. Prepare the patient's skin prior to placing the electrodes. Good electrode-to-skin contact is important for a good EEG signal, as the skin is a poor conductor of electricity. Wash sites thoroughly with soap and water. We do not recommend using ether or pure Shave hair from sites, if necessary. alcohol, because this dries the skin and increases the resistance. Use a skin preparation paste to remove skin cells and oil before placing the electrodes. Select the desired electrode montage in the Setup EEG menu or in the EEG Impedance / Montage window. 4 Attach the reference electrode first. 5 Place the electrodes on the patient's head according to the selected montage. Use electrode gel if you are not using pre-gelled electrodes. Remember to select a site where the signal will not be interfered with by muscle artifacts. 6 Connect the electrode connector end to the trunk cable. 249 17 Monitoring EEG 7 Check the electrode-to-skin impedance in the EEG Impedance / Montage window. 8 For good signal quality, keep all lead wires together and away from other electric devices and metallic bodies. Using the EEG Impedance/Montage Window To open the window, in the Setup EEG menu, select Show Montage, or select the EEG Montage SmartKey. The window may be configured to look slightly different on your monitor. 1 Electrode locations on the patient's head. The symbols represent the electrode-to-skin impedance. 2 Wiring and impedance values for the selected montage Choosing an EEG Electrode Montage 1 To activate one of the five pre-configured electrode montages, select the arrow beside the label in the EEG Impedance / Montage window and choose a montage from the list. 2 Attach the electrodes as illustrated in the EEG Impedance / Montage window. The five default electrode montage configurations can be modified and renamed in Configuration Mode. Montage Name Montage A Montage B Montage C Montage D Montage E EEG1+

Fp1 O1 F3 C3 Fp1 EEG1-

T3 T3 C3 P3 T5 Label1 Fp1-T3 O1-T3 F3-C3 C3-P3 Fp1-T5 EEG2+

Fp2 O2 F4 C4 Fp2 EEG2-

T4 T4 C4 P4 T6 Label2 Fp2-T4 O2-T4 F4-C4 C4-P4 Fp2-T6 The electrode locations are labeled according to the international 10-20 electrode placement system. 250 17 Monitoring EEG Changing the Impedance Limit The impedance limit can be set for all electrodes simultaneously in the Setup EEG menu, or in the EEG Impedance / Montage window using the pop-up keys. If the limit is exceeded during monitoring, an INOP will appear and the graphic impedance indicator will change. To change the impedance limit, either use the pop-up keys that appear with the EEG Impedance / Montage window, or in the Setup EEG menu, select Impedance Limit to call up a list of selections between 1 and 30 kOhm, then select the required limit from this list. About Electrode-to-Skin Impedance Electrode-to-skin impedance is the main quality indicator for the measured EEG signal. During normal EEG monitoring, electrode-to-skin impedance is measured continuously and disconnected electrodes are detected. The impedance value for each single, independent signal electrode is displayed in the EEG Impedance / Montage window. If the measured electrode-to skin impedance of one or more electrodes is above the limit, an INOP will be issued. For impedance measurement at least two electrodes, plus the reference electrode, must be connected. 251 17 Monitoring EEG Impedance Indicators Electrode/Skin Impedance Symbol Color Electrode not connected Noisy signal Electrode connected, impedance above limit Electrode connected, impedance at or below limit red gray yellow green Displayed Impedance Value no value Action connect electrode 60 k (fixed) check electrode-to-skin connections measured value

(e.g. 15 k) measured value

(e.g. 3 k) check limit, check electrode-to-skin contact no action necessary About Compressed Spectral Arrays (CSA) The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA). The CSA window provides an overview of the patient's EEG values over time. It may be configured to look slightly different on your monitor. To view the CSA window permanently embedded on a Screen, select a Screen configured to display the CSA window. To view the CSA window over the current Screen, select the EEG CSA SmartKey, if configured, or select Setup EEG or Main Setup then Show CSA. 252 17 Monitoring EEG The CSA contains the following information Lead label CSA label Montage label Filter settings Buffer label and time Current SEF Threshold The energy at each frequency is computed and displayed as a spectral line for example, Fp1-T3, Fp2-T4 CSA1 or CSA2 according to EEG channel for example, Montage A for example, 1-30 Hz the buffer and interval between spectral lines on the CSA can only be changed in Configuration Mode EEG values are sampled at configured time intervals and displayed as color-coded trendlines. Trendlines are available for the three frequency numerics (SEF, PPF, MDF) INOP marker Filter change marker Montage change marker Status line Spectral lines Trendlines Annotations:

Changing CSA Settings When CSAs are shown embedded on the Main Screen, select the CSA to show the pop-up keys. When the CSA is shown in a window over the current screen, the pop-up keys are always displayed. Setup CSA Window Buffer On/Off SEF On/Off MDF On/Off PPF This menu entry lets you choose one of the three pre-configured buffers. A buffer defines the interval between the spectral lines displayed in the CSA. switch the trendline of the specific numeric on or off Changing EEG Settings Be aware that any changes made to EEG settings apply to both EEG channels. Switching EEG Numerics On and Off Each EEG numeric can be individually switched on or off in the Setup EEG menu. 1 In the Setup EEG menu, select the numeric label. Select On or Off to switch between the settings. 2 Changing the Scale of the EEG Waves for Display This only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings. 1 In the Setup EEG menu, select Wave Scale to call up a list of wave scales. Select the required scale from this list. 2 Scaling information is displayed with each EEG wave. 253 17 Monitoring EEG If Show Gridlines is set to On in Configuration Mode, gridlines and the current wave scale values are shown with the EEG wave. If Show Gridlines is set to Off in Configuration Mode, the current wave scale is indicated by a size bar beside the EEG wave. Changing Filter Frequencies The low and high pass filters screen out undesirable interference from the raw EEG wave display. The current EEG filter frequency settings are shown in the header of the CSA. Changing filter settings affects the EEG wave and all the EEG numerics. Whenever the filter setting is changed, a filter change marker appears next to the spectral lines. To change the filter settings:

1 In the Setup EEG menu, select Low Filter or High Filter to call up a list of available frequencies. Select the required frequency from this list. Changing the Speed of the EEG Wave 2 The EEG measurement has its own speed control and is not affected by the wave speed settings of the other measurements. In the Setup EEG menu, select EEG 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). EEG Reports The content of EEG Reports is always the same and does not need to be configured. To print an EEG Report, in the Setup EEG menu, select Print Report. Alternatively, you can select the CSA and use the Print Report pop-up key to start the report. To modify the buffer and trendline settings on the CSA Report, in the Reports menu, select CSA On EEG Rep.. If you do not change these settings, the monitor will use the default settings with the trendlines for the SEF numeric on and the buffer time from Buffer C. CSA On EEG Rep. Buffer Trend SEF Trend MDF Trend PPF This menu entry lets you choose one of the three pre-configured buffer times switch the trendline of the specific numeric on or off EEG Safety Information WARNING Do not touch the patient, or table, or instruments during defibrillation. When connecting electrodes and/or patient cables, ensure that the EEG leads and connectors do not come into contact with other conductive parts or earth. 254 High-frequency Surgery - To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the EEG electrodes should not be located between the surgical site and the electrosurgical unit return electrode. 17 Monitoring EEG EEG and Electrical Interference CAUTION Interference from a non-grounded instrument near the patient and electrosurgery interference can cause problems with the waveform and the CSA. Radiated field strengths above 1 V/m and patient signals 50 V may cause noise on the EEG waves at various frequencies. Therefore, it is recommended to avoid the use of electrical radiating equipment in close proximity to the patient monitor. The noise does not influence the measurement accuracy. Interference from ECG can be eliminated by adjusting the low filter settings. 255 17 Monitoring EEG 256 18 18Monitoring BIS Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient's forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS intended use statement. The BIS Module provides the monitor with an EEG wave and the following numerics:

Bispectral Index (BIS). The BIS numeric reflects the patients level of consciousness. It ranges from 100 (fully awake) to 0 (suppression; no electrical brain activity). Signal Quality Index (SQI). The SQI numeric reflects signal quality and provides information about the reliability of the BIS, SEF, TP, SR, and Bursts numerics during the last minute. It ranges from 0 to 100%:

SQI < 15%: the numerics cannot be derived SQI 15% to 50%: the numerics cannot be reliably derived SQI 50% to 100%: the numerics are reliable. Electromyographic Activity (EMG). The EMG numeric reflects the electrical power of muscle activity and high frequency artifacts. EMG < 55 dB: this is an acceptable EMG EMG 30 dB: this is an optimal EMG

(note that the minimum possible EMG is approximately 25 dB). Suppression Ratio (SR). The SR is the percentage of time over the last 63-second period during which the EEG is considered to be in a suppressed state. Spectral Edge Frequency (SEF). The SEF is the frequency below which 95% of the Total Power is measured. Total Power (TP). The TP numeric indicates the power in the frequency band 0.5 to 30 Hz. The useful range is 30 - 100 dB. Bursts (BISx used with the Extend sensor only). The Bursts numeric helps you quantify suppression by measuring the number of EEG bursts per minute, where an EEG burst is defined as a period of activity followed and preceded by inactivity (at least 0.5 second). BIS Monitoring Setup There are two BIS solutions available for use with the M1034A BIS module: using the Digital Signal Converter (DSC) and BIS Engine or using the BISx. 257 18 Monitoring BIS Monitoring BIS Using the DSC and BIS Engine BIS Engine Cable 1 2 BIS Module 3 BIS Engine 4 Digital Signal Converter (DSC) 5 6 BIS Sensor Patient Interface Cable 1 If you are monitoring BIS with the DSC and BIS Engine, a. Connect the BIS Engine to the BIS module using the BIS Engine Cable. b. Connect the digital signal converter (DSC) to the digital signal converter port on the front of the BIS Engine. Use the attachment clip to secure the digital signal converter near, but not above the patient's head. c. Attach the patient interface cable (PIC) to the digital signal converter (DSC). 2 Attach the BIS sensor to the patient following the instructions supplied with the sensor. Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values. A variety of sensors are available for use in the OR and ICU environments. 3 Connect the BIS sensor to the patient interface cable. As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window. Monitoring BIS using the BISx BIS Module 1 2 BISx 3 4 BIS Sensor Patient Interface Cable 258 18 Monitoring BIS 1 If you are monitoring BIS using the BISx, a. Connect the BISx to the BIS module b. Use the clip on the rear of the BISx to affix it in a position convenient for your patient, not above the patient's head. 2 Attach the BIS sensor to the patient following the instructions supplied with the sensor. Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values. A variety of sensors are available for use in the OR and ICU environments. CAUTION Ensure that the BISx does not come into prolonged contact with your patient's skin, as it may generate heat and cause discomfort. The BISx may remain connected to a patient during defibrillation as long as the sensor is not located between the defibrillator pads. 3 Attach the patient interface cable (PIC) to the BISx. 4 Connect the BIS sensor to the PIC. As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window. Manufacturer's Information BIS Engine, DSC, BISx, the Patient Interface Cable and the BIS Sensors are manufactured by Aspect Medical Systems. BIS Continuous Impedance Check This checks:

the combined impedance of the signal electrodes plus the reference electrode. This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results. the impedance of the ground electrode. This is done every ten minutes and takes approximately 4 seconds. It causes an artifact in the EEG wave, and the message Ground Check is shown on the monitor screen during the check. If the ground electrode does not pass this check, another check is started. This continues until the ground electrode passes the check. If the Continuous Impedance Check interferes with other measurements, it can be switched off. To do this:

1 In the Setup BIS menu, select Cont. Imp. Check. Select On or Off as required. 2 259 18 Monitoring BIS CAUTION Switching the continuous impedance check off will disable automatic notification to the user of impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done if the check interferes with or disturbs other measurements. BIS Cyclic Impedance Check This measures the exact impedance of each individual electrode. It causes a disturbed EEG wave, and the INOP BIS IMPEDANCE CHCK is shown on the monitor screen during the check. Starting a Cyclic Impedance Check The Cyclic Impedance Check is automatically started when a sensor is connected. To manually start a Cyclic Impedance Check:

select Cyclic Check in the Setup BIS menu to toggle between On and Off, or select StartCyclicCheck in the BIS window. Stopping a Cyclic Impedance Check The Cyclic Impedance Check stops automatically if the impedances of all electrodes are within the valid range. To manually stop a Cyclic Impedance Check:

If you stop a Cyclic Impedance Check before the ground electrode has passed, a ground electrode impedance check will be started automatically. This cannot be switched off. select Cyclic Check in the Setup BIS menu to toggle between On and Off, or select Stop CyclicCheck in the window. BIS Window To open the BIS window, in the Setup BIS menu, select Show Sensor. The window may look slightly different on your monitor. The graphic in the BIS Window automatically adapts to show the type of sensor you are using, showing three or four electrodes as required. Each symbol in the graphic represents an electrode and illustrates the most recently-

measured impedance status of the electrodes. Although BIS may still be measured when the electrode status is red or yellow, for best performance, all electrodes should be green. In addition, if the measured electrode-to skin impedance of any electrode or electrode combination is above the limit, or if disconnected electrodes are detected, an INOP will be issued, either BIS HIGH IMPEDANCE or BIS LEAD OFF. 260 18 Monitoring BIS 1 Reference Electrode 2 Ground Electrode Signal Electrode(s) 3 4 Time of the most recent cyclic check BIS Impedance Indicators Electrode-to-Skin Impedance Electrode has no skin contact Too much signal noise, impedance cannot be measured Impedance above limit Impedance within valid range Symbol Color Action red gray yellow green Reconnect electrode, or check the sensor-

to-skin contact. If necessary, clean and dry skin. Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin. Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin. No action necessary In addition to the symbols, the impedance value in kOhm is also displayed. Changing the BIS Smoothing Rate The smoothing rate defines how the monitor averages the BIS value. To change the smoothing rate, in the Setup BIS menu, select Smoothing Rate then choose either:

15 sec: this provides increased responsiveness to changes in the patient's state. 30 sec: this provides a smoother BIS trend with decreased variability and sensitivity to artifacts. 261 18 Monitoring BIS Switching BIS and Individual Numerics On and Off To switch the BIS measurement on or off:

In the Setup BIS menu, select BIS and then On or Off as required. To switch individual numerics provided by the BIS Module on or off:

In the Setup BIS menu, select SQI, TP, SEF, SR, EMG, or Bursts and then On or Off as required. Changing the Scale of the EEG Wave Changing the scale only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings. The scale information shown depends on whether gridlines are switched on or off for display. This setting can only be changed in Configuration Mode. 1 In the Setup BIS menu, select Scale to call up a list of wave scales. Select the required scale from this list. When gridlines are switched off, you can choose from the available scale values: 50 V, 2 100 V, 200 V, and 500 V. Scaling information is displayed as a vertical bar on the EEG wave together with its height equivalent in mV. When gridlines are switched on, scales are defined as a range, either 25 V, 50 V, 100 V, or 250 V. Scaling information is shown in the form of gridlines. Switching BIS Filters On or Off The low and high pass filters screen out undesirable interference from the raw EEG wave display. The notch filter removes line frequency interference. Filter settings affect the EEG wave and the SEF and TP values, but they do not affect the BIS, EMG, SR, and SQI values. The filter settings are set in Configuration Mode. You can switch all the filters on or off together in Monitoring Mode. 1 In the Setup BIS menu, select Filters. Select On or Off as required. 2 BIS Safety Information For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and Etomidate, please contact Aspect Medical Systems to request a copy of their publication "A Clinician's Guide to the Bispectral Index". Considerations for Use Due to limited clinical experience in the following applications, BIS values should be interpreted cautiously in patients with known neurological disorders, those taking psychoactive medications, and in children below the age of 1. 262 18 Monitoring BIS WARNING Conductive Parts: The conductive parts of sensors and connectors should not contact other conductive parts, including earth. High-frequency Surgery: To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the BIS sensor should not be located between the surgical site and the electro-

surgical unit return electrode. Defibrillation: The BIS sensor must not be located between defibrillator pads when a defibrillator is used on a patient connected to the patient monitor. Securing Cables: To minimize the risk of patient strangulation, the patient interface cable (PIC) must be carefully placed and secured. CAUTION Revisions: The system will only function if all component revisions are compatible. Otherwise, an incompatibility INOP is displayed. If the DSC has an older software revision than the BIS Engine, the DSC will automatically be upgraded by the BIS Engine. Do not disconnect the DSC from the BIS Engine, or disconnect the BIS module from the monitor, or switch the monitor power off within the first ten seconds after connection, as this will disrupt a possible software upgrade and cause damage to the DSC. Impedance Checks: Impedance checks may influence data acquisition of other electroencephalographic devices. 263 18 Monitoring BIS 264 19 19Assigning a Telemetry Device and a Monitor to One Patient It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called

"pairing" and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be:

any Philips telemetry device (only for indirect connections, see below). a TRx/TRx+ Intellivue Telemetry system transceiver. an MP5 monitor or X2 Multi measurement module with a telemetry interface, declared as a telemetry device and with a telemetry equipment label. For complete user information, including accessory listings and specifications, for the M4841A/

M4851A TRx/TRx+ IntelliVue Telemetry Transceiver, refer to the Instructions for Use provided with the device. How Can You Combine Devices?

With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor. With a direct connection to the monitor an MP5 or X2 is connected via MSL cable to the monitor, or a telemetry transceiver with a short range radio adapter is assigned to an MP5 or X2 which is connected (Companion Mode) to a an MX600/700/800 host monitor the data arrive with a minimal delay on the monitor screen. Indirect Connection - Manual Pairing The telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use. To pair the monitor with a telemetry device at the monitor:

265 19 Assigning a Telemetry Device and a Monitor to One Patient 1 2 Select Main Setup then Measurements Select Telemetry The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor. Telemetry Data Window The measurements from the telemetry device are shown in the telemetry data window on the monitor. 1 A current alarm generated by the telemetry device. 2 Delayed - indication that data in the window is delayed 3 Telemetry data window WARNING All data presented in the telemetry data window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG analog output. Direct Connection - Automatic Pairing The following direct connections are possible:

an MP5 or X2, declared as a telemetry device, and connected with an MSL cable to a monitor. WARNING When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel. When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected. 266 19 Assigning a Telemetry Device and a Monitor to One Patient Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. Pairing an X2 or MP5 With a Telemetry Interface to a Host Monitor An X2 Multi-measurement module or an MP5 using an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a "telemetry device" at the Information Center. When the X2 or MP5 is disconnected from the host monitor it will remain paired and the measurement data will appear at the host monitor in the Telemetry Data window. After the X2 or MP5 is disconnected from the monitor it may take over 15 seconds until their data is displayed at the Information Center. Pairing of a host monitor and a telemetry device, with all the related functionality, is only possible when the host monitor is using a wired LAN connection or a wireless LAN interface (but not using the IntelliVue Instrument Telemetry interface). The X2 or MP5 can also be manually paired to a host monitor without a direct connection, as described in Indirect Connection - Manual Pairing on page 265. Refer also to Use Models With Telemetry on page 269 for further related use modes. Functions Available When the Telemetry Data Window is Displayed Controlling the Telemetry Device from the Bedside You can change settings for a paired telemetry device at the monitor:

1 Select the telemetry data screen element Select the Setup Tele pop-up key 2 The Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here. Viewing and Silencing Telemetry Alarms at the Bedside When a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic * TELE ALARM message will appear in the alarm status area with standard alarm tones. The * TELE ALARM message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example ** HR LOW) will appear in the telemetry data window. If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:

1 Select the telemetry screen element. 267 19 Assigning a Telemetry Device and a Monitor to One Patient Select the Silence Bed pop-up key. 2 Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms. WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured. Suspending Telemetry Alarms When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected. Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device. Using Standby When you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring. Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device. General Telemetry-related Functions The following functions are valid for directly and indirectly connected telemetry devices. ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated and the Setup ECG menu will no longer be accessible. When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitor's own measurements, the SpO2T measurement (if present) will no longer be displayed. In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa. In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. 268 19 Assigning a Telemetry Device and a Monitor to One Patient Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:

Heart Rate ECG Arrhythmia ST QT SpO2T HR/Pulse Alarm On/Off, Heart Rate High/Low Limit, Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead Placement Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T PVCs On/Off, Vent. Bigeminy On/

Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/Off ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm Limit QT analysis On/Off, QT Lead, QTc High Alarm On/Off, QTc Alarm On/Off, QTc High Limit, QTc High Limit, QTc Formula2, QT Baseline SpO2 Alarms on/off, SpO2 Alarm limits NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off 1Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6. 2This setting will only be synchronized when the Information Center supports QT Analysis for Telemetry WARNING Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate. Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6 If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or !! CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient. Use Models With Telemetry The standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the Information Center in the same patient sector as the monitor data. The following variations are possible:

1 The monitor is paired with a telemetry transceiver - indirect connection 269 19 Assigning a Telemetry Device and a Monitor to One Patient telemetry data appear on the monitor 2 An MP5 or X2 is declared as a telemetry device and paired with an MX600/700/800 monitor -

direct or indirect connection MP5/X2 measurement data appear on the monitor it is paired with a telemetry transceiver cannot be used with the MP5/X2 3 A telemetry transceiver directly connected (SRR or for MP5 cable) to an MP5 or X2, that is connected (Companion Mode) to an MX600/700/800 monitor - direct connection telemetry data appear on the host monitor telemetry transceiver is paired with the host monitor but is assigned to the MP5 or X2 the MP5 or X2 must have no equipment label The different variations require different configuration settings; refer to the Configuration Guide for details. 270 20 20Trends Trends are patient data collected over time and displayed in graphic, tabular or histogram 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 aperiodically-

measured 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 Change Screen window, then select a Screen designed to show an embedded trend window. To open the tabular trends window over the current Screen, select Main Setup, Trends, then Vitals Trend, or select the Vitals Trend SmartKey To open the graphic trends window over the current Screen, select the Graph Trend SmartKey

. To open the histogram trend window over the current screen, select Main Setup, Trends, then Histogram, or select the Histo- gram SmartKey. The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom or the top of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the 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. 271 20 Trends Trends Pop-Up Keys When you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. Pop-Up Keys Select Group Select Interval Print/ Record Print Vital Signs Graph Trend Selecting this pop-up key lets you.... see a pop-up list of trend groups and select a group for viewing. see a pop-up list of available data resolution settings and select the level of detail shown in the trend view. print a tabular trends report or make a tabular trend recording of the data in the current window. The report will use the current trend interval settings. 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. move the cursor one page to the left or right to navigate through the trends database timeline. jump to the beginning or the end of the trends database to see the most recent or oldest trend information stored. 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 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, 272 20 Trends Select the graphical trend or the arrow pop-up keys to activate the cursor. 1 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends 1 Aperiodic values are shown with a timestamp 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. To view the Vital Signs trend with one column for each NBP measurement (see Defining the Column Interval Using the NBP Measurement on page 277):

1 With the Vital Signs trend open, select Interval. 2 Select NBP from the pop-up list. 273 20 Trends Viewing Histogram Trends The title line of the window shows the label of the trended measurement and the resolution of the data; in the RR histogram above, 1 minute trend samples. The horizontal axis shows the range and unit of the displayed measurement. The vertical axis shows the percentage of time. The columns in the foreground show how much of the time the measured values fell into this range on the scale. For example, in the histogram above, the RR value was between 15 and 20 rpm during 70%

of the last four hours. The arrow mark over that column shows that the currently measured value is also in this range. These columns are displayed in the same color as the measurement data. The columns in the background show the cumulative percentage value: each of the foreground columns is added to the sum of those columns to the left of it. A question mark is displayed if less than two-thirds of the data are valid samples. The pop-up keys in the window can be used to change the measurement, the time period and the range. You can also print out a histogram report. The SpO2 histograms can be trend histograms or realtime histograms with 1 second samples. For SpO2 realtime histograms, the range cannot be changed. 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. 274 Expanded View 20 Trends in the Segment menu, select Expand to have that segment enlarged to fill the window. To expand the segment to fill the Graphical Trends window, 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 menu, select Highlight repeatedly until the highlight is on the required measurement. 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 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. 2 Optimum Scale in the Segment menu, select Optimum Scale. To have the monitor automatically select an optimum scale for viewing, based on current values, 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 Use the Add, Change, Sort Up and Sort Down pop-up keys to change or re-order the group as In the Segment menu, select Change Group. 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 Graphical 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. 275 20 Trends To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or:

1 Select Main Setup, Trends, then 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. 2 To temporarily change the order in which the measurements are displayed in a group, 1 Select Main Setup, Trends, then Trend Groups. Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort Down pop-up keys. 2 Trend Interval The trend interval defines the resolution of trend data shown on the Screen. High-resolution data is especially suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative. 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. (Data from VueLink or IntelliBridge modules cannot be included in trends when the label is a free-text label.) 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 In the Main Setup menu, select Trends. Select Trend Priority. 2 To add measurements to the priority list, 1 2 Use the Sort Up and Sort Down pop-up keys to change the priority order. Select the pop-up key Add and choose from the pop-up list of available measurements. 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. Select Parameter Scales. Select the measurement or parameter you want to change from the list. 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. 2 3 4 5 276 Graphical Trend Presentation 20 Trends Graphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, 1 Select Main Setup then select Trends. 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. 2 This sample ABP trend shows the continuously-measured values for the systolic, diastolic and mean pressures displayed in band form. Defining the Column Interval Using the NBP Measurement You can have the NBP measurement determine the interval between the columns on the Vital Signs trend. Each NBP measurement will generate a column in the trend table. The values for the other measurements are added to the column to provide a complete vital signs set for the NBP measurement time. To use the NBP measurement to determine the column interval:

1 Select Main Setup then Trends. In the Trends menu, select Setup VitalSigns. In the Vital Signs menu, select Column and then NBP from the pop-up menu. 2 3 Setting Measurement and Period for Histograms To set the default for the measurement data to be used in the histogram, 1 Select Main Setup then select Trends. Select Setup Histogram. Select Data Source. Select either a realtime SpO2 or Trended Data. From the trended data list select the required measurement. 2 3 4 To set the default period for the histogram, Select Main Setup then select Trends. 1 Select Histogram. Select Select Period and select the required time period from the list. 2 3 When viewing a histogram, the data source, the period and the range can be changed using the pop-up keys. 277 20 Trends Documenting Trends To print a Vital Signs or Graphical Trends report, in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. 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. To make a Vital Signs recording, in the Vital Signs window, select the Print/ Record pop-up key, then select the Record Vitals pop-

up key. Vital Signs recordings print the trend data for the current group and trend period shown in the Vital Signs window. Trends Databases Depending on the purchased options and the monitor's configuration, the trends databases store information for up to 32 measurements for up to 72 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. 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. 278 20 Trends 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, histogram 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. Setting the Screen Trend Time To set the ScreenTrend Time for all graphical, histogram and horizon screen trends ("global" trend time), 1 Select a screen trend then select Setup Trend, or select Main Setup then select 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. 2 To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends, 1 Select a screen trend. Select Change TrendTime Select the required trend time. Selecting Global leaves the trend time set to the global screen trend time. 2 3 Changing the Selection of Screen Trends Displayed 1 2 Select the screen trend. 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, Select Change Trend followed by Add Trend and select a screen trend from the pop-up list. 2 Activating the Cursor for Screen Trends To activate the cursor for Screen Trends:

279 20 Trends 1 Select the screen trend. Select Activate Cursor. 2 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, Select Main Screen. Changing the Screen Trend View To switch between tabular, graphic, histogram and horizon views, select the screen trend then select Change View and select the required view. Tabular View Aperiodic measurements such as NBP, C.O., C.I., and Wedge can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label. The trend time for tabular screen trends depends on the space available on the Screen. Up to 30 measurements or 12 hours information can be shown. Histogram View The histogram view presents a combination of graphical trend and histogram. The histogram is on the right hand side in a horizontal presentation with vertical gridlines representing 25%, 50%, 75% and 100%. Each column shows the percentage of time that the measurement values were in a specific range. This range is represented by the column's position in the graphical trend gridlines. The arrow mark next to a column shows that the currently measured value is in the range covered by that column. If less than two-thirds of the samples are valid, a question mark will be displayed with the histogram, except when the histogram consists of intermittently measured data. 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:

280 20 Trends a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition. The horizon can be set to represent your patient's current 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 2 To set the horizon, select the horizon trend. 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. Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits. 2 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 is displayed can be set in the Trends window. 1 Select Main Setup then select Trends. Select HorizonArrowTime. Select 10, 5 or 2 minutes. 2 3 281 20 Trends 282 21 21Calculations Calculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information. Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations. Ventilation Minute Volume (MINVOL) Compliance (COMP) Dead Space (Vd) Dead Space/Tidal Volume Ratio (Vd/Vt) Alveolar Ventilation

(ALVENT) Oxygenation Arterial Oxygen Content (CaO2) Venous Oxygen Content (CvO2) Arteriovenous Oxygen Content

(CavO2) Oxygen Availability Index (DO2I) Oxygen Consumption (VO2) Oxygen Consumption Index

(VO2I) Oxygen Extraction Ratio (O2ER) Alveolar-Arterial Oxygen Difference (AaDO2) Percent Arteriovenous Shunt

(Qs/Qt) Hemodynamic Cardiac Index (C.I.) Stroke Volume (SV) Stroke Index (SI) Systemic Vascular Resistance (SVR) Systemic Vascular Resistance Index (SVRI) Pulmonary Vascular Resistance (PVR) Pulmonary Vascular Resistance Index (PVRI) Left Cardiac Work (LCW) Left Cardiac Work Index (LCWI) Left Ventricular Stroke Work (LVSW) Left Ventricular Stroke Work Index (LVSWI) Right Cardiac Work (RCW) Right Cardiac Work Index (RCWI) Right Ventricular Stroke Work (RVSW) Right Ventricular Stroke Work Index (RVSWI) Extra Vascular Lung Water Index (EVLWI) Intrathoracic Blood Volume Index (ITBVI) Global End Diastolic Volume Index (GEDVI) The hemodynamic calculations available depend on the Cardiac Output measurement method being used and the regulatory standards that apply for your hospital: see the Monitoring Cardiac Output chapter for availability details. 283 21 Calculations Viewing Calculations Select the Calcs SmartKey to open the Calculations window. Select the Calc Type field and select the required calculation type for display. Calculations Windows This example calculations window shows the Hemodynamic Calculations window. The ventilation and oxygenation windows are similar. 1 Height used for the calculations 2 Weight used for the calculations 3 Calculation Time 4 Calculations input values 5 Output values 6 Indexed calculation values Calculations Pop-Up Keys Depending on the calculations group you choose, a selection of pop-up keys will appear to let you navigate through the stored events and carry out calculations-related tasks. 284 21 Calculations Pop-Up Keys Resample Vitals Perform Calc Print/Record On/Off DateTime On/Off Ranges Cardiac Output Hemo Review Vent Review Oxygen Review Selecting this pop-up key lets you.... use the most recent monitored values. Resampling sets the calculation time to the current time, and displays the corresponding values for the previous second. perform the displayed calculation using the currently-input values and store the calculation in the calculations database print or record the displayed calculation. toggle between showing the date and time or the units for the calculation input values. toggle between showing the normal ranges or the units for the calculation output values. access the C.O. procedure window. open the hemodynamic calculations review window. open the ventilation calculations review window. open the oxygenation calculations review window. Reviewing Calculations To enter the calculations review window, select the Oxygen Review, Vent Review, or Hemo Review pop-up key as required. The review window lists all the input and output values for each measurement in the calculations group. The timeline in the review window lists the times the calculations were performed. To review individual calculations, select the calculation in the review window and then select the Original Calc pop-up key. The storage time for calculations is the same as the trend database storage time configured for the monitor. So if trends are stored for 48 hours, the calculations will also be stored for 48 hours. Performing Calculations You must check that all input values are appropriate for your patient before performing calculations. 1 2 Check the calculation time in the Calc Time field. Select the Calcs SmartKey to open the Calculations window. When you enter the calculation window, this field will show either the current time or the time of the most recent available C.O. measurement, depending on your monitor configuration. To choose a different calculation time, select the Calc Time field. This calls up a list showing the timestamps of calculations performed earlier. Select a time from this list, or select Select Time to enter a time of your choice. The values from the Vital Signs database from the 30 minute period before the selected time will be used. To enter the current time, select the Resample Vitals pop-up key. If you choose the current time, the monitor will resample all the required values that are monitored. 3 Enter any values that must be entered or edited manually. Select the value field and then use the pop-up keypad to enter the required values. Select Enter to confirm each entered value. Manually-

entered values are marked with an asterisk (*). 285 21 Calculations Entering Values for Calculations The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available. If the calculation time is the last C.O. time, values will be used from up to and including 30 minutes before the C.O. time, except for height and weight where the last available value will be used. To enter calculations values manually or edit automatically-entered values, select the value field to open the on-screen keyboard and use this to enter the correct value. Values edited manually are marked with an asterisk (*). If you enter a value that has more decimal places than allowed for a particular input, the value you enter will be rounded off after you select Enter. If you enter a value which cannot be stored, the message Value out of range will appear. Enter a new value. In hemodynamic calculations, if the systolic and diastolic pressures are manually entered, the mean pressure is calculated and marked with an asterisk (*). The formula used to estimate the mean pressure is [systolic + (diastolic x 2)] / 3. Automatic Value Substitution If the monitor cannot find a value required for calculation, it automatically tries to find an equivalent source for this value. For example, if C.O. is required but unavailable, the monitor automatically looks for CCO as a alternative source of C.O. values, or an alternative Pressure label may be used instead of ABP. The label of the value in the Calculations window does not change. Substituted values are marked with an asterisk (*). Automatic Unit Conversion The monitor needs consistent units for performing calculations. It automatically converts units where necessary before it performs the calculation, for example, pressures sourced in kPa, cmH2O, or mbar are automatically converted to mmHg, or to cmH2O for ventilation calculations. Manual Unit Conversion If you need to convert units for other purposes you can use the Unit Conversion window:

1 Select Main Setup then select Calculations. Select Unit Conversion. Select the field under the unit you know and use the on-screen keypad to enter the known value. The converted value automatically appears in the adjacent field. 2 3 BSA Formula Your monitor provides both the Boyd and Dubois formulas for the calculation of body surface area

(BSA). For calculations, the monitor uses the setting defined in the Patient Demographics menu. All calculation results that use BSA are indexed to the selected formula. To check the current setting, select the patient name to enter the Patient Demographics menu. BSA(B) indicates that the Boyd formula is used; BSA(D) indicates that the Dubois formula is used. 286 Comparing Dynamic Compliance Values 21 Calculations If you compare the dynamic compliance value (COMP) from the ventilation calculations with the value from the Spirometry measurement you may see a difference. This comes from the different sampling methods:

The algorithm in the ventilation calculations takes into account only two sets of paired AWP/

AWV data: those from complete expiration and complete inspiration, when AWF is zero. The algorithm in the Spirometry application takes into account all sets of paired AWP/AWV data

(125Hz sampling rate), over one complete breath cycle, and calculates an "averaged" compliance using a least square method. Documenting Calculations To send a Calculations recording to a connected recorder, in the Calculations window, select the Print/ Record pop-up key, then select the Record Calc pop-up key. Calculations recordings print the patient demographic information and the content of the current Calculations window on the recorder strip. To print a report for the calculation group currently on the monitor screen, select the pop-up key Print Calc. To print the review window, select the pop-up key Print in the review window. All the calculations in the current group will be printed in the report. Calculation reports can be printed on central or local printers. This example report shows the oxygen calculation group. Ventilation and hemodynamic calculation reports are similar. Patient information 1 2 Calculation group 3 Three columns of calculations input and output values, with times, units and ranges, where appropriate 287 21 Calculations 288 22 22High Resolution Trend Waves High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance. They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient's condition across different hi-res trend waves.This can aid in the early detection of cardiorespiratory and hemodynamic problems. The amount of data you can show on a screen depends on the display size and resolution: for example, on an eight inch (20 cm) wave trace on your monitor screen, you can view approximately six minutes of hi-res trend wave trace. The hi-res waves are drawn at a speed of 3 cm/minute. The availability of hi-res trend waves depends on your monitor configuration and on the options purchased for your monitor. Changing the Hi-Res Trend Waves Displayed To change the selection of hi-res trend waves on the Screen:

1 Select a displayed hi-res trend wave. Select the required hi-res trend wave from the pop-up list. 2 If there are no hi-res trend waves on the Screen, you must change to a Screen with hi-res trend waves. Hi-Res Trend Wave Scales Hi-res trend waves are either compressed realtime waves or fast numeric trends. Hi-res trend waves from compressed realtime waves include: Resp, CO2, ABP, PAP, CVP, ICP, AWP, anesthetic agents. Hi-res trend waves from fast numeric trends include: btbHR, SpO2, tcpO2, tcpCO2, Pulse, Perf, CPP, BIS, CCO, inO2, Delta SpO2. Hi-res trend waves from realtime waves use the wave scale as their display scale. Changing the wave scale changes the hi-res trend wave scale. Hi-res trend waves from numerics use a pre-defined display scale dependent on the patient category. Hi-Res Trend Waves and OxyCRG OxyCRG is a combination of three hi-res trend waves, btbHR, SpO2, and Resp, mainly used in neonatal monitoring. 289 22 High Resolution Trend Waves Printing Hi-Res Trend Wave Reports all VisibleWaves - prints all waves and hi-res trend waves currently displayed All Waves - prints realtime waves and hi-res trend waves for all currently-monitored measurements HiRes Waves - prints hi-res trend waves for the currently-monitored measurements To print hi-res trend waves on reports, you can choose to print either OxyCRG Waves - prints hi-res trend waves for btbHR, SpO2, and Resp. For each hi-res trend wave, a maximum of six minutes of measurement data will be printed. See the Printing Patient Reports chapter for more information on setting up reports. Hi-Res Trend Wave Recordings The selection of waves in hi-res trend wave recordings and the recording speed are defined by the pre-

configured HiResTrd recording template. See the Recording chapter for more information. To start a hi-res trend waves recording, 1 select the Recor- dings SmartKey, if configured, or select Main Setup then select Recordings. select the HiRes Recordng pop-up key. 2 290 23 23Event Surveillance Events are electronic records of episodes in your patient's condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations. Depending on the level of event surveillance available on your monitor, the information stored for each event episode can include:

waveforms for up to four measurements of your choice (depending on episode type, see Events Pop-Up Keys on page 293 for more details) numeric vital signs for all the measurements monitored any alarm conditions active when the event episode was triggered any annotations connected with the event. You can navigate through the event database to view events retrospectively, and you can document events on a recording or report marked with the patient name, bed label, and the data and time. When an MP5 is connected to a host monitor, event surveillance will be disabled. No new events will be detected and no existing events will be deleted. There is no data exchange between the host monitor and the MP5 for event surveillance. When the MP5 is disconnected from the host monitor event surveillance will resume and new events will be detected. Levels of Event Surveillance The appearance of the Events windows and menus and the settings you can select for events depends on the event surveillance option purchased for your monitor: basic event surveillance, advanced event surveillance, or neonatal event review (NER). This table lists the differences between the options. To determine which level of event surveillance your monitor has, select Main Setup then Event Surveill. followed by Setup Events and select the trigger group to see the available event groups. if the only event group listed is NER, your monitor has the Neonatal Event Review option if there is one event group and it is not NER, your monitor has the Basic Event Surveillance option if you see six event groups, your monitor has the Advanced Event Surveillance option. 291 23 Event Surveillance Event Functionality Event groups Basic Event Surveillance Option C06 1 Measurements per group 3 Triggers per measurement 1 Advanced Event Surveillance Option C07 6 (one group can be configured to NER) 4 2 Neonatal Event Review

(NER) Option C04 NER 3 (plus 1 for episode recording) 1 Simple ("at least one") Combined ("at least two") Simple ("at least one") Trigger types Annotation Types of event episode Event views no Average trend Snapshot events Graphic Event Review window, Graphic Event Episode window 25 events for 24 hours yes yes Average trend High resolution trend Snapshot events Summary view, graphic and tabular Event Review window, graphic and tabular Event Episode window 25 events for 24 hours 25 events for 8 hours 50 events for 8 hours 50 events for 24 hours yes High Resolution Trend Graphic and tabular Event Review window, graphic and tabular Event Episode window 25 events for 24 hours 25 events for 8 hours 50 events for 8 hours 50 events for 24 hours no Database capability Event Notification no Event Groups defines which waveforms are recorded in the event data. The event group monitors the patient's signals to detect event triggers In basic event surveillance only one event group can be active at a time, with Advanced Event Surveillance all six groups can be active simultaneously. Active event groups monitor for event triggers. Event groups are defined in Configuration Mode. In monitoring mode the groups can be adapted to current conditions, for example episode types and threshold levels can be changed. Event Episodes 292 23 Event Surveillance When an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event). Manually-triggered event episodes document patient information from the time leading up to the event trigger; they do not have a post-time. The episode type defines the level of detail captured in an event episode. The higher the data resolution, the shorter the period that the monitor can store in its memory. High-resolution data is suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative. Event Episode Types Average trend 20 minutes, five samples per minute HiResTrend Four minutes, four samples per second. Neonatal Event Review (NER) is a type of HiResTrend Realtime Wave Snapshot 15 seconds Events Pop-Up Keys Pre-time 2 minutes 4 minutes 6 minutes 8 minutes 10 minutes 12 minutes 14 minutes 16 minutes 18 minutes 1 minute 2 minutes 3 minutes 5 seconds 10 seconds Post-time 18 minutes 16 minutes 14 minutes 12 minutes 10 minutes 8 minutes 6 minutes 4 minutes 2 minutes 3 minutes 2 minutes 1 minute 10 seconds 5 seconds Depending on the events view you choose, a selection of the events pop-up keys let you navigate through the stored events and carry out events-related tasks. Pop-Up Keys Event Setup Show Episode Show Review Review Group Show Summary Manual Event Selecting this pop-up key lets you.... open the Event Setup menu. open the Event Episode window to review the selected event in detail. open the Event Review window. choose a different event group for reviewing in the Event Review window

(Advanced Event Surveillance only). open the Event Summary window. start a manually-triggered event capture. 293 23 Event Surveillance Pop-Up Keys Start CAR Stop CAR CAR Histogrm Vitals View Graphic View Graphic Review CAR Review Table Review Delete Event Select Annotatn Print/ Record Event Triggers Selecting this pop-up key lets you.... open the Start CAR window to start a Car seat Assessment Record (CAR) period or stop a currently running CAR. open the window showing the CAR SpO2 histogram move the cursor left or right to the next event to navigate through the events database. Placing the cursor over an event highlights it and shows the event values for the selected event. jump to the first or last event in the event database. toggle between a tabular and graphic version of the Event Episode window currently viewed. toggle between a tabular and graphic version of the Event Review window currently viewed. delete the currently-selected event from the database. The monitor asks you to confirm this deletion. You cannot retrieve deleted events. access the list of available annotations to add a nursing note for the current event episode (Advanced Event Surveillance only). access the printing and recording pop-up keys to document events. You can trigger event capture manually, for example, if you want to record a patient's condition before a procedure. You can also set events to trigger automatically, when the patient's values cross a predefined threshold value, or when a particular measurement or procedure is carried out. If more than one trigger is available for the measurements in the active event group, the trigger condition may be At Least One Param., At Least Two Param., At Least Three Par., or All Four Parameter. If the trigger is At Least One Param. (this is short for "at least one measurement parameter"), the monitor starts an event capture if a trigger occurs in any of this event group's measurements. If the trigger is At Least Three Par., the monitor captures events when three or more trigger thresholds from this event group's measurements are violated. With Enhanced Condition you can not only select a minimum number of triggers to trigger an event but define which specific measurement triggers these must be. For example, At Least Two Param. will cause an event to be captured if a trigger occurs in any two of this event group's measurements - with Enhanced Condition you can select that only when triggers are in HR and SpO2 an event will be captured. 294 23 Event Surveillance The trigger condition for event groups is set in the monitor's Configuration Mode. If You Use Alarm Limits As Event Triggers The event capture is triggered automatically when your patient's values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions. The asterisk symbols beside the trigger tell you about the alarm triggers:

*** indicates a high priority (red) alarm

** indicates a lower priority (yellow) alarm. This category includes short yellow arrhythmia alarms, which may be configured to be shown as one star alarms (*) on your monitor. Triggers without asterisk symbols are user-defined triggers. If You Set User-defined Threshold Triggers You can define event triggers that are independent of alarm limits. You must set a threshold value and a threshold time for the trigger. If you set the trigger threshold time to 12 seconds, the monitor triggers an event if the threshold is violated for more than 12 seconds. If You Set "On Measurement" Triggers You can set aperiodic measurements (such as NBP) or procedures (such as Cardiac Output) to trigger an event whenever they start. If You Set Use-defined Deviation Triggers You can define event triggers that are independent of specific limits and based instead on deviations from the current values. You must set a deviation and a period of time in which the deviation occurs. There are three types of deviation available: ANY Deviation, UP Deviation where only changes in a positive direction are detected and DOWN Deviation where only changes in a negative direction are detected. The deviation can be defined either in relative terms as a percentage, for example 10%, or as an absolute value, such as 10 bpm. Event Retriggering If a condition that triggered an event persists and the values remain beyond the trigger threshold, a new event will not be triggered. 295 23 Event Surveillance For a new event to be triggered by the same condition, the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold. Event Notification

(Advanced Event Surveillance Only). You can be notified when an event is detected. For each event group you can define a type of notification depending on the severity of the event conditions. The notification can be a status message with a prompt tone or a standard *, **, or *** alarm notification. These event alarms are handled exactly like measurement alarms; they can be silenced and are also suspended when all alarms are suspended. You should only use alarm notification for events which are comparable in severity to standard measurement alarms to avoid potential confusion due to too many alarms. Notification in the form of an alarm is not available when the trigger condition is At Least One Param.. Selecting None switches event notification off. Setting the type of notification, or switching notification off, is done in Configuration Mode. Setting Triggers for NER and Basic Event Surveillance 1 Group Name Episode Type 2 3 Measurements used as event triggers 1 2 3 4 5 Select Main Setup then Event Surveill. followed by Setup Events to enter the Event Setup window. Select the name of the current episode type to set the episode pre/post time. Set the event trigger for each measurement. Select each trigger name and select, if available, either an alarm trigger, or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. Set the trigger status to Activated to start event triggering. If the status is Deactivated event surveillance is effectively switched off. Select Confirm to confirm your changes. 296 Setting Triggers and Notification for Advanced Event Surveillance 23 Event Surveillance Group Name 1 2 Group Type 3 Notification Type 4 Episode Type Trigger Condition 5 6 Measurements used as event triggers 1 2 3 4 5 Select the group name to enter the setup window for that group. Set the trigger status to Activated, to have this event group trigger events, or Deactivated. Set the episode type. Select the name of the current episode type and select an episode type from the pop-up list. The pre/post episode time for the selected episode type is displayed. Set the trigger for each measurement. Select each trigger name and select either an alarm trigger or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. If a deviation trigger is configured, set the deviation and duration. Select Confirm to confirm your changes. Triggering Events Manually To manually trigger an event, select the SmartKey Manual Event and (for Advanced Event Surveillance) select the group in which the event will be triggered. For manually-triggered events, patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group. Running a Car Seat Assessment Record In the NER group you can run a Car Seat Assessment Record (CAR). This is a special period of event surveillance using the current setup of the NER group. To start a CAR period:

1 Select the Start CAR pop-up key or SmartKey. 297 23 Event Surveillance 2 Select the required time period for the assessment. Select Confirm to start the CAR. 3 If the NER group was not active it will be activated automatically. During the CAR period an SpO2 histogram is also generated with 1 second samples. For general information about the presentation of data in a histogram, see Viewing Histogram Trends on page 274. The CAR SpO2 histogram is unique: it can only be accessed from the events function. It is generated from the beginning of the CAR period (contrary to the non-SpO2 histograms which are generated from trended data retrospectively at the end of a time period). Settings are fixed for this histogram and cannot be changed when viewing it. The Events Database The maximum number of events that can be stored in the event database depends on the database configuration and the level of event surveillance used. The event database is set up in the monitor's Configuration Mode. Events are stored in the monitor's event database for the configured lifetime, either 8 hours or 24 hours. Deleted events cannot be retrieved. Events are automatically deleted when:

their configured lifetime is over the storage capacity of the database is exceeded (storing a further event deletes the oldest event in the memory) a patient is discharged. As the event database is cleared when you discharge a patient, you should ensure that you have documented any events you require for the patient records before you confirm the discharge. Viewing Events To see a summary of all the events in every group in the event database, use the Event Summary window. To review all the events in a particular event group, use the Event Review window. To review individual event episodes in detail, use the Event Episode window. To start viewing events, either:

in the Main Setup menu, select Event Surveill. and then select the event view you require from the list, or select the Event Surveill SmartKey and then select the event view you require from the list. Event Summary and Event Counter Vertical bars mark events in the Event Summary window. The timeline shows the position of the stored events in the event database. Selecting this view activates a cursor that lets you navigate across the timeline. Use the Show Episode pop-up key to select individual events for review in the Event Episode window. It also calls up the events pop-up keys. 298 23 Event Surveillance The event counter counts the total number of events in the database. If more than one event group was set to trigger events within the event history, the event counter also counts the event group totals. Counting Combi-Events If one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a brady event, the brady event is not counted as a single event but as part of the apnea event. Counting Neonatal Event Review (NER) Events For neonatal events (NER, formerly "OxyCRG"), apnea events (A), bradycardia events (B), and combinations of these events are counted and classified by the event counter in the Event Summary. If they are associated with a Desaturation (D), this is also marked. Manual events (M) are counted separately. For example, A(D):2(1) indicates that two apnea events occurred and one of them was associated with a desaturation. Event Summary Window

(Advanced Event Surveillance only). The Event Summary window shows the number of stored events in each event group and the total number of events in the database. Vertical bars mark events on a timeline showing the position of the stored events in the event database. The symbol next to the group name indicates the activation and notification status:

symbol meaning group activated, notification set to ***alarm group activated, notification set to **alarm group activated, notification set to *alarm group activated, notification set to screen prompt group is activated, notification is switched off no symbol group not activated Selecting the Event Summary window calls up the events pop-up keys. Parts of the Event Summary window can also be embedded in Screens so that they are always visible, for example the Total row showing the total number of events with the bars on the timeline or the column showing all the groups with the activation and notification status. 299 23 Event Surveillance Event Review Window To enter the Event Review window, select the graphic event summary, if available, or select the events pop-up key Show Review. When you open the Event Review window, it automatically shows the event group with the most recent event. To view other event groups, select the pop-up key Review Group and select the group from the list. Event Episode Window To enter the Event Episode window, select the pop-up key Show Episode. Depending on the event group settings, the Event Episode window shows either 20 minutes of average trend event information, four minutes of high-resolution event information, or 15 seconds of realtime wave information. Follow-on event values 1 2 Trigger event values, highlighted 3 Timeline, showing episode Pre/Post-time 4 Active event group 300 23 Event Surveillance The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded. In this example, Desat 71<85 tells you that 71 was the lowest SpO2 value measured during the event time and that the Desat trigger threshold was set to 85 when the event was triggered. If the event was manually triggered, the event value boxes display

"manual". Annotating Events 1 2 To annotate an event, in the Event Episode window, select the pop-up key Select Annotatn. Select the required annotation from the pop-up list of available annotations for the currently active event group. Up to 20 annotations can be configured to let you add commonly-used clinical notes to event episodes for documentation purposes. To see the complete list of available annotations, in the Event Setup menu, select Event Annotation. Documenting Events You can print a report or make a recording of the events history stored in the database or of individual event episodes or a Car Seat Assessment Record. Documenting Event Review 1 2 In the Event Review window, select the pop-up key Print/ Record. This calls up the event documentation pop-up keys. For a graphic Event Review recording, select the Record Graphic pop-up key. For a tabular Event Review recording, select the Record Tabular pop-up key. For a CAR review report, select the Print CAR pop-up key To print an Event Report, select the Print Review pop-up key. Documenting an Event Episode 1 In the Event Episode window, select the pop-up key Print/ Record. This calls up the event documentation pop-up keys. 2 To make an Event Episode recording, select the Record pop-up key. To print an Event Episode, select the Print Episode pop-up key. Event Recordings Event recordings can be sent to a locally-connected M1116B recorder module. Event Review Recordings Each event review recording strip begins with a summary of the events stored in the event database. Recording strip annotation is explained in the Recording chapter. 301 23 Event Surveillance 1 Event total per event group 2 Event types 3 Total events in database 4 Event groups 5 Recording strip code 6 Patient information and medical record no. In graphic event review recordings, events are represented by bars, and each event group is printed on a separate channel. The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections). 302 23 Event Surveillance In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp. The measurements in the event group are shown in the next columns, marked "Parameter 1, Parameter 2...", along with the event values measured at the time of the event. For each event, the trigger values are shown. This section of the recording is A4 or letter size, so that it fits in a patient file. Event Episode Recordings Event episode recordings are divided into four sections. The first section shows the patient information and the event group of the episode with the event values for the group measurements. The trigger symbol marks the event trigger. The second section (2 below) shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording. If there are four measurements in the event group being recorded, two waveforms will be recorded in two separate waveforms segments. 303 23 Event Surveillance The third section (3 above) shows the most important vital signs information, including numerics, active alarms, and any annotations made on the event episode. The fourth section (4 above) shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered. Event Reports Event reports can be printed on A4 and letter size paper on a printer connected locally or centrally to your monitor. Event Review Reports The event review report documents all the events stored in the event database for a selected group. 304 23 Event Surveillance Event Episode Reports The event episode report documents the patient information from the currently-selected event. See the Event Recordings on page 301 for an explanation of the report elements. 305 23 Event Surveillance Event Summary Reports

(Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups. 306 23 Event Surveillance 307 23 Event Surveillance 308 24 24ProtocolWatch ProtocolWatch (PW) is a clinical decision support tool. It allows you to run a clinical protocol which can monitor developments in the patient's condition, taking into account:

measured values from the monitor ProtocolWatch notifies you when certain conditions or combinations of conditions occur and it documents developments in a log which can be printed. values manually entered by you (for example manual temperature measurements, lab values) your assessment of patient status SSC Sepsis Protocol The SSC (Surviving Sepsis Campaign) Sepsis Protocol is a protocol implemented for the ProtocolWatch application. The SSC Sepsis Protocol is for use in screening for severe sepsis and monitoring of its treatment. It is a computerized implementation of the January 2008 Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Philips does not make any claims about their effectiveness to reduce the morbidity or mortality associated with severe sepsis. The SSC Sepsis Protocol assists you in recognizing the early signs and symptoms of sepsis by comparing the state of your patient to the defined criteria and then guides you through the recommended treatment protocol. Use of the SSC Sepsis Protocol requires thorough knowledge of the complete SSC Guidelines for Management of Severe Sepsis and Septic Shock. Due to space limitations on the screen, the recommendations cannot always be reproduced in the full detail available in the printed and on-line guidelines. The SSC Sepsis Protocol is not a diagnostic or therapeutic tool and is not intended to replace the competent judgment of a clinician. The SSC Sepsis Protocol consists of three separate consecutive phases:

Severe Sepsis Screening - measurement values and patient status are compared to the Severe Sepsis Screening criteria. When these criteria have been met, the clinician confirms the presence of infection and sepsis-related organ dysfunction and can authorize entering the Sepsis Resuscitation Bundle. Sepsis Resuscitation Bundle - the recommendations for sepsis resuscitation are listed and can be checked off as they are implemented. After achievement of all the sepsis resuscitation goals, or at the latest after 6 hours, the Sepsis Resuscitation Bundle is completed and the Sepsis Management Bundle begins. Sepsis Management Bundle - the recommendations to maintain patient status are listed and can be checked off as they are implemented. The Sepsis Management Bundle ends when 24 hours have passed since the Sepsis Resuscitation Bundle began. 309 24 ProtocolWatch Depending on the option your monitor has, it may be that only the Severe Sepsis Screening phase is implemented. If, at the end of this phase sepsis has been confirmed, and the patient is transferred for treatment in the resuscitation and management phases, you can transfer the current state, the settings and the log from the SSC Sepsis Protocol in the MMS to another monitor with the full version of the SSC Sepsis Protocol. The transfer of data and settings must be enabled in Configuration mode. WARNING Always consider the specific clinical context for your patient, before following SSC Sepsis Protocol treatment recommendations. The SSC Sepsis Protocol and this description are based on the SSC Guidelines for Management of Severe Sepsis and Septic Shock from January 2008 and the SSC Bundle definitions from January 2005. To check the version of the Guidelines and Bundle definitions on the monitor, Select Main Setup then Revision then ProtocolWatch followed by SSC Sepsis Orientation On The Screen At the top of each window there is an orientation line showing the phases available on your monitor, with the currently active phase highlighted. You can also place the ProtocolWatch symbol, together with the currently active phase, on the main screen, in one of the numeric positions. This allows you to see at a glance which phase is currently active, even when no SSC Sepsis Protocol window is currently displayed. If you need to enter data or perform an action in an SSC Sepsis Protocol window, the symbol will turn into a SmartKey. Transferring Patients And Moving Manually Between Phases If a patient has already been diagnosed as having severe sepsis before connecting them to the monitor, you can select Main Setup then ProtocolWatch followed by Manual Transition to go directly to the Sepsis Resuscitation Bundle to monitor treatment. Direct entry to the Sepsis Management Bundle is also possible using the Manual Transition function and the time into the selected bundle can be set. If a patient has been screened on arrival, for example in the emergency department, then transferred to Intensive Care when Sepsis is confirmed, the current state, the settings and the log from the SSC Sepsis Protocol will be transferred with the MMS to the new monitor. Should it be necessary, you can select the phase at the new monitor manually with Main Setup then ProtocolWatch followed by Manual Transition. The transfer of data and settings must be enabled in Configuration mode. 310 24 ProtocolWatch CAUTION It is not possible to transfer SSC Sepsis Protocol data from a monitor with release F.0 software to another monitor with release G.0 software or above, and vice versa. Suspending the Protocol for 24 Hours To suspend the protocol for 24 hours:

1 Select Main Setup then ProtocolWatch followed by Suspend for 24 hours. Select Confirm. 2 The protocol will resume activity after 24 hours with Severe Sepsis Screening. Severe Sepsis Screening As soon as an adult patient is connected to the monitor, and heart rate or pulse is being measured, the protocol begins to observe heart rate, temperature and respiration rate values in the background. If temperature or respiration rate is not being measured continuously, a pop-up window appears at 4-

hour intervals to ask for manually measured values. These values are all compared to the screening criteria: HR above 90, Temp above 38.3C (100.9F) or below 36.0C (96.8F), RR above 20. If any one of the values fulfills the screening criteria, the first Severe Sepsis Screening window appears:

The measured value which has fulfilled the criteria is shown highlighted (in the example above it is respiration). There is a check box for the infection signs and symptoms listed, if the monitor has measured values which meet the screening criteria, and for all signs and symptoms which cannot be measured by the monitor. Check the box if you can confirm that this sign or symptom is present and new. If the patient is mechanically ventilated, the Mechanically ventilated box must be checked. If you have manually measured temperature or respiration rate, you can enter the values using the Enter RR and Enter Temp keys. 311 24 ProtocolWatch Select Confirm when the check boxes reflect the current patient status. Select Remind 15 min if you want to delay filling out this screen. (When you enter the screen manually this key will be a Cancel key, as no action is required in this case.) Changing Conditions The window reappears if:

a previously fulfilled criteria is again fulfilled a new HR or RR criteria is fulfilled, the HR or RR value which previously fulfilled the criteria now triggers a ** RR HIGH, ** HR HIGH alarm or a ***TACHY xxx > yy alarm, after 8 hours (configurable to 12 hours) if at least one infection sign is still present. Two Or More Infection Signs Or Symptoms Confirmed If you have confirmed two or more infection signs in the first Severe Sepsis Screening window, a new pop-up window appears asking Is the patient history suggestive of a new infection?. If you select Yes, the next screen appears requesting a lactate measurement. If you select No, the screening phase continues and the first Severe Sepsis Screening window reappears in the situations described in Changing Conditions above. Lactate Measurement To enter the Lactate value, select the Enter Lact key. If the value entered is > 4 mmol/l the check box is automatically checked. Select Confirm when a value has been entered. What follows depends on the Lactate value:

If Lactate is > 4 mmol/l: the value meets the criteria for severe sepsis and a window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle. If Lactate is 4 mmol/l: a further window appears requiring your input to determine on the basis of blood pressure values whether the patient meets the criteria for severe sepsis. Hypotension Evaluation SBP decrease > 40mmHg (5.0kPa) below baseline. If the Lactate value was not above 4 mmol/l, the next window asks whether the patient has persistent hypotension. The protocol defines Hypotension as:

SBP < 90mmHg (12.0kPa), or MAP < 65mmHg (9.0kPa), or You can see this definition in the window by selecting Show Details. If the patient has persistent hypotension as defined, select Yes. This acknowledges that the patient meets the criteria for severe sepsis and a final window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle. If the patient does not have persistent hypotension, select No. After an hour a screen appears asking Is the previously acknowledged infection still present?. 312 24 ProtocolWatch If you select Yes, the window for the Lactate measurement will reappear. If you select No, screening continues - comparing heart rate, temperature and respiration rate values against the screening criteria. Authorized Clinician Review To review the protocol, select Protocol Log. You can also print out the log to document the screening phase. Select Confirm to complete the screening phase and, if you have the appropriate monitor option, continue to the Sepsis Resuscitation Bundle phase. Sepsis Resuscitation Bundle The treatment recommendations from the Sepsis Resuscitation Bundle are presented and the implementation of the recommendations is monitored. When the Sepsis Resuscitation Bundle phase begins, the ProtocolWatch Screen automatically appears on the monitor (if configured and available on the monitor). The lower area of the screen contains:

a reminder list of the treatment recommendations - recommendations which have been fulfilled are shown in gray, overdue recommendations are shown in orange a timer showing the time already passed in this phase three horizon trends for MAP, CVP and ScvO2 or SvO2, if these measured values are available a list of the latest manually entered values - if you select this list you will open the Manual Entry Log window where the last 24 manually entered values are shown for reference If ScvO2 or SvO2 and CVP are not being continuously measured, a pop-up window appears at hourly intervals to ask for a manually measured value. Monitoring the Sepsis Resuscitation Bundle Recommendations When you select the lower area of the ProtocolWatch Screen, the Sepsis Resuscitation Bundle window appears. If you do not have the ProtocolWatch Screen displayed, the Sepsis Resuscitation Bundle window appears automatically once an hour. 313 24 ProtocolWatch Select the Enter Lact key to enter a lactate value. When you have entered a value, or if a lactate value had previously been entered, the box is checked. Check the Take Blood Cultures box when you have taken blood cultures. Check the Administer Intravenous Antibiotics box when you have started broad-spectrum antibiotic therapy. The remaining three recommendations are automatically compared to the Sepsis Resuscitation Bundle criteria, if the measurements are available on the monitor. A box is checked when the corresponding recommendation has been fulfilled. Depending on your configuration, continuously measured CVP values may be disregarded if they exceed a set limit. Whether this is so, and which limit is applied, is set in the monitor's Configuration mode. If you have manually measured ScvO2 or CVP, you can enter the values using the Enter ScvO2 and Enter CVP keys. The box is checked automatically if the value fulfills the recommendation. The boxes for MAP, ScvO2/SvO2 and CVP can also be checked manually (for cases where the monitor does not measure them) but only when the timer has reached 4 hours to ensure that these values are achieved and maintained mid-term. Check these boxes if the recommendation has been fulfilled. To see more details about the recommendations, select the Show Details key. Select Confirm when the check boxes reflect the current treatment status. Checking The Sepsis Resuscitation Bundle Window During the Sepsis Resuscitation Bundle you can open the Sepsis Resuscitation Bundle window at any time to check the status or to make entries. The recommendations are shown as follows:

Recommendations which are not yet fulfilled are shown in black. They also appear in the list on the lower area of the ProtocolWatch Screen. Recommendations which are overdue are shown in orange. Recommendations which have been fulfilled and confirmed are shown in gray. They no longer appear in the list on the lower area of the ProtocolWatch Screen. Previewing the Sepsis Management Bundle At any time during the Sepsis Resuscitation Bundle you can preview the Management Bundle in order to see which recommendations will follow there. Select the Preview Managmnt key. Ending The Sepsis Resuscitation Bundle When all recommendations have been fulfilled and confirmed, or when 6 hours have passed since the bundle started, the Sepsis Resuscitation Bundle is ended. You are asked to confirm with the Yes key that the Sepsis Management Bundle should now be started. If you select No, the Sepsis Resuscitation Bundle is extended for 1 hour. Sepsis Management Bundle The stabilization recommendations from the Sepsis Management Bundle are presented and the implementation of the recommendations is monitored. 314 24 ProtocolWatch When the Sepsis Management Bundle phase begins, the ProtocolWatch Screen is automatically updated (if configured and available on the monitor). In the lower area of the Screen, the list of recommendations for the Sepsis Management Bundle replaces the list for the Sepsis Resuscitation Bundle. The timer shows the combined time for both phases. Monitoring the Sepsis Management Bundle Recommendations When you select the lower area of the ProtocolWatch Screen, the Sepsis Management Bundle window appears. If you do not have the ProtocolWatch Screen displayed, the Sepsis Management Bundle window appears automatically once every six hours. The Low Dose Steroids for septic shock per policy recommendation and/or the Drotrecogin Alfa per policy recommendation may not appear if they have been configured not to do so for your hospital. Check the Low Dose Steroids administered box when you have started steroid therapy or the Low Dose Steroids contra-indicated box if this treatment is contra-indicated for your patient. Check the Drotrecogin Alfa administered box when you have started recombinant human activated protein C therapy or the Drotrecogin Alfa contra-indicated box if this treatment is contra-indicated for your patient. The boxes for Maintain Glucose <8.3mmol/l (150 mg/dl) and Maintain Insp. Plateau Pressure

<30cmHO can only be checked when the timer has reached 20 hours to ensure that the stabilization of these values is achieved long-term. Check these boxes if the recommendation has been fulfilled. Recommendations which have been fulfilled are shown in gray with the time fulfillment was entered. To see more details about the recommendations, select the Show Details key. Select Confirm when the check boxes reflect the current treatment status. Ending The Sepsis Management Bundle The Sepsis Management Bundle normally ends 24 hours after the Sepsis Resuscitation Bundle started, as documented by the bundle timer on the ProtocolWatch screen. You are asked to confirm with the Yes key that routine monitoring should now resume. By selecting No you can extend the Sepsis Management Bundle phase by an additional 6 hours. 315 24 ProtocolWatch After completion of the Sepsis Management Bundle a sepsis standby phase begins which allows time for further patient stabilization and recovery. During this phase Severe Sepsis Screening is suspended. The standby phase is by default 7 days but the length can be adjusted in Configuration Mode. Viewing And Printing The Protocol Log The Protocol Log stores all user interactions, alarms and phase transitions while the SSC Sepsis Protocol is running. To view the Log select Main Setup then ProtocolWatch followed by Protocol Log You can choose between three different views of the Protocol Log:

Summary View - a short form which does not include when the windows were triggered Full View - a complete log of all user interactions, alarms and phase transitions Phase View - you can view log entries for one phase by selecting that phase on the orientation line When the Log consists of several pages, you can move through the pages with the Previous Page and Next Page keys. To start a Protocol Log printout, select Print. The log is cleared whenever a patient is discharged. Always Discharge Patients It is essential that patients are discharged when monitoring ends. As a reminder, the monitor can be configured to display a pop-up window when the monitor has been switched off, in Standby mode, or not monitoring basic vitals for a certain time. The window asks whether a new patient is being monitored and offers a pop-up key to discharge the previous patient if this is the case. The window must be configured in Configuration Mode. When the previous patient is discharged, this clears the protocol log, resets the timers and deletes manually entered measurement values. 316 25 25Recording The M1116B plug-in recorder records numerics for all active measurements and up to three waveforms. You can use it for local recording mounted in the monitor's FMS. 1 M1116B Plug-in Recorder 2 Continue LED - flashes if a continuous recording is ongoing 3 RUN/CONT key - starts a delayed recording or makes the current recording continuous STOP key - stops the current recording 4 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. Recordings made on the M3160A may look slightly different to those described here. 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 Recor- dings SmartKey to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed. The selection of pop-up keys available depends on the monitor you are using. 317 25 Recording Delayed Recordng RT A Recordng RT B Recordng RT C Recordng Select Waves HiRes Recordng All ECG Waves Vital Signs Alarm Limits ST Segments ECG QT Setup Recordng Stop All Recordng Quickstarting Recordings To quickstart any type of recording using a pre-configured recordings template, Select the Recor- dings SmartKey and then select the pop-up key of the recording type you want to start. Alternatively, you can Select the Main Setup SmartKey, select Recordings, then select the recording type. To quickstart a delayed recording, M1116B only You can also start a delayed recording by pressing the Run/Cont key on the recorder module. Select the SmartKey Delayed Record to immediately start a delayed recording. Extending Recordings Timed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue until stopped manually or by an INOP condition. To extend an ongoing recording by its runtime, reselect its Start pop-up key once. To make an ongoing recording continuous, reselect its Start pop-up key twice within 5 seconds. You can also make an ongoing recording continuous by pressing the Run/Cont key on the M1116B only recorder module. Stopping Recordings Recordings stop automatically when the preset runtime is over, when the recorder runs out of paper, when you open the recorder door or when the recorder has an INOP condition. To manually stop a recording, select the Recor- dings SmartKey and then select the pop-up key Stop All Recordng. You can also stop a recording by pressing the Stop key on the recorder module. M1116B only Recording Without a Template To record without a pre-configured template, selecting the waves you require, 1 Either: Select the Recor- dings SmartKey then select the pop-up key Select Waves. Or: Select the SmartKey Record Waves. 318 25 Recording 2 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If 3 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. Select the Start pop-up key to start the recording. 4 Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping. Overview of Recording Types This table details settings for local recordings. For details on recordings made on the central recorder, see your Information Center Instructions for Use. Delayed Alarm Realtime (RT) Type of recording manual automatic, triggered by defined alarm conditions manual All ECG Waves manual HiRes Trend manual Recording Destination Information recorded Number of waves local recorder and central from the start trigger minus the delay time up to 3 local recorder and central from the start trigger minus the delay time up to 3 printer n/a local recorder and central from the start trigger n/a up to 3 local recorder only from the start trigger, in realtime all ECG waves currently monitored and available local recorder only from the start trigger minus delay time up to 3 high-

resolution trends

(beat-to-beat) waves Speed Runtime 50, 25, 12.5, 6.25, 2.5 mm/sec 15, 20, 25, or 30 seconds 50, 25, 12.5, 6.25, 2.5 mm/sec 15, 20, 25, or 30 seconds n/a n/a Stops automatically automatically n/a Delay Time 10, 15 seconds 10, 15 seconds Overlap up to 3 waves up to 3 waves n/a n/a n/a = not applicable 50, 25, 12.5, 6.25, 2.5 mm/sec 6, 8, 10, 15 seconds or continuously automatically if limited, manually if continuous none 25 mm/sec 4 seconds per wave automatically none up to 3 waves none 1, 2, 2.5, 3, 6 cm/

min 10 minutes, or continuously automatically if limited, manually if continuous 6, 5, 4, 3, 2, 1 minutes up to 3 waves Procedure or Context manual, use the context window's pop-

up keys to start local recorder only defined by the context up to 3 waves, or specific to the context, e.g. a wedge procedure defined by the context defined by the context defined by the context defined by the context defined by the context All ECG Waves Recordings An All ECG Waves recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead. All available leads are recorded sequentially in the standardized lead order. The recording is realtime, that is, the information recorded is not simultaneous. 319 25 Recording Creating and Changing Recordings Templates 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, three realtime recordings (two for MP20/30), and one high resolution recording. All ECG Waves recordings do not need to be configured, they always use the same format. Changing recordings templates changes the settings that will be used each time a recording of this name is triggered. 1 Select the Main Setup permanent key to call up the Main Setup menu. Select Recordings to enter the Setup Recording menu. Select the name of the template you want to create or change. Each recording name is linked to a recording type, delayed, alarm, realtime, and hi-res trends. Recording names can be changed in the monitor's Configuration Mode. 2 3 4 Design the template by selecting each menu item and entering the information for the template. Recorder: choose which recorder the recording will print to (Local, Central 2-Ch, or Central 4-

Ch recorder, or Printer (for realtime reports in alarm recording only)). Channel 1, Channel 2, etc.: choose which waveform to record in each channel. If the wave assigned to a recording channel in a particular template is not available when a recording is triggered, the channel is left blank on the recording strip. The pop-up list of available (currently monitored) waves differs according to the recording type:

Realtime, delayed and alarm recordings: the list shows all the currently available waves. High-resolution recordings: the list shows all the available high-resolution waves. 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 SecondryLead will always record the current secondary lead in the chosen recorder channel Any Agent will always record the currently selected anesthetic agent. For high-resolution recordings only the Any Agent setting is available. Overlap: define whether the recorded waveforms will be printed overlapping or beside each other. Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time Speed: choose the recording print speed. before the recording is started. This interval is called the "Delay Time" and can be set as specified in Overview of Recording Types on page 319. This setting can only be changed in Configuration Mode. Run Time: 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. 320 Changing ECG Wave Gain 25 Recording The ECG Gain setting in the General Recording Setup window defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings, 1 In the Setup Recording menu select General. Select ECG Gain. Select the required setting:

Auto: the wave recording will use the same scale as the ECG wave on the monitor screen 5 mm/mV, 10 mm/mV, 20 mm/mV: the wave recording will use a scale of 5, 10, or 20 millimeters per millivolt. 2 3 Recording Priorities Manually-started recordings have priority over automatically-started recordings. If an automatically-triggered alarm recording is running, and a realtime or delayed recording is manually started, the alarm recording is stopped and the manually-requested recording is started. More recent manually-started recordings have priority over older manually-started recordings. If a manually-started recording is running, and another manually-started recording is triggered, then the older recording is stopped and the more recent manually-started recording is started. Alarm recordings are prioritized according to alarm priority. If an alarm recording triggered by a yellow alarm is running and a new alarm recording is triggered by a red alarm, the yellow alarm recording is stopped and the red alarm recording is started. Recording Strip The information printed on the recording strip includes the patient name and MRN, bed number, date and time of recording, recording speed, and recording code. Active alarm and INOP messages as well as numerics for all currently monitored measurements are also printed. Recording strip annotations are printed at the beginning of the recording strip and updated at regular intervals, every 15 minutes for recordings made at speeds lower than 6.25 mm/s, and every 60 seconds for recordings made at speeds greater or equal to 6.25 mm/s. Recording Strip Code The recording strip code printed in the first line of the initial annotation has up to seven characters, specifying recording type, operating mode, application area, patient category, and delay time, if applicable. 321 25 Recording Recording type Operating mode Application area Patient category Code 90 8A 0B 91 M D C S I O C N A P N Meaning Realtime Delayed Alarm Context (Procedures) Monitoring Demo Configuration Service ICU OR CCU NICU Adult Pediatric Neonatal Recorded Waveforms A selection of up to three waveforms is recorded, marked with wave labels and wave scale information. Wave scale information can be in the form of a calibration bar, like the 1 mV calibration bar for ECG, or calibration steps before the waveform starts. 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. 322 Reloading Paper M1116B 1 Use the latch on the right side of the recorder door to pull the door open. 25 Recording 2 Remove the empty core. 3 Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top. Recommended paper: 40477A and 40477B. Pull out some paper and fold along the front edge at a 45 angle. This makes it easier to feed the paper under the roller as shown. Feed the paper through and pull some paper out from the top of the roller. 4 5 6 Close the recorder door. 7 To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper. Recorder Status Messages Recorder Status Messages For example:

Local alarm recording running No Central alarm recording available No local alarm recording available No alarm recording available Central Recorder out of paper Local Recorder out of paper Central Recorder door open Local Recorder door open

<Recorder name> not supported Explanation The named recording is currently running. No alarm recording can be made on the selected recorder. Try selecting another recorder. If a local recorder was selected, the monitor will try to reroute the recording to a central recorder. Recordings configured to a central recorder cannot be rerouted to a local recorder. Alarm recordings may be lost. Try configuring Printer as the alarm recording destination. 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. The M1116A recorder is not supported. Connect a M1116B plug-in recorder. 323 25 Recording 324 26 26Printing Patient Reports Starting Report Printouts Most patient reports can be printed by selecting Main Setup then Reports (or the Print 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. Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up 1 Select Main Setup then select Reports Select Auto Print Dbs. Always will print all reports when a matching printer is available. Host Only will print the reports stored on the host monitor when a matching printer is 2 available. Reports stored in the companion database (shown in gray on the Reports Job List) must be manually sent to the printer. See Checking Report Status and Printing Manually on page 330. Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See Checking Report Status and Printing Manually on page 330. Printout Location Depending on availability, reports can be printed on locally connected printers, printers connected to the Information Center or the Application server, an external PC-based print server with Philips server software 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. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient. When an X2 or MP5 is connected to a host monitor, reports requested or stored on the X2 or MP5 can be printed via the host monitor. Reports requested on the X2 or MP5 when connected to a host monitor will not show any patient alarms or INOPs. In order to see alarms, reports should be requested on the host monitor. 325 26 Printing Patient Reports Starting the Different Types of Report Report types Vital Signs Report Graphic Trends Report Events Reports Report contents depends on selected trend group, data resolution, and period. Event Episode Graphic or tabular Event Review EEG Report ECG Reports EEG Waves, numerics, CSAs, montage information and impedance values Depends on format selected ST Map Report Cardiac Output Report Wedge Report Calculations Report Drug Calculator Report ST data in a transversal and/or horizontal multiaxis diagram, Trial curves and numerics Wedge numerics and reference wave Hemodynamic, Oxygenation, or Ventilation Review Titration Table Drip Table Alarm Limits Report Graphic and numeric report of all current Realtime Reports, including oxyCRG Reports Loops Report Battery Report alarm limits patient data and numerics, and either:

all displayed waves OR all measured waves OR all measured RT waves Or all measured HiRes waves, OR oxyCRG waves (RT waves:

ECG Primary lead, Pleth, Resp; HiRes waves: btbHR, HiRes SpO2, HiRes Resp) Individual Loops diagram with timestamp, currently measured numerics Battery serial numbers, information on the currently-measured and potential charge status of the battery or batteries How to start printing reports In the Vital Signs window, select Print/ Record, then select Print. In the Graphical Trends window, select Print. In the Event Episode or Event Review window, select the pop-up key Print/ Record, then select Print Review or Print Episode. In the Setup EEG menu, select Print Report. Select the ECG Report A or ECG Report B Smartkeys, if configured, or the Print Reports SmartKey followed by ECG Report A or ECG Report B. In the ST Map (Current) or ST Map (Trend) window, select Print. In the Cardiac Output (Right Heart) or Cardiac Output

(Transpulmonary) window, select the pop-up key Print/

Record. In the Wedge window, select the Print Wedge pop-up key. In the Calculations windows, select the Print/ Record pop-

up key. In the Titration Table window, select the Print Titr.Tbl pop-

up key. In the Drip Table window, select the Print Drip Tbl pop-up key. In the Alarm Limits window, select Print Limits. Select the Realtime Report SmartKey, if configured. In the Loops window, select Print Loop. In the Battery Status window, select Print Status. Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available. In the Main Setup select Reports then Central Report A, Central Report B or Central Report C. Stopping Reports Printouts To stop Reports printing, in the Reports menu, select Delete Report to stop the current print job Delete All Repts to cancel all queued report printouts 326 26 Printing Patient Reports Scheduled Rep. to select Off and switch off scheduled reports. Setting Up Reports As the content of context-linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the procedure window these reports do not need to be set up, however a target printer can be configured in the Setup Reports menu. 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. ECG report layout and Auto Reports settings must be defined in Configuration Mode. Setting Up ECG Reports 2 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, then 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. Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG report printouts. Select Speed and select the report print speed. Select Annotation and switch to On if the printed ECG wave should be annotated with beat labels. See the ECG, Arrhythmia, ST and QT Monitoring chapter 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 3 4 The settings you choose in the 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, Select Main Setup, Reports, then Vital Signs Rep. or Graph Trend Rep.. 1 Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor's trend configuration. 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, 2 3 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, 327 26 Printing Patient Reports 1 2 3 4 Select Main Setup, Reports, then 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. Select End Case Report and switch to On if you want the selected report to print automatically when you select End Case to discharge a patient. Switch End Case Report to Off if the report is a Scheduled Report only. 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. (hrs) 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"). Switch 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, Select Main Setup, Reports, then Setup Reports to enter the Setup Reports menu. 1 Select Report and then select the report you want to set up. 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:

VisibleWaves: 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. HiRes Waves: all measured HiRes waves. OxyCRG Waves: the OxyCRG/Neonatal Event Review waves. Vital Signs: trend information in tabular form. Graph Trend: trend information in graphic form. ECG reports: ECG3X4, ECG6X2, ECG12X1, ECG4X2, ECG8X1,ECG12X1 (2P) EEG reports: EEG Report. Episode: a single patient event episode. Review: an overview of patient events Alarm Limits: a list of all currently set alarm limits. 2 328 26 Printing Patient Reports 3 4 5 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: Unspecified to use the default size for the template chosen, Landscape or Portrait. Select Target Device and choose which printer the print job will be sent to: Unspecified 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. Printer names for locally-connected printers can be defined in Configuration Mode. You can see whether a specified printer is centrally or locally connected in the Setup Printers menu under Port. If

"Local" is included in the port name, e.g. Local 2, that indicates locally-connected printers, and

"Remote", e.g.Remote 1, indicates centrally-connected 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. In the Setup Printers menu, select Printer and then select the name of the device you want to 1 switch on or off for Reports printing from the pop-up list. Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Printer Status setting will automatically be set to Disabled and "grayed out". 2 Dashed Lines on Reports 329 26 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 and Printing Manually 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, In Companion, Retry, Cancelling, Error. Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Repts key. CAUTION The Reports Job List includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality. 330 26 Printing Patient Reports If an MP5 or an X2 is connected to a host monitor, all print requests which are stored in the print database are shown "grayed out" on the Reports Job List and will not be deleted with the Delete All Repts key. Printing Manually Those jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host Only or Never, some or all reports will not be printed automatically and will be shown in gray. Any jobs shown in gray must be printed manually; to do this, 1 In the Reports Job List, select the required report Select Print Report. 2 Selecting Print All Reps will send all reports to the printer. Printer Status Messages Printer Status Message Print job queued for <Printer Name>

Print job could not be queued

(insufficient resources) Print job could not be queued

(queue is full) Print job could not be queued (no matching printer found) Cancelling all print jobs Cancelling the active print job Cancelling print jobs due to patient discharge Cancelling # print jobs due to hotstart Printing failed: No report configured!

Printing on <Printer Name>... 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. Delete All Reps has been selected in the Reports menu, OR The Operating Mode has been changed from Monitoring Mode to Demonstration or Service Mode. The current report is being canceled as the result of a user request. When a patient is discharged, all queued reports are canceled except those stored in the print database. The monitor has restarted and all report requests have been canceled except those stored in the print database. "#" is the number of reports canceled. 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. 331 26 Printing Patient Reports Printer Status Message Printer <Printer Name>

unavailable -> job suspended Print database full -> job suspended Job on <Printer Name> failed

(data unavailable) Job on <Printer Name> failed

(printer unavailable) Job on <Printer Name> failed

(data requisition error) Possible causes and suggested action 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. 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 330). Alternatively you can delete another report from the Reports Job List (using the Delete Report key) to create space for your report. A report cannot be started on the requested printer. One of three reasons is shown in the status message:

data unavailable - the connected X2 or MP5 has been removed before the data for the report was transferred. printer unavailable - make sure the printer is plugged in, switched on, and has paper loaded. data requisition error - an internal error has caused data required for the report to be unavailable, try starting the report again. Print job on <Printer Name>

done The report has been printed. Sample Report Printouts Each report header contains the patient's bed label, last name and first name, middle name (if there is enough space) 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. 332 Alarm Limits Report 26 Printing Patient Reports 1 Measurement labels, with alarms off symbol where alarms are switched off 2 Graphic view of current alarm limits in relation to currently monitored measurement value 333 26 Printing Patient Reports Realtime Report Patient demographic information, time stamp 1 2 Active Alarms and INOPs, followed by vital signs 3 Measurement waves section 334 Cardiac Output Report ECG Reports 26 Printing Patient Reports Patient information 1 2 Numeric block 3 Wave area 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 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 Other Reports See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports. 335 26 Printing Patient Reports 336 27 27Using the Drug Calculator Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time. Term Dose Rate Amount Volume Definition total quantity of drug to be delivered to the patient over time volume of the mixture to be delivered to the patient over time amount of drug to be added to diluent to make up a mixture quantity of mixture of diluent and drug ml Units amount units per time or per kg/

time, if the drug is weight-

dependent ml/hour ng, mcg*, mg, g, mUnit, Unit, where g stands for gram Concentration Standardized Rate ratio of the amount of drug to the solution volume 1ml volume of the mixture to be delivered to the patient per hour amount units per ml ml/hr

*Be aware that your hospital may use either 'g' or 'mcg' as an abbreviation for microgram. These abbreviations are equivalent. WARNING Before you administer any drug, always check that the correct calculation units and patient category are selected. Consult your pharmacy if you have questions. Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge. The Drug Calculator performs calculations based on the values input during use, it does not check the plausibility of the calculations performed. 337 27 Using the Drug Calculator Accessing the Drug Calculator To access the Drug Calculator, select Main Setup then Calculations followed by Drug Calculator, or select the Drug Calc SmartKey, if configured. Performing Drug Calculations Using the service Support Tool, a list of drugs can be configured for the monitor containing pre-

defined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the Drug Calculator window opens a list of configured drugs. Contact your pharmacist if you have any questions about the drugs in the list. If ANY DRUG is the only entry in the list of drugs, no drugs have been pre-configured for your monitor. Drug calculations can be performed for non-specific drugs. You must have a Support Tool to add additional drugs to the Drug Calculator. About the Rule of Six If the Rule of Six has been enabled for use with individual drugs in your Drug Calculator, you can use the formula in crisis situations to quickly calculate the amount of a drug needed to yield a target dose for continuous infusion for neonatal or pediatric patients (the drug amount is given in "mg", the patient weight in "kg"). The Rule of Six can only be used with the dose unit mcg/kg/min. CAUTION JCAHO recommends disabling the Rule of Six. The configuration is not JCAHO-compliant if Rule of Six is enabled. The Drug Calculator uses the following formula for Rule of Six calculations, based on the patient's weight:

For a target dose of 0.1 mcg/kg/min, the Drug Calculator multiplies 0.6 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml. For a target dose of 1.0 mcg/kg/min, the Drug Calculator multiplies 6.0 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml. 338 Performing Calculations for a Non-Specific Drug 27 Using the Drug Calculator If a list of drugs has not been configured for your monitor, you can use the Drug Calculator to calculate drug doses for a single, generic drug called ANY DRUG. Selecting the arrow beside the drug name in the Drug Calculator window shows that are no other drugs configured. 1 Enter three of these four values: dose, amount, volume, rate of the infusion solution. 2 To enter values, select the correct unit, then select each value field and use the pop-up keypad to enter the correct value. If you have chosen a weight-dependent dose unit, you must enter the patient weight now or choose a different unit. If available, the patient weight from the Patient Demographics window is entered automatically in the Drug Calculator window when the Drug Calculator is accessed. To change the patient weight, select the Weight key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. 3 When you have entered three values, the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field. Standardized rate and concentration are also calculated. Performing Calculations for a Specific Drug 1 Select the arrow beside ANY DRUG, then select the required drug from the list of drugs. This opens the window for the selected drug. 339 27 Using the Drug Calculator 2 Select the correct patient category for your patient. If you have a neonatal or pediatric patient, the Rule Of 6 choice may be available. Select if required. 3 Enter the patient weight, if necessary. If available, the patient weight from the Patient Demographics window is entered automatically in the Drug Calculator window. To change the patient weight, select the Weight key then use the on-

screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. Select the weight unit shown to change between lb and kg. 4 When a specific drug is selected, the initial values for Dose, Amount and Volume are the configured Start values for this drug. The Rate is then calculated. If other values are required you can calculate any value by entering the remaining three values as described in Performing Calculations for a Non-Specific Drug on page 339. The column on the right of the window shows either drug dose or dosage rate, whichever is the calculated value. The current calculated value is shown on a scale with the recommended range in green. If the current calculated value lies outside the recommended range it is shown in red. If you have changed values in the Drug Calculator and you want to revert to the configured values, select Reset Values key at any time. Charting Infusion Progress The Drip Table shows you at a glance how much of the infusion has been administered to your patient and how much time is left. If the Drip Time exceeds 24 hours, the Drip Time timestamp shows - - :- - : - - . To see the Drip Table, in the Drug Calculator window, select the Drip Table pop-up key. 340 Using the Titration Table 27 Using the Drug Calculator Use the Titration Table to see at a glance what dose your patient would receive of a drug at different infusion rates. By clicking on the title row of the table you can switch between the Dose increments and Rate increments view. Values outside of the recommended range are shown in red. To see the Titration Table, The Titration Table is configured with the service Support Tool. in the Drug Calculator window, select the pop-up key Titr. Table. Documenting Drug Calculations In the Drug Calculator window, select the pop-up key Record DrugCalc to immediately start a recording of the current drug calculation. In the Titration Table window, select the pop-up key Print Titr.Tbl to print a report of the current Titration Table. In the Drip Table window, select the pop-up key Print Drip Tbl to print a report of the current Drip Table. 341 27 Using the Drug Calculator 342 28 28IntelliBridge EC10 Module An IntelliBridge EC10 module transmits information from a connected external device to your monitor. The IntelliBridge EC5 ID module is used to provide identification information from the external device. Data imported from the external device, for example waveforms, measurement numerics, settings and alarms, can be displayed on the monitor, passed on to an Information Center and included in trends as appropriate. The external device may show more information than is available on the monitor. Data from IntelliBridge EC10 modules cannot be included in monitor trends when the label is a free-text label. 1 module name 2 setup indicator LED setup/data viewing key connection status LED external device cable connector 3 4 5 See the documentation supplied with the IntelliBridge module for a list of supported devices and accessories, and for configuration information. Connecting an External Device Insert the module into the FMS or integrated module slot. 1 2 Check that you have the correct EC5 ID module for the external device - indicated on the EC5 label. Switch the external device on. 3 Connect the EC5 ID module to the external device. 4 Connect the EC5 to the EC10 module using the supplied cable. 5 6 The connection status LED (4) will flash green until it has correctly identified the external device and started communication. Check that the connection status LED then lights green continuously indicating that communication has been established. 343 28 IntelliBridge EC10 Module Changing Waves and Numerics Displayed To change the waves and numerics from the IntelliBridge module displayed on the Screen, 1 Select Main Setup, Measurements, then <External Device> to enter the setup menu for the connected device. Select Setup Driver. Select Setup Wavesor Setup Numerics and make the changes required. 3 4 Close the setup menu. The monitor takes a few seconds to activate the change. 2 Viewing the IntelliBridge Device Data Window To view the IntelliBridge device data window, either select the setup key on the IntelliBridge module, or select the External Devices SmartKey and then select the pop-up key with the device name on it, or in the Setup <External Device> menu, select Show Device Data. Check that the correct external device ID is shown in the window title. Select the device data window then Setup Device to open the setup menu for the connected device. With the More Data key you can page through additional data which does not fit on the first screen. When an infusion system is connected the data is presented differently. The data from each pump is displayed in a horizontal frame in the window. Data from several infusion pumps can be displayed. To see a detailed information window for one of the pumps, you can select data for that pump on the Screen or select the More Data pop-up key. Using Screens with External Device Data Your monitor may be configured to show external device data permanently on the Screens. Select the device data window to display the pop-up keys that let you access the setup menu and make changes. 344 28 IntelliBridge EC10 Module Alarms/INOPs from External Devices The IntelliBridge module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the External Device Data window tells you either Device Alarms Ignored or Device Alarms Accepted or No Alarms Available. External device alarms status symbols precede some, but not all, measurement labels. the monitor is configured to accept external device alarms, but the alarms are switched off at the external device. Alarms from external devices are transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device. Refer to the documentation supplied with the IntelliBridge module for details of how alarms are announced on the monitor and the Information Center. INOPs from the IntelliBridge Module INOP Text

!!NO DEVICE DATA

!!!NO DEVICE DATA NO DEVICE DATA DEVICE UNSUPPORTED DEVICE CHECK CONF. DEVICE CHECK SETUP INOP Condition Communication has been lost to a connected device when

!! a medium priority INOP or patient alarm was present

!!! a high priority INOP or patient alarm was present Communication has been lost to a connected device with no (or only low priority) INOPs/physical alarms. Device identification completed but no appropriate device driver installed Device identification completed but communication could not be established due to errors Device identification completed but communication could not be established due to timeout Language Conflict with External Device Drivers You should avoid language conflicts between the IntelliBridge module device driver and the monitor. Be aware that if you connect an IntelliBridge module with a different operating language to the monitor, the monitor will show:

measurement labels in the monitor language alarm and INOP texts in the IntelliBridge module device driver language. 345 28 IntelliBridge EC10 Module 346 29 29VueLink Modules A VueLink module transmits information from a connected external device to your monitor. Each module can be connected to one of up to three preselected external devices, and supports alarms from the external device. Data from VueLink modules cannot be included in monitor trends when the label is a free-text label. The external device may show more information than is available on the monitor. The number of waves and numerics you can view simultaneously on your monitor's main screen depends on the module type. Type A modules support one wave and two numerics, type B modules support two waves and six numerics. Module Type Max. Wave Auxiliary Ventilator Gas Analyzer Anesthesia Machine Auxiliary Plus A B B B B 1 2 2 2 2 Max. Numeric 2 6 6 6 External Devices standalone measurement module ventilators gas analyzers anesthesia machines 6 external multi-measurement devices 1 module name 2 4 3 device label selection LED setup key external device cable connector setup indicator LED 6 7 module type (A or B) 5 The device labels (2) on the module indicate for which external devices the module is configured. The selection LED (3) shows which device is currently active. The device label text may differ slightly from the labels on the external devices. 347 29 VueLink Modules See the documentation supplied with the VueLink module for a list of supported devices and accessories, and for configuration information. Connecting an External Device Insert the module into the FMS or integrated module slot. 1 2 Check that the device selection LED (3) lights to show that it has correctly identified the external device. If not, select Main Setup, Measurements and then the name of the external device to enter the setup menu for the connected device. In the device setup menu, select Device, select the correct device from the list, and confirm the selection. 3 4 Connect the external device to the module and switch it on. Once the VueLink device has been correctly connected, you can select the External Devices SmartKey and then select the Setup Device pop-up key to access the setup menu for the connected device. CAUTION Selecting the wrong device can cause unpredictable system behavior. Rectify this by switching off the external device when it is safe to do so, and selecting the correct device. Changing VueLink Waves and Numerics Displayed To change the waves and numerics from the VueLink module displayed on the Screen, 1 Select Main Setup, Measurements and then the name of the connected device to enter its setup menu. Select the item you want to change, then select the new item from the pop-up list, or Select Show Device Data to view the device data window. 2 3 Close the setup menu. The monitor takes a few seconds to activate the change. 348 Viewing the VueLink Device Data Window 29 VueLink Modules 1 Mode information from external device 2 Name of external device 3 Type of external device 4 Device Alarms Accepted To view the VueLink device data window, either select the setup hardkey on the VueLink module or the External Devices SmartKey, and then select the pop-up key for the device, or in the Setup <External Device> menu, select Show Device Data. Select the device data window then the Setup Device key to open the setup menu for the connected device. Using VueLink Screens Your monitor may be configured to show VueLink device data permanently on the Screens. Select the device data window to display the external device pop-up keys that let you access the setup menu and carry out external device tasks. Switching VueLink On and Off To switch VueLink measurements on and off, in the setup menu for the external device, select Device Interface to toggle between the settings On and Off. 349 29 VueLink Modules Alarms/INOPs From External Devices The VueLink module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the VueLink info window tells you, depending on the configuration setting, either Device Alarms Ignored or Device Alarms Accepted or, when the external device is not supplying alarm data, No Alarms Available. When Device Alarms Ignored is set, alarms from the external device will not be displayed on the monitor and will not be transmitted to the Information Center. External device alarms status symbols precede some, but not all, measurement labels. the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.

alarms status of this external measurement is unknown Alarms from external devices are:

transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device. always non-latching on the monitor. announced as a flashing numeric while the alarm condition persists. announced audibly and visibly at the Information Center. Language Conflict with External Device Drivers You should avoid language conflicts between the VueLink module device driver and the monitor. Be aware that if you connect a VueLink module with a different operating language to the monitor, the monitor will show:

measurement labels in the monitor language alarm and INOP texts in the VueLink module device driver language. 350 30 30Using Timers With the Timers function you can set timers to notify you when a specific time period has expired. CAUTION Do not use the timers to schedule critical patient-related tasks. Viewing Timers You can view currently active timers in the Timers window or directly on the Main Screen (if a timer has been substituted for a numeric). To open the Timers window:

Select the Timer SmartKey Select Main Setup then select Timer or The maximum number of timers which can be active depends on your monitor model. For a timer with a defined run time a progress bar is shown with the run time for that timer. Next to the progress bar the elapsed time or the remaining time is shown, depending on whether the timer is counting up or down. On the left, the label of the timer and a symbol indicating the type of expiry notification is shown. Timer Types There are four types of timer: Basic, Enhanced, Cyclic and No Limit. A Basic timer has a single, defined run time and progress is shown in the progress bar. An Enhanced timer is like a Basic timer but the progress bar shows progress beyond the end of the run time. A Cyclic timer is like a Basic timer but restarts automatically when the run time is expired. A No Limit timer has no run time or progress bar and shows the time elapsed since the timer was started. The type of timer is set in the monitor's Configuration Mode and is associated with the timer label. 351 30 Using Timers Timer Setup Pop-up Keys When you open the Timers window and select a timer, then select the setup key, the setup window opens and a selection of pop-up keys appear to let you activate and control the timers. Pop-Up Keys Start Stop Clear Timers Selecting this pop-up key lets you.... start the timer. stop the timer, allowing either restarting after a pause (Start key) or clearing

(Clear key). clear the timer, ending this timer episode. return to the timer window showing all active timers Setting Up Timers The timer type, display color of the timer and whether a window automatically pops up on expiry are settings made in Configuration Mode for each timer label. The remaining timer settings can be made in Monitoring Mode. If you change settings when a timer is running it will not be stopped. The timer will continue to count but the new settings will be applied. To display the setup window for a timer, in the Timers window, select the required timer, then select the setup key or select a timer on the Screen then select Setup Timers. Timer Label You can select from a variety of specific labels, for example Tourniquet, Infus, Docu or from four non-specific labels TimerA, TimerB, TimerC, and TimerD. When you assign a label to a timer, the monitor automatically applies the associated configuration settings to this timer, but the timer continues counting and is not reset. To select a label, in the Timers window:

1 Select the required timer and display the Setup window. Select Label. Select a specific or non-specific label from the list. 2 3 Run Time The run time can be set between 1 minute and 96 hours. No Limit timers have no run time. To set the run time, in the Timers window:

1 Select the required timer and display the Setup window. Select Run Time. Select a run time from the list. 2 3 352 Timer Counting Direction 30 Using Timers Timers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up. To change the direction, in the Timers window:

1 Select the required timer and display the Setup window. Select Direction to switch between Up and Down. 2 Notification When a timer expires (except a No Limit timer), the color changes to red and a message appears in the status line on the Main Screen. Be aware that if a timer has been configured to display in light red, the color will not visibly change when the timer expires. Additional notification is also available and can be set to:

Alarm: An INOP alarm indicates the expiry of the timer Sound: A single tone indicates the expiry of the timer No Sound: No additional notification To set the additional notification, in the Timers window:

1 Select the required timer and display the Setup window. Select Notification and select the notification level required from the list. 2 If an MP5 is connected to a host monitor, and notification is set on the MP5 to Alarm, the INOP alarm will appear on the host monitor TimeExpired:MMS. Timer Volume For all Timers with the notification setting Sound, you can set the volume of the tone. To set the volume, in the Timers window:

1 Select the required timer and display the Setup window. Select Timer Volume and select a volume setting from the list. 2 Displaying a Timer On The Main Screen If you want to have a timer displayed on the Main Screen, you can substitute it for a numeric which is not directly associated with a wave. If limited space is available, some of the timer display elements may not be displayed. The minimum information displayed is the label and the elapsed or remaining time. 353 30 Using Timers To display a timer on the Main Screen:

1 Select the numeric you want to substitute. Select Change Numeric. Select Any Timer. 2 3 Main Screen Timer Pop-up Keys When you select a timer displayed on the Main Screen, additional pop-up keys become available:

Pop-Up Keys Setup <Timer Label>

Change Timer Timers Selecting this pop-up key lets you.... enter the setup screen for the currently selected timer. select a different timer for display. enter the Timers window. Displaying A Clock On The Main Screen In the same way that you can substitute a timer for a numeric, you can also substitute a larger clock display for a numeric. To display a clock on the Main Screen:

1 2 Select the numeric you want to substitute. Select Change Numeric. Select Clock. 3 When you select the clock on the Main Screen you can select Date, Time in the menu to set the date and time. 354 31 31Respiratory Loops Using a Spirometry module or a VueLink/IntelliBridge module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient's lung function, and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close). You can measure:

Pressure-volume loops Pressure-flow loops Volume-flow loops. Note that you cannot store loops from different patients and different source devices in the same list as they are patient and device specific. This prevents you from inadvertently comparing information from different patients. Viewing Loops In the loops display, the current loop is drawn in white, and up to six stored loops are color-coded to match their timestamps. The currently-used source device is shown in the window title. To view respiratory loops permanently on your Screen, select the current Screen name to open the Change Screen menu, then select a Screen configured to display the loops screen element. Select the loops screen element to access the loops pop-up keys. 355 31 Respiratory Loops select Main Setup then Loops, or select the Loops SmartKey, if configured. To open the Loops window, and its associated pop-up keys, In the Loops window, in addition to the stored loops, two realtime airway waves and up to nine available numerics from the source device can be shown. Capturing and Deleting Loops Up to six loops of each kind can be stored for reference. To capture the current Loop and display it in the Loops window, select the Capture Loop pop-up key. The monitor will prompt you to save the loop for reference, either in addition to or in place of previously stored loops. Status messages at the bottom of the window provide information on the loop capture process. To delete Loops from the reference list, Select the Select Loop pop-up key to view the list of stored loops and delete the loops from the list. Showing/Hiding Loops Colored rectangles beside the loops timestamps and color-coded with the loops tell you whether each loop is currently displayed or not:

A filled-in rectangle marks loops currently shown in the Loops window A rectangle outline marks loops not currently shown. Selecting the timestamp of the currently-displayed loop hides it and shows the next in the list; selecting the timestamp of a currently hidden loop displays it. Changing Loops Display Size To change the loops display size, in the Loops window, select the pop-up key Select Size then select This does not affect the size of loops printed in reports. Size X0.5 to display loops at half the usual size Size X1 to display loops at the usual size Size X2 to display loops at twice the usual size Using the Loops Cursor To view the coordinates for any point on a stored loop, 1 Select the pop-up key Select Loop. Select the required loop from the list of available loops. 2 3 Use the arrow pop-up keys to move the cursor around the loop. The values for both loop axes are shown for every point on the loop. Select the X at the top of the loop list to exit the cursor. 356 Changing Loops Type 31 Respiratory Loops To change the loop type, in the Loops window, select the Loop Type pop-up key (only available if the source device delivers three waves), then select Press/Volume to display Pressure/Volume loops Flow/Volume to display Volume/Flow loops Press/Flow to display Pressure/Flow loops. or, if the source device only delivers two waves, 1 In the Loops window, select the Setup Device pop-up key to enter the setup window for the external device. Select Wave 1 and select pressure, flow, or volume waves as required. Repeat for Wave 2. 2 Setting Up Source Device Select the Setup Device pop-up key to view the settings of the current source device. The source device for the loops is indicated in the Loops window title. If the source device is changed, all reference loops from a previous device are cleared from the reference list when the first loop from the new source device is captured. Reconnecting the previous device recalls its reference list. Documenting Loops 1 In the Loops window, select the pop-up key Print Loop From the list of available loops, select an individual loop, or select Print All to print a report of all 2 For each loop, the report prints the currently-displayed loop, with the loop capture timestamp up to six realtime numerics provided by the loop source device SpO2, etCO2, PO2, and PCO2 numerics from the patient monitor, if available. 357 31 Respiratory Loops 358 32 32Laboratory Data Laboratory data can be entered manually at the Information Center or at the monitor. For details on manual entry at the monitor, see Entering Measurements Manually on page 42. Selected laboratory data can be integrated on the monitor - values are then stored in the database and included in trends and reports and can be displayed as a numeric on the main screen. Which data can be stored and used on the monitor in this way is selected in Configuration Mode. Viewing Received Data When new data has been received from the Information Center a New Lab Data received. Check Lab Results Window. message will appear with the arrival time. To view the data, select Main Setup then select Lab Results or the Lab Results SmartKey. The Lab Results window shows the most recent set of data received. The data is grouped into categories:

Blood Gases Electrolytes Hematology Metabolites Chemistry Enzymes/Markers Coagulation Urine Diagnostics If no results are available for a particular category, that category will not be shown. Values which were entered manually at the Information Center will be marked with an asterisk (*). 359 32 Laboratory Data 360 33 33Care 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, modules, Multi-Measurement Module, MMS extensions, Flexible Module Rack, 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. The general care and cleaning information given here meets the requirements of Aspect Medical Systems for their BIS measurement devices. 361 33 Care and Cleaning Cleaning the Monitor Clean with a lint-free cloth, moistened with warm water (40C/104F 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 selecting and holding the Main Screen key until the padlock symbol appears on it, indicating that touch operation is disabled. Select and hold again to re-enable touch operation.Unplug a mouse, keyboard or other connected device before cleaning it. Disinfecting the Monitor 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:

Product Type liquid liquid, spray liquid spray liquid spray wipes spray Ingredients Isopropanol 80%

100 g concentrate contains:

Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 g Ethanol 100 mg/g Propan-2-ol (= 2-Propanol) 90 mg/g; Propan-1-ol (= 1-

Propanol) 60 mg/g 50% 1-Propanol 0.5% accelerated hydrogen peroxide 0.5% accelerated hydrogen peroxide 0.5% accelerated hydrogen peroxide 0.5% accelerated hydrogen peroxide Product Name Isopropanol Bacillol AF Bacillol25 Meliseptol Accel TB RTU Oxivir Tb Cleaner Disinfectant Oxivir Tb Wipes Carpe DiemTM/MC Tb Ready-to-Use General Virucide, Bactericide, Tuberculocide, Fungicide, Sanitizer 362 33 Care and Cleaning Product Name Carpe DiemTM/MC Tb Wipes Super Sani-Cloth Germicidal Disposable Wipes SANI-CLOTH PLUS Germicidal Disposable Wipes SANI-CLOTH HB Germicidal Germicidal Disposable Wipes Product Type wipes wipes wipes wipes Ingredients 0.5% accelerated hydrogen peroxide isopropanol 55%

quaternary ammonium chlorides 0.5%

isopropanol 15%

quaternary ammonium chlorides 0.25%

isopropanol < 0.15%

quaternary ammonium chlorides 0.14%

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. 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. Cleaning the SO2 Optical Module The outside of the optical module can be cleaned as described under Cleaning the Monitor on page 362. The compartment with the fiber-optic connection can only be cleaned with a dry cloth. Do not introduce any moisture into this compartment. Cleaning the Recorder Printhead (M1116B only) If you run recordings at low speed (1 or 2cm/min) for extended periods, deposits of paper debris may collect on the print head making recordings unevenly fainter in horizontal stripes. 1 Remove the recorder. 2 Open the recorder door and un-thread the paper from behind the rubber roller. 3 Tear off or roll up the excess paper into the roll chamber to get it out of your way. 363 33 Care and Cleaning 4 Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two inches of the strip come out from the top of the roller. 5 Close the recorder door, aligning both ends of the strip over the top of the door. 6 Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip through and out of the recorder. 7 Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the recorder. 364 34 34Maintenance 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. Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use. 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. If the MMS and MMS Extensions are mounted on the monitor, make sure that they are locked into place and do not slide out without releasing the locking mechanism. 2 3 4 WARNING 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. 365 34 Maintenance and Troubleshooting Inspecting the Cables and Cords 1 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 Measurement Link cable and ensure that it makes good connection with the MMS and the FMS. Make sure that there are no breaks in the insulation. Inspect the cable connecting the MMS to the monitor. Make sure the connectors are properly engaged. 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. 2 3 4 5 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. 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 DVD. 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 Monitor Tests Safety checks. Selected tests on the basis of IEC 60601-1 Frequency 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. At least once every two years, or as needed. Monitor Maintenance Check ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation) Replace backlight

(integrated displays only) Multi-measurement Module and Module Tests Performance assurance for all measurements not listed below. Multi-measurement Module and Module Maintenance NBP calibration Microstream CO2 calibration and performance test Mainstream and sidestream CO2 calibration check (M3014A) 25,000 - 30,000 hours (about three years) of continuous usage, 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. 366 Troubleshooting 34 Maintenance and Troubleshooting If you suspect a problem with an individual measurement, read the Instructions for Use and double-

check 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 In the Main Setup menu, select Revisions. Select the pop-up key corresponding to the status log you want to consult, for example, for the MMS or the monitor. 2 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, MMS, FMS and modules as described in the Service Guide. You will find detailed disposal information on the following web page:

http://www.healthcare.philips.com/main/about/Sustainability/Recycling/pm.wpd The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium). 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 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. 2 When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder. 3 Write "Empty" on the cylinder and dispose of it appropriately for scrap metal. 367 34 Maintenance and Troubleshooting WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder. 368 35 35Accessories 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 6-Electrode Cable Set Part No. Length M1669A 2.7 m M1668A 2.7 m M1667A 2.7 m 10-Electrode Cable set

(5+5) M1663A 2.0 m 10-Electrode Cable set

(6+4) M1665A 2.7 m 369 35 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 6-Electrode Cable Sets Description OR Grabber ICU Grabber ICU Snap Length 1.0 m 1.0 m 1.0 m 0.45 m 0.7 m AAMI Part No. M1675A M1671A M1673A M1622A M1624A IEC Part No. M1678A M1672A M1674A

M1626A Length 1.0 m/1.6 m 1.0 m/1.6 m 1.0 m/1.6 m 0.7 m/1.3 m AAMI Part No. M1973A M1968A M1644A M1647A IEC Part No. M1974A M1971A M1645A M1648A Length 1.0 m/1.6 m 1.0 m/1.6 m 1.0 m/1.6 m AAMI Part No. M1684A M1680A M1682A IEC Part No. M1685A M1681A M1683A 10-Electrode (5+5)Cable Sets Description ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded For Limb Leads see 5-electrode cable sets Length 1.0 m 1.0 m 1.0 m 10-Electrode (6+4)Cable Sets Description ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded For Limb Leads see 6-electrode cable sets Length 1.0 m 1.0 m 1.0 m 370 AAMI Part No. M1976A M1602A M1979A IEC Part No. M1978A M1604A M1984A AAMI Part No. M1532A M1537A M1557A IEC Part No. M1533A M1538A M1558A 35 Accessories One-piece Cables Description 3-lead Grabber, ICU 5-lead Grabber, ICU Length 1.0 m 1.0 m AAMI Part No. 989803143181 989803143201 IEC Part No. 989803143171 989803143191 Radio-translucent Cables Pack of five single wires, radio-translucent, 0.9 m, M1649A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer for shielded leadsets - grabber and snap Set organizer for non-shielded lead sets - miniclip Bedsheet clip Replacement red cover for trunk cable (for 5-electrode cable sets) Supported Cables Trunk Cables 3-electrode 5-electrode 3-electrode 4-electrode 5-electrode 6-electrode 3-electrode 5-electrode Part No. M1501A M1502A M1503A M1664A M1504A M1679A M1636A M1638A M1509A 989808148861 Length 0.9 m 2.7 m 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. M1540C M1500A IEC Part No. M1550C M1510A AAMI Part No. M1560C M1520A IEC Part No. M1570C M1530A 3-Electrode Cable Sets Description OR ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded Length 1.0 m 1.0 m 1.0 m 0.45 m 0.7 m AAMI Part No. M1601A M1603A M1605A M1608A M1609A IEC Part No. M1611A M1613A M1615A M1618A M1619A 371 35 Accessories 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Clip non-shielded 3-Electrode One Piece Cables Length 1.0 m/1.6 m 1.0 m/1.6 m 1.0 m/1.6 m 0.7 m/1.3 m AAMI Part No. M1621A M1623A M1625A M1629A IEC Part No. M1631A M1633A M1635A M1639A AAMI 3-Electrode One Piece Cables OR Grabber ICU Snap Length AAMI Part No. 1.9 m 1.9 m M1970A M1972A IEC 3-electrode One Piece Cables OR Grabber ICU Grabber IEC Part No. M1980A M1981A 5-Electrode One Piece Cables AAMI 5-electrode One Piece Cables OR Grabber ICU Snap Length AAMI Part No. 2.5 m 2.5 m M1975A M1977A IEC 5-electrode One Piece Cables OR Grabber ICU Grabber IEC Part No. M1985A M1986A Part No. M1501A 3-electrode 5-electrode M1502A Shielded 3-electrode M1503A Shielded 5-electrode M1504A M1509A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer Bedsheet clip 372 NBP Accessories 35 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 Reusable Comfort Cuffs Patient Category Adult (Thigh) Large Adult Adult Small Adult Pediatric Infant Limb Circumference 42 to 54 cm 34 to 43 cm 27 to 35 cm 20.5 to 28 cm 14 to 21.5 cm 10 to 15 cm Part No. M1576A M1575A M1574A M1573A M1572A M1571A Adult/Pediatric Reusable Comfort Cuff Kits Cuff Kits Infant, pediatric, small adult, adult Small adult, adult, large adult, thigh Infant, pediatric, small adult, adult, large adult, thigh Tubing M1598B (1.5 m) or M1599B (3 m) Part No. M1577A M1578A M1579A Adult/Pediatric Reusable EasyCare Cuffs Patient Category Limb Circumference Part No. Tubing Adult Thigh Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant 44 - 56 cm 35 - 45 cm 35 - 45 cm 27.5 - 36 cm 27.5 - 36 cm 20.5 - 28.5 cm 14 - 21.5 cm 10 - 15 cm

(Pack of five) M4559B (M4559B5) M4558B (M4558B5) M4557B (M4557B5) M4556B (M4556B5) M4555B (M4555B5) M4554B (M4554B5) M4553B (M4553B5) M4552B (M4552B5) M1598B (1.5 m) or M1599B (3 m) 373 35 Accessories Adult/Pediatric Single Patient Cuffs Patient Category Adult (Thigh) Large Adult Adult Small Adult Pediatric Infant Limb Circumference 42 to 54 cm 34 to 43 cm 27 to 35 cm 20.5 to 28 cm 14 to 21.5 cm 10 to 15 cm Part No. M1879A M1878A M1877A M1876A M1875A M1874A Adult/Pediatric Single Patient, Soft Cuffs Patient Category Adult (Thigh) Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference 44 - 56 cm 35 - 45 cm 35 - 45 cm 27.5 - 36 cm 27.5 - 36 cm 20.5 - 28.5 cm 14.0 - 21.5 cm 10 - 15 cm Part No. M4579B M4578B M4577B M4576B M4575B M4574B M4573B M4572B Neonatal/Infant Single Patient Cuffs Tubing M1598B (1.5 m) or M1599B (3 m) Tubing M1598B (1.5 m) or M1599B (3 m) Cuffs Limb Circumference Size 1 Size 2 Size 3 Size 4 Size 5 (Infant) 3.1 to 5.7 cm 4.3 to 8.0 cm 5.8 to 10.9 cm 7.1 to 13.1 cm 10 to 15 cm Part No. A - Luer connector B - ISO 80369-1 compliant connector M1866A/B M1868A/B M1870A/B M1872A/B M1873B Tubing For A-version cuffs:

M1596B (1.5 m) or M1597B

(3 m) For B-version cuffs:

M1596C (1.5 m) or M1597C

(3 m) 374 Neonatal/Infant Single Patient, Soft Cuffs Cuffs Size 1 Size 2 Size 3 Size 4 Size 5 (Infant) Limb Circumference 3.1 to 5.7 cm 4.3 to 8.0 cm 5.8 to 10.9 cm 7.1 to 13.1 cm 10 to 15 cm Part No. M1866S M1868S M1870S M1872S M1873S Neonatal/Infant Cuff Kits 35 Accessories Tubing M1596C (1.5 m) or M1597C (3 m) Cuff Kits Standard, Single Patient, Luer connector: 10 x M1866A, 10 x M1868A, 10 x M1872A, and 20 x M1870A Standard, Single Patient, ISO 80369-1 compliant connector: 5 x M1866B, 10 x M1868B, 20 x M1870B, 10 x M1872B, and 5 x M1873B Soft, Single Patient, ISO 80369-1 compliant connector: 5 x M1866S, 10 x M1868S, 20 x M1870S, 10 x M1872S, 5 x M1873S Part No. M1820-60020 989803167541 989803167551 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. If you are using the M3012A Hemodynamic MMS Extension, and you want to measure temperature and invasive pressure at the same time, we recommend that you use the pressure transducer CPJ840J6, with a round module connector piece, and not a transducer with a square connector. Pressure transducers with square connectors may make it difficult to connect the adjacent Temperature connector at the same time. Transducer, accessories, sensor kits Reusable pressure transducer 5 V/V/mmHg sensitivity Sterile disposable pressure domes for CPJ840J6 (pack of 50) Transducer holder for CPJ840J6 (pack of 4) IV pole mount for CPJ840J6 Monitoring Line Set for CPJ840J6 Single channel disposable sensor kit (20) - (EU/EFTA only) Dual channel disposable sensor kit (20) (EU/EFTA only) Transducer holder for M1567/8A (EU/EFTA only) IV pole mount for M1567/8A (EU/EFTA only) Adapter cable for disposable sensor kit 3,0m for M1567/8A Part No. CPJ840J6 CPJ84022 CPJ84046 CPJ84447 CPJ84026 M1567A M1568A M2271A M2272C M1634A 375 35 Accessories Transducer, accessories, sensor kits Pressure transducer kits PiCCO monitoring kit, 30cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A and central venous pressure line PULSION Pressure Interface Cable for disposable pressure transducer Part No. PV8103 PV8115 PV8115CVP PMK 206 SpO2 Accessories This section lists accessories for use with Philips SpO2 technology. For accessory lists for other SpO2 technologies, refer to the instructions for use provided with these devices. 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:

Masimo adapter cables, Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "Long"

version) or with a cable longer than 2 m. All listed sensors operate without risk of exceeding 41C on the skin, if the initial skin temperature does not exceed 35C. Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result. Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor. Option A01 is the Philips FAST-SpO2 version; Option A02 is the Nellcor OxiMax-compatible version. The SpO2 Option A02 may not be available in all countries. Some sensors may not be available in all countries. 376 Product Number Description Compatible with Opt. A01 Opt. A02 Comments 35 Accessories Philips reusable sensors. M1191A/B M1191AL/BL M1192A M1193A M1194A M1195A M1196A M1191T M1192T M1193T M1196T Adult sensor (2 m cable), for patients over 50 kg. Any finger, except thumb. M1191A/B with longer cable (3 m) Small adult, pediatric sensor (1.5 m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Neonatal sensor (1.5 m cable) for patients between 1kg and 4 kg. Hand or foot. Ear sensor (1.5 m cable) for patients more than 40 kg. Infant sensor (1.5 m cable) for patients between 4kg and 15 kg. Any finger except thumb. Adult clip sensor (3 m cable) for patients over 40 kg. Any finger except thumb. Adult sensor (0.45 m cable), for patients over 50 kg. Any finger, except thumb. Small adult, pediatric sensor (0.45 m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Neonatal sensor (0.9 m cable) for patients between 1 kg and 4 kg. Hand or foot. Adult clip sensor (0.9 m cable) for patients over 40 kg. Any finger except thumb. 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 Philips disposable sensors. Available worldwide. M1131A M1132A M1133A Adult/Pediatric finger sensor, 0.45 m cable

(patient size > 20 kg) Infant finger or toe sensor, 0.9 m cable

(patient size 3 - 10 kg) Adult/Infant/Neonatal, 0.9 m cable Foot or hand for neonates < 3 kg Big toe or thumb for patients between 10 kg and 20 kg Any finger except thumb for patients > 40 kg yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes no no no no no no no no no no no yes yes yes yes no no no No adapter cable required. Requires M1943 (1 m) or M1943AL (3 m) adapter cable Option A01: Use adapter cable M1943A or M1943AL. Option A02: Must use adapter cable M1943NL. Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. 377 35 Accessories Product Number Description M1134A Adhesive-free, Adult/Infant/Neonatal, 0.9 m cable Foot or hand for neonates < 3 kg Big toe or thumb for patients between 10 kg and 20 kg Any finger except thumb for patients > 40 kg Compatible with Opt. A01 yes Opt. A02 no Comments Use adapter cable M1943A or M1943AL. NELLCOR disposable sensors (must be ordered from Nellcor) OxiMax MAX-A Adult finger sensor (patient size > 30 kg) OxiMax MAX-A with long cable OxiMax MAX-AL OxiMax MAX-P Pediatric foot/hand sensor (patient size 10-

50 kg) Infant foot/hand sensor (patient size 3-20 kg) OxiMax MAX-I OxiMax MAX-N Adult finger or neonatal foot/hand sensor

(patient size > 40 kg or < 3 kg) Forehead sensor Adult nasal sensor Adult SoftCare sensor MAX-FAST OxiMax MAX-R OxiMax SC-A OxiMax SC-NEO Neonatal SoftCare sensor OxiMax SC-PR Oxisensor II D-25 Adult sensor (patient size > 30 kg) Oxisensor II D-20 Pediatric sensor (patient size 10-50 kg) Oxisensor II I-20 Oxisensor II N-25 Neonatal sensor (patient size < 3 kg or > 40 Infant sensor (patient size 3-20 kg) Pre-term infant SoftCare sensor OxiCliq A OxiCliq P OxiCliq I OxiCliq N kg) See OxiMax MAX-A See OxiMax MAX-P See OxiMax MAX-I See OxiMax MAX-N Adult / neonatal sensor Oxiband OXI-A/

N Oxiband OXI-P/I Pediatric / infant sensor Durasensor Adult finger clip sensor DS100A Dura-Y D-YS Y-sensor 378 Option A01: Use adapter cable M1943A or M1943AL. Option A02: Must use adapter cable M1943NL. Must use M1943NL adapter cable. Must use M1943A or M1943 AL adapter cable. Option A01: Use adapter cable M1943A or M1943AL together with OC-3 adapter cable. Option A02: Must use adapter cables M1943NL and OC-3 adapter cable. Must use M1943NL adapter cable. yes yes yes yes yes no no no no no yes yes yes yes yes yes yes yes no no no no yes yes yes yes yes yes yes yes yes yes no no no no yes yes yes yes yes yes yes yes Product Number Description Extension / Adapter Cables for Philips and Nellcor Sensors M1941A Extension cable (2 m) M1943A M1943AL M1943NL Adapter cable (1.1 m cable) Adapter cable (3 m cable) OxiMax adapter cable (3 m cable) OC-3 Adapter Cable for OxiCliq sensors yes yes yes no yes yes no no yes yes 35 Accessories Compatible with Opt. A01 Opt. A02 Comments For use with Philips reusable sensors and M1943A adapter cable. Adapter cable for Philips/Nellcor disposable sensors. Adapter cable for Philips disposable/

Nellcor disposable and reusable sensors. Available from Nellcor only. Philips Part Number Product Number Description Compatible with Opt. A01 Opt. A02 Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-Site Sensor (> 1kg) Ear Sensor (> 30 kg) MASIMO LNOP reusable sensors. LNOP DCI LNOP DCIP LNOP YI LNOP TC-I MASIMO LNCS reusable sensors. LNCS DCI LNCS DCIP LNCS YI LNCS TC-I MASIMO LNOP disposable adhesive sensors. LNOP Adt LNOP Adtx LNOP Pdt LNOP Pdtx LNOP Inf-L LNOP Neo-L Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-Site Sensor (> 1kg) Ear Sensor (> 30 kg) Adult Sensor (> 30 kg) Adult Sensor (> 30 kg) Pediatric Sensor (10 - 50 kg) Pediatric Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Sensor (< 3 kg) or Adult adhesive Sensor (> 40 kg) Neonatal Pre-Term Sensitive Skin Sensors

(< 1 kg) LNOP NeoPt-L yes yes yes yes yes yes yes yes yes yes yes yes yes yes yes MASIMO LNCS disposable adhesive sensors. LNCS Adtx LNCS Adtx-3 LNCS Pdtx yes Adult Finger Sensor, 18 inch (> 30 kg) Adult Finger Sensor, 3 feet (> 30 kg) yes Pediatric Finger Sensor, 18 inch (10 - 50 kg) yes no no no no no no no no no no no no no no no no no no n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 379 35 Accessories Product Number Description LNCS Pdtx-3 LNCS Inf LNCS Inf-3 LNCS Neo LNCS Neo-3 LNCS NeoPt LNCS NeoPt-3 Pediatric Finger Sensor, 3 feet (10 - 50 kg) Infant Toe Sensor, 18 inch (3 - 20 kg) Infant Toe Sensor, 3 feet (3 - 20 kg) Neonatal Foot Sensor, 18 inch (< 3 kg) or Adult Finger Sensor 18 inch(> 40 kg) Neonatal Foot Sensor, 3 feet (< 3 kg) or Adult Finger Sensor, 3 feet(> 40 kg) Neonatal pre-term sensitive skin Sensor 18 inch (< 1 kg) Neonatal pre-term sensitive skin Sensor 3 feet (< 1 kg) Adapter Cable for MASIMO sensors. LNOP MP12 LNC MP10 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors Compatible with Opt. A01 yes yes yes yes Opt. A02 no no no no yes yes yes yes yes no no no no no Philips Part Number n/a n/a n/a n/a n/a n/a n/a 451261000761 989803148221 The Philips M3001A/M3002A option A01 and the M1020B option A01 SpO2 Module use 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 (French 12) Esophageal/Stethoscope Probe (French 18) Esophageal/Stethoscope Probe (French 24) 380 Part No. 21075A 21076A 21078A M1837A 21091A 21093A 21094A 21095A Minimum measurement time for accurate readings 90 sec 60 sec 60 sec 90 sec 60 sec 180 sec 210 sec 310 sec Temperature Probes Esophageal/Rectal Probe (French 12) Foley Catheter Probe (12 French) Foley Catheter Probe (16 French) Foley Catheter Probe (18 French) Adapter cable 1.5m Adapter cable 3.0m 35 Accessories Minimum measurement time for accurate readings 90 sec 180 sec 180 sec 180 sec Part No. 21090A M2255A 21096A 21097A 21082B 21082A Cardiac Output (C.O.) Accessories See Pressure accessories for PULSION continuous cardiac output accessories. Description Accessories common to both methods Accessories PiCCO inline temperature probe Right Heart Thermodilution C.O. Interface Cables Right heart catheter for thermodilution Edwards CO-Set+ (only with 23001A/B) Injectate Probes Transpulmonary Thermodilution C.O. Interface Cables PULSION Pressure Transducer Kits (pressure line available in various lengths) Pressure Interface Cable for disposable pressure transducer Set of ice buckets Remote handswitch Latex free 2.7 meter cable 2.4 m + 2.4 m cable

(from Edwards Lifesciences) contact Edwards Lifesciences for information 2.4m injectate temp. probe (reusable) 0.5m injectate temp. probe (reusable) Ice bath temp. probe 2.4 m + 2.4 m cable Contact PULSION for information PULSION PMK 206 Part No. 14455A 15244A M1646A M1642A M1643A 831HF75 23001A 23001B 23002A M1643A 381 35 Accessories Mainstream CO2 Accessories Description CO2 Sensor Adult/Pediatric Airway Adapter (reusable) Infant Airway Adapter (reusable) Adult Airway Adapter (single-patient use) Infant Airway Adapter (single-patient use) Sidestream CO2 Accessories Description CO2 Sensor Nasal and Oral-Nasal Cannulas CO2 Nasal Cannula, Adult CO2 Nasal Cannula, Pediatric CO2 Nasal Cannula, Infant CO2 / O2 Nasal Cannula, Adult CO2 / O2 Nasal Cannula, Pediatric CO2 / O2 Nasal Cannula, Infant CO2 Oral-Nasal Cannula, Adult CO2 Oral-Nasal Cannula, Pediatric CO2 / O2 Oral-Nasal Cannula, Adult CO2 / O2 Oral-Nasal Cannula, Pediatric Airway Adapters Airway Adapter Set, ET > 4.0 mm 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 382 Part No. M2501A M2513A M2516A M2533A M2536A Part No. M2741A M2744A M2745A M2746A M2750A M2751A 989803144471 M2756A M2757A M2760A M2761A M2768A 989803144531 M2772A M2773A M2776A M2777A 35 Accessories Mainstream CO2 Accessories (for M3016A) Description CO2 Sensor Standard Airway Adapter (reusable) Small Airway Adapter (reusable) Microstream CO2 Accessories Part No. M1460A M1465A 14363A

"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 O2" is a combined oral-nasal-O2-CO2 FilterLine.

"NIV Line" is a nasal FilterLine suitable for mask ventilation (for example, C-PAP). The accessories are supplied in packs of 25. Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A). 383 35 Accessories Microstream accessory selection flowchart Is the patient intubated?

Yes Short-term

(up to 6 hours) No Does the patient need oxygen?

Yes Long-term

(up to 72 hours) Short-term

(up to 8 hours) Oral/Nasal Long-term

(up to 24 hours) Nasal No Long-term

(up to 24 hours) Nasal Short-term

(up to 8 hours) Oral/Nasal Short-term

(up to 8 hours) Nasal Key Applications Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Lab, Long-term 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 Set Long:

A/

P:989803160241*

FilterLine:

M1925A*

Smart CapnoLine O2:

A: M2522A P: M2520A Smart CapnoLine O2 Long A:989803160281*

P:989803160271*

CapnoLine HO2:

A: M4680A P: M4681A CapnoLine H:

A: M4689A P: M4690A I/N: M4691A FilterLine H Set:

A/P: M1921A I/N: M1923A FilterLine H Set Long A/

P:989803160251*

I/

N:989803160261*

VitaLine H Set:

A/

P:989803159571*

I/N:

989803159581*

FilterLine H:

M1926A*

*Not available in all geographies. Spirometry Accessories Description Adult/Pediatric Flow Sensor Neonatal Flow Sensor Adult/Pediatric CO2/Flow Sensor Neonatal CO2/Flow Sensor Pediatric CO2/Flow Sensor 384 NIV Line:

A: 4686A P: M4687A Smart CapnoLine:

A: M2526A P: M2524A Smart CapnoLine Plus Long A:989803160301*

Part No. M2785A M2786A M2781A M2782A M2783A 35 Accessories Measurement of CO2 and Spirometry with Neonates For measurement of CO2 and Spirometry with neonates, the use of the M3014A Mainstream CO2 Extension, the M1014A Spirometry Module and the M2782A Combined CO2/Flow Sensor is recommended. The M1923A Filterline H Set Infant/Neonatal used for Microstream CO2 measurement with the M3015A Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A). tcGas Accessories This symbol indicates that the specified transducer (but not its membranes) is designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and is defibrillator proof. Description tcpO2/CO2 transducer Accessory Kit for M1918A (O-ring remover, absorbent paper, electrolyte solution, 12 replacement membranes) Application Kit for M1918A (4x25 disposable fixation rings, contact fluid) tcpO2/CO2 transducer Accessory Kit for M1918B (10 replacement membranes, electrolyte solution) Application Kit for M1918B (4x25 disposable fixation rings, contact fluid) Calibration gas - 6 gas bottles Calibration gas - 6 gas bottles (Europe and Japan only) Replacement tubing (5 tubes) Calibration unit Radiometer TCC3 calibration unit (available from Radiometer) 1May not be available in all countries due to pending regulatory clearance EEG Accessories Part No. M1918A 15209-60010 15209-60020 M1918B1 9898031519511 9898031519611 15210-60010 15210-64010 M2205A 15210B n/a Description Trunk Cable 2.7 m Trunk Cable, 1.0 m Reusable 80-cm-long 5-lead cables with 10 mm silver/silverchloride leadwired cup electrodes

(Adult) Part No. M2268A M2269A M1931A 385 35 Accessories Description Reusable 80 cm 5-lead cables with 6 mm silver/silverchloride leadwired cup electrodes

(Pediatric/Neonatal) Reusable 80 cm 5-lead cables with clip Disposable EEG electrodes EC2 Electrode Cream (conductive paste) Part No. M1932A M1934A M1935A M1937A BIS Accessories To re-order sensors, contact Aspect Medical Systems. BIS sensors are not available from Philips. SO2 Accessories for M1021A Contact your local Hospira representative for information on accessories. They are not available from Philips. Description Optical Module Hospira Opticath Catheter family (SvO2, ScvO2) Hospira Part No. 50131 Contact Hospira for part numbers of compatible catheters SO2 Accessories for M1011A Contact your local PULSION or Edwards representative for information on accessories. They are not available from Philips. Description Philips SO2 Optical Module Pulsion: CeVOX Fiberoptic Probe family (ScvO2) Edwards: Philips-compatible versions of the PreSep Catheter (ScvO2) or Swan-Ganz Oximetry Catheter

(SvO2) families Recorder Accessories Product Number (Order Number) 989803151591 Contact PULSION for part numbers of compatible probes Contact Edwards for part numbers of compatible catheters Description For M1116B recorder:

10 rolls of paper 80 rolls of paper 386 Part No. 40477A 40477B 35 Accessories Battery Accessories Description Lithium Ion Smart Battery 1Ah (internal battery for X2) Battery Charger and Conditioner (requires size adapter 4512 610 17451 to charge M4607A battery) Size adapter for M4607A battery Part No. M4607A 865432 4512 610 17451 387 35 Accessories 388 36 Specifications 36Specifications The specifications in this section apply to the MX600, MX700 and MX800 patient monitors. The monitors are not user installable. They must be installed by qualified service personnel. 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 health care facilities. The monitor is to be used by trained health care professionals. The monitor is only for use on one patient at a time. It is not intended for home use. Rx only:

U.S. Federal Law restricts this device to sale by or on the order of a physician. Not a therapeutic device. The transcutaneous gas measurement (tcGas) is restricted to neonatal patients only. 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). BIS is intended for use under the direct supervision of a licensed health care practitioner or by personnel trained in its proper use. It is intended for use on adult and pediatric patients within a hospital or medical facility providing patient care to monitor the state of the brain by data acquisition of EEG signals. The BIS may be used as an aid in monitoring the effects of certain anesthetic agents. Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation. The SSC Sepsis Protocol, in the ProtocolWatch clinical decision support tool, is intended for use with adult patients only. The derived measurement Pulse Pressure Variation (PPV) is intended for use with sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. The PPV measurement has been validated only for adult patients. The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. WARNING The monitor is not intended for use in an MRI environment or in an oxygen-enriched environment

(for example, hyperbaric chambers). Manufacturer's Information You can write to Philips at this address 389 36 Specifications Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.healthcare.philips.com/us/. Copyright 2011. Koninklijke Philips Electronics N.V. All Rights Reserved. BIS Manufacturer's Information BISx, the BIS Engine, the DSC, the Patient Interface Cable and the BIS Sensor are manufactured by Aspect Medical Systems:

Aspect Medical Systems, Inc 141 Needham St Newton, MA 02464 USA 1-617-559-7000 Free call:

1-888-BIS_INDEX 1-888-247-4633 Email: bis_info@aspectms.com Web: www.aspectmedical.com Address of the EU Authorized Representative:

Aspect Medical Systems International B.V. Rijnzathe 7d2 3454 PV De Meern The Netherlands Phone: +31.30.662.9140 Email: amsint@aspectms.com Trademark Acknowledgement PiCCOTM is a trademark of PULSION Medical Systems AG. Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc, and are registered in the USA, EU and other countries. Microstream, FilterLine, and Smart CapnoLine are trademarks or registered trademarks of Oridion Systems Ltd. Citrix and ICA (Independent Computing Architecture) are registered trademarks of Citrix Systems, Inc. The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor, Durasensor, Dura-

Y, Oxiband, Oxicliq, OxiMax. MAX-FAST is a trademark of Mallinckrodt Inc. 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. 390 36 Specifications Symbols These symbols can appear on the monitor and its associated equipment. Symbols Refer to accompanying documents Protective earth Equipotential grounding Standby FMS power-on indicator Error LED Alternating current Electrical input indicator

(In some cases gas input indicator) Connection direction indicator Electrical output indicator

(In some cases gas output indicator) Gas input indicator Gas output indicator Connection direction indicator Connector has special protection against electric shocks and is defibrillator proof Quick mount release built-in wireless network USB interface Data input/output symbol Non-ionizing radiation symbol Identifies year and month of manufacture Pressure connector NBP connector Always use separate collection for waste electrical and electronic equipment (WEEE) Cardiac Output connector Temperature connector Monitor supports 12-lead ECG SpO2 connector 391 36 Specifications Symbols Masimo SET technology Silence Alarms Nellcor OxiMax compatible Alarms On/Off Uses FAST SpO2 algorithm Alarms Switched Off Main Screen SmartKeys Back key ECG Sync Output/

Analog ECG Output 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. Grounding The monitor must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter. If the monitor is used in internal examinations on the heart or brain, ensure that the room incorporates an equipotential grounding system to which the monitor has a separate connections. 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. The monitor uses double fusing (line and neutral). All network cables must be unshielded. Equipotential Grounding Combining equipment Fusing Network Cables 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 (Symbols on page 389) to see which symbols are used to mark the connections. WARNING Connect only medical devices to the ECG output connector socket. 392 Rear of the Monitor 36 Specifications 1 2 3 4 5 Serial/MIB (RS232) interface cards, type RJ45 or Flexible Nurse Call interface card or combination of both (optional) AC power input Protective earth screw hole Equipotential ground connector Measurement link connectors (MSL)

(Two standard in MX800, one standard in MX600/700) USB rear connectors (for remote control, keyboard, pointing devices, printer) Serial RS232 connector Nurse Call Wired network connector Video out connector (digital/analog) 6 7 8 9 10 The following connectors are only present with the iPC 11 12 13 14 The following connectors are only present with the Independent Display Interface 15 16 USB rear connectors (for keyboard, pointing devices, printer) Audio in/out Local Area Network Video out connector (digital/analog) Serial RS232 connector for touch Video out connector (digital/analog) 393 36 Specifications Left side of the Monitor 1 ECG Sync Output/Analog ECG output connector Right side of the Monitor 1 USB side connector (only present with the iPC) 394 36 Specifications Monitor Mounting Precautions Mount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved mounting solution. Select the mounting equipment and the mounting position so that no patient, operator or other person can be harmed by a monitor removed intentionally or released accidentally from the mount. When using the Quick Mount, be aware of the danger of accidental activation of the Quick Mount release button when lifting or moving items located under the monitor, such as pole mounts, etc. If in doubt, use the Philips Fix Mount solution to avoid such situations. Refer to the respective IntelliVue Monitor Service Manual, Installation Instructions chapter, for more details. Altitude Setting Altitude affects tcGas and CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety Specifications The monitors, together with the Multi-Measurement Modules (M3001A/M3002A), and the Flexible Module Rack (M8048A), all modules and MMS extensions, comply with the Medical Device Directive 93/42/EEC. Aspect BISx, Aspect BIS Engine and Aspect DSC comply with the requirements of the Council Directive 93/42/EEC of 14 June 1993 (Medical Device Directive). 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 +Suppl. No. 1-94 + Am. 2; IEC 60601-1-1:2000; EN 60601-1-1:2001;

IEC 60601-1-2:2001 + A1:2004; EN 60601-1-2:2001 + A1:2006. The possibility of hazards arising from software errors was minimized in compliance with ISO 14971:2007, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999. Classification (according to IEC 60601-1): Class 1, Type CF, Continuous Operation. The BIS measurement uses a Type BF applied part. EMC And Radio Regulatory Compliance This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme la norme NMB-

001 du Canada. 395 36 Specifications IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network Adapter) 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 maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210. The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210. The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems. The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA. CAUTION High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices. IntelliVue 802.11 Bedside Adapter CE compliances:

This device is compliant to Council Directive 73/23/EEC (Low voltage directive) & 89/336/

EEC (EMC directive) & 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive) The radio component contained in this device is compliant to Council Directive 1999/5/

EC (Radio Equipment and Telecommunications Terminal Equipment Directive) IntelliVue Instrument Telemetry ISM (2.4GHz) 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. 396 36 Specifications IntelliVue Instrument Telemetry WMTS (US only) FCC Radio Compliance: This device complies with Part 15 of the FCC Rules. 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. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service. Short Range Radio Interface (MX600/700/800 and 865244 Remote Control) 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 component contained in this device is in compliance with the essential requirements and other relevant provisions of Council Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive) In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66. Class 1 radio equipment. Physical Specifications Product MX800 Monitor Maximum Weight

<12 kg (<26.4 lb) MX600/MX700 Monitor

<9.5 kg (<20.9 lb) M3001A Multi-Measurement Module (MMS) M3002A Multi-Measurement Module (MMS) M3012A Hemodynamic MMS Extension M3014A Capnography MMS Extension M3015A Microstream CO2 MMS Extension-

M3016A Mainstream CO2 MMS Extension M8048A 8-Slot Flexible Module Rack (FMS-8) 865243 4-Slot Flexible Module Rack (FMS-4)

<650 g (<1.4 lb)

<1.25 kg (<2.8 lb)

<550 g (<1.2 lb)

<500 g (<0.99 lb)

<550 g (<1.21 lb)

<450 g (<0.99 lb)

<3500 g (<7.7 lb)

<950 g (<2.09 lb) W x H x D

<478 x 364 x 152 mm

<18.82 x 14.33 x 5.98 in

<392 x 321 x 163 mm

<15.43 x 12.64 x 6.42 in 188 x 96.5 x 51.5 mm 7.4 x 3.8 x 2 in 188 x 99 x 86 mm 7.4 x 3.9 x 3.4 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<190 x 98 x 40 mm

<7.5 x 4 x 1.6 in

<320 x 135 x 120 mm 12.6 x 5.3 x 4.7 in

<194 x 139 x 110 mm

<7.64 x 5.47 x 4.33 in Comments without cable management without cable management including battery, without handle or options without plug-in modules without MMS Mount 397 36 Specifications Product M8025A Remote Alarm Device M1006B Invasive Press Module M1029A Temperature Module M1012A Cardiac Output Module M1014A Spirometry Module M1018A Transcutaneous Gas Module M1020B SpO2 Module M1021A Mixed Venous Oxygen Saturation Module M1011A SO2 Module

- Optical Module M1027A Electroencephalograph Module M1034A BIS Interface Module BISx

- DSC Digital Signal Converter

- BIS Engine M1032A Vuelink Module 865115 IntelliBridge EC10 Module 865114 IntelliBridge EC5 Module M1116B Thermal Array Recorder Module 865244 Remote Control 398 Maximum Weight

<300 g (<0.7 lb) 190 g (6.7 oz) Option #C01: 225 g (7.9 oz) 215 g (7.6 oz) 225 g (7.9 oz) 250 g (8.8 oz) 350 g (11.3 oz)

<250 g (<0.55 lb) 460 g (13.04 oz)

<200g (<7.1 oz)

<200g (<7.1 oz) 210 g (7.4 oz) 215 g (7.6 oz) 499 g (1.1 lb) W x H x D 62 x 125 x 63 mm 2.4 x 5 x 2.5 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 72.5 x 99.6 x 97.5 mm 2.9 x 3.9 x 3.8 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 72.5 x 99.6 x 97.5 mm 2.9 x 3.9 x 3.8 in 36 x 99.6 x 102.5 mm 1.4 x 3.9 x 4.0 in 50 x 30 x 120 mm 2.0 x 1.2 x 4.7 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in diameter x height:

95.3 x 63.5 mm 3.8 x 2.5 in 240 g (8.4 oz) 200 g (7.0 oz) 170 g (6.0 oz) 130 g (4.6 oz) (without cabling) 66 x 25 x 107 mm 2.6 x 1.0 x 4.25 in 43 x 93 x 95 mm 1.7 x 3.7 x 3.7 in 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in 36 x 99.6 x 102.5 mm 1.4 x 3.9 x 4.0 in 35 x 17 x 57 mm 1.4 x 0.7 x 2.1 in 21.5 x 17 x 65 mm 0.9 x 0.7 x 2.6 in 73 x 99.6 x 97 mm 2.9 x 3.6 x 3.9 in. 53 x 165 x 23 mm 2.1 x 6.5 x 0.9 in

<250 g (<8.8 oz) 507.5 g (17.9 oz) 35 g (1.1 oz) 25 g (0.8 oz) Comments including 2.9m cable without cables with PIC Plus Cable

(1.22 m, 4 ft) and cable to BIS module with PIC Plus Cable

(1.22 m, 4 ft) with D-Sub 9-pin male or female connector without cable and strain relief without navigator knob 36 Specifications Environmental Specifications The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges. 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. MX600/700/800 Monitor Item Temperature Range Condition Operating Humidity Range Altitude Range Ingress Protection Storage Operating Storage Operating Storage Range 0 to 40C (32 to 100F) 0 to 35C (32 to 95F) when equipped with the iPC

-20 to 60C (-4 to 140F) 15% to 95% Relative Humidity (RH) (non condensing) 5% to 95% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft) IPX1 X2 (M3002A) and External Power Supply (M8023A) Item Temperature Range Temperature Range when charging the battery Humidity Range Altitude Range Condition Operating Storage including transportation Operating Range 0 to 40C (32 to 104F)

-20 to 60C (-4 to 140F) 0 to 35C (32 to 95F) Operating Storage including transportation Operating Storage including transportation X2 15% to 95% Relative Humidity (RH) 5% to 95% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15) Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A, Measurement Modules, and 8-Slot Flexible Module Rack M8048A Item Temperature Range Humidity Range Altitude Range Condition Operating Non-operating Operating Non-operating Operating Non-operating Range 0 to 45C (32 to 113F)

-40 to 70C (-40 to 158F) 95% Relative Humidity (RH) max. @ 40C (104F). M3015A only non-condensing. 90% Relative Humidity (RH) max. @ 65C (150F)

-500 m to 4600 m (-1600 to 15000 ft)

-500 m to 15300 m (-1600 to 50000 ft) 399 Range 0 to 40C (32 to 100F)

-20 to 60C (-4 to 140F) 15% to 95% Relative Humidity (RH) (non condensing) 5% to 95% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft) IPX1 Range

+5 to 45C (41 to 113F)

-10 to 70C (14 to 158F) 95% Relative Humidity (RH) max. @ 40C (104F) (non condensing) 95% Relative Humidity (RH) max. @ 65C (150F) (non condensing) up to 3048 m (10000 ft) up to 3048 m (10000 ft) Range 0 to 40C (32 to 100F)

-20 to 60C (-4 to 140F) 15% to 95% Relative Humidity (RH) (non condensing) 5% to 95% Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m (15000 ft) 36 Specifications 4-Slot Flexible Module Rack 865243 Item Temperature Range Humidity Range Altitude Range Ingress Protection Condition Operating Storage Operating Storage Operating Storage Thermal Array Recorder Module M1116B Item Temperature Range Humidity Range Altitude Range Remote Control 865244 Item Temperature Range Humidity Range Altitude Range Condition Operating Non-operating Operating Non-operating Operating Non-operating Condition Operating Storage Operating Storage Operating Storage 400 Performance Specifications 36 Specifications Indicators Power Specifications MX600/700/800 Performance Specifications Power Consumption Line Voltage Current Frequency Alarms Off Alarms On/Standby/Error External Power Audible feedback for user input Prompt tone QRS tone, or SpO2 modulation tone 4 different alarm sounds Remote tone for alarms on other beds in network Tone for Timer expired Resolution Sounds Trends

<200 W average 100 to 240 V 1.9 to 0.9 A 50/60 Hz red (crossed out alarms symbol) LED red/yellow/light blue (cyan) LED green/red LED integrated in power switch green LED Information High Res Trend Waves Measurements available Events Alarm Signal Review Alarms Resolution Update speed Information Episode data Capacity (max.) System delay Pause duration Extended alarm pause Information Capacity 12, 16, 24 or 32 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:

neonatal extended 12 numerics, 24 hours @ 12 secs or 32 numerics 32 hours @ 1 minute intensive care extended: 16 numerics 120 hours @ 5 minutes anesthesia extended 32 numerics 9 hours @ 12 seconds HR, SpO2, Resp, tcpO2, Pulse, Perf, tcpO2, CO2, ABP, PAP, CVP, ICP, CPP, BIS, CCO, AWP, Anesthetic Agents, Delta SpO2, inO2 Measurement samples are taken at a resolution of four samples per second waves are drawn at a speed of 3 cm/minute trigger condition and time, event classification and associated detailed view of episode data configurable, either:

4 minutes of high resolution trend or 20 minutes of numerics trend @ 12 sec. resolution or 15 seconds of 4 waves @ 125 samples/sec. (Snapshot) including all current numerics, alarms and inops 25 or 50 events for either 8 or 24 hours less than 3 seconds 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes all alarms / inops, main alarms on/off, alarm silence and time of occurrence 300 items 401 36 Specifications MX600/700/800 Performance Specifications Real Time Clock Buffered Memory Range Accuracy Hold Time Hold Time Contents X2 (M3002A) Performance Specifications Power Specifications Power consumption Battery Specifications Operating Voltage Operating Time

(with new, fully charged battery at 25C) Charge Time Alarms Off Alarms On/Standby / Error AC Power Battery External Power Resolution Information System delay Pause duration Extended alarm pause Information Capacity Indicators Sounds Trends Alarm signal Review Alarms 402 from: January 1, 1997, 00:00 to: December 31, 2080, 23:59 better than 4 seconds per day infinite if powered by AC; otherwise at least 48 hours (typical:

>72 hours) if powered by AC: infinite without power: at least 8 hours Active settings, trends, patient data, realtime reports, events, review alarms

<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, SpO2 measurements in use, NBP measurement every 15 minutes) When X2 is off: 2 hours When X2 is in use, and connected to a monitor, without extensions: 12 hours approx. When X2 is in use, and connected to the external power supply

(M8023A), without extensions: 12 hours approx. red (crossed-out alarm symbol) LED red/yellow/light blue (cyan) LED green / red LED green LED yellow (charging)/red blinking (empty) LED green LED Audible feedback for user input Prompt tone QRS tone, or SpO2 modulation tone 4 different alarm sounds 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 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes all alarms / inops, main alarms on/off, alarm silence and time of occurrence 300 items X2 (M3002A) Performance Specifications Real Time Clock Buffered Memory Range Accuracy Hold Time Hold Time Contents 36 Specifications from: January 1, 1997, 00:00 to: December 31, 2080, 23:59

<4 seconds per day (typically) infinite if powered by host monitor or external power supply;

otherwise at least 48 hours if powered by host monitor or external power supply: infinite without power: at least 48 hours (typical: >72 hours) Active settings, trends, patient data, realtime reports, review alarms M8023A External Power Supply (for M3002A) Performance Specifications Power Specifications Power consumption Line Voltage Current Frequency Power Indicators

<12 W average

<30 W peak 100 to 240 V ~

1.3 to 0.7 A 50/60 Hz ~

green LED M3001A MMS Performance Specifications Trends Trend Data Buffered Memory Contents if powered by monitor mains connection via MSL: infinite without power applied: at least 6 hours trend data, patient identification and all active settings Integrated PC (iPC) Performance Specifications PC Components Processor Solid-state drive RAM Intel Core 2 Duo SP9300/SP9400 100 GB or above 4 GB 865244 Remote Control Performance Specifications Power (when not connected to the USB interface of the monitor) Two AA primary cells Interface Specifications MX600/700/800 Interface Specifications Network Standard Connector Isolation 100-Base-TX (IEEE 802.3 Clause 25) RJ45 (8 pin) basic insulation (reference voltage: 250 V; test voltage: 1500 V) 403 36 Specifications MX600/700/800 Interface Specifications Standard Connectors Mode Power Isolation Standard Connector Power Isolation Connector Power Isolation Connector Power Isolation Connector Contact Isolation Delay Connector Contact Isolation Delay Type Technology Frequency Band Type Technology Frequency Band Type Technology Frequency Band Type Technology Frequency band Modulation technique Effective radiated power MIB/RS232 USB Interface (4 ports) RS232 (Standard) RS232 (Independent display interface option) Basic Nurse Call Relay Flexible Nurse Call Relay IntelliVue Instrument Telemetry Wireless Network

(USA only) IntelliVue Instrument Telemetry Wireless Network

(except USA) IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter) Short Range Radio Interface 404 IEEE 1073-3.2-2000 RJ45 (8 pin) Software-controllable BCC (RxD/TxD cross over) or DCC (RxD/TxD straight through) 5 V 5 %, 100 mA (max.) basic insulation (reference voltage: 250 V; test voltage: 1500 V) USB 2.0 full-speed (embedded host) USB series "Standard A" receptacle Low power port 4.4V min; max. load for all ports together 500 mA none RJ45 (8-pin) none basic insulation (reference voltage: 250 V; test voltage: 1500 V) RJ45 (8-pin) none none modular Jack 6P6C, active open and closed contact

<=100 mA, <=24 V DC basic insulation (reference voltage: 250 V; test voltage: 1500 V)

<[Configured Latency +0.5] sec 20 pin MDR (Mini D-Ribbon), active open and closed contacts

<=100 mA, <=24 V DC basic insulation (reference voltage: 250 V; test voltage: 1500 V)

<[Configured Latency +0.5] sec Internal WMTS Adapter compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructure WMTS, 1395-1400 MHz and 1427-1432 MHz Internal ISM Adapter compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructure 2.4 GHz ISM Internal Wireless Adapter IEEE 802.11a/b/g 2.4 GHz and 5 GHz ISM Band Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) DSSS (O -QPSK) max. 0 dBm (1 mW) 36 Specifications MX600/700/800 Interface Specifications Measurement Link (MSL) Video Interface (standard) Video Interface (Independent display interface option) Connectors Voltage Power Power Sync. LAN signals Serial signals Connector Digital video signals Analog video signals HSYNC/VSYNC signals DDC signals DDC power Connector Pixel clock frequency Digital video signals Analog video signals HSYNC/VSYNC signals DDC signals DDC power ODU out (Proprietary) 56 V 10 %

45 W 5 V CMOS Level; 78.125 kHz (typ.) IEEE 802.3 10-Base-T compliant RS-422 compliant DVI (digital and analog, single link) single link TMDS 0.7 Vpp@75 Ohm TTL none 5 V +/-5% @0-55 mA DVI (digital and analog, single link) 31,5 MHz - 119 MHz single link TMDS 0.7 Vpp@75 Ohm TTL none 5 V +/-5% @0-55 mA ECG Sync Output/Analog ECG Output (1/4" stereo phone jack with tip, ring, sleeve) General Analog ECG Output

(ring, tip) Connector Isolation Full scale on display Gain error Baseline offset Bandwidth Output voltage swing Signal delay Signal delay with older versions of the M3001A MMS

[identifiable with the serial number prefix DE227 or DE441 and option string #A01]

Pacemaker Pulse 1/4" phone with tip, ring, sleeve functional isolation signal gain x measured ECG voltage

<15 %

<100 mV 1 to 100 Hz 4 V (min)

<22 ms

<30 ms filtered and included in ECG output signal 405 36 Specifications MX600/700/800 Interface Specifications Digital Pulse Output

(ring)

<0.4 V @ I=-1 mA

>2.4 V @ I=1 mA 100 ms10 ms (active high)

<1 ms (from 0.4 V to 2.4 V)

< 25ms per AAMI EC13

< 35ms per AAMI EC13 Output low voltage level Output high voltage level Pulse Width Pulse Rise Time Signal delay Signal delay with older versions of the M3001A MMS

[identifiable with the serial number prefix DE227 or DE441 and option string #A01]

Measurement Link (MSL) X2 (M3002A) Interface Specifications Connectors Power Power Sync. LAN signals Serial signals Local signals Cable detection Marker In Wave Output Connector Output levels ECG Sync Pulse Output

(rectangular pulse) Wireless Network Device Interface Short Range Radio Interface1 Isolation Pulse Width Delay from R-wave peak to start of pulse Minimum required R-wave amplitude Signals Type Technology Frequency Band Modulation Technique Effective radiated power Female ODU (Proprietary) 30 V to 60 V input RS-422 compliant input 78.125 kHz (typical) IEEE 802.3 10-Base-T compliant RS-422 compliant Provided for connecting MMS 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 0.5 V RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V 20%, 3.5 W continuous Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) DSSS (O -QPSK) max. 0 dBm (1 mW) 1 The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A Intellivue Telemetry System Transceiver 406 36 Specifications M8023A External Power Supply (for M3002A) 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 Integrated PC (iPC) Interface Specifications Ethernet LAN (external) USB Audio DVI Video with DVI-I connector Display Specifications 19" WSXGA+

15" WXGA Connector LAN Signals Reinforced insulation 6 external ports (5 rear, 1 right side) Type A connectors microphone input stereo headphone output stereo DVI VGA RJ-45 IEE 802.3 1000-Base-T compliant IEC60601-1 A-k compliant USB 2.0 supporting high speed mode 3.5 mm audio jack 3.5 mm audio jack supports resolutions up to 1920x1200 supports resolutions up to 2048x1536 Type Resolution Refresh frequency Useful screen Pixel size Type Resolution Refresh frequency Useful screen Pixel size 482 mm active matrix color LCD (TFT) 1680 x 1050 (WSXGA+) 58 Hz 409,5 mm x 255.9 mm 0.244 mm x 0.244 mm 389 mm active matrix color LCD (TFT) 1280 x 768 (WXGA) 59.9 Hz 334.1 mm x 200.5 mm 0.261 mm x 0.261 mm 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. 407 36 Specifications ECG/Arrhythmia/ST Performance Specifications Cardiotach Range Accuracy Resolution Sensitivity Range Resolution Range Accuracy Resolution Range Accuracy Resolution Range Resolution Range Resolution Range - adult Range - pediatric and neonatal Brady Normal Tachy Diagnostic Mode Extended Monitoring Mode Monitoring Mode Filter Mode Diagnostic Mode Extended Monitoring Mode Monitoring Mode Filter Mode PVC Rate ST Numeric QT Numeric QTc Numeric QTc Numeric QT-HR Numeric Sinus and SV Rhythm Ranges Bandwidth Bandwidth when the ECG is transmitted from a telemetry device via short range radio Differential Input Impedance 408 Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm 1% of range 1 bpm 200 Vpeak 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 1 ms

-600 to +600 ms 1 ms 15 to 300 bpm 15 to 350 bpm Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Adult/neo/pedi: 0.05 to 150 Hz Adult/neo/pedi: 0.5 to 150 Hz Adult: 0.5 to 40 Hz Neo/pedi: 0.5 to 55 Hz Adult/neo/pedi: 0.5 to 20 Hz Adult/neo/pedi: 0.05 to 40 Hz Adult/neo/pedi: 0.5 to 40 Hz Adult: 0.5 to 40 Hz Neo/pedi: 0.5 to 40 Hz Adult/neo/pedi: 0.5 to 20 Hz

>2 M RA-LL leads (Resp)

>5 M at all other leads (at 10 Hz including patient cable) ECG/Arrhythmia/ST Performance Specifications Common Mode Rejection Ratio Electrode Offset Potential Tolerance Auxiliary Current

(Leads off Detection) Input Signal Range ECG/Arrhythmia/ST/QT Alarm Specifications Range 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 QTc High 15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 15 to 100 bpm None, fixed setting 2 PVCs 1 to 99 PVCs/minute 20 to 300 bpm 3 to 99 PVCs/minute 3 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 36 Specifications Diagnostic mode: >86 dB (with a 51 k/47 nF imbalance). Filter mode: >106 dB (with a 51 k/47 nF imbalance). 500 mV Active electrode: <100 nA Reference electrode: <900 nA 5 mV 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) 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps 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, IEC 60601-2-27 Respiration Excitation Waveform Noise Suppression Time to Alarm for Tachycardia Vent Tachycardia 1 mVpp,206 bpm Sinusoidal signal, 260 A, 40.5 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 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 Vent Tachycardia 2 mVpp,195 bpm Tall T-Wave Rejection Capability 409 36 Specifications Heart Rate Averaging Method ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27 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 aver\-aged to compute the HR. HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds HR change from 80 to 40 bpm:

Range: [5.6 to 6.4 sec] Average: 6.0 seconds Response Time of Heart Rate Meter to Change in Heart Rate Heart Rate Meter Accuracy and Response to Irregular Rhythm 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) Accuracy of Input Signal Reproduction Pacemaker Pulse Rejection Performance Respiration Respiration Performance Specifications Respiration Rate Bandwidth Noise Range 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 (rms) referred to the input Respiration Alarm Specifications Range Adjustment Delay High Low Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps Apnea Alarm 10 to 40 seconds 5 second steps max. 14 seconds for limits from 0 to 20 rpm:

max. 4 seconds for limits above 20 rpm: max. 14 seconds 410 SpO2 36 Specifications Unless otherwise specified, this information is valid for SpO2 measured using the M3001A and M3002A Multi-measurement modules and the M1020B measurement module. The SpO2 Performance Specifications in this section apply to devices with Philips SpO2 technology. For SpO2 Performance Specifications valid for other SpO2 technologies, refer to the instructions for use provided with these devices. Complies with ISO 9919:2005 / EN ISO 9919:2009 (except alarm system; alarm system complies with IEC 60601-2-49:2001). Measurement Validation: The SpO2 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. Maximum with NBP INOP suppression on: 60 seconds. 411 0 to 100%

Philips Reusable Sensors:

M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2 % (70 % to 100 %) M1193A, M1194A, M1195A, 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), M1134A (adult/infant) = 2 %

M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate), M1134A

(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 (adult/pedi/infant), LNCS DC-1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2% (70% to 100%) LNOP YI (neonate), LNCS YI (neonate) = 3% (70% to 100%) LNOP TC-I, LNCS TC-I: 3.5 % (70 % to 100 %) Masimo Disposable Sensors with LNOP MP12 or LNC MP10:

LNOP DC-I, LNOP DC-IP, LNOP YI (adult/pedi/infant, LNCS DC-1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2 % (70 % to 100 %) LNOP Neo-L, LNOP NeoPt-L, LNCS Neo-L, LNCS NeoPt-L: 3 % (70 % to 100 %) Philips Reusable Sensors M1193AN = 3 % (70 % to 100 %) Philips Disposable Sensors with M1943NL:

M1901B (Adult), M1902B, M1903B, M1904B = 2 % (70 % to 100 %) M1901B (Neonate) = 3 %

NellcorPB Sensors with M1943NL:

MAX-FAST, MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N (Adult) = 2 %

(70 % to 100 %) SC-A, OxiCliq A, P, I, N (Adult) = 2.5 % (70 % to 100 %) MAX-N (Neonate), Dura-Y D-YS (Infant to Adult), DS-100A,Oxiband OXI-

A/N (Adult), OXI-P/I = 3 % (70 % to 100 %) MAX-R, OxiCliq N (Neonate), SC-NEO (Neonate), SC-PR (Neonate), Dura-Y D-YS with D-YSE or D-YSPD clip = 3.5 % (70 % to 100 %) Dura-Y D-YS (Neonate), Oxiband OXI-A/N (Neonate) = 4 % (70 % to 100 %) 1%

36 Specifications SpO2 Performance Specifications SpO2 The specified accuracy is the root-mean-square

(RMS) difference between the measured values and the reference values Range Option #A01 Accuracy Option #A02 Accuracy Resolution 412 36 Specifications 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%

SpO2 Performance Specifications Pulse Range Accuracy Resolution Sensors Pulse Oximeter Calibration Range SpO2 Alarm Specifications Range SpO2 Desat Pulse Tachycardia Bradycardia 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 Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 30 to 100 bpm Adjustment 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) 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps Delay

(0, 1, 2, 3,... 30) +4 seconds or Smart Alarm Delay (see table below)

(0, 1, 2, 3,... 30) +4 seconds max. 14 seconds max. 14 seconds max. 14 seconds SpO2 Smart Alarm Delay Specifications The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control. Deviation from violated alarm limit Resulting alarm delay 1%

2%

3%

4%

5%

6%

Short 25 sec

(maximum delay) 12 sec 10 sec 10 sec 10 sec 10 sec Medium 50 sec

(maximum delay) 25 sec 16 sec 12 sec 10 sec 10 sec Long 100 sec

(maximum delay) 50 sec 33 sec 25 sec 20 sec 16 sec 413 36 Specifications SpO2 Smart Alarm Delay Specifications The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control. Deviation from violated alarm limit Resulting alarm delay 7%

8%

9%

>9%

NBP Short 10 sec 10 sec 10 sec 10 sec Medium 10 sec 10 sec 10 sec 10 sec Long 14 sec 12 sec 11 sec 10 sec Complies with IEC 60601-2-30:1999/EN60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic Diastolic Mean Pulse Rate Accuracy Pulse Rate Measurement Accuracy Pulse Rate Range Measurement Time Cuff Inflation Time Initial Cuff Inflation Pressure Auto Mode Repetition Times STAT Mode Cycle Time 414 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) 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 36 Specifications NBP Performance Specifications Venipuncture Mode Inflation Inflation Pressure Adult Pediatric Neonatal Automatic deflation after 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 Systolic Diastolic Mean Range 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) NBP Overpressure Settings Adult Pediatric Neonate

>300 mmHg (40 kPa) >2 sec

>300 mmHg (40 kPa) >2 sec

>150 mmHg (20 kPa) >2 sec Adjustment 10 to 30 mmHg: 2 mmHg (0.5 kPa)

>30 mmHg: 5 mmHg (1 kPa) not user adjustable Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate Range Accuracy Resolution

-40 to 360 mmHg 25 to 350 bpm 1% Full Range 1 bpm 415 36 Specifications Invasive Pressure Performance Specifications Input Sensitivity Transducer Frequency Response Zero Adjustment Gain Accuracy Overall Accuracy Range Accuracy Drift Accuracy Drift Non linearity and Hysteresis

(including transducer) Volume displacement of CPJ840J6 Analog output Specifications Analog Output available only with M1006B #C01 (@ CAL 200 mmHg) Range Level Accuracy Offset Resolution Signal delay Sensitivity: 5 V/V/mmHg (37.5 V/V/kPa) Adjustment range: 10%

Load Impedance: 200 to 2000 (resistive) Output Impedance: 3000 (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 mm3 /100 mmHg

-0.4 V to 3.6 V 1 V / 100 mmHg 3% full scale 30 mV 8 Bit (@ 5 V range) 20 ms Invasive Pressure Alarm Specifications Invasive Pressure Alarm Specifications Range Pressure

-40 to 360 mmHg

(-5.0 to 48 kPa) Extreme High Extreme Low Pulse Difference to high limit 0 to 25 mmHg Clamping at -40 to 360 mmHg Difference to low limit 0 to 25 mmHg Clamping at -40 to 360 mmHg 25 to 300 bpm Adjustment Delay max. 12 seconds

-40 to 50 mmHg 2 mmHg (0.5 kPa)

>50 mmHg 5 mmHg (1 kPa) 5 mmHg steps (0.5 kPa) 5 mmHg steps (1.0 kPa) 5 mmHg steps (0.5 kPa) 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) 416 36 Specifications Delay max. 14 seconds max. 14 seconds Invasive Pressure Alarm Specifications Range Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 25 to 100 bpm Tachycardia Bradycardia Temp Adjustment 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range Resolution Accuracy Average Time Constant

-1 to 45C (30 to 113F) 0.1C (0.2F) 0.1C (0.2F) Less than 10 seconds Temp Alarm Specifications Range Temp High/Low Alarms

-1 to 45C (30 to 113F) Adjustment

-1 to 35C (30 to 95F), 0.5C (1.0F) steps 35 to 45C (95 to 113F), 0.1C (0.2F) steps CO2 The CO2 measurement in 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 CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, 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% O2 and N2 balance, up to 35C 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. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) Included in Accuracy specifications 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 417 Resolution Stability Range Accuracy awRR Warm-up Time 36 Specifications M3015A Microstream CO2 Performance Specifications Rise Time Sample Flow Rate Gas Sampling Delay Time Sound Pressure Total System Response Time 190 ms for neonatal mode

(measured with FilterLine H for neonatal) 240 ms for adult mode

(measured with FilterLine H for adult) 50 + 15/-7.5 ml/minute Maximum:

3 seconds (2m sample lines) 6 seconds (4m sample lines) Acoustic noise: <45 dBA The total system response time is the sum of the delay time and the rise time. Microstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Microstream CO2 readings. The formula for the correction calculation is:

where:

PBTPS = partial pressure at body temperature and pressure, saturated PATPD = partial pressure at ambient temperature and pressure, dry M3014A Mainstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 35C, Pabs = 760 mmHg, flow rate = 2 l/min. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 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 CO2 transducer attached for full accuracy specification Less than 60 ms (with adult or infant reusable or disposable adapter) Resolution Stability:

Short term drift Long term drift Range Accuracy awRR Warm-up Time Response Time 418 M3014A Sidestream CO2 Performance Specifications CO2 Range Accuracy Resolution Stability:

Short term drift Long term drift Range Accuracy awRR Warm-up Time Sample Flow Rate Total System Response Time Operating Temperature 36 Specifications 0 to 150 mmHg (0 to 20.0 kPa) 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 CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 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 CO2 sensor attached for full accuracy specification 50 10 ml/minute 3 seconds 0 to 40C (32 to 100F) M3014A Mainstream and Sidestream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is:

where:

PBTPS = partial pressure at body temperature and pressure, saturated PATPD = partial pressure at ambient temperature and pressure, dry Pabs = absolute pressure PH2O = 42 mmHg @35C and 100% RH M3016A Mainstream CO2 Performance Specifications CO2 Range Accuracy Resolution Stability

-4 to 150 mmHg (-0.5 to 20.0 kPa) 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% O2 and N2 or N2O balance. Outside these conditions the accuracy reaches at a minimum the requirements of EN864/

ISO9918. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 1.0 mmHg over a 7 day period 419 36 Specifications M3016A Mainstream CO2 Performance Specifications awRR Range Accuracy Warm-up Time Response Time 0 to 150 rpm 2 rpm 20 minutes with CO2 transducer attached for full accuracy specification Less than 125 ms (for step from 10% to 90%) Mainstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2 readings. The formula for the correction calculation is:

where:

PBTPS = partial pressure at body temperature and pressure, saturated PATPD = partial pressure at ambient temperature and pressure, dry Pabs = absolute pressure PH2O = 42 mmHg @35C and 100% RH Range Adjustment Delay CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High awRR High awRR Low 20 to 95 mmHg (2 to 13 kPa) 10 to 90 mmHg (1 to 12 kPa) 1 mmHg (0.1 kPa) 2 to 20 mmHg

(0.3 to 3.0 kPa) steps of 1 mmHg (0.1 kPa) Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm M3002A/M3014A/M3016A: less than 14 seconds M3015A: less than 21 seconds. M3002A/M3014A/M3016A: less than 14 seconds M3015A: less than 21 seconds. M3002A/M3014A/M3016A: less than 14 seconds M3015A: less than 21 seconds. M3015A:

settings <20 rpm: less than 8 seconds

>20 rpm: less than 21 seconds M3002A/M3014A/M3016A settings <20 rpm: less than 4 seconds

>20 rpm: less than 14 seconds set apnea delay time + 4 seconds

(M3002A/M3014A/M3016A) or 8 seconds (M3015A with 2 m sample lines) or 11 seconds

(M3015A with 4 m sample lines). Apnea delay 10 to 40 seconds 5 second steps Interfering Gas and Vapor Effects On CO2 Measurement Values The specified deviations for M3002A/M3014A are valid when the appropriate corrections are switched on and set correctly. 420 36 Specifications M3002A/M3014A M3015A Additional deviation due to gas interference, measured at 0 -

40 mmHg CO2 1 mmHg 2 mmHg 2 mmHg 2 mmHg 2 mmHg

-5 mmHg 1 mmHg not specified for use 5%

5%

5%

5%

5%

5%

5%

+5 mmHg 1 mmHg 1 mmHg 1 mmHg 1 mmHg 5%

5%

5%

5%

5%

Gas or Vapor Gas Level

(% volume fraction) 60%

4%

5%

5%

5%

80%

50%

15%

0.1%

0.1%

0.1%

1.0%

Nitrous Oxide Halothane Enflurane Isoflurane Sevoflurane Xenon Helium Metered dose inhaler propellants Desflurane Ethanol Isopropanol Acetone Methane Spirometry The following specifications apply for 760 mmHg ambient pressure and patient gas: room air at 35C, unless otherwise noted Spirometry Performance Specifications Flow Wave (AWF) Range Accuracy Scales Scale Default Volume Wave (AWV) Range Accuracy Scales Scale Default 25 l/min (neonatal) 100 l/min (pediatric) 180 l/min (adult) 3% or 0.125 l/min (neonatal) 0.25 l/min (pediatric) 0.5 l/min (adult) 10, 20, 40, 60, 80, 100, 120, 150 l/min 20 l/min (neonatal) 100 l/min (pediatric) 150 l/min (adult) 0 to 100 ml (neonatal) 0 to 400 ml (pediatric) 0 to 3000 ml (adult) 5% or 3 ml (neonatal) 12 ml (pediatric) 90 ml (adult), whichever is greater 50, 100, 200, 600, 800, 1000, 2000, 3000 ml 50 ml (neonatal) 200 ml (pediatric) 800 ml (adult) 421 36 Specifications Spirometry Performance Specifications Pressure Wave (AWP) Respiration Rate numeric (RRspir) Inspired Minute Volume numeric (MVin) Range Accuracy Scales Scale Default Range Resolution Range Resolution Expired Minute Volume numeric (MVexp) Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Inspired Volume numeric (TVin) Expired Volume numeric (TVexp) Lung Compliance numeric Airway Resistance numeric Peak Inspiratory Pressure numeric (PIP) Negative Inspiratory Pressure numeric Mean Airway Pressure Plateau Pressure numeric Positive End-Expiratory Pressure numeric

(PEEP) 422

-20 to 120 cmH2O 2% or 0.5 cmH2O whichever is greater 10, 20, 40, 60, 80, 100, 120 cmH2O 20 cmH2O (neonatal) 40 cmH2O (pediatric) 40 cmH2O (adult) 2 to 120 breaths/min 1 breath/min 0.01 to 5 l/min (neonatal) 0.06 to 30 l/min (pediatric) 0.4 to 60 l/min (adult) 0.01 l/min (neonatal/pediatric) 0.1 l/min (adult) 0.01 to 5 l/min (neonatal) 0.06 to 30 l/min (pediatric) 0.4 to 60 l/min (adult) 0.01 l/min (neonatal/pediatric) 0.1 l/min (adult) 5 to 100 ml (neonatal) 30 to 400 ml (pediatric) 200 to 3000 ml (adult) 1 ml (neonatal/pediatric) 10 ml (adult) 5 to 100 ml (neonatal) 30 to 400 ml (pediatric) 200 to 3000 ml (adult) 1 ml (neonatal/pediatric) 10 ml (adult) 0 to 500 ml/cmH2O 1 ml/cmH2O 0 to 500 cmH2O/l/s (neonatal) 0 to 250 cmH2O/l/s (pediatric) 0 to 100 cmH2O/l/s (adult) 1 cmH2O/l/s 0 to 120 cmH2O 1 cmH2O

-20 to 0 cmH2O 1 cmH2O 0 to 120 cmH2O 1 cmH2O 0 to 120 cmH2O 1 cmH2O 0 to 99 cmH2O 1 cmH2O 36 Specifications Spirometry Performance Specifications Barometric Pressure numeric (PB) Peak Inspiratory Flow numeric (PIF) Range Resolution Range Resolution Peak Expiratory Flow numeric (PEF) Range Resolution Range Resolution Inspiration to Expiration ratio numeric

(I:E) 400 to 800 mmHg 1 mmHg 0.3 to 25 l/min (neonatal) 1 to 100 l/min (pediatric) 2 to 180 l/min (adult) 0.1 l/min (neonatal) 1 l/min (pediatric/adult) 0.3 to 25 l/min (neonatal) 1 to 100 l/min (pediatric) 2 to 180 l/min (adult) 0.1 l/min (neonatal) 1 l/min (pediatric/adult) 1: 0.2 ... 9.9 0.1 Cardiac Output / Continuous Cardiac Output C.O./CCO Performance Specifications C.O. (right heart) C.O. (transpulmonary) EVLW ITBV CCO Blood Temperature Injectate Temperature Range Accuracy Repeatability Range Accuracy Repeatability Range Standard Deviation Range Accuracy Repeatability Range Standard Deviation Display Update Range Range 0.1 to 20.0 l/min Instrument Specification (electrical): 3% or 0.1 l/min System Specification: 5%.or 0.2 l/min Instrument Specification (electrical): 2% or 0.1 l/min System Specification: 3%.or 0.1 l/min 0.1 to 25.0 l/min Instrument Specification (electrical): 4% or 0.15 l/min System Specification: 5% or 0.2 l/min Instrument Specification (electrical): 2% or 0.1 l/min System Specification: 3% or 0.1 l/min 10 to 5000 ml 10% or 1 ml/kg 50 to 6000 ml 10% or 30 ml 5% or 20 ml 0.1 to 25.0 l/min 10% or 0.3 l/min 2 seconds nominal 17.0 to 43C (62.6 to 109,5F)

-1 to 30C (30.2 to 86.0F) 423 36 Specifications C.O./CCO Alarm Specifications TBlood Range 17 to 43C CCO 0.1 to 25.0 l/min tcGas Adjustment Delay Steps of 0.5C (17 to 35C) Steps of 0.1C (35 to 43C) Steps of 1F (63 to 95F) Steps of 0.2F (95 to 109F) 0.1 l/min (0.1 to 10.0 l/min) 0.5 l/min (10.0 to 25.0 l/min) 10 seconds after the value exceeds the set limit range 10 seconds after the value exceeds the set limit range Complies with IEC 60601-2-23:1999/EN60601-2-23:2000. tcGas Performance Specifications tcpO2 Range Resolution Overall Accuracy

(incl. transducer) tcpO2 Test Signal tcpO2 Drift, including transducer tcpO2 response time, including transducer tcpCO2 Range Resolution Overall Accuracy

(incl. transducer) tcpCO2 Test Signal tcpCO2 Drift, including transducer tcpCO2 response time, including transducer Warm-up Time Site Timer Transducer Heating 0 to 750 mmHg (0 to 100 kPa) 1 mmHg (0.1 kPa) 0 to 20.9% O2 better than +5 mmHg (+0.7 kPa) Above 20.9% O2 better than +10% of reading 60 mmHg (8.0 kPa) Typically 1.25%/h Typically 30 s 5 to 200 mmHg (0.7 to 26.7 kPa) 1 mmHg (0.1 kPa) 5 to 76 mmHg (0.7 to 10.1 kPa) better than +5 mmHg(+0.7 kPa) Above 76 mmHg (10.1 kPa) better than +10% of reading 40 mmHg (5.3 kPa) Typically 2.5%/h Typically 60 s

<3 minutes 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hours. Change Site alarm when site time is expired and configurable automatic heating switch-off Available Temperatures -

37.0C, 41.0 to 45C in steps of 0.5C 424 tcGas Alarm Specifications tcpO2 Range 10 to 745 mmHg 1.0 to 99.5 kPa tcpCO2 10 to 195 mmHg 1.0 to 26 kPa 36 Specifications Adjustment Alarm Delay 10 seconds after the value exceeds the set limit range. 10 to 30 mmHg: 1 mmHg 1.0 to 4.0 kPa: 0.1 kPa 32 to 100 mmHg: 2 mmHg 4.2 to 13 kPa: 0.2 kPa 105 to 745 mmHg: 5 mmHg 13.5 to 99.5 kPa: 0.5 kPa 10 to 30 mmHg: 1 mmHg 1.0 to 4.0 kPa: 0.1 kPa 32 to 100 mmHg: 2 mmHg 4.2 to 13 kPa: 0.2 kPa 105 to 195 mmHg: 5 mmHg 13.5 to 26 kPa: 0.5 kPa Intravascular Oxygen Saturation SO2, SvO2, ScvO2 Performance Specifications Range Accuracy Resolution Stability (system) Response Time (10 % to 90 %) 10% to 100%

2% (i.e. 2 units), 1 standard deviation over 40% to 100%1 range. 1%

Drift <2% over 24 hours 5 seconds 1 The accuracy specification for Edwards Lifesciences Philips-compatible catheters has been verified in the saturation range 40%-95%. Alarm Specifications SO2, SvO2, ScvO2 Range 10% to 100%

Adjustment 1%

Delay max. 15 +4 seconds after value exceeds the set limit range EEG Complies with IEC 60601-2-26:1994/EN60601-2-26:1994. EEG Performance Specifications Leakage Current Input Signal Range Differential Input Impedance Max. DC Input Offset Voltage Input Protection Common Mode Rejection Noise Electromagnetic Susceptibility

<=10 mA @ 110 Vac 1 mVp-p

>15 M @ 10 Hz 320 mV Against defibrillation (5 kV) and electrosurgery

>105 dB @ 5 k imbalance and 60 Hz

<0.4 mVRMS (1 to 30 Hz)

<10 mVp-p @ 3 V/m, 26-1000 MHz 425 36 Specifications EEG Performance Specifications Electrode Impedance Measurement Range Accuracy Bandwidth Low Filter Cut-Off Frequencies High Filter Cut-Off Frequencies BIS BIS Performance Specifications Bispectral Index (BIS) Range Signal Quality Index (SQI) Range EMG Range Suppression Ratio (SR) Spectral Edge Frequency (SEF) Total Power (TP) Bursts Noise Wave Scale Update Frequency (BIS Numeric) Bandwidth High Pass Filters Low Pass Filters Notch Filters (for line frequency) Impedance Measurement Range BIS Alarm Specifications BIS High/Low Alarm Range 0 - 100 0 to 30 k 1 k 0.5 Hz to 50 Hz (-3 dB) 0.5, 1.0, 2.0, and 5.0 Hz

(12 dB/octave) 15 Hz (65 dB/octave) 30 Hz (75 dB/octave) 50 Hz (85 dB/octave) BIS, BISx M1034A 0 - 100 0 - 100%

0 - 100 dB 0 - 100%

0.5 - 30.0 Hz 0 - 100 dB

(BISx only) 0 - 30 /minute

<0.3 V RMS (2.0 V peak-to-peak) With gridlines on: 25 V, 50 V, 100 V, 250 V With gridlines off: 50 V, 100 V, 200 V, 500 V 2048 ms 0.25 - 100 Hz (-3 dB) 0.25 Hz, 1 Hz, 2 Hz (-3 dB) 30 Hz, 50 Hz, 70 Hz, 100 Hz (-3 dB) 50 Hz, 60 Hz 0 to 999 k Adjustment 1 Alarm Delay Max. 2 seconds 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 Service Guide. 426 36 Specifications 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 patient 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 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 The monitor is suitable for use in all establishments other than domestic and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes RF emissions CISPR 11 Harmonic emissions IEC 61000-3-2 Voltage fluctuations IEC 61000-3-3 Class A n/a n/a 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. Avoiding Electromagnetic Interference (Resp and BIS) The respiration (Resp) and BIS measurements are very sensitive measurements that measure very small signals. 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 these measurements. 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. 427 36 Specifications Immunity test Electrostatic discharge

(ESD) IEC 61000-4-2 Electrical fast transient/

burst IEC 61000-4-4 Surge IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11 IEC 60601-1-2 test level 6 kV contact 8 kV air 6 kV contact 8 kV air Compliance level Electromagnetic environment guidance 2 kV for power supply lines 1 kV for input/output lines 2 kV for power supply lines 1 kV for input/output lines 1 kV differential mode 2 kV common mode 1 kV differential mode 2 kV common mode

<5% UT (>95% dip in UT) for 0.5 cycles 40% UT (60% dip in UT) for 5 cycles 70% UT (30% dip in UT) for 25 cycles

<5% UT (>95% dip in UT) for 5 sec 3 A/m

<5% UT (>95% dip in UT) for 0.5 cycles 40% UT (60% dip in UT) for 5 cycles 70% UT (30% dip in UT) for 25 cycles

<5% UT (>95% dip in UT) for 5 sec 3 A/m Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. Mains power quality should be that of a typical commercial and/or hospital environment 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. 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 (50/

60 Hz) magnetic field IEC 61000-4-8 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, UT 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 meters (m). The values given in brackets are for respiration and BIS. 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. Interference may occur in the vicinity of equipment marked with this symbol:

428 36 Immunity test Conducted RF IEC 61000-4-6 IEC 60601-1-2 test level 3 VRMS 150 kHz to 80 MHz Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz Compliance level Electromagnetic environment guidance 3 VRMS

(1 VRMS for respiration and BIS) 3 V/m

(1 V/m for respiration and BIS) Recommended separation distance:

d = 1.2P for respiration and BIS:

d = 3.5P Recommended separation distance:

80 MHz to 800 MHz d = 1.2P 80 MHz to 800 MHz for respiration and BIS d = 3.5P 800 MHz to 2,5 GHz d = 2.3P 800 MHz to 2,5 GHz for respiration and BIS d = 7.0P 2.0 to 2,3 GHz for short range radio d = 7.0P 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 meters (m). The values given in brackets are for respiration and BIS. 429 36 Specifications Frequency of transmitter 150 kHz to 80 MHz Equation Rated max. output power of transmitter 0.01 W 0.1 W 1 W 10 W 100 W d = 1.2P for respiration and BIS:

d = 3.5P 80 MHz to 800 MHz d = 1.2P for respiration and BIS:

d = 3.5P 800 MHz to 2,5 GHz d = 2.3P for respiration and BIS:

d = 7.0P Separation distance Separation distance Separation distance 0.1 (0.4) m 0.4 (1.1) m 1.3 (3.5) m 3.8 (11.1) m 12.0 (35.0) m 0.1 (0.4) m 0.4 (1.1) m 1.3 (3.5) m 3.8 (11.1) m 12.0 (35.0) m 0.2 (0.7) m 0.7 (2.2) m 2.3 (7.0) m 7.3 (22.1) m 23.0 (70.0) m 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 electrosurgery 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 (M1032 within 30 seconds). If any user interaction is required, the monitor indicates this with a technical alarm (INOP). Restart time After power interruption, an ECG wave will be shown on the display after 30 seconds maximum. 430 37Default Settings Appendix 37 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 pre-configured 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 Line Frequency Units Afghanistan land 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 50/60 [Hz]

50 50 50 50 60 60 50 60 60 50 50 50 60 50 50 50 60 50 60 50 50 50 Weight kg, lb kg kg kg kg lb lb kg lb lb kg kg kg kg kg kg kg kg kg lb kg kg kg Units Height in, cm cm cm cm cm in in cm in in cm cm cm cm cm cm cm cm cm in cm cm cm ECG Cable Color IEC, AAMI AAMI IEC IEC IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC 431 37 Default Settings Appendix Country-Description Line Frequency Units Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Brunei Darussalam 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 Cte d'Ivoire Croatia Cuba Cyprus 60 60 60 60 50 50 50 60 60 60 50 50 50 50 50 50 50 60 60 60 50 60 50 50 60 60 60 60 50 50 60 60 50 50 60 50 432 Weight lb lb kg lb kg kg kg lb kg lb kg kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb kg kg lb kg kg kg kg kg Units Height in in cm in cm cm cm in cm in cm cm cm cm cm cm cm cm in cm cm in cm cm in in cm in cm cm in cm cm cm cm cm ECG Cable Color AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC AAMI IEC IEC IEC IEC IEC AAMI AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI IEC IEC IEC IEC Country-Description Line Frequency Units Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands, Malvinas Faroe Islands Fiji 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 50 60 50 50 60 60 50 60 50 50 50 50 60 60 60 50 50 50 60 60 50 50 60 50 50 60 50 60 50 50 60 60 50 60 60 60 60 Weight kg lb kg kg kg kg kg kg kg kg kg kg lb lb lb kg kg kg lb lb kg kg lb kg kg lb kg lb kg kg lb kg kg lb lb kg kg 37 Default Settings Appendix Units Height cm in cm cm cm cm cm cm cm cm cm cm in in in cm cm cm in in cm cm in cm cm in cm in cm cm in cm cm in in cm cm ECG Cable Color IEC AAMI IEC AAMI AAMI AAMI IEC AAMI IEC IEC IEC IEC AAMI AAMI AAMI IEC IEC IEC AAMI AAMI IEC IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI 433 37 Default Settings Appendix Country-Description Line Frequency Units 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 Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republics Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao 434 60 60 60 50 50 50 50 50 50 50 50 50 50 50 50 60 50 50 50 50 60 60 60 50 60 50 50 50 50 50 60 60 50 50 60 Weight lb lb kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg lb lb kg kg lb kg kg kg kg kg lb lb kg kg lb Units Height in in cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm in in cm cm in cm cm cm cm cm in in cm cm in ECG Cable Color AAMI AAMI AAMI IEC IEC IEC IEC IEC AAMI AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI IEC IEC AAMI AAMI IEC IEC AAMI Country-Description Line Frequency Units Macedonia, The former Yugoslavian Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federal States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Islands Northern Mariana Islands Norway 50 50 50 50 60 50 50 60 60 50 60 60 60 60 60 60 60 50 50 50 50 60 50 60 60 50 50 60 50 60 50 50 60 60 60 50 Weight kg kg kg kg lb kg kg lb kg kg lb lb kg lb lb lb lb kg kg kg kg lb kg lb lb kg kg lb kg kg kg kg lb lb lb kg 37 Default Settings Appendix Units Height cm cm cm cm in cm cm in cm cm in in cm in in in in cm cm cm cm in cm in in cm cm in cm in cm cm in in in cm ECG Cable Color IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC 435 37 Default Settings Appendix Country-Description Line Frequency Units 50 Oman 50 Pakistan 60 Palau 50 Palestinian Territory 60 Panama 60 Papua New Guinea 50 Paraguay 60 Peru 60 Philippines 60 Pitcairn 50 Poland 50 Portugal 60 Puerto Rico 50 Qatar 60 Reunion 50 Romania 50 Russian Federation 50 Rwanda 60 Saint Helena 60 Saint Kitts and Nevis 50 Saint Lucia Saint Pierre and Miquelon 60 Saint Vincent and the Grenadines 50 60 Samoa 60 San Marino Sao Tome and Principe 60 50 Saudi Arabia 50 Senegal Serbia 50 50 Serbia & Montenegro 60 Seychelles Sierra Leone 50 50 Singapore 50 Slovakia Slovenia 50 60 Solomon Islands Somalia 50 436 Weight kg kg lb kg lb lb kg kg kg lb kg kg lb kg lb kg kg kg lb kg kg lb kg lb lb lb kg kg kg kg lb kg kg kg kg lb kg Units Height cm cm in cm in in cm cm cm in cm cm in cm in cm cm cm in cm cm in cm in in in cm cm cm cm in cm cm cm cm in cm ECG Cable Color AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC AAMI IEC IEC IEC IEC AAMI IEC Country-Description Line Frequency Units 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 Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela 60 60 50 60 50 60 60 60 50 50 50 60 60 60 50 60 60 60 60 60 50 50 60 60 60 60 60 50 50 60 60 50 60 60 60 Weight lb lb kg lb kg kg lb lb kg kg kg kg lb lb kg lb lb lb lb lb kg kg lb kg lb lb lb kg kg lb lb kg lb lb lb 37 Default Settings Appendix Units Height in in cm in cm cm in in cm cm cm cm in in cm in in in in in cm cm in cm in in in cm cm in in cm in in in ECG Cable Color AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI 437 37 Default Settings Appendix Country-Description Line Frequency Units Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 50 50 60 60 50 50 60 60 Weight kg kg lb lb kg kg lb lb Units Height cm cm in in cm cm in in ECG Cable Color IEC AAMI AAMI AAMI IEC AAMI AAMI AAMI Alarm and Measurement Default Settings The default wave speed for all measurements except Respiration is 25 mm/sec. For Respiration the default wave speed is 6.25 mm/sec. In the following tables, settings may be entered only once per table row if they are the same for all patient categories. Alarm Default Settings Alarm Settings Alarm Volume Alarms Off Pause Al. 5Min Pause Al. 10Min Auto Alarms Off AlarmOffReminder Visual Latching Audible Latching Alarm Reminder Reminder Time Alarm Sounds RedAlarmInterval Yel.Al. Interval Alarm Low Red Alarm Volume Yell.AlarmVolume Inop Volume AutoIncrease Vol IncreaseVolDelay 438 Factory Default H10/H20/H40 H30 (deviations from H10/H20/

H40) 5 2 min Enabled Enabled Off Off Red&Yellow Red&Yellow On 3 min Traditional 10 sec 20 sec 4 AlarmVol. +2 AlarmVol. +0 AlarmVol. +0 2 Steps 20 sec Red Only Off 2 Alarm Settings Keep Blinking Relay1 Sensitiv. Relay2 Sensitiv. Relay3 Sensitiv. CyanRelayLatency Yel.RelayLatency Alarm Text NoCentrMonMinVol 37 Default Settings Appendix Factory Default H10/H20/H40 H30 (deviations from H10/H20/

H40) No R&Y&C Red&Yellow Red 5 sec 2 sec Standard On4 ECG, Arrhythmia, ST and QT Default Settings ECG Settings High Limit Low Limit ECG/Arrhy Alarms Alarm Source ECG QRS Volume Primary Lead Secondary Lead Analysis Mode Lead Placement Mod.LeadPlacment Filter AutoFilter Default ECG Size Color Asystole Thresh. ExtrTachy Tachy Clamp ExtrBrady Brady Clamp ECG AL. OFF Inop Fallback Alarms Off AlarmSource Sel. Va Lead Factory defaults H10/H20/H40 Adult 120 bpm 50 bpm On Auto On 1 II V Multi Lead Standard Off Monitor Off Size X1 Green 4.0 sec 20 bpm 200 bpm 20 bpm 40 bpm Cyan On Enabled Enabled V2 Pedi 160 bpm 75 bpm On Auto On 1 II V Multi Lead Standard Off Monitor Off Size X1 Green 4.0 sec 20 bpm 220 bpm 20 bpm 40 bpm Cyan On Enabled Enabled V2 Neo 200 bpm 100 bpm On Auto On 1 II V Multi Lead Standard Off Monitor Off Size X1 Green 3.0 sec 20 bpm 240 bpm 20 bpm 50 bpm Cyan On Enabled Enabled V2 H30 (deviations from H10/H20/H40) Adult Neo Pedi Auto Filter 40 bpm 60 bpm 80 bpm 439 37 Default Settings Appendix ECG Settings Vb Lead SyncPulse Sensit SyncPulse Marker PulseAlarms Tele Factory defaults H10/H20/H40 Adult V5 Medium On Enabled Pedi V5 Medium On Enabled Neo V5 Medium On Enabled Pulse Default Settings Pulse Settings Alarm Source Pulse (source label) System Pulse Alarms Off AlarmSource Sel. Pulse Alarm Settings Pulse Alarms1 High Limit Low Limit ExtrBrady Brady Clamp ExtrTachy Tachy Clamp Factory defaults H10/H20/H40 Adult Auto On SpO Enabled Enabled Pedi Auto On SpO Enabled Enabled Neo Auto On SpO Enabled Enabled Factory defaults H10/H20/H40 Adult On 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pedi On 160 bpm 75 bpm 20 bpm 40 bpm 20 bpm 220 bpm Neo On 200 bpm 100 bpm 20 bpm 50 bpm 20 bpm 240 bpm H30 (deviations from H10/H20/H40) Neo Adult Pedi H30 (deviations from H10/H20/H40) Neo Adult Auto Auto Pedi Auto Auto Auto Auto H30 (deviations from H10/H20/H40) Adult Neo Pedi 40 bpm 60 bpm 80 bpm 1 When Pulse is not the alarm source, the alarms will be Off. Pulse alarms use the settings of the currently selected Pulse alarm source. Respiration Default Settings Respiration Settings High Limit Low Limit Apnea Time Factory defaults H10/H20/H40 Adult 30 rpm 8 rpm 20 sec Pedi 30 rpm 8 rpm 20 sec Neo 100 rpm 30 rpm 20 sec H30 (deviations from H10/H20/H40) Adult Neo Pedi 440 37 Default Settings Appendix Respiration Settings Alarms Resp Detection Color Factory defaults H10/H20/H40 Adult On On Auto

(Trigger Mode) Yellow Pedi On On Auto

(Trigger Mode) Yellow Neo On On Auto

(Trigger Mode) Yellow H30 (deviations from H10/H20/H40) Neo Adult Pedi Off Off Off White White White SpO2 Default Settings SpO2 Settings Mode Repeat Time Alarms QRS Volume Tone Modulation Tone Mod. Type Perfusion Average NBP Alarm Suppr. Extd. Auto OnOff Color Average In Mon. Signal Quality SpO2 Alarm Default Settings Factory Defaults Adult Continuous 15 min On 1 Yes Enhanced On 10 sec On Disabled Cyan (light blue) No On Pedi Continuous 15 min On 1 Yes Enhanced On 10 sec On Disabled Cyan (light blue) No On Neo Continuous 15 min On 1 Yes Enhanced On 10 sec On Disabled Cyan (light blue) No On Setting Desat Limit Low Limit High Limit Desat Delay High Alarm Delay Low Alarm Delay SmartAlarmDelay (SAD) High Alarm Delay (SAD) Low Alarm Delay (SAD) Label Pulse settings Pulse (SpO) For all other Pulse default settings, refer to the Pulse Default Settings table. Adult 80 90 100 20 sec 10 sec 10 sec Off Short Short SpO On Pedi 80 90 100 20 sec 10 sec 10 sec Off Short Short SpO On Neo 80 85 95 20 sec 10 sec 10 sec Off Short Short SpO On 441 37 Default Settings Appendix NBP Default Settings NBP Settings Mode Alarms from High Limit Low Limit Alarms NBP Repeat Time Pulse (NBP) Unit Done Tone Start Time VP Pressure Reference Color Factory defaults H10/H20/H30 Neo Adult Manual Auto Sys. Sys. 90/60 (70) 160/90 (110) 40/20 (24) 90/50 (60) On On On On 10 min 10 min On On mmHg mmHg Off Off Synchronize Synchronize d d 60 mmHg 30 mmHg Auscultatory Auscultatory Invasive Red Pedi Auto Sys. 120/70 (90) 70/40 (50) On On 10 min On mmHg Off Synchronize d 40 mmHg Red Red H30 (deviations from H10/H20/H40) Adult Neo Pedi 180/90 (110) 70/50 (65) 3 min 3 min 3 min On NotSynchron

. On NotSynchron. NotSynchron

. Magenta Magenta Magenta Temperature Default Settings Temp Settings Low Limit High Limit Alarms Unit Range Color Factory defaults H10/H20/H40 Adult 36 39 On C 35...43 Green Pedi 36 39 On C 35...43 Green Neo 36 39 On C 35...43 Green H30 (deviations from H10/H20/H40) Adult Neo 35 35 Pedi 35 Light Green Light Green Light Green 442 Invasive Pressure Default Settings 37 Default Settings Appendix Factory defaults H10/H20/H40 Neo Sys. 90/60 (70) 55/20 (36) On Disabled 5 5 105/75 (75) Pedi Sys. 120/70 (90) 70/40 (50) On Disabled 10 10 140/80 (100) Adult Sys. 160/90 (110) 90/50 (70) On Disabled 15 15 190/100 (125) ABP, P, P1, P2, P3, P4, UAP, ART, Ao, FAP, BAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low Sys. High Clamp/Dia. High Clamp (Mean High Clamp) Sys. Low Clamp/Dia. Low Clamp (Mean Low Clamp) Scale Mean only Filter Mercury Cal Artifact Suppr. Unit Color Pulse settings for all arterial pressures except P1 to P4 Pulse (Press label) For all other Pulse default settings, refer to the Pulse Default Settings table. 100 No 12 Hz Yes 60 sec mmHg Red 100 No 12 Hz Yes 60 sec mmHg Red 150 No 12 Hz Yes 60 sec mmHg Red 80/45 (65) 60/35 (45) 45/15 (30) On On On CVP, RAP, LAP, UVP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low Sys. High Clamp/ Dia. High Clamp (Mean High Clamp) Sys. Low Clamp/Dia. Low Clamp (Mean Low Clamp) Scale Factory defaults H10/H20/H40 Adult Mean 14/6 (10) 6/-4 (0) On Disabled 5 5 20/10 (15) Pedi Mean 10/2 (4) 2/-4 (0) On Disabled 5 5 15/5 (10) Neo Mean 10/2 (4) 2/-4 (0) On Disabled 5 5 15/5 (10) 0/-5 (-5) 0/-5 (-5) 0/-5 (-5) 30 30 30 H30 (deviations from H10/H20/H40) Adult Pedi Neo 180/90 (110) 70/50 (70) 65/45 (65) H30 (deviations from H10/H20/H40) Adult Neo Pedi 443 Factory defaults H10/H20/H40 Adult Yes 12 Hz Yes 60 sec mmHg Cyan (light blue) Pedi Yes 12 Hz Yes 60 sec mmHg Cyan (light blue) Neo Yes 12 Hz Yes 60 sec mmHg Cyan (light blue) H30 (deviations from H10/H20/H40) Neo Adult Pedi Blue Blue Blue 37 Default Settings Appendix CVP, RAP, LAP, UVP Settings Mean only Filter Mercury Cal Artifact Suppr. Unit Color PAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low Sys. High Clamp/Dia. High Clamp (Mean High Clamp) Sys. Low Clamp/Dia. Low Clamp (Mean Low Clamp) Scale Mean only Filter Mercury Cal Artifact Suppr. Unit Color Factory Defaults Adult Dia. 34/16 (20) 10/0 (0) On Disabled 5 5 45/20 (25) 5/-5 (-5) 30 No 12 Hz Yes 60 sec mmHg Yellow ICP, IC1, IC2 Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low Sys. High Clamp/Dia. High Clamp (Mean High Clamp) Factory Defaults Adult Mean 14/6 (10) 6/-4 (0) On Disabled 10 10 20/10 (15) 444 Pedi Dia. 60/4 (26) 24/-4 (12) On Disabled 5 5 65/5 (35) 15/-5 (5) 30 No 12 Hz Yes 60 sec mmHg Yellow Pedi Mean 10/2 (4) 2/-4 (0) On Disabled 10 10 15/5 (10) Neo Dia. 60/4 (26) 24/-4 (12) On Disabled 5 5 65/5 (35) 15/-5 (5) 30 No 12 Hz Yes 60 sec mmHg Yellow Neo Mean 10/2 (4) 2/-4 (0) On Disabled 10 10 15/5 (10) 37 Default Settings Appendix ICP, IC1, IC2 Settings Sys. Low Clamp/Dia. Low Clamp (Mean Low Clamp) Scale Mean only Filter Mercury Cal Artifact Suppr. Unit Color Factory Defaults Adult 0/-5 (-5) 30 Yes 12 Hz Yes 60 sec mmHg Magenta Pedi 0/-5 (-5) 30 Yes 12 Hz Yes 60 sec mmHg Magenta Cardiac Output Default Settings Neo 0/-5 (-5) 30 Yes 12 Hz Yes 60 sec mmHg Magenta C.O. Settings Auto-Calibration Tblood HighLimit Tblood Low Limit Tblood Alarms Temperature Unit Color CCO/CCI Settings Settings common to CCO and CCI Alarms From CCO From Color CCO Alarms CCO High Limit CCO Low Limit CCI Alarms CCI High Limit CCI Low Limit Factory defaults H10/H20/H40 Adult On 39.0C 36.0C On C Green Pedi On 39.0C 36.0C On C Green Neo On 39.0C 36.0C On C Green H30 (deviations from H10/H20/H40) Adult Pedi Neo Yellow Yellow Yellow Factory Adult Factory Pedi Factory Neo CCO ABP Green On 8.5 l/min 4.0 l/min CCO ABP Green On 3.7 l/min 2.6 l/min CCO ABP Green On 1.3 l/min 0.3 l/min On 4.3 l/min/m2 2.0 l/min/m2 On 4.3 l/min/m2 2.6 l/min/m2 On 5.2 l/min/m2 1.2 l/min/m2 445 37 Default Settings Appendix CO2 Default Settings Factory defaults H10/H20/H40 Adult 30 50 4 On mmHg 40 mmHg On Off Pedi 30 50 4 On mmHg 40 mmHg On Off CO2 Settings etCO Low etCO High imCO High CO Alarms Unit Scale imCO NO Corr. (only M3015A/M3016A) Oxygen Corr. (only M3014A) Gas Corr. (only M3014A) Off Humidity Corr. BTPS Off Max Hold On awRR On awRR Alarms High Limit (awRR) 30 Low Limit (awRR) 8 20 sec Apnea Time Color Yellow 16%

16%

Off BTPS Off On On 30 8 20 sec Yellow Neo 30 50 4 On mmHg 40 mmHg On Off 16%

Off BTPS Off On On 60 30 20 sec Yellow H30 (deviations from H10/H20/H40) Adult Neo 25 25 60 60 Pedi 25 60 50 Off 50 Off 50 Off White White White Spirometry Default Settings Factory Adult 20 4.0 l/min 8.0 l/min 40 0 25 8 30 150 l/min 800 ml 40 cmH2O Factory Pedi 20 2.5 l/min 4.0 l/min 25 0 25 8 30 100 l/min 200 ml 40 cmH2O Factory Neo 20 0.4 l/min 0.8 l/min 20 0 25 30 60 20 l/min 50 ml 20 cmH2O Spirometry Settings Apnea Time MVexp Low MVexp High PIP High PEEP Low PEEP High High Limit (RRspir) Low Limit (RRspir) Scale (AWF) Scale (AWV) Scale (AWP) 446 37 Default Settings Appendix tcGas Default Settings tcGas Settings tcpO High Limit tcpO Low Limit tcpO Alarms tcpCO HighLimit tcpCO Low Limit tcpCO Alarms Site Timer Disable Timer Heat Switch Off (i.e., after Site Timer elapsed) Transducer Temp. CO Correction (Severinghaus) MetabolismFactor tcGas Unit Temperature Unit tcpO Color tcpCO Color Factory Adult 80 mmHg 50 mmHg On 50 mmHg 30 mmHg On 4.0 hours Not Allowed No 43.0C On 8 mmHg mmHg C Blue Green Factory Pedi 80 mmHg 50 mmHg On 50 mmHg 30 mmHg On 4.0 hours Not Allowed No 43.0C On 8 mmHg mmHg C Blue Green Intravascular Oxygen Saturation SO2 Settings Low Limit HR High Limit Alarms Light Intensity Color Hb/Hct Entry Factor Entry SvO2 Settings Low Limit High Limit Alarms Light Intensity Color Hb/Hct Entry Factor Entry Factory Adult 70%

80%

On On Yellow Hct [%]

Disabled Factory Adult 60%

80%

On On Yellow Hct [%]

Disabled Factory Pedi 70%

80%

On On Yellow Hct [%]

Disabled Factory Pedi 60%

80%

On On Yellow Factory Neo 80 mmHg 50 mmHg On 50 mmHg 30 mmHg On 4.0 hours Not Allowed No 43.0C On 8 mmHg mmHg C Blue Green Factory Neo 70%

80%

On On Yellow Hct [%]

Disabled Factory Neo 60%

80%

On On Yellow 447 37 Default Settings Appendix ScvO2 Settings Low Limit High Limit Alarms Light Intensity Color Factory Adult 70%

80%

On On Yellow SvO2 Default Settings SvO2 Settings Low Limit High Limit Alarms Light Intensity Color Hb/Hct Entry Factor Entry Factory Adult 60%

80%

On On Yellow Hct [%]

Disabled Factory Pedi 70%

80%

On On Yellow Factory Pedi 60%

80%

On On Yellow ScvO2 Default Settings ScvO2 Settings Low Limit High Limit Alarms Light Intensity Color Factory Adult 70%

80%

On On Yellow Factory Pedi 70%

80%

On On Yellow EEG Default Settings Factory Neo 70%

80%

On On Yellow Factory Neo 60%

80%

On On Yellow Factory Neo 70%

80%

On On Yellow EEG Settings TP, SEF MDF, PPF, Delta, Theta, Alpha, Beta SEF Threshold Numeric Average Wave Scale Show Gridlines Low Filter 448 Factory Pedi On Off 90%

8 sec Factory Adult On Off 90%

8 sec 100V (or +/- 50V if Show Gridlines is configured to Yes) No 0.5 Hz Factory Neo On Off 90%

8 sec No 0.5 Hz No 0.5 Hz 37 Default Settings Appendix EEG Settings High Filter Impedance Limit Smoothing CSA Color Factory Adult 30 Hz 5 kOhm On Yellow Factory Pedi 30 Hz 5 kOhm On Yellow Factory Neo 30 Hz 5 kOhm On Yellow BIS Default Settings BIS Settings SQI EMG SR SEF TP Bursts Scale Show Gridlines Filters Low Filter High Filter Notch Filter High Limit Low Limit Alarms Smoothing Rate Color Neo On On On Off Off On Pedi On On On Off Off On Factory defaults H10/H20/H40 Adult On On On Off Off On 100V (or +/- 50V if Show Gridlines is configured to Yes) No On 2 Hz 70 Hz On 70 20 On 30 sec Yellow No On 2 Hz 70 Hz On 70 20 On 30 sec Yellow No On 2 Hz 70 Hz On 70 20 On 30 sec Yellow VueLink Default Settings Device Alarms Color Ignored Green H30 (deviations from H10/H20/H40) Neo Adult Pedi Off Off Off 15 sec Magenta 15 sec Magenta 15 sec Magenta 449

10-Electrode (5+5)Cable Sets 370 10-Electrode (6+4)Cable Sets 370 10-Lead Placement 120 3-Electrode Cable Sets 370, 371 3-Electrode One Piece Cables 372 4-Slot Flexible Module Rack (FMS-4) 16 5-Electrode Cable Sets 370, 372 5-Electrode One Piece Cables 372 6-Electrode Cable Sets 370 6-Lead Placement 119 A Abdominal Breathing 160 Aberrantly-Conducted Beats 131 About Arrhythmia Monitoring 129 About Automatic Alarm Limits 59 About Compressed Spectral Arrays

(CSA) 252 About ECG Leads 116 About Electrode-to-Skin Impedance 251 About Label Sets 39 About QT/QTc Interval Monitoring 149 About Smart Alarm Delays 59, 169 About ST Monitoring 139 About the Rule of Six 338 About the ST Measurement Points 143 Accessing the Drug Calculator 338 Accessing the Setup C.O. and Setup CCO Menus 197 Accessories 369 Accessories Compliant with EMC Standards 425 Acknowledging Alarms 53 Acknowledging Disconnect INOPs 53 Activating the Cursor for Screen Trends 279 Adjusting a Measurement Wave 37 Adjusting ST Measurement Points 143 Adjusting the Alarm Limits 170 Adjusting the Arrhythmia Alarm Limits 136 Adjusting the Calibration Factor 186 Adjusting the CO2 Wave Scale 222 Adjusting the Desat Limit Alarm 171 Adjusting the iPC Audio Volume 46 Adjusting the Screen Brightness 43 Admitting a Centrally-Monitored Patient 96 Admitting a Patient 95 Adult Mode 229 Adult/Pediatric Reusable Comfort Cuff Kits 373 Adult/Pediatric Reusable Comfort Cuffs 373 Adult/Pediatric Reusable EasyCare Cuffs 373 Adult/Pediatric Single Patient Cuffs 374 Adult/Pediatric Single Patient, Soft Cuffs 374 After Insertion 246 Alarm and Measurement Default Settings 436 Alarm Behavior at Power On 62 Alarm Default Settings 436 Alarm Delays 169 Alarm Lamp 50 Alarm Latching Behavior 62 Alarm Limits 56 Alarm Limits Report 333 Alarm Message 50 Alarm Messages Window 60 Alarm Recordings 63 Alarm Reminder 54 Alarm Source Selection Disabled 157 Alarm Sources 176 Alarm Tone Configuration 51 Alarms 49 Alarms and Alarm Limits 230 Alarms/INOPs From External Devices 350 Alarms/INOPs from External Devices 345 All ECG Waves Recordings 319 Altitude Setting 393 Always Discharge Patients 316 Annotating Events 301 Aperiodic Trends Database 278 Applying the Sensor 165 Applying the tcGas Transducer 237 Arrhythmia Alarm Chaining 138 Arrhythmia Alarm Timeout Periods 136 Arrhythmia Alarms 135 1Index Arrhythmia Alarms and Latching 136 Arrhythmia Beat Labels 132 Arrhythmia Options 130 Arrhythmia Relearn and Lead Fallback 135 Arrhythmia Relearning 134 Arrhythmia Status Messages 132 Assessing a Suspicious SpO2 Reading 168 Assigning a Telemetry Device and a Monitor to One Patient 265 Assisting Venous Puncture 179 Atrial Fibrillation Alarm 131 Attaching and Removing the CO2 Transducer 219 Attaching the Flow Sensor 226 Audible Alarm Indicators 51 Authorized Clinician Review 313 Auto Detection Mode 160 Automatic Alarm Suppression 231 Automatic Arrhythmia Relearn 135 Automatic Purging 228 Automatic Unit Conversion 286 Automatic Value Substitution 286 Automatically Resolving Patient Mismatch 105 Avoiding Electromagnetic Interference

(Resp and BIS) 425 Avoiding Pace Pulse Repolarization Tails 114 B Battery Accessories 386 Battery INOPs 73 BIS 424 BIS Accessories 385 BIS Continuous Impedance Check 259 BIS Cyclic Impedance Check 260 BIS Default Settings 447 BIS Impedance Indicators 261 BIS INOPs 87 BIS Manufacturer's Information 388 BIS Monitoring Setup 257 BIS Safety Information 262 BIS Window 260 Bright Alarm Limits 50 BSA Formula 286 449 C C.O. Injectate Guidelines 206 C.O. INOPs 84 C.O./CCO Curve Alert Messages 207 C.O./CCO Prompt Messages 209 C.O./CCO Safety Information 210 C.O./CCO Warning Messages 209 Cableless Measurement Device INOPs 92 Calculated Values INOPs 92 Calculating Cerebral Perfusion Pressure 191 Calculating Oxygen Extraction 247 Calculating Pulse Pressure Variation 191 Calculating SpO2 Difference 172 Calculating Temp Difference 182 Calculations 283 Calculations Pop-Up Keys 284 Calculations Windows 284 Calibrating NBP 179 Calibrating Reusable Transducer CPJ840J6 189 Calibrating the tcGas Transducer 235 Calibrating the Transducer 219 Calibration Failure 236 Capture 12-Lead 123 Capture 12-Lead Pop-up Keys 125 Capturing and Deleting Loops 356 Capturing the 12-Lead ECG 123 Cardiac Output (C.O.) Accessories 381 Cardiac Output / Continuous Cardiac Output 421 Cardiac Output Default Settings 443 Cardiac Output Report 335 Cardiac Overlay 159 Care and Cleaning 361 Care Group Alarms 110 Care Groups 105 Carrying out a Pre-insertion Calibration 243 CCO Calibration Status Indicators 202 Central Recording 317 Changing a Screen's Content 32 Changing Alarm Limits 57 Changing awRR Alarm Limits 224 Changing CO2 Alarms 223 Changing Conditions 312 Changing CSA Settings 253 Changing ECG Wave Gain 321 Changing EEG Settings 253 Changing Filter Frequencies 254 450 Changing HR/Pulse Alarm Limits 157 Changing Lead Sets 117 Changing Loops Display Size 356 Changing Loops Type 357 Changing Measurement Labels (e.g. Pressure) 39 Changing Measurement Settings 36 Changing Monitor Settings 42 Changing QTc Alarm Limits 153 Changing Resp Detection Modes 160 Changing ST Alarm Limits 145 Changing the Alarm Tone Volume 52 Changing the Apnea Alarm Delay 162, 223, 230 Changing the Averaging Time 168 Changing the BIS Smoothing Rate 261 Changing the Concentration of Inspired O2 and the Inspired Agents 232 Changing the ECG Filter Settings 115 Changing the Hi-Res Trend Waves Displayed 289 Changing the Impedance Limit 251 Changing the Lab Value Required for Entry 246 Changing the Pressure Wave Scale 187 Changing the Scale of the EEG Wave 262 Changing the Scale of the EEG Waves for Display 253 Changing the Scale of the ST Map 148 Changing the Screen Trend View 280 Changing the Selection of Screen Trends Displayed 279 Changing the Size of the ECG Wave 114 Changing the Size of the Respiration Wave 161 Changing the Speed of the EEG Wave 254 Changing the Speed of the Respiration Wave 162 Changing the Temperature of the Inspired Gas 232 Changing the Trending Interval 149 Changing the Type of Balance Gas 231 Changing The View To A Single Wave Set 151 Changing the Volume of the QRS Tone 115 Changing the Wave Group Speed 37 Changing The Wave Speed 38 Changing VueLink Waves and Numerics Displayed 348 Changing Wave Speed for a Channel 37 Changing Wave Speeds 37 Changing Waves and Numerics Displayed 344 Charting Infusion Progress 340 Checking Paced Status 112 Checking Printer Settings 329 Checking Report Status and Printing Manually 330 Checking Suspicious Values 247 Checking The Sepsis Resuscitation Bundle Window 314 Checking Transducer Accuracy 219 Checking Your Monitor Revision 43 Chest Electrode Placement 120 Choosing an ECG Lead for Arrhythmia Monitoring 130 Choosing an EEG Electrode Montage 250 Choosing EASI or Standard Lead Placement 116 Choosing Measured AWV Components 231 Choosing Standard or Modified Electrode Placement 122 Choosing the NBP Alarm Source 178 Choosing the Pressure Alarm Source 188 Cleaning the Monitor 362 Cleaning the Recorder Printhead (M1116B only) 363 Cleaning the SO2 Optical Module 363 Cleaning, Sterilizing and Disinfecting Monitoring Accessories 363 CO2 415 CO2 Default Settings 444 CO2 INOPs 82 Comparing Dynamic Compliance Values 287 Configuration 170 Connecting Additional Displays to the Monitor 33 Connecting an External Device 343, 348 Connecting ECG Cables 111 Connecting SpO2 Cables 166 Connecting the Optical Module 246 Connectors 390 Controlling the Telemetry Device from the Bedside 267 Conventional 12-Lead ECG 121 Correcting the Measurement if Limb is not at Heart Level 175 Counting Combi-Events 299 Counting Neonatal Event Review (NER) Events 299 Country-Specific Default Settings 429 Creating and Changing Recordings Templates 320 Current View 146 D Dashed Lines on Reports 329 Data Exchange Between Information Centers 102 Data Upload from an MMS 102 Default Profile 35 Default Settings Appendix 429 Defining the Column Interval Using the NBP Measurement 277 Deriving Alarms From awRR 224 Determining a Pressure's Most Recent Zero 185 Devices for Acquiring Measurements 15 Direct Connection - Automatic Pairing 266 Disabling the tcGas Site Timer 235 Disabling Touchscreen Operation 26 Discharging a Patient 97 Disconnecting from Power 45 Disinfecting the Monitor 362 Display INOPs 75 Displaying A Clock On The Main Screen 354 Displaying a Mean Pressure Value Only 187 Displaying a Timer On The Main Screen 353 Displaying an ST Reference Baseline 148 Disposing of Empty Calibration Gas Cylinders 367 Disposing of the Monitor 367 Documenting Alarm Limits 60 Documenting an Event Episode 301 Documenting C.O. Measurements 206 Documenting Calculations 287 Documenting Drug Calculations 341 Documenting Event Review 301 Documenting Events 301 Documenting Loops 357 Documenting Trends 278 During Measurements 176 E EASI ECG Lead Placement 125 EASI Electrode Placement 126 ECG Alarms Off Disabled 128 ECG and Arrhythmia Alarm Overview 126 ECG Lead Fallback 117 ECG Lead Placements 117 ECG Leads Monitored 117 ECG Reports 335 ECG Safety Information 128 ECG Source Tracking at the Information Center 268 ECG, Arrhythmia, QT and ST INOPs 75 ECG, Arrhythmia, ST and QT Default Settings 437 ECG, Arrhythmia, ST and QT Monitoring 111 ECG/Arrhythmia/ST/QT 405 ECG/Resp Accessories 369 Ectopic Status Messages 133 Editing and Saving RH C.O. Measurements 205 Editing Patient Information 97 Editing PiCCO C.O. Measurements 202 Editing the Wedge 193 EEG 423 EEG Accessories 385 EEG and Electrical Interference 255 EEG Default Settings 446 EEG INOPs 87 EEG Monitoring Setup 249 EEG Reports 254 EEG Safety Information 254 Electromagnetic Compatibility (EMC) Specifications 425 Electromagnetic Emissions 425 Electromagnetic Immunity 425 Electrosurgery Interference/Defibrillation/

Electrostatic Discharge 428 EMC And Radio Regulatory Compliance 393 Enabling Automatic Mode and Setting Repetition Time 178 Enabling Sequence Mode and Setting Up The Sequence 178 Ending The Sepsis Management Bundle 315 Ending The Sepsis Resuscitation Bundle 314 Enhanced Asystole Detection 128 Entering Measurements Manually 42 Entering the HemoCalc Window 198 Entering the Setup Pulse Menu 155 Entering Values for Calculations 286 Environmental Specifications 397 Event Episode Recordings 303 Event Episode Reports 305 Event Episode Window 300 Event Episodes 292 Event Groups 292 Event Notification 296 Event Recordings 301 Event Reports 304 Event Retriggering 295 Event Review Recordings 301 Event Review Reports 304 Event Review Window 300 Event Summary and Event Counter 298 Event Summary Reports 306 Event Summary Window 299 Event Surveillance 291 Event Triggers 294 Events Pop-Up Keys 293 Example Module (SpO2) 17 Examples 169 Expanded View 275 Extended Pressure Label Set 184 Extended Temperature Label Set 182 Extending Recordings 318 Extending the Alarm Pause Time 55 Extreme Alarm Limits for Heart Rate 127, 157 Extreme Alarm Limits for Pressure 188 F Fast Transients/Bursts 428 Finishing tcGas Monitoring 238 Flashing Numeric 50 Flexible Module Rack (M8048A) 15 Freezing All Waves 38 Freezing An Individual Wave 38 Freezing Waves 38 Functions Available When the Telemetry Data Window is Displayed 267 Further Information for Both Modules 247 G Gas Compensation 229 General Points 361 General Telemetry-related Functions 268 Getting Started 43 Graphical Trend Presentation 277 Guidelines for PiCCO C.O. Injectate 206 Guidelines for Right Heart Thermodilution C.O. Injectate 206 H Hardkeys 29 Hemodynamic Parameters 195 High ETVI 206 High Resolution Trend Waves 289 451 Hi-Res Trend Wave Recordings 290 Hi-Res Trend Wave Scales 289 Hi-Res Trend Waves and OxyCRG 289 Histogram View 280 Horizon View 280 How are Yellow Arrhythmia Alarms Indicated? 137 How Can You Combine Devices? 265 HR Alarms When Arrhythmia Analysis is Switched Off 128 Hypotension Evaluation 312 I Ice-Bath Setup for RH Thermodilution C.O. Measurements 205 Identifying tcGas Module Components 233 Identifying the Pressure Analog Output Connector 193 If You Set "On Measurement" Triggers 295 If You Set Use-defined Deviation Triggers 295 If You Set User-defined Threshold Triggers 295 If You Use Alarm Limits As Event Triggers 295 Impedance Indicators 252 Indications For Use Of QT Interval Monitoring 150 Indirect Connection - Manual Pairing 265 Initiating Arrhythmia Relearning Manually 134 Injectate Volume, Patient Weight and ETVI Values (PiCCO Only) 206 INOPs from the IntelliBridge Module 345 Inserting the Catheter 244 Inspecting the Cables and Cords 366 Inspecting the Equipment and Accessories 365 Inspecting the Monitor 44 Installation Safety Information 390 IntelliBridge EC10 Module 343 IntelliBridge INOPs 90 IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network Adapter) 394 IntelliVue Instrument Telemetry ISM

(2.4GHz) 394 IntelliVue Instrument Telemetry WMTS

(US only) 395 Intended Use 387 Interface Specifications 401 Interfering Gas and Vapor Effects On CO2 Measurement Values 418 Intermittent Bundle Branch Block 131 452 Intravascular Oxygen Saturation 423, 445 Introducing the Monitor 13 Introducing the Oscillometric NBP Measurement 173 Introduction 13 Invasive Pressure Accessories 375 Invasive Pressure Alarm Specifications 414 Invasive Pressure and Pulse 413 Invasive Pressure Default Settings 441 ISO/IEC Standard Audible Alarms 52 L Label Compatibility 41 Laboratory Data 359 Lactate Measurement 312 Language Conflict with External Device Drivers 345, 350 Latching Alarms 61 Lateral Chest Expansion 160 Lead Placement for Monitoring Resp 159 Left side of the Monitor 392 Levels of Event Surveillance 291 Limitations For Use Of QT Interval Monitoring 150 Locked Profiles 36 M M3012A Hemodynamic MMS Extension 24 M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions 22 Main Screen Timer Pop-up Keys 354 Mainstream CO2 Accessories 382 Mainstream CO2 Accessories (for M3016A) 383 Maintaining Recording Strips 322 Maintenance and Troubleshooting 365 Maintenance Task and Test Schedule 366 Major Parts and Keys 14 Making a Temp Measurement 181 Making Segment Settings 274 Making the In-Vivo Calibration 245 Making the Pressure Calibration 189 Managing Patients 95 Manual Detection Mode 161 Manual Purging 229 Manual Unit Conversion 286 Manually Resolving Patient Mismatch 103 Manufacturer's Information 259, 387 Measurement Limitations 174 Measurement Modes 174 Measurement Modules 16 Measurement of CO2 and Spirometry with Neonates 384 Measurement Principles 214 Measurement Specifications 405 Measuring C. O. Using the PiCCO Method 198 Measuring C.O. Using the Right Heart Thermodilution Method 203 Measuring CO2 using M3014A or X2 214 Measuring Continuous Cardiac Output 198 Measuring Frozen Waves 38 Measuring Mainstream CO2 using M3016A 218 Measuring Microstream CO2 using M3015A/B 220 Measuring Pulmonary Artery Wedge Pressure 192 Measuring Pulse Pressure Variation 198 Measuring SpO2 166 Measuring Systemic Vascular Resistance 198 Metabolism Correction for tcpCO2 239 Microstream CO2 Accessories 383 Minimum Volume for No Central Monitoring INOP 52 Minimum Volume for Severe Yellow or Red INOPs 52 MMS Extensions 21 MMS, MMS Extensions and FMS INOPs 74 Modified 12-Lead ECG 122 Monitor INOPs 70 Monitor Mounting Precautions 393 Monitor Safety Specifications 393 Monitoring After a Power Failure 45 Monitoring Airway Flow, Volume and Pressure 225 Monitoring BIS 257 Monitoring BIS using the BISx 258 Monitoring BIS Using the DSC and BIS Engine 258 Monitoring Carbon Dioxide 213 Monitoring Cardiac Output 195 Monitoring EEG 249 Monitoring Intravascular Oxygen Saturation 241 Monitoring Invasive Pressure 183 Monitoring NBP 173 Monitoring Paced Patients 113 Monitoring Pulse Rate 155 Monitoring Respiration Rate (Resp) 159 Monitoring SpO2 165 Monitoring tcGas 233 Monitoring Temperature 181 Monitoring the Sepsis Management Bundle Recommendations 315 Monitoring the Sepsis Resuscitation Bundle Recommendations 313 Moving Windows 26 N NBP 412 NBP Accessories 372 NBP Default Settings 440 NBP INOPs 77 NBP Timestamp 176 Neonatal and Pediatric Modes 229 Neonatal/Infant Cuff Kits 375 Neonatal/Infant Single Patient Cuffs 374 Neonatal/Infant Single Patient, Soft Cuffs 375 Networked Monitoring 45 New Patient Check 98 New/Dried Out Transducers 235 No. of Segments 275 Non-Physiological Artifact Suppression 188 Notification 353 Nurse Call Systems 51 O One-piece Cables 371 Operating and Navigating 24 Operating Modes 31 Optimizing Lead Placement for Resp 159 Optimizing Scale Settings 230 Optimizing the Waveform 187 Optimum Scale 275 Orientation On The Screen 310 Other Bed Pop-Up Keys 109 Other Reports 335 Overview of Recording Types 319 P Pairing an X2 or MP5 With a Telemetry Interface to a Host Monitor 267 Patient Alarm Messages 65 Patient Alarms and INOPs 65 Patient Category and Paced Status 96 Patient Mismatch - If Both Patient Data Sets Are Correct 104 Patient Mismatch - If Neither Patient Data Set is Correct 104 Patient Mismatch - If One Set of Patient Data is Correct 103 Pausing or Switching Off Alarms 54 Performance Specifications 399 Performing a Light Intensity Calibration 244 Performing Calculations 285 Performing Calculations for a Non-Specific Drug 339 Performing Calculations for a Specific Drug 339 Performing Drug Calculations 338 Performing In-Vivo Calibration 244, 247 Performing PiCCO C.O. Measurements 201 Performing RH C.O. Measurements 205 Perfusion Change Indicator 171 Perfusion Numeric 171 Permanent Keys 26 Physical Specifications 395 Pleth Wave 171 Pop-Up Keys 29 Power Loss Tone 53 Power On/Power Off Behavior 44 Preparing to Measure Mainstream CO2 215, 218 Preparing to Measure Microstream CO2 221 Preparing to Measure NBP 175 Preparing to Measure Sidestream CO2 216 Preparing to Monitor with the M1011A Narrow Module 246 Preparing to Monitor with the M1021A Wide Module 242 Pressure INOPs 80 Previewing the Sepsis Management Bundle 314 Printer Status Messages 331 Printing a Test Report 329 Printing an ST Map Report 149 Printing Hi-Res Trend Wave Reports 290 Printing Manually 331 Printing Patient Reports 325 Printing the 12-Lead ECG 124 Printing The QT Waves 152 Printout Location 325 ProtocolWatch 309 ProtocolWatch INOPs 92 Pulse Default Settings 438 Pulse INOPs 76 Q QRS Tone 157 QT Alarms 152 QT Measurement Algorithm 149 QT View 151 Quick Admitting a Patient 96 Quickstarting Recordings 318 R Radio-translucent Cables 371 Realtime Report 334 Rear of the Monitor 391 Recommended Cables 369 Recommended Separation Distance 426 Recommended separation distances from portable and mobile RF communication equipment 427 Recorded Waveforms 322 Recorder Accessories 386 Recorder Status Messages 323 Recording 317 Recording Priorities 321 Recording ST Segments 142 Recording Strip 321 Recording Strip Code 321 Recording The QT Waves 152 Recording Without a Template 318 Reference Method 174 Releasing Frozen Waves 39 Reloading Paper 323 Remembraning the tcGas Transducer 235 Removing Exhaust Gases from the System 218, 222 Resetting Arrhythmia Alarm Timeouts 55 Resetting the Timeout Period 137 Resolving Label Conflicts 40 Resolving Patient Information Mismatch 102 Resp Detection Modes and Cardiac Overlay 161 Resp INOPs 77 Resp Safety Information 162 Respiration 408 Respiration Default Settings 439 Respiratory Loops 355 Restart time 428 Restarting Paused Alarms 55 Restarting the tcGas SiteTimer 234 Review Alarms Window 60 Reviewing Alarms 60 Reviewing Calculations 285 453 Rhythm Status Messages 133 Right side of the Monitor 392 Run Time 352 Running a Car Seat Assessment Record 297 S Safety and Performance Tests 424 Sample Report Printouts 332 Saving and Calibrating PiCCO C.O. Measurements 202 Screen Trends 279 ScvO2 Default Settings 446 Selecting a Measurement Label 242 Selecting a Pressure for Monitoring 184 Selecting a Temperature for Monitoring 181 Selecting Leads for ST Analysis 140 Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 116 Selecting Screen Elements 25 Selecting the Active Alarm Source ECG or Pulse? 156 Selecting the Primary and Secondary ECG Leads 112 Selecting The QT Leads 150 Selecting the tcGas HeatPowerDisplay Mode 238 Sepsis Management Bundle 314 Sepsis Resuscitation Bundle 313 Set Combiners and Organizers 371, 372 Setting Measurement and Period for Histograms 277 Setting SpO2/Pleth as Pulse Source 172 Setting the Computation Constant 205 Setting the Date and Time 43 Setting the Gas Compensation Mode 231 Setting the Horizon 281 Setting the Horizon Trend Scale 281 Setting the Paced Status (Pace Pulse Rejection) 114 Setting the QRS Volume 172 Setting The QT Baseline 151 Setting the Screen Trend Time 279 Setting the tcGas Barometric Pressure 235 Setting the tcGas Sensor Temperature 233 Setting the tcGas Site Timer 234 Setting the Time Period for the Trend Indicator Arrow 281 Setting Triggers and Notification for Advanced Event Surveillance 297 Setting Triggers for NER and Basic Event Surveillance 296 454 Setting up all CO2 Measurements 222 Setting Up Auto Reports 327 Setting up CO2 Corrections 222 Setting Up ECG Reports 327 Setting Up Individual Print Jobs 328 Setting Up Reports 327 Setting up RH C.O. Measurements 204 Setting Up Source Device 357 Setting up Spirometry 230 Setting Up the 12-Lead ECG 124 Setting Up the In-Vivo Calibration 244, 245 Setting up the Modules 44 Setting Up the PiCCO C.O. Measurement 200 Setting up the Pressure Measurement 183 Setting Up Timers 352 Setting Up Tone Modulation 172 Setting Up Trends 274 Setting Up Vital Signs and Graphic Trend Reports 327 Severe Sepsis Screening 311 Short Range Radio Interface (MX600/700/

800 and 865244 Remote Control) 395 Showing/Hiding Loops 356 Shutting the iPC Down 47 Sidestream CO2 Accessories 382 Single- or Multi-lead ST Alarming 145 Skin Preparation for Electrode Placement 111 SmartKeys 27 SO2 Accessories for M1011A 386 SO2 Accessories for M1021A 386 SO2 INOPs 83 Special Situations at Shutdown 47 Specifications 387 Spirometry 419 Spirometry Accessories 384 Spirometry Default Settings 444 Spirometry INOPs 89 Spirometry Values Window 230 SpO2 409 SpO2 Accessories 376 SpO2 Default Settings 439 SpO2 INOPs 79 SpO2 Sensors 165 SpO2 Signal Quality Indicator (Fast SpO2 only) 167 SSC Sepsis Protocol 309 ST Alarms 145 Standard 3-Lead Placement 118 Standard 5-Lead Placement 119 Standby Mode 31 Starting a Cyclic Impedance Check 260 Starting and Stopping Measurements 176 Starting and Stopping Recordings 317 Starting Monitoring 44 Starting Report Printouts 325 Starting the Different Types of Report 326 Starting the iPC 46 Sterilizing the Monitor 363 Stopping a Cyclic Impedance Check 260 Stopping Recordings 318 Stopping Reports Printouts 326 Storing and Sending the 12-Lead ECG 124 Storing tcGas Transducers 235 Supported Cables 371 Suppressing Sampling (not Mainstream CO2) 223 Suppressing Zero Calibration 222 Suspending Telemetry Alarms 268 Suspending the Protocol for 24 Hours 311 SvO2 Default Settings 446 Swapping a Complete Profile 35 Swapping a Settings Block 35 Switching a Measurement On and Off 37 Switching All Yellow Arrhythmia Alarms On or Off 136 Switching Arrhythmia Analysis On and Off 130 Switching Between ST Map Views 148 Switching BIS and Individual Numerics On and Off 262 Switching BIS Filters On or Off 262 Switching EEG Numerics On and Off 253 Switching Individual Arrhythmia Alarms On and Off 136 Switching Individual QTc Alarms On and Off 153 Switching Manually Entered Measurements On and Off 42 Switching Numerics On and Off 37 Switching On 44 Switching Printers On Or Off for Reports 329 Switching Pulse from NBP On/Off 179 Switching Pulse On and Off 156 Switching QT Monitoring On and Off 153 Switching ST On and Off 140 Switching to a Different Screen 32 Switching VueLink On and Off 349 Symbols 389 Synchronized Settings 269 System Pulse Source 155 T Tabular View 280 tcGas 422 tcGas Accessories 385 TcGas Corrections 238 tcGas Default Settings 445 tcGas INOPs 86 Technical Alarm Messages (INOPs) 70 Telemetry Data Window 266 Telemetry INOPs 91 Temp 415 Temperature Accessories 380 Temperature Correction for tcpCO2 238 Temperature Default Settings 440 Temperature INOPs 78 Testing Alarms 62 The Events Database 298 Timer Counting Direction 353 Timer Label 352 Timer Setup Pop-up Keys 352 Timer Types 351 Timer Volume 353 To Change the Size of all the ECG Waves 115 To Change the Size of an Individual ECG Wave 115 To Discharge a Patient 97 To Pause All Alarms 54 To Switch All Alarms Off 54 To Switch Individual Measurement Alarms On or Off 55 Trademark Acknowledgement 388 Traditional Audible Alarms (HP/Agilent/

Philips/Carenet) 51 Transferring a Centrally-Monitored Patient 99 Transferring a Centrally-Monitored Patient with X2 or MP5 100 Transferring a Centrally-Monitored Patient with X2 or MP5 using IIT 100 Transferring a Patient with an X1 (no Information Center) 101 Transferring a Patient with an X2 or MP5

(no Information Center) 101 Transferring Patients 98 Transferring Patients And Moving Manually Between Phases 310 Trend Group 275 Trend Groups 275 Trend Interval 276 Trend Parameter Scales 276 Trend Priority 276 Trend Scales for Segment Measurements 275 Trend View 147 Trending Multiple-Value Measurements 279 Trends 271 Trends Databases 278 Trends Pop-Up Keys 272 Triggering Events Manually 297 Troubleshooting 367 Troubleshooting tcGas Calibration 237 Troubleshooting the Pressure Calibration 190 Troubleshooting the Zero 186 Trunk Cables 369, 371 Two Or More Infection Signs Or Symptoms Confirmed 312 U Unavailable Printer Re-routing Reports 330 Understanding Profiles 34 Understanding PVC-Related Alarms 139 Understanding Screens 32 Understanding Settings 36 Understanding SpO2 Alarms 168 Understanding the Arrhythmia Display 132 Understanding the Care Group Overview Bar 106 Understanding the ECG Display 112 Understanding the NBP Numerics 175 Understanding the Resp Display 160 Understanding the ST Display 141 Updating an ST Map Reference Baseline 148 Updating ST Baseline Snippets 142 Updating The Frozen Wave 39 Use Models With Telemetry 269 Using a Mouse or Trackball 26 Using ECG Alarms 127 Using Input Devices with the iPC and Monitor 47 Using Keys 26 Using Labels 39 Using Microstream Accessories 221 Using Pulse Alarms 156 Using Resp Alarms 162 Using Screens with External Device Data 344 Using Standby 268 Using the C.O. Procedure Window 196 Using the Drug Calculator 337 Using the EEG Impedance/Montage Window 250 Using the FilterLine and Airway Adapter 221 Using the Integrated PC 46 Using the Loops Cursor 356 Using the On-Screen Calculator 31 Using the On-Screen Keyboard 30 Using the Remote Control 29 Using the Sidestream Sensor Holder 218 Using the SmartKeys Key 30 Using the tcGas Site Timer 234 Using the Titration Table 341 Using the Touchscreen 26 Using the Visitor Screen 34 Using the Wave Cursor 187 Using the X2 or MP5 with a Host Monitor 47 Using the XDS Remote Display 34 Using the Zero Hardkey 186 Using Timers 351 Using VueLink Screens 349 V Viewing All Alarm Limits 56 Viewing an ST Map 148 Viewing And Printing The Protocol Log 316 Viewing and Silencing Telemetry Alarms at the Bedside 267 Viewing Arrhythmia Waves 132 Viewing Calculations 284 Viewing Events 298 Viewing Graphic Trends 272 Viewing Histogram Trends 274 Viewing Individual Alarm Limits 56 Viewing Loops 355 Viewing Received Data 359 Viewing ST Maps 146 Viewing the Alarm Latching Settings 61 Viewing the IntelliBridge Device Data Window 344 Viewing the iPC Desktop on the Monitor Display 46 Viewing the My Care Group Window 107 Viewing the Other Bed Window 108 Viewing the Realtime 12-Lead ECG 123 Viewing the VueLink Device Data Window 349 455 Viewing Timers 351 Viewing Trends 271 Viewing Vital Signs Trends 273 Visual Alarm Indicators 50 Visual Alarm Status Information in the Other Bed Window 109 VueLink Default Settings 447 VueLink INOPs 90 VueLink Modules 347 W Weight 206 What is a Timeout Period? 137 Where Can I Find More Information? 130, 150 While Alarms are Paused or Off 55 Working in the ST Map Task Window 148 X X1 Connectors and Symbols 18 X1 Multi-Measurement Module

(M3001A) 17 X2 Controls and Indicators 20 X2 Left Side 21 X2 Multi-Measurement Module

(M3002A) 18 X2 Overview 19 X2 Patient Connectors, Right Side 21 Y Yellow Arrhythmia Alarms 136 Z Zero Calibration 228 Zeroing a Pressure Measurement 185 Zeroing All Pressures Simultaneously 186 Zeroing ICP (or IC1/IC2) 185 Zeroing the Pressure Transducer 184 Zeroing the tcGas Relative Heat Power 238 456

 

 

INSTRUCTIONS FOR USE IntelliVue MP2 Patient Monitor Release G.0 with Software Revision G.0x.xx P a t i e n t M o n i t o r i n g Printed in Germany 09/08

*M8102-9001B*

Part Number M8102-9001B 4512 610 28821 S M8102-9001B 1Table Of Contents 1 Installation Installation Checklist Unpacking and Checking the Shipment 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 Extending Measurements Operating and Navigating Operating Modes Understanding Screens Using the XDS Remote Display Using the Visitor Screen Understanding Profiles Understanding Settings Changing Measurement Settings Switching a Measurement On and Off Adjusting a Measurement Wave Using Labels Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from AC Mains Power Monitoring After a Power Failure Networked Monitoring Capturing Alarm Reports and Printing 3 Whats New?

Whats New in Release G.0?

Whats New in Release F.0?

4 Alarms Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms 1 2 3 3 3 5 6 7 7 7 10 10 13 16 22 23 24 24 25 26 27 27 27 28 30 30 31 32 32 32 33 35 36 40 41 42 1 9 35 39 i Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at On/Off Alarm Recordings 5 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 6 Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients 7 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 Changing the Size of the ECG Wave 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 Lead Fallback ECG Lead Placements Capture 12-Lead EASI ECG Lead Placement ECG and Arrhythmia Alarm Overview Using ECG Alarms ECG Safety Information About Arrhythmia Monitoring Switching Arrhythmia Analysis On and Off Choosing an ECG Lead for Arrhythmia Monitoring Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring ii 53 83 89 43 45 49 50 51 51 51 53 59 83 85 85 85 86 89 89 90 90 91 92 93 94 94 95 95 95 96 96 100 101 102 103 104 105 106 106 107 110 111 117 Switching ST On and Off Understanding the ST Display and Windows Updating ST Baseline Snippets About the ST Measurement Points ST Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 8 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 9 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Display Changing Resp Detection Modes Changing the Size of the Respiration Wave Changing the Speed of the Respiration Wave Using Resp Alarms Changing the Apnea Alarm Delay Resp Safety Information 10 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 SpO2 Signal Quality Indicator (Fast SpO2 only) Assessing a Suspicious SpO2 Reading Changing the Averaging Time Setting the Measurement Mode Understanding SpO2 Alarms Pleth Wave Perfusion Numeric Perfusion Change Indicator Setting SpO2/Pleth as Pulse Source Setting Up Tone Modulation Setting the QRS Volume 11 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP 117 118 119 120 122 122 127 130 131 133 133 134 134 137 138 138 139 140 140 140 140 143 143 144 144 145 145 146 146 146 147 148 148 148 148 149 151 152 133 137 143 151 iii 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 12 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 13 Monitoring Invasive Pressure Setting up the Pressure Measurement Zeroing the Pressure Transducer 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 Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Measuring Mainstream CO2 using M3016A Measuring Microstream CO2 using M3015A Setting up all CO2 Measurements 15 Assigning Two Devices to One Patient How Can You Combine Devices?

Functions Available When the Telemetry Data Window is Displayed Functions Available For Devices Connected Via SRR General Telemetry-related Functions 16 Enhancing Telemetry Monitoring with the Monitor 17 Trends Viewing Trends Setting Up Trends Documenting Trends Trends Databases Screen Trends iv 154 154 154 154 155 155 156 157 158 159 161 162 162 163 163 163 163 165 166 168 171 173 174 177 181 182 182 187 189 192 192 193 157 159 167 177 185 187 18 Recording Starting and Stopping Recordings Overview of Recording Types Creating and Changing Recordings Templates Recorder Status Messages 19 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up 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 and Printing Manually Printer Status Messages Sample Report Printouts 20 Care and Cleaning General Points Cleaning the Monitor Disinfecting the Monitor Sterilizing the Monitor Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning Batteries and the Battery Compartment 21 Using Batteries Battery Power Indicators Checking Battery Charge Replacing a Battery Optimizing Battery Performance Battery Safety Information 22 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 23 Accessories ECG/Resp Accessories NBP Accessories 199 200 200 201 203 204 204 205 206 206 206 207 207 207 208 209 213 214 214 214 215 215 218 220 220 221 222 225 225 226 227 227 227 229 233 199 203 213 217 225 229 v 243 271 234 235 239 239 240 240 240 241 243 244 244 246 246 246 247 248 251 254 255 267 271 277 277 278 281 281 282 283 283 283 286 Invasive Pressure Accessories SpO2 Accessories Temperature Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Mainstream CO2 Accessories (for M3016A) Microstream CO2 Accessories Battery Accessories 24 Specifications Intended Use Manufacturers Information Symbols Installation Safety Information Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Out-Of-Hospital Transport - Standards Compliance Monitor Performance Specifications M4607A Battery Specifications Measurement Specifications Safety and Performance Tests 25 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 SpO2 Default Settings NBP Default Settings Temperature Default Settings Invasive Pressure Default Settings CO2 Default Settings vi 1 1Installation Installation should be carried out by qualified service personnel, either by the hospitals 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 Task 1 2 3 4 5 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 1 Installation Unpacking and Checking the Shipment Step Task 6 7 8 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 Comments Monitor with options as ordered ECG accessories NBP accessories SpO2 accessories Pressure accessories Temperature accessories CO2 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) 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. 2 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 monitors battery. MSL Cable connects to power supply (M8023A) 1 1 2 3 4 4 2 3 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. 4 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 patients 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. Test Test or Inspection to be Performed Visual Inspect the monitor, measurement accessories and cables for any damage. Power On Functionality Test Safety Tests (1) to (4) System 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. 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. 6 Setting the Date and Time 1 Installation Setting the Date and Time To set the date and time:

1 2 3 4 5 Press the SmartKeys key to enter the SmartKeys window. Select the Main Setup SmartKey to enter the Main Setup menu. Select the Date, Time screen element from the monitors 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. 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 institutions 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. If you need to enter configuration mode:

1 2 In the Main Setup menu, select Operating Modes. Select Config and enter the passcode. The passcode for configuration mode is given in the monitors 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 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). The part number is M8102-944XB, where X is a digit dependent on the language. The English training guide is M8102-9441B. 8 2 2Basic 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 monitors 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, SpO2, and optionally invasive blood pressure, temperature and CO2. 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 patients 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 217. Controls, Indicators and Connectors MP2 Overview 4 3 4 2 1 8 5 6 7 6 5 9 1 2 3 4 5 6 7 8 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 Controls, Indicators and Connectors 2 Basic Operation MP2 Controls and Indicators 6 7 5 4 3 2 8 9 10 11 1 1 On/Standby switch 2 On/Standby LED. Green when 3 4 5 6 7 8 9 monitor is on. Red indicates an error. Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected. External power LED. Green when monitor is powered from an external power source. Alarms off indicator. When alarms are suspended, the lamp is red, and the ALARMS OFF message appears on the screen. Active INOP alarm lamp in light blue. Stays lit until active INOP is acknowledged. Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is acknowledged. Silence key 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 MP2 Patient Connectors, Right Side Symbols (International) Text (English versions only) 1 2 7 4 3 6 5 1 2 3 4 5 6 MP2 Left Side 1 2 3 4 5 6 1 2 3 4 5 6 7 1 2 Pressure (option) Temperature (option) Noninvasive blood pressure SpO2 ECG sync pulse output

(See page 252 for specifications) ECG/Respiration CO2 (option) 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 monitors 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 CO2 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 CO2 extension adds microstream capnography and optionally either pressure or temperature to the monitor. The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the monitor. Only one CO2 measurement at a time is supported. M3014A Capnography M3015A Microstream 1 2 5 7 6 1 3 M3016A Mainstream 2 1 2 4 3 1 2 3 4 Pressure connectors (red) Temperature connector (brown) Mainstream/sidestream connector CO2

(optional) Cardiac Output connector 5 6 7 Inlet Microstream connector CO2 Gas sample outlet 14 Extending Measurements 2 Basic Operation M3012A Hemodynamic MMS Extension MSL Connector to MP2 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:

Key with symbol

(international) Text replaces symbol (English versions only) 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. 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 2 Basic Operation A typical main screen looks like this:

4 5 6 7 8 9 3 2 Bed9 Adult Doe, John SpO2 Sinus Rhythm 1mV HR M NBP Sys. All Sett. reset Profile Adult 10 1 11 MP2 Screen Elements Item Description Comments 1 2 3 4 5 6 Alarm volume off indicator Patient name / alarm message field Patient category and bed label / INOP message field 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. SpO2 LOW Adult Bed4 HR SpO2 ST-I ST-V6 If red and yellow alarms are active at the same time, they rotate in the alarm field. Bed4 HR Adult ST-I ST-V6 APNEA SpO2 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. APNEA SpO2 ALL ECG ALARMS OFF HR ST-I ST-V6 Network connection indicator Measurement label Paced status 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 Description 7 8 9 Measurement numeric/values Measurement wave Status line 10 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 217. 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. Measurement setup menu No Central Monit. NBP Pulse 60

Setup NBP Auto NBPs HIGH 08:28 NBP meas. + autom. cycle started Sys. Alarms :

On Al. from :

Sys Start/

Stop Mode :

Auto Stop All Repeat:

15 min NBP STAT 1 2 3 4 5 Main screen Bed4 Adult Doe, John HR SpO2 Pulse 60 Auto 15 min 18 Operating and Navigating 2 Basic Operation Key to measurement setup menu:

Item Description Comment 1 2 3 4 5 INOP and alarm message field. Wave/numerics window. Status/prompt message. Next page arrows. Measurement menu buttons. 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 Repeat 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 monitors configuration. For this reason, this book generally describes entry to a measurements 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 Measmt. Select. Admit/

Dischrge Alarm Limits Vitals Trend Profiles Alarm Volume QRS Volume Monitor Standby Touch to view more SmartKeys Main Setup is one of the SmartKeys. enter Main Setup menu - you can get to all setup windows using this key enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained. enter profile menu, or revert to default profile previous Screen change Screen, or revert to default screen quick admit a patient enter patient identification menu to admit/discharge/transfer end case to discharge a patient lock touchscreen operation set alarm limits change alarm volume change screen brightness (not for independent displays) change QRS volume 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 re-learn arrhythmia start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series start NBP measurement and measurement series 20 Operating and Navigating 2 Basic Operation start veni puncture (inflate cuff to subdiastolic pressure) stop current NBP measurement set the NBP repeat time access patient reports switch CO2 pump off zero invasive pressure transducer 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 unpair equipment and continue central monitoring with the telemetry device start 12-Lead Capture (only available if Information Center is connected) access ST Map application select measurement device 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 Not Admitted Last Name

Q W E

R

T

Y

U

I

) PO A S D F G H J K L

Z X C V B MN

Shift Alt

Back Clr Enter 21 2 Basic Operation Operating Modes Operating Modes 2 1 When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:

Select the Main Setup menu. 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 monitors 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. 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. Config 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 After closing any open menus or windows, press the Main Screen key to access the Change 2 Choose the new Screen from the Change Screens menu. Screens menu. Changing a Screens 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 2 Select the element you want to change. For example, touch the wave to enter the wave setup menu, or touch the numeric to enter the numeric setup menu. From the menu that appears, select Change Wave or Change Numeric, and then select the wave or numeric you want. 23 2 Basic Operation Using the XDS Remote Display 1 Wave B 1 Big Wave Change Screen 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 monitors default Screen is shown. Modified Screens are still available in the Change Screen menu. If the monitor is switched off and then on again, modified Screens are erased from the monitors 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). Vital Signs B 2 Waves A 2 Waves B Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. 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, Press the Main Screen key to open the Change Screen menu. Select the name of the visitor Screen configured for your monitor from the list of available Screens. 1 2 To select a Screen with waves and numerics again, Touch the gray rectangle in the center of the screen showing the visitor Screens name, or press the Main Screen key, to open the Change Screen menu and then select a Screen from the list. 24 Understanding Profiles 2 Basic Operation 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 (oF or oC) pressure unit (mmHg or kPa). 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 Doe, John Profiles Profile

: Profile Adult Patient Category

: Adult Paced Display

: No

: Vital Signs Profile Measmnt. Adult Patient Measmnt. Pedi Please Confirm To activate the highlighted settings block select Confirm Measmnt.Settings

: Measmt. Adult Please Confirm Confirm Cancel Profiles Menu, showing current settings 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. 25 2 Basic Operation Understanding Settings 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. 1 Swapping a Complete Profile Press the SmartKeys key and Either select Main Setup and then Profiles in the Setup menu. Or select the Profiles SmartKey In the Profiles menu, select Profile. 2 3 Chose a profile from the pop-up list. 4 Confirm your selection. Swapping a Settings Block 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. 3 Choose a settings block from the pop-up list. 4 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 26 Changing Measurement Settings 2 Basic Operation 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 monitors 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. 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 monitors screen. The monitor stops data acquisition and alarming for this measurement. 1 Enter the measurements 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 CO2 waves. Global Speed, for all waves not included in the other group. 27 2 Basic Operation Using Labels Changing the Wave Group Speed 1 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, Select Main Setup -> User Interface Select Global Speed or RespiratorySpeed, as required Select a value from the list of available speeds. 2 3 Changing Wave Speed for a Channel Select Change Speed. To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 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 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 Select Label. 3 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 monitors 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 28 Using Labels 2 Basic Operation 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. Unavailable measurements are grayed-out PAP ZERO+CHECK CAL

*** APNEA Measurement Selection ABP Tcore NBP SpO2 ECG Resp Temp PAP CO2 CPP Temp Change Label De-

Activate Setup SpO2 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:

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. Select the label to be corrected. 1 2 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 Setup <Measurement label>: to enter the Setup menu for the measurement and change becomes invisible to the monitor, as though it had been unplugged. the conflicting devices label to a different label. Select the De-activate pop-up key to disable the conflicting measurement. 4 29 2 Basic Operation Changing Monitor Settings Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used. If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. 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 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. Select the setting you Adjusting the Screen Brightness 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 monitoring locations and optimizes power usage for battery powered monitors. 1 2 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 monitors Configuration Mode. 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. In the Main Setup menu, select Date, Time. 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. 1 2 3 Checking Your Monitor Revision Select Main Setup -> Revision to open the Monitor Revision menu. Select the correct device from the device pop-up keys. 1 2 30 Getting Started 2 Basic Operation 3 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. Check all the external cables, plug-ins and accessories. 2 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 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. 5 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. 31 2 Basic Operation Disconnecting from AC Mains Power 2 Connect the required patient cables and sensors. The connectors are color-coded to the patient cables and sensors for easy identification. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor. 2 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. 3 Refer to the appropriate measurement section for details of how to perform the measurements you require. 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, using one of the optional interfaces:

Standard wired LAN Wireless LAN IntelliVue Instrument Telemetry System (IIT) WARNING Do not connect patient monitors to the standard hospital network. 32 Capturing Alarm Reports and Printing 2 Basic Operation 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 wireless networks in comparison to those on wired networks. Capturing Alarm Reports and Printing You can print out standard reports, alarm reports and trends with the IntelliVue PC Printing Solution. This is a software package which allows you to print to a standard, off-the-shelf printer or to an electronic file such as PDF. You can download the IntelliVue PC Printing Solution free-of-charge from the Internet and install it on an existing PC. Capturing Alarm Reports The monitor can be set up to automatically capture alarm reports, triggered by selected alarms. The necessary settings must be made in Configuration mode. When one of the selected alarms occurs, the monitor automatically captures the alarm and creates a report which is stored in the database. As soon as the monitor is connected to a PC or network with the IntelliVue PC Printing Solution software, it will automatically print the reports, or send them to a patient-specific folder as an electronic file. 33 2 Basic Operation Capturing Alarm Reports and Printing 34 3 3Whats New?

This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital. Whats New in Release G.0?

Short Range Radio Interface for MP2 A short range radio interface is now available for the MP2 monitor. This allows a telemetry transceiver with a short range radio adapter to be assigned to the monitor, resulting in a direct connection. The measurement data from the telemetry transceiver appear directly on the monitor screen with a minimal delay and are combined with the monitor data in one sector at the Information Center. IntelliVue XDS Solution Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. New Fields in the Admission Form A Middle Name field is now available in the admission form - whether it appears is configurable. Two additional ID fields, Lifetime Id and Encounter Id, can also be configured to appear and their names can be customized to fit hospital requirements. SpO2 Enhancements Additional SpO2 Labels - SpO2pr and SpO2po labels have been added. New manual measurement mode when telemetry devices are connected via a short range radio link. Signal Quality Indicator displayed with the SpO2 numerics. ECG Enhancements New */**Afib yellow alarm when an atrial fibrillation waveform is detected. QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points. 35 3 Whats New?

Whats New in Release F.0?

Whats New in Release F.0?

QT/QTc Interval Monitoring QT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a 'QTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and 'QTc enabling alarm notification. Manual Data Entry Measurement values (for example lab data or manually measured temperatures) can be entered manually into the monitor and stored in the database. They can then be used for trends, reports and also be displayed as a numeric on screen, if required. Horizon Trend Enhancements The trend indicator arrow indicates how the patient trend has developed in a set time period. This period is now configurable and can be set to 10 minutes, 5 minutes or 2 minutes. The horizon (or baseline) can now be set to a range or to a specific value. Connecting an MP5 to a Monitor (Companion Mode is indicated) The MP5 monitor can be connected to one of the MP20 to MP90 monitors (then called the host monitor) and used like an MMS. This provides monitoring continuity in transport situations allowing measurement data and patient demographics from the MP5 to be transferred to another monitor. When the MP5 is connected to a host monitor, no alarms will be announced on the MP5. NBP - Programmable Measurement Sequence Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously you can have regular measurements continue after the sequence has run. New Printing Options For Reports Reports can now also be printed via an external PC-based print server or to an internal print database, when no printer is available (for example, during transport). As soon as a printer becomes available, the reports stored in the database will print automatically. Manual Pairing At Monitor Previously, devices could only be manually paired at the Information Center. You can now pair devices at the monitor as long as the monitor is already connected to the Information Center. Moving Windows And Menus Windows and menus can now be moved on the monitor screen. Using touch or a mouse you can select the title of a window and then drag it across the screen. Some positions on the screen are not allowed, such as ones overlapping the alarm field or the monitor info line. Invasive Pressure Changes Wave cursor - A cursor is now available on the realtime pressure wave to allow you to define a position and store the corresponding value. Reduced alarm limit steps in lower ranges - The alarm limits setting in 2 mmHg steps is now possible in ranges up to 50 mmHg (previously up to 30 mmHg). 36 Whats New in Release F.0?

3 Whats New?

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 and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings. New Smart Keys A SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used. Better Visibility Of Gridlines The brightness of the gridlines on the realtime waves has been increased for better visibility. 37 3 Whats New?

Whats New in Release F.0?

38 4 4Alarms 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 ECG/ARRH ALARM OFF (yellow only, no red INOP) CUFF OVERPRESS CUFF NOT DEFLATED OCCLUSION TELE DISCONNECT. Replace TeleBatt 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. n** HR HIGH 39 4 Alarms Visual Alarm Indicators 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. 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 (

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

) at the side. If both red and 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 monitors 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. 40 Audible Alarm Indicators 4 Alarms 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). 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 monitors Configuration Mode, you can:

increase the alarm volume of unacknowledged alarms at regular intervals change the interval between alarm sounds (ISO/IEC Standard 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 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 41 4 Alarms Acknowledging Alarms 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 monitors 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. 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 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. APNEA 42 Pausing or Switching Off Alarms 4 Alarms 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. 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, Select Main Setup -> Alarms -> Alarm Settings 1 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. Depending on the configuration, you may need to select Confirm to complete the change. To Switch All Alarms Off You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause. Alarms Off 43 4 Alarms Pausing or Switching Off Alarms Press the Alarms key. Pausing alarms infinitely is the same as switching them 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. 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. No alarms are sounded and no alarm messages are shown. INOP messages are shown but no INOP tones are ALARMS PAUSED 1:28 ALARMS OFF sounded. The only exceptions are the INOPs CUFF NOT DEFLATED, CUFF OVERPRESS 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 patients condition closely. To extend the alarm pause time to five or 10 minutes, 44 Alarm Limits 4 Alarms 1 2 Select one of the alarm fields. This calls up the Review Alarms window. 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, SpO2), 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. 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 85120 HR 50 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. 45 4 Alarms Alarm Limits 1 Alarm Limits Off 2

'QTc SpO2 NBPs ABPs All Lim. Narrow 3 All Lim. Wide 1 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 2 3 Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Set narrow or wide alarm AutoLimits for all measurements 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:

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 measurements Setup Menu, 1 2 In the measurements 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 SpO2:

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. 46 Alarm Limits 4 Alarms 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. 1 ABPs 2 Alarms On/Off 3 4 5 6 7 8 10 9 1 2 3 4 5 6 7 8 9 10 Parameter label High red alarm (view only) 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) Graphic view of alarm limits with currently measured value To change alarm limits, 1 Enter the Alarm 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. 47 4 Alarms Alarm Limits 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 wide and narrow limits have a fixed relationship to the measured value within the non-

pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinicians judgement about the specific patient. 3 1 2 2 1 4 Wide alarm limits Narrow alarm limits Alarm Limits Measurement value 1 2 3 4 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 patients 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 monitors Configuration Mode. AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitors 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. 48 Reviewing Alarms 4 Alarms Documenting Alarm Limits To print a list of all current alarm limit settings on an available printer:

Select the Main Setup SmartKey. Select Reports from the Main Setup menu. Select Alarm Limits. 1 2 3 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 23 Apr 14:08:30 23 Apr 14:08:19 23 Apr 14:42:55

***Apnea Alarms Silenced

**AwRR LOW (14<15)

**SpO2 NON-PULSAT. Alarm Limits PauseAl. 5 MIn PauseAl. 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. 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. 49 4 Alarms Latching 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 monitors 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 R&Y Off R&Y R&Y Off Off R Off R R R = red alarms, Y = yellow alarms Alarm Latching Behavior 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 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 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 112 for information on one-star yellow alarms latching behavior. 50 Testing Alarms Testing Alarms 4 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 SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed. 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 1 2 3 4 5 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. 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. 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. 51 4 Alarms Alarm Recordings 52 5 5Patient Alarms and INOPs This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 59. 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, SpO2, 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. Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices. Alarm Message

*/**AFIB

***APNEA or

***APNEA mm:ss sec or

***APNEA >10min

***ASYSTOLE

**awRR HIGH

**awRR LOW

**BIS HIGH From Condition Indication ECG/

Arrhythmia CO2, Resp, Spirometry Atrial fibrillation waveform detected Respiration has stopped for longer than the preset apnea time. mm:ss denotes the Apnea duration in minutes and seconds. ECG CO2, Resp, AGM 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. CO2, Resp, AGM The airway respiration rate has dropped below the low alarm limit. BIS The Bispectral Index value has exceeded the high alarm limit. yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 53 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message

**BIS LOW From BIS Condition Indication The Bispectral Index value has dropped below the low alarm limit.

***BRADY/P xxx<yyy or

***BRADY xxx<yyy

**CCO/CCI HIGH

**CCO/CCI LOW

**CPP HIGH

**CPP LOW

***DESAT or

***DESAT xxx<yyy

**etCO2 HIGH

**etCO2 LOW

**etO2 HIGH

**etO2 LOW Press, SpO2 The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit. Continuous Cardiac Output or CC Index is above the high alarm limit. CCO CCO CPP CPP SpO2 CO2, Resp, AGM Continuous Cardiac Output or CC Index is below the low alarm limit. The CPP value has exceeded the high alarm limit. The CPP value has fallen below the low alarm limit. The SpO2 value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. The end tidal CO2 high alarm limit has been exceeded. CO2, Resp, AGM The end tidal CO2 value has fallen below the low alarm limit. O2, AGM The end tidal O2 high alarm limit has been exceeded. O2, AGM The end tidal O2 value has fallen below the low alarm limit.

EVENT:<GRP>

*/**/*** EVENT at Information center Event surveillance Event surveillance

***EXTREME BRADY

***EXTREME TACHY ECG ECG An event has occurred and the event notification is configured to alarm.

<GRP> is the event group An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group. The bradycardia limit has been exceeded. The tachycardia limit has been exceeded. 54 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. 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 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone. event group name flashes, yellow or red alarm lamp and alarm tone

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message

**HR HIGH From ECG Condition Indication The heart rate high alarm limit has been exceeded.

**HR LOW ECG The heart rate has fallen below the low alarm limit.

*/**IRREGULAR HR

*/**MISSED BEAT

*/**MULTIFORM PVCs ECG/

Arrhythmia ECG/

Arrhythmia ECG/

Arrhythmia

**NBP HIGH

**NBP LOW NBP NBP

*/**NON-SUSTAIN VT ECG/

Arrhythmia

*/**PACER NOT CAPT ECG/

Arrhythmia

(paced patients only)

*/**PACER NT PACING ECG/

*/**PAIR PVCs

*/**PAUSE Arrhythmia

(paced patients only) ECG/

Arrhythmia ECG/

Arrhythmia Consistently irregular heart rhythm. No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only). Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats. 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. 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. 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. A missed beat with a pace pulse was detected. A missed beat without a pace pulse was detected. A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected. No beat detected for a period greater than the pause threshold. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. 55 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message

***<Pressure>

DISCONNECT From PRESS

***<Pressure> HIGH PRESS

**<Pressure> HIGH PRESS

***<Pressure> LOW PRESS

**<Pressure> LOW PRESS

**Pulse HIGH

**Pulse LOW

*/**PVCs/min HIGH

**QTc HIGH

**'QTc HIGH

*/**R-ON-T PVCs PRESS SpO2 PRESS SpO2 ECG/

Arrhythmia ECG/QT ECG/QT ECG/

Arrhythmia

**RR HIGH RESP Condition Indication 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). 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. 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. 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. 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. The pulse rate has exceeded the high alarm limit. The pulse rate has dropped below the low alarm limit. 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

'QTc value has exceeded the 'QTc high limit for more than 5 minutes 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.). The respiration rate has exceeded the high alarm limit. numeric flashes, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, red alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 56 Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message

**RR LOW From RESP Condition Indication The respiration rate has dropped below the low alarm limit.

*/**RUN PVCs HIGH ECG/

Arrhythmia A run of PVCs greater than 2 was detected.

**<SO2 label> HIGH SvO2/SO2

**<SO2 label> LOW SvO2/SO2

**<SpO2 label> HIGH SpO2

**<SpO2 label> LOW SpO2 The the measured intravascular oxygen saturation has exceeded the high limit. The measured intravascular oxygen saturation has fallen below the low limit. The arterial oxygen saturation has exceeded the high alarm limit. The arterial oxygen saturation has fallen below the low alarm limit.

**ST<n> HIGH

**ST<n> LOW ECG/ST The ST elevation in lead <n> is higher than the limit. ECG/ST The ST depression in lead <n> is lower than the limit.

**ST MULTI <n>,<n> ECG/ST

**ST MULTI at Information Center ECG/ST

*/**SVT ECG/

Arrhythmia

***TACHY/P xxx>yyy or

***TACHY xxx>yyy

**Tblood HIGH

**Tblood LOW

**tcpO2 HIGH/

**tcpCO2 HIGH

**tcpO2 LOW/

**tcpCO2 LOW C.O. C.O. tcGas tcGas The ST depression or elevation is outside of the limit in two or more leads <n> and <n>

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. A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit. exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit. The blood temperature value has exceeded the high alarm limit. The blood temperature value has fallen below the low alarm limit. The tcpO2 or tcpCO2 value has exceeded the high alarm limit. The tcpO2 or tcpCO2 value has fallen below the low alarm limit. Press, SpO2 The heart rate from the Pulse signal has numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. 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. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. 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, yellow alarm lamp, alarm tone

(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. 57 5 Patient Alarms and INOPs Patient Alarm Messages From Condition Indication Alarm Message

*/**/***TELE ALARM

**<Temperature label> HIGH

**<Temperature label> LOW

*/**VENT BIGEMINY

***VENT FIB/TACH

*/**VENT RHYTHM

*/**VENT TRIGEMINY

***VTACH Telemetry TEMP TEMP ECG/

Arrhythmia ECG ECG/

Arrhythmia ECG/

Arrhythmia ECG, Arrhythmia This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window. The temperature has exceeded the high alarm limit. The temperature has fallen below the low alarm limit. A dominant rhythm of N, V, N, V (N =

supraventricular beat, V = ventricular beat) was detected. A fibrillatory waveform for 4 consecutive seconds was detected. A dominant rhythm of adjacent Vs >

vent rhythm limit and ventricular HR <

VTach HR limit was detected. A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V =

ventricular beat) was detected. Ventricular tachycardia has been detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach HR limit). A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information. yellow or red alarm lamp and alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone.

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

**/***VueLink ALARM at Information Center VueLink 58 Technical Alarm Messages (INOPs) 5 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 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. 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 INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. BATTERIES INCOMP or BATT 1/

BATT 2 INCOMPAT INOP tone Source What to do 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). See <Pressure label> INOPS (under Pressure). PRESS PRESS 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 Monitor PRESS Battery Battery Battery Battery Batteries Batteries scale to display complete wave. 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. See <Pressure label> INOPS (under Pressure). The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery 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 battery cannot be used with this monitor. Replace with the correct battery (M4607A). 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 re-

issued 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. 59 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BATTERIES LOW or BATT 1/

BATT 2 LOW INOP tone BATTERIES MALFUNC. or BATT 1/BATT 2/ BATTERY MALFUNCT. 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 BATT 1/BATT 2 MISSING INOP tone. During this INOP, alarms cannot be paused or switched off. BIS CABLE INCOMPAT INOP tone. 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 Source What to do Batteries The estimated battery-powered operating time remaining is less than 20 minutes. 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 Batteries The battery in the Telemetry device is low and must be replaced soon. The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately. 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 Philips-

supported 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. 60 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication BIS ENGINE MALFUNC INOP tone 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 Source What to do BIS BIS BIS BIS BIS BIS BIS BIS BIS BIS Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine. 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. 61 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BIS SENSOR USAGE INOP tone 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 Source What to do BIS BIS BIS BIS BIS BIS ECG/

Arrhythmia QT ST C.O. C.O. Excessive sensor usage. Replace sensor. A Cyclic Impedance Check will start automatically. 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. 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. 62 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication CCO NO <Pressure label>

numeric is replaced by -?-

INOP tone may sound CCO NO CALIBRATION numeric is replaced by -?-

CCO NO PRESS at Information Center CCO NOT SUPPORTED numeric is replaced by -?-

INOP tone 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. C.O. C.O. C.O. C.O. C.O. CENTRAL:TELE ONLY INOP tone Charge BATT1/BATT2 now INOP tone Monitor Batteries 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 pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. 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 pressure from an external device 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. 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. The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. 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. The pressure measurement must be zeroed before a CCO calibration. System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station. Battery must be charged. Connect the monitor to mains power or exchange the battery. 63 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication 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

!!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 Source What to do Batteries Monitor Battery Monitor Telemetry Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor/

Multi-

Measuremt Module Monitor Monitor Monitor 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. There was a problem loading the drug settings. Check that the settings are complete and correct. Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate. 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. 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. 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. 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. 64 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Check Screen Res INOP tone Check Settings INOP tone Check SpeedPoint INOP tone. Check Touch Input INOP tone Check Waves INOP tone CHK ECG Sync Cable INOP tone Chk IndepDsp Cable CHK MSL Connection INOP tone Chk SpO2T Settings INOP tone C LEAD OFF HR Numeric is replaced by -?- for 10 seconds. INOP tone. CO2 AUTO ZERO Numeric is replaced by a -?-

if the Autozero lasts >15 sec, INOP tone sounds. CO2 CAL MODE CO2 numeric displays current CO2 value for accuracy check CO2 CAL RUNNING Numeric is replaced by a -?-

CO2 CHANGE SCALE CO2 CHK ADAPTER Numeric is replaced by a -?-

INOP tone. CO2 CHECK CAL Numeric is replaced by a -?-

INOP tone. Source What to do Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Telemetry ECG CO2 CO2 CO2 CO2 CO2 CO2 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. 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. Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel. 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. Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate. 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 CO2 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 CO2 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 CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. 65 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do CO2 C.O. C.O. CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 The CO2 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. 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 CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off. There is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 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 CO2 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 CO2 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. INOP Message, Indication CO2 DEACTIVATED INOP tone. C.O. DEACTIVATED INOP tone. C.O. EQUIP MALF Numeric is replaced by a -?-

INOP tone. CO2 EQUIP MALF Numeric is replaced by -?-

INOP tone. CO2 FAILED CAL Numeric is replaced by -?-

INOP tone. CO2 NO SENSOR Numeric is replaced by -?-

INOP tone. CO2 NO TRANSDUC Numeric is replaced by -?-

INOP tone. CO2 NO TUBING Numeric is replaced by -?-

INOP tone.

(!!/!!!)CO2 OCCLUSION Numeric is replaced by a -?-

INOP tone. CO2 OVERRANGE Numeric is replaced by -?-

INOP tone. CO2 PUMP OFF Numeric is replaced by a -?-. CO2 PURGING Numeric is replaced by a -?-

INOP tone. CO2 SENS. WARMUP Numeric is displayed with a -?-

Microstream CO2: INOP tone. Mainstream CO2: no INOP tone 66 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do C.O. CO2 CO2 CO2 CO2 CO2 CPP CPP NBP NBP INOP Message, Indication C.O. UNPLUGGED numeric is replaced by -?-

INOP tone. CO2 UPDATE FW Numeric is replaced by a -?-

INOP tone. CO2 WAIT CAL2 Numeric is replaced by a -?-

CO2 ZERO FAILED Numeric is replaced by a -?-

INOP tone. CO2 ZERO REQUD Numeric is replaced by a -?-

INOP tone CO2 ZERO RUNNING CPP CHK SOURCES Numeric is replaced by a -?-

CPP CHK UNITS Numeric is replaced by a -?-

!!/!!!CUFF NOT DEFLAT Numeric is displayed with a -?-

Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off.

!!/!!!CUFF OVERPRESS Numeric displayed with -?- ;

Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off. CVP INOPS DEVICE CHECK SETUP INOP tone. DEVICE CHECK CONF. INOP tone. DEVICE DEMO DATA INOP tone 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 CO2 sensor. If the INOP persists, contact your service personnel. 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.]

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. See <Pressure label> INOPS (under Pressure). PRESS IntelliBridge Device identification completed, but communication could not be established due to timeout. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but communication could not be established due to error. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode. 67 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication DEVICE REAL DATA INOP tone

<Device> UNPLUGGED INOP tone. DEVICE UNSUPPORTED INOP tone.

<EC10/EC40> EQUIP MALF INOP tone. ECG/ARRH ALARM OFF

!!ECG/AR ALARM OFF 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. ECG EL. NOISY <ECG LEAD>

(!!/!!!)ECG LEADS OFF ECG NOISY SIGNAL INOP tone. ECG ECG ECG ECG Source What to do IntelliBridge The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. IntelliBridge The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but no appropriate device driver installed. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Malfunction in the IntelliBridge module. If this message ECG ECG appears repeatedly, the module must be replaced. Contact your service personnel. 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 alarm source. Contact your service personnel. The ECG hardware is faulty. Monitor 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. Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. 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. The signal electrode in one or both channels exceeds the user-

selected 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. ECG EcgOut EQUIP MALF INOP tone EEG EQUIP MALF INOP tone EEG IMPEDANCE HIGH or EEG1 and/or EEG2 IMPED. HIGH EEG EEG EEG<X> LEAD OFF <n>

[X = channel, n = electrode]

EEG 68 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication EEG<X> LEAD OFF

[X = channel]

at Information Center 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.

!!INSERT BATTERY Severe yellow INOP tone. During this INOP, alarms cannot be paused or switched off. Intell.Dsp Malf. INOP tone Intell.Dsp Missing Intell.Dsp Unsupp. Internal.Comm.Malf INOP tone INVALID LEADSET EEG EEG EEG EEG EEG EEG EEG PRESS FMS FMS PRESS PRESS Display Display Battery Display Display Display Monitor Telemetry 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. 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 electro-

surgery. 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. 69 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication LA LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. LAP INOPs LEADSET UNPLUGGED LL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. MCC Reversed INOP tone MCC Unsupported INOP tone Meas. DEACTIVATED MEASSRV UNSUPPORTD INOP tone MMS Ext. EQUIP MALF INOP tone MMS Ext. UNPLUGGED INOP tone MMS Ext. Unpowered INOP tone MMSExt.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. MSL Power Overload INOP tone. Source What to do ECG PRESS Telemetry ECG Monitor Monitor MMS MMS Extension MMS Extension MMS Extension MMS Extension MMS MMS Monitor Monitor Monitor Monitor 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). The leadset has been unplugged from the telemetry device. 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. 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. 70 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication NBP Deactivated INOP tone. NBP EQUIP MALF Numeric is replaced by -?-

INOP tone. NBP INTERRUPTED Numeric is replaced by -?-

INOP tone. NBP NBP NBP NBP MEASURE FAILED Numeric may be displayed with a -?-

INOP tone. NBP No Central Monit. INOP tone Monitor 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. 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.

!!/!!! NO DEVICE DATA NO DEVICE DATA NO ECG AT CENTRAL NO ECG SOURCE NO PPV FROM MeasSrv at Information Center NO PPV FROM <Device>

OUT OF AREA P/P1/P2/P3/P4 INOPS PAP INOPS PPV BAD <Pressure Label>

SIGNAL IntelliBridge Communication with connected device has been lost. Monitor Telemetry MMS or FMS MMS or FMS Telemetry PRESS PRESS PPV The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device. A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. 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. The telemetry device has left the access point coverage area. 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. 71 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication PPV BAD SIGNAL at Information Center PPV CHK SOURCES

<Pressure label> ARTIFACT Numeric questionable

<Pressure label>

DEACTIVATED INOP tone

<Pressure label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<Pressure label> NO TRANSDUCER Numeric is replaced by -?-

INOP tone.

<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

<Pressure label>

UNPLUGGED INOP tone.

<Pressure label>

ZERO+CHECK CAL Numeric is replaced by -?-

Source What to do PPV PPV PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS The arterial pressure source selected for PPV is not providing a pulsatile signal. 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. 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. 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. 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. 72 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<pTemp label> CHECK PROBE Numeric is replaced by -?-

INOP tone.

<pTemp label> DEACTIVATED INOP tone.

<pTemp label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<pTemp label> INCOMPAT.

<pTemp label> MEAS FAILED Numeric is replaced by -?-

INOP tone.

<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 PW:Check Settings PW in conflict RA LEAD OFF Numeric is replaced by -?-

INOP tone. RAP INOPS Rem.Alarmdev.Malf INOP tone Rem. Display Malf. Source What to do Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Protocol Watch Protocol Watch Protocol Watch ECG PRESS Monitor Remote display 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. 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 40C /50 to 104F). 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. 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 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). 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). 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. There is a problem with an input device at the remote display. Perform a visual and functional check of all input devices. Contact your service personnel. 73 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication

!!/!!! 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 LEADS OFF Numeric is replaced by -?-

INOP tone. RL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. Settings Malfunc. INOP tone.

<SO2 Label> CAL FAILED Numeric is replaced by -?-

INOP tone.

<SO2 Label> CAL MODE Numeric is replaced by -?-

INOP tone.

<SO2 Label>CAL REQUIRED Numeric is replaced by -?-

INOP tone.

<SO2 Label> CANNOT MEAS Numeric is replaced by -?-

INOP tone.

<SO2 Label>CONFIG ERROR Numeric is replaced by -?-

INOP tone.

<SO2 Label> CONN OPTMOD Numeric is replaced by -?-

INOP tone.

<SO2 Label> EQUIP MALF Numeric displays -?-. INOP tone SO2 INCOMPATIBLE INOP tone

<SO2 Label> IN-VIVO CAL Source What to do Telemetry The battery in the telemetry device is almost empty and must be replaced. RESP Contact your service personnel. The RESP hardware is faulty. RESP RESP ECG Monitor SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 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. 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. The monitor cannot use the predefined settings for monitoring. Contact your service personnel. 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 signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter. The Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode. The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds. The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel. The SO2 Module or Optical Module is not supported. Contact your service personnel. 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. 74 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<SO2 Label>LIGHT INTENS Numeric is replaced by -?-

INOP tone.

<SO2 Label> LOW LIGHT Numeric is replaced by -?-

INOP tone.

<SO2 Label> NO OPTMOD Numeric is replaced by -?-

INOP tone.

<SO2 Label> OPTMOD MALF

<SO2 Label> PRE-INS CAL Numeric displays -?-

INOP tone

<SO2 Label> UNPLUGGED Numeric displays -?-. INOP tone SO2 UPGRADE INOP tone

<SO2 Label> WARMUP Numeric is displayed with ?

SOME ECG ALRMS 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 Source What to do SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 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 capability is needed, use another Optical Module. The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete. Measurement switched on and SO2/SvO2 module unplugged from the rack. The SO2 module is currently in upgrade mode. Monitoring is not possible in this mode. The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished. Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile. Contact your service personnel to check the speaker and the connection to the speaker. Monitor 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. 75 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication SPIRO NO BREATH SPIRO GAS COMPENS?

SPIRO PATIENT CAT.

'SpO2 CHK SOURCES Numeric is replaced by -?-

'SpO2 CHK UNITS Numeric is replaced by -?-

<SpO2 label> DEACTIVATED INOP tone

<SpO2 label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<SpO2 label> ERRATIC Numeric is replaced by -?-

INOP tone.

<SpO2 label> EXTD. UPDATE Label is displayed with a -?-

(questionable numeric)

<SpO2 label> INTERFERNCE Numeric is replaced by -?-

INOP tone.

<SpO2 label> LOW PERF Label is displayed with a -?-

(questionable numeric)

<SpO2 label> NOISY SIGN. Numeric is replaced by -?-

INOP tone.

<SpO2 label> NON-PULSAT. Numeric is replaced by -?-

INOP tone.

<SpO2 label> NO SENSOR Numeric is replaced by -?-

INOP tone.

<SpO2 LABEL> POOR SIGNAL Label is displayed with a -?-

(questionable numeric) 76 Source What to do 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. SpO2 Difference SpO2 Difference SpO2 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. 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 SpO2 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 or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel. SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 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 SpO2 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 SpO2 measurement is poor and measurement accuracy may be compromised. Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<SpO2 LABEL> PULSE?

Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> SEARCHING Numeric unavailable

<SpO2 label> SENSOR MALF Numeric is replaced by -?-

INOP tone.

<SpO2 LABEL> SENSOR OFF Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> UNKN.SENSOR Numeric is replaced by a -?-

<SpO2 LABEL> UNPLUGGED Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> UPGRADE Label is displayed with a -?-, numeric is unavailable Sp - vO2 CHK SOURCES Numeric is replaced by -?-

Sp - vO2 CHK UNITS Numeric is replaced by -?-

SRR INTERFERENCE INOP tone SRR INVALID CHAN INOP tone SRR MALFUNCTION 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 TAAP DISABLED INOP tone Tamb INOPs Tart INOPs Source What to do SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 Sp - vO2 Sp - vO2 Monitor Monitor The detectable pulsations of the SpO2 signal are outside the specified pulse rate range. SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. The SpO2 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 SpO2 measurement. Use only specified sensors and cables. An SpO2 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 SpO2 measurement is currently in UPGRADE mode. Monitoring is not possible in this mode. 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 short range radio connection has interference from another device. Try using another channel. The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration. Malfunction in the short range radio device. If the INOP persists contact your service personnel. 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 TEMP Monitor currently being measured. The monitor is using the CVP value preset in the Setup SVR menu. See <Temp label> INOPs (under Temp) The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor. TEMP TEMP See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp) 77 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Tblood NO TRANSDUC Numeric is replaced by -?-

INOP tone Tblood OVERRANGE Numeric is replaced by -?-

Tcereb INOPS Tcore INOPs tcpO2 (or tcpCO2 or tcGas) CAL FAILED Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL REQUIRD Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL RUNNING Numeric displays first -?- , then numeric is displayed with a ?

tcpO2 (or tcpCO2 or tcGas) CHECK TIME tcpO2 (or tcpCO2 or tcGas) CHANGE SITE If Heat Switch Off is configured to Yes, numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) EQUIP MALF Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) NO TRANSDUC Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) STABILIZING Numeric is displayed with a ?

tcpO2 (or tcpCO2 or tcGas) UNPLUGGED Numeric is replaced by -?-

INOP tone. TELE CONFIG UNSUPP INOP tone Source What to do C.O. No transducer attached to the module or catheter disconnected. C.O. Tblood out of range 17C - 43C. TEMP TEMP tcGas tcGas tcGas See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp). A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration 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 calibration chamber on the module, connect the calibration unit to the calibration 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 tcpO2/tcpCO2 calibration is finished. tcGas Site Timer due to time out in 15 minutes or less. tcGas tcGas tcGas tcGas 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 tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement. 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. Monitor Telemetry device not supported (companion mode) 78 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication

!!/!!!TELE DISCONNECT INOP tone TELE EQUIP MALF INOP tone TELE INCOMPATIBLE

!!/!!! TELE INOP Severe yellow/red INOP tone. Tele Sync Unsupp. INOP tone TELE UNSUPPORTED INOP tone

<'Temp> CHK SOURCES Numeric is replaced by -?-

<'Temp> CHK UNITS Numeric is replaced by -?-

<Temp label> DEACTIVATED INOP tone Telemetry Monitor Monitor Telemetry Telemetry Monitor TEMP Difference TEMP Difference TEMP

<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 TEMP Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup. For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.) If this INOP persists, ask your service personnel to survey the interference sources. The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device. SRR-enabled telemetry device is not supported by this central software revision. Please check configuration. Check for further details at the Information Center or in the Telemetry Data window on the monitor. The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above. 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. 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. Make sure the TEMP probe is connected to the MMS or module. If you silence this INOP, the measurement will be switched off. 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. 79 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do TEMP Try changing the application site of the transducer.

[The temperature is less than -1qC, or greater than 45qC.]

Monitor See <Temp label> INOPs (under Temp). TEMP TEMP TEMP TEMP TEMP TEMP PRESS Monitor TEMP IntelliBridge Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary. 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. 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. PRESS ECG VueLink VueLink Monitor INOP Message, Indication

<Temp label> OVERRANGE Numeric is replaced by -?-

INOP tone. Tesoph INOPS TEXT UPLOAD FAILED INOP tone 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.

<VueLink option> CHK CABLE INOP tone.

<VueLink option> CHK CONF. INOP tone. 80 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<VueLink option> CHECK SETUP INOP tone. VueLnk EQUIP MALF INOP tone. VueLnk NO CONFIG INOP tone. VueLnk UNPLUGGED INOP tone. Source What to do VueLink VueLink VueLink VueLink 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. 81 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) 82 6 6Managing 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. NOTE It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center. To admit a patient, 1 Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window. SBed10 Adult Doe, John Patient Demographics Last Name

: Doe First Name

: John MRN Patient Cat. Admit Patient

: 12345678

: Adult Transfer Dischrge Patient End Case 83 6 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 patients last name (family name), for example Smith. First Name: Enter the patients first name, for example Joseph. Middle Name (if configured to appear): Enter the patients middle name. Lifetime Id, Encounter Id: Whether these fields appear and how they are labelled can be configured for your hospital. One or both fields may be displayed and the labels may read:

MRN, Case Id, Visit Id, etc. Enter the appropriate data for the fields displayed. 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 patients height. Weight: Enter the patients weight. BSA: The monitor calculates the body surface area automatically. Date Of Birth: Enter the patients 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. Select Confirm. The patient status changes to admitted. 5 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 patients name appears on the bedside monitor and the Information Center. 84 Quick Admitting a Patient 6 Managing Patients 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. Quick Admitting a Patient 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. Select the Quick Admit SmartKey. 1 2 Enter the required data (ID fields 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). 3 4 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 ID field 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 WARNING Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient. 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, Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window and associated pop-up keys. 1 85 6 Managing Patients Transferring Patients 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 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, SpO2, 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 1 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. 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 patients 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 mismatch, a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer. 3 4 Verify that the settings for patient category and paced mode are correct. If you accidentally transfer a patient, use Re-Admit to restore this patients 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. 86 Transferring Patients 6 Managing Patients 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. Resolving Patient Information Mismatch When you connect together devices which store patient demographic data, for example:

an MMS and a monitor, an X2 or MP5 and a host monitor, a monitor and an Information Center, the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical. WARNING 1 When a monitor is connected to an Information Center by the wireless IntelliVue Instrument 2 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. It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Category, may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in the case of asystole. It is important that the Patient Category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set. In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a telemetry device at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center. 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 Select Patient 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. For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patients data and ask Complete transfer of this patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. 87 6 Managing Patients Transferring Patients 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. 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 by selecting one of the sectors in the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. Select Patient DOE, JOHN F 1234HG9556, 2008/00123 Adult Non-Paced MILLER, Adult Paced Same Patient New Patient Patient Mismatch - If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient. Patient Mismatch - If Both Patient Data Sets Are Correct A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor. Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor. 88 7 7ECG, 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 105), ST monitoring (see page 117) and QT monitoring (see page 127). Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity. Select sites with intact skin, without impairment of any kind. 1 2 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. 4 Dry skin thoroughly. 5 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 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. 2 89 7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads 1 - ECG Connector 1 3 Attach the electrode cable to the patient cable. 4 Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display. CAUTION 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 is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis. You should choose a lead as primary or secondary lead that has the following characteristics:

the QRS complex should be either completely above or below the baseline and it should not be biphasic the QRS complex should be tall and narrow the P-waves and T-waves should be less than 0.2 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. 90 Understanding the ECG Display 7 ECG, Arrhythmia, ST and QT Monitoring 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. 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. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation. Understanding the ECG Display Your display may be configured to look slightly different. 1 8 2 3 4 5 M EASI 7 Paced Rhythm HR bpm 6 1 2 3 4 5 6 7 8 Lead label of the displayed wave 1 mV calibration bar Pacer spikes Pace pulse markers Current heart rate Current heart rate alarm limits EASI lead placement label ECG Filter label ECG HR numeric: This is the heart rate 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. 91 7 ECG, Arrhythmia, ST and QT Monitoring Monitoring Paced Patients 1 Pacer spikes configured to have a fixed size 1 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. If so configured, the monitor can supply its own synchronization marks; in this case the synchronization marks from a defibrillator will not be shown. ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the left side. Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this:

1 2 1 2 Normal Beats Pace Pulses/Beats You should choose a lead as primary or secondary lead that has these characteristics:

the normal QRS complex 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 complex 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. 92 Changing the Size of the ECG Wave 7 ECG, Arrhythmia, ST and QT Monitoring 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. When Paced is set to Yes:

Paced Pace Pulse Rejection is switched on. This means that pacemaker pulses are Non-Paced not counted as extra QRS complexes. 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. 1 Repolarization tail

(note width) 1 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. 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, or an individual size using the Size Up / Size Down keys, 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. 93 7 ECG, Arrhythmia, ST and QT Monitoring Changing the Volume of the QRS Tone 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 2 In the Setup ECG menu, select Adjust Size. 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 menu select QRS Volume and then select the appropriate volume from the pop-up list. 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 Setup ECG menu, select Filter and then select the appropriate setting. Monitor: Use under normal measurement conditions. Ext. Monitor: Use for pediatric and neonatal patients when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting. 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 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. 94 Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 7 ECG, Arrhythmia, ST and QT Monitoring Diag: 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. When you are using a telemetry transmitter connected via short range radio to the monitor, the upper bandwidth for all filter settings is limited to 40 Hz. Selecting Positions of Va and Vb Chest Leads (for 6-

lead 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. In the Setup ECG menu, select Va Lead. Select the position used from the list. Select Vb Lead and select the position used from the list 1 2 3 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. 95 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback ECG Leads Monitored If you are using a 3-electrode set a 5-electrode set a 6-electrode set a 10-electrode set an EASI 5-electrode set these leads are available:

Resp is measured between electrodes:

RA and LL I, II, III RA and LL I, II, III, aVR, aVL, aVF, V and MCL I, II, III, aVR, aVL, aVF, Va, Vb RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Changing Lead Sets To change the ECG lead set, When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement. When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in the Setup ECG menu 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 Electrode colors AAMI EASI IEC AAMI RA LA LL RL V V1 V2 I S A N E R L F N C C1 C2 White Black Red Green Brown Brown/Red Brown/Yellow IEC Red Yellow Green Black White White/Red White/Yellow 96 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring Electrode labels Electrode colors AAMI EASI IEC AAMI V3 V4 V5 V6 C3 C4 C5 C6 Brown/Green Brown/Blue Brown/Orange Brown/Violet IEC White/Green White/Brown White/Black White/Violet Standard 3-Lead Placement 1 2 1 2 3 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 3 Standard 5-Lead Placement 1 I aVR V aVL II 5 a V F 2 III 3 4 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 97 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Placements 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 V3R V4R V1 V2 V3 VE V6 V4 V5 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 98 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring 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 1 2 5 4 3 1 - V1 - V6 2 - LA 3 - LL 4 - RL 5 - RA 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 99 7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead Modified 12-Lead ECG 6 5 1 2 4 3 1 - LA 2 - V1 - V6 3 - LL 4 - RL 5 - RA 6 - Angle of Lewis 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. 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. 100 EASI ECG Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring 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. EASI Electrode Placement 1 E (V) on the lower sternum at the level of the fifth intercostal space on the left midaxillary line at the same level as the E electrode on the upper sternum 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 2 3 4 5 A (LL) S (LA) I (RA) N 2 1 3 4 5 101 7 ECG, Arrhythmia, ST and QT Monitoring ECG and Arrhythmia Alarm Overview 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 Additional Alarms with Basic Arrhythmia Option Additional Alarms with Enhanced Arrhythmia Option

***Asystole

***Ventricular Tachycardia

**Afib

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**PVCs/min HIGH(PVC >

limit/min)

**High heart rate

**Low heart rate

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs 102 Using ECG Alarms 7 ECG, Arrhythmia, ST and QT Monitoring 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 ' value) to the high and low alarm limits. Extreme Brady Limit Low Limit High Limit Extreme Tachy Limit

' Extreme Brady

' 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

'ExtrTachy and 'ExtrBrady. ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitors 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 Detect. 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. 103 7 ECG, Arrhythmia, ST and QT Monitoring ECG Safety Information ECG Safety Information 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 patients 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. 104 About Arrhythmia Monitoring 7 ECG, Arrhythmia, ST and QT 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 algorithms 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 monitors QRS detector. Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate 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 patients condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-

lead 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 102, the rhythm and ectopic messages detected are listed in Arrhythmia Status Messages on page 109. 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. 105 7 ECG, Arrhythmia, ST and QT Monitoring Switching Arrhythmia Analysis On and Off Switching Arrhythmia Analysis On and Off 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. 1 2 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 complex 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 Alarm The monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability. In order to generate an Afib alarm the following criteria must be detected for 1 minute:

normal beat RR intervals must be irregular 106 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring PR interval deviation must be large P-wave region must not match well Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm. An Afib alarm can be falsely detected in the presence of:

sinus arrhythmia, muscle noise, or electrode motion artifact. If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations. See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis. 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 1 P 1mV 7 2 P P 3 Paced Rhythm Pair PVCs Delayed 6 4 PVC 2 5 HR 75 1 2 3 Beat label Pace pulse marks Rhythm status message 107 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display 4 5 6 7 PVC Numeric HR Numeric 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 108 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Status Messages The monitor displays two types of status messages:

Rhythm Status Messages -- to indicate the patients 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 ASYSTOLE VENT FIB/TACH V-TACH SUSTAINED V-TACH VENT RHYTHM No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal A fibrillatory wave for 4 consecutive seconds A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate Limit Ventricular tachycardia rhythm for more than 15 seconds A dominant rhythm of adjacent PVCs and a HR dthe V-Tach HR Limit 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 VENT BIGEMINY VENT TRIGEMINY PACED RHYTHM IRREGULAR HR SINUS BRADY SINUS RHYTHM SINUS TACHY SV BRADY SV RHYTHM SV TACHY UNKNOWN ECG RHYTHM Rhythm cannot be determined LEARNING ECG LEARNING RHYTHM CANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be Algorithm is learning the ECG beat morphology Algorithm is learning the rhythm of the classified beats A dominant rhythm of SV beats not preceded by P-waves analyzed B or E B, E B, E B, E E E E E B, E E B, E B, E B, E B, E B, E B, E 109 7 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) RUN PVCs PAIR PVCs PACER NOT CAPT PACER NT PACING PAUSE R-ON-T PVCs MULTIFORM PVCs FREQUENT SVPBs SVPBs SV BEATS PACED BEATS No ectopic activity within the last minute E More than 2 consecutive PVCs within the last minute E Pair PVCs within the last minute B, E Pause with pace pulse (paced patient only) within the last minute 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. 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 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 Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm rhythm status message Learning ECG. status message changes to Learning Rhythm. 2 After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly. 3 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. 110 Arrhythmia Alarms 7 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 alarm 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). 111 7 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. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply. WARNING When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-

star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. 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 and Afib. 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, when more alarms are switched off than configured in your active profile. 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:

Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold. 1 To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted. 2 Select the appropriate setting from the pop-up list. 112 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring 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. See Arrhythmia Alarm Chaining on page 114 for more details on alarm chains. 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 114). This setting can only be changed in Configuration Mode. To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd. Resetting the Timeout Period To reset the timeout period, press the Alarms key and then reselect it. 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 except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:

Alarm Condition Example Audible Indicators Short yellow alarm tone sounds ... Visual Indicators Alarm message displayed ... Single alarm instance Non-sustained V-tach Continuous alarm condition PVCs/min HIGH Same intermittent alarm condition Pair of PVCs 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 113 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms 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 every time the configured timeout 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 timeout expires. 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 102 for information on which alarms are included in the different arrhythmia options. See Arrhythmia Alarm Timeout Periods on page 113 for an explanation of how alarm timeouts work. 114 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Red Arrhythmia Alarms Asystole 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*

AFib Irregular HR

(occurs only if no other arrhythmia alarms are present) First level timeout period

(TimeOut 1st) Second level timeout period

(TimeOut 2nd) y t i r o i r p r e h g i h y t i r o i r p r e w o l 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

*If HR High/Low alarms are configured as standard yellow alarms, they are independent of the arrhythmia alarms and are not in the Rate alarms chain. 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. 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). 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. 115 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms V-Tach Run Limit

** Non-Sustain VT PVC Run < 8 HR > 100

**Pair PVCs PVC =

2

***V-Tach PVC Run t8 HR > 100 V-Tach Heart Rate Limit 100

** Run PVCs PVC Run > 2butd12 HR d 100

** Vent Rhythm PVC Run > 12 HR d 100 1 2 3 4 5 6 7 8 9 10 11 12 14 15 Number of Consecutive PVCs (PVC Run) Ventricular Rhythm Run Limit e t a R t r a e H r a u c i r t n e V l 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. 116 About ST Monitoring 7 ECG, Arrhythmia, ST and QT 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. 117 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display and Windows 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 Choose a lead from the list in the Setup ST Leads window. 2 Select the Delete key. This removes this lead from the list. NOTE The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen. To change the order in which ST leads are displayed, 1 2 In the Setup ST Leads menu, choose a lead from the list. Select the Sort Up or Sort Down key to move the lead up or down in the list. Understanding the ST Display and Windows Your monitor screen may be configured to look slightly different from the illustrations. 2 3 1 ST-II 1.2 ST-V 2.5 ST-aVR -3.0 1 2 3 ST numerics Current HR alarm limits Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor 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 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 havent 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 Setup ST Analysis menu, select ST-Index to toggle between On and Off. 118 Updating ST Baseline Snippets 7 ECG, Arrhythmia, ST and QT Monitoring 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. 1 2 ST-II

-0.30.8?-1.1 ST Baseline 3 4 5 6 1mv 1sec ST Baseline from 04 Apr 07 9:38 1 2 3 4 5 6 ST label and numeric Baseline ST numeric and difference since baseline was stored 1mV calibration bar Current snippet ST baseline Timestamp of most recently stored baseline snippet 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, Select the ST numerics then ST Baseline to open the ST Baseline window. In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines. 1 2 119 7 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points 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. R-wave peak at 0 msec J point, for example, 48 msec T Difference = ST value P Q S Isoelectric point set to -80 msec 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 monitors 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, 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. 1 2 120 About the ST Measurement Points 7 ECG, Arrhythmia, ST and QT Monitoring 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). ST label and the ST numeric that would apply using the current points 1mV calibration bar ST-I 0.1 Adjust ST Points Cursors for adjusting ST points Highlighted ST point 1mv 1sec ST Points adjusted at 04 Apr 07 11:38 Update Apply Changes 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). ISO 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. 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. 4 121 7 ECG, Arrhythmia, ST and QT Monitoring ST Alarms 5 To update the ST snippet shown in the Adjust ST Points window, select the Update pop-

up key. 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 menu, select ST Alarm Mode and select either Single ST or Multi ST. 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. In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST. Select the alarm to be adjusted. 1 2 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. 122 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring SBed10 Adult ST Map (Current) ST-II HIGH Limb Leads Chest Leads Size Up Trend View Size Down Select Interval Show Baseline Print Show Values If an ST lead is switched off, its axis is not shown in the map. 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 123 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps 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 Map (Current) ST-II HIGH 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 Map (Trend) ST-II HIGH Limb Leads Chest Leads 5 min trending interval Show Values Show Baseline Print Scroll to view more pop-up keys Size Up Current View Size Down Select Interval 124 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring 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 191. 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. 125 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps Changing the Trending Interval To determine how frequently the monitor displays a trended sample, In Trend view, select Select Interval. Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. 1 2 Printing an ST Map Report To print the most recently viewed (current or trend) window, Select Main Setup - > Reports. Select ST Map. Press Print. 1 2 3 126 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT 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 P T 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. 127 7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval 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, Select the QT numeric to enter the Setup QT Analysis window. Select QT Lead and select All, Primary Lead or one of the available single leads. 1 2 When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads. 128 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT View In the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads. Changing The View To A Single Wave Set To view one set of waves in a larger scale, you can cycle through the different views, Select Current view to see the set of current waves. Select Baseline view to see the set of baseline waves. Select Split view to return to the combined view with current and baseline waves. 1 2 3 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 'QTc value. To set the baseline, Select Set Baseline and set the value. 129 7 ECG, Arrhythmia, ST and QT Monitoring QT Alarms 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 'QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a 'QTc alarm from being generated. Discharging a patient clears the baseline. Printing The QT Waves To start a printout, Select Print QT. Recording The QT Waves To start a recording, Select Record QT. QT Alarms There are two QT alarms, QTc high limit alarm and 'QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The 'QTc 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. The following additional messages on the cause of the invalid measurements may also be displayed. Additional Message QT Startup Asystole or Leads Off Cause of Invalid QT Measurement QT monitoring was just turned on or has been reset 1 Not all specified leads needed to perform QT analysis are available, or 2 Asystole condition is detected Not enough valid QRS complexes to generate a QT measurement Insufficient Valid Leads Invalid rhythm for QTc Not enough valid RR intervals to generate QT-HR, the averaged HR High QT-HR used for QTc calculation QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics) R-wave of the signal is too small T-wave of the signal is too small End of the T-Wave cannot be accurately detected QT measurement is outside the specified range of valid QT values (200-

800 msec) QTc measurement is outside the specified range of valid QTc values

(200-800 msec) QTc measurements are not stable Small R Wave Small T Wave End of T Not detected QT Out Of Range QTc Out Of Range QTc Erratic 130 Switching QT Monitoring On and Off 7 ECG, Arrhythmia, ST and QT Monitoring 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

'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. In the Setup QT Analysis menu, select High Limit. Select the appropriate setting. Select 'High Limit. Select the appropriate setting. 1 2 3 4 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. 131 7 ECG, Arrhythmia, ST and QT Monitoring Switching QT Monitoring On and Off 132 8 8Monitoring 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 SpO2 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 SpO2 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 monitors databases. To define which pulse rate is used as system pulse, 1 2 In the Setup Pulse menu, select System Pulse. Select one of the SpO2 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. 133 8 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 SpO2 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. In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and Off. 2 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. 134 Using Pulse Alarms 8 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 102, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow

(medium severity) INOP after a fixed number of hours. 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 Alarm Source Selection. 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 SpO2 is 30 bpm; for HR 15 bpm, and for Pressure 25 bpm. 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. WARNING The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis. If arrhythmia detection is needed, do not rely on the audible QRS tone. 135 8 Monitoring Pulse Rate Using Pulse Alarms 136 9 9Monitoring Respiration Rate

(Resp) For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patients 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. 137 9 Monitoring Respiration Rate (Resp) Understanding the Resp Display 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 patients 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 1 Ohm Resp numeric and label 22RR Changing Resp Detection Modes The Resp detection level can be set either automatically or manually. To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings. 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, 138 Changing the Size of the Respiration Wave 9 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. 139 9 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. In the Setup Resp menu, select Apnea Time. Select the appropriate setting. 1 2 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. 140 Resp Safety Information 9 Monitoring Respiration Rate (Resp) Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate 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. 141 9 Monitoring Respiration Rate (Resp) Resp Safety Information 142 10 10Monitoring SpO2 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 (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). Pleth waveform - visual indication of patients 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 SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information. SpO2 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 Follow the SpO2 sensors instructions for use, adhering to all warnings and cautions. 2 Remove colored nail polish from the application site. 3 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. 143 10 Monitoring SpO2 Connecting SpO2 Cables 4 Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patients 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 41C on the skin if the initial skin temperature does not exceed 35C. Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line. Connecting SpO2 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 SpO2 1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 2 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. 144 SpO2 Signal Quality Indicator (Fast SpO2 only) 10 Monitoring SpO2 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. SpO2 Signal Quality Indicator (Fast SpO2 only) The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the current values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled. SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse. When pulse rate is very low, or strong arrhythmia is present, the SpO2/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value. If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality. NOTE 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. 145 10 Monitoring SpO2 Changing the Averaging Time Changing the Averaging Time Depending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high. In the SpO2 Setup, select Average. Select the required averaging time from the list. 1 2 Setting the Measurement Mode When a telemetry device supplies SpO2T to the monitor via short range radio transmission, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save the telemetry devices battery power. To set the measurement mode, In the SpO2 Setup, select Mode. Select Continuous or Manual mode. 1 2 Making a Manual Measurement When the measurement mode is set to manual, In the SpO2 Setup, select Measure SpO2. When manual measurements are made, there will be no continuous SpO2 monitoring or alarming. The manual measurement value reflects a momentary status. The numerics from SpO2T measurements made in manual mode, for example SpO2T, PerfT, PulseT, will remain for a time on the main screen. They are annotated with the time that the measurement was made to distinguish them from continuously measured values. Perf T Understanding SpO2 Alarms This refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit. 146 Pleth Wave 10 Monitoring SpO2 CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 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 251). Adjusting the Alarm Limits In the Setup SpO2 menu:

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. 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. In the Setup SpO2 menu, select DesatLimit. 1 2 Adjust the limit. 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. 147 10 Monitoring SpO2 Perfusion Numeric minimum size for reliable SpO2 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 SpO2 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 SpO2/Pleth as Pulse Source In the Setup SpO2 menu, select Pulse (SpO2) to enter the Setup Pulse menu. In the Setup Pulse menu, select SystPulse and select SpO2 from the pop-up list. 1 2 Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 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 SpO2 menu, select Tone Mod. to toggle between Yes (for on) and No (for off). 148 Setting the QRS Volume 10 Monitoring SpO2 Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated. Setting the QRS Volume In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume. 149 10 Monitoring SpO2 Setting the QRS Volume 150 11 11Monitoring 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. 151 11 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 (intra-

arterial). 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. 152 Preparing to Measure NBP 11 Monitoring NBP 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 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. 4 Apply the cuff to a limb at the same level as the patients 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. Auto 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. 153 11 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 Mode 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 In the Setup NBP menu, select Mode and select Sequence from the pop-up menu. Select Setup Sequence to open the Setup 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. 4 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:

154 Switching Pulse from NBP On/Off 11 Monitoring NBP Menu option Pressure value monitored systolic Sys. diastolic Dia. mean Mean systolic and diastolic in parallel Sys&Dia diastolic and mean in parallel Dia&Mean Sys&Mean systolic and mean in parallel Sys&Dia&Mean 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 Pulse NBP Sys. 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 In the NBP Setup menu select VeniPuncture. Puncture vein and draw blood sample. 2 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. 155 11 Monitoring NBP Calibrating NBP Cuff pressure Venous puncture measurement mode NBP

(60) VP Time left in venous puncture mode 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. 156 12 12Monitoring 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 Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes. 5 Select an appropriate temperature label. 6 Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement. 157 12 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 labels stored color and alarm settings. In the Setup <Temp> menu, select Label. Select the appropriate label from the list. 1 2 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 'Temp. 1 In the Main Setup menu, select Measurements. In the Setup 'Temp menu, select First Temp. Label the measurement source as appropriate. Select Second Temp. Label the measurement source as appropriate. 2 3 4 5 158 13 13Monitoring 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 monitors 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. 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. 159 13 Monitoring Invasive Pressure Setting up the Pressure Measurement 4 Connect the pressure line to the patient catheter. 5 6 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 patients 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 labels 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. In the Setup <Press> menu, select Label. Select the appropriate label from the list. 1 2 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 P PAP RAP UAP UVP Description 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. Description Label BAP FAP IC1, IC2 P1, P2, P3, P4 Alternative non-specific pressure labels Brachial arterial pressure Femoral arterial pressure Alternative intracranial pressures 160 Zeroing the Pressure Transducer 13 Monitoring Invasive Pressure 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 monitors 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 manufacturers 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 Pressures 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 pressures 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 Turn off the stopcock to the patient. 2 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>. 3 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. CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. 161 13 Monitoring Invasive Pressure Adjusting the Calibration Factor 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 Press 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:

Corrective Action The hardware is faulty. Contact your service personnel. 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. Message cant zero;

equipment malf. cant zero;

excessive offset Make sure the transducer is vented to air and try again. If this fails, the hardware cant zero -

unstable signal cant zero - no transducer cant zero;

pulsat. pressure Make sure that the transducer is vented to air, not to the patient, and try again. unable to zero -

timed out switch <Press> on first Try pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel. Pressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressures label. 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. 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. 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 hospitals procedure. 1 2 To confirm you want to use the new calibration factor, select the Confirm popup. Displaying a Mean Pressure Value Only Use this when you want to see only the mean pressure. In the pressures 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). 162 Changing the Pressure Wave Scale 13 Monitoring Invasive Pressure Changing the Pressure Wave Scale 1 2 3 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. 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. Pressure value monitored Menu option Sys. Dia. Mean Sys & Dia Dia & Mean Sys & Mean Sys&Dia&Mean Select and set the High Limit and Low Limit for the pressure(s) you have selected. systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel 163 13 Monitoring Invasive Pressure Choosing the Pressure Alarm Source 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 ' 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

' Extreme Low

' 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 'Extr. High and 'Extr. Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message. 164 Calibrating Reusable Transducer CPJ840J6 13 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6 Depending on your monitors 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 Zero the transducer. 2 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 on monitor 12 PIN 3 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. 4 165 13 Monitoring Invasive Pressure Calculating Cerebral Perfusion 5 Select the calibration pressure from the list, for example 200 mmHg. Select Confirm to recalculate the calibration factor using the applied pressure. 6 7 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 pressures setup menu. 8 9 Reconnect the patient and start measuring again. Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration. Message cant calibr.; equipmt malf. cant calibrate;out of range cant calibr.; no transd. cant cal.; unstable signal cant 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. In the Main Setup menu, select Measurements. In the Setup CPP menu, select ABP, ART, Ao, BAP or FAP as the arterial pressure source. 1 2 166 14 14Monitoring 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 CO2 measurement at a time is supported. Use the CO2 measurement to monitor the patients respiratory status and to control patient ventilation. There are two methods for measuring carbon dioxide in the patients airway:

Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patients breathing system. This method is available using the monitors built-in CO2 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 patients airway and analyzes it with a remote CO2 sensor. You can measure sidestream CO2 using the monitors built-in CO2 measurement (optional) or using the M3014A Capnography Extension, or the M3015A Microstream CO2 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 CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2. When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2. The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure. The measurement provides:

a CO2 waveform. an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase. an inspired minimum CO2 (imCO2): the smallest value measured during inspiration. an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform. 167 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off). WARNING Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation. Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols. Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, 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 etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 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 etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only. Measuring CO2 using the CO2 Option or M3014A The monitor (with the CO2 option) or the M3014A Capnography Extension measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method or the sidestream method. The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 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 patients 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 CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 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 CO2 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 CO2 connector on the monitor (when the optional CO2 measurement is integrated) or on the extension. 168 Measuring CO2 using the CO2 Option or M3014A 14 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 CO2 including the ventilator, the patients breath and your own. in the setup menu for the CO2, 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 CO2 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 CO2 1 Plug the sensor cable into the monitors CO2 input connector. Allow the sensor two minutes warm up time 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:

169 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patients breath and your own. In the setup menu for the CO2, 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 Y-

section. 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. 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. 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 Push the sensor into the holder until it clicks into position. 2 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 170 Measuring Mainstream CO2 using M3016A 14 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the sidestream CO2 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 CO2 using M3016A The M3016A Mainstream CO2 Extension measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO2 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 CO2 1 Attach the transducer connector to the CO2 connector on the M3016A extension. 2 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 CO2 readings. 1 2 3 4 5 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 CAL1. Is it the same as the value on the calstick? If not, calibrate the transducer now. 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. Place the transducer on one of the calstick cells and select Start CAL1. 2 171 14 Monitoring Carbon Dioxide Measuring Mainstream CO2 using M3016A other cell and select Start CAL2 then press Confirm. 3 Enter the calibration value printed on the calstick then press Confirm to start calibration. 4 When the message CO2 CAL1 done;Start CAL2 cal appears, put the transducer on the 5 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. 6 Attaching and Removing the CO2 Transducer Airway Adapter CO2 Transducer 1 Open the latch and place the transducer onto the airway adapter. Place the airway adapter in the patients breathing circuit between the endotracheal tube and the Y-

piece. You may see the CO2 SENSOR WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. 2 To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. WARNING To prevent stress on the endotrachial tube, support the transducer and airway adapter. To avoid infection, use only sterilized airway adapters. 172 Measuring Microstream CO2 using M3015A 14 Monitoring Carbon Dioxide Measuring Microstream CO2 using M3015A The M3015A Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patients expired gas using Microstream technology. The measurement is equipped with an automatic barometric pressure compensation. Preparing to Measure Microstream CO2 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 The Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory. 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 CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine). Using the FilterLine and Airway Adapter 1 Attach the female Luer connector to the CO2 inlet connector on the extension by pushing the socket cover down and screwing the connector into place. inlet connector cover outlet connector 2 Check that the FilterLine is not kinked. 3 Change the FilterLine if a CO2 OCCLUSION INOP appears on the monitor or if the readings become extremely erratic. 173 14 Monitoring Carbon Dioxide Setting up all CO2 Measurements Disconnect the FilterLine during suctioning and nebulizing therapies. Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. CO2 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 CO2 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 SmartKey, if configured. To prevent an automatic zero calibration from being started in the next five minutes, in the Setup CO2 menu, select No Zero For 5Min, or select the Suppress CO2 Zero Selecting No Zero For 5Min 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 all CO2 Measurements These tasks are common to all CO2 measurements except where otherwise noted. Adjusting the CO2 Wave Scale In the CO2 Wave menu or the Setup CO2 menu, select Scale. 1 2 Choose a suitable scale range from the pop-up list. Setting up CO2 Corrections Temperature, water vapor in the patients breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections. Correction Altitude

(M3014A only) Altitude is set during installation. The monitor automatically applies an appropriate correction. 174 Setting up all CO2 Measurements 14 Monitoring Carbon Dioxide Correction O2

(M3014A only) Humidity N2O

(M3016A mainstream and M3015A microstream only) Gas

(M3014A only) Agent

(M3014A only) In the Setup CO2 menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list. At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO2 menu, and scroll down to look at Hum. Corr or HumidityCorr. In the Setup CO2 menu, select N2O Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on. If the N2O correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below). In the Setup CO2 menu, select Gas Corr. and select Helium, N2O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection. If the Gas correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with N2O Corr. (see above). 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 CO2) available. To temporarily stop sampling, in the Setup CO2 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 CO2 menu, select Pump On. Changing CO2 Alarms This refers to CO2 specific alarms. See the Alarms section for general alarm information. You change CO2 alarm settings in the Setup CO2 menu. To switch etCO2 alarms on and off:

Select etCO2 Alarms and toggle between On and Off. To change the etCO2 alarm limits:

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. 175 14 Monitoring Carbon Dioxide Setting up all CO2 Measurements To change the imCO2 high limit:

Select imCO2 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. In the Setup CO2 menu, select awRR. In Setup awRR menu, select Apnea. 1 2 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 CO2 menu, select awRR. In the Setup awRR menu, select Alarms. 2 3 Choose On to derive alarms from the airway respiration signal or Off to disable them. Changing awRR Alarm Limits In the Setup CO2 menu, select awRR. Select High Limit to set the upper alarm limit. Select Low Limit to set the lower alarm limit. Select the appropriate setting. 1 2 3 176 15 15Assigning Two Devices to One Patient It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called pairing and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be:

any Philips telemetry device (only for indirect connections, see below). a TRx+/TRx+ Intellivue Telemetry system transceiver. How Can You Combine Devices?

With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor. With a direct connection to the monitor, via a short range radio link - the data arrive with a minimal delay on the monitor screen. Indirect Connection - Manual Pairing The telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use. To pair the monitor with a telemetry device at the monitor:

1 Select Main Setup then Measurements Select Telemetry 2 The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor. Telemetry Data Window The measurements from the telemetry device are shown in the telemetry data window on the monitor when there is no direct connection via short range radio link. 177 15 Assigning Two Devices to One Patient How Can You Combine Devices?

TELE INOP Delayed

* TELE ALARM

** HR 140>120 SOME ECG ALRMS OFF HR NBP Sys.

%SpO2T Telemetry data window Auto 10 min etCO2 imCO2 WARNING All data presented in the telemetry data window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG Sync Pulse output. Direct Connection - Automatic Pairing The following direct connections are possible:

a TRx+4841A Intellivue Telemetry system transceiver connected via short range radio (SRR) link to an MP2 with SRR capability. If a telemetry device is assigned to a monitor via a direct short range radio link, the monitor and the telemetry device are automatically paired at the Information Center (if configured). The measured data from the telemetry device ECG and, if available, SpO2T will appear on the monitor screen and will be sent through the monitor to the Information Center. The ECG waves and numerics appear in place of the monitors own ECG, and SpO2T is displayed as an additional measurement. When ECG is measured with the telemetry device there will be no Respiration measurement derived. WARNING When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel. When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected. 178 How Can You Combine Devices?

15 Assigning Two Devices to One Patient Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. See the "Enhancing Telemetry Monitoring with the Monitor" chapter. Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor Monitors which have this capability have a short range radio symbol A telemetry device with a short range radio adapter can be assigned to a monitor directly. To assign a telemetry device to a monitor:

on the model label. 1 2 3 Press the Check button on the telemetry device. The measurement selection key on the monitor will change to show the assign telemetry icon Select the assign telemetry icon. In the Assign Telemetry Device menu, select the correct equipment label for the telemetry device. 4 Check that the assignment is successful and that transmission has begun:

A Tele Device assigned message appears on the monitor a tone sounds at the telemetry device and the Laeds Off indicators light the ECG wave appears on the monitor To confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label. If a monitor is already paired to another device, you cannot assign a telemetry device to that monitor. If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Telemetry Data Window as described above. If a monitor is manually paired with a telemetry device with a short range radio adapter, the short range radio assignment will be automatically made. If a telemetry device disappears from the list in the Assign Telemetry Device menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the assign telemetry icon will appear crossed out If the devices are unpaired, the short range radio connection will be ended. WARNING Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section 36.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a TELE DISCONNECT INOP. 179 15 Assigning Two Devices to One Patient How Can You Combine Devices?

Correct channel configuration is important, refer to the Configuration Guide for details. If a TELE DISCONNECT INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission. SpO2T Manual Mode When a telemetry device with a short range radio connection supplies SpO2T to the monitor, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save battery power. To ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor. Unassigning a Telemetry Transceiver with SRR Adapter at the Monitor If a monitor and a telemetry device are paired, the assignment and the short range radio connection will be ended when the devices are unpaired (see Unpairing the Monitor and Telemetry Device on page 180). If the monitor does not have a connection to an Information Center, you must manually end the assignment and the short range radio connection. 1 2 3 Select the Measurement Selection key. In the Measurement Selection window, select the Tele pop-up key. In the Tele device window select Unassign Tele. Refer also to Use Models With Telemetry on page 202 for further related use modes. Unpairing the Monitor and Telemetry Device If the patient will no longer be monitored with the telemetry device, or only with the telemetry device and no longer with the monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device:

select the Unpair To Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the monitor select the Unpair To Tele SmartKey to end pairing and have the Information Center receive the measurement data from the telemetry device or use the Unpair function at the Information Center. NOTE The Unpair SmartKeys and pop-up keys appear only on the monitor which is directly involved in pairing. 180 Functions Available When the Telemetry Data Window is Displayed 15 Assigning Two Devices to One Patient Functions Available When the Telemetry Data Window is Displayed Controlling the Telemetry Device from the Bedside You can change settings for a paired telemetry device at the monitor:

1 Select the telemetry data screen element Select the Setup Tele pop-up key 2 The Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here. Viewing and Silencing Telemetry Alarms at the Bedside When a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic Tele Alarm message will appear in the alarm status area with standard alarm tones. The Tele Alarm message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example *HR Low) will appear in the Telemetry Data Window. If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:

1 Select the telemetry screen element. Select the Silence Bed pop-up key. 2 Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms. WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured. Suspending Telemetry Alarms When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected. Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device. Using Standby When you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring. Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device. 181 15 Assigning Two Devices to One Patient Functions Available For Devices Connected Via SRR Functions Available For Devices Connected Via SRR Telemetry Device Tele 1 The Telemetry Device window can be opened from the Measurement Selection window, by selecting the Tele pop-up key, or via Main Setup -> Telemetry Device. The window shows the equipment label of the assigned telemetry device and, for monitors with SRR capability, a battery status symbol and a symbol indicating the signal quality of the SRR link If the monitor has a connection to an Information Center, the pop-up keys Unpair to Mon. and Unpair to Tele let you end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device. If the monitor does not have a connection to an Information Center, or there is a pairing mismatch, the Unassign Tele pop-up key lets you end the telemetry device assignment and close the SRR link. Temporarily Stopping the Short Range Radio Connection To temporarily disable the SRR connection for this device, for example, in case of interference:

Select the Stop SRR pop-up key. This closes the SRR link and the telemetry device switches over to standard telemetry transmission. The battery status symbol will no longer be shown and the SRR quality indicator symbol will be crossed out. To return to SRR use:

Select the Start SRR pop-up key and press the Check button on the telemetry transceiver. Setting Up Measurements The Setup ECG and Setup SpO2T pop-up keys give you access to the measurement setup menus. The Measmt. Select. pop-up key takes you directly to the Measurement Selection window where all connected measurement devices are shown. General Telemetry-related Functions The following functions are valid for directly and indirectly connected telemetry devices. 182 General Telemetry-related Functions 15 Assigning Two Devices to One Patient ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated the ECG Setup menu will no longer be accessible. When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitors own measurements, the SpO2T measurement (if present) will no longer be displayed. In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa. In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:

Heart Rate ECG Arrhythmia ST QT SpO2T HR/Pulse Alarm On/Off, Heart Rate High/Low Limit, Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead Placement Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/

min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-

Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/Off ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm Limit QT analysis On/Off, QT Lead, QTc High Alarm On/Off, 'QTc Alarm On/Off, QTc High Limit, 'QTc High Limit, QTc Formula2, QT Baseline SpO2 Alarms on/off, SpO2 Alarm limits NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off 1.Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6. 2.These setting will only be synchronized when the Information Center supports QT Analysis for Telemetry. WARNING Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate. Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6 183 15 Assigning Two Devices to One Patient General Telemetry-related Functions If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient. 184 16 16Enhancing Telemetry Monitoring with the Monitor You can use a monitor without a network connection to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio. Monitor and Telemetry Transceiver Requirements The monitor and the telemetry transceiver need a direct connection via a short range radio link. Not all revisions of the telemetry transceiver can be used directly with the monitor, if you connect a device that cannot be used you will see a TELE UNSUPPORTED INOP. Data Sent to the Information Center The data sent to the Information Center includes numerics from NBP, SpO2, Pulse from SpO2 and predictive temperature. INOPs from these measurements, battery INOPs and a general INOP generated by alarms from any other measurement (MORE BED ALARMS) will also be transmitted. NOTE The monitor must be configured appropriately to support direct connection to a telemetry transceiver;

refer to the Configuration Guide for details. Changing Assignment to a New Telemetry Transceiver 1 Assign the telemetry transceiver to the monitor; see Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor on page 179. 2 Make the required measurements; the data will be automatically sent to the Information Center via the telemetry transceiver. It is not necessary to unassign the telemetry transceiver. This will happen automatically when the next telemetry transceiver is assigned. The patient is also discharged (if configured), ensuring that the measurement data is erased before data from the next patient appears. Always assign the telemetry transceiver before you start making measurements. 185 16 Enhancing Telemetry Monitoring with the Monitor 186 17 17Trends Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patients condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-

measured 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 Change Screen window, then select a Screen designed to show an embedded trend window. To open the tabular trends window, select Main Setup > Trends >

Vitals Trend, or select the Vitals Trend SmartKey. To open the graphic trends window over the current Screen, select Main Setup > Trends > Graph Trend, or select the Graph Trend SmartKey. Vitals Trend Graph Trend 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 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 graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. 187 17 Trends Viewing Trends Pop-Up Keys Select Group Select Interval Print Vital Signs Graph Trend Selecting this pop-up key lets you.... see a pop-up list of trend groups and select a group for viewing. 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. 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 SpO2 RR 4 Apr Select Group Vital Signs Print Select Interval Scroll to view more pop-up keys 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, 1 Select the graphical trend or the arrow pop-up keys to activate the cursor. 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 188 Setting Up Trends 17 Trends 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends Vital Signs: Standard HR SpO2 etCO2 imCO2 RR awRR Select Interval Select Group Graph Trend Print Aperiodic values are shown with a timestamp Scroll to view more pop-up keys 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. 189 17 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 menu, select Highlight repeatedly until the highlight is on the required measurement. 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:

In the Segment menu, select Change Group 1 2 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:

190 Setting Up Trends 17 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, Select Main Setup -> Trends -> Trend Groups Select the Trend Group and then the measurement you want to move and use the Sort Up/

Sort Down pop-up keys. 1 2 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, In the Main Setup menu, select Trends. Select Trend Priority. 1 2 To add measurements to the priority list, Select the pop-up key Add and choose from the pop-up list of available measurements. 1 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. Select Parameter Scales. Select the measurement or parameter you want to change from the list. 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. 2 3 4 5 Graphical Trend Presentation Graphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, Select Main Setup -> Trends 1 191 17 Trends Documenting Trends Select Global Style and choose 2 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. ABP 240 50 This sample ABP trend shows the continuously-

measured values for the systolic, diastolic and mean pressures displayed in band form. Documenting Trends To print a Vital Signs or Graphical Trends report, in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitors 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. 192 Screen Trends 17 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, histogram 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. 193 17 Trends Screen Trends SBed9 HR Adult SpO2 ALARMS OFF Perf Arrhythmia Off 1mV Auto 15 min Temp Measurement numerics Measurement wave M NBP Sys. NBPs 65

-60min

-30min NBPs ABP 240 50 65

-30min

-60min NBP graphical screen trend Example of other graphical screen trends: ABP SBed9 HR Adult Pulse ALARMS OFF SpO2 Arrhythmia Off 1mV Auto 15 min Temp Measurement numerics Measurement wave M NBP NBP Sys. Tabular screen trend 194 Screen Trends 17 Trends Setting the Screen Trend Time 1 2 To set the ScreenTrend Time for all graphical, histogram and horizon screen trends (global trend time), 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 trend or a group of aligned screen trends, 1 2 3 Select a screen trend Select Change TrendTime 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 2 Select the screen trend. 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 2 Select the screen trend to open the screen trend menu, 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, histogram 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. 195 17 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 patients condition since the baseline was set. The horizon view is made up of:

a horizon, drawn in white, as a reference 1 2 3 point or baseline to help you visualize changes in your patients condition. The horizon can be set to represent your patients current 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 patients 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 the same, the horizon is a baseline - if the values are different the horizon is a range. Select Set High Horizon to select the upper horizon value. If the high and low horizon values are Set Low Horizon to select the lower horizon value. Auto Horizon to set the horizon for the selected horizon trend to the currently-measured 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. value 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. 196 Screen Trends 17 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 patients 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. Select Main Setup > Trends Select HorizonArrowTime. Select 10, 5 or 2 minutes. 1 2 3 197 17 Trends Screen Trends 198 18 18 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, Select the Main Setup SmartKey then select Recordings. Select the pop-up key Select Waves, 1 2 3 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If 4 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. Select the Start pop-up key to start the recording. 5 Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping. 199 18 Recording Overview of Recording Types Overview of Recording Types Delayed Alarm Realtime (RT) Type of recording manual central Recording Destination Information recorded automatic, triggered by defined alarm conditions central printer manual central from the start trigger minus the delay time from the start trigger minus the delay time N/A from the start trigger Number of waves up to 2 up to 2 Speed Runtime Stops Delay Time Overlap 50, 25, 6.25 mm/sec 25 mm/sec N/A N/A automatically automatically 10, 15 seconds 10, 15 seconds Off On (up to 2 waves) Off On (up to 2 waves) N/A = not applicable N/A N/A N/A N/A N/A N/A up to 2 50, 25, 6.25 mm/sec continuously manually none Off On (up to 2 waves) Creating and Changing Recordings Templates 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. 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 monitors Configuration Mode. 1 2 3 4 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 200 Recorder Status Messages 18 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 200. 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 No recorder available. Alarm recordings will be lost. Try configuring Printer as the alarm recording destination. The named recorder is out of paper. Central Recorder out of paper Central Recorder door open The door of the specified recorder is open. 201 18 Recording Recorder Status Messages 202 19 19Printing 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. Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up 1 2 Select Main Setup - > Reports Select Auto Print Dbs. Always will print all reports when a matching printer is available. Host only will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in grey on the Reports Job List) must be manually sent to the printer. See Checking Report Status and Printing Manually on page 207. Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See Checking Report Status and Printing Manually on page 207. 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. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient. Report types Report contents 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, How to start printing reports In the Vital Signs window, select Print In the Graphic Trends window, select Print Select the ECG Report SmartKeys, if configured In the ST Map window, select Print. 203 19 Printing Patient Reports Stopping Reports Printouts Report types Report contents Alarm Limits Report Realtime Reports Battery Report Graphic and numeric report of all current alarm limits 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 Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available. How to start printing reports In the Alarm Limits window, select Print Limits Select the Realtime Reports SmartKey, if configured In the Battery Status window, select Print Status. In the Main Setup select Reports then Central Report A, B or C. Stopping Reports Printouts To stop Reports printing, in the Reports menu, select Delete Report to stop the current print job Delete All Repts 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 1 The settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG Reports, 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. Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the ECG report printouts. 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. 3 4 2 Setting Up Vital Signs and Graphic Trend Reports The settings you choose in the Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed. 204 Setting Up Individual Print Jobs 19 Printing Patient Reports To set up Vital Signs and Graphic Trend reports, 1 2 3 4 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 monitors trend configuration. 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, 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 3 4 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. 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. 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 monitors 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 Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu. 205 19 Printing Patient Reports Checking Printer Settings 2 3 4 5 6 Select Report and then select the report you want to set up. 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:

VisibleWaves: 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 monitors 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: Unspecified to use the default size for the template chosen, Landscape or Portrait. 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 monitors 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. 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. 1 206 Dashed Lines on Reports 19 Printing Patient Reports 2 Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Enabled/Disabled setting will automatically be set to Disabled and grayed out. Dashed Lines on 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 monitors 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 and Printing Manually 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) 207 19 Printing Patient Reports Printer Status Messages Request date and time Report paper format Job status: Preparing, Printing, Waiting, In Database, In Companion, Retry, Cancelling, Error Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Reps key. CAUTION The reports job list includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality. Printing Manually Those jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host only or Never, some or all reports will not be printed automatically and will be shown in grey. Any jobs shown in grey must be printed manually; to do this, 1 In the Reports Job List, select the required report Select Print Report. 2 Selecting Print All Reps. will send all reports to the printer. Printer Status Messages Printer Status Message Print job queued

<Printer name>

Print job cant queue;queue full Cancelling all print jobs Cancelling the active print job Deleted N print jobs;discharge Deleted N print jobs; hotstart Print failed;No report configurd Printing on

<Printer name>

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. 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. 208 Sample Report Printouts 19 Printing Patient Reports Printer Status Message NoPrinter <Printer name>;job susp Print Database full->job suspnd. Job <Printer name>

fail;

Print job on

<Printer name>

done Possible causes and suggested action 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. 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 207). Alternatively you can delete another report from the Reports Job List (using the Stop report key) to create space for your report. 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. Sample Report Printouts Each report header contains the patients bed label, last name and first name, middle name (if there is enough space) 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 monitors Configuration Mode. 209 19 Printing Patient Reports Sample Report Printouts Alarm Limits Report NBed6 Alarm Limits HR ST-I ST-II ST-III ST-aVR ST-aVL Doe, John ST-aVF ST-V1 ST-V2 ST-V3 ST-V4 ST-V5 123456789-P1 19 Apr 07 15:59:37 ST-V6 SpO2 NBPs ABPs RR Apnea Time 20 sec Measurement labels, with alarms off symbol where alarms are switched off Graphic view of current alarm limits in relation to currently monitored measurement value Realtime Report NBed6 Realtime Report Doe, John 123456789-P1 19 Apr 07 15:59:54 Patient Cat.: Adult Paced: No Gender: Male

**ABPs HIGH SpO2 NON-PULSAT. HR 60 bpm 0 /m PVC 0.0 mm ST-I 0.0 mm ST-II ST-III 0.0 mm Date of Birth: 19 Nov 1963 Age: 43 years Height: 69 in Patient Cat.: Adult Paced: No 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 ST-V6 SpO2 Pulse Perf NBPPulse 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 Patient demographic information, time stamp Active Alarms and INOPs, followed by vital signs Measurement waves section 210 19 Printing Patient Reports Sample Report Printouts ECG Reports Patient information Numeric block Wave area 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 patients 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 Available Formats Available Paper Sizes 12-Lead ECG Multi-lead ECG 3X4 landscape 6X2 landscape 12X1 portrait 12X1 landscape 12X1 (2P) landscape 2X4 landscape 8X1 portrait 8X1 landscape 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 Other Reports See the sections on Trends for other example reports. 211 19 Printing Patient Reports Sample Report Printouts 212 20 20Care 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 hospitals 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 manufacturers 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. 213 20 Care and Cleaning Cleaning the Monitor Cleaning the Monitor Clean with a lint-free cloth, moistened with warm water (40C/104F 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 Dilution of Ammonia <3%, Window cleaner Ethanol 70%, Isopropanol 70%, Window cleaner

, Alconox 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 hospitals 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. 214 Cleaning, Sterilizing and Disinfecting Monitoring Accessories 20 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. Cleaning Batteries and the Battery Compartment Wipe with a lint-free cloth, moistened with warm water (40C/104F maximum) and soap. Do not use strong solvents. Do not soak the battery. 215 20 Care and Cleaning Cleaning Batteries and the Battery Compartment 216 21 21Using 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). 217 21 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 batterys 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 Yellow Red, flashing 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 Red, flashes intermittently battery or charger malfunction less than 10 minutes power remaining battery 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. 218 Battery Power Indicators 21 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 219). Battery status indicator Battery malfunction 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.

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 TimeToEmpty:

2:33 hrs Capacity remaining fullCharge

[mAh]

[mAh]

Capacity, remaining tells you how much power is left in the battery. Capacity, fullCharge tells you how much power the battery can hold when fully charged. 219 21 Using Batteries Checking Battery Charge TimeToEmpty 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. TimeToFull is shown in place of TimeToEmpty 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 TimeToFull/TimetoEmpty is shown. Symbols indicating critical situations are colored red. Battery status symbols Battery malfunction symbols battery is empty

(red) incompatible battery battery not charging as the temperature is above or below the specified range

(red) battery malfunction battery requires maintenance

(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 Select the battery status information on the Screen to open the Battery Status window Select the Print Status pop-up key. 2 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. Replacing a Battery To replace the battery, 1 Press the battery eject button. This releases the battery. 220 Optimizing Battery Performance 21 Using Batteries Battery eject button The INOP !!INSERT BATTERY is suppressed for 15 seconds, allowing you sufficient time to load a new battery. 2 Remove the battery from the compartment. 3 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. 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). 221 21 Using Batteries Battery Safety Information 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 Insert the battery into a monitor connected to the external power supply (M8023A). 2 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 2 Charge the battery until it is completely full. Open the Battery Status window and check Insert the battery into a monitor connected to the external power supply. that the Batt Fully Charged message is displayed. 3 Disconnect the monitor from mains power, and let the monitor run until there is no battery power left and the monitor switches itself off. 4 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. NOTE 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. 222 Battery Safety Information 21 Using Batteries 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 100C (212F) 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. 223 21 Using Batteries Battery Safety Information 224 22 22Maintenance 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 hospitals 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. Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use. 2 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 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the 2 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. 3 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. 225 22 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 monitors 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 CO2 calibration and performance test Mainstream and sidestream CO2 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 226 Troubleshooting 22 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, In the Main Setup menu, select Revision. 1 2 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 countrys 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. You will find detailed disposal information on the following web page:

http://www.medical.philips.com/main/company/sustainability/recycling/patient_monitoring/

The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium). 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 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. 2 When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder. 3 Write Empty on the cylinder and dispose of it appropriately for scrap metal. WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder. 227 22 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders 228 23 23Accessories 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 6-Electrode Cable Set 10-Electrode Cable set

(5+5) 10-Electrode Cable set

(6+4) Part No. M1669A Length 2.7m M1668A 2.7m M1667A 2.7m M1663A 2.0m M1665A 2.7m 229 23 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR Grabber shielded ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1675A M1671A M1673A M1622A M1624A M1678A M1672A M1674A

M1626A 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Miniclip non-shielded Length 1.0m/1.6m 1.0m/1.6m 1.0m/1.6m 0.7m/1.3m AAMI Part No. IEC Part No. M1973A M1968A M1644A M1647A 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 AAMI Part No. IEC Part No. M1684A M1680A M1682A M1685A M1681A M1683A 10-Electrode (5+5)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 5-electrode cable sets M1976A M1602A M1979A M1978A M1604A M1984A 10-Electrode (6+4)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 6-electrode cable sets M1532A M1537A M1557A M1533A M1538A M1558A 230 ECG/Resp Accessories One-piece Cables 23 Accessories Description 3-lead Grabber, ICU 5-lead Grabber, ICU Length 1.0m 1.0m AAMI Part No. IEC Part No. 989803143181 989803143201 989803143171 989803143191 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 non-

shielded 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) Part No. M1501A M1502A M1503A M1664A M1504A M1679A M1636A M1638A M1509A 989808148861 Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. M1540C M1500A IEC Part No. M1550C M1510A AAMI Part No. M1560C M1520A IEC Part No. M1570C M1530A 0.9m 2.7m 231 23 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1601A M1603A M1605A M1608A M1609A M1611A M1613A M1615A M1618A M1619A 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. IEC Part No. M1621A M1623A M1625A M1629A M1631A M1633A M1635A M1639A 3-Electrode One Piece Cables AAMI 3-Electrode One Piece Cables Length OR Grabber ICU Snap 1.9m 1.9m AAMI Part No. M1970A M1972A IEC 3-electrode One Piece Cables OR Grabber ICU Grabber IEC Part No. M1980A M1981A 5-Electrode One Piece Cables AAMI 5-electrode One Piece Cables Length OR Grabber ICU Snap 2.5m 2.5m AAMI Part No. M1975A M1977A IEC 5-electrode One Piece Cables IEC Part No. OR Grabber ICU Grabber M1985A M1986A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer Bedsheet clip 3-electrode 5-electrode Shielded 3-electrode Shielded 5-electrode Part No. M1501A M1502A M1503A M1504A M1509A 232 NBP Accessories 23 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 Reusable Cuff Kits 20 cm 16 cm 13 cm 42 to 54 cm 34 to 43 cm 27 to 35 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 Part No. Tubing M1598B (1.5m) or M1599B (3m) M1576A M1575A M1574A M1573A M1572A M1571A Cuff Kits Part No. M1577A Infant, pediatric, small adult, adult Small adult, adult, large adult, thigh M1578A Infant, pediatric, small adult, adult, large adult, thigh M1579A Adult/Pediatric Antimicrobial Coated Reusable cuffs Patient Category (color) Limb Circumference

(cm) 45 - 56.5 Adult Thigh (grey) Large Adult X-Long (burgundy) 35.5 - 46.0 35.5 - 46.0 Large Adult (burgundy) 27.5 - 36.5 Adult X-Long (navy blue) Adult (navy blue) 27.5 - 36.5 20.5 - 28.5 Small Adult (royal blue) 13.8 - 21.5 Pediatric (green) Infant (orange) 9 - 14.8 Bladder Width Part No. Tubing M1598B

(1.5m) or M1599B (3m) 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 233 23 Accessories Invasive Pressure Accessories Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs Patient Category Adult (Thigh) Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference

(cm) Bladder Width Part No. Tubing M1598B (1.5m) or M1599B (3m) 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 M4579A M4578A M4577A M4576A M4575A M4574A M4573A M4572A Neonatal/Infant Cuffs (Disposable, non-sterile) 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. Tubing 2.2 cm 2.8 cm 3.9 cm 4.7 cm M1866A M1868A M1870A M1872A 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. Transducer, accessories, sensor kits Reusable pressure transducer 5 PV/.V/mmHg sensitivity Sterile disposable pressure domes for CPJ840J6 (pack of 50) Transducer holder for CPJ840J6 (pack of 4) IV pole mount for CPJ840J6 Single channel disposable sensor kit (20) - (EU/EFTA only) Dual channel disposable sensor kit (20) (EU/EFTA only) Transducer holder for M1567/8A (EU/EFTA only) IV pole mount for M1567/8A (EU/EFTA only) Adapter cable for disposable sensor kit 3,0m for M1567/8A Monitoring Line Set Part No CPJ840J6 CPJ84022 CPJ84046 CPJ84447 M1567A M1568A M2271A M2272C M1634A CPJ84026 234 SpO2 Accessories SpO2 Accessories 23 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:

Masimo adapter cables, Philips reusable sensors or adapter cables with part numbers ending in -L (indicates Long version). All listed sensors operate without risk of exceeding 41C on the skin, if the initial skin temperature does not exceed 35C. Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result. Product Number Description Philips reusable sensors. Comments M1191A/B M1191AL/

BL M1192A M1193A M1194A M1195A M1196A Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb. M1191A/B with longer cable (3 m) No adapter cable required. 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. 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. Adult clip sensor (3m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. 235 23 Accessories SpO2 Accessories Product Number M1191T M1192T M1193T M1196T Description Comments Requires M1943

(1 m) or M1943AL

(3 m) adapter cable Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb. 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. Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. No adapter cable required. M1191ANL Special Edition (SE) M1192AN M1193AN M1194AN M1195AN Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb. Special Edition (SE) Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Special Edition (SE) Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot. Special Edition (SE) Ear sensor (1.5m cable) for patients more than 40 kg. Special Edition (SE) Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb. Philips disposable sensors. Not available in the USA and Canada. M1904B M1903B M1902B M1901B Identical to OxiMax MAX-A Identical to OxiMax MAX-P Identical to OxiMax MAX-I Identical to OxiMax MAX-N Philips disposable sensors. Available worldwide. M1131A Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg) Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. 236 SpO2 Accessories 23 Accessories Product Number M1132A M1133A Description Comments Infant finger or toe sensor, 0.9m cable

(patient size 3 - 10 kg) 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. Use adapter cable M1943A or M1943AL. NELLCOR disposable sensors (must be ordered from Nellcor) OxiMax MAX-A OxiMax MAX-AL OxiMax MAX-P OxiMax MAX-I OxiMax MAX-N Oxisensor II D-25 Oxisensor II D-20 Oxisensor II I-20 Oxisensor II N-25 OxiCliq A OxiCliq P OxiCliq I OxiCliq N Adult finger sensor (patient size >30 kg) OxiMax MAX-A with long cable Use adapter cable M1943A or M1943AL. 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) Adult sensor (patient size >30kg) Pediatric sensor (patient size 10-50 kg) Infant sensor (patient size 3-20 kg) Neonatal sensor (patient size <3 kg or

>40 kg) See OxiMax MAX-A See OxiMax MAX-P See OxiMax MAX-I See OxiMax MAX-N 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 Extension cable (2 m) M1943A M1943AL Adapter cable (1.1 m cable) Adapter cable (3 m cable) For use with Philips reusable sensors and adapter cables. Adapter cable for Philips/Nellcor disposable sensors. 237 23 Accessories SpO2 Accessories Product Number OC-3 Description Comments Adapter Cable for OxiCliq sensors Available from Nellcor only. Product Number Description MASIMO LNOP LNOP DC-I LNOP DC-IP LNOP YI LNOP TC-I MASIMO LNCS LNCS DC-I LNCS DC-IP LNCS TC-I reusable sensors. Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-site Sensor (> 1 kg) Ear Sensor (> 30 kg) reusable sensors. Adult reusable Sensor (> 30 kg) Pediatric reusable Sensor (10 - 50 kg) Reusable ear Sensor (> 30 kg) disposable adhesive sensors. MASIMO LNOP LNOP Adt LNOP Adtx LNOP Pdt LNOP Pdtx LNOP Inf-L LNOP Neo-L Adult Sensor (> 30 kg) Adult Sensor (> 30 kg) Pediatric Sensor (10 - 50 kg) Pediatric Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Sensor (<3kg) or Adult adhesive Sensor (> 40 kg) LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin Sensors (<1kg) MASIMO LNCS LNCS Adtx LNCS Pdtx LNCS Inf-L LNCS Neo-L disposable adhesive sensors. Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Foot Sensor (< 3 kg) or Adult Finger Sensor (> 40 kg) Philips Part Number 989803140321 989803140331 n/a 989803140341 989803148281 989803148291 989803148301 989803140231 n/a 989803140261 n/a 989803140311 989803140291 989803140301 989803148231 989803148241 989803148251 989803148271 LNCS NeoPt-L Neonatal pre-term sensitive skin Sensor 989803148261

(< 1 kg) Adapter Cable for MASIMO sensors. LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors 451261000761 989803148221 LNC MP10 238 Temperature Accessories 23 Accessories 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) Foley Catheter Probe (16 French) Foley Catheter Probe (18 French) Adapter cable 1.5m Adapter cable 3.0m Part No. Minimum measurement time for accurate readings 90 sec 60 sec 60 sec 90 sec 60 sec 180 sec 210 sec 310 sec 180 sec 180 sec 180 sec 21075A 21076A 21078A M1837A 21091A 21093A 21094A 21095A M2255A 21096A 21097A 21082B 21082A Mainstream CO2 Accessories Description CO2 Sensor Adult/Pediatric Airway Adapter (reusable) Infant Airway Adapter (reusable) Adult Airway Adapter (single-patient use) Infant Airway Adapter (single-patient use) Part No. M2501A M2513A M2516A M2533A M2536A 239 23 Accessories Sidestream CO2 Accessories Sidestream CO2 Accessories Description CO2 Sensor Nasal and Oral-Nasal Cannulas CO2 Nasal Cannula, Adult CO2 Nasal Cannula, Pediatric CO2 Nasal Cannula, Infant CO2 / O2 Nasal Cannula, Adult CO2 / O2 Nasal Cannula, Pediatric CO2 / O2 Nasal Cannula, Infant CO2 Oral-Nasal Cannula, Adult CO2 Oral-Nasal Cannula, Pediatric CO2 / O2 Oral-Nasal Cannula, Adult CO2 / O2 Oral-Nasal Cannula, Pediatric Airway Adapters Airway Adapter Set, ET > 4.0 mm 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 989803144471 M2756A M2757A M2760A M2761A M2768A 989803144531 M2772A M2773A M2776A M2777A Mainstream CO2 Accessories (for M3016A) Description CO2 Sensor Standard Airway Adapter (reusable) Small Airway Adapter (reusable) Part No. M1460A M1465A 14363A Microstream CO2 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. 240 Battery Accessories 23 Accessories Smart CapnoLine O2 is a combined oral-nasal-O2-CO2 FilterLine. NIV Line is a nasal FilterLine suitable for mask ventilation (for example, C-PAP). Single purpose means CO2 measurement only, dual purpose means CO2 measurement and O2 delivery. The accessories are supplied in packs of 25. Microstream accessory selection flowchart Yes Is the patient intubated?

No Does the patient need oxygen?

Yes No Short-term

(up to 6 hours) Long-term Short term Long term Long-term Short term

(up to 72 hours)

(up to 8 hours)

(up to 24 hours)

(up to 24 hours)

(up to 8 hours) Short term

(up to 8 hours) Oral/Nasal Nasal Nasal Oral/Nasal Nasal Key Applications Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Lab, Long-term 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) CapnoLine HO2:

A: M4680A P: M4681A CapnoLine H:

A: M4689A P: M4690A I/N: M4691A NIV Line:

A: 4686A P: M4687A Smart CapnoLine:

A: M2526A P: M2524A Smart CapnoLine Plus Long A:989803160301*

Smart CapnoLine O2:

A: M2522A P: M2520A Smart CapnoLine O2 Long A:989803160281*

P:989803160271*

FilterLine Set:

A/P: M1920A FilterLine Set Long:

A/P:989803160241*

FilterLine:

M1925A*

FilterLine H Set:

A/P: M1921A I/N: M1923A FilterLine H Set Long A/P:989803160251*

I/N:989803160261*

VitaLine H Set:

A/P:989803159571*

I/N: 989803159581*

FilterLine H:

M1926A*

*Not available in all geographies. 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 241 23 Accessories Battery Accessories 242 24 24Specifications 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). NOTE1 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. NOTE2 EMC Environment All measurements (except the sidestream CO2 measurement with M2741A sensor) and system interfaces (except short range radio and wireless LAN) are, in addition, suitable for use in establishments directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes (see table in Electromagnetic Emissions on page 267). The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. WARNING The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment

(for example, hyperbaric chambers. Manufacturers Information You can write to Philips at this address 243 24 Specifications Symbols Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.philips.com. Copyright 2002 - 2008. Koninklijke Philips Electronics N.V. All Rights Reserved. Trademark Acknowledgement The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor, Durasensor, Dura-

Y, Oxiband, Oxicliq, OxiMax. MAX-FAST is a trademark of Mallinckrodt Inc. 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 On/Off/Standby Main Screen DC power source Battery symbol Battery Eject SmartKeys ECG Sync Pulse Output indicator Pressure connector Temperature connector NBP connector SpO2 connector Connection direction indicator Connector has special protection against electric shocks and is defibrillator proof Uses FAST SpO2 algorithm 244 Installation Safety Information 24 Specifications Symbols Silence Alarms Alarms Alarms Off ECG connector Error LED LAN connection indicator for connection to a wired network IntelliVue Instrument Telemetry wireless network Monitor supports 12-

lead ECG built-in short range radio interface 2002-

06 Identifies year and month of manufacture Always use separate collection for waste electrical and electronic equipment (WEEE) built-in wireless network 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 two-

wire 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. All network cables must be unshielded. Network Cables 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 244 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. 245 24 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 CO2 measurements. The monitor must be configured at installation to the correct altitude. 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. 246 Out-Of-Hospital Transport - Standards Compliance 24 Specifications The MP2 including the Wireless IntelliVue Adapter - 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 maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210. The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210. The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems. CAUTION High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices. The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA. The radio component contained in this device is compliant to Council Directive 1999/5/

EC (Radio Equipment and Telecommunications Terminal Equipment Directive) In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1;

ARIB STD-T66. The MP2 including the short range radio interface - 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 1 radio equipment. In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66. Out-Of-Hospital Transport - Standards Compliance The MP2 patient monitor with measurements and interfaces other than those listed below cannot be used for patient transport outside of the hospital environment. The MP2 patient monitor, with the following measurements and interfaces:

ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A) LAN, Battery 247 24 Specifications Out-Of-Hospital Transport - Standards Compliance 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 (SpO2) and EN ISO 21647 (CO2). 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 T(15 A/m) Operating ambient temperature testing over the range from 0 to 40C (32 to 100F). Operating ambient humidity testing up to 95% RH at 40C (100F), non condensing. NOTE Additional requirements can be necessary for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU. 248 Out-Of-Hospital Transport - Standards Compliance 24 Specifications Physical Specifications Specification Comments Maximum Weight 1.25 kg

(2.8 lb) Size (W x H x D) 188 x 99 x 86 mm 7.4 x 3.9 x 3.4 in including battery, without options without handle and options M8023A External Power Supply Weight and Dimensions Maximum Weight 700 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 Range Temperature Range Temperature Range with the Wireless IntelliVue Adapter or IntelliVue Instrument Telemetry Wireless Network or when charging the battery Humidity Range Operating Storage including transportation Operating 0 to 40C (32 to 104F)

-20 to 60C (-4 to 140F) 0 to 35C (32 to 95F) Operating Storage including transportation 15% to 95% Relative Humidity (RH) 5% to 95% Relative Humidity (RH) 249 24 Specifications Monitor Performance Specifications Item Altitude Range Ingress Protection Condition Range Operating Storage including transportation Monitor External Power Supply

(M8023A)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m1 (15000 ft) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15) IP31(protected against the ingress of solid foreign objects 2.5 mm in diameter or larger, and the ingress of water when the water is dripping vertically) when rested on its rubber feet on a flat, level surface. IP32 when mounted as shown in the section Mounting the External Power Supply (M8023A) on page 3 of the Installation chapter and as described in the Service Guide. 1.Sufficient for flight altitudes up to 12,000 m with pressurized cabins. Monitor Performance Specifications Performance Specifications Power Specifications Power consumption Battery Specifications Operating Voltage Operating Time

(with new, fully charged battery at 25C) Charge Time

<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, SpO2 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. red (crossed-out alarm symbol) LED red/yellow/light blue (cyan) LED green / red LED green LED yellow (charging)/red blinking (empty) LED green LED 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. Alarms Off Alarms On/Standby / Error AC Power Battery External Power Audible feedback for user input Prompt tone QRS tone, or SpO2 modulation tone 4 different alarm sounds Resolution Information Indicators Sounds Trends 250 Monitor Performance Specifications 24 Specifications Performance Specifications Alarm signal Review Alarms Real Time Clock System delay Pause duration Extended alarm pause Information Capacity Range Accuracy Hold Time Buffered Memory Hold Time Contents less than 3 seconds 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes all alarms / inops, main alarms on/off, alarm silence and time of occurrence 300 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 Power consumption Line Voltage Current Frequency AC Power Indicators Monitor Interface Specifications

<12 W average

<30 W peak 100 to 240 V ~

1.3 to 0.7 A 50/60 Hz ~

green LED Measurement Link

(MSL) ECG Sync Pulse Output

(See Connectors on page 246 for safety-

related information) Connectors Power Power Sync. LAN signals Serial signals Local signals Cable detection Marker In Wave Output Connector Output levels Isolation Pulse Width Delay from R-wave peak to start of pulse Minimum required R-

wave amplitude 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 0.5 V 251 24 Specifications Monitor Performance Specifications Monitor Interface Specifications Wireless Network Device Interface

(integrated, for compatible network options see below) Signals Frequency Band RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V 20%, 3.5 W continuous USA: 2.400 2.483GHz, 5.15 ~ 5.35Ghz, 5.725 ~ 5.825Ghz Europe: 2.400 2.483GHz, 5.15~ 5.35Ghz, 5.47 ~ 5.725Ghz Japan: 2.400 2.483GHz, 4.90 5.091GHz, 5.15 5.25GHz China: 2.400 2.483GHz, 5.725 ~5.85Ghz Modulation Technique 802.11b/g Effective radiated power DSSS (DBPSK, DQPSK, CCK) OFDM (BPSK,QPSK, 16-QAM, 64-QAM) 802.11a OFDM (BPSK,QPSK, 16-QAM, 64-QAM) 2.4 GHz FCC: max 18 dBm ETSI: max 18 dBm 5 GHz FCC: max 24 dBm ETSI: max 18 dBm Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) Short Range Radio Interface1 Type Technology Frequency Band Modulation Technique DSSS (O -QPSK) Effective radiated power max. 0 dBm (1 mW) 1.The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A IntelliVue Telemetry System Transceiver. 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 252 M4607A Battery Specifications 24 Specifications Compatible Devices IntelliVue Instrument Telemetry Wireless Network (USA only) Internal WMTS Adapter Technology IntelliVue Instrument Telemetry Wireless Network (except USA) Internal ISM Adapter Technology compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure WMTS, 1395-1400 MHz and 1427-1432 MHz compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure 2.4 GHz ISM IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter) Internal Wireless Adapter IEEE 802.11a/b/g 2.4 GHz and 5 GHz ISM Band Frequency Band Frequency Band Technology Frequency Band M4607A Battery Specifications One battery is required for battery operation of the monitor. M4607A Battery Specifications Physical Specifications W x D x H Weight Performance Specifications 66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in) 160 g 5%

Nominal Voltage Rated Capacity at discharge C/5 10.8 Volt 1000 mAh (typical) Environmental Specifications Temperature Range Humidity Range Battery Type Safety Electromagnetic Compatibility (EMC) Communication Standard Discharge 0 to 60qC (32 to 122qF) Charge 0 to 60qC (32 to 122qF) Storage and Transportation: -20 to 65qC (-4 to 140qF) Operating: 15% to 95% Relative Humidity (RH) Storage and Transportation: 5% to 95% Relative Humidity (RH) Lithium Ion Mangan, 10.8 V, 1000 mAh, complies with UL 2054 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 v1.1 253 24 Specifications Measurement 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 Range Accuracy Resolution Sensitivity Range Resolution Range Accuracy Resolution Range Accuracy Resolution Range Resolution Range Resolution Range - adult Range - pediatric and neonatal Brady Normal Tachy PVC Rate ST Numeric QT Numeric QTc Numeric

'QTc Numeric QT-HR Numeric Sinus and SV Rhythm Ranges Bandwidth Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm 1% of range 1 bpm t200 Vpeak 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 1 ms

-600 to +600 ms 1 ms 15 to 300 bpm 15 to 350 bpm Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Adult/neo/pedi: 0.05 to 150 Hz Neo/pedi: 0.5 to 150 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Neo/pedi: 0.5 to 55 Hz Adult/neo/pedi: 0.5 to 20 Hz 254 Measurement Specifications 24 Specifications ECG/Arrhythmia/ST Performance Specifications Bandwidth when the ECG is transmitted from a telemetry device via short range radio Adult/neo/pedi: 0.05 to 40 Hz Neo/pedi: 0.5 to 40 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Differential Input Impedance Common Mode Rejection Ratio Electrode Offset Potential Tolerance Auxiliary Current

(Leads off Detection) Input Signal Range Neo/pedi: 0.5 to 40 Hz Adult/neo/pedi: 0.5 to 20 Hz

>2 M: RA-LL leads (Resp)

>5 M: at all other leads (at 10 Hz including patient cable) Diagnostic mode: >86 dB (with a 51 k:/47 nF imbalance). Filter mode: >106 dB (with a 51 k:/47 nF imbalance). 500 mV 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

'QTc High Range 15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 15 to 100 bpm 2 PVCs 1 to 99 PVCs/minute 20 to 300 bpm 3 to 99 PVCs/minute 3 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 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) 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps 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 Sinusoidal signal, 260 PA, 40.5 kHz RL drive gain 44 dB max., max. voltage 1.8 Vrms 255 24 Specifications Measurement Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Time to Alarm for Tachycardia Vent Tachycardia 1 mVpp,206 bpm Vent Tachycardia 2 mVpp,195 bpm Tall T-Wave Rejection Capability Heart Rate Averaging Method Response Time of Heart Rate Meter to Change in Heart Rate Heart Rate Meter Accuracy and Response to Irregular Rhythm Accuracy of Input Signal Reproduction Pacemaker Pulse Rejection Performance 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 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 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. HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds 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 Accuracy Resolution Bandwidth Noise 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:(rms) referred to the input 256 Measurement Specifications 24 Specifications Respiration Alarm Specifications High Low Range Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm 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 Apnea Alarm 10 to 40 seconds 5 second steps Delay max. 14 seconds for limits from 0 to 20 rpm:

max. 4 seconds for limits above 20 rpm: max. 14 seconds 257 24 Specifications SpO2 Measurement Specifications Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-

49:2001). Measurement Validation: The SpO2 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. Maximum with NBP INOP suppression on60 seconds. 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:

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: d15 mW Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed) 70% to 100%

Range Accuracy SpO2 Performance Specifications SpO2 The specified accuracy is the root-mean-

square (RMS) difference between the measured values and the reference values Resolution Range Accuracy Resolution Pulse Sensors Pulse Oximeter Calibration Range 258 Measurement Specifications 24 Specifications SpO2 Alarm Specifications SpO2 Desat Pulse Tachycardia Bradycardia Range 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 Adjustment 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 5 bpm steps Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm 5 bpm steps 5 bpm steps Clamping at 30 to 100 bpm Delay

(0, 1, 2, 3,... 30)

+4 seconds max. 14 seconds max. 14 seconds max. 14 seconds NBP Complies with IEC 60601-2-30:1999/EN60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic Diastolic Mean Pulse Rate Accuracy Pulse Rate Measurement Accuracy Pulse Rate Range Measurement Time 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) 259 24 Specifications Measurement Specifications NBP Performance Specifications Cuff Inflation Time Initial Cuff Inflation Pressure Auto Mode Repetition Times STAT Mode Cycle Time Venipuncture Mode Inflation Inflation Pressure Adult Pediatric Neonatal Adult/pediatric Neonatal Automatic deflation after 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 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 Adjustment 10 to 30 mmHg: 2 mmHg (0.5 kPa)

>30 mmHg: 5 mmHg (1 kPa) Diastolic Mean 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) NBP Overpressure Settings Adult Pedi Neo

>300 mmHg (40 kPa) >2 sec

>300 mmHg (40 kPa) >2 sec

>150 mmHg (20 kPa) >2 sec not user adjustable 260 Measurement Specifications 24 Specifications Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate Range Accuracy Resolution Input Sensitivity Transducer Frequency Response Zero Adjustment Gain Accuracy Range:

Accuracy Drift Accuracy Drift Non linearity and Hysteresis

(including transducer) Volume displacement of CPJ840J6 Overall Accuracy 40 to 360 mmHg 25 to 350 bpm 1% Full Range 1 bpm Sensitivity:5 V/V/mmHg (37.5 V/V/kPa) Adjustment range:10%

Load Impedance:200 to 2000 : (resistive) Output Impedance:d3000 : (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 d0.4% FS (@CAL 200 mmHg) 4% of reading or 4 mmHg (0.5 kPa), whichever is greater 0.1 mm3 /100 mmHg Invasive Pressure Alarm Specifications Range Pressure 40 to 360 mmHg

(5.0 to 48 kPa) Extreme High Extreme Low Pulse Difference to high limit 0 to 25 mmHg Clamping at -40 to 360 mmHg Difference to low limit 0 to 25 mmHg Clamping at -40 to 360 mmHg 25 to 300 bpm Delay max. 12 seconds Adjustment

-40 to 50 mmHg 2 mmHg (0.5 kPa)

>50 mmHg 5 mmHg (1 kPa) 5 mmHg steps (0.5 kPa) 5 mmHg steps (1.0 kPa) 5 mmHg steps (0.5 kPa) 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) 261 24 Specifications Measurement Specifications Invasive Pressure Alarm Specifications Range Tachycardia Adjustment 5 bpm steps Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 25 to 100 bpm 5 bpm steps 5 bpm steps 5 bpm steps Delay max. 14 seconds max. 14 seconds Bradycardia Temp Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range Resolution Accuracy Average Time Constant 1 to 45qC (30 to 113qF) 0.1qC (0.2qF) 0.1qC (0.2qF) Less than 10 seconds Temp Alarm Specifications Temp High/Low Alarms Range 1 to 45qC (30 to 113qF) Adjustment

-1 to 35qC (30 to 95qF), 0.5qC (1.0qF) steps 35 to 45qC (95 to 113qF), 0.1qC (0.2qF) steps The CO2 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 CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, 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% O2 and N2 balance, up to 35qC 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. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) Included in Accuracy specifications 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 Resolution Stability Range Accuracy awRR Warm-up Time CO2 262 Measurement Specifications 24 Specifications M3015A Microstream CO2 Performance Specifications Rise Time 190 ms for neonatal mode

(measured with FilterLine H for neonatal) 240 ms for adult mode

(measured with FilterLine H for adult) 50 + 15/-7.5 ml/minute Maximum:

3 seconds (2m sample lines) 6 seconds (4m sample lines) Acoustic noise: <45 dBA The total system response time is the sum of the delay time and the rise time. Sound Pressure Total System Response Time Sample Flow Rate Gas Sampling Delay Time M3014A Mainstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 35C, Pabs = 760 mmHg, flow rate = 2 l/min. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 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 CO2 transducer attached for full accuracy specification Less than 60 ms (with adult or infant reusable or disposable adapter) Resolution Stability:

Short term drift Long term drift Range Accuracy awRR Warm-up Time Response Time M3014A Sidestream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 0.8 mmHg over four hours Accuracy specification will be maintained over a 120 hour period 2 to 150 rpm 1 rpm 263 Resolution Stability:

Short term drift Long term drift Range Accuracy awRR 24 Specifications Measurement Specifications M3014A Sidestream CO2 Performance Specifications Warm-up Time Sample Flow Rate Total System Response Time Operating Temperature 2 minutes with CO2 sensor attached for full accuracy specification 50 10 ml/minute 3 seconds 0 to 40C (32 to 100F) M8102A/M3014A Mainstream and Sidestream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is:

PATPD

PBTPS Pabs

Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35C and 100% RH. M3016A Mainstream CO2 Performance Specifications CO2 Range Accuracy 4 to 150 mmHg (-0.5 to 20.0 kPa) 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% O2 and N2 or N2O balance. Outside these conditions the accuracy reaches at a minimum the requirements of EN864/ISO9918. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 1.0 mmHg over a 7 day period 0 to 150 rpm 2 rpm 20 minutes with CO2 transducer attached for full accuracy specification Less than 125 ms (for step from 10% to 90%) Resolution Stability Range Accuracy awRR Warm-up Time Response Time Mainstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2 readings. The formula for the correction calculation is:

PATPD

PBTPS Pabs

Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 47 mmHg @37qC and 100% RH. 264 Measurement Specifications 24 Specifications CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High Range 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) 10 to 90 mHg (1 to 12 kPa) Adjustment 2 to 20 mmHg

(0.3 to 3.0 kPa) steps of 1 mmHg

(0.1 kPa) awRR High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm awRR Low Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps Apnea delay 10 to 40 seconds 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 CO2 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 Gas Level

(% volume fraction) 60 4 5 5 5 80 50

15 0.1 0.1 0.1 1.0 M3015A M8102A/M3014A Additional deviation due to gas interfence, measured at 0 - 40 mmHg CO2 1 mmHg 2 mmHg 2 mmHg 2 mmHg 2 mmHg

-5 mmHg 1 mmHg not specified for use 5%

5%

5%

5%

5%

5%

5%

+5 mmHg 1 mmHg 1 mmHg 1 mmHg 1 mmHg 5%

5%

5%

5%

5%

265 24 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 Compliance Group 1 RF emissions CISPR 11 for the MP2 or X2 with all accessories except the M2741A Sidestream CO2 sensor RF emissions CISPR 11 for the MP2 or X2 whenever used with the M2741A Sidestream CO2 sensor Class B Class A Avoiding Electromagnetic Interference The monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The monitor is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes. 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. 266 Safety and Performance Tests 24 Specifications 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. 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. IEC 60601-1-2 test level 6 kV contact 8 kV air Compliance level 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input/output lines 2 kV for power supply lines 1 kV for input/output lines 1 kV differential mode 2 kV common mode 1 kV differential mode 2 kV common mode

<5% UT

(>95% dip in UT) for 0.5 cycles 40% UT

(60% dip in UT) for 5 cycles 70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec 3 A/m

<5% UT

(>95% dip in UT) for 0.5 cycles 40% UT

(60% dip in UT) for 5 cycles 70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec 3 A/m Immunity test Electrostatic discharge (ESD) IEC 61000-4-2 Electrical fast transient/burst IEC 61000-4-4 Surge IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-

11 Power frequency

(50/60 Hz) magnetic field IEC 61000-4-8 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%. 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 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, UT 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. 267 24 Specifications Safety and Performance Tests 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. 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 VRMS 150 kHz to 80 MHz Compliance level 3 VRMS

(1 VRMS for respiration) Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz 3 V/m

(1 V/m for respiration) For short range radio, see note1. Electromagnetic environment guidance Recommended separation distance:

1,2 P d

for respiration:

3,5 P d 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

2.0 to 2,3 GHz for short range radio d 7,0 P

1.If ECG/SpO2 signals are acquired from a telemetry device via short range radio the compliance level is 3V/m except in the range 2.0 to 2.3 GHz where it is 1 V/m. 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. 268 Safety and Performance Tests 24 Specifications 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 those measurements which do not use the general formula. Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz d

1,2 P d

1,2 P d

2,3 P for respiration:

d

3,5 p for respiration:

d

3,5 P for respiration:

d

7,0 P for short range radio in the range 2.0 to 2.3 GHz:

d

7,0 P Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.2 (0.7) 0.7 (2.2) 2.3 (7.0) 7.3 (22.1) 23.0 (70.0) Equation Rated max. output power of transmitter (W) 0.01 0.1 1 10 100 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. 269 24 Specifications Safety and Performance Tests 270 25 25Default 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 monitors 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 Line Frequency Units Afghanistan land 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 50/60 [Hz]

50 50 50 50 60 60 50 60 60 50 50 50 60 50 50 50 60 50 60 50 50 50 Weight kg, lb kg kg kg kg lb lb kg lb lb kg kg kg kg kg kg kg kg kg lb kg kg kg ECG Cable Color Units Height in, cm IEC, AAMI cm cm cm cm in in cm in in cm cm cm cm cm cm cm cm cm in cm cm cm AAMI IEC IEC IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC 271 25 Default Settings Appendix Country-Specific Default Settings 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 Cte 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 60 60 60 60 50 50 50 60 60 60 50 50 50 50 50 50 50 60 60 60 50 60 50 50 60 60 60 60 50 50 60 60 50 50 60 50 50 60 50 50 60 60 50 60 50 50 50 50 60 60 60 lb lb kg lb kg kg kg lb kg lb kg kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb kg kg lb kg kg kg kg kg kg lb kg kg kg kg kg kg kg kg kg kg lb lb lb in in cm in cm cm cm in cm in cm cm cm cm cm cm cm cm in cm cm in cm cm in in cm in cm cm in cm cm cm cm cm cm in cm cm cm cm cm cm cm cm cm cm in in in AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC IEC AAMI AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI IEC IEC IEC IEC IEC AAMI IEC AAMI AAMI AAMI IEC AAMI IEC IEC IEC IEC AAMI AAMI AAMI 272 Country-Specific Default Settings 25 Default Settings Appendix 50 Finland 50 France 50 French Guiana 60 French Polynesia 60 French Southern Territories 50 Gabon 50 Gambia, The 60 Georgia 50 Germany 50 Ghana 60 Gibraltar 50 Greece 60 Greenland 50 Grenada 50 Guadeloupe 60 Guam 60 Guatemala 50 Guernsey 60 Guinea 60 Guinea-Bissau 60 Guyana 60 Haiti 60 Heard Island and McDonald Islands 60 Holy See, Vatican City State 60 Honduras 50 Hong Kong 50 Hungary 50 Iceland 50 India 50 Indonesia 50 Iran, Islamic Republic of 50 Iraq 50 Ireland 50 Isle of Man 50 Israel 50 Italy 50 Jamaica 60 Japan 50 Jersey 50 Jordan 50 Kazakhstan 50 Kenya 60 Kiribati Korea, Democratic Peoples Republic of 60 60 Korea, Republic of 50 Kuweit Kyrgyzstan 60 50 Lao Peoples Democratic Republics 50 Latvia 50 Lebanon Lesotho 50 kg kg kg lb lb kg kg lb kg kg lb kg lb kg kg lb kg kg lb lb kg kg lb lb kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg lb lb kg kg lb kg kg kg kg cm cm cm in in cm cm in cm cm in cm in cm cm in cm cm in in cm cm in in cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm in in cm cm in cm cm cm cm IEC IEC IEC AAMI AAMI IEC IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC AAMI AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI IEC 273 25 Default Settings Appendix Country-Specific Default Settings Liberia Libyan Arab. Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The former Yugoslavian Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federal States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia 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 50 60 60 50 50 60 50 50 50 50 60 50 50 60 60 50 60 60 60 60 60 60 60 50 50 50 50 60 50 60 60 50 50 60 50 60 50 50 60 60 60 50 50 50 60 50 60 60 50 60 kg lb lb kg kg lb kg kg kg kg lb kg kg lb kg kg lb lb kg lb lb lb lb kg kg kg kg lb kg lb lb kg kg lb kg kg kg kg lb lb lb kg kg kg lb kg lb lb kg kg cm in in cm cm in cm cm cm cm in cm cm in cm cm in in cm in in in in cm cm cm cm in cm in in cm cm in cm in cm cm in in in cm cm cm in cm in in cm cm IEC AAMI AAMI IEC IEC AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI 274 Country-Specific Default Settings 25 Default Settings Appendix Philippines 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 60 60 50 50 60 50 60 50 50 50 60 60 50 60 50 60 60 60 50 50 50 50 60 50 50 50 50 60 50 60 60 50 60 50 60 60 60 50 50 50 60 60 60 50 60 60 60 60 60 50 kg lb kg kg lb kg lb kg kg kg lb kg kg lb kg lb lb lb kg kg kg kg lb kg kg kg kg lb kg lb lb kg lb kg kg lb lb kg kg kg kg lb lb kg lb lb lb lb lb kg cm in cm cm in cm in cm cm cm in cm cm in cm in in in cm cm cm cm in cm cm cm cm in cm in in cm in cm cm in in cm cm cm cm in in cm in in in in in cm AAMI AAMI IEC IEC AAMI AAMI AAMI IEC IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC AAMI IEC IEC IEC IEC AAMI IEC AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC 275 25 Default Settings Appendix Country-Specific Default Settings Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UK United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 50 60 60 60 60 60 50 50 50 60 60 50 60 60 60 50 50 60 60 50 50 60 60 kg lb kg lb lb lb kg kg kg lb lb kg lb lb lb kg kg lb lb kg kg lb lb cm in cm in in in cm cm cm in in cm in in in cm cm in in cm cm in in IEC AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI AAMI AAMI IEC AAMI AAMI AAMI 276 Alarm and Measurement Default Settings 25 Default Settings Appendix Alarm and Measurement Default Settings Settings are only entered once per table row if they are the same for all patient categories1. 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 5 2 min. Enabled Enabled Off Off Red & Yell Red & Yell On 3 min Traditional 10 sec 20 sec 4 AlarmVol +2 AlarmVol +0 AlarmVol +0 2 Steps 20 sec No R & Y & I Red & Yell Red 5 sec 2 sec Standard 4 1.A profile Outdoor exists for use in typical outdoor conditions (bright sunlight, higher ambient noise). See the Configuration Guide for details. 277 25 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

'ExtrTachy Tachy Clamp

'ExtrBrady Brady Clamp ALL ECG IN. Fallback Alarms Off Alarm Source Sel. Va Lead Vb Lead SyncPulse sensit SyncPulse Marker Fallback ECGTele Arrhythmia Settings Arrhythmia Pause Threshold VTach HR VTach Run 278 Pedi 160 bpm 75 bpm Neo 200 bpm 100 bpm 3.0 sec 220 bpm 240 bpm 50 bpm Factory Defaults Adult 120 bpm 50 bpm On Auto On 1 II V 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 V2 V5 Medium On Enabled Factory Defaults Adult On 2.0 sec 100 5 Pedi 120 Neo Off 1.5 sec 150 ECG, Arrhythmia, ST and QT Default Settings 25 Default Settings Appendix Pedi 200 5 Neo 210 5 Arrhythmia Settings Vent Rhythm SVT HR SVT Run PVCs/min Non-Sustain 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 Afib IrregularHR HR Alarms TimeOut 1st TimeOut 2nd Arrhy Off Message SOME ECG IN Factory Defaults Adult 14 180 5 10 On On On On On On On On On On On On On On On On Short Yell 3 min 10 min Yes On 279 25 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 Pedi Off Factory Defaults Adult Single ST On On On

-80 ms 48 ms J+60 Neo Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL Settings Factory Defaults Factory Adult Factory Pedi Factory Neo ST(Label) On Off For Alarm Mode = Single-ST ST(Label) High ST(Label) Low For Alarm Mode = Multi-ST ST(Label) High ST(Label) Low QT Settings QT Lead QTc High Limit

'QTc Limit QTc High Alarm On/Off

'QTc High Alarm On/Off QT Analysis QTc Formula

+2.0 mm

-2.0 mm

+1.0 mm

-1.0 mm Factory Defaults Factory Adult Factory Pedi Factory Neo 480 ms 460 ms All 500 ms 60 ms On On Off Bazett 280 Pulse Default Settings 25 Default Settings Appendix Pulse Default Settings Pulse Settings Alarms Source Pulse (Label) System Pulse Alarms Off Alarm Source Sel. Pulse Alarm Settings Pulse (SpO2) Pulse Alarms High Limit Low Limit

' Extr Brady Brady Clamp

' Extr Tachy Tachy Clamp Factory Defaults Adult Auto On SpO2 Enabled Enabled Factory Defaults Adult On Off 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pedi Neo Pedi Neo 160 bpm 75 bpm 200 bpm 100 bpm 40 bpm 50 bpm 220 bpm 240 bpm Pulse alarms use the settings of the currently selected Pulse alarm source. Respiration Default Settings Respiration Settings Factory Defaults Adult Pedi High Limit Low Limit Apnea Time Alarms Resp Auto/Manual Resp Speed Color 30 rpm 8 rpm 20 sec On On Auto (Trigger Mode) 6.25 mm/s Yellow Neo 100 rpm 30 rpm 281 25 Default Settings Appendix SpO2 Default Settings SpO2 Default Settings SpO2 Settings Alarms QRS Volume Tone Modulation Tone Mod. Type Speed Perfusion Average NBP Alarm Suppr. Extd. Auto OnOff Color Factory Defaults Pedi Neo Adult On 1 Yes Enhanced 25 mm/s On 10 sec On Disabled light blue (cyan) SpO2 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

'Extr Brady Brady Clamp

' ExtrTachy Tachy Clamp Adult 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pediatric Neonatal 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 160 bpm 75 bpm 20 bpm 40 bpm 20 bpm 220 bpm 80 85 95 20 sec 10 sec 10 sec on SpO2 on on 200 bpm 100 bpm 20 bpm 50 bpm 20 bpm 240 bpm 282 NBP Default Settings 25 Default Settings Appendix NBP Default Settings NBP Settings Mode Alarms from High Alarm Limit Low Alarm Limit Alarms NBP Repetition Time Pulse (NBP) Unit Done Tone Start Time VP Pressure Reference Color Factory Defaults Adult Auto Sys. 160/90 (110) 90/50 (60) On On 10 min On mmHg Off Synchronized 60 mmHg Auscultatory Red Temperature Default Settings Temp Settings Low Limit High Limit Alarms Unit Range Color Factory Defaults Adult 36 39 On qC 35...43 Green Pedi Neo Manual 120/70 (90) 70/40 (50) 90/60 (70) 40/20 (24) 40 mmHg 30 mmHg Invasive Pedi Neo Invasive Pressure Default Settings ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Factory Defaults Adult Sys. 160/90 (110) 90/50 (70) On Disabled Pedi Neo 120/70 (90) 70/40 (50) 90/60 (70) 55/20 (36) 283 25 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 ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings

'Extreme High

'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Factory Defaults Adult 15 15 190/100 (125) 80/45 (65) 150 25 mm/s No 12 Hz Yes 60 sec mmHg Red Factory Defaults CVP, RAP, LAP, UVP Settings Adult Pedi Neo 10/2 (4) 2/-4 (0) 10/2 (4) 2/-4 (0) 5 5 15/5 (10) 0/-5 (-5) 5 5 15/5 (10) 0/-5 (-5) Alarms from High Limit Low Limit Alarms Extreme Alarms

'Extreme High

'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Average in Mon. Signal Quality Mean 14/6 (10) 6/-4 (0) On Enabled 5 5 20/10 (15) 0/-5 (-5) 30 25 mm/s Yes 12 Hz Yes 60 sec mmHg light blue (cyan) No On 284 Invasive Pressure Default Settings 25 Default Settings Appendix Pedi Neo 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) Pedi Neo 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) PAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms

'Extreme High

'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color 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 ICP, IC1, IC2 Settings Factory Defaults Alarms from High Limit Low Limit Alarms Extreme Alarms

'Extreme High

'Extreme Low Low Clamp High Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color 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 285 25 Default Settings Appendix CO2 Default Settings CO2 Default Settings Factory Defaults CO2 Settings etCO2 low etCO2 high imCO2 high CO2 Alarms Unit Scale ImCO2 N2O Corr (only M3015A/M3016A) Oxygen Corr (only M3014A) Gas Corr (only M3014A) Humidity Corr Max Hold AwRR AwRR Alarms AwRR high limit AwRR low limit Apnea time Color Adult 30 50 4 on mmHg 40 mmHg on Off 16%

Off BTPS Off On On 30 8 20 secs Yellow Pedi Neo 100 30 286

10-lead placement (ECG) 99 12-lead placement (ECG) 99 3-lead placement (ECG) 97 5-lead placement (ECG) 97 A AAMI ECG lead labels 96 abdominal breathing and Resp electrode placement 138 aberrantly conducted beats 106 accessories 10-electrode cable sets 230 3-electrode cable sets 230, 232 5-electrode cable sets 230, 232 5-electrode one piece cables 232 6-electrode cable sets 230 CO2 173 CO2 (mainstream) 239, 240 CO2 (microstream) 240 ECG 229 NBP adult cuffs 234 comfort cuffs 233 disposable cuffs 233 multi-patient comfort cuff kits 233 neonatal/infant cuffs

(disposable) 234 reusable cuffs 233 single-hose disposable cuffs 234 Nellcor 235 pressure 234 Pulsion 234 resp 229 set combiners and organizers 231, 232 SpO2 235 Nellcor adhesive sensors

(disposable) 235 Philips sensors (disposable) 235 Philips sensors (reusable) 235 temperature 239 trunk cables 229, 231 active alarms 39 address, Philips 244 addressograph (printer configuration setting) 209 adjusting ST measurement points 120 adjusting wave scale (pressure) 163 adjusting wave size (CO2) 174 admit editing information 85 quick admit 85 admitting a patient 83 airway adapter CO2, microstream accessory 173 alarm latching 50, 112 alarm limits changing 46 checking 45 manually adjusting 46 narrow 48 report 210 ST 122 switching auto limits on/off 48 using automatic limits 48 wide 48 window 45 alarm recording choosing recorded measurements 200 alarm source selection, disabled 135 alarms acknowledging 42 active 39 active SpO2 source 148 alphabetical listing 53 apnea delay 176 apnea delay time (Resp) 140 arrhythmia 39 audible indicators 41 awrr limits 176 chaining 114 CO2 specific 175 CO2, apnea delay 176 CO2, awRR 176 desat, SpO2 147 effect on pressure alarms during zero 161 extending pause time 44 high priority 39 INOP 39 ISO/IEC standard 41 key 16 limit, SpO2 260 message field 17 NBP source 154 off indicator 17 patient messages 53 pausing 43 1Index physiological 53 pleth as source 148 recordings 51 red 39 reminder 43 restarting 44 reviewing window 49 selftest 51 silencing 42 SpO2 high and low limits 147 SpO2 specific 146 ST 122 suspended symbol 44 switching on and off 44 temperature 157 testing 51 tone configuration 41 traditional 41 visual indicators 40 volume, changing 41 yellow 39 alarms key 16 alphabetical listing of alarms 53 analog output ECG 246 apnea alarm delay CO2 176 apnea alarm delay time (RESP) 140 apnea alarms and Resp detection modes 140 arrhythmia aberrantly conducted beats 106 analysis, how it works 105 atrial fibrillation and flutter 106 beat labels 108 initiating learning 110, 111 intermittent bundle branch block 107 learning during ventricular rhythm 111 levels of analysis 102, 105 monitoring non-paced patients 106 monitoring paced patients 106 options 105 relearning 110 relearning and lead fallback 111 status messages 109 switching on/off 106 understanding the display 107 arrhythmia alarms 39, 111 adjusting alarm limits 112 all yellow on/off 112 i chaining 114 latching 112 multiple 114 pvc-related alarms 115 sinus and SV rhythm ranges 257, 260 switching on/off 112 timeout periods 113 arrhythmia monitoring and defibrillation 104 arrhythmia options 102 arrhythmia relearning with EASI INOP 101 arterial pressure source 166 arterial pulsation 143 artifact suppression (pressure) 163 atrial fibrillation and flutter 106 audlatching (arrhythmia alarms) 112 auto alarm limits switching on/off 48 using 48 auto detection mode (Resp) 138 autofilter 94 automatic arrhythmia relearn 111 automatic default setting 27 automatic NBP repeat time 154 autosize ECG wave 94 awRR alarm limits 176 awRR alarms CO2 176 B baseline ST map, updating 125 ST, updating 119 basic arrhythmia option 102, 105 battery and display brightness 221 battery reports 220 battery status window 219 charge status 220 compartment 217 conditioning 222 conserving power 221 indicators 218 LED 218 malfunction indicator 219 malfunction symbols 218 monitoring time 219 power gauge 218 recharging 217 replacing 220 safety information 222 ii status indicator 18, 219 symbol 245 time to empty 220 time to full 220 battery eject symbol 245 battery performance optimizing 221 battery status indicator 18 beat labels arrhythmia 108 bed information 33 blood pressure. See also NBP (non-invasive) or PRESS (invasive) Brightness SmartKey 30 brightness, adjusting 30 C calculating cerebral perfusion 166 calculating temperature difference 158 calibrating CO2 transducer 171 calibration interval, NBP 226 NBP 156 pressure 165 pressure transducer 165 capnography mainstream 14 Microstream 14 carbon dioxide, see CO2 167 cardiac overlay and Resp detection modes 139 when measuring Resp 137 cardiotach alarms 102 cautions 9 central recorder choosing 200 cerebral perfusion 166 chaining 114 change screen menu 23 change screen window 16, 24 Changing 23 changing ECG lead sets 96 changing Resp detection mode 138 changing Resp wave size 139 changing Resp wave speed 140 changing screen content 23 channels recorder 200 checking battery charge 220 checking paced status 90 checklist delivery 2 installation 1 cleaning infection control 213 method 214 monitoring accessories 215 recommended substances 214 CO2 airway adapter 173 alarms, apnea delay 176 alarms, awRR 176 alarms, specific 175 awRR alarm limits 176 checking transducer accuracy 171 correction, humidity 175 correction, N2O 175 corrections 174 FilterLine 173 measuring mainstream 168, 171 measuring microstream 173 method, mainstream 167 method, microstream 167 method, sidestream 167 microstream accessories 173 microstream extension 173 removing exhaust gases 171, 174 transducer, calibrating 171 transducer, using 172 troubleshooting 174 wave scale, adjusting 174 CO2 (mainstream). accessories 239, 240 CO2 (microstream). accessories 240 conditioning batteries 222 configuration mode 22 entering 7 conflict label 28 connecting power 4 connecting temperature probe 157 connection direction symbol 245 connectors 246 temp 157 conventional 12-lead ECG 99 correcting the NBP measurement 153 CPAP (RESP) 139 cuff pressure, NBP 154 selection, NBP 153 current view ST map 122 D damage mechanical 31 damage claims 2 date, setting 7, 30 DC power symbol 245 default profile 26 default settings 271 checking country-specific 7 defibrillation and arrhythmia monitoring 104 and ECG monitoring 104 synchronization marks 91 defibrillator proof symbol 245 defibrillator synch maintenance interval 226 delay time recording 201 demonstration mode 22 desat alarm, SpO2 147 detection modes (Resp) 138 diagnostic (ECG filter setting) 95 discharging a patient 85 disconnect INOPs silencing 43 disinfecting infection control 213 recommended substances 214 display arrhythmia 107 ECG 91 NBP 153 Resp 138 ST 118 display brightness 221 display settings 25 disposal gas cylinder 227 parts and accessories 227 dual Temp measurement 158 dyshemoglobins intravascular (SpO2) 145 E early systolic blood pressure, NBP 154 EASI activating 95 ECG monitoring 101 lead placement 101 EASI ECG lead labels 96 ECG 89 accessories 229 alarms off (Config Mode) 103 changing lead sets 96 choosing electrode sites 95 conventional 12-lead 99 external pacing electrodes 105 filter settings 94 fusion beat pacemakers 105 intrinsic rhythm 104 modified 12-lead 99 New Lead Setup 96 pacemaker failure 104 rate adaptive pacemakers 105 unfiltered 95 wave size 93 ECG analog output 246 ECG cable for operating room 104 ECG cables, connecting 90 ECG connector 90 ECG display 91 ECG electrode colors 96 ECG electrode placement during electro-surgery 104 ECG gain in reports 204 ECG lead labels 96 ECG lead placement choosing EASI/Standard 95 ECG leads monitored 96 ECG report 211 lead layout 204 ECG safety information 104 ECG source tracking 183 ECG wave autosize 94 calibration bar 94 ectopic status messages (arrhythmia monitoring) 110 electrical output symbol 245 electrode placement (ECG) 89 conventional 12-lead 99 modified 12-lead 99 electrode placement (Resp) 137 with abdominal breathing 138 with lateral chest expansion 138 electro-surgery and ECG 104 EMC interference Resp 140 EMI filter for ECG 94 end case discharging a patient 85 report, printing 85 end case reports setup 205 enhanced arrhythmia option 102, 105 exclamation mark symbol 245 exhaust gases, removing 171, 174 extension cable for SpO2 144 external pacing electrodes and ECG monitoring 105 extreme bradycardia alarm 103, 135 extreme pressure alarms 164 extreme rate alarms 103, 135 extreme tachycardia alarm 103, 135 F fallback (ECG) 96 FAST Fourier artefact suppression technology 143 filter (ECG filter setting) 94 filter (ECG) 94 FilterLine CO2, microstream accessory 173 flushing invasive pressure accessories 159 functional arterial oxygen saturation 143 fusion beat pacemakers and ECG monitoring 105 G gas cylinder empty, disposing of 227 getting started 31 global trend time 195 graphic trends 188 graphic trends report 192 H hemodynamic measurement extension 15 hemodynamic MMS extension 15 horizon trend trend time 195 HR = RR (Resp) 138 HR alarms when arrhythmia off 103 HR alarms off (Config Mode) 103 HR and pulse alarm source selection 135 HR from (heart rate source) 134 humidity correction CO2 175 I IEC ECG lead labels 96 If 183 IIT 32 IMV (Resp) 139 indicators battery malfunction 219 battery status 18, 219 infection control iii cleaning 213 disinfecting 213 sterilizing 213 Information Center central recording 199 transferring patients 86 INOPs indicators 39 message field 17 silencing 43 installation checklist 1 connectors 246 personnel 1 Instructions for Use intended audience 9 IntelliVue Instrument Telemetry System

(IIT) 32 intermittent bundle branch block 107 intermittent mandatory ventilation

(Resp) 139 interruption symbol 245 intravascular dyshemoglobins (SpO2) 145 intrinsic rhythm 104 ISO point (ST) 120 J J point (ST) 120 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 50 alarms, behavior 50 latching arrhythmia alarms 112 lateral chest expansion (neonates) monitoring Resp 138 lead fallback and arrhythmia relearning 111 lead fallback (ECG) 96 lead labels (ECG) 96 iv lead placement activating EASI/Standard 95 for Resp measurement 137 leads monitored (ECG) 96 Leads Off INOP (ECG) 96 levels of arrhythmia analysis 105 M main screen key 16 main setup 19 mains power connecting to 3 mainstream capnography 14 mainstream CO2 measuring 168, 171 maintenance cables 225 cords 225 measurements, schedule 226 microstream CO2, calibration 226 schedule 225 visual inspection 225 malfunction symbols battery 218 manual detection mode (Resp) 139 and apnea alarms 140 manufacture date symbol 245 manufacturers information 244 map ST 122 Mason-Likar lead system 99 max hold setting (CO2) 168 measurement adjusting a wave 27 preparation 31 setting up 27 wave speed, changing 27 measurement extension M3012A 15 M3015A 14 M3016A 14 measurement label 17 measurement labels 28 changing 28 measurement points, ST 120 measurement server ECG connector 90 measurement settings 25 measurement setup menu 18 measurements setting up 31 switching on and off 27 mechanical damage 31 menu main setup 19 measurement setup 18 merging patient data 88 messages alarm 17 INOP 17 status and prompt 18 methemoglobin (SpO2) 145 Microstream capnography 14 microstream CO2 173 accessories 173 maintenance, calibration 226 measuring 173 mismatch patient data, resolving 87 MMS extensions 14 modified 12-lead ECG 99 modifying screens 23 monitor inspecting before use 31 quick operating giude 6 starting monitoring 32 switching on 31 monitor (ECG filter setting) 94 monitor defaults 271 monitor revision how to find 30 monitor settings 25 changing 30 monitoring preparation 31 starting 31 monitoring mode 22 mounting power supply 3 mounting information 3 MSL cable 4 multi-lead ST alarming 122 N N2O correction CO2 175 narrow alarm limits 48 NBP adult cuffs 234 alarm source 154 ANSI/AAMI SP10-1992 151 automatic mode, enabling 154 calibrating 156 calibration interval 226 comfort cuff kits 233 comfort cuffs 233 cuff pressure 154 cuff, applying 153 cuff, selecting 153 cuff, tightness 153 disposable cuffs 233 how the measurement works 151 measurement correction 153 measurement limitations 152 measurement methods, auto 152 measurement methods, manual 152 measurement methods, sequence 152 measurement methods, stat 152 measurement, starting 154 measurement, stopping 154 neonatal cuffs (disposable) 234 numerics 153 oscillometric method 151 pediatric cuffs 234 preparing to measure 152 repeat time 153 repeat time for automatic 154 repetition time, setting 154 reusable cuffs 233 single-hose disposable cuffs 234 site inspection 153 time of last measurement 153 units 153 venous puncture 155 neonates Resp electrode placement 138 network connection indicator 17 networked monitoring 33 new features 35 non-invasive blood pressure. See NBP non-paced patients arrhythmia monitoring 106 numerics explanation of NBP display 153 O on-screen keyboard 21 operating modes 22 configuration 22 demonstration 22 monitoring 22 passcode protection 22 service 22 operating room ECG cable 104 orange ECG cable 104 organizers 231, 232 Oridion Systems Ltd 244 oscillometric NBP measurement method 151 overlap in recordings 201 overlapping screen trends 195 P pace pulse rejection (ECG) about 91 switching on/off 93 paced patients arrhythmia monitoring 106 repolarization tails 93 safety information 104 setting status 104 paced status 17 checking 90 pacemaker failure 104 paper size for reports 206 parameter scales trends 191 passcode protection 22 patient admit 83 category, NBP 151 discharge 85 end case 85 patient alarm messages 53 patient category field 17 patient demographics window 83 patient mismatch 87 patient name field 17 patient reports contents 209 patient trends viewing 187 paused alarms 43 extending time 44 restarting 44 performance specifications pressure 255, 262 performance test 267 perfusion indicator 143, 144, 148 Philips contact information 244 physiological alarms 39 pleth alarm source 148 pleth wave 147 pleth waveform 143 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 89 pressure alarms during zero 161 arterial source 166 calibration pressure 165 cerebral perfusion, calculating 166 performance specifications 255, 262 wave scale 163 wave size 163 zeroing the transducer 161 pressure accessories 234 pressure artifact suppression 163 pressure of NBP cuff 154 pressure transducer calibration 165 zeroing 161 primary lead (ECG) selecting 90 print job suspended 207 printer disabling 206 settings 206 status messages 208 unavailable 207 printing ST map reports 126 status log 227 trends reports 192 priority list for trends 191 probes disposable temperature 157 profiles 25 default profile 26 patient category 26 swapping a complete profile 26 swapping setting block 26 prompts 18 pulse alarms 134 system pulse source 133 pulse numerics for SpO2 144 PVC-related alarms 115 Q QRS tone 135 changing volume 30 QRS tone pitch, SpO2 148 QRS volume, changing 94 QT alarms 130 QT baseline 129 QT measurement algorithm 127 v QT monitoring limitations 128 QT/QTc monitoring 127 quick admit 85 R radiated field immunity Resp 140 rate adaptive pacemakers and ECG monitoring 105 realtime report 210 realtime reports content 206 recorder status messages 201 recording central 199 changing recording type 200 channels 200 choosing central recorder 200 choosing recording speed 201 creating templates 200 preventing fading ink 201 runtime 201 setting the runtime 201 setup menu 200 starting and stopping 199 wave overlap 201 recording alarms 51 recording delay time 201 recycling 227 rejecting pace pulses 91 relearning arrhythmia 110 reminder, alarm 43 replacing batteries 220 repolarization tails 93 reports alarm limits 210 battery reports 220 choosing paper size 206 contents 209 ECG 211 end case 205 patient trends 192 realtime report 210 re-routing 207 scheduled 205 setting up 204 ST map 126 stopping printouts 204 re-routing reports 207 resolution trends 191 resolving patient mismatch 87 resp accessories 229 Resp alarms vi apnea alarm delay time 140 Resp detection level and apnea detection 140 Resp detection modes and cardiac overlay 139 changing 138 Resp display 138 Resp monitoring and cardiac overlay 137 Resp safety information 140 Resp wave changing size 139 changing speed 140 restarting paused alarms 44 retrolental fibroplasia (SpO2) 147 reviewing alarms window 49 rhythm status messages (arrhythmia monitoring) 109 runtime setting recording runtime 201 S safety maintenance interval 226 monitor 246 safety information batteries 222 ECG 104 Resp 140 safety test 267 safety tests performance tests 5 power on test 5 system 5 visual inspection 5 same patient data merge 88 scale ECG wave 93 Resp wave 139 scales for trends waveforms 191 scheduled reports 205 screen adjusting brightness 30 screen trend trend time 195 screen trends 193 screens changing content 23 switching 23 understanding 23 visitor screen 24 secondary lead (ECG) selecting 90 selecting the primary lead (ECG) 90 selecting the secondary lead (ECG) 90 selftest alarms 51 sensor disposable SpO2 143 sequence mode 154 service mode 22 set combiners 231, 232 setting up trends 189 setting up reports 204 setting up the sepuence 154 settings 26 about 26 default 271 measurement settings 26 monitor settings 26 screen settings 26 synchronized telemetry and monitor 183 settings blocks 25 Setup Recording menu 200 short yellow alarms on/off 112 signal quality of SpO2 145 silence key 16 sinus and SV rhythm ranges 257, 260 skin preparation ECG 89 SmartKeys 19 key 16 SmartKeys key 16 SmartKeys symbol 245 source tracking ECG 183 specifications 243 arrhythmia 255 speed recording 201 wave speed, changing 27 SpO2 accessories 235 active alarm source 148 alarms specific to 146 arterial pulsation 143 assessing suspicious reading 145 connecting the cables 144 disposable sensors 143 extension cable 144 FAST technology 143 Nellcor adhesive sensors

(disposable) 235 perfusion indicator 143, 144, 148 Philips sensors (disposable) 235 Philips sensors (reusable) 235 pleth as alarm source 148 pleth wave 147 pleth waveform 143 pulse numerics 144 QRS tone 148 signal quality 145 site inspection 145 site selection 143 tone modulation 148 SpO2 desat alarm 147 SpO2 limit alarms 147 ST adjusting alarm limits 122 alarms 102, 122 baseline, updating 119 ensuring diagnostic quality 117 filtering 117 measurement points, adjusting adjusting 120 multi-lead alarms 122 numerics in ECG wave 92 snippets 119 ST display 118 ST map baseline, updating 125 current view 122 report, printing printing ST map report 126 scale, changing scale ST map 125 task window 125 trend view 124 trending interval, changing 126 trending priority 125 ST maps 122 ST point 120 standard 10-lead placement 99 standard 3-lead placement 97 standard 5-lead placement (ECG) 97 standby mode 22 Standby screen 22 standby symbol 245 starting monitoring 32 status line 18 status log printing 227 status messages printer 208 recorder 201 status messages (arrhythmia) 109 ectopic 110 rhythm 109 sterilizing infection control 213 stopping reports printouts 204 surgical ECG cable 104 suspended alarm 44 suspicious SpO2 reading 145 switching on monitor 31 switching screens 23 symbols 244 battery 218 synchronization marks (defibrillator) 91 system pulse 133 systolic blood pressure, NBP, early 154 T tabular trends 189 Tamb 158 task window for ST map 125 Tcereb 158 telemetry alarms 181 suspending at bedside 181 telemetry device controlling from bedside 181 silencing alarms at bedside 181 unpairing 180 temperature 157 accessories 239 alarm settings 157 connecting probe to monitor 157 difference, calculating 158 dual Temp measurement 158 extended label set 158 first 158 label 158 making a measurement 157 probe, disposable 157 probe, selecting 157 second 158 temperature probe connecting 157 templates creating for recordings 200 test blocks, how to perform 5 testing alarms 51 time, setting 7, 30 tone configuration, alarm 41 tone mod (SpO2) 148 tone modulation 148 touchscreen disable/re-enable 16 using 18 transducer CO2, accuracy 171 CO2, calibrating 171 pressure, zeroing 161 transferring centrally-monitored patients 86 transport brightness setting 221 trend time 195 global 195 trend view ST map 124 trending interval ST map 126 trends resolution 191 screen trends 193 setting parameter scales 191 setup 189 viewing 187 trends pop-up keys 187 trends priority list 191 ST map 125 troubleshooting CO2 174 trunk cables accessories 229, 231 Ttymp 158 Tvesic 158 U Understanding 25 unfiltered ECG signal 95 unpacking 2 unpairing 180 user interface settings changing 30 V V electrode placement (ECG) 98 venous puncture 155 viewing arrhythmia waves 108 viewing trends 187 visible waves report 206 visitor screen 24 vislatching (arrhythmia alarms) 112 vital signs report 192 voltage setting 4 volume alarm 41 W warnings 9 wave adjusting 27 changing speed 27 scale (CO2) 174 vii scale (pressure) 163 size (CO2) 174 size (pressure) 163 wave channel speed 28 wave group speed 28 wave size Resp 139 wave size (ECG) changing 93 wave speed eeg speed wave speed global speed 27 respiratory speed 27 wave speed (Resp) 140 whats new 35 wide alarms limits 48 wired network connection symbol 245 Z zero effect on pressure alarms 161 zeroing pressure transducer 161 viii

 

 

INSTRUCTIONS FOR USE IntelliVue Patient Monitor MP5 Release G.0 with Software Revision G.0x.xx Patient Monitoring Part Number M8105-9001C Printed in Germany 09/08 4512 610 29031

*M8105-9001C*

M8105-9001C 1Table Of Contents 1 Installation Installation Checklist Unpacking and Checking the Shipment Mounting the Monitor Connecting the Monitor to AC Mains Checking Out The Monitor Loading Paper Operating the Monitor Setting the Date and Time Checking Country-Specific Default Settings Handing Over the Monitor 2 Basic Operation Introducing the Monitor Operating and Navigating Operating Modes Understanding Screens Using the XDS Remote Display (not MP5T) Using the Visitor Screen Understanding Profiles Understanding Settings Adjusting a Measurement Wave Freezing Waves Using Labels Entering Measurements Manually Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from Power Networked Monitoring Using the MP5 with a Host Monitor 3 Whats New?

Whats New in Release G.0?

Whats New in Release F.0?

4 Alarms Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms 1 2 3 3 3 4 5 6 6 6 9 13 19 20 21 21 22 24 25 26 27 29 29 30 30 32 32 33 35 36 40 41 43 44 45 50 1 9 35 39 i Latching Alarms Testing Alarms Alarm Behavior at On/Off Alarm Recordings 5 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 6 Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients Care Groups 7 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 Changing the Size of the ECG Wave 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 Lead Fallback ECG Lead Placements Capture 12-Lead EASI ECG Lead Placement ECG and Arrhythmia Alarm Overview Using ECG Alarms ECG Safety Information About Arrhythmia Monitoring Switching Arrhythmia Analysis On and Off Choosing an ECG Lead for Arrhythmia Monitoring Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring Switching ST On and Off Understanding the ST Display ii 55 85 99 52 52 53 53 55 61 85 87 87 88 89 92 99 99 100 100 100 101 103 103 104 104 105 105 106 106 110 111 112 113 114 115 116 116 117 120 121 127 127 128 Updating ST Baseline Snippets Recording ST Segments About the ST Measurement Points ST Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 8 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 9 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Display Changing Resp Detection Modes Changing the Size of the Respiration Wave Changing the Speed of the Respiration Wave Using Resp Alarms Changing the Apnea Alarm Delay Resp Safety Information 10 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 SpO2 Signal Quality Indicator (Fast SpO2 only) Assessing a Suspicious SpO2 Reading Changing the Averaging Time Setting the Measurement Mode Understanding SpO2 Alarms Pleth Wave Perfusion Numeric Perfusion Change Indicator Setting SpO2/Pleth as Pulse Source Setting Up Tone Modulation Setting the QRS Volume 11 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP Starting and Stopping Measurements 129 130 130 132 133 137 140 141 143 143 144 144 147 148 148 149 150 150 150 150 153 153 154 154 155 155 156 156 156 157 158 158 158 158 159 161 162 164 143 147 153 161 iii 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 12 Measuring Predictive Temperature Making a Temperature Measurement 13 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 14 Monitoring Invasive Pressure Setting up the Pressure Measurement Zeroing the Pressure Transducer Adjusting the Calibration Factor Displaying a Mean Pressure Value Only Changing the Pressure Wave Scale Optimizing the Waveform Using the Wave Cursor Non-Physiological Artifact Suppression Choosing the Pressure Alarm Source Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion Calculating Pulse Pressure Variation 15 Monitoring Carbon Dioxide Using the CO2 Measurement Measuring Microstream CO2 Setting up all CO2 Measurements 16 Assigning Two Devices to One Patient How Can You Combine Devices?

Functions Available When the Telemetry Data Window is Displayed Functions Available For Devices Connected Via SRR General Telemetry-related Functions Use Models With Telemetry 17 Enhancing Telemetry Monitoring with the Monitor 18 Trends Viewing Trends Setting Up Trends Documenting Trends iv 165 165 166 166 167 167 169 173 174 175 176 178 178 178 179 179 179 179 181 182 182 186 189 190 195 199 200 201 202 207 210 213 169 173 175 185 195 205 207 Trends Databases Screen Trends 19 High Resolution Trend Waves OxyCRG Printing Hi-Res Trend Wave Reports Hi-Res Trend Wave Recordings 20 Event Surveillance Event Episodes Events Pop-Up Keys Event Triggers The Events Database Viewing Events Annotating Events Documenting Events 21 ProtocolWatch Severe Sepsis Screening 22 Recording Starting and Stopping Recordings Overview of Recording Types All ECG Waves Recordings Creating and Changing Recordings Templates Changing ECG Wave Gain Recording Priorities Sample Recording Strip Reloading Paper Recorder Status Messages 23 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up 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 and Printing Manually Printer Status Messages Sample Report Printouts 214 215 219 219 220 221 222 222 224 224 226 226 231 237 238 239 239 240 241 241 243 243 245 246 246 248 249 249 249 249 249 250 251 252 219 221 231 237 245 v 24 Using the Drug Calculator Accessing the Drug Calculator Performing Drug Calculations Charting Infusion Progress Using the Titration Table Documenting Drug Calculations 25 Using the Timer Viewing the Timer Timer Setup Pop-up Keys Setting Up Timers Displaying a Timer On The Main Screen Displaying A Clock On The Main Screen 26 Laboratory Data Viewing Received Data 27 Care and Cleaning General Points Cleaning the Monitor Disinfecting the Monitor Sterilizing the Monitor Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning and Disinfecting the Predictive Temperature Accessories Cleaning Batteries and the Battery Compartment 28 Using Batteries Battery Power Indicators Checking Battery Charge Replacing a Battery Optimizing Battery Performance Battery Safety Information 29 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 30 Accessories ECG/Resp Accessories NBP Accessories Invasive Pressure Accessories SpO2 Accessories vi 257 261 265 267 271 277 281 257 258 260 260 260 261 261 262 263 264 265 267 268 268 268 269 269 269 271 274 274 274 275 277 277 278 279 279 279 281 285 286 287 Temperature Accessories Predictive Temperature Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Microstream CO2 Accessories Recorder Accessories Cable for Direct Connection of a Telemetry Device Battery Accessories 31 Installation and Specifications Intended Use Manufacturers Information Symbols Installation Safety Information Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Out-Of-Hospital Transport - Standards Compliance Monitor Performance Specifications M4605A Battery Specifications Measurement Specifications Safety and Performance Tests 32 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 SpO2 Default Settings NBP Default Settings Temperature Default Settings Predictive Temperature Default Settings Invasive Pressure Default Settings CO2 Default Settings 291 291 292 292 292 293 294 294 295 296 296 298 300 300 301 302 304 308 309 321 327 333 333 334 337 337 338 339 339 340 340 342 295 327 vii viii 1 1Installation Installation should be carried out by qualified service personnel, either by the hospitals 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 monitor 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 Task 1 2 3 4 5 6 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) Connect the monitor to AC mains 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 3) Perform Safety Tests, if required by local laws and regulations (see Checking Out The Monitor on page 3) Load paper into the recorder, if present (see Loading Paper on page 4) Check Box when Task Done 1 1 Installation Unpacking and Checking the Shipment Step Task 7 8 9 Check/set the time and date (see Setting the Date and Time on page 6) Check that the country-specific default settings are appropriate (see Checking Country-Specific Default Settings on page 6) 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 Comments Monitor with options as ordered ECG accessories NBP accessories SpO2 accessories Pressure accessories Temperature accessories Predictive Temperature accessories CO2 Accessories Recorder paper Powercord Telemetry Interface cable Measurement Link (MSL) cable Instructions for Use Quick Guide Documentation CD-ROM (includes Service Guide and Instructions for Use) 1 optional 1 optional optional optional optional optional optional 1 optional optional 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. 2 Mounting the Monitor Repacking 1 Installation 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 The monitor can be rested on a flat surface, hung on the bed rail, or mounted on a wall. See the Service Guide for details. Connecting the Monitor to AC Mains The monitor has a wide-range power supply that allows you to operate the monitor from an AC

(alternating current) power source of 100 V to 240 V ( 10%) and 50 to 60 Hz ( 5%). WARNING Always use the supplied power cord with the earthed mains plug to connect the monitor to an earthed AC mains socket. Never adapt the mains plug from the power supply to fit an unearthed AC mains socket.

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 patients 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. Test Test or Inspection to be Performed Visual Inspect the monitor, measurement accessories and cables for any damage. Power On Functionality Test 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 blue Main Screen key at the bottom right of the screen to test the Touchscreen. The key should turn light blue then after several seconds return to its standard blue color. 3 1 Installation Loading Paper Test Safety Tests (1) to (4) System Test or Inspection to be Performed 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. Loading Paper 1 Use the latch on the right side of the recorder door to pull the door open. 2 Remove the empty core. 3 Insert a new roll and secure it in place on the paper holder. The paper feeds from the bottom of the roll and over the top of the recorder door. Recommended paper: M4816A and M4817A. 4 With at least one inch of paper extending beyond the edge of the door, swing the recorder door up and push it firmly closed. 5 To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper. 4 Operating the Monitor 1 Installation Operating the Monitor To complete installation you will need to operate the monitor. Here is a short introduction for those not experienced with IntelliVue monitors. 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 to enter a menu. Touching the time, as shown here, brings you to the date and time menu needed for the next section. 3 Touch again to select an item on the menu and 4 You can touch numerics, waves and any work through the menu activities. item on the screen, to get you to the corresponding menu. 5 If you cannot find a menu by touching the screen you can always use the Main Setup key which will get you to all menus on the monitor 5 1 Installation Setting the Date and Time Setting the Date and Time To set the date and time:

Select the Date, Time screen element from the monitors 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. Select Store Date, Time to change the date and time. 1 2 3 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 institutions 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. If you need to enter configuration mode:

1 2 In the Main Setup menu, select Operating Modes. Select Config and enter the passcode. The passcode for configuration mode is given in the monitors 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. Ensure that the users have access to the following documentation delivered with the monitor:

Instructions for Use (this book) - for more detailed questions during use

Quick Guide - for quick reminders during use 6 Handing Over the Monitor 1 Installation Additionally, we recommend working through the Training Guide for self-training on the monitor before use (not available in all languages). The part number is M8105-944XB, where X is a digit dependent on the language. The English training guide is M8105-9441B. An English training video, M8000-9451E, is also available. 7 1 Installation Handing Over the Monitor 8 2 2Basic Operation These Instructions for Use are for clinical professionals using the IntelliVue MP5 and MP5T

(M8105A and M8105AT) patient monitors. This basic operation section gives you an overview of the monitor 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 particular for the MP5T, refer to the table on the following page to see which sections of this guide are applicable to your monitor. 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 monitors display, such as measurements, alarms, patient data and so forth. Introducing the Monitor The MP5 monitor provides a comprehensive set of basic physiological measurements: NBP, SpO2, and optionally ECG, invasive blood pressure, predictive temperature, standard temperature and CO2. Through networking it provides information integration, documentation and information access. The MP5 can be used with adult, pediatric and neonatal patients in a hospital and transport environment. 9 2 Basic Operation Introducing the Monitor The monitor stores data in trend and event databases. You can see tabular trends (vital signs) and document them on a central printer. You can view measurement trend graphs, with up to three measurements combined in each graph, to help you identify changes in the patients physiological condition. You can view fast-changing measurement trends with beat to beat resolution and see up to four high resolution trend segments. The MP5 monitor can also be connected to another IntelliVue patient monitor (MP20 to MP90), where it acts as a multi-measurement module (MMS), acquiring measurements for the host monitor. When connected to a host monitor, the host controls the MP5 including all alarm functionality. No alarms are available on the MP5, and the alarm lamps are controlled by the host. You can recognize when an MP5 is connected to a host monitor by the following indication on the screen:

Companion Mode Companion Mode No Alarm Display When the MP5 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor with all settings and data. On connection to a new host monitor, the MP5 resumes its role as MMS, transferring all settings and data, ensuring fully continuous monitoring. When the MP5 is connected to a host monitor it still requires batteries or AC power; it also cannot charge its batteries via the host monitors AC connection. The MP5T monitor is intended for use together with a telemetry device. It has no ECG measurement of its own but does have NBP and optionally SpO2 and predictive temperature. When the telemetry device is directly connected to the MP5T, the measurements from the MP5T are transmitted with those from the telemetry device (ECG and optionally SpO2) to the Information Center. The MP5T alone has no network capability (no direct wired or wireless connection to the Information Center). The following comparison table shows in detail the differences between MP5 and MP5T:

Functionality (including optional features) ECG SpO2 NBP Predictive Temperature Temperature Invasive Pressure Carbon Dioxide Direct Telemetry Connection ECG Output signal LAN networking capability WLAN networking capability Short range radio interface IntelliVue Instrument Telemetry networking capability Severe Sepsis Screening OxyCRG high resolution trend Neonatal event review Integrated recorder Drug Calculator MP5

1

MP5T

10 Introducing the Monitor Functionality (including optional features) Gas monitor support Connection to a host monitor (companion mode) Connection to an external display Nurse call capability 1.MP5 options without ECG do not have an ECG output signal The MP5/MP5T patient monitor has an 8.4-inch TFT LCD flat panel SVGA display. You operate the monitor with the Touchscreen. There is an optional built-in recorder. 2 Basic Operation MP5T MP5

11 2 Basic Operation Introducing the Monitor MP5/MP5T Major Parts and Keys 1 2 3 4 5 7 6 1 2 3 4 5 6 7 Color-coded alarm lamps Alarms off lamp Measurement connectors (see below) Predictive Temperature Unit ECG out (not MP5T and MP5 options without ECG) On/Standby Switch Indicator LEDs US measurement connectors Pressure and Temp Noninvasive Pressure SpO2 ECG/

Respiration Telemetry device CO2 International measurement connectors Pressure and Temp Noninvasive Pressure SpO2 ECG/

Respiration Telemetry device MP5(T) front panel 1 2 3 4 On/Standby switch On/Standby/Error LED - green when monitor is switched on, red if there is a problem with the monitor Battery status LED - green, yellow or red, see Battery section for details AC power operation LED - green when the monitor is connected to AC power (mains) 1 2 3 4 12 Operating and Navigating 2 Basic Operation Operating and Navigating Everything you need to operate the monitor is contained on its screen. Almost every element on the screen is interactive. Screen elements include measurement numerics, waveforms, screen keys, information fields, alarms fields and menus:

1 2 3 4 5 6 7 8 9 10 3 Waves A ALARMS PAUSED 2:59 Pulse Temp Bed 3 Doe, John Adult II 1mv Pleth Resp NBPSys. 1Ohm Auto 10 min NBP mmHg HR SpO2 RR Local Recorder out of paper hrs Silence Pause Alarms Start/

Stop Repeat Time Delayed Record Vitals Trend Default Profile End Case Main Setup Main Screen 17 16 15 14 13 12 11 Monitor information line Other screen elements 1 2 3 4 5 6 7 network connection indicator

(documented in Information Center Instructions for Use) bed label patient identification patient category paced status date and time current screen name/enter change screen menu 10 status line - shows information and messages prompting you for action 11 close all open menus and windows and return to main screen 12 enter Main Setup menu 13 scroll right to display more SmartKeys 14 SmartKeys - these change according to your monitors configuration 15 scroll left to display more SmartKeys 16 Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to immediately re-enable alarm indicators. 13 2 Basic Operation Operating and Navigating Monitor information line 8 9 adjust alarm volume/level indicator alarm status area - shows active alarm messages Other screen elements 17 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on. Selecting Screen Elements Touch a screen element to get to the actions linked to that element. For example, touch the Patient Identification element to call up the Patient Demographics window, or touch the HR numeric to call up the Setup ECG menu. Touch the ECG wave segment to call up the ECG lead menu. Using the Setup Menu The elements at the top of the Screen are grouped together for ease of navigation. Touch any item at the top of the Screen to open the Setup menu; then touch the element you want. Setup Alarm Messages Alarm Limits Alarm Volume My Care Group Change Screen Profiles Admit/Dischrg Paced No Network Bed Information Date, Time Disabling Touchscreen Operation To temporarily disable touchscreen operation of the monitor, press and hold the Main Screen permanent key. A padlock will appear on the Main Screen permanent key. Press and hold the Main Screen permanent key again to re-enable the touchscreen operation. Moving Windows You can move windows and menus using the Touchscreen. To move a window 1 Select the title of the window and keep your finger on the title. 2 Move your finger on the Touchscreen to move the window. 3 Take your finger off the screen to place the window in the final position. Not all locations on the screen can be a target position, a window cannot overlap the monitor info line, the alarms and INOPs or the status line. 14 Operating and Navigating Using Keys The monitor has three different types of keys. Permanent Keys 2 Basic Operation A permanent key is a graphical key that remains on the screen all the time to give you fast access to functions. Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to immediately re-enable alarm indicators. Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Main Screen - close all open menus and windows and return to the main screen. Main Setup - enter main setup menu. SmartKeys A SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased. enter profile menu, or revert to default profile access timers freeze waves set alarm limits change Screen, or revert to default screen previous Screen quick admit a patient enter patient identification menu to admit/discharge/transfer change alarm volume end case to discharge a patient change QRS volume view information for patients in other beds 15 2 Basic Operation Operating and Navigating enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained. change screen brightness (not for independent displays) review beat labels (annotate arrhythmia wave) re-learn arrhythmia change amplitude (size) of ECG wave access wedge procedure window

- start/stop manual NBP measurement

- start auto series

- stop current automatic measurement within series start NBP measurement and measurement series start veni puncture (inflate cuff to subdiastolic pressure) start/stop NBP STAT measurement stop automatic or STAT NBP measurement and measurement series stop current NBP measurement start NBP STAT measurement set the NBP repeat time zero invasive pressure transducer start a delayed recording access pop-up recording keys access Vital Signs recording key access Select Waves recording key set wide automatic alarm limits set narrow automatic alarm limits switch CO2 pump off access neonatal event review review vital signs trend review graph trend access the calculator access the Drug Calculator gas analyzer - exit standby mode suppress zero for all gas measurements 16 Operating and Navigating 2 Basic Operation unpair equipment and continue central monitoring with the monitor unpair equipment and continue central monitoring with the telemetry device start 12-Lead Capture (only available if Information Center is connected) access ST Map application set standard or EASI lead placement access patient reports new lead setup manual data entry access ProtocolWatch start/stop car seat assessment record open the histogram window open unit conversion window 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 and capital Lock keys 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. 17 2 Basic Operation Operating and Navigating Using the On-Screen Calculator You can use the on-screen calculator to perform any of the standard operations for which you would normally use a handheld calculator. To access the on-screen calculator, select the Calculator SmartKey, or select Main Setup

-> Calculations -> Calculator. Calculator MC MR M+

Back C/CE 18 Operating Modes 2 Basic Operation Operating Modes 2 1 When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:

Select the Main Setup menu. 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 monitors 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. 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. When an MP5 is connected to a host monitor (Companion Mode is indicated):

The MP5 will adopt the operating mode of the host monitor:

Config

You cannot change the operating mode at the MP5. Standby Mode Standby mode can be used when you want to temporarily interrupt monitoring. To enter Standby mode, select the Monitor Standby SmartKey or select Main Setup, followed by Monitor Standby. 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. This can be configured to a moving image or a blank screen. 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, 19 2 Basic Operation Understanding Screens Select anything on the screen or press any key. If you connect an MP5 that is powered on (and not in Standby) to a host monitor in Standby mode, the host will leave Standby mode. When connected to a host monitor, with both the host and the MP5 in Standby mode, leaving Standby on the MP5 will also make the host leave Standby. Understanding Screens Your monitor comes with a set of preconfigured Screens, optimized for common monitoring scenarios such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and SmartKeys 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 1 To switch to a different Screen, select the monitor info line and then Change Screen in the Setup Menu, or select the Change Screen SmartKey. 2 Choose the new Screen from the pop-up list. Changing a Screens Content If you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, high-res waves, or trends. Be aware that these changes cannot be stored permanently in Monitoring Mode. To change the selection of elements on a Screen, 1 2 Select the element you want to change. From the menu that appears, select Change Wave, Change Numeric, or Change HiResTrend, and then select the wave or numeric you want, or select the high-

resolution trend wave you want from the list of available waves. If you do not see Change Numeric in the menu, this Screen may be configured to always display the numeric beside its wave. Changing the wave will automatically change the numeric. The changed Screen is shown with an asterisk in the monitor info line. 20 Using the XDS Remote Display (not MP5T) 2 Basic Operation 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, either select the name of the Screen in the Change Screen menu or use the previous/next arrows at the top of the Change Screen menu to move back and forth in the Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed. Change Screen 3 Waves A Split Screen A Graph Trends Vital Signs B Vital Signs A Vital Signs A*

After a patient discharge, the monitors default Screen is shown. Modified Screens are still available in the Change Screen menu. If the monitor is switched off and then on again, modified Screens are erased from the monitors 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 configured to Yes). Using the XDS Remote Display (not MP5T) Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. 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, Select the monitor info line to open the Setup menu Select Change Screen Select the name of the visitor Screen configured for your monitor from the list of available Screens. 1 2 3 To select a Screen with waves and numerics again, 21 2 Basic Operation Understanding Profiles Select any element on the Screen to open the Screen menu and 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. If you are using a second display, each display can have its own individual screen selection. 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 (F or C), pressure unit (mmHg or kPa). 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. Profiles

: Profile A Profile Patient Category: Adult Paced Display Measmt. Settings:Measurement A Monitor Settings: Monitor A

: No

: S-014 Measurement A Measurement B Measurement C Measurement D Profiles Menu, showing current settings Available choices in measurement menu 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. 22 Understanding Profiles 2 Basic Operation 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. 23 2 Basic Operation Understanding Settings Swapping a Complete Profile Select the monitor info line and then Profiles in the Setup menu, or select the Profiles SmartKey. In the Profiles menu, select Profile. 1 2 3 Chose a profile from the pop-up list. 4 Confirm your selection. Swapping a Settings Block 1 2 Select the monitor info line and then Profiles in the 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. 3 Choose a settings block from the pop-up list. 4 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 monitors Configuration Mode. All settings are reset to the stored defaults:

when you discharge a patient

when you load a Profile 24 Adjusting a Measurement Wave 2 Basic Operation

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.

via the Main Setup permanent key- if you want to setup a measurement when the measurement is switched off, use the Main Setup permanent key 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 monitors screen. The monitor stops data acquisition and alarming for this measurement. 1 Enter the measurements 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 all respiratory waves: CO2, Resp. anesthetic agents and O2

Global Speed, for all waves not included in the other group. Changing the Wave Group Speed 1 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, Select Main Setup -> User Interface Select Global Speed or RespiratorySpeed, as required Select a value from the list of available speeds. 3 2 25 2 Basic Operation Freezing Waves Changing Wave Speed for a Channel Select Change Speed. To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 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 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. Freezing Waves You can freeze waves on the screen and measure parts of the wave using cursors. The waves are frozen with a history of 20 seconds so that you can go back and measure what you have seen. Freezing An Individual Wave To freeze a wave, 1 Enter the Wave menu for the measurement by selecting the wave on the screen. 2 Select Freeze Wave. The realtime wave is replaced with the frozen wave. Freezing All Waves To freeze all waves on the screen, Select the Freeze Waves SmartKey. 1 All realtime waves are replaced with frozen waves. Measuring Frozen Waves To measure a frozen wave, Select the frozen wave. This automatically positions the vertical cursor. The cursor can be repositioned by touching the required point on the wave, or 1 2 Use the up/down arrow keys to activate and move the horizontal cursor. The horizontal cursor measures the wave value, which is displayed above the cursor line. If the wave is a pressure wave, the cursor value can be stored as a systolic, diastolic or mean pressure value and if the pressure wave is a PAP wave, it can also be stored as a PAWP value. The stored value appears in the trend database as a manually entered value. To return to the vertical cursor use the

<> pop-up key. Changing The Wave Speed 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. 26 Using Labels 2 Basic Operation 1 To change the wave speed:

Select the frozen wave. Select Change Speed. Select a speed from the list. 2 3 Updating The Frozen Wave To update the wave, that is freeze the current wave:

1 2 Select the frozen wave. Select Freeze Again. Releasing Frozen Waves To release frozen waves, Select a frozen wave. Select Unfreeze Waves. 1 2 All frozen waves are released. Using Labels Depending on the monitor options purchased, you may be able to measure two 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 Select Label. 3 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 monitors 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 gas monitor connected to the monitor there is a potential conflict with the CO2 label. Depending on your configuration, the monitor will either 27 2 Basic Operation Using Labels

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. If a measurement label is causing a label conflict it is shown in red. WARNING When an MP5 with an active measurement, say SpO2, is connected to a host monitor with the same measurement already active, the SpO2 measurement on the MP5 is deactivated and the Meas. DEACTIVATED INOP is displayed. The measurement can only be reactivated if the MP5 is disconnected from the host monitor. The label conflict can be resolved on the host monitor like any other label conflict. When the MP5 is connected to a host monitor, the Measurement Selection window can be opened, but only the measurement Setup key is functional. Derived measurements are not active and cannot be activated, but become active again when the MP5 is disconnected from the host monitor. Resolve any label conflicts at the host monitor. To resolve a label conflict, Select the measurement selection key or select Main Setup -> Measurement Selection to display the Measurement Selection window. Select the measurement to be deactivated. Select the De-activate pop-up key to disable the conflicting measurement. When the measurement has been deactivated the question marks under the measurement selection key will be replaced by XXX. 1 2 3 Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used. 28 Entering Measurements Manually 2 Basic Operation If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. Entering Measurements Manually You can enter values into the monitor that have been measured with other equipment or manually (for example, manual temperatures, lab values). These values are then stored in the database, included in trends and reports, and passed on to the Information Center and central charting systems. There is no alarm functionality for manually entered measurements. To enter values, Select the Enter Values SmartKey or select Main Setup -> Enter MeasValues Select the measurement you want to enter values for. The Edit <Measurement> window will open. If the measurement is switched off, switch it on by selecting the label. Select Value and enter the value. Select Date/Time to enter the date and time for the value. The default is always the current date and time. For compound labels, for example ABPs, ABPd and ABPm, select the Format field to select whether all values are required or a single value. Select Confirm. 1 2 3 4 5 6 7 When a manually entered value has been configured to display as a numeric on the screen, you can also enter a new value for this measurement by selecting the numeric, then selecting Enter MeasValues. Manually entered measurement values are marked with a * on the display, in trends, and so forth. Each measurement has a defined measurement interval after which a value becomes invalid (no value is then displayed). Values can be entered up to two hours after they have been measured or up to the measurement interval, if this is shorter. The list of measurement labels which appears in the Manual Entry window is set in Configuration Mode. No values can be entered manually on the MP5 when it is connected to a host monitor. Switching Manually Entered Measurements On and Off To switch a manually entered measurement on or off, Select the Enter Values SmartKey or select Main Setup -> Enter MeasValues Select the measurement you want to switch on or off. Select the measurement label field to switch between On and Off 1 2 3 Changing Monitor Settings To change monitor settings such as brightness, or QRS tone volume, select the Main Setup permanent key and then select User Interface to enter a submenu where you can change these settings. 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 monitoring locations and optimizes power usage for battery powered monitors. 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 monitors 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, In the Main Setup menu, select User Interface Select Touch ToneVolume, 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. 1 2 Setting the Date and Time 1 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. Select the Date, Time screen element from the monitors 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. Select Store Date, Time to change the date and time. 2 3 Checking Your Monitor Revision 1 2 Select Main Setup -> Revision to open the Monitor Revision menu. From the Monitor Revision menu, select the monitor component for which you need revision information. Getting Started Once you understand the basic operation principles and have completed the Training Program, 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 Check all the external cables, plug-ins and accessories. 2 Plug the power cord into the AC power source. If you are using battery power, ensure that the battery has sufficient power for monitoring. When you use a battery for the first time, you must charge it, following the instructions given in the section on Charging Batteries. 3 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 monitoring 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.

The MP5 switches on automatically when connected to a running host monitor.

When the MP5 is disconnected from a running host monitor, it 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. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor. 2 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. 3 Refer to the appropriate measurement section for details of how to perform the measurements you require. 31 2 Basic Operation Disconnecting from Power WARNING During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns. Disconnecting from Power The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect, unplug the power cable. Monitoring After a Power Failure If the monitor is without power 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

Wireless LAN

IntelliVue Instrument Telemetry System (IIT) WARNING Do not connect patient monitors to the standard hospital network. Additionally, when the MP5 is equipped with IIT and declared at the Information Center as a telemetry device, it allows data continuity when paired to a host monitor. After disconnection from the host monitor, it continues to monitor the patient during transport and provides continuous data to the same sector on the Information Center. (See the Instructions for Use for your host monitor for viewing telemetry data on the host.) 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 Care Group, the monitoring equipment, and technical information about the network, select the monitor info line to enter the Setup menu, then select Bed Information. Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks. Printout functionality and data export are not guaranteed when using a standard hospital network. 32 Using the MP5 with a Host Monitor 2 Basic Operation Using the MP5 with a Host Monitor Host monitors that can support the MP5 as a multi-measurement module require software revision F.00.00 or higher. When you connect an MP5 to a host monitor, an integrated system is formed for monitoring a single patient. The following general observations and considerations apply to such a system:

The host monitor is the master of the system, and you have full control over all the systems operation only from the host monitor.

Functions you can operate on the MP5 are restricted to measurements originating in that device. If you try to operate controls that are disabled, you are prompted by the message Not available in Companion Mode.

Depending on how it is configured, your host monitor can determine whether the user interface of a connected MP5 is completely disabled or not, and what is displayed (a standard main screen, or a blank screen similar to the Standby screen indicating Companion Mode). This is controlled by two monitor settings that are applied to the MP5 on connection. You can change the settings in Configuration Mode.

Some general settings, such as line frequency, QRS sound, ECG lead colors, from the host monitor are applied to the MP5 on connection. When disconnected from the host, the MP5 applies its own settings again.

No audible alarms are available on an MP5 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps which are controlled by the host monitor. Alarms become active again as soon as the MP5 is disconnected from the host monitor.

The host monitor is the master of all ADT information. ADT operations on the MP5 are disabled, and any pending actions on the MP5 (for example, admit or end case) are cancelled.

The date and time of the MP5 is synchronized with that of the host monitor.

Event surveillance in the MP5 is disabled. Main Setup menu operations and SmartKeys are disabled. While connected to host monitor, no new events are detected in the MP5, and no events are deleted. There is no transfer of stored events from the MP5 to the host monitor. After disconnection from the host monitor, event surveillance is enabled again in the MP5, and new events are detected. The MP5 is connected to the host monitor using the measurement link (MSL) cable:

33 2 Basic Operation Using the MP5 with a Host Monitor 34 3 3Whats New?

This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital. Whats New in Release G.0?

Short Range Radio Interface for MP5 A short range radio interface is now available for the MP5 monitor. This allows a telemetry transceiver with a short range radio adapter to be assigned to the monitor resulting in a direct connection, as an alternative to the cable connection. The measurement data from the telemetry transceiver appear directly on the monitor screen with a minimal delay and are combined with the monitor data in one sector at the Information Center. Product Options Without ECG The monitor now has several options, with varying measurement combinations, without an ECG measurement. Microstream CO2 in MP5 The Microstream CO2 measurement method is now available in MP 5 monitors. Histogram Trend Trended values can also be viewed in the form of a histogram. The SpO2 histograms can be trend histograms or realtime histograms with 1 second samples. Car Seat Assessment Record In Event Surveillance, in the NER group, you can run a Car Seat Assessment Record (CAR). This is a special period of event surveillance for neonates during a car seat test. During the CAR period a realtime SpO2 histogram is also generated with 1 second samples. IntelliVue XDS Solution Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. 35 3 Whats New?

Whats New in Release F.0?

New Fields in the Admission Form A Middle Name field is now available in the admission form - whether it appears is configurable. Two additional ID fields, Lifetime Id and Encounter Id, can also be configured to appear and their names can be customized to fit hospital requirements. SpO2 Enhancements Additional SpO2 Labels - SpO2pr and SpO2po labels have been added.

New manual measurement mode when telemetry devices are connected via a short range radio link.

Signal Quality Indicator displayed with the SpO2 numerics. ECG Enhancements

New */**Afib yellow alarm when an atrial fibrillation waveform is detected.

QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points. Whats New in Release F.0?

The SSC Sepsis protocol is now available on the MP5 in the form of the screening option. If a patient has been screened on arrival with an MP5, then transferred to Intensive Care when Sepsis is confirmed, the current state, the settings and the log from the SSC Sepsis Protocol can be transferred from the MP5 by connecting it to the new monitor. QT/QTc Interval Monitoring QT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a QTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and QTc enabling alarm notification. Manual Data Entry Measurement values (for example lab data or manually measured temperatures) can be entered manually into the monitor and stored in the database. They can then be used for trends, reports and also be displayed as a numeric on screen, if required. Horizon Trend Enhancements The trend indicator arrow indicates how the patient trend has developed in a set time period. This period is now configurable and can be set to 10 minutes, 5 minutes or 2 minutes. The horizon (or baseline) can now be set to a range or to a specific value. Connecting an MP5 to a Monitor (Companion Mode is indicated) The MP5 monitor can be connected to one of the MP20 to MP90 monitors (then called the host monitor) and used like an MMS. This provides monitoring continuity in transport situations allowing measurement data and patient demographics from the MP5 to be transferred to another monitor. When the MP5 is connected to a host monitor, no alarms will be announced on the MP5. Pairing MP5 with another IntelliVue Monitor The MP5 (with IIT) can be declared as a telemetry device at the Information Center and paired with another monitor. The data from the MP5 will then be shown on the same sector on the Information Center as that from the other monitor. 36 Whats New in Release F.0?

3 Whats New?

Sending Data To An Information Center Via A Telemetry Device For the MP5T monitor, or an MP5 monitor without a connection to an Information Center, a small set of monitoring data can be sent from the monitor to the Information Center via a connected telemetry device. NBP - Programmable Measurement Sequence Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously you can have regular measurements continue after the sequence has run. New Printing Options For Reports Reports can now also be printed via an external PC-based print server or to an internal print database, when no printer is available (for example, during transport). As soon as a printer becomes available, the reports stored in the database will print automatically. Manual Pairing At Monitor Previously, devices could only be manually paired at the Information Center. You can now pair devices at the monitor as long as the monitor is already connected to the Information Center. Moving Windows And Menus Windows and menus can now be moved on the monitor screen. Using touch or a mouse you can select the title of a window and then drag it across the screen. Some positions on the screen are not allowed, such as ones overlapping the alarm field or the monitor info line. Invasive Pressure Changes Wave cursor - A cursor is now available on the realtime pressure wave to allow you to define a position and store the corresponding value. Reduced alarm limit steps in lower ranges - The alarm limits setting in 2 mmHg steps is now possible in ranges up to 50 mmHg (previously up to 30 mmHg). 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 and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings. New Smart Keys A SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used. Better Visibility Of Gridlines The brightness of the gridlines on the realtime waves has been increased for better visibility. 37 3 Whats New?

Whats New in Release F.0?

38 4 4Alarms 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

ECG/ARRH ALARM OFF (yellow only, no red INOP) CUFF OVERPRESS CUFF NOT DEFLATED OCCLUSION TELE DISCONNECT. Replace TeleBatt 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 39 4 Alarms Visual Alarm Indicators 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. Visual Alarm Indicators WARNING No alarms are available on the MP5 when connected to a host monitor. Alarms become active again as soon as the MP5 is disconnected from the host monitor.

Alarm fields and other visual alarm indicators are disabled on the MP5 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps, which are controlled by the host monitor. No Alarm Display is shown in the field for red alarms, Companion Mode is shown in the yellow alarms field, and the INOPs field is blacked out. Companion Mode No Alarm Display

) at the side. The background color of the alarm Alarm message: An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow (

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 monitors 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:

40 Audible Alarm Indicators 4 Alarms 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. Nurse call systems: If configured to do so, red, yellow and light blue alarms are indicated on any device connected to the nurse call relay. 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). 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.

No alarms are available on the MP5 when connected to a host monitor (Companion Mode is indicated). Alarms become active again as soon as the MP5 is disconnected from the host monitor.

When connected to a host monitor (Companion Mode is indicated), no alarm tones are available on the MP5. Alarm Tone Configuration The audible alarm indicators of your monitor are configurable. In the monitors Configuration Mode, you can:

increase the alarm volume of unacknowledged alarms at regular intervals

change the interval between alarm sounds (ISO/IEC Standard 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. 41 4 Alarms Audible Alarm Indicators

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 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 The alarm volume symbol at the top right of the monitor screen gives you an indication of the current volume. To change the volume, select the volume symbol and then select the required volume from the pop-up selection. 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 monitors 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. There is no alarm volume indication on the MP5 screen when the MP5 is connected to a host monitor

(Companion Mode is indicated). 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) 42 Acknowledging Alarms 4 Alarms NBP Cuff Overpress (configurable to yellow or red) Power Loss Tone When power is lost - no power is available from the power cable or from a battery - a buzzer will sound, if so configured. The tone can be silenced by pressing the On/Off power switch. Acknowledging Alarms To acknowledge all active alarms and INOPs, select the Silence permanent key. This switches off the audible alarm indicators and alarm lamps. Silence 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 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. APNEA 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. 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. 43 4 Alarms Pausing or Switching Off Alarms 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, Select Main Setup -> Alarms -> Alarm Settings 1 2 Check the Alarms Off setting. This setting can only be changed in Configuration Mode. To Pause All Alarms Select the Pause Alarms permanent key. If your monitor is configured to infinite pause time, the permanent key is labelled Alarms Off, and selecting it switches alarms off. Depending on the configuration, you may need to select Confirm to complete the change. Pause Alarms To Switch All Alarms Off You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause and the permanent key is labelled Alarms Off. Select the Alarms Off permanent key. Depending on the configuration, you may need to select Confirm to complete the change. 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. 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 44 Alarm Limits 4 Alarms

No alarms are sounded and no alarm messages are shown.

INOP messages are shown but no INOP tones are ALARMS OFF sounded. The only exceptions are the INOPs CUFF NOT DEFLATED, CUFF OVERPRESS 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.

The nurse call relay is not active. 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, select the permanent key PAUSE ALARMS (or ALARMS OFF) 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, select the ALARMS OFF or PAUSE ALARMS permanent key and then reselect it. 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 patients condition closely. To extend the alarm pause time to five or 10 minutes, Select one of the alarm fields. This calls up the Alarm Messages window. 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. 1 2 Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO2), 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. 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. 45 4 Alarms Alarm Limits Viewing Individual Alarm Limits 85120 HR 50 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 any alarm field to open the Alarm Messages window, then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured. Alarm Limits ST-V4 ST-V5 ST-V6 SpO2 Pulse (SpO2) NBPs ABPs PAPd awRR Apnea Time 1 2 3 Off sec 46 Alarm Limits 4 Alarms 1 2 3 Measurement labels, with alarms off symbol where appropriate Current alarm limits Graphic view of current yellow and red alarm limits and currently monitored measurement value. Off indicates the measurement is switched off 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:

All Al. On/All Al. Off, All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all Print Limits/Record Limits to print a list of all current alarm limit settings on a measurements. connected printer or recorder. 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 measurements Setup Menu, 1 2 In the measurements 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. 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. 47 4 Alarms Alarm Limits 1 HR Alarms On/Off 10 Parameter label High red alarm (view only) 2 3 4 5 6 7 8 9 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) Graphic view of alarm limits with currently measured value 1 2 3 4 5 6 7 8 9 10 To change alarm limits, 1 Enter the Alarm 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. 48 Alarm Limits 4 Alarms 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 wide and narrow limits have a fixed relationship to the measured value within the non-

pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinicians judgement about the specific patient. 3 1 2 2 1 4 Wide alarm limits Narrow alarm limits Alarm Limits Measurement value 1 2 3 4 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 patients 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 monitors Configuration Mode. AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitors 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. Documenting Alarm Limits The alarm limits pop-up keys appear with the Alarm Limits and Change Limits windows. Select the Print Limits pop-up key to print an overview of all alarm limits on a connected printer. 49 4 Alarms Reviewing Alarms Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder. 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 see the currently active alarms and INOPs listed in one place, select any of the alarm status areas on the monitor screen. The Alarm Messages window pops up. All alarms and INOPs are erased from the Review Alarms window when you discharge a patient, or if you change to Demonstration Mode. Alarm Messages Window The Alarm Messages window shows all the currently active alarms and INOPs sorted by priority, beginning at the top with the most recent. INOPs are shown on the left hand side and patient alarms are shown on the right hand side. Any active red alarms are shown first, followed by yellow alarms. Acknowledged alarms or INOPs are shown with the check mark symbol. The Alarm Messages window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive (grayed-out). Selecting the Review Alarms pop-up key opens the Review Alarms window. Alarm Messages Resp LEADS OFF LL LEAD OFF

** awRR LOW Review Alarms Alarm Limits If you do not immediately understand an INOP or alarm message, refer to its help text.

In the Alarm Messages window, select the INOP message. This calls up a help window with an Pause Al. 5 Min. Pause Al. 10 Min. explanation of the INOP message and, where appropriate, a suggested solution for the problem.

If the alarm or INOP was generated in a device other than the monitor (for instance, in an MMS or FMS), this source is specified at the end of the help text (Source: FMS). Review Alarms Window 50 Reviewing Alarms 4 Alarms The Review Alarms window contains a list of the most recent alarms and INOPs with date and time information. Review Alarms 5 Apr 16:55:18 *** Apnea 5 Apr 16:55:18 ** ABPs HIGH (120 >95) 5 Apr 16:55:18 Alarms On 5 Apr 16:45:15 ** SpO2 NON-PULSAT. 5 Apr 16:44:57 Alarms Off 5 Apr 16:44:46 ** awRR LOW (14<15) 5 Apr 16:44:39 ** SpO2 LOW (95<99) 5 Apr 16:44:28 ** ABPs HIGH (120>95) 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. No entries are made in the Review Alarms window of the MP5 while it is connected to a host monitor, except the time when the MP5 was connected to the host (Companion Entered), and when it was disconnected (Companion Left). Alarms can be reviewed on the host monitor. 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 alarm resulting from an event alarm notification, the Event Episode window for that event will open. If you select an alert other than a high or low alarm, a help text window opens with more information. This is the same as the help text window that opens in the Alarm Messages window. 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. 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. Selecting the Active Alarms pop-up key opens the Alarm Messages window. Alarm Limits Active Alarms Pause Al. 5 Min. Pause Al. 10 Min. 51 4 Alarms Latching Alarms 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 monitors 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 = red alarms, Y = yellow alarms R&Y R&Y 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 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 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 122 for information on one-star yellow alarms latching behavior. 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 SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed. 52 Alarm Behavior at On/Off 4 Alarms 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 1 2 3 4 5 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. 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. 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. 53 4 Alarms Alarm Recordings 54 5 5Patient Alarms and INOPs This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 61. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. For information on alarms and INOPs from the gas module refer to your Gas Module Instructions for Use. Patient Alarm Messages The measurement labels and abbreviations for pressure, temperature, SpO2, 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. Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices. Refer to your Gas Module Instructions for Use for patient alarms and INOPs from the gas module. Alarm Message

*/**AFIB

***APNEA or

***APNEA mm:ss sec or

***APNEA >10min

***ASYSTOLE

**awRR HIGH

**awRR LOW From Condition Indication ECG/

Arrhythmia CO2, Resp, Spirometry Atrial fibrillation waveform detected Respiration has stopped for longer than the preset apnea time. mm:ss denotes the Apnea duration in minutes and seconds. ECG CO2, Resp, AGM 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. CO2, Resp, AGM The airway respiration rate has dropped below the low alarm limit. yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. 55 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message

**BIS HIGH

**BIS LOW From BIS BIS Condition Indication The Bispectral Index value has exceeded the high alarm limit. The Bispectral Index value has dropped below the low alarm limit.

***BRADY/P xxx<yyy or

***BRADY xxx<yyy

**CCO/CCI HIGH Press, SpO2 The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit. Continuous Cardiac Output or CC Index is above the high alarm limit. CCO

**CCO/CCI LOW

**CPP HIGH

**CPP LOW

***DESAT or

***DESAT xxx<yyy CCO CPP CPP SpO2

**etCO2 HIGH

**etCO2 LOW

**etO2 HIGH

**etO2 LOW Continuous Cardiac Output or CC Index is below the low alarm limit. The CPP value has exceeded the high alarm limit. The CPP value has fallen below the low alarm limit. The SpO2 value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. The end tidal CO2 high alarm limit has been exceeded. CO2, Resp, AGM CO2, Resp, AGM The end tidal CO2 value has fallen below the low alarm limit. O2, AGM The end tidal O2 high alarm limit has been exceeded. O2, AGM The end tidal O2 value has fallen below the low alarm limit.

EVENT:<GRP>

*/**/*** EVENT at Information center Event surveillance Event surveillance

***EXTREME BRADY

***EXTREME TACHY ECG ECG An event has occurred and the event notification is configured to alarm.

<GRP> is the event group An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group. The bradycardia limit has been exceeded. The tachycardia limit has been exceeded. 56 numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. 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 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone. event group name flashes, yellow or red alarm lamp and alarm tone

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message

**HR HIGH From ECG Condition Indication The heart rate high alarm limit has been exceeded.

**HR LOW ECG The heart rate has fallen below the low alarm limit.

*/**IRREGULAR HR

*/**MISSED BEAT

*/**MULTIFORM PVCs ECG/

Arrhythmia ECG/

Arrhythmia ECG/

Arrhythmia

**NBP HIGH

**NBP LOW NBP NBP

*/**NON-SUSTAIN VT ECG/

Arrhythmia

*/**PACER NOT CAPT ECG/

Arrhythmia

(paced patients only)

*/**PACER NT PACING ECG/

*/**PAIR PVCs

*/**PAUSE Arrhythmia

(paced patients only) ECG/

Arrhythmia ECG/

Arrhythmia Consistently irregular heart rhythm. No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only). Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats. 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. 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. 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. A missed beat with a pace pulse was detected. A missed beat without a pace pulse was detected. A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected. No beat detected for a period greater than the pause threshold. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. 57 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message

***<Pressure>

DISCONNECT From PRESS

***<Pressure> HIGH PRESS

**<Pressure> HIGH PRESS

***<Pressure> LOW PRESS

**<Pressure> LOW PRESS

**Pulse HIGH

**Pulse LOW

*/**PVCs/min HIGH

**QTc HIGH

**QTc HIGH

*/**R-ON-T PVCs PRESS SpO2 PRESS SpO2 ECG/

Arrhythmia ECG/QT ECG/QT ECG/

Arrhythmia

**RR HIGH RESP Condition Indication 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). 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. 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. 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. 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. The pulse rate has exceeded the high alarm limit. The pulse rate has dropped below the low alarm limit. 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 QTc value has exceeded the QTc high limit for more than 5 minutes 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.). The respiration rate has exceeded the high alarm limit. numeric flashes, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, red alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 58 Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message

**RR LOW From RESP Condition Indication The respiration rate has dropped below the low alarm limit.

*/**RUN PVCs HIGH ECG/

Arrhythmia A run of PVCs greater than 2 was detected.

**<SO2 label> HIGH SvO2/SO2

**<SO2 label> LOW SvO2/SO2

**<SpO2 label> HIGH SpO2

**<SpO2 label> LOW SpO2 The the measured intravascular oxygen saturation has exceeded the high limit. The measured intravascular oxygen saturation has fallen below the low limit. The arterial oxygen saturation has exceeded the high alarm limit. The arterial oxygen saturation has fallen below the low alarm limit.

**ST<n> HIGH

**ST<n> LOW ECG/ST The ST elevation in lead <n> is higher than the limit. ECG/ST The ST depression in lead <n> is lower than the limit.

**ST MULTI <n>,<n> ECG/ST

**ST MULTI at Information Center ECG/ST

*/**SVT ECG/

Arrhythmia

***TACHY/P xxx>yyy or

***TACHY xxx>yyy

**Tblood HIGH

**Tblood LOW

**tcpO2 HIGH/

**tcpCO2 HIGH

**tcpO2 LOW/

**tcpCO2 LOW C.O. C.O. tcGas tcGas The ST depression or elevation is outside of the limit in two or more leads <n> and <n>

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. A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit. exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit. The blood temperature value has exceeded the high alarm limit. The blood temperature value has fallen below the low alarm limit. The tcpO2 or tcpCO2 value has exceeded the high alarm limit. The tcpO2 or tcpCO2 value has fallen below the low alarm limit. Press, SpO2 The heart rate from the Pulse signal has numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. 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. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. 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, yellow alarm lamp, alarm tone

(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. 59 5 Patient Alarms and INOPs Patient Alarm Messages From Condition Indication Alarm Message

*/**/***TELE ALARM

**<Temperature label> HIGH

**<Temperature label> LOW

*/**VENT BIGEMINY

***VENT FIB/TACH

*/**VENT RHYTHM

*/**VENT TRIGEMINY

***VTACH Telemetry TEMP TEMP ECG/

Arrhythmia ECG ECG/

Arrhythmia ECG/

Arrhythmia ECG, Arrhythmia This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window. The temperature has exceeded the high alarm limit. The temperature has fallen below the low alarm limit. A dominant rhythm of N, V, N, V (N =

supraventricular beat, V = ventricular beat) was detected. A fibrillatory waveform for 4 consecutive seconds was detected. A dominant rhythm of adjacent Vs >

vent rhythm limit and ventricular HR <

VTach HR limit was detected. A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V =

ventricular beat) was detected. Ventricular tachycardia has been detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach HR limit). A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information. yellow or red alarm lamp and alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone.

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

**/***VueLink ALARM at Information Center VueLink 60 Technical Alarm Messages (INOPs) 5 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. The measurement labels and abbreviations for pressure, temperature and SpO2 INOP messages are explained in the individual chapters. INOP Message, Indication 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. 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 INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. Source What to do 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). See <Pressure label> INOPS (under Pressure). PRESS PRESS 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 Monitor PRESS Battery Battery Battery Battery Batteries scale to display complete wave. 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. See <Pressure label> INOPS (under Pressure). The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery 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 battery cannot be used with this monitor. Replace with the correct battery (M4607A). 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 re-

issued 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. 61 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BATTERIES INCOMP or BATT 1/

BATT 2 INCOMPAT INOP tone BATTERIES LOW or BATT 1/

BATT 2 LOW INOP tone BATTERIES MALFUNC. or BATT 1/BATT 2/ BATTERY MALFUNCT. 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 BATT 1/BATT 2 MISSING INOP tone. During this INOP, alarms cannot be paused or switched off. BIS CABLE INCOMPAT INOP tone. 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 Source What to do Batteries The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book. Batteries The estimated battery-powered operating time remaining is less than 20 minutes. 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 Batteries The battery in the Telemetry device is low and must be replaced soon. The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately. 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 Philips-

supported 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. 62 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication BIS ENGINE INCOMPT INOP tone BIS ENGINE MALFUNC INOP tone 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 Source What to do BIS BIS BIS BIS BIS BIS BIS BIS BIS BIS 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. 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. 63 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do INOP Message, Indication BIS SENSOR MALFUNC INOP tone BIS SENSOR USAGE INOP tone 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 BIS BIS BIS BIS BIS BIS BIS ECG/

Arrhythmia 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. 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. 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. CANNOT ANALYZE QT CANNOT ANALYZE ST QT ST 64 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication 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 CCO NO CALIBRATION numeric is replaced by -?-

CCO NO PRESS at Information Center CCO NOT SUPPORTED numeric is replaced by -?-

INOP tone 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 -?-

Source What to do C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. 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 pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. 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 pressure from an external device 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. 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. The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. 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. The pressure measurement must be zeroed before a CCO calibration. 65 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication CENTRAL:TELE ONLY INOP tone 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

!!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 Source What to do System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station. 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. There was a problem loading the drug settings. Check that the settings are complete and correct. Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate. 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. 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. 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 Batteries Batteries Monitor Battery Monitor Telemetry Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor/

Multi-

Measuremt Module 66 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication 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 Touch Input INOP tone Check Waves INOP tone CHK ECG Sync Cable INOP tone Chk IndepDsp Cable CHK MSL Connection INOP tone Chk SpO2T Settings INOP tone Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Telemetry C LEAD OFF HR Numeric is replaced by -?- for 10 seconds. INOP tone. CO2 AUTO ZERO Numeric is replaced by a -?-

if the Autozero lasts >15 sec, INOP tone sounds. CO2 CAL MODE CO2 numeric displays current CO2 value for accuracy check CO2 CAL RUNNING Numeric is replaced by a -?-

ECG CO2 CO2 CO2 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. 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. 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. Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel. 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. Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate. 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 CO2 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. 67 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication CO2 CHANGE SCALE CO2 CHK ADAPTER Numeric is replaced by a -?-

INOP tone. CO2 CHECK CAL Numeric is replaced by a -?-

INOP tone. CO2 DEACTIVATED INOP tone. C.O. DEACTIVATED INOP tone. C.O. EQUIP MALF Numeric is replaced by a -?-

INOP tone. CO2 EQUIP MALF Numeric is replaced by -?-

INOP tone. CO2 FAILED CAL Numeric is replaced by -?-

INOP tone. CO2 NO SENSOR Numeric is replaced by -?-

INOP tone. CO2 NO TRANSDUC Numeric is replaced by -?-

INOP tone. CO2 NO TUBING Numeric is replaced by -?-

INOP tone.

(!!/!!!)CO2 OCCLUSION Numeric is replaced by a -?-

INOP tone. CO2 OVERRANGE Numeric is replaced by -?-

INOP tone. CO2 PUMP OFF Numeric is replaced by a -?-. Source What to do CO2 CO2 CO2 CO2 C.O. C.O. CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 The CO2 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 CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. The CO2 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. 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 CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off. There is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 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 CO2 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 CO2 menu. 68 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do CO2 CO2 C.O. CO2 CO2 CO2 CO2 CO2 CPP CPP NBP NBP INOP Message, Indication CO2 PURGING Numeric is replaced by a -?-

INOP tone. CO2 SENS. WARMUP Numeric is displayed with a -?-

Microstream CO2: INOP tone. Mainstream CO2: no INOP tone C.O. UNPLUGGED numeric is replaced by -?-

INOP tone. CO2 UPDATE FW Numeric is replaced by a -?-

INOP tone. CO2 WAIT CAL2 Numeric is replaced by a -?-

CO2 ZERO FAILED Numeric is replaced by a -?-

INOP tone. CO2 ZERO REQUD Numeric is replaced by a -?-

INOP tone CO2 ZERO RUNNING CPP CHK SOURCES Numeric is replaced by a -?-

CPP CHK UNITS Numeric is replaced by a -?-

!!/!!!CUFF NOT DEFLAT Numeric is displayed with a -?-

Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off.

!!/!!!CUFF OVERPRESS Numeric displayed with -?- ;

Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off. CVP INOPS DEVICE CHECK SETUP INOP tone. 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 CO2 sensor. If the INOP persists, contact your service personnel. 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.]

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. See <Pressure label> INOPS (under Pressure). PRESS IntelliBridge Device identification completed, but communication could not be established due to timeout. IntelliBridge INOP abbreviations may differ slightly depending on the device category. 69 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication DEVICE CHECK CONF. INOP tone. DEVICE DEMO DATA INOP tone DEVICE REAL DATA INOP tone

<Device> UNPLUGGED INOP tone. DEVICE UNSUPPORTED INOP tone.

<EC10/EC40> EQUIP MALF INOP tone. ECG/ARRH ALARM OFF

!!ECG/AR ALARM OFF 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. ECG EL. NOISY <ECG LEAD>

(!!/!!!)ECG LEADS OFF ECG NOISY SIGNAL INOP tone. EcgOut EQUIP MALF INOP tone EEG EQUIP MALF INOP tone Source What to do IntelliBridge Device identification completed, but communication could not be established due to error. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode. IntelliBridge The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. IntelliBridge The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but no appropriate device driver installed. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Malfunction in the IntelliBridge module. If this message ECG ECG appears repeatedly, the module must be replaced. Contact your service personnel. 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 alarm source. Contact your service personnel. The ECG hardware is faulty. Monitor Contact your service personnel. The ECG in the Telemetry device is faulty. ECG ECG ECG ECG ECG 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. Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. 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. EEG The EEG hardware is faulty. Contact your service personnel. 70 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication EEG IMPEDANCE HIGH or EEG1 and/or EEG2 IMPED. HIGH EEG Source What to do The signal electrode in one or both channels exceeds the user-

selected 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. 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 electro-

surgery. 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. EEG EEG EEG EEG EEG EEG EEG EEG PRESS FMS FMS PRESS PRESS Display Display Battery EEG<X> LEAD OFF <n>

[X = channel, n = electrode]

EEG<X> LEAD OFF

[X = channel]

at Information Center 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.

!!INSERT BATTERY Severe yellow INOP tone. During this INOP, alarms cannot be paused or switched off. Intell.Dsp Malf. INOP tone Display There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your service personnel. 71 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Intell.Dsp Missing Intell.Dsp Unsupp. Internal.Comm.Malf INOP tone INVALID LEADSET LA LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. LAP INOPs LEADSET UNPLUGGED LL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. MCC Reversed INOP tone MCC Unsupported INOP tone Meas. DEACTIVATED MEASSRV UNSUPPORTD INOP tone MMS Ext. EQUIP MALF INOP tone MMS Ext. UNPLUGGED INOP tone MMS Ext. Unpowered INOP tone MMSExt.Unsupported INOP tone MMS UNPLUGGED INOP tone. MMS UNSUPPORTED INOP tone.

!!/!!!MORE BED ALARMS At Information Center Source What to do Display Display Monitor Telemetry ECG PRESS Telemetry ECG Monitor Monitor MMS MMS Extension MMS Extension MMS Extension MMS Extension MMS MMS Monitor 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. 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). The leadset has been unplugged from the telemetry device. 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. 72 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication MSL Power High MSL Power Off INOP tone. MSL Power Overload INOP tone. NBP Deactivated INOP tone. NBP EQUIP MALF Numeric is replaced by -?-

INOP tone. NBP INTERRUPTED Numeric is replaced by -?-

INOP tone. Monitor Monitor Monitor NBP NBP NBP NBP MEASURE FAILED Numeric may be displayed with a -?-

INOP tone. NBP No Central Monit. INOP tone Monitor

!!/!!! NO DEVICE DATA NO DEVICE DATA NO ECG AT CENTRAL NO ECG SOURCE 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. 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 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. 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. IntelliBridge Communication with connected device has been lost. Monitor Telemetry The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device. A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. 73 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do INOP Message, Indication NO PPV FROM MeasSrv at Information Center NO PPV FROM <Device>

OUT OF AREA P/P1/P2/P3/P4 INOPS PAP INOPS PPV BAD <Pressure Label>

SIGNAL PPV BAD SIGNAL at Information Center PPV CHK SOURCES

<Pressure label> ARTIFACT Numeric questionable

<Pressure label>

DEACTIVATED INOP tone

<Pressure label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<Pressure label> NO TRANSDUCER Numeric is replaced by -?-

INOP tone.

<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. MMS or FMS MMS or FMS Telemetry PRESS PRESS PPV PPV PPV PRESS PRESS PRESS PRESS PRESS PRESS PRESS 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. The telemetry device has left the access point coverage area. 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. 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. 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. 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.

<Pressure label> REDUCE SIZE PRESS 74 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<Pressure label>

UNPLUGGED INOP tone.

<Pressure label>

ZERO+CHECK CAL Numeric is replaced by -?-

<pTemp label> CHECK PROBE Numeric is replaced by -?-

INOP tone.

<pTemp label> DEACTIVATED INOP tone.

<pTemp label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<pTemp label> INCOMPAT.

<pTemp label> MEAS FAILED Numeric is replaced by -?-

INOP tone.

<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 PW:Check Settings PW in conflict Source What to do PRESS PRESS Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Protocol Watch Protocol Watch Protocol Watch 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. 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. 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 40C /50 to 104F). 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. 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 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). 75 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication RA LEAD OFF Numeric is replaced by -?-

INOP tone. RAP INOPS Rem.Alarmdev.Malf INOP tone Rem. Display Malf.

!!/!!! 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 LEADS OFF Numeric is replaced by -?-

INOP tone. RL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. Settings Malfunc. INOP tone.

<SO2 Label> CAL FAILED Numeric is replaced by -?-

INOP tone.

<SO2 Label> CAL MODE Numeric is replaced by -?-

INOP tone.

<SO2 Label>CAL REQUIRED Numeric is replaced by -?-

INOP tone.

<SO2 Label> CANNOT MEAS Numeric is replaced by -?-

INOP tone.

<SO2 Label>CONFIG ERROR Numeric is replaced by -?-

INOP tone.

<SO2 Label> CONN OPTMOD Numeric is replaced by -?-

INOP tone. Source What to do ECG PRESS Monitor Remote display Telemetry 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). 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. There is a problem with an input device at the remote display. Perform a visual and functional check of all input devices. Contact your service personnel. The battery in the telemetry device is almost empty and must be replaced. RESP Contact your service personnel. The RESP hardware is faulty. RESP RESP ECG Monitor SO2 SO2 SO2 SO2 SO2 SO2 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. 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. The monitor cannot use the predefined settings for monitoring. Contact your service personnel. 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 signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter. The Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode. The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds. 76 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<SO2 Label> EQUIP MALF Numeric displays -?-. INOP tone SO2 INCOMPATIBLE INOP tone

<SO2 Label> IN-VIVO CAL

<SO2 Label>LIGHT INTENS Numeric is replaced by -?-

INOP tone.

<SO2 Label> LOW LIGHT Numeric is replaced by -?-

INOP tone.

<SO2 Label> NO OPTMOD Numeric is replaced by -?-

INOP tone.

<SO2 Label> OPTMOD MALF

<SO2 Label> PRE-INS CAL Numeric displays -?-

INOP tone

<SO2 Label> UNPLUGGED Numeric displays -?-. INOP tone SO2 UPGRADE INOP tone

<SO2 Label> WARMUP Numeric is displayed with ?

SOME ECG ALRMS OFF Speaker Malfunct. INOP tone SPIRO MALFUNCTION SPIRO INCOMPATIBLE SPIRO UPGRADE SPIRO CANNOT MEAS Source What to do SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel. The SO2 Module or Optical Module is not supported. Contact your service personnel. 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 capability is needed, use another Optical Module. The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete. Measurement switched on and SO2/SvO2 module unplugged from the rack. The SO2 module is currently in upgrade mode. Monitoring is not possible in this mode. The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished. Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile. Contact your service personnel to check the speaker and the connection to the speaker. Monitor 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. 77 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication SPIRO PURGE FAILED SPIRO UNKN. SENSOR SPIRO ALARMS SUPPR SPIRO PURGING SPIRO NO SENSOR SPIRO NO BREATH SPIRO GAS COMPENS?

SPIRO PATIENT CAT. SpO2 CHK SOURCES Numeric is replaced by -?-

SpO2 CHK UNITS Numeric is replaced by -?-

<SpO2 label> DEACTIVATED INOP tone

<SpO2 label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<SpO2 label> ERRATIC Numeric is replaced by -?-

INOP tone.

<SpO2 label> EXTD. UPDATE Label is displayed with a -?-

(questionable numeric)

<SpO2 label> INTERFERNCE Numeric is replaced by -?-

INOP tone.

<SpO2 label> LOW PERF Label is displayed with a -?-

(questionable numeric)

<SpO2 label> NOISY SIGN. Numeric is replaced by -?-

INOP tone. 78 Source What to do 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. 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. SpO2 Difference SpO2 Difference SpO2 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. 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 SpO2 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 or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel. SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 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. Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<SpO2 label> NON-PULSAT. Numeric is replaced by -?-

INOP tone.

<SpO2 label> NO SENSOR Numeric is replaced by -?-

INOP tone.

<SpO2 LABEL> POOR SIGNAL Label is displayed with a -?-

(questionable numeric)

<SpO2 LABEL> PULSE?

Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> SEARCHING Numeric unavailable

<SpO2 label> SENSOR MALF Numeric is replaced by -?-

INOP tone.

<SpO2 LABEL> SENSOR OFF Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> UNKN.SENSOR Numeric is replaced by a -?-

<SpO2 LABEL> UNPLUGGED Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> UPGRADE Label is displayed with a -?-, numeric is unavailable Sp - vO2 CHK SOURCES Numeric is replaced by -?-

Sp - vO2 CHK UNITS Numeric is replaced by -?-

SRR INTERFERENCE INOP tone SRR INVALID CHAN INOP tone SRR MALFUNCTION SVR/SVRI CHK SOURCES Numeric is replaced by -?-

SVR/SVRI CHK UNITS Numeric is replaced by -?-

Source What to do SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 Sp - vO2 Sp - vO2 Monitor Monitor 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 SpO2 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 SpO2 measurement is poor and measurement accuracy may be compromised. The detectable pulsations of the SpO2 signal are outside the specified pulse rate range. SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. The SpO2 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 SpO2 measurement. Use only specified sensors and cables. An SpO2 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 SpO2 measurement is currently in UPGRADE mode. Monitoring is not possible in this mode. 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 short range radio connection has interference from another device. Try using another channel. The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration. Malfunction in the short range radio device. If the INOP persists contact your service personnel. 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. 79 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication SVR/SVRI SET CVP USED Numeric is replaced by -?-

T/T1/T2/T3/T4 INOPs TAAP DISABLED INOP tone Tamb INOPs Tart INOPs Tblood NO TRANSDUC Numeric is replaced by -?-

INOP tone Tblood OVERRANGE Numeric is replaced by -?-

Tcereb INOPS Tcore INOPs tcpO2 (or tcpCO2 or tcGas) CAL FAILED Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL REQUIRD Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL RUNNING Numeric displays first -?- , then numeric is displayed with a ?

tcpO2 (or tcpCO2 or tcGas) CHECK TIME tcpO2 (or tcpCO2 or tcGas) CHANGE SITE If Heat Switch Off is configured to Yes, numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) EQUIP MALF Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) NO TRANSDUC Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) STABILIZING Numeric is displayed with a ?

Source What to do SVR/SVRI A CVP value is required for this calculation, but is not TEMP Monitor TEMP TEMP C.O. currently being measured. The monitor is using the CVP value preset in the Setup SVR menu. See <Temp label> INOPs (under Temp) The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor. See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp) No transducer attached to the module or catheter disconnected. C.O. Tblood out of range 17C - 43C. TEMP TEMP tcGas tcGas tcGas See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp). A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration 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 calibration chamber on the module, connect the calibration unit to the calibration 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 tcpO2/tcpCO2 calibration is finished. tcGas Site Timer due to time out in 15 minutes or less. tcGas tcGas tcGas 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 tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement. The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes. 80 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do tcGas The measurement is switched on but the module is unplugged. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement. Monitor Telemetry device not supported (companion mode) INOP Message, Indication tcpO2 (or tcpCO2 or tcGas) UNPLUGGED Numeric is replaced by -?-

INOP tone. TELE CONFIG UNSUPP INOP tone

!!/!!!TELE DISCONNECT INOP tone TELE EQUIP MALF INOP tone TELE INCOMPATIBLE

!!/!!! TELE INOP Severe yellow/red INOP tone. Tele Sync Unsupp. INOP tone TELE UNSUPPORTED INOP tone

<Temp> CHK SOURCES Numeric is replaced by -?-

<Temp> CHK UNITS Numeric is replaced by -?-

<Temp label> DEACTIVATED INOP tone Telemetry Monitor Monitor Telemetry Telemetry Monitor TEMP Difference TEMP Difference TEMP

<Temp label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<Temp label> NO TRANSDUCER Numeric is replaced by -?-

INOP tone. TEMP TEMP Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup. For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.) If this INOP persists, ask your service personnel to survey the interference sources. The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device. SRR-enabled telemetry device is not supported by this central software revision. Please check configuration. Check for further details at the Information Center or in the Telemetry Data window on the monitor. The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above. 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. 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. Make sure the TEMP probe is connected to the MMS or module. If you silence this INOP, the measurement will be switched off. 81 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do TEMP 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 -1C, or greater than 45C.]

Monitor See <Temp label> INOPs (under Temp). TEMP TEMP TEMP TEMP TEMP TEMP PRESS Monitor TEMP IntelliBridge Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary. 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. 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. PRESS ECG VueLink VueLink Monitor INOP Message, Indication

<Temp label> UNPLUGGED INOP tone

<Temp label> OVERRANGE Numeric is replaced by -?-

INOP tone. Tesoph INOPS TEXT UPLOAD FAILED INOP tone 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.

<VueLink option> CHK CABLE INOP tone.

<VueLink option> CHK CONF. INOP tone. 82 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<VueLink option> CHECK SETUP INOP tone. VueLnk EQUIP MALF INOP tone. VueLnk NO CONFIG INOP tone. VueLnk UNPLUGGED INOP tone. Source What to do VueLink VueLink VueLink VueLink 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. 83 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) 84 6 6Managing 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. Note that when the MP5 is connected to a host monitor, its ability to admit or discharge a patient is disabled, and the host monitor controls patient demographic and ADT information. 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. NOTE It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center. To admit a patient, 1 Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window. 85 6 Managing Patients Admitting a Patient Patient Demographics Adult No Last Name First Name Middle Name Lifetime Id Encounter Id Patient Cat. Paced Height Weight BSA (D) DOB Age Gender Notes (1):

Notes (2):

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 patients last name (family name), for example Smith. First Name: Enter the patients first name, for example Joseph. Middle Name (if configured to appear): Enter the patients middle name. Lifetime Id, Encounter Id: Whether these fields appear and how they are labelled can be configured for your hospital. One or both fields may be displayed and the labels may read:

MRN, Case Id, Visit Id, etc. Enter the appropriate data for the fields displayed. 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 patients height. Weight: Enter the patients weight. BSA: The monitor calculates the body surface area automatically. Date Of Birth: Enter the patients 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. Select Confirm. The patient status changes to admitted. 5 86 Quick Admitting a Patient 6 Managing Patients 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 patients 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. Quick Admitting a Patient 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. Select the Quick Admit SmartKey. 2 Enter the required data (ID fields 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). 1 3 4 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 ID field 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. 87 6 Managing Patients Discharging a Patient Discharging a Patient WARNING Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient. A discharge:

clears the information in the Patient Demographics window erases all patient data (such as trend, event, and calculation 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. 1 2 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, Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window and associated pop-up keys. 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 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, SpO2, 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. 88 Transferring Patients 6 Managing Patients 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 using IIT Scenario: A centrally-monitored patient is moved with the MP5 to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. The MP5 has an IntelliVue Instrument Telemetry interface (IIT), is connected to a host monitor and is declared as a telemetry device at the Information Center. NOTE The Transfer key is not available while the MP5 is connected to a host monitor (Companion Mode is indicated). 1 Remove the MP5 from the host monitor. 2 Move the patient using the MP5 as the transport monitor. 3 At the new location, just before connecting the MP5 to the new host monitor:

open the Patient Demographics window. select the Transfer pop-up key. wait until the transfer has completed. 4 Connect the MP5 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MP5 to the receiving monitor. 5 Verify that the settings for patient category and paced mode are correct. Transferring a Centrally-Monitored Patient with the Monitor 1 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. 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 patients 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 mismatch, a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer. 3 4 Verify that the settings for patient category and paced mode are correct. 89 6 Managing Patients Transferring Patients If you accidentally transfer a patient, use Re-Admit to restore this patients 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. Resolving Patient Information Mismatch When you connect together devices which store patient demographic data, for example:

an MMS and a monitor,

an X2 or MP5 and a host monitor,

a monitor and an Information Center, the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical. WARNING 1 When a monitor is connected to an Information Center by the wireless IntelliVue Instrument 2 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. It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Category, may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in the case of asystole. It is important that the Patient Category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set. In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a telemetry device at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center. Manually Resolving Patient Mismatch The patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor Info Line and in the Select Patient window. The monitor displays a message such as Different patients in Central and Monitor. The Select Patient 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. 90 Transferring Patients 6 Managing Patients For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patients data and ask Complete transfer of this patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. 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. 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 by selecting one of the sectors in the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. Select Patient DOE, JOHN F 1234HG9556, 2008/00123 Adult Non-Paced MILLER, Adult Paced Same Patient New Patient Patient Mismatch - If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient. Patient Mismatch - If Both Patient Data Sets Are Correct A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor. 91 6 Managing Patients Care Groups Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor. Care Groups If your monitor is connected to an Information Center, you can group bedside monitors into Care Groups. This lets you:

view information on the monitor screen from another bed in the same or in a different Care Group.

be notified of yellow or red alarm conditions at the other beds in the Care Group.

see the alarm status of all the beds in the Care Group on each monitor screen. There are two main types of Care Groups:

standard care group (Bed-based Care Group) - up to 12 patients monitored by up to 4 Information Centers

unit group (Unit-based Care Group) - for a complete unit with up to 64 patients monitored by up to 4 Information Centers Monitors must be assigned to these Care Groups at the Information Center. There is a third care group which can be assigned locally at the bedside. This is the My Central care group which includes all beds (up to 16) from the Information Center your bed is connected to. This care group setting is typically used in facilities with only one Information center. The selection of beds is automatic and cannot be changed. The functions available with Care Groups depend on the Information Center revision your monitors are connected to. See your Information Center Instructions for Use for further details. Understanding the Care Group Overview Bar The Care Group monitors status is shown in symbol form in the Care Group overview bar. Flashing symbols indicate active alarms, symbols that are not flashing indicate alarms that have been acknowledged. Selecting a bed symbol calls up the window for that bed or a setup window to select this. Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed 7 Bed 8 Bed 9 Bed11 Bed 12 Bed 13 Bed 14 The Care Group overview bar must be configured to display on the monitor Screen. If it is not visible on your monitor, select a Screen which has been configured to show the bar. 92 Care Groups 6 Managing Patients Care Group Symbols (four alternative display possibilities depending on space available) Bed 8 Bed 5 Bed 14 Bed 11 Bed 9 Bed 7 Bed 6 Bed 8 Bed 5 Bed 14 Bed 11 Bed 9 Bed 7 Bed 6 Bed 4 Bed 12 No data from this bed The alarms are on but there are no currently active alarms at this monitor The highest priority alarm at this monitor is a standard INOP The highest priority alarm at this monitor is a short yellow alarm The highest priority alarm at this monitor is a yellow alarm The highest priority alarm at this monitor is a red alarm The highest priority alarm at this bed is a yellow INOP The highest priority alarm at this bed is a red INOP The alarms at this monitor are suspended The monitor is in standby mode The monitor is in Demonstration mode Bed 3 Bed 3 The current monitor Care Group Symbols (used in the Care Group overview bar and the My Care Group window) This is a telemetry bed 93 6 Managing Patients Care Groups Care Group Symbols (used in the Care Group overview bar and the My Care Group window) This bed is on a wireless network This bed is on a wired network This is a paired bed, with a bedside monitor and a telemetry transmitter assigned. My Care Group Beds From:

Room 2 Room 4 Bed 2 Bed 4 Bed 8 Room 1 Room 3 Room 5 Smith, Mary Jones, Paul Murphy, Sarah Miller, John Baker, Jane Green, Liza Scott, James Black, Harald Viewing the My Care Group Window This window shows the alarm status, bed name, and patient name for every bed in the Care Group. The window for the Unit group (shown here) shows first the beds of the Information Center this bed is connected to. By selecting the Information Center name you can display a list of all Information Centers associated with the Unit group, and select another Information Center to view. To enter the My Care Group window, select the Other Patients SmartKey, if in the Main Setup menu, select My Care configured, or Group. Use the My Care Group pop-up keys to navigate through the Care Groups:

My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed. Other Units lets you view a list of all the Care Units in your Care Domain. Select any Care Unit to view a list of the Information Centers connected to it. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed. Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity. 94 Care Groups 6 Managing Patients Viewing the Other Bed Window The Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network. Waves and numeric information from another bed are delayed. If configured, Other Bed information is displayed in color, using the colors defined by the Information Center. The Other Bed window can be configured to popup automatically when an alarm occurs at another bed. To avoid too many windows appearing (for example, in large care groups) and covering the monitors own bed data on the screen, you can temporarily disable this automatic popup:

Select Main Setup > Network > Auto Window Select Disabled 1 2 When automatic popup is disabled in this way, an icon will appear as a reminder in the Care Group Overview Bar next to the monitors own bed label To open the Other Bed window, select any field in the monitor info line to enter the Setup menu, then select My CareGroup

. and select the required bed, or Select the Other Patients SmartKey, if configured, and select the required bed. Bed Label VTACH ABP HR ST-II ST-V ABP CVP RESP PAP PULSE T1 PVC The Other Bed window may be configured to display embedded in a specially designed Screen. To display the embedded Other Bed screen element, in the Change Screen menu, select a Screen designed to show the Other Bed information permanently. Bed Label ABP PAP VTACH HR PVC Changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check that the correct other bed is displayed. NBP Sys 95 6 Managing Patients Care Groups Other Bed Pop-Up Keys Select the Other Patients SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys:

Next Wave lets you view waveforms not currently shown in the other bed window. More Vitals lets you view more numerics not currently shown in the other bed window. Next Bed lets you view waveforms and numerics from the next available bed in the Care Group. My Care Group lets you call up the Care Group window to select another bed. Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity. Silence Bed lets you silence active alarms at the other bed. (Whether you see this key depends on the revision and configuration of the Information Center your monitors are connected to.) WARNING The Silence Bed pop-up key in the Other Bed window silences alarms at a remote bed. Be aware that accidental use of this key could silence alarms for the wrong patient. To silence own bed alarms use the Silence permanent key on screen. Visual Alarm Status Information in the Other Bed Window

If individual alarms are switched off at the other bed, this is indicated by the crossed alarm symbol beside the measurement numeric.

If alarms are switched off at the other bed, the message Alarms Off is shown in the other bed window.

In the embedded Other Bed window, the crossed speaker symbol in the upper right hand indicates that the volume of the audible alarm status change notification for the other beds in the care group is set to zero at the overview monitor. Care Group Alarms Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group. The visual and audible indicators used depend on the monitor and Information Center configuration. When an alarm is detected at another bed in the Care Group,

the alarm status is shown in the Care Group overview bar as an icon.

a message informing you about the care group alarm is shown in the monitor status line.

if configured, the Other Bed window, the Alarming Beds window or the My Care Group window may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at the Information Center). The automatic alarm notification is suppressed when a window, menu or pop-up keys are active.

if configured, an audible status change notification is issued. The tone type and volume can be configured. Automatic alarm notification can be switched off permanently in the monitors Configuration Mode or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode:

96 Care Groups 6 Managing Patients 1 2 Select the network symbol on the monitor screen to call up the Network menu. Select Auto Window to toggle between the settings Enabled and Disabled. This setting resets to the default at discharge and when the monitor is switched on. Always re-enable the Auto Window as soon as possible. 97 6 Managing Patients Care Groups 98 7 7ECG, 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 115), ST monitoring (see page 127) and QT monitoring (see page 137). Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity. Select sites with intact skin, without impairment of any kind. 1 2 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. 4 Dry skin thoroughly. 5 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 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. 2 3 Attach the electrode cable to the patient cable. 4 Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display. CAUTION 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. 99 7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads 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 is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis. You should choose a lead as primary or secondary lead that has the following characteristics:

the QRS complex should be either completely above or below the baseline and it should not be biphasic

the QRS complex should be tall and narrow

the P-waves and T-waves should be less than 0.2 mV To select a lead as primary or secondary lead:

In the Setup ECG menu, select Primary Lead or Secondary Lead, 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. 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. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation. Understanding the ECG Display Your display may be configured to look slightly different. 100 Monitoring Paced Patients 7 ECG, Arrhythmia, ST and QT Monitoring 1 8 2 3 4 5 M EASI 7 Paced Rhythm HR bpm 6 1 2 3 4 5 6 7 8 Lead label of the displayed wave 1 mV calibration bar Pacer spikes Pace pulse markers Current heart rate Current heart rate alarm limits EASI lead placement label ECG Filter label ECG HR numeric: This is the heart rate 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. 1 Pacer spikes configured to have a fixed size 1 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. If so configured, the monitor can supply its own synchronization marks; in this case the synchronization marks from a defibrillator will not be shown. ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the left side. Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this:

101 7 ECG, Arrhythmia, ST and QT Monitoring Monitoring Paced Patients 1 2 1 2 Normal Beats Pace Pulses/Beats You should choose a lead as primary or secondary lead that has these characteristics:

the normal QRS complex 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 complex 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. When Paced is set to Yes:

Paced 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 on the main screen. 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. 102 Changing the Size of the ECG Wave 7 ECG, Arrhythmia, ST and QT Monitoring 1 Repolarization tail

(note width) 1 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. 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, or an individual size using the Size Up / Size Down keys, the calibration bar may be a different size for each wave. To Change the Size of an Individual ECG Wave 1 2 Select the wave segment you want to change. This calls up the lead menu for this segment. 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 1 2 To change the size of all the ECG waves on the screen by a fixed adjustment factor, In the Setup ECG menu, select Adjust Size. 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 Previous Size: to return one step to the previous size Auto Size: to let the monitor choose the optimal adjustment factor for all the ECG waves. 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). 103 7 ECG, Arrhythmia, ST and QT Monitoring Changing the ECG Filter Settings To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop-up list. There will be no QRS tone when the MP5 is connected to a host monitor. 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 Setup ECG menu, select Filter and then select the appropriate setting. Monitor: Use under normal measurement conditions. Ext. Monitor: Use for pediatric and neonatal patients when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting. 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 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: 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. When you are using a telemetry transmitter connected via short range radio to the monitor, the upper bandwidth for all filter settings is limited to 40 Hz. Selecting Positions of Va and Vb Chest Leads (for 6-

lead 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. In the Setup ECG menu, select Va Lead. Select the position used from the list. 1 2 104 Choosing EASI or Standard Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring Select Vb Lead and select the position used from the list 3 Choosing EASI or Standard Lead Placement You must enable either standard lead placement or EASI lead placement. In the Setup ECG menu, select Lead 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 recorder strips and 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. ECG Leads Monitored If you are using a 3-electrode set a 5-electrode set a 6-electrode set a 10-electrode set an EASI 5-electrode set these leads are available:

Resp is measured between electrodes:

I, II, III RA and LL I, II, III, aVR, aVL, aVF, V and MCL RA and LL I, II, III, aVR, aVL, aVF, Va, Vb RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Changing Lead Sets To change the ECG lead set,

When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement.

When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in the Setup ECG menu and the INOP message will disappear. 105 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback 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 Electrode colors AAMI EASI IEC AAMI RA LA LL RL V V1 V2 V3 V4 V5 V6 I S A N E R L F N C C1 C2 C3 C4 C5 C6 White Black Red Green Brown Brown/Red Brown/Yellow Brown/Green Brown/Blue Brown/Orange Brown/Violet IEC Red Yellow Green Black White White/Red White/Yellow White/Green White/Brown White/Black White/Violet 106 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring Standard 3-Lead Placement 1 2 1 2 3 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 3 Standard 5-Lead Placement 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 1 I aVR V aVL II 5 a V F 2 III 3 4 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. 107 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Placements 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 V3R V4R V1 V2 V3 VE V6 V4 V5 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 108 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring 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 1 2 5 4 3 1 - V1 - V6 2 - LA 3 - LL 4 - RL 5 - RA 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 109 7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead Modified 12-Lead ECG 6 5 1 2 4 3 1 - LA 2 - V1 - V6 3 - LL 4 - RL 5 - RA 6 - Angle of Lewis 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. Choosing Standard or Modified Electrode Placement If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch Mod.Lead Placment to On in the monitor. To do this, in the Setup ECG menu, select Mod.LeadPlacment to toggle between On and Off. When Mod.Lead Placment 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. ECG Report, and captured 12-lead ECGs will not be annotated at the Information Center. When Mod.LeadPlacment is set to Off, 12 Lead ECG Reports will be labelled 12 Lead 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. 110 EASI ECG Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring 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. 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. EASI Electrode Placement 1 E (V) on the lower sternum at the level of the fifth intercostal space on the left midaxillary line at the same level as the E electrode on the upper sternum 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 2 3 4 5 A (LL) S (LA) I (RA) N 2 1 3 4 5 111 7 ECG, Arrhythmia, ST and QT Monitoring ECG and Arrhythmia Alarm Overview 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 Additional Alarms with Basic Arrhythmia Option Additional Alarms with Enhanced Arrhythmia Option

***Asystole

***Ventricular Tachycardia

**Afib

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**PVCs/min HIGH(PVC >

limit/min)

**High heart rate

**Low heart rate

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs 112 Using ECG Alarms 7 ECG, Arrhythmia, ST and QT Monitoring 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 value) to the high and low alarm limits. Extreme Brady Limit Low Limit High Limit Extreme Tachy Limit Extreme Brady 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 ExtrTachy and ExtrBrady. ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitors 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 Detect. 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. 113 7 ECG, Arrhythmia, ST and QT Monitoring ECG Safety Information ECG Safety Information 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 patients 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. 114 About Arrhythmia Monitoring 7 ECG, Arrhythmia, ST and QT 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 algorithms 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 monitors QRS detector. Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate 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 patients condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-

lead 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 112, the rhythm and ectopic messages detected are listed in Arrhythmia Status Messages on page 119. 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. 115 7 ECG, Arrhythmia, ST and QT Monitoring Switching Arrhythmia Analysis On and Off Switching Arrhythmia Analysis On and Off 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. 1 2 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 complex 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 Alarm The monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability. In order to generate an Afib alarm the following criteria must be detected for 1 minute:

normal beat RR intervals must be irregular 116 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring

PR interval deviation must be large

P-wave region must not match well Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm. An Afib alarm can be falsely detected in the presence of:

sinus arrhythmia,

muscle noise, or

electrode motion artifact. If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations. See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis. 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 1 P 1mV 7 2 P P 3 Paced Rhythm Pair PVCs Delayed 6 4 PVC 2 5 HR 75 1 2 3 Beat label Pace pulse marks Rhythm status message 117 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display 4 5 6 7 PVC Numeric HR Numeric Ectopic status message Delayed arrhythmia wave Viewing Arrhythmia Waves To review arrhythmia beat labels, in the Setup Arrhythmia 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 118 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Status Messages The monitor displays two types of status messages:

Rhythm Status Messages -- to indicate the patients 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 ASYSTOLE VENT FIB/TACH V-TACH SUSTAINED V-TACH VENT RHYTHM No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal A fibrillatory wave for 4 consecutive seconds A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate Limit Ventricular tachycardia rhythm for more than 15 seconds A dominant rhythm of adjacent PVCs and a HR the V-Tach HR Limit 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 VENT BIGEMINY VENT TRIGEMINY PACED RHYTHM IRREGULAR HR SINUS BRADY SINUS RHYTHM SINUS TACHY SV BRADY SV RHYTHM SV TACHY UNKNOWN ECG RHYTHM Rhythm cannot be determined LEARNING ECG LEARNING RHYTHM CANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be Algorithm is learning the ECG beat morphology Algorithm is learning the rhythm of the classified beats A dominant rhythm of SV beats not preceded by P-waves analyzed B or E B, E B, E B, E E E E E B, E E B, E B, E B, E B, E B, E B, E 119 7 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) RUN PVCs PAIR PVCs PACER NOT CAPT PACER NT PACING PAUSE R-ON-T PVCs MULTIFORM PVCs FREQUENT SVPBs SVPBs SV BEATS PACED BEATS No ectopic activity within the last minute E More than 2 consecutive PVCs within the last minute E Pair PVCs within the last minute Pause with pace pulse (paced patient only) within the last minute 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. 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 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 Arrhythmia menu, select Relearn Arrhy. While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm rhythm status message Learning ECG. status message changes to Learning Rhythm. 2 After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly. 3 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. 120 Arrhythmia Alarms 7 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.

A telemetry device is directly connected to the monitor, or disconnected. 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 alarm 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). 121 7 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. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply. WARNING When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-

star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. 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 and Afib. 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, when more alarms are switched off than configured in your active profile. 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:

Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold. 1 To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted. 2 Select the appropriate setting from the pop-up list. 122 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring 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. See Arrhythmia Alarm Chaining on page 124 for more details on alarm chains. 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 124). This setting can only be changed in Configuration Mode. To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd. Resetting the Timeout Period To reset the timeout period, select the Alarms Off or Pause Alarms permanent key and then reselect it. 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 except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:

Alarm Condition Example Audible Indicators Short yellow alarm tone sounds ... Visual Indicators Alarm message displayed ... Single alarm instance Non-sustained V-tach Continuous alarm condition PVCs/min HIGH Same intermittent alarm condition Pair of PVCs 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 123 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms 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 every time the configured timeout 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 timeout expires. 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 112 for information on which alarms are included in the different arrhythmia options. See Arrhythmia Alarm Timeout Periods on page 123 for an explanation of how alarm timeouts work. 124 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Red Arrhythmia Alarms Asystole 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*

AFib Irregular HR

(occurs only if no other arrhythmia alarms are present) First level timeout period

(TimeOut 1st) Second level timeout period

(TimeOut 2nd) y t i r o i r p r e h g i h y t i r o i r p r e w o l 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

*If HR High/Low alarms are configured as standard yellow alarms, they are independent of the arrhythmia alarms and are not in the Rate alarms chain. 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. 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). 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. 125 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms e t a R t r a e H r a u c i r t n e V l V-Tach Run Limit

** Non-Sustain VT PVC Run < 8 HR > 100

**Pair PVCs PVC =

2

***V-Tach PVC Run 8 HR > 100 100

** Run PVCs PVC Run > 2 but 12 HR 100

** Vent Rhythm PVC Run > 12 HR 100 V-Tach Heart Rate Limit 1 2 3 4 5 6 7 8 9 10 11 12 14 15 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. 126 About ST Monitoring 7 ECG, Arrhythmia, ST and QT 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. 127 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display 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 Choose a lead from the list in the Setup ST Leads window. 2 Select the Delete key. This removes this lead from the list. NOTE The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen. To change the order in which ST leads are displayed, 1 2 In the Setup ST Leads menu, choose a lead from the list. Select the Sort Up or Sort Down key to move the lead up or down in the list. Understanding the ST Display Your monitor screen may be configured to look slightly different from the illustrations. 2 3 1 ST-II 1.2 ST-V 2.5 ST-aVR -3.0 1 2 3 ST numerics Current HR alarm limits Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor 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 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 havent 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 Setup ST Analysis menu, select ST-Index to toggle between On and Off. 128 Updating ST Baseline Snippets 7 ECG, Arrhythmia, ST and QT Monitoring 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. If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select a Screen configured to show snippets from the pop-up list of available Screens. 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. The Baseline Window opens with the ST pop-up keys Update Baseline, Record ST, Change ST Lead, Adjust ST Points, ST Map and arrow keys for scrolling through the available leads. To view the ST Baseline window, select any snippet on the Screen. ST Baseline 1 2 ST-II

-0.8 1.9

?-2.7 3 4 5 6 ST Baseline from 14 Feb 03 9:38 1 2 3 4 5 6 ST label and numeric Baseline ST numeric and difference since baseline was stored 1mV calibration bar Current snippet ST baseline Timestamp of most recently stored baseline snippet 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. 129 7 ECG, Arrhythmia, ST and QT Monitoring Recording ST Segments The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines, Select an ST snippet to open the ST Baseline window. In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines. 1 2 Recording ST Segments To record all currently available ST snippets and baselines, in the ST Baseline window, select the pop-up key Record ST. 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. R-wave peak at 0 msec J point, for example, 48 msec T Difference = ST value P Q S Isoelectric point set to -80 msec 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 monitors configuration, the ST point can be positioned either 130 About the ST Measurement Points 7 ECG, Arrhythmia, ST and QT Monitoring

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 Use the Select Point pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active. ST label and the ST numeric that would apply using the current points 1mV calibration bar ST-I 0.0 Adjust ST Points Cursors for adjusting ST points Timestamp of most recent ST point adjustment Highlighted ST point ST Points adjusted at 04 Apr 07 11:38 ISO Point -80 J Point 48 ST Point J+60 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). ISO 131 7 ECG, Arrhythmia, ST and QT Monitoring ST Alarms 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. 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. 4 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. 5 To update the ST snippet shown in the Adjust ST Points window, select the Update pop-

up key. 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 menu, select ST Alarm Mode and select either Single ST or Multi ST. 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. In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST. 1 132 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring 2 3 Select the alarm to be adjusted. 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.

alarm status indicator 12-Lead EASI indicator ST index (for EASI) ST Map (Current) EASI Limb leads EASI Chest Leads ST map ST label, value and polarity of corresponding lead 133 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps If an ST lead is switched off, its axis is not shown in the map. 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 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. 134 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring ST Map (Trend) Limb Leads Chest Leads Interval 12 sec trending interval current ST values 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 212. 135 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps 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, In Trend view, select Select Interval. Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. 1 2 Printing an ST Map Report To print the most recently viewed (current or trend) window, Select Main Setup - > Reports. Select ST Map. Press Print. 1 2 3 136 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT 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 P T 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. 137 7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval 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, Select the QT numeric to enter the Setup QT Analysis window. Select QT Lead and select All, Primary Lead or one of the available single leads. 1 2 When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads. 138 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT View In the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads. Changing The View To A Single Wave Set To view one set of waves in a larger scale, you can cycle through the different views, Select Current view to see the set of current waves. Select Baseline view to see the set of baseline waves. Select Split view to return to the combined view with current and baseline waves. 1 2 3 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 QTc value. To set the baseline, Select Set Baseline and set the value. 139 7 ECG, Arrhythmia, ST and QT Monitoring QT Alarms 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 QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a QTc alarm from being generated. Discharging a patient clears the baseline. Printing The QT Waves To start a printout, Select Print QT. Recording The QT Waves To start a recording, Select Record QT. QT Alarms There are two QT alarms, QTc high limit alarm and QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The QTc 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. The following additional messages on the cause of the invalid measurements may also be displayed. Additional Message QT Startup Asystole or Leads Off Cause of Invalid QT Measurement QT monitoring was just turned on or has been reset 1 Not all specified leads needed to perform QT analysis are available, or Insufficient Valid Leads Invalid rhythm for QTc Not enough valid RR intervals to generate QT-HR, the averaged HR 2 Asystole condition is detected Not enough valid QRS complexes to generate a QT measurement High QT-HR Small R Wave Small T Wave End of T Not detected QT Out Of Range QTc Out Of Range QTc Erratic used for QTc calculation QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics) R-wave of the signal is too small T-wave of the signal is too small End of the T-Wave cannot be accurately detected QT measurement is outside the specified range of valid QT values (200-

800 msec) QTc measurement is outside the specified range of valid QTc values

(200-800 msec) QTc measurements are not stable 140 Switching QT Monitoring On and Off 7 ECG, Arrhythmia, ST and QT Monitoring 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 High Alarm or QTc High 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. In the Setup QT Analysis menu, select QTc High Limit. Select the appropriate setting. Select QTc High Limit. Select the appropriate setting. 1 2 3 4 Switching QT Monitoring On and Off To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analysis to switch between On and Off. 141 7 ECG, Arrhythmia, ST and QT Monitoring Switching QT Monitoring On and Off 142 8 8Monitoring 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 SpO2 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 SpO2 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 monitors databases. To define which pulse rate is used as system pulse, 1 2 In the Setup Pulse menu, select System Pulse. Select one of the SpO2 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. 143 8 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 SpO2 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. In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and Off. 2 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 Alarm Source (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 Alarm Source 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 Alarm Source 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. 144 Using Pulse Alarms 8 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 112, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow

(medium severity) INOP after a fixed number of hours. 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 Alarm Source Selection. 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 SpO2 is 30 bpm; for HR 15 bpm, and for Pressure 25 bpm. 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 ExtrTachy and ExtrBrady. 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. WARNING The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis. If arrhythmia detection is needed, do not rely on the audible QRS tone. 145 8 Monitoring Pulse Rate Using Pulse Alarms 146 9 9Monitoring Respiration Rate

(Resp) For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patients 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. 147 9 Monitoring Respiration Rate (Resp) Understanding the Resp Display 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 patients 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 1 Ohm 22RR Changing Resp Detection Modes The Resp detection level can be set either automatically or manually. To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings. 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, 148 Changing the Size of the Respiration Wave 9 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. 149 9 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. In the Setup Resp menu, select Apnea Time. Select the appropriate setting. 1 2 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. 150 Resp Safety Information 9 Monitoring Respiration Rate (Resp) Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate 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. 151 9 Monitoring Respiration Rate (Resp) Resp Safety Information 152 10 10Monitoring SpO2 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 (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).

Pleth waveform - visual indication of patients 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 SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information. SpO2 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 Follow the SpO2 sensors instructions for use, adhering to all warnings and cautions. 2 Remove colored nail polish from the application site. 3 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. 153 10 Monitoring SpO2 Connecting SpO2 Cables 4 Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patients 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 41C on the skin if the initial skin temperature does not exceed 35C. Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line. Connecting SpO2 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 SpO2 1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 2 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. 154 SpO2 Signal Quality Indicator (Fast SpO2 only) 10 Monitoring SpO2 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. SpO2 Signal Quality Indicator (Fast SpO2 only) The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the current values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled. SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse. When pulse rate is very low, or strong arrhythmia is present, the SpO2/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value. If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality. NOTE 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. 155 10 Monitoring SpO2 Changing the Averaging Time Changing the Averaging Time Depending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high. In the SpO2 Setup, select Average. Select the required averaging time from the list. 1 2 Setting the Measurement Mode When a telemetry device supplies SpO2T to the monitor via short range radio transmission, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save the telemetry devices battery power. To set the measurement mode, In the SpO2 Setup, select Mode. Select Continuous or Manual mode. 1 2 Making a Manual Measurement When the measurement mode is set to manual, In the SpO2 Setup, select Measure SpO2. When manual measurements are made, there will be no continuous SpO2 monitoring or alarming. The manual measurement value reflects a momentary status. The numerics from SpO2T measurements made in manual mode, for example SpO2T, PerfT, PulseT, will remain for a time on the main screen. They are annotated with the time that the measurement was made to distinguish them from continuously measured values. Perf T Understanding SpO2 Alarms This refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit. 156 Pleth Wave 10 Monitoring SpO2 CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 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 304). Adjusting the Alarm Limits In the Setup SpO2 menu:

Select High Limit then choose the high alarm limit.

Select Low Limit then choose the low alarm limit. 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. In the Setup SpO2 menu, select Desat Limit. 1 2 Adjust the limit. 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. 157 10 Monitoring SpO2 Perfusion Numeric minimum size for reliable SpO2 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 SpO2 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 SpO2/Pleth as Pulse Source In the Setup SpO2 menu, select Pulse (SpO2) to enter the Setup Pulse menu. In the Setup Pulse menu, select System Pulse and select SpO2 from the pop-up list. 1 2 Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 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 SpO2 menu, select Tone Modulation to toggle between Yes (for on) and No (for off). 158 Setting the QRS Volume 10 Monitoring SpO2 Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated. Setting the QRS Volume In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume. When the MP5 is connected to a host monitor there will be no QRS tone. 159 10 Monitoring SpO2 Setting the QRS Volume 160 11 11Monitoring 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. 161 11 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 (intra-

arterial). 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 Auscultatory 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. 162 Preparing to Measure NBP 11 Monitoring NBP 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 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. 4 Apply the cuff to a limb at the same level as the patients 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. Auto 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. 163 11 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. Action to be performed Start manual measurement Start Auto series NBP Setup menu Start/Stop SmartKeys Start/

Stop Start NBP NBP Stat Start Stat Start/

Stop Stop NBP Start/

Stop Stop NBP Start STAT measurement NBP STAT Stop Manual measurements Start/Stop Stop current Auto measurement Start/Stop 164 Enabling Automatic Mode and Setting Repetition Time 11 Monitoring NBP Action to be performed Stop current STAT measurement and end series NBP Setup menu Start/Stop NBP STAT Stop Auto, Manual or STAT measurement AND series Stop All SmartKeys Start/

Stop NBP STAT Stop NBP Stop All 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 Mode and select Auto from the pop-up menu. For an automatic measurement, select Repeat Time and set the time interval between two measurements. Enabling Sequence Mode and Setting Up The Sequence 1 2 3 In the Setup NBP menu, select Mode and select Sequence from the pop-up menu. Select Setup Sequence to open the Setup 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. 4 To have measurements continue after the sequence, set the number of measurements for your last cycle to Continuous and this cycle will run indefinitely. 165 11 Monitoring NBP Choosing the NBP Alarm Source 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 Alarms from and choose from:

Menu option Pressure value monitored systolic Sys. diastolic Dia. mean Mean systolic and diastolic in parallel Sys&Dia diastolic and mean in parallel Dia&Mean Sys&Mean systolic and mean in parallel Sys&Dia&Mean 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 Pulse NBP Sys. Auto 166 Assisting Venous Puncture 11 Monitoring NBP 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 In the NBP Setup menu select VeniPuncture. Puncture vein and draw blood sample. 2 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. Cuff pressure Venous puncture measurement mode NBP

(60) VP Time left in venous puncture mode 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. 167 11 Monitoring NBP Calibrating NBP 168 12 12Measuring Predictive Temperature With the predictive temperature measurement1a reading is available after six to15 seconds because the monitor uses an algorithm to predict what the temperature would be if the probe were left in place until a steady reading results. If a predictive measurement is not possible you can switch to Continuous mode. Here the probe is left in place until a steady reading is available - after approximately three minutes for oral and rectal measurements and five minutes for axillary measurements. When making a rectal measurement in Continuous mode, stay with the patient until the measurement is complete and remove the probe immediately. The reading is displayed until the probe is returned to the holder or until 10 minutes have passed. The monitor will automatically make a Predictive mode measurement unless you select Continuous mode. There are no limit alarms for the predictive temperature measurement. WARNING Do not use in the presence of flammable anesthetics, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide.

Long-term monitoring in Continuous mode (beyond five minutes) is not recommended.

Do not use the Predictive Temperature measurement on neonates. Axillary or orally measured predictive temperature values do not represent the core temperature. Care is needed when comparing measured values: only compare values measured at the same measurement site. Making a Temperature Measurement 1 2 Select the correct probe and holder for the measurement site: blue for oral or axillary measurements, red for rectal measurements. Insert the temperature probe in the probe holder into the unit and plug the cable connector into the socket at the back of the unit. The cable can be fixed at an appropriate length by pressing it into the channel on the underside of the unit. 1.The Predictive temperature measurement may not be available in all countries 169 12 Measuring Predictive Temperature Making a Temperature Measurement 3 Check that the correct temperature label for the measurement site is displayed: pTrect, pToral, or pTaxil, and for axillary measurements verify that the correct patient category is selected. 4 Remove the probe from the holder to turn the temperature measurement on. 5 Fit a new single-use probe cover onto the probe. 6 When the ready prompt appears, apply the probe to the patient. During the measurement a progress indicator is displayed on the screen. When the temperature value is available it appears on the screen with the time the measurement was made. pToral 7 Discard the single-use probe cover and return the probe to the holder. WARNING Never apply the probe to the patient when the probe is not connected to the unit.

Always use a single-use probe cover to limit patient cross-contamination.

Measurement errors or inaccurate readings may result when:

probe covers other than the specified probe covers are used (see Accessories section) the incorrect probe for the measurement site is used the patient temperature is below ambient temperature

When making rectal temperature measurements, insert the probe slowly and carefully to avoid tissue damage.

Use of the incorrect probe holder may result in patient cross-contamination.

Always ensure that the used probe cover is removed before attaching a new probe cover. CAUTION Biting the probe during an oral measurement may result in damage to the probe.

Do not take an axillary measurement through the patients clothing. Direct probe-cover-to-skin contact is required.

If a probe is dropped or damaged, have it checked out by qualified service personnel before further use. 170 Making a Temperature Measurement 12 Measuring Predictive Temperature

Do not autoclave. To prevent damage to the unit, probe and accessories, refer to the cleaning procedures in the Care and Cleaning chapter. Selecting a Temperature Label Tell the monitor which temperature you want to monitor by selecting its temperature label. When you choose a label, the monitor uses that labels stored color and unit. 1 In the Setup <Temp> menu, select Label. Select the appropriate label from the list. 2 pTrect rectal temperature - this label is automatically selected if the rectal pToral oral temperature pTaxil axillary temperature probe is in use, and cannot be changed Selecting Predictive or Continuous mode If you need to select Continuous mode, check that the probe is in the holder, then:

In the Setup <Temp> menu, select Mode. Select Continuous. 1 2 To end a Continuous mode measurement return the probe to the holder. When the probe has been returned to the holder, the mode will be automatically reset to Predictive mode. After 10 minutes the measurement is automatically ended and the value is no longer displayed. 171 12 Measuring Predictive Temperature Making a Temperature Measurement 172 13 13Monitoring Temperature 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. 4 Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes. 5 Select an appropriate temperature label. 6 Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement. 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 labels stored color and alarm settings. In the Setup <Temp> menu, select Label. Select the appropriate label from the list. 1 2 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 Note that pT labels are only available with the Predictive Temperature measurement on the MP5 monitor. 173 13 Monitoring Temperature Calculating Temp Difference 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 Temp. 1 In the Main Setup menu, select Measurements. In the Setup Temp menu, select First Temp. Label the measurement source as appropriate. Select Second Temp. Label the measurement source as appropriate. 2 3 4 5 174 14 14Monitoring Invasive Pressure CAUTION Do not use the MP5 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. Setting up the Pressure Measurement 1 2 3 Plug in the pressure cable. 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. 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 Connect the pressure line to the patient catheter. 5 6 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 patients 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 labels 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. In the Setup <Press> menu, select Label. 1 175 14 Monitoring Invasive Pressure Zeroing the Pressure Transducer 2 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 P PAP RAP UAP UVP Description 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. Description Label BAP FAP IC1, IC2 P1, P2, P3, P4 Alternative non-specific pressure labels Brachial arterial pressure Femoral arterial pressure Alternative intracranial pressures 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 monitors 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. 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 manufacturers 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. 176 Zeroing the Pressure Transducer 14 Monitoring Invasive Pressure Determining a Pressures 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 pressures 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 Turn off the stopcock to the patient. 2 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>. 3 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. CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. Zeroing Two Pressures Simultaneously WARNING Before zeroing two pressures, make sure that both pressure transducers are vented to atmospheric pressure. If you have two pressures and have the Zero SmartKey configured you can zero both pressures simultaneously. Selecting the SmartKey calls up a list of active pressures. Select All Press to zero all pressures simultaneously. Troubleshooting the Zero The status line lists the probable cause of an unsuccessful zero:

177 14 Monitoring Invasive Pressure Adjusting the Calibration Factor Corrective Action The hardware is faulty. Contact your service personnel. 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. Message unable to zero -

equipment malfunction unable to zero -

excessive offset Make sure the transducer is vented to air and try again. If this fails, the hardware unable to zero -

unstable signal unable to zero -

no transducer unable to zero -

pulsatile pressure unable to zero -

timed out switch <Press> on first Try pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel. Pressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressures label. 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. 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. 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 hospitals procedure. 1 2 To confirm you want to use the new calibration factor, select the Confirm popup. Displaying a Mean Pressure Value Only Use this when you want to see only the mean pressure. In the pressures 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 3 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. 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. 178 Optimizing the Waveform 14 Monitoring Invasive Pressure 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. Using the Wave Cursor When the pressure wave is selected, you can display a cursor in the wave. It appears as a white horizontal line in the wave. Using the pop-up keys you can move the cursor up or down to the required position and store the corresponding value. The cursor value can be stored as a systolic, diastolic or mean pressure value and if the pressure wave is a PAP wave it can also be stored as a PAWP value. The stored value appears in the trend database as a manually entered value. To display and position the cursor 1 2 Select the pressure wave. Select Activate Cursor. 3 Use the pop-up arrow keys to position the cursor. Using the pop-up keys you can also change the scale or the speed for the wave, freeze the wave or start a printout or recording. 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 Alarms from and choose the source. Menu option Sys. Dia. Mean Pressure value monitored systolic diastolic mean 179 14 Monitoring Invasive Pressure Choosing the Pressure Alarm Source Pressure value monitored Menu option Sys & Dia Dia & Mean Sys & Mean Sys&Dia&Mean Select and set the High Limit and Low Limit for the pressure(s) you have selected. systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel 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 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 Extreme Low 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 Extreme High and Extreme Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message. 180 Calibrating Reusable Transducer CPJ840J6 14 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6 Depending on your monitors 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 Zero the transducer. 2 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 on monitor 12 PIN 3 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. 4 181 14 Monitoring Invasive Pressure Calculating Cerebral Perfusion 5 Select the calibration pressure from the list, for example 200 mmHg. Select Confirm to recalculate the calibration factor using the applied pressure. 6 7 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 pressures setup menu. 8 9 Reconnect the patient and start measuring again. Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration. Message unable to calibrate -

equipment malfunction unable to calibrate -

out of range unable to calibrate - no transducer unable to calibrate -

unstable signal unable to calibrate -

perform 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. In the Main Setup menu, select Measurements. In the Setup CPP menu, select ABP, ART, Ao, BAP or FAP as the arterial pressure source. 1 2 The CPP value will not be available when the MP5 is connected to a host monitor. Calculating Pulse Pressure Variation Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures. The average variation in pulse pressure is calculated over periods of 32 seconds. WARNING This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician. 182 Calculating Pulse Pressure Variation 14 Monitoring Invasive Pressure

The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.

PPV calculation may lead to inaccurate values in the following situations:

at respiration rates below 8 rpm during ventilation with tidal volumes lower than 8 ml/kg for patients with acute right ventricular dysfunction (cor pulmonale).

The PPV measurement has been validated only for adult patients To select an arterial pressure as PPV source:

In the Main Setup menu, select Measurements. In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source. 1 2 183 14 Monitoring Invasive Pressure Calculating Pulse Pressure Variation 184 15 15Monitoring Carbon Dioxide Use the CO2 measurement to monitor the patients respiratory status and to control patient ventilation. There are two methods for measuring carbon dioxide in the patients airway:

Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patients breathing system.

Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patients airway and analyzes it with a remote CO2 sensor. Two variations of this method, with different sensors, are available as options on the monitor. They are referred to here as sidestream CO2 and Microstream CO2. 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 CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2. When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2. The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure. The measurement provides:

a CO2 waveform.

an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase.

an inspired minimum CO2 (imCO2): the smallest value measured during inspiration.

an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off). waveform. WARNING Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation. Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols. 185 15 Monitoring Carbon Dioxide Using the CO2 Measurement Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, 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 etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 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 etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only. Using the CO2 Measurement The MP5 monitor measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method or the sidestream method. The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 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 patients 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 CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference. Electrical Shock Hazard: Do not open the monitor. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor or monitor. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel. CAUTION Use the CO2 measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory. Preparing to Measure Mainstream CO2 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 CO2 connector on the monitor. 2 Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition. 186 Using the CO2 Measurement 15 Monitoring Carbon Dioxide 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 CO2 including the ventilator, the patients breath and your own. in the setup menu for the CO2, 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 CO2 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 CO2 1 Plug the sensor cable into the monitors CO2 input connector. Allow the sensor two minutes warm up time 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:

including the ventilator, the patients breath and your own. expose the sensor to room air and keep it away from all sources of CO2 In the setup menu for the CO2, select Start Zero Cal. 187 15 Monitoring Carbon Dioxide Using the CO2 Measurement 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 Y-

section. 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. 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. 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 Push the sensor into the holder until it clicks into position. 2 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 188 Measuring Microstream CO2 15 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the sidestream CO2 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 Microstream CO2 The Microstream CO2 method measures the partial pressure of carbon dioxide in a patients expired gas using Microstream technology. The measurement is equipped with an automatic barometric pressure compensation. Preparing to Measure Microstream CO2 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 The Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory. 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 CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine). Using the FilterLine and Airway Adapter 1 Attach the female Luer connector to the CO2 inlet connector on the extension by pushing the socket cover down and screwing the connector into place. 2 Check that the FilterLine is not kinked. 3 Change the FilterLine if a CO2 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 CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. 189 15 Monitoring Carbon Dioxide Setting up all CO2 Measurements CO2 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 CO2 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 SmartKey, if configured. To prevent an automatic zero calibration from being started in the next five minutes, in the Setup CO2 menu, select No Zero For 5Min, or select the Suppress CO2 Zero Selecting No Zero For 5Min 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 all CO2 Measurements These tasks are common to all CO2 measurements except where otherwise noted. Adjusting the CO2 Wave Scale In the CO2 Wave menu or the Setup CO2 menu, select Scale. 1 2 Choose a suitable scale range from the pop-up list. Setting up CO2 Corrections Temperature, water vapor in the patients breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections. If one of the corrections does not appear in your Setup CO2 menu, your CO2 measurement does not require that correction. Correction Altitude O2 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 20%. 190 Setting up all CO2 Measurements 15 Monitoring Carbon Dioxide Correction Humidity Gas Agent At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO2 menu, and scroll down to look at HumidtyCorr. In the Setup CO2 menu, select Gas Corr. and select Helium, N2O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection. In the Setup CO2 menu, select Agent 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 CO2) available. To temporarily stop sampling, in the Setup CO2 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 CO2 menu, select Pump On. Changing CO2 Alarms This refers to CO2 specific alarms. See the Alarms section for general alarm information. 1 In the Setup CO2 menu, select etCO2 High or imCO2 High and choose the high alarm limit. Select etCO2 Low and choose the low alarm limit. 2 Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. In the Setup CO2 menu, select awRR. 1 2 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. Deriving Alarms From awRR 1 In the Setup CO2 menu, select awRR. In the Setup awRR menu, select Alarms. 2 3 Choose On to derive alarms from the airway respiration signal or Off to disable them. 191 15 Monitoring Carbon Dioxide Setting up all CO2 Measurements Changing awRR Alarm Limits In the Setup CO2 menu, select awRR. Select High Limit to set the upper alarm limit. Select Low Limit to set the lower alarm limit. Select the appropriate setting. 1 2 3 192 Setting up all CO2 Measurements 15 Monitoring Carbon Dioxide 193 15 Monitoring Carbon Dioxide Setting up all CO2 Measurements 194 16 16Assigning Two Devices to One Patient It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called pairing and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be:

any Philips telemetry device (only for indirect connections, see below).

a TRx+/TRx+ Intellivue Telemetry system transceiver.

an MP5 monitor with a telemetry interface, declared as a telemetry device and with a telemetry equipment label. How Can You Combine Devices?

With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor.

With a direct connection to the monitor, via a short range radio (SRR) link or with a direct cable connection - the data arrive with a minimal delay on the monitor screen. Indirect Connection - Manual Pairing The telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use. To pair the monitor with a telemetry device at the monitor:

1 Select Main Setup then Measurements Select Telemetry 2 The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor. 195 16 Assigning Two Devices to One Patient How Can You Combine Devices?

Telemetry Data Window The measurements from the telemetry device are shown in the telemetry data window on the monitor when there is no direct connection via cable or short range radio link. Bed2 Bed3 Bed4 Not Admitted Bed6 TELE INOP Adult TELE ALARM Bed7 15:37 Bed8 Bed1 Telemetry Bed9 CANNOT ANALYZE ST Jmb01 PVCs > 10/min HR

%SpO2T PVC Telemetry data window Delayed WARNING All data presented in the telemetry data window are delayed for several seconds. For MP5 only: If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output. Direct Connection - Automatic Pairing The following direct connections are possible:

a TRx+4841A Intellivue Telemetry system transceiver connected via short range radio (SRR) link to an MP5 with SRR capability.

a TRx+4841A Intellivue Telemetry system transceiver connected to an MP5 directly with a cable.

an MP5, declared as a telemetry device, and connected with an MSL cable to a monitor (MP20-90). If a telemetry device is connected to a monitor directly with a cable, or if it is assigned to a monitor via a direct short range radio link, the monitor and the telemetry device are automatically paired at the Information Center (if configured). The measured data from the telemetry device ECG and, if available, SpO2T will appear on the monitor screen and will be sent through the monitor to the Information Center. The ECG waves and numerics appear in place of the monitors own ECG, and SpO2T is displayed as an additional measurement. When ECG is measured with the telemetry device there will be no Respiration measurement derived. When you disconnect the cable, the devices remain paired until you Unpair them at the monitor or Information Center. When the devices are paired but disconnected, the telemetry data is displayed on the screen as described in Telemetry Data Window on page 196. 196 How Can You Combine Devices?

16 Assigning Two Devices to One Patient WARNING When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel.

When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected.

Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. See the "Enhancing Telemetry Monitoring with the Monitor" chapter. Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor Monitors which have this capability have a short range radio symbol A telemetry device with a short range radio adapter can be assigned to a monitor directly. To assign a telemetry device to a monitor:

on the model label. 1 2 3 Press the Check button on the telemetry device. The measurement selection key on the monitor will change to show the assign telemetry icon Select the assign telemetry icon. In the Assign Telemetry Device menu, select the correct equipment label for the telemetry device. 4 Check that the assignment is successful and that transmission has begun:

A Tele Device assigned message appears on the monitor

a tone sounds at the telemetry device and the Laeds Off indicators light

the ECG wave appears on the monitor To confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label. If a monitor is already paired to another device, you cannot assign a telemetry device to that monitor. If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Telemetry Data Window as described above. If a monitor is manually paired with a telemetry device with a short range radio adapter, the short range radio assignment will be automatically made. If a telemetry device disappears from the list in the Assign Telemetry Device menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the assign telemetry icon will appear crossed out If the devices are unpaired, the short range radio connection will be ended. 197 16 Assigning Two Devices to One Patient How Can You Combine Devices?

WARNING Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section 36.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a TELE DISCONNECT INOP. Correct channel configuration is important, refer to the Configuration Guide for details. If a TELE DISCONNECT INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission. SpO2T Manual Mode When a telemetry device with a short range radio connection supplies SpO2T to the monitor, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save battery power. To ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor. Unassigning a Telemetry Transceiver with SRR Adapter at the Monitor If a monitor and a telemetry device are paired, the assignment and the short range radio connection will be ended when the devices are unpaired (see Unpairing the Monitor and Telemetry Device on page 199). If the monitor does not have a connection to an Information Center, you must manually end the assignment and the short range radio connection. 1 2 3 Select the Measurement Selection key. In the Measurement Selection window, select the Tele pop-up key. In the Tele device window select Unassign Tele. Pairing an MP5 With a Telemetry Interface to a Host Monitor An MP5 using an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a telemetry device at the Information Center

(telemetry equipment label is configured). When the MP5 is disconnected from the host monitor it will remain paired and the measurement data will appear at the host monitor in the Telemetry Data window. After the MP5 is disconnected from the monitor it may take over 15 seconds until its data is displayed at the Information Center. NOTE Pairing of a host monitor and a telemetry device, with all the related functionality, is only possible when the host monitor is using a wired LAN connection or a wireless LAN interface (but not using the IntelliVue Instrument Telemetry interface). The MP5 can also be paired to a host monitor without a direct connection, as described in Indirect Connection - Manual Pairing on page 195. 198 Functions Available When the Telemetry Data Window is Displayed 16 Assigning Two Devices to One Patient Refer also to Use Models With Telemetry on page 202 for further related use modes. Unpairing the Monitor and Telemetry Device If the patient will no longer be monitored with the telemetry device, or only with the telemetry device and no longer with the monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device:

select the Unpair To Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the monitor select the Unpair To Tele SmartKey to end pairing and have the Information Center receive the measurement data from the telemetry device or use the Unpair function at the Information Center. NOTE The Unpair SmartKeys and pop-up keys appear only on the monitor which is directly involved in pairing. Functions Available When the Telemetry Data Window is Displayed Controlling the Telemetry Device from the Bedside You can change settings for a paired telemetry device at the monitor:

1 Select the telemetry data screen element Select the Setup Tele pop-up key 2 The Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here. Viewing and Silencing Telemetry Alarms at the Bedside When a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic Tele Alarm message will appear in the alarm status area with standard alarm tones. The Tele Alarm message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example *HR Low) will appear in the Telemetry Data Window. If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:

1 Select the telemetry screen element. Select the Silence Bed pop-up key. 2 Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms. 199 16 Assigning Two Devices to One Patient Functions Available For Devices Connected Via SRR WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured. Suspending Telemetry Alarms When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected. Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device. Using Standby When you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring. Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device. Functions Available For Devices Connected Via SRR Telemetry Device Tele 1 The Telemetry Device window can be opened from the Measurement Selection window, by selecting the Tele pop-up key, or via Main Setup -> Telemetry Device. The window shows the equipment label of the assigned telemetry device and, for monitors with SRR capability, a battery status symbol and a symbol indicating the signal quality of the SRR link If the monitor has a connection to an Information Center, the pop-up keys Unpair to Mon. and Unpair to Tele let you end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device. If the monitor does not have a connection to an Information Center, or there is a pairing mismatch, the Unassign Tele pop-up key lets you end the telemetry device assignment and close the SRR link. Temporarily Stopping the Short Range Radio Connection To temporarily disable the SRR connection for this device, for example, in case of interference:

Select the Stop SRR pop-up key. 200 General Telemetry-related Functions 16 Assigning Two Devices to One Patient This closes the SRR link and the telemetry device switches over to standard telemetry transmission. The battery status symbol will no longer be shown and the SRR quality indicator symbol will be crossed out. To return to SRR use:

Select the Start SRR pop-up key and press the Check button on the telemetry transceiver. Setting Up Measurements The Setup ECG and Setup SpO2T pop-up keys give you access to the measurement setup menus. The Measmt. Select. pop-up key takes you directly to the Measurement Selection window where all connected measurement devices are shown. General Telemetry-related Functions The following functions are valid for directly and indirectly connected telemetry devices. ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated the ECG Setup menu will no longer be accessible. When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitors own measurements, the SpO2T measurement (if present) will no longer be displayed. In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa. In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:

Heart Rate ECG Arrhythmia HR/Pulse Alarm On/Off, Heart Rate High/Low Limit, Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead Placement Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/

min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-

Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/Off 201 16 Assigning Two Devices to One Patient Use Models With Telemetry ST QT SpO2T ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm Limit QT analysis On/Off, QT Lead, QTc High Alarm On/Off, QTc Alarm On/Off, QTc High Limit, QTc High Limit, QTc Formula2, QT Baseline SpO2 Alarms on/off, SpO2 Alarm limits NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off 1.Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6. 2.These setting will only be synchronized when the Information Center supports QT Analysis for Telemetry. WARNING Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate.

Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6 If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient. Use Models With Telemetry The standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the Information Center in the same patient sector as the monitor data. The following variations are possible:

1 MP5 monitor is paired with a telemetry transceiver - direct or indirect connection telemetry data appear on the monitor the MP5 cannot be connected to a host monitor (Companion Mode) 2 MP5 is declared as a telemetry device and paired with one of the larger monitors (MP20-90) -

direct or indirect connection MP5 measurement data appear on the monitor it is paired with a telemetry transceiver cannot be used with the MP5 3 A telemetry transceiver with a short range radio adapter is assigned to an MP5 which is connected

(Companion Mode) to a larger host monitor (MP20 - MP90) - direct connection. telemetry data appear on the host monitor telemetry transceiver is paired with the host monitor but is assigned to the MP5 the MP5 must have no equipment label The different variations require different configuration settings; refer to the Configuration Guide for details. 202 Use Models With Telemetry 16 Assigning Two Devices to One Patient NOTE If a telemetry transceiver is directly connected to an X2 or MP5 that is connected (via Companion Mode) to a host monitor with revision F software, a TELE CONFIG UNSUPP INOP will appear as this combination is not supported. 203 16 Assigning Two Devices to One Patient Use Models With Telemetry 204 17 17Enhancing Telemetry Monitoring with the Monitor You can use an MP5T or MP5 monitor without a connection to an Information Center to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio. Monitor and Telemetry Transceiver Requirements The monitor and the telemetry transceiver need a direct connection, either with a cable or with a short range radio link. Monitors which can be used for cable connection have a socket labeled

. Not all revisions of the telemetry transceiver can be used directly with the monitor, a message Sending patient data to Telemetry Device... will appear after connection when the telemetry device supports this function. Due to data availability restrictions, in particular that no alarm data are available, it is not recommended to use a monitor connected to a host monitor (via Companion Mode) to collect data in this way. If such a monitor is used a CENTRAL: TELE ONLY INOP will be displayed. Data Sent to the Information Center The data sent to the Information Center includes numerics from NBP, SpO2, Pulse from SpO2 and predictive temperature. INOPs from these measurements, battery INOPs and a general INOP generated by alarms from any other measurement (MORE BED ALARMS) will also be transmitted. NOTE The monitor must be configured appropriately to support direct connection to a telemetry transceiver;

refer to the Configuration Guide for details. Changing Assignment to a New Telemetry Transceiver 1 Connect the telemetry transceiver to the monitor (if a cable connection is used), or Assign the telemetry transceiver to the monitor; see Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor on page 197. 2 Make the required measurements; the data will be automatically sent to the Information Center via the telemetry transceiver. 3 Disconnect the telemetry transceiver from the monitor (if a cable connection is used). When a short range radio connection is used, it is not necessary to unassign the telemetry transceiver. This will happen automatically when the next telemetry transceiver is assigned. The 205 17 Enhancing Telemetry Monitoring with the Monitor patient is also discharged (if configured), ensuring that the measurement data is erased before data from the next patient appears. Always assign the telemetry transceiver before you start making measurements. NOTE When a direct connection is used: your monitor may be configured to automatically discharge the patient either when the telemetry transceiver is disconnected or when another telemetry transceiver is connected. Be aware that in the second case you must always connect the new telemetry transceiver before you start making measurements, otherwise the measured data will be erased by the discharge when you connect the new telemetry transceiver. 206 18 18Trends Trends are patient data collected over time and displayed in graphic, tabular or histogram form to give you a picture of how your patients condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-

measured 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, select the Screen name in the monitor info line to enter the Change Screen menu, then select a Screen designed to show an embedded trend window. To open the tabular trends window over the current Screen, select the Vitals Trend SmartKey. Vitals Trend Graph Trend To open the graphic trends window over the current Screen, select the Graph Trend SmartKey. To open the graphic trends window over the current screen, select Main Setup > Trends > Graph Trend. To open the histogram trend window over the current screen, select Main Setup > Trends > Histogram, or select the Histogram 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 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. Histo-

gram 207 18 Trends Trends Pop-Up Keys Viewing Trends When you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. Pop-Up Keys Select Group Select Interval Print/

Record Print Vital Signs Graph Trend Selecting this pop-up key lets you.... see a pop-up list of trend groups and select a group for viewing. see a pop-up list of available data resolution settings and select the level of detail shown in the trend view. print a tabular trends report or make a tabular trend recording of the data in the current window. The report will use the current trend interval settings. 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. move the cursor one page to the left or right to navigate through the trends database timeline. jump to the beginning or the end of the trends database to see the most recent or oldest trend information stored. 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 SpO2 RR Temp Select Group Select Interval 208 Viewing Trends 18 Trends 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, 1 Select the graphical trend or the arrow pop-up keys to activate the cursor. 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends Vital Signs: Standard HR SpO2 RR Temp NBPs NBPd NBPm Aperiodic values are shown with a timestamp 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. 209 18 Trends Setting Up Trends Viewing Histogram Trends Histogram: RR (4hrs @ 1min) rpm The title line of the window shows the label of the trended measurement and the resolution of the data;

in the RR histogram above, 1 minute trend samples. The horizontal axis shows the range and unit of the displayed measurement. The vertical axis shows the percentage of time. The columns in the foreground show how much of the time the measured values fell into this range on the scale. For example, in the histogram above, the RR value was between 15 and 20 rpm during 70%

of the last four hours. The arrow mark over that column shows that the currently measured value is also in this range. These columns are displayed in the same color as the measurement data. The columns in the background show the cumulative percentage value: each of the foreground columns is added to the sum of those columns to the left of it. A question mark is displayed if less than two-thirds of the data are valid samples. The pop-up keys in the window can be used to change the measurement, the time period and the range. You can also print out a histogram report. The SpO2 histograms can be trend histograms or realtime histograms with 1 second samples. For SpO2 realtime histograms, the range cannot be changed. 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. 210 Setting Up Trends 18 Trends 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. 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 menu, select Highlight repeatedly until the highlight is on the required measurement. 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:

In the Segment menu, select Change Group 1 2 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 211 18 Trends Trend Groups Setting Up Trends 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:

1 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. 2 To temporarily change the order in which the measurements are displayed in a group, Select Main Setup -> Trends -> Trend Groups Select the Trend Group and then the measurement you want to move and use the Sort Up/

Sort Down pop-up keys. 1 2 Trend Interval The trend interval defines the resolution of trend data shown on the Screen. High-resolution data is especially suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patients status typically changes more gradually, a longer trend may be more informative. 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, In the Main Setup menu, select Trends. Select Trend Priority. 1 2 To add measurements to the priority list, Select the pop-up key Add and choose from the pop-up list of available measurements. 1 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. Select Parameter Scales. 2 212 Documenting Trends 18 Trends 3 4 5 Select the measurement or parameter you want to change from the list. 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 CO2) can be viewed in line or band form. To change the presentation style, 1 Select Main Setup -> Trends Select Global Style and choose 2

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. ABP 240 50 This sample ABP trend shows the continuously-

measured values for the systolic, diastolic and mean pressures displayed in band form. Setting Measurement and Period for Histograms To set the default for the measurement data to be used in the histogram, Select Main Setup -> Trends Select Setup Histogram. Select Data Source. Select either a realtime SpO2 or Trended Data. From the trended data list select the required measurement. To set the default period for the histogram, Select Main Setup -> Trends Select Setup Histogram. Select Select Period and select the required time period from the list. 1 2 3 4 1 2 3 When viewing a histogram, the data source, the period and the range can be changed using the pop-up keys. Documenting Trends To print a Vital Signs or Graphical Trends report, 213 18 Trends Trends Databases in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitors configuration. Trends reports can be printed on central or local printers. To make a Vital Signs recording, in the Vital Signs window, select the Print/Record pop-up key, then select the Record Vitals pop-up key. Vital Signs recordings print the trend data for the current group and trend period shown in the Vital Signs window. 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.

- 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. 214 Screen Trends Screen Trends 18 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, histogram 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. Measurement waves or high-res trend waves Screen trends Measurement numerics ABP 240 50 Setting the Screen Trend Time To set the ScreenTrend Time for all graphical, histogram and horizon screen trends (global trend time), Select a screen trend then select Setup Trend, or select Main Setup -> Trends. 1 215 18 Trends 2 Screen 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 trend or a group of aligned screen trends, 1 Select a screen trend Select Change TrendTime Select the required trend time. Selecting Global leaves the trend time set to the global screen trend time. 2 3 Changing the Selection of Screen Trends Displayed 1 2 Select the screen trend. 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 2 Select the screen trend to open the screen trend menu, 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, Select Main Screen. Changing the Screen Trend View To switch between tabular, graphic, histogram 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. NBP mmHg 15:15 15:30 15:45 16:00 16:15 120/80(95) 120/80(95) 120/80(95) 120/80(95) 120/80(95) 16:30 16:45 17:00 17:15 17:30 120/80(95) 120/80(95) 120/80(95) 120/80(95) 120/80(95) 216 Screen Trends 18 Trends The trend time for tabular screen trends depends on the space available on the Screen. Up to 30 measurements or 12 hours information can be shown. Histogram View The histogram view presents a combination of graphical trend and histogram. The histogram is on the right hand side in a horizontal presentation with vertical gridlines representing 25%, 50%, 75% and 100%. Each column shows the percentage of time that the measurement values were in a specific range. This range is represented by the columns position in the graphical trend gridlines. The arrow mark next to a column shows that the currently measured value is in the range covered by that column. If less than two-thirds of the samples are valid, the histogram will be replaced by a question mark. Horizon View The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patients condition since the baseline was set. The horizon view is made up of:

a horizon, drawn in white, as a reference 1 2 3 point or baseline to help you visualize changes in your patients condition. The horizon can be set to represent your patients current 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 patients 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 Set Low Horizon to select the lower horizon value. the same, the horizon is a baseline - if the values are different the horizon is a range. 217 18 Trends Screen Trends value Auto Horizon to set the horizon for the selected horizon trend to the currently-measured 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 2 Select the horizon trend. 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 patients 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. Select Main Setup > Trends Select HorizonArrowTime. Select 10, 5 or 2 minutes. 1 2 3 218 19 19High Resolution Trend Waves High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance. They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patients condition across different hi-res trend waves. The hi-res waves are drawn at a speed of 3 cm/minute. Hi-res trend waves use the wave scale as their display scale. Changing the wave scale changes the hi-res trend wave scale. OxyCRG OxyCRG is a combination of three hi-res trend waves, btbHR, SpO2, and Resp, mainly used in neonatal monitoring. Printing Hi-Res Trend Wave Reports To print hi-res trend waves on reports, you can choose to print either

all VisibleWaves - prints all waves and hi-res trend waves currently displayed

OxyCRG Waves - prints hi-res trend waves for btbHR, SpO2, and Resp. For each hi-res trend wave, a maximum of six minutes of measurement data will be printed. See the section on Reports for more information on setting up reports. 219 19 High Resolution Trend Waves Hi-Res Trend Wave Recordings Hi-Res Trend Wave Recordings The selection of waves in hi-res trend wave recordings and the recording speed are defined by the pre-

configured HiResTrd recording template. See the section on Recordings for more information. To start a hi-res trend waves recording, select the Recordings SmartKey, if configured, or select Main Setup -> Recordings select the HiRes Recording pop-up key. 1 2 220 20 20Event Surveillance Events are electronic records of episodes in your patients condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations. The information the monitor stores for each event episode includes:

waveforms for up to three measurements, ECG, SpO2 and Respiration

numeric vital signs for all the measurements monitored

any alarm conditions active when the event episode was triggered You can navigate through the event database to view events retrospectively, and you can document events on a recording or report marked with the patient name, bed label, and the data and time. When an MP5 is connected to a host monitor, event surveillance will be disabled. No new events will be detected and no existing events will be deleted. There is no data exchange between the host monitor and the MP5 for event surveillance. When the MP5 is disconnected from the host monitor event surveillance will resume and new events will be detected. Event Episodes When an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event). Manually-triggered event episodes document patient information from the time leading up to the event trigger; they do not have a post-time. Event trigger Event pre-time Event post-time Event Episode Neonatal Event Review - Event Episode Pre-time HiResTrnd Four minutes, four samples per second. 1 minute 2 minutes 3 minutes Post-time 3 minutes 2 minutes 1 minute 221 20 Event Surveillance Events Pop-Up Keys Events Pop-Up Keys Depending on the events view you choose, a selection of the events pop-up keys let you navigate through the stored events and carry out events-related tasks. Pop-Up Keys Event Setup Show Episode Show Review Manual Event CAR Histogrm Selecting this pop-up key lets you.... open the Event Surveillance Setup menu. open the Event Episode window to review the selected event in detail. open the Event Review window. start a manually-triggered event capture. open the window showing the CAR SpO2 histogram move the cursor left or right to the next event to navigate through the events database. Placing the cursor over an event highlights it and shows the event values for the selected event. jump to the first or last event in the event database. Vitals View Delete Event Print/

Record Graphic View toggle between a tabular and graphic version of the Event Episode window currently viewed. delete the currently-selected event from the database. The monitor asks you to confirm this deletion. You cannot retrieve deleted events. access the printing and recording pop-up keys to document events. Event Triggers You can trigger event capture manually, for example, if you want to record a patients condition before a procedure. You can also set events to trigger automatically, when the patients values cross a predefined threshold value, or when a particular measurement or procedure is carried out. The trigger condition for event groups is set in the monitors Configuration Mode. If you use alarm limits as event triggers, the event capture is triggered automatically when your patients values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions. The asterisk symbols beside the trigger tell you about the alarm triggers:

*** indicates a high priority (red) alarm

** indicates a lower priority (yellow) alarm. Triggers without asterisk symbols are user-defined triggers. 222 Event Triggers 20 Event Surveillance If you set user-defined threshold triggers, you can define event triggers that are independent of alarm limits. You must set a threshold value and a threshold time for the trigger. If you set the trigger threshold time to 12 seconds, the monitor triggers an event if the threshold is violated for more than 12 seconds. If you set user-defined deviation triggers, you can define event triggers that are independent of specific limits and based instead on deviations from the current values. You must set a deviation and a period of time in which the deviation occurs. There are three types of deviation available: ANY Deviation, UP Deviation where only changes in a positive direction are detected and DOWN Deviation where only changes in a negative direction are detected. The deviation can be defined either in relative terms as a percentage, for example 10%, or as an absolute value, such as 10 bpm. Event Retriggering If a condition that triggered an event persists and the values remain beyond the trigger threshold, a new event will not be triggered. For a new event to be triggered by the same condition, the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold. Setting Triggers Select Main Setup -> Event Surveill. -> Setup Events to enter the Event Setup window. Select the name of the episode type to set the episode pre/

post time. Event Setup Group Name:

Episode Type:

NER HighRes Trend (4min): -2/+2 min Activated HR (Pulse) All ***/** Alarms for sec HIGH SpO2 Resp All ***/** Alarms Set the event trigger for each measurement. Select each trigger name and select, if available, either an alarm trigger, or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. Set the trigger status to Activated to start event triggering. If the status is Deactivated event surveillance is effectively switched off. Select Confirm to confirm your changes. 1 2 3 4 5 Triggering Events Manually To manually trigger an event, select the SmartKey Manual Event. For manually-triggered events, patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group. Running a Car Seat Assessment Record In the NER group you can run a Car Seat Assessment Record (CAR). This is a special period of event surveillance using the current setup of the NER group. 223 20 Event Surveillance The Events Database To start a CAR period:

Select the Start CAR pop-up key or SmartKey. Select the required time period for the assessment. Select Confirm to start the CAR. 1 2 3 If the NER group was not active it will be activated automatically. During the CAR period an SpO2 histogram is also generated with 1 second samples. For general information about the presentation of data in a histogram, see Viewing Histogram Trends on page 210. The CAR SpO2 histogram is unique: it can only be accessed from the events function. It is generated from the beginning of the CAR period (contrary to the non-SpO2 histograms which are generated from trended data retrospectively at the end of a time period). Settings are fixed for this histogram and cannot be changed when viewing it. The Events Database The maximum number of events that can be stored in the event database depends on the database configuration. The event database is set up in the monitors Configuration Mode. Events are stored in the monitors event database for the configured lifetime, either 8 hours or 24 hours. Deleted events cannot be retrieved. Events are automatically deleted when:

their configured lifetime is over

the storage capacity of the database is exceeded (storing a further event deletes the oldest event in the memory)

a patient is discharged. As the event database is cleared when you discharge a patient, you should ensure that you have documented any events you require for the patient records before you confirm the discharge. Viewing Events

To review all the events, use the Event Review window.

To review individual event episodes in detail, use the Event Episode window. To start viewing events, either:

in the Main Setup menu, select Event Surveill. and then select the event view you select the Event Surveill. SmartKey and then select the event view you require from the list, or require from the list. Event Counter Apnea events (A), bradycardia events (B), and combinations of these events are counted and classified by the event counter in the Event Summary. If they are associated with a Desaturation (D), this is also marked. Manual events (M) are counted separately. In the example below, A(D):2(1) indicates that two apnea events occurred and one of them was associated with a desaturation. 16 Stored Events:

A(D):2(1) B(D):7(1) AB (D): 1(1) D:6 M:0 224 Viewing Events Counting Combi-Events 20 Event Surveillance If one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a brady event, the brady event is not counted as a single event but as part of the apnea event. Event Review Window To enter the Event Review window, select the graphic event summary, if available, or select the events pop-up key Show Review. Event Review

(Total: 4) HR Brady SpO2 DESAT Resp APNEA Manual Total Event bars: Each event bar represents one event. The height indicates the event severity. Bars that extend over more than one channel represent combi-events. Manually-captured events are marked with a bar above the timeline instead of in the measurement channels. Event values: Event information for the currently-selected event is shown on the left of the review window. The trigger measurement is highlighted. If an alarm triggers the event, the monitor shows the alarm conditions that triggered the event. If the event trigger was user-defined, instead of an alarm condition the monitor shows for example SpO2 94<96, where the second number is the current event trigger threshold and the first number is the maximum deviation from the set limit. Trigger threshold: The horizontal lines show the trigger thresholds. Gaps in the line indicate that the trigger was inactive for a while, possibly because alarms were switched off or because there was an INOP condition in the group measurements. Timeline: The timeline at the bottom indicates the period currently stored in the event database. Event Episode Window To enter the Event Episode window, select the pop-up key Show Episode. 225 20 Event Surveillance Annotating Events The Event Episode window shows four minutes of high-resolution event information. Event Episode Trigger event values, highlighted Follow-on event values Timeline, showing episode Pre/Post-

time Active event group HR Brady 104 < 110 SpO2 Desat 71 < 85 Resp 7 Jul NER The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded. In this example, Brady 104<110 tells you that 104 was the lowest HR value measured during the event time and that the low HR trigger threshold was set to 110 when the event was triggered. If the event was manually triggered, the event value boxes display manual. Annotating Events 1 To annotate an event, in the Event Episode window, select the pop-up key Select Annotatn. Select the required annotation from the pop-up list of available annotations for the currently active 2 event group. Up to 20 annotations can be configured to let you add commonly-used clinical notes to event episodes for documentation purposes. To see the complete list of available annotations, in the Event Setup menu, select Event Annotation. Documenting Events You can print a report or make a recording of the events history stored in the database or of individual event episodes or a Car Seat Assessment Record. Documenting Event Review In the Event Review window, select the pop-up key Print/Record. This calls up the event documentation pop-up keys. 1 226 Documenting Events 20 Event Surveillance 2 For a graphic Event Review recording, select the Record Graphic pop-up key. For a tabular Event Review recording, select the Record Tabular pop-up key. For a CAR review report, select the Print CAR pop-up key To print an Event Report, select the Print Review pop-up key. Documenting an Event Episode 1 In the Event Episode window, select the pop-up key Print/Record. This calls up the event documentation pop-up keys. 2 To make an Event Episode recording, select the Record pop-up key. To print an Event Episode, select the Print Episode pop-up key. Event Recordings Event Review Recordings Each event review recording strip begins with a summary of the events stored in the event database. Recording strip annotation is explained in the Recording chapter. In graphic event review recordings, events are represented by bars. The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections). In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp. The measurements in the event group are shown in the next columns, marked Parameter 1, Parameter 2..., along with the event values measured at the time of the event. For each event, the trigger values are shown. Event Episode Recordings Event episode recordings are divided into four sections. 1 The first section shows the patient information and the event group of the episode with the event values for the group measurements. The trigger symbol marks the event trigger. 2 The second section shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording. 1. 91MIN Green, Sarah 37549201 23 Jan 02 10:43 NICU3 Group: NER HR : BRADY 95>110 SpO2 Resp : APNEA (31 sec) 227 20 Event Surveillance Documenting Events 25 mm/min

-2 min 2. 2:36

+2 min btbHR SpO2 Resp 3. HR 142 bpm SPO2 97%

RR 0 rpm Intervention req.

***Apnea 4.

**BRADY

***Apnea HR 142 bpm Pulse 142 bpm CVP (-?-) mmHg SpO2 98%

PERF 4.9 RR 80 rpm NBP EQUIP MALF 3 The third section shows the most important vital signs information, including numerics, active alarms, and any annotations made on the event episode. 4 The fourth section shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered. Event Reports Event reports can be printed on A4 and letter size paper. 228 Documenting Events Event Review Reports 20 Event Surveillance The event review report documents all the events stored in the event database. 229 20 Event Surveillance Event Episode Reports Documenting Events The event episode report documents the patient information from the currently-selected event. See the section on event recordings for an explanation of the report elements. 230 21 21ProtocolWatch ProtocolWatch (PW) is a clinical decision support tool. It allows you to run a clinical protocol which can monitor developments in the patients condition, taking into account:

measured values from the monitor

values manually entered by you (for example manual temperature measurements, lab values)

your assessment of patient status ProtocolWatch notifies you when certain conditions or combinations of conditions occur and it documents developments in a log which can be printed. Severe Sepsis Screening Severe Sepsis Screening is a protocol implemented for the ProtocolWatch application. It is a computerized implementation of the January 2008 Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock 2 Sepsis Definitions. Philips does not make any claims about their effectiveness to reduce the morbidity or mortality associated with severe sepsis. Severe Sepsis Screening assists you in recognizing the early signs and symptoms of sepsis by comparing the state of your patient to the defined criteria. Use of the protocol requires thorough knowledge of the Sepsis Definitions in the SSC Guidelines for Management of Severe Sepsis and Septic Shock. Severe Sepsis Screening is not a diagnostic or therapeutic tool and is not intended to replace the competent judgement of a clinician. In Severe Sepsis Screening the measurement values and patient status are compared to the Severe Sepsis Screening criteria. When these criteria have been met, the clinician confirms the presence of infection and sepsis-related organ dysfunction and can authorize entering the Sepsis Resuscitation Bundle. On the MP5 monitor only Severe Sepsis Screening is implemented. If at the end of this phase sepsis has been confirmed, the patient will normally be transferred to an intensive care unit for treatment in the sepsis resuscitation and management phases. In this case you can connect the MP5 to another IntelliVue monitor with the full version of the SSC Sepsis Protocol and transfer the current state, the settings and the log. CAUTION It is not possible to transfer SSC Sepsis Protocol data from an MP5 monitor with release F.0 software to another monitor with release G.0 software and vice versa. 2.Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock - 2008 January Surviving Sepsis Campaign, (All Rights Reserved) 231 21 ProtocolWatch Severe Sepsis Screening Severe Sepsis Screening and this description are based on the SSC Guidelines for Management of Severe Sepsis and Septic Shock2 from January 2008 and the SSC Bundle definitions from January 2005. To check the version of the Guidelines and Bundle definitions on the monitor, Select Main Setup -> Revision -> ProtocolWatch -> SSC Sepsis ProtocolWatch-SSC Sepsis Inactive Screening SSC Standby SSC Sepsis is only intended for adult patients. SSC Sepsis Protocol rev A.02.04 SSC Guidelines for Management of Severe Sepsis and Septic Shock from Jan 2008 - Copyright Surviving Sepsis Campaign (All rights reserved) SSC/IHI Bundle Definitions from Jan 2005 Caution: Consider specific clinical context before following SSC Sepsis treatment recommendations The SSC Sepsis Protocol is not a diagnostic or therapeutic tool and is not intended to replace the competent judgement of a clinician. SSC: Surviving Sepsis Campaign IHI: Institute for Healthcare Improvement 14-Mar-2007 08:10:20 Orientation On The Screen At the top of each window there is an orientation line showing the phases available on your monitor, with the currently active phase highlighted. ProtocolWatch - Sepsis Resuscitation Bundle Inactive Screening SSC Standby You can also place the ProtocolWatch symbol, together with the currently active phase, on the main screen, in one of the numeric positions. This allows you to see at a glance which phase is currently active, even when no SSC Sepsis Protocol window is currently displayed. If you need to enter data or perform an action in an SSC Sepsis Protocol window, the symbol will turn into a SmartKey. SSC Screening SSC Screening Suspending the Protocol for 24 Hours To suspend the protocol for 24 hours:

Select Main Setup -> ProtocolWatch -> Suspend for 24 hours. Select Confirm. 1 2 The protocol will resume activity after 24 hours with Severe Sepsis Screening. 232 Severe Sepsis Screening 21 ProtocolWatch Severe Sepsis Screening As soon as an adult patient is connected to the monitor, and heart rate or pulse is being measured, the protocol begins to observe heart rate, temperature and respiration rate values in the background. If temperature or respiration rate is not being measured continuously, a pop-up window appears at 4-

hour intervals to ask for manually measured values. These values are all compared to the screening criteria: HR above 90, Temp above 38.3C (100.9F) or below 36.0C (96.8F), RR above 20. If any one of the values fulfils the screening criteria, the first Severe Sepsis Screening window appears:

ProtocolWatch-Severe Sepsis Screening Inactive Screening SSC Standby Which of the following signs and symptoms of infection are both PRESENT and NEW to the patient?

T<36.0C (96.8F) or T>38.3C (100.9F) Tachycardia (HR>90bpm) Respiration 39.5C 60bpm Spontaneous Respiration (RR > 20rpm) Mechanically ventilated WBC >12000/l or <4000/l or >10% immature forms Acutely altered mental status Chills with rigors Hyperglycemia (Glucose > 6.7 mmol/l or >120mg/dl) in absence of diabetes Protocol Log Enter T1 Enter SpRR ProtocolWatch Confirm Remind 15 min The measured value which has fulfilled the criteria is shown highlighted (in the example shown above it is temperature). There is a check box for the infection signs and symptoms listed,

if the monitor has measured values which meet the screening criteria, and

for all signs and symptoms which cannot be measured by the monitor. Check the box if you can confirm that this sign or symptom is present and new. If the patient is mechanically ventilated, the Mechanically ventilated box must be checked. If you have manually measured temperature or respiration rate, you can enter the values using the Enter RR and Enter Temp keys. Select Confirm when the check boxes reflect the current patient status. Select Remind 15 min if you want to delay filling out this screen. (When you enter the screen manually this key will be a Cancel key, as no action is required in this case.) 233 21 ProtocolWatch Changing Conditions The window reappears if:

a previously fulfilled criteria is again fulfilled

a new HR or RR criteria is fulfilled, Severe Sepsis Screening

the HR or RR value which previously fulfilled the criteria now triggers a **High alarm or a ***

Tachy alarm,

after 8 hours (configurable to 12 hours) if at least one infection sign is still present. Two Or More Infection Signs Or Symptoms Confirmed If you have confirmed two or more infection signs in the first Severe Sepsis Screening window, a new pop-up window appears:

ProtocolWatch-Severe Sepsis Screening Inactive SSC Standby Is the patient history suggestive of a new infection Screening Protocol Log Show Details ProtocolWatch Yes No Remind 15 min If you select Yes, the next screen appears requesting a lactate measurement. If you select No, the screening phase continues and the first Severe Sepsis Screening window reappears in the situations described in Changing Conditions above. Lactate Measurement ProtocolWatch-Severe Sepsis Screening Inactive SSC Sepsis protocol requires Lactate measurement now. Lactate>4mmol/l (36mg/dl)?

SSC Standby Screening Protocol Log Enter Lact ProtocolWatch Confirm Remind 15 min To enter the Lactate value, select the Enter Lact key. If the value entered is > 4 mmol/l the check box is automatically checked. Select Confirm when a value has been entered. What follows depends on the Lactate value:

If Lactate is > 4 mmol/l: the value meets the criteria for severe sepsis and a window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle.

If Lactate is 4 mmol/l: a further window appears requiring your input to determine on the basis of blood pressure values whether the patient meets the criteria for severe sepsis. 234 Severe Sepsis Screening Hypotension Evaluation 21 ProtocolWatch If the Lactate value was not above 4 mmol/l, the next window asks whether the patient has persistent hypotension. ProtocolWatch-Severe Sepsis Screening Inactive Does the patient have persistent Hypotension?

Screening SSC Standby Protocol Log Show Details ProtocolWatch Yes No Remind 15 min The protocol defines Hypotension as:

SBP < 90mmHg (12.0kPa), or

MAP < 65mmHg (9.0kPa), or

SBP decrease > 40mmHg (5.0kPa) below baseline. You can see this definition in the window by selecting Show Details. If the patient has persistent hypotension as defined, select Yes. This acknowledges that the patient meets the criteria for severe sepsis and a final window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle. If the patient does not have persistent hypotension, select No. After an hour the following screen appears. ProtocolWatch-Severe Sepsis Screening Inactive Screening SSC Standby Is the previously acknowledged infection still present?

Protocol Log Show Details ProtocolWatch Yes No Cancel If you select Yes, the window for the Lactate measurement will reappear. If you select No, screening continues comparing heart rate, temperature and respiration rate values against the screening criteria. Authorized Clinician Review ProtocolWatch-Severe Sepsis Screening The patient meets the SSC Sepsis protocol criteria for severe sepsis. Review by authorized clinician is recommended. SSC Standby Screening Inactive Protocol Log ProtocolWatch Confirm Remind 5 min 235 21 ProtocolWatch Severe Sepsis Screening To review the protocol, select Protocol Log. You can also print out the log to document the screening phase. Select Confirm to complete the screening phase. Viewing And Printing The Protocol Log The Protocol Log stores all user interactions, alarms and phase transitions while the SSC Sepsis Protocol is running. To view the Log select Main Setup -> ProtocolWatch -> Protocol Log You can choose between three different views of the Protocol Log:

Summary View - a short form which does not include when the windows were triggered

Full View - a complete log of all user interactions, alarms and phase transitions

Phase View - you can view log entries for one phase by selecting that phase on the orientation line When the Log consists of several pages, you can move through the pages with the Previous Page and Next Page keys. To start a Protocol Log printout, select Print. The log is cleared whenever a patient is discharged. Always Discharge Patients It is essential that patients are discharged when monitoring ends. As a reminder, the monitor can be configured to display a pop-up window when the monitor has been switched off, in Standby mode, or not monitoring basic vitals for a certain time. The window asks whether a new patient is being monitored and offers a pop-up key to discharge the previous patient if this is the case. The window must be configured in Configuration Mode. When the previous patient is discharged, this clears the protocol log, resets the timers and deletes manually entered measurement values. 236 22 22 Recording The optional integrated recorder records numerics for all active measurements and up to three waveforms. When the MP5 is connected to a host monitor (Companion Mode is indicated on the MP5 display), only data originating in the MP5 can be printed locally on the integrated recorder. All data can be printed on a recorder connected to the host monitor. Integrated Recorder 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. Recordings made on the M3160A may look slightly different to those described here. 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 Recordings SmartKey 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 HiRes Recordng All ECG Waves Vital Signs Alarm Limits ST Segments Setup Recordng Stop all Recordng 237 22 Recording Overview of Recording Types Quickstarting Recordings To quickstart any type of recording using a preconfigured recordings template, Select the Recordings SmartKey and then select the pop-up key of the recording type you want to start. Alternatively, you can Select the Main Setup SmartKey, select Recordings, then select the recording type. To quickstart a delayed recording, Select the SmartKey Delayed Record to immediately start a delayed recording. Extending Recordings Timed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue until stopped manually or by an INOP condition. To extend an ongoing recording by its runtime, reselect its Start pop-up key once. To make an ongoing recording continuous, reselect its Start pop-up key twice within 5 seconds. Stopping Recordings Recordings stop automatically when the preset runtime is over, when the recorder runs out of paper, when you open the recorder door or when the recorder has an INOP condition. To manually stop a recording, select the Recordings SmartKey and then select the pop-up key Stop All Recordng. Recording Without a Template To record without a preconfigured template, selecting the waves you require, Either: Select the Recordings SmartKey then select the pop-up key Select Waves. Or: Select the SmartKey Record Waves. 1 2 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If 3 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. Select the Start pop-up key to start the recording. 4 Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping. Overview of Recording Types This table details settings for local recordings. For details on recordings made on the central recorder, see your Information Center Instructions for Use. 238 All ECG Waves Recordings 22 Recording Type of recording Recording Destination Information recorded Number of waves Delayed manual Alarm Realtime (RT) All ECG Waves HiResTrnd automatic, triggered by defined alarm conditions manual manual manual local recorder and central local recorder and central printer local recorder and central local recorder only local recorder only from the start trigger minus the delay time up to 3 from the start trigger minus the delay time up to 3 N/A from the start trigger N/A up to 3 from the start trigger, in realtime all ECG waves currently monitored and available from the start trigger minus delay time up to 3 high-

resolution trends

(beat-to-beat) waves Speed Runtime 50, 25, 12.5, 6.25, 2.5 mm/sec 15, 20, 25, or 30 seconds 50, 25, 12.5, 6.25, 2.5 mm/sec 15, 20, 25, or 30 seconds N/A N/A Stops automatically automatically N/A Delay Time 10, 15 seconds 10, 15 seconds N/A 50, 25, 12.5, 6.25, 2.5 mm/sec 6, 8, 10, 15 seconds or continuously automatically if limited, manually if continuous none 25 mm/sec 4 seconds per wave automatically none Overlap up to 3 waves up to 3 waves N/A up to 3 waves none 1, 2, 2.5, 3, 6 cm/min 10 minutes, or continuously automatically if limited, manually if continuous 6, 5, 4, 3, 2, 1 minutes up to 3 waves Procedure or Context manual, use the context windows pop-

up keys to start local recorder only defined by the context up to 3 waves, or specific to the context, e.g. a wedge procedure defined by the context defined by the context defined by the context defined by the context defined by the context N/A = not applicable All ECG Waves Recordings An All ECG Waves recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead. All available leads are recorded sequentially in the standardized lead order. The recording is realtime, that is, the information recorded is not simultaneous. Creating and Changing Recordings Templates 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, two realtime recordings, and one high resolution recording. All ECG Waves recordings do not need to be configured, they always use the same format. Changing recordings templates changes the settings that will be used each time a recording of this name is triggered. Select the Main Setup permanent key to call up the Main Setup menu. Select Recordings to enter the Setup Recordings menu. 1 2 239 22 Recording Changing ECG Wave Gain 3 Select the name of the template you want to create or change. Each recording name is linked to a recording type, delayed, alarm, realtime, and hi-res trends. Recording names can be changed in the monitors Configuration Mode. 4 Design the template by selecting each menu item and entering the information for the template.

Recorder: choose which recorder the recording will print to (Local, Central 2-Ch. or Central 4-

Ch. recorder, or a printer (for realtime reports in alarm receording only)).

Channels 1 - 4: choose which waveform to record in each channel. If the wave assigned to a recording channel in a particular template is not available when a recording is triggered, the channel is left blank on the recording strip. The pop-up list of available (currently monitored) waves differs according to the recording type:

Realtime, delayed and alarm recordings: the list shows all the currently available waves. High-resolution recordings: the list shows all the available high-resolution waves. 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 Secondary Lead will always record the current secondary lead in the chosen recorder Agent will always record the currently selected anesthetic agent. For high-resolution recordings only the Agent setting is available.

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 channel before the recording is started. This interval is called the Delay Time and can be set as specified in the table on page 239. 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. Changing ECG Wave Gain The ECG Gain setting in the General Recording Setup window defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings, 1 2 3 In the Setup Recording menu select General Select ECG Gain. Select the required setting:

Auto: the wave recording will use the same scale as the ECG wave on the monitor screen 5 mm/mV, 10 mm/mv, 20 mm/mV: the wave recording will use a scale of 5, 10, or 20 millimeters per millivolt. 240 Recording Priorities 22 Recording Recording Priorities Manually-started recordings have priority over automatically-started recordings. If an automatically-triggered alarm recording is running, and a realtime or delayed recording is manually started, the alarm recording is stopped and the manually-requested recording is started. More recent manually-started recordings have priority over older manually-started recordings. If a manually-started recording is running, and another manually-started recording is triggered, then the older recording is stopped and the more recent manually-started recording is started. Alarm recordings are prioritized according to alarm priority. If an alarm recording triggered by a yellow alarm is running and a new alarm recording is triggered by a red alarm, the yellow alarm recording is stopped and the red alarm recording is started. Sample Recording Strip The information printed on the recording strip includes the patient name and MRN, bed number, date and time of recording, recording speed, and recording code. Active alarm and INOP messages as well as numerics for all currently monitored measurements are also printed. Recording strip annotations are printed at the beginning of the recording strip and updated at regular intervals, every 15 minutes for recordings made at speeds lower than 6.25 mm/s, and every 60 seconds for recordings made at speeds greater or equal to 6.25 mm/s. This sample recording strip shows a typical initial annotation:

Recording strip code Recording Speed Measurement numerics Patient information and medical record No. Alarms and INOPs 25 mm/sec Bed 3 37549201 90DIN 23 Jan 02 10:43 Green, Sarah

*** EXTREME BRADY

** ABPs HIGH

** PAPd HIGH SOME ECG ALARMS OFF HR 120 bpm SPO2 95%

Pulse 120 bpm PERF 10.0 ABP 120/70 (91) mmHg PAP 28/15 /21) mmHg NBP 120/80 (90) mmHg 23 Jan 02 10:31 etCO2 40 mmHg imCO2 0 mmHg awRR RR 15 rpm Tnaso 37.0C Recording Strip Code The recording strip code printed in the first line of the initial annotation has up to seven characters, specifying recording type, operating mode, application area, patient category, and delay time, if applicable. 241 22 Recording Sample Recording Strip Recording type Operating mode Application area Patient category Code Meaning 90 8A 0B 91 M D C S I O C N A P N Realtime Delayed Alarm Context (Procedures) Monitoring Demo Configuration Service ICU OR CCU NICU Adult Pediatric Neonatal As there are no alarms available on the MP5 when it is connected to a host monitor (Companion Mode is indicated on the MP5 display), recordings made on the local recorder are annotated with Companion Mode and No Alarm Display. Recorded Waveforms A selection of up to three waveforms is recorded, marked with wave labels and wave scale information. Wave scale information can be in the form of a calibration bar, like the 1 mV calibration bar for ECG, or calibration steps before the waveform starts. 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. 242 Reloading Paper Reloading Paper 22 Recording 1 Use the latch on the right side of the recorder door to pull the door open. 2 Remove the empty core. 3 Insert a new roll and secure it in place on the paper holder. The paper feeds from the bottom of the roll and over the top of the recorder door. Recommended paper: M4816A and M4817A. 4 With at least one inch of paper extending beyond the edge of the door, swing the recorder door up and push it firmly closed. 5 To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper. CAUTION When the recorder is disabled (door open, or out of paper), any alarm recordings will be sent to the central station recorder, if there is one. If no recorder is available, alarm recordings may be lost during the time the recorder is disabled. 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 Recorder Status Messages

<Recording name> running No <recorder name> alarm recording available Explanation The named recording is currently running. No alarm recording can be made on the selected recorder. Try selecting another recorder. If a local recorder was selected, the monitor will try to reroute the recording to a central recorder. Recordings configured to a central recorder cannot be rerouted to a local recorder. Alarm recordings may be lost. Try configuring Printer as the alarm recording destination. No alarm recording available No recorder available. Alarm recordings will be lost. Try configuring Printer as the alarm recording destination.

<Recorder name> out of paper The named recorder is out of paper.

<Recorder name> door open The door of the specified recorder is open. 243 22 Recording Recorder Status Messages 244 23 23Printing 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. Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up 1 2 Select Main Setup - > Reports Select Auto Print Dbs. Always will print all reports when a matching printer is available. Host only will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in grey on the Reports Job List) must be manually sent to the printer. See Checking Report Status and Printing Manually on page 250. Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See Checking Report Status and Printing Manually on page 250. 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. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient. When the MP5 is connected to a host monitor, reports requested or stored on the MP5 can be printed via the host monitor. Reports requested on the MP5 when connected to a host monitor will not show any patient alarms or INOPs. In order to see alarms, reports should be requested on the host monitor. 245 23 Printing Patient Reports Stopping Reports Printouts Report types Report contents Vital Signs Report depends on selected trend group, data resolution, and period. Graphic Trends Report Events Reports ECG Reports ST Map Report Wedge Report Drug Calculator Report Alarm Limits Report Realtime Reports, including oxyCRG Reports (Neonatal Event Review) Battery Report Event Episode with up to 5 episodes Graphic or tabular Event Review Depends on format selected ST data in a transversal and/or horizontal multiaxis diagram, Wedge numerics and reference wave Titration Table Drip Table Graphic and numeric report of all current alarm limits Patient data and numerics, and either:

all displayed waves OR all measured waves OR all measured RT waves OR all measured HiRes waves, OR oxyCRG waves (RT waves: ECG Primary lead, Pleth, Resp; HiRes waves: btbHR, HiRes SpO2, HiRes Resp) Battery serial number, information on the currently-measured and potential charge status of the battery Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available. In the Events window, select the pop-up key How to start printing reports In the Vital Signs window, select Print/

Record, then select Print In the Graphic Trends window, select Print Print/Record, then select the pop-up key Print Review or Print Episode Select the ECG Report SmartKeys, if configured In the ST Map window, select Print. In the Wedge window, select the Print Wedge pop-up key In the Titration Table window, select the Print Titr.Tbl pop-up key In the Drip Table window, select the Print Drip Tbl pop-up key In the Alarm Limits window, select Print Limits Select the Realtime Reports SmartKey, if configured In the Battery Status window, select Print Status. In the Main Setup select Reports then Central Report A, B or C. Stopping Reports Printouts To stop Reports printing, in the Reports menu, select Delete Report to stop the current print job Delete All Repts 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. 246 Setting Up Reports 23 Printing Patient Reports Setting Up ECG Reports 1 The settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG Reports, 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. Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the ECG report printouts. 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. 3 4 2 Setting Up Vital Signs and Graphic Trend Reports The settings you choose in the 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 3 4 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 monitors trend configuration. 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, 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 3 4 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. 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. 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. 247 23 Printing Patient Reports Setting Up Individual Print Jobs To set the time of day at which you want the report to print every day: select Start Hour and To set the time interval in minutes between two scheduled reports: select Rep. Freq.(Hr) Start Minute and select the required time from the pop-up list 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 monitors 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 Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu. Select Report and then select the report you want to set up. 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:

VisibleWaves: 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 monitors priority list. HiRes Waves: all measured HiRes waves OxyCRG Waves: the OxyCRG/Neonatal Event Review waves. Vital Signs: trend information in tabular form. Graph Trend: trend information in graphic form. ECG3X4, ECG6X2, ECG12X1, ECG4X2, ECG8X1, ECG12X1(2P): ECG reports. Episode: a single patient event episode. Review: an overview of patient events 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: Unspecified to use the default size for the template chosen, Landscape or Portrait. 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 monitors Configuration Mode (for example, Remote 1 or Database). 2 3 4 5 6 Some settings may be inactive (grayed-out) in this menu for reports that can only be started in a special window. 248 Checking Printer Settings 23 Printing Patient Reports 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 1 You can enable or disable printer status to switch individual printers on or off for report printouts. 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. Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Enabled/Disabled setting will automatically be set to Disabled and grayed out. 2 Dashed Lines on 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 monitors memory. 249 23 Printing Patient Reports Checking Report Status and Printing Manually 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 and Printing Manually 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, In Companion, Retry, Cancelling, Error Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Reps key. CAUTION The reports job list includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality. Printing Manually Those jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host only or Never, some or all reports will not be printed automatically and will be shown in grey. Any jobs shown in grey must be printed manually; to do this, 1 In the Reports Job List, select the required report Select Print Report. 2 Selecting Print All Reps. will send all reports to the printer. 250 Printer Status Messages 23 Printing Patient Reports Printer Status Messages Possible causes and suggested action Printer Status Message Print job queued for <Printer name> The report has been placed in the queue for the named printer. Print job could not be queued 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 Cancelling all print jobs Cancelling the active print job Cancelling N print jobs due to patient discharge Deleted N print jobs due to hotstart Printing failed:

no report configured!

Printing on device

<Printer name>

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. Delete 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. 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. 251 23 Printing Patient Reports Sample Report Printouts Printer Status Message Print device

<Printer name>

unavailable - job suspended Print Database full -> job suspended Job on <Printer name> failed Print job on device <Printer name> done Possible causes and suggested action 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. 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 249). Alternatively you can delete another report from the Reports Job List (using the Stop report key) to create space for your report. A report cannot be started on the requested printer. One of three reasons will also be shown in the status message:

data requisition error - an internal error has caused data required for the report to be unavailable, try starting the report again.

printer unavailable - make sure the printer is plugged in, switched on, and has paper loaded.

data unavailable - the connected X2 or MP5 has been removed before the data for the report was transferred. The report has been printed. Sample Report Printouts Each report header contains the patients bed label, last name and first name, middle name (if there is enough space) 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 monitors Configuration Mode. 252 Sample Report Printouts 23 Printing Patient Reports Alarm Limits Report Patient Name Measurement labels, with alarms off symbol where alarms are switched off Realtime Report Graphic view of current alarm limits in relation to currently monitored measurement value 253 23 Printing Patient Reports Sample Report Printouts Patient demographic information, time stamp Active Alarms and INOPs, followed by vital signs Measurement waves section 254 23 Printing Patient Reports Sample Report Printouts ECG Reports Patient information Numeric block Wave area 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 patients 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 Available Formats Available Paper Sizes 12-Lead ECG Multi-lead ECG 3X4 landscape 6X2 landscape 12X1 portrait 12X1 landscape 12X1 (2P) landscape 2X4 landscape 8X1 portrait 8X1 landscape 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 Other Reports See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports. 255 23 Printing Patient Reports Sample Report Printouts 256 24 24Using the Drug Calculator Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time. Term Dose Rate Amount Definition Units total quantity of drug to be delivered to the patient over time volume of the mixture to be delivered to the patient over time amount of drug to be added to diluent to make up a mixture quantity of mixture of diluent and drug Volume Concentration ratio of the amount of drug to the solution Standardized Rate volume 1ml volume of the mixture to be delivered to the patient per hour amount units per time or per kg/

time, if the drug is weight-dependent ml/hour ng, mcg*, mg, g, mUnit, Unit, where g stands for gram ml amount units per ml ml/hr

*Be aware that your hospital may use either g or mcg as an abbreviation for microgram. These abbreviations are equivalent. WARNING Before you administer any drug, always check that the correct calculation units and patient category are selected. Consult your pharmacy if you have questions. Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge. The Drug Calculator performs calculations based on the values input during use, it does not check the plausibility of the calculations performed. Accessing the Drug Calculator To access the Drug Calculator, select Main Setup -> Calculations ->

Drug Calculator, or select the Drug Calculator SmartKey, if configured. 257 24 Using the Drug Calculator Performing Drug Calculations Performing Drug Calculations Using the service Support Tool, a list of drugs can be configured for the monitor containing pre-

defined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the Drug Calculator window opens a list of configured drugs. Contact your pharmacist if you have any questions about the drugs in the list. If ANY DRUG is the only entry in the list of drugs, no drugs have been preconfigured for your monitor. Drug calculations can be performed for non-specific drugs. You must have a Support Tool to add additional drugs to the Drug Calculator. About the Rule of Six If the Rule of Six has been enabled for use with individual drugs in your Drug Calculator, you can use the formula in crisis situations to quickly calculate the amount of a drug needed to yield a target dose for continuous infusion for neonatal or pediatric patients (the drug amount is given in mg, the patient weight in kg). The Rule of Six can only be used with the dose unit mcg/kg/min. CAUTION JCAHO recommends disabling the Rule of Six. The configuration is not JCAHO-compliant if Rule of Six is enabled. The Drug Calculator uses the following formula for Rule of Six calculations, based on the patients weight:

For a target dose of 0.1 mcg/kg/min, the Drug Calculator multiplies 0.6 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.

For a target dose of 1.0 mcg/kg/min, the Drug Calculator multiplies 6.0 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml. Performing Calculations for a Non-Specific Drug If a list of drugs has not been configured for your monitor, you can use the Drug Calculator to calculate drug doses for a single, generic drug called Any Drug. Selecting the arrow beside the drug name in the Drug Calculator window shows that are no other drugs configured. 1 Enter three of these four values: dose, amount, volume, and rate of the infusion solution. To enter values, select the correct unit, then select each value field and use the pop-up keypad to enter the correct value. Drug Calculator ANY DRUG Dose Rate Amount Volume Concentr 1 ml/hr Weight mg/min ml/hour mg ml 2 480 25 100 0.25 mg/ml 0.004 mg/min 150 lb If you have chosen a weight-dependent dose unit, you must enter the patient weight now or choose a different unit. If available, the patient weight from the Patient Demographic window is entered automatically in the Drug Calculator window when the Drug Calculator is accessed. To change the patient weight, select the Weight key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. 2 258 Performing Drug Calculations 24 Using the Drug Calculator 3 When you have entered three values, the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field. Standardized rate and concentration are also calculated. Performing Calculations for a Specific Drug Select the arrow beside ANY DRUG, then select the required drug from the list of drugs. This opens the Drug Calculator window for the selected drug. 1 2 Patient Category Adult Pedi Neo Drug Calculator (Adult) Lidocaine Dose Rate Amount Volume Concentr. ml/hr Weight mg/min ml/hour mg ml mg/ml mg/min lb Select the correct patient category for your patient. If you have a neonatal or pediatric patient, the Rule Of 6 choice may be available. Select if required. Reset Values 3 Enter the patient weight, if necessary. If available, the patient weight from the Patient Demographic window is entered automatically in the Drug Calculator window. To change the patient weight, select the Weight key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. Select the weight unit shown to change between lb and kg. 4 When a specific drug is selected, the initial values for Dose, Amount and Volume are the configured Start values for this drug. The Rate is then calculated. If other values are required you can calculate any value by entering the remaining three values as described in Performing Calculations for a Non-Specific Drug. The column on the right of the Drug Calculator window shows either drug dose or dosage rate, whichever is the calculated value. The current calculated value is shown on a scale with the recommended range in green. If the current calculated value lies outside the recommended range it is shown in red. If you have changed values in the Drug Calculator and you want to revert to the configured values, select Reset Values key at any time. 259 24 Using the Drug Calculator Charting Infusion Progress Charting Infusion Progress The Drip Table shows you at a glance how much of the infusion has been administered to your patient and how much time is left. To see the Drip Table, in the Drug Calculator window, select the Drip Table pop-up key. If the Drip Time exceeds 24 hours, the Drip Time timestamp shows - - :- - : - - . Lidocaine Dose Rate Amount Volume Weight DripTime Drip Table mg/min ml/hour mg ml lb hr:min:sec Using the Titration Table Amount Volume Drip Time Titration Table Dose Rate Amount Volume Weight Dose mg/min mg/min mg/min Rate Dose Lidocaine Dose increments From a low of To a high of In increments of Dose Rate mg/min ml/hour mcg ml lb Rate Rate Dose Use the Titration Table to see at a glance what dose your patient would receive of a drug at different infusion rates. By clicking on the title row of the table you can switch between the Dose Increments and Rate Increments view. Values outside of the recommended range are shown in red. To see the Titration Table, in the Drug Calculator window, select the pop-up key Titr.Table. The Titration Table is configured with the service Support Tool. Documenting Drug Calculations In the Drug Calculator window, select the pop-up key Record DrugCalc to immediately start a recording of the current drug calculation. In the Titration Table window, select the pop-up key Print Titr. Tbl to print a report of the current Titration Table. In the Drip Table window, select the pop-up key Print Drip Tbl to print a report of the current Drip Table. 260 25 25Using the Timer With the Timer function you can set a timer to notify you when a specific time period has expired. CAUTION Do not use the timers to schedule critical patient-related tasks. Viewing the Timer You can view the currently active timer in the Timer window or directly on the Main Screen (if a timer has been substituted for a numeric). To open the Timer window:

Select the Timer SmartKey or Select Main Setup -> Timer For a timer with a defined run time a progress bar is shown with the run time for that timer. Next to the progress bar the elapsed time or the remaining time is shown, depending on whether the timer is counting Up or Down. On the left, the label of the timer and a symbol indicating the type of expiry notification is shown. Timer Types There are four types of timer: Basic, Enhanced, Cyclic and No Limit. A Basic timer has a single, defined run time and progress is shown in the progress bar. An Enhanced timer is like a Basic timer but the progress bar shows progress beyond the end of the run time. A Cyclic timer is like a Basic timer but restarts automatically when the run time is expired. A No Limit timer has no run time or progress bar and shows the time elapsed since the timer was started. The type of timer is set in the monitors Configuration Mode and is associated with the timer label. Timer Setup Pop-up Keys When you open the Timer window and select the Setup Label pop-up key, the Setup window opens and a selection of pop-up keys appear to let you activate and control the timer. 261 25 Using the Timer Setting Up Timers Pop-Up Keys Start Stop Clear Timers Selecting this pop-up key lets you.... start the timer. stop the timer, allowing either restarting after a pause (Start key) or clearing

(Clear key). clear the timer, ending this timer episode. return to the timer window Setting Up Timers The timer type, display color of the timer and whether a window automatically pops up on expiry are settings made in Configuration Mode for each timer label. The remaining timer settings can be made in Monitoring Mode. If you change settings when a timer is running it will not be stopped. The timer will continue to count but the new settings will be applied. To display the Setup window for a timer, in the Timer window, select Setup Label, or select a timer on the Main Screen then select Setup Timers Timer Label You can select from a variety of specific labels, for example Tourniquet, Infusion, Documentation or from four non-specific labels Timer A, B, C, D. When you assign a label to a timer, the monitor automatically applies the associated configuration settings to this timer, but the timer continues counting and is not reset. To select a label, in the Timer window:

1 Select the Setup Label pop-up key to display the Setup window. Select Label. Select a specific or non-specific label from the list. 2 3 Run Time The run time can be set between 1 minute and 96 hours. No Limit timers have no run time. To set the run time, in the Timer window:

1 Select the Setup Label pop-up key to display the Setup window. Select Run Time. Select a run time from the list. 2 3 Timer Counting Direction Timers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up. To change the direction, in the Timer window:

1 Select the Setup Label pop-up key to display the Setup window. 262 Displaying a Timer On The Main Screen 25 Using the Timer Select Direction to switch between Up and Down. 2 Notification When a timer expires (except a No Limit timer), the color changes to red and a message appears in the status line on the Main Screen. Be aware that if a timer has been configured to display in light red, the color will not visibly change when the timer expires. Additional notification is also available and can be set to:

Alarm An INOP alarm indicates the expiry of the timer Sound A single tone indicates the expiry of the timer No Sound No additional notification To set the additional notification, in the Timer window:

1 Select the Setup Label pop-up key to display the Setup window. Select Notification and select the notification level required from the list. 2 If an MP5 is connected to a host monitor, and notification is set on the MP5 to Alarm, the INOP alarm will appear on the host monitor TimeExpired:MMS. Timer Volume For all Timers with the notification setting Sound, you can set the volume of the tone. To set the volume, in the Timer window:

1 Select the Setup Label pop-up key to display the Setup window. Select Timer Volume and select a volume setting from the list. 2 Displaying a Timer On The Main Screen If you want to have a timer displayed on the Main Screen, you can substitute it for a numeric which is not directly associated with a wave. If limited space is available, some elements displayed in the Timer window may not be displayed. The minimum information displayed is the label and the elapsed or remaining time. TimerA 2 hrs To display a timer on the Main Screen:

1 2 3 Select the numeric you want to substitute. Select Change Numeric. Select Any Timer. 263 25 Using the Timer Displaying A Clock On The Main Screen Main Screen Timer Pop-up Keys When you select a timer displayed on the Main Screen, additional pop-up keys become available:

Pop-Up Keys Setup Label Change Timer Timers Selecting this pop-up key lets you.... enter the setup screen for the currently selected timer. select a different timer for display. enter the Timers window. Displaying A Clock On The Main Screen In the same way that you can substitute a timer for a numeric, you can also substitute a larger clock display for a numeric. To display a clock on the Main Screen:

1 2 Select the numeric you want to substitute. Select Change Numeric. Select Clock. 3 When you select the clock on the Main Screen you can select Date, Time in the menu to set the date and time. 264 26 26Laboratory Data Laboratory data can be entered manually at the Information Center or at the monitor. For details on manual entry at the monitor, see Entering Measurements Manually on page 39. Selected laboratory data can be integrated on the monitor - values are then stored in the database and included in trends and reports and can be displayed as a numeric on the main screen. Which data can be stored and used on the monitor in this way is selected in Configuration Mode. Viewing Received Data When new data has been received from the Information Center a New lab data received. Check Lab Results Window message will appear with the arrival time. To view the data, select Main Setup > Lab Results or the Lab Results SmartKey. Lab Results - 08:50 22. Feb Description Volume Range Timestamp Parameter Blood Gases PCO2 PO2 BE pH Unit mmHg mmHg mol/L Metabolites Glu BUN Enzymes/Markers cTnI mol/L mg/dl ng/ml The Lab Results window shows the most recent set of data received. The data is grouped into categories:

Blood Gases

Electrolytes

Hematology

Metabolites

Chemistry 265 26 Laboratory Data Viewing Received Data

Enzymes/Markers

Coagulation

Urine Diagnostics If no results are available for a particular category, that category will not be shown. Values which were entered manually at the Information Center will be marked with an * . 266 27 27Care 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 hospitals 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 manufacturers 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. 267 27 Care and Cleaning Cleaning the Monitor Cleaning the Monitor Clean with a lint-free cloth, moistened with warm water (40C/104F 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 selecting and holding the Main Screen key until the padlock symbol appears on it, indicating that touch operation is disabled. Select and hold again to re-enable touch operation. Recommended cleaning agents are:

Tensides (dishwasher detergents) Ammonias Alcohol Edisonite Schnellreiniger, Alconox Dilution of Ammonia <3%, Window cleaner Ethanol 70%, Isopropanol 70%, Window cleaner Disinfecting the Monitor 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 hospitals 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. 268 Cleaning, Sterilizing and Disinfecting Monitoring Accessories 27 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. Cleaning and Disinfecting the Predictive Temperature Accessories Probes Wipe the probe and cord regularly with a cloth dampened with warm water and a mild detergent solution. As needed, disinfect the probe and cord with a 70% isopropyl alcohol solution, or a nonstaining disinfectant. Probe Holders 1 Disconnect the probe and remove it from the holder. 2 Remove the holder from the unit. 3 Clean the inner and outer surfaces by swabbing them with a cloth dampened with a mild detergent solution. 4 As needed, disinfect the probe holder with a 70% isopropyl alcohol solution, or a nonstaining disinfectant. 5 Thoroughly dry all surfaces before reassembling the equipment. Cleaning Batteries and the Battery Compartment Wipe with a lint-free cloth, moistened with warm water (40C/104F maximum) and soap. Do not use strong solvents. Do not soak the battery. 269 27 Care and Cleaning Cleaning Batteries and the Battery Compartment 270 28 28Using Batteries One Philips M4605A rechargeable Lithium Ion battery must be inserted into the battery compartment on the right side of the monitor to use the MP5 monitor with battery power. Battery compartment You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. When an MP5 is connected to a host monitor, no battery data from the MP5 is visible on the host. Battery INOPs, however, are displayed. The battery normally recharges automatically when the monitor is connected to mains power. 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 batterys actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window. 271 28 Using Batteries Battery LED Battery Power Indicators 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 mains power, this means If the monitor is running on battery power, this means Green Yellow Red, flashing battery power is > 90%

battery charging (battery power

< 90%) Red, flashes intermittently battery or charger malfunction less than 10 minutes power remaining battery malfunction 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. 2:40 hrs Battery power gauge: This shows the remaining battery power. It is divided into sections, each representing 20% of the total power. If three and a half sections are filled, as in this example, this indicates that 70% battery power remains. If no battery is detected, the battery gauge is grayed-out. If no data is available from the battery, question marks are shown in the gauge. Monitoring Time Available: Below the battery power gauge a time is displayed. 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 and recordings you carry out), the age of the battery, and the remaining capacity of the battery. Battery malfunction symbols: If a problem is detected with the battery, these symbols are displayed. They may be accompanied by an INOP message or by a battery status message in the monitor information line providing more details. Symbols indicating critical situations are colored red. Battery status symbols Battery malfunction symbols battery is empty

(red) incompatible battery 272 Battery Power Indicators 28 Using Batteries battery not charging as the temperature is above or below the specified range

(red) battery malfunction battery requires maintenance

(red) battery has no power left charging stopped to protect the battery

(red) battery temperature too high 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 TimeToEmpty:

Capacity remaining fullCharge 5:20 hrs 5700 6135

[mAh]

[mAh]

Capacity, remaining tells you how much power is left in the battery. Capacity, fullCharge tells you how much power the battery can hold when fully charged. TimeToEmpty 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 and recordings you carry out), the age of the battery, and the remaining capacity of the battery. TimeToEmpty 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 and recordings you carry out), the age of the battery, and the remaining capacity of the battery. TimeToFull is shown in place of TimeToEmpty if the monitor is connected to mains power, and tells you how much time is left until the battery is charged to 90%. If >10 hrs is shown here, the battery may not charge completely when the monitor is in use. You can use the M8043A Smart Battery Charger to charge the batteries externally. Recording Battery Status To print the information in the Battery Status window on a connected recorder, 1 Select the battery status information on the Screen to open the Battery Status window Select the Record Status pop-up key. 2 Printing Battery Reports To print the information in the Battery Status window on a connected printer, 273 28 Using Batteries Checking Battery Charge Select the battery status information on the Screen to open the Battery Status window Select the Print Status pop-up key. 1 2 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. Replacing a Battery To replace the battery, 1 2 3 4 Press the battery compartment latch to open the battery compartment door. Push the release clip in the compartment. Pull gently on the canvas strap to move the battery towards you, then grasp the battery and pull it out fully. Slide the new battery into position, making sure that the battery contacts are facing in the correct direction, as outlined on the inside of the battery compartment. 5 Close the battery compartment door. Optimizing Battery Performance The performance of rechargeable batteries may deteriorate over time. Battery maintenance as recommended here can help to slow down this process. 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). 274 Battery Safety Information Charging a Battery 28 Using Batteries A battery can be charged in monitors used to monitor patients. Charging is quicker in monitors which are switched off. You can also use the M8043A Smart Battery Charger to charge batteries. 1 Insert the battery into a monitor connected to mains power. The battery LED will light yellow to indicate that charging is in process (it can take up to three minutes before charging begins). 2 Charge the battery until it is full, the battery LED is green, and the battery power gauge is filled. In certain situations, where many measurements are in use plus the recorder, the load on the monitor may be so high that the batteries will not charge. 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 mains power. Switch the monitor power off. 2 3 Charge the battery until it is completely full. Open the Battery Status window and check that the Batt Fully Charged message is displayed. 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. 5 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. NOTE The battery will discharge over time if it is stored inside the monitor without AC power connection. 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 M4605A. Use of a different battery may present a risk of fire or explosion. 275 28 Using Batteries Battery Safety Information 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 100C (212F) 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. 276 29 29Maintenance 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 hospitals 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. Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use. 2 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 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the 2 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. 3 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. 277 29 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 monitors 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) Replace backlight

(integrated displays only) Measurement Tests Performance assurance for all measurements not listed below. Measurement Maintenance NBP calibration Mainstream and sidestream CO2 calibration check Microstream CO2 calibration and performance test Predictive Temperature Battery Maintenance Battery At least once every two years, or as needed. 50,000 hours (about four years) of continuous usage, 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 if you suspect the measurement values are incorrect. 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 278 Troubleshooting 29 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, In the Main Setup menu, select Revision. Select a pop-up key according to the status log you want to consult. 2 3 View the status log by selecting Status Log from the Monitor Revision window. 1 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 countrys 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. You will find detailed disposal information on the following web page:

http://www.medical.philips.com/main/company/sustainability/recycling/patient_monitoring/

The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium). 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 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. 2 When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder. 3 Write Empty on the cylinder and dispose of it appropriately for scrap metal. WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder. 279 29 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders 280 30 30Accessories 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 6-Electrode Cable Set 10-Electrode Cable set

(5+5) 10-Electrode Cable set

(6+4) Part No. M1669A Length 2.7m M1668A 2.7m M1667A 2.7m M1663A 2.0m M1665A 2.7m 281 30 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR Grabber shielded ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1675A M1671A M1673A M1622A M1624A M1678A M1672A M1674A

M1626A 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Miniclip non-shielded Length 1.0m/1.6m 1.0m/1.6m 1.0m/1.6m 0.7m/1.3m AAMI Part No. IEC Part No. M1973A M1968A M1644A M1647A 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 AAMI Part No. IEC Part No. M1684A M1680A M1682A M1685A M1681A M1683A 10-Electrode (5+5)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 5-electrode cable sets M1976A M1602A M1979A M1978A M1604A M1984A 10-Electrode (6+4)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 6-electrode cable sets M1532A M1537A M1557A M1533A M1538A M1558A 282 ECG/Resp Accessories One-piece Cables 30 Accessories Description 3-lead Grabber, ICU 5-lead Grabber, ICU Length 1.0m 1.0m AAMI Part No. IEC Part No. 989803143181 989803143201 989803143171 989803143191 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 non-

shielded 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) Part No. M1501A M1502A M1503A M1664A M1504A M1679A M1636A M1638A M1509A 989808148861 Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. M1540C M1500A IEC Part No. M1550C M1510A AAMI Part No. M1560C M1520A IEC Part No. M1570C M1530A 0.9m 2.7m 283 30 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1601A M1603A M1605A M1608A M1609A M1611A M1613A M1615A M1618A M1619A 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. IEC Part No. M1621A M1623A M1625A M1629A M1631A M1633A M1635A M1639A 3-Electrode One Piece Cables AAMI 3-Electrode One Piece Cables Length OR Grabber ICU Snap 1.9m 1.9m AAMI Part No. M1970A M1972A IEC 3-electrode One Piece Cables OR Grabber ICU Grabber IEC Part No. M1980A M1981A 5-Electrode One Piece Cables AAMI 5-electrode One Piece Cables Length OR Grabber ICU Snap 2.5m 2.5m AAMI Part No. M1975A M1977A IEC 5-electrode One Piece Cables IEC Part No. OR Grabber ICU Grabber M1985A M1986A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer Bedsheet clip 3-electrode 5-electrode Shielded 3-electrode Shielded 5-electrode Part No. M1501A M1502A M1503A M1504A M1509A 284 NBP Accessories 30 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 Reusable Cuff Kits 20 cm 16 cm 13 cm 42 to 54 cm 34 to 43 cm 27 to 35 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 Part No. Tubing M1598B (1.5m) or M1599B (3m) M1576A M1575A M1574A M1573A M1572A M1571A Cuff Kits Part No. M1577A Infant, pediatric, small adult, adult M1578A Small adult, adult, large adult, thigh Infant, pediatric, small adult, adult, large adult, thigh M1579A Adult/Pediatric Antimicrobial Coated Reusable cuffs Patient Category (color) Limb Circumference

(cm) 45 - 56.5 Adult Thigh (grey) Large Adult X-Long (burgundy) 35.5 - 46.0 Large Adult (burgundy) 35.5 - 46.0 27.5 - 36.5 Adult X-Long (navy blue) 27.5 - 36.5 Adult (navy blue) Small Adult (royal blue) 20.5 - 28.5 13.8 - 21.5 Pediatric (green) Infant (orange) 9 - 14.8 Bladder Width Part No. Tubing M1598B

(1.5m) or M1599B (3m) 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 285 30 Accessories Invasive Pressure Accessories Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs Patient Category Adult (Thigh) Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference

(cm) Bladder Width Part No. Tubing M1598B (1.5m) or M1599B (3m) 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 M4579A M4578A M4577A M4576A M4575A M4574A M4573A M4572A Neonatal/Infant Cuffs (Disposable, non-sterile) 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. Tubing 2.2 cm 2.8 cm 3.9 cm 4.7 cm M1866A M1868A M1870A M1872A 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. Transducer, accessories, sensor kits Reusable pressure transducer 5 V/.V/mmHg sensitivity Sterile disposable pressure domes for CPJ840J6 (pack of 50) Transducer holder for CPJ840J6 (pack of 4) IV pole mount for CPJ840J6 Single channel disposable sensor kit (20) - (EU/EFTA only) Dual channel disposable sensor kit (20) (EU/EFTA only) Transducer holder for M1567/8A (EU/EFTA only) IV pole mount for M1567/8A (EU/EFTA only) Adapter cable for disposable sensor kit 3,0m for M1567/8A Monitoring Line Set Part No CPJ840J6 CPJ84022 CPJ84046 CPJ84447 M1567A M1568A M2271A M2272C M1634A CPJ84026 286 SpO2 Accessories SpO2 Accessories 30 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:

Masimo adapter cables,

Philips reusable sensors or adapter cables with part numbers ending in -L (indicates Long version). All listed sensors operate without risk of exceeding 41C on the skin, if the initial skin temperature does not exceed 35C. Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result. Product Number Description Philips reusable sensors. Comments M1191A/B M1191AL/

BL M1192A M1193A M1194A M1195A M1196A Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb. M1191A/B with longer cable (3 m) No adapter cable required. 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. 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. Adult clip sensor (3m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. 287 30 Accessories SpO2 Accessories Product Number M1191T M1192T M1193T M1196T Description Comments Requires M1943

(1 m) or M1943AL

(3 m) adapter cable Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb. 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. Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. No adapter cable required. M1191ANL Special Edition (SE) M1192AN M1193AN M1194AN M1195AN Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb. Special Edition (SE) Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Special Edition (SE) Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot. Special Edition (SE) Ear sensor (1.5m cable) for patients more than 40 kg. Special Edition (SE) Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb. Philips disposable sensors. Not available in the USA and Canada. M1904B M1903B M1902B M1901B Identical to OxiMax MAX-A Identical to OxiMax MAX-P Identical to OxiMax MAX-I Identical to OxiMax MAX-N Philips disposable sensors. Available worldwide. M1131A Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg) Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. 288 SpO2 Accessories 30 Accessories Product Number M1132A M1133A Description Comments Infant finger or toe sensor, 0.9m cable

(patient size 3 - 10 kg) 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. Use adapter cable M1943A or M1943AL. NELLCOR disposable sensors (must be ordered from Nellcor) OxiMax MAX-A OxiMax MAX-AL OxiMax MAX-P OxiMax MAX-I OxiMax MAX-N Oxisensor II D-25 Oxisensor II D-20 Oxisensor II I-20 Oxisensor II N-25 OxiCliq A OxiCliq P OxiCliq I OxiCliq N Adult finger sensor (patient size >30 kg) OxiMax MAX-A with long cable Use adapter cable M1943A or M1943AL. 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) Adult sensor (patient size >30kg) Pediatric sensor (patient size 10-50 kg) Infant sensor (patient size 3-20 kg) Neonatal sensor (patient size <3 kg or

>40 kg) See OxiMax MAX-A See OxiMax MAX-P See OxiMax MAX-I See OxiMax MAX-N 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 Extension cable (2 m) M1943A M1943AL Adapter cable (1.1 m cable) Adapter cable (3 m cable) For use with Philips reusable sensors and adapter cables. Adapter cable for Philips/Nellcor disposable sensors. 289 30 Accessories SpO2 Accessories Product Number OC-3 Description Comments Adapter Cable for OxiCliq sensors Available from Nellcor only. Description Product Number 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. LNCS DC-I LNCS DC-IP LNCS TC-I MASIMO LNOP disposable adhesive sensors. LNOP Adt LNOP Adtx LNOP Pdt LNOP Pdtx LNOP Inf-L LNOP Neo-L Adult Sensor (> 30 kg) Adult Sensor (> 30 kg) Pediatric Sensor (10 - 50 kg) Pediatric Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Sensor (<3kg) or Adult adhesive Sensor (> 40 kg) LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin Adult reusable Sensor (> 30 kg) Pediatric reusable Sensor (10 - 50 kg) Reusable ear Sensor (> 30 kg) Sensors (<1kg) MASIMO LNCS disposable adhesive sensors. LNCS Adtx LNCS Pdtx LNCS Inf-L LNCS Neo-L Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Foot Sensor (< 3 kg) or Adult Finger Sensor (> 40 kg) Philips Part Number 989803140321 989803140331 n/a 989803140341 989803148281 989803148291 989803148301 989803140231 n/a 989803140261 n/a 989803140311 989803140291 989803140301 989803148231 989803148241 989803148251 989803148271 LNCS NeoPt-L Neonatal pre-term sensitive skin Sensor 989803148261

(< 1 kg) Adapter Cable for MASIMO sensors. LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors 451261000761 989803148221 LNC MP10 290 Temperature Accessories 30 Accessories 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) Foley Catheter Probe (16 French) Foley Catheter Probe (18 French) Adapter cable 1.5m Adapter cable 3.0m Part No. Minimum measurement time for accurate readings 90 sec 60 sec 60 sec 90 sec 60 sec 180 sec 210 sec 310 sec 180 sec 180 sec 180 sec 21075A 21076A 21078A M1837A 21091A 21093A 21094A 21095A M2255A 21096A 21097A 21082B 21082A Predictive Temperature Accessories Temperature Probes and Disposable Covers Part No. Welch Allyn Part No. Oral probe with probe well (holder), 2.7m cable (9ft) Rectal probe with probe well (holder), 2.7 m cable (9ft) Disposable probe covers: 1,000 (40 boxes, 25 per box) 989803143381 989803143391 M4823A 02895-000 02895-100 05031-101 291 30 Accessories Mainstream CO2 Accessories Mainstream CO2 Accessories Description CO2 Sensor Adult/Pediatric Airway Adapter (reusable) Infant Airway Adapter (reusable) Adult Airway Adapter (single-patient use) Infant Airway Adapter (single-patient use) Part No. M2501A M2513A M2516A M2533A M2536A Sidestream CO2 Accessories Description CO2 Sensor Nasal and Oral-Nasal Cannulas CO2 Nasal Cannula, Adult CO2 Nasal Cannula, Pediatric CO2 Nasal Cannula, Infant CO2 / O2 Nasal Cannula, Adult CO2 / O2 Nasal Cannula, Pediatric CO2 / O2 Nasal Cannula, Infant CO2 Oral-Nasal Cannula, Adult CO2 Oral-Nasal Cannula, Pediatric CO2 / O2 Oral-Nasal Cannula, Adult CO2 / O2 Oral-Nasal Cannula, Pediatric Airway Adapters Airway Adapter Set, ET > 4.0 mm 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 989803144471 M2756A M2757A M2760A M2761A M2768A 989803144531 M2772A M2773A M2776A M2777A Microstream CO2 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. 292 Recorder Accessories 30 Accessories

Smart CapnoLine is a combined oral-nasal FilterLine.

Smart CapnoLine O2 is a combined oral-nasal-O2-CO2 FilterLine.

NIV Line is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).

Single purpose means CO2 measurement only, dual purpose means CO2 measurement and O2 delivery.

The accessories are supplied in packs of 25. Microstream accessory selection flowchart Yes Is the patient intubated?

No Does the patient need oxygen?

Yes No Short-term

(up to 6 hours) Long-term Short term Long term Long-term Short term

(up to 72 hours)

(up to 8 hours)

(up to 24 hours)

(up to 24 hours)

(up to 8 hours) Short term

(up to 8 hours) Oral/Nasal Nasal Nasal Oral/Nasal Nasal Key Applications Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Lab, Long-term 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) CapnoLine HO2:

A: M4680A P: M4681A CapnoLine H:

A: M4689A P: M4690A I/N: M4691A NIV Line:

A: 4686A P: M4687A Smart CapnoLine:

A: M2526A P: M2524A Smart CapnoLine Plus Long A:989803160301*

Smart CapnoLine O2:

A: M2522A P: M2520A Smart CapnoLine O2 Long A:989803160281*

P:989803160271*

FilterLine Set:

A/P: M1920A FilterLine Set Long:

A/P:989803160241*

FilterLine:

M1925A*

FilterLine H Set:

A/P: M1921A I/N: M1923A FilterLine H Set Long A/P:989803160251*

I/N:989803160261*

VitaLine H Set:

A/P:989803159571*

I/N: 989803159581*

FilterLine H:

M1926A*

*Not available in all geographies. Recorder Accessories Description 10 rolls of paper 80 rolls of paper Part No. M4816A M4817A 293 30 Accessories Cable for Direct Connection of a Telemetry Device Cable for Direct Connection of a Telemetry Device Telemetry Interface Cable, 2.0m, PN 989803146911 Battery Accessories Description Battery Charger and Conditioner Part No. M8043A 294 31 31Installation and 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. The MP5 and MP5T monitors are also intended for use during patient transport inside the hospital environment; only the MP5 monitor for use during patient transport 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 Predictive Temperature unit is intended for use with adult and pediatric patients in a hospital environment. 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). The derived measurement Pulse Pressure Variation (PPV) is intended for use with sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. The PPV measurement has been validated only for adult patients. NOTE1 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. NOTE2 EMC Environment The following measurements and system interfaces are, in addition, suitable for use in establishments directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes (see table in Electromagnetic Emissions on page 321):

ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A and Microstream CO2)

LAN, Video Out, Battery, Nurse Call, RS232, and recorder interfaces The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. 295 31 Installation and Specifications Manufacturers Information WARNING The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment

(for example, hyperbaric chambers. Manufacturers 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 - 2008. Koninklijke Philips Electronics N.V. All Rights Reserved. Trademark Acknowledgement The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor, Durasensor, Dura-

Y, Oxiband, Oxicliq, OxiMax. MAX-FAST is a trademark of Mallinckrodt Inc. 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). 296 Symbols 31 Installation and Specifications Symbols Refer to accompanying documents Protective earth RS-232 RS232 connector Standby Equipotential grounding 2002-

06 Identifies year and month of manufacture Non-ionizing radiation symbol Alternating current Connection direction indicator Electrical input indicator Electrical output indicator Connector has special protection against electric shocks and is defibrillator proof Gas input indicator Gas output indicator Quick mount release LAN connection indicator for connection to a wired network Nurse call relay connection indicator Battery symbol VIDEO Analog interface indicator for connection to any analog video display IntelliVue Instrument Telemetry wireless network Data input/output symbol 297 31 Installation and Specifications Installation Safety Information Symbols Always use separate collection for waste electrical and electronic equipment (WEEE) built-in wireless network Error LED Pressure connector Temperature connector Telemetry device connector NBP connector SpO2 connector ECG connector Monitor supports 12-

lead ECG Uses FAST SpO2 algorithm built-in short range radio interface 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. Grounding The monitor must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter. Equipotential Grounding If the monitor is used in internal examinations on the heart or brain, ensure that the room incorporates an equipotential grounding system to which the monitor has separate connections. 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. The monitor uses double pole/neutral fusing. All network cables must be unshielded. Fusing Network Cables 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 296 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. 298 Installation Safety Information 31 Installation and Specifications

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. Left Side of Monitor 1 1 2 Measurement connectors (combination will vary due to optional measurements, see below) ECG analog output/marker input connector 2 US measurement connectors Pressure and Temp Noninvasive Pressure SpO2 ECG/

Respiration Telemetry device CO2 International measurement connectors Pressure and Temp Noninvasive Pressure SpO2 ECG/

Respiration Telemetry device CO2 299 31 Installation and Specifications Altitude Setting 1 2 3 4 5 6 1 2 3 4 Serial/MIB (RS232) connector Nurse call connector Wired network connector Analog video out connector Equipotential grounding Protective earth Battery compartment AC power inlet Recorder (optional) MSL Connector (for connection to a host monitor) 1 2 3 4 5 6 Right Side of Monitor 4 3 2 1 Altitude Setting Altitude affects CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety Specifications 0366 The monitor complies with the Medical Device Directive 93/42/EEC. 300 EMC And Radio Regulatory Compliance 31 Installation and Specifications 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 1, 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 MP5 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 MP5 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. IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network Adapter) - 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 maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210. The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210. The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems. The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA. 301 31 Installation and Specifications Out-Of-Hospital Transport - Standards Compliance CAUTION High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices. IntelliVue 802.11 Bedside Adapter CE compliances:

This device is compliant to Council Directive 73/23/EEC (Low voltage directive) & 89/

336/EEC (EMC directive) & 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive) The radio component contained in this device is compliant to Council Directive 1999/5/

EC (Radio Equipment and Telecommunications Terminal Equipment Directive) The MP5 including the short range radio interface - 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 1 radio equipment. In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66. Out-Of-Hospital Transport - Standards Compliance The MP5 patient monitor with measurements and interfaces other than those listed below, and the MP5T, cannot be used for patient transport outside of the hospital environment. The MP5 patient monitor with the following measurements and interfaces:

ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A and Microstream CO2) LAN, Video Out, Battery, Nurse Call, RS232, and recorder interfaces 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 100g).

Random Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/

EN 60068-2-64 (RMS acceleration 5g).

Sinusoidal Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-6 (acceleration up to amplitude 2g).

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). 302 Out-Of-Hospital Transport - Standards Compliance 31 Installation and Specifications

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 (SpO2) and EN ISO 21647 (CO2).

Altitude Range from -500 to 3000 m operating and -500 to 4600 m storage and transportation.

Extended radiated susceptibility tests The MP5 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:10 V/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 (>3V/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 T(15 A/m)

Operating ambient temperature testing over the range from 0 to 40C (32 to 100F).

Operating ambient humidity testing up to 95 % RH at 40C (100F), non condensing. NOTE There may be additional requirements for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU. Physical Specifications Specification Comments Maximum Weight 4.0 kg 5 %

(8.8 lb) W x H x D

<259 x 248 x 186 mm 10.2 x 9.8 x 7.3 in

<312 x 248 x 186 mm 12.3 x 9.8 x 7.3 in with ECG/Resp, NBP, SpO2 and battery without Predictive Temperature unit with Predictive Temperature unit 303 31 Installation and Specifications Monitor Performance Specifications 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 (except monitors with the predictive temperature unit). 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 Range Temperature Range Temperature Range with IntelliVue 802.11 Bedside Adapter or IntelliVue Instrument Telemetry Wireless Network or when charging the battery Temperature Range with Predictive Temperature Unit Humidity Range Altitude Range Ingress Protection Operating Storage Transportation1 Operating 0 to 40C (32 to 104F)

-20 to 60C (-4 to 140F)

-20 to 60C (-4 to 140F) 0 to 35C (32 to 95F) Operating Storage 10 to 40C (50 to 104F)

-20 to 50C (-4 to 120F) Operating Storage Transportation Operating Storage Transportation Monitor without the predictive temperature unit Monitor with the Predictive Temperature Unit 15 % to 95 % Relative Humidity (RH) (non condensing) 5 % to 90 % Relative Humidity (RH) 5 % to 90 % Relative Humidity (RH)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m2 (15000 ft)

-500 m to 4600 m2(15000 ft) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15 and protected against contact with or ingress of objects larger than 2.5 mm) IPX1 (protection against ingress of water when the water is dripping vertically) 1.Short-term storage during shipment. 2.Sufficient for flight altitudes up to 12,000 m with pressurized cabins. Monitor Performance Specifications Performance Specifications Power Specifications Power consumption Line Voltage Current Frequency

<40 W average

<65 W peak 100 to 240 V ~

1.3 to 0.7 A 50/60 Hz ~

304 Monitor Performance Specifications 31 Installation and Specifications Performance Specifications Battery Specifications Operating Time

(with new, fully charged battery) Charge Time Basic monitoring configuration: >4 hours

(Brightness set to Optimum, ECG/Resp, SpO2 measurements in use, NBP measurement every 15 minutes) Extended monitoring configuration: >3 hours

(Brightness set to Optimum, ECG/Resp, SpO2, Press/

Temp, CO2 measurements in use, NBP every 15 minutes, Recorder) When monitor is off: 4 hours When monitor is in use: 5 hours and above, depending on monitor configuration (in some configurations the battery may not completely recharge in the monitor, in this case the M8043A Smart Battery Charger should be used) red (crossed-out alarm symbol) LED red/yellow/light blue (cyan) LED green/red LED green LED red/yellow/green LED Indicators Sounds Trends Alarms Off Alarms On/Standby/Error AC Power Battery LED Audible feedback for user input Prompt tone QRS tone, or SpO2 modulation tone 4 different alarm sounds Remote tone for alarms on other beds in network Tone for Timer expired Resolution Information High-Res Trend Waves Measurements Events Alarm signal Review Alarms OxyCRG Resolution Update speed Information Episode data System delay Pause duration Extended alarm pause Information Capacity 12, 16, 24 or 32 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:

neonatal extended 12 numerics, 24 hours @ 12 secs or 32 numerics 32 hours @ 1 minute intensive care extended: 16 numerics 120 hours @ 5 minutes anesthesia extended 32 numerics 9 hours @ 12 seconds HR, SpO2, Resp Measurement samples are taken at a resolution of four samples per second waves are drawn at a speed of 3 cm/minute trigger condition and time, event classification and associated detailed view of episode data 4 minutes of high resolution trend less than 3 seconds 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes all alarms / inops, main alarms on/off, alarm silence and time of occurrence 300 items 305 31 Installation and Specifications Monitor Performance Specifications Performance Specifications Real Time Clock Range Accuracy Hold Time Buffered Memory Hold Time Contents from: January 1, 1997, 00:00 to: December 31, 2080, 23:59

<2 seconds per day (typically) infinite if powered by AC; otherwise at least 48 hours (typical:

>72 hours) if powered by AC: infinite without power: at least 48 hours (typical: >72 hours) Active settings, trends, patient data, realtime reports, events, review alarms Monitor Interface Specifications Measurement Link

(MSL) Network MIB/RS232 ECG Sync Pulse Mode Connectors Power Sync. LAN signals Serial signals Local signals Standard Connector Isolation Standard Connectors Mode Power Isolation Pulse Width Delay from R-wave peak to start of pulse Output voltage swing Female ODU (Proprietary) RS-422 compliant input 78.125 kHz (typical) IEEE 802.3 10-Base-T compliant RS-422 compliant Internal use only IEEE 802.3 10-Base-T RJ45 (8 pin) 1.5 kV IEEE 1073-3.2-2000 RJ45 (8 pin) BCC (RxD/TxD cross over) 5 V +/-5 %, 100 mA (max.) 1.5 kV 100 +/-10 ms (high) 20 ms maximum per AAMI EC13

+/-5 V minimum ECG Output/Marker Input (1/4 stereo phone jack with tip, ring, sleeve) General ECG Output

(ring, tip) Connector Signal Gain Full Scale on Display Gain Error Baseline Offset Bandwidth Output Impedance 1/4 phone each with tip, ring, sleeve 320 to 3200 in 19 steps signal gain x measured ECG voltage

<20 %

<150 mV 1 to 80 Hz ECG Output (ring): <2.2 K 20 %

ECG Output/Marker Input (tip) <2.5 k 20 %

30 ms 0 to -12 V, negative edge pulse

<7 k

<100 s

>4 ms Marker Input Requirements

(tip) Signal delay Signal Type Pulse Source Impedance Pulse Fall Time Pulse Duration 306 Monitor Performance Specifications 31 Installation and Specifications Monitor Interface Specifications Basic Nurse Call Relay Wireless Network Device Interface

(integrated, for compatible network options see below) Short Range Radio Interface1 Connector Contact Isolation Delay Signals 3.5 mm phone jack, active closed contact only

<=100 mA, <=24 V DC 1.5 kV

<(Configured Latency + 0.5 sec) RD+/-, TD+/-: IEEE 802.3 10 Base-T, PWR, GND 12.5 V 20 %, 3.5 W continuous Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) Type Technology Frequency Band Modulation Technique DSSS (O -QPSK) Effective radiated power max. 0 dBm (1 mW) 1.The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A IntelliVue Telemetry System Transceiver. Display Specifications All displays Integrated SVGA Display Sweep Speeds Resolution Refresh frequency Useful screen Pixel size Video Interface SVGA Horizontal Frequency Refresh frequency Video Signals Connector 6.25, 12.5, 25 and 50 mm/s;

800 x 600 60 Hz 170.4 x 127.8 mm 0.213 x 0.213 mm 37.5 kHz 60 Hz 0.7 Vpp @ 75 Ohm, HSYNC/VSYNC Signals TTL 15 pin D-SUB Compatible Devices Displays (must be approved for medical use) M8031B M8033C XGA color 15 LCD touchscreen SXGA color 17 LCD Touchscreen IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter) Internal Wireless Adapter Technology Frequency Band IEEE 802.11a/b/g 2.4 GHz and 5 GHz ISM Band IntelliVue Instrument Telemetry Wireless Network (USA only) Internal WMTS Adapter Technology IntelliVue Instrument Telemetry Wireless Network (except USA) Internal ISM Adapter Technology Frequency Band Frequency Band compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure WMTS, 1395-1400 MHz and 1427-1432 MHz compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure 2.4 GHz ISM 307 31 Installation and Specifications M4605A Battery Specifications M4605A Battery Specifications One battery is required for battery operation of the monitor. M4605A Battery Specifications Physical Specifications W x D x H Weight Performance Specifications 149 mm (5.866 in) x 89 mm (3.504 in) x 19.8 mm (0.78 in) 490 g (1.08 lb) per battery Nominal Voltage Rated Capacity at discharge C/5 Continuous Discharge Capability 10.8 Volt 6000 mAh 6.5 A Environmental Specifications Temperature Range Humidity Range Battery Type Safety Electromagnetic Compatibility (EMC) Communication Standard Discharge 0 to 50C (32 to 122F) Charge 0 to 50C (32 to 122F) Storage and Transportation: -20 to 65C (-4 to 140F) Operating: 15 % to 95 % Relative Humidity (RH) Storage and Transportation: 5 % to 95 % Relative Humidity (RH) Smart Battery 10.8 V, 6000 mAh, Lithium Ion complies with UL 2054 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 v 1.1 308 Measurement Specifications 31 Installation and 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 Range Accuracy Resolution Sensitivity Range Resolution Range Accuracy Resolution Range Accuracy Resolution Range Resolution Range Resolution Range - adult Range - pediatric and neonatal Brady Normal Tachy PVC Rate ST Numeric QT Numeric QTc Numeric QTc Numeric QT-HR Numeric Sinus and SV Rhythm Ranges Bandwidth Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm 1% of range 1 bpm 200 Vpeak 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 1 ms

-600 to +600 ms 1 ms 15 to 300 bpm 15 to 350 bpm Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Adult/neo/pedi: 0.05 to 150 Hz Neo/pedi: 0.5 to 150 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Neo/pedi: 0.5 to 55 Hz Adult/neo/pedi: 0.5 to 20 Hz 309 31 Installation and Specifications Measurement Specifications ECG/Arrhythmia/ST Performance Specifications Bandwidth when the ECG is transmitted from a telemetry device via short range radio Adult/neo/pedi: 0.05 to 40 Hz Neo/pedi: 0.5 to 40 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Differential Input Impedance Common Mode Rejection Ratio Electrode Offset Potential Tolerance Auxiliary Current

(Leads off Detection) Input Signal Range Neo/pedi: 0.5 to 40 Hz Adult/neo/pedi: 0.5 to 20 Hz

>2 M RA-LL leads (Resp)

>5 M at all other leads (at 10 Hz including patient cable) Diagnostic mode: >86 dB (with a 51 k/47 nF imbalance). Filter mode: >106 dB (with a 51 k/47 nF imbalance). 500 mV 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 QTc High Range 15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 15 to 100 bpm 2 PVCs 1 to 99 PVCs/minute 20 to 300 bpm 3 to 99 PVCs/minute 3 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 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) 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps 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 Sinusoidal signal, 260 A, 40.5 kHz RL drive gain 44 dB max., max. voltage 1.8 Vrms 310 Measurement Specifications 31 Installation and Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Time to Alarm for Tachycardia Vent Tachycardia 1 mVpp,206 bpm Vent Tachycardia 2 mVpp,195 bpm Tall T-Wave Rejection Capability Heart Rate Averaging Method Response Time of Heart Rate Meter to Change in Heart Rate Heart Rate Meter Accuracy and Response to Irregular Rhythm Accuracy of Input Signal Reproduction Pacemaker Pulse Rejection Performance 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 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 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. HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds 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 Accuracy Resolution Bandwidth Noise 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 (rms) referred to the input 311 31 Installation and Specifications Measurement Specifications Respiration Alarm Specifications High Low Range Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm 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 Apnea Alarm 10 to 40 seconds 5 second steps Delay max. 14 seconds for limits from 0 to 20 rpm:

max. 4 seconds for limits above 20 rpm: max. 14 seconds 312 Measurement Specifications 31 Installation and Specifications SpO2 Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-

49:2001). Measurement Validation: The SpO2 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. Maximum with NBP INOP suppression on: 60 seconds. Range Accuracy SpO2 Performance Specifications SpO2 The specified accuracy is the root-mean-

square (RMS) difference between the measured values and the reference values Resolution Range Accuracy Resolution Pulse Sensors 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:

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%

313 31 Installation and Specifications Measurement Specifications SpO2 Alarm Specifications SpO2 Desat Pulse Tachycardia Bradycardia Range 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 Adjustment 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 5 bpm steps Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm 5 bpm steps 5 bpm steps Clamping at 30 to 100 bpm Delay

(0, 1, 2, 3,... 30)

+4 seconds max. 14 seconds max. 14 seconds max. 14 seconds NBP Complies with IEC 60601-2-30:1999/EN60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic Diastolic Mean Pulse Rate Accuracy Pulse Rate Measurement Accuracy Pulse Rate Range Measurement Time 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) 314 Measurement Specifications 31 Installation and Specifications NBP Performance Specifications Cuff Inflation Time Initial Cuff Inflation Pressure Auto Mode Repetition Times STAT Mode Cycle Time Venipuncture Mode Inflation Adult Inflation Pressure Pediatric Neonatal Adult/pediatric Neonatal Automatic deflation after 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 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 Adjustment 10 to 30 mmHg: 2 mmHg (0.5 kPa)

>30 mmHg: 5 mmHg (1 kPa) Diastolic Mean 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) NBP Overpressure Settings Adult Pedi Neo

>300 mmHg (40 kPa) >2 sec

>300 mmHg (40 kPa) >2 sec

>150 mmHg (20 kPa) >2 sec not user adjustable 315 31 Installation and Specifications Measurement Specifications Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate Range Accuracy Resolution Input Sensitivity Transducer Frequency Response Zero Adjustment Gain Accuracy Range:

Accuracy Drift Accuracy Drift Non linearity and Hysteresis

(including transducer) Volume displacement of CPJ840J6 Overall Accuracy 40 to 360 mmHg 25 to 350 bpm 1% Full Range 1 bpm Sensitivity:5 V/V/mmHg (37.5 V/V/kPa) Adjustment range:10%

Load Impedance:200 to 2000 (resistive) Output Impedance:3000 (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 mm3 /100 mmHg Invasive Pressure Alarm Specifications Range Pressure 40 to 360 mmHg

(5.0 to 48 kPa) Extreme High Extreme Low Pulse Difference to high limit 0 to 25 mmHg Clamping at -40 to 360 mmHg Difference to low limit 0 to 25 mmHg Clamping at -40 to 360 mmHg 25 to 300 bpm Delay max. 12 seconds Adjustment

-40 to 50 mmHg 2 mmHg (0.5 kPa)

>50 mmHg 5 mmHg (1 kPa) 5 mmHg steps (0.5 kPa) 5 mmHg steps (1.0 kPa) 5 mmHg steps (0.5 kPa) 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) 316 Measurement Specifications 31 Installation and Specifications Invasive Pressure Alarm Specifications Range Tachycardia Adjustment 5 bpm steps Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 25 to 100 bpm 5 bpm steps 5 bpm steps 5 bpm steps Delay max. 14 seconds max. 14 seconds Bradycardia Temp Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range Resolution Accuracy Average Time Constant 1 to 45C (30 to 113F) 0.1C (0.2F) 0.1C (0.2F) Less than 10 seconds Temp Alarm Specifications Temp High/Low Alarms Range 1 to 45C (30 to 113F) Adjustment

-1 to 35C (30 to 95F), 0.5C (1.0F) steps 35 to 45C (95 to 113F), 0.1C (0.2F) steps Predictive Temperature Performance Specifications Technology Probe Types Temperature Measurement Range Resolution Accuracy

(Oral, axillary and rectal measurements) Welch Allyn SureTemp Plus oral/axillary, rectal 26.7 to 43.3C (80 to 110F) 0.1C (0.2F) 0.1C (0.2F) (in continuous mode, complies with ASTM 1112-

00 CO2 The CO2 measurement complies with EN ISO 21647:2004 + Cor.1:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001). 317 31 Installation and Specifications Measurement Specifications Microstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20 kPa), or 20 % CO2, 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 % O2 and N2 balance, up to 35C 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. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) Included in Accuracy specifications 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 190 ms for neonatal mode

(measured with FilterLine H for neonatal) 240 ms for adult mode

(measured with FilterLine H for adult) 50 + 15/-7.5 ml/minute 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. Resolution Stability Range Accuracy awRR Warm-up Time Rise Time Sample Flow Rate Gas Sampling Delay Time Sound Pressure Total System Response Time Microstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Microstream CO2 readings. The formula for the correction calculation is:

PBTPS = (PATPD . 0.94) Mainstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 35C, Pabs = 760 mmHg, flow rate = 2 l/min. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 0.8 mmHg over four hours Accuracy specification will be maintained over a 120 hour period Resolution Stability:

Short term drift Long term drift 318 Measurement Specifications 31 Installation and Specifications Mainstream CO2 Performance Specifications awRR 2 to 150 rpm 1 rpm 2 minutes with CO2 transducer attached for full accuracy specification Less than 60 ms (with adult or infant reusable or disposable adapter) Warm-up Time Response Time Range Accuracy Sidestream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 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 CO2 sensor attached for full accuracy specification 50 10 ml/minute 3 seconds 0 to 40C (32 to 100F) Resolution Stability:

Short term drift Long term drift Range Accuracy awRR Warm-up Time Sample Flow Rate Total System Response Time Operating Temperature Mainstream and Sidestream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is:

PATPD

PBTPS Pabs

Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35C and 100% RH. CO2 Alarm Specifications etCO2 High etCO2 Low Range 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) 10 to 90 mmHg (1 to 12 kPa) Adjustment Delay less than 14 seconds 319 31 Installation and Specifications Measurement Specifications CO2 Alarm Specifications imCO2 High awRR High awRR Low Apnea delay Range 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 less than 14 seconds less than 14 seconds settings <20 rpm: less than 4 seconds settings >20 rpm: less than 14 seconds set apnea delay time +4 seconds Interfering Gas and Vapor Effects On CO2 Measurement Values The specified deviations 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 Gas Level

(% volume fraction) 60 4 5 5 5 80 50

Additional deviation due to gas interference, measured at 0 - 40 mmHg CO2 1 mmHg 2 mmHg 2 mmHg 2 mmHg 2 mmHg

-5 mmHg 1 mmHg not specified for use 15 0.1 0.1 0.1 1.0

+5 mmHg 1 mmHg 1 mmHg 1 mmHg 1 mmHg 320 Safety and Performance Tests 31 Installation and Specifications 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 Compliance Group 1 RF emissions CISPR 11 Class A RF emissions CISPR 11 Harmonic emissions IEC 61000-3-2 Voltage fluctuations IEC 61000-3-3 Class B complies complies Avoiding Electromagnetic Interference The monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The monitor is suitable for use in all establishments other than those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. The monitor, with the following measurements and interfaces:

ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2

(only Mainstream Sensor M2501A) LAN, Video Out, Battery, Nurse Call, RS232, and recorder interfaces is suitable for use in all establishments including those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. 321 31 Installation and Specifications Safety and Performance Tests 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. 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. IEC 60601-1-2 test level 6 kV contact 8 kV air Compliance level 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input/output lines 2 kV for power supply lines 1 kV for input/output lines 1 kV differential mode 2 kV common mode 1 kV differential mode 2 kV common mode

<5% UT

(>95% dip in UT) for 0.5 cycles 40% UT

(60% dip in UT) for 5 cycles 70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec 3 A/m

<5% UT

(>95% dip in UT) for 0.5 cycles 40% UT

(60% dip in UT) for 5 cycles 70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec 3 A/m Immunity test Electrostatic discharge (ESD) IEC 61000-4-2 Electrical fast transient/burst IEC 61000-4-4 Surge IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-

11 Power frequency

(50/60 Hz) magnetic field IEC 61000-4-8 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%. 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 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, UT is the a.c. mains voltage prior to application of the test level. 322 Safety and Performance Tests 31 Installation and Specifications 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. 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 VRMS 150 kHz to 80 MHz Compliance level 3 VRMS

(1 VRMS for respiration) Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz 3 V/m

(1 V/m for respiration) For short range radio, see note1. Electromagnetic environment guidance Recommended separation distance:

1,2 P d

for respiration:

3,5 P d 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

2.0 to 2,3 GHz for short range radio d 7,0 P

1.If ECG/SpO2 signals are acquired from a telemetry device via short range radio the compliance level is 3V/m except in the range 2.0 to 2.3 GHz where it is 1 V/m. 323 31 Installation and Specifications Safety and Performance Tests 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 those measurements which do not use the general formula. Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz d

1,2 P d

1,2 P d

2,3 P for respiration:

d

3,5 p for respiration:

d

3,5 P for respiration:

d

7,0 P for short range radio in the range 2.0 to 2.3 GHz:

d

7,0 P Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.2 (0.7) 0.7 (2.2) 2.3 (7.0) 7.3 (22.1) 23.0 (70.0) Equation Rated max. output power of transmitter (W) 0.01 0.1 1 10 100 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). 324 Safety and Performance Tests 31 Installation and Specifications Restart time After power interruption, an ECG wave will be shown on the display after 30 seconds maximum. 325 31 Installation and Specifications Safety and Performance Tests 326 32 32Default 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 monitors 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 Line Frequency Units Afghanistan land 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 50/60 [Hz]

50 50 50 50 60 60 50 60 60 50 50 50 60 50 50 50 60 50 60 50 50 50 Weight kg, lb kg kg kg kg lb lb kg lb lb kg kg kg kg kg kg kg kg kg lb kg kg kg ECG Cable Color Units Height in, cm IEC, AAMI cm cm cm cm in in cm in in cm cm cm cm cm cm cm cm cm in cm cm cm AAMI IEC IEC IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC 327 32 Default Settings Appendix Country-Specific Default Settings 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 Cte 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 60 60 60 60 50 50 50 60 60 60 50 50 50 50 50 50 50 60 60 60 50 60 50 50 60 60 60 60 50 50 60 60 50 50 60 50 50 60 50 50 60 60 50 60 50 50 50 50 60 60 60 lb lb kg lb kg kg kg lb kg lb kg kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb kg kg lb kg kg kg kg kg kg lb kg kg kg kg kg kg kg kg kg kg lb lb lb in in cm in cm cm cm in cm in cm cm cm cm cm cm cm cm in cm cm in cm cm in in cm in cm cm in cm cm cm cm cm cm in cm cm cm cm cm cm cm cm cm cm in in in AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC IEC AAMI AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI IEC IEC IEC IEC IEC AAMI IEC AAMI AAMI AAMI IEC AAMI IEC IEC IEC IEC AAMI AAMI AAMI 328 Country-Specific Default Settings 32 Default Settings Appendix 50 Finland 50 France 50 French Guiana 60 French Polynesia 60 French Southern Territories 50 Gabon 50 Gambia, The 60 Georgia 50 Germany 50 Ghana 60 Gibraltar 50 Greece 60 Greenland 50 Grenada 50 Guadeloupe 60 Guam 60 Guatemala 50 Guernsey 60 Guinea 60 Guinea-Bissau 60 Guyana 60 Haiti 60 Heard Island and McDonald Islands 60 Holy See, Vatican City State 60 Honduras 50 Hong Kong 50 Hungary 50 Iceland 50 India 50 Indonesia 50 Iran, Islamic Republic of 50 Iraq 50 Ireland 50 Isle of Man 50 Israel 50 Italy 50 Jamaica 60 Japan 50 Jersey 50 Jordan 50 Kazakhstan 50 Kenya Kiribati 60 Korea, Democratic Peoples Republic of 60 60 Korea, Republic of 50 Kuweit 60 Kyrgyzstan Lao Peoples Democratic Republics 50 50 Latvia 50 Lebanon Lesotho 50 kg kg kg lb lb kg kg lb kg kg lb kg lb kg kg lb kg kg lb lb kg kg lb lb kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg lb lb kg kg lb kg kg kg kg cm cm cm in in cm cm in cm cm in cm in cm cm in cm cm in in cm cm in in cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm in in cm cm in cm cm cm cm IEC IEC IEC AAMI AAMI IEC IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC AAMI AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI IEC 329 32 Default Settings Appendix Country-Specific Default Settings Liberia Libyan Arab. Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The former Yugoslavian Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federal States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia 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 50 60 60 50 50 60 50 50 50 50 60 50 50 60 60 50 60 60 60 60 60 60 60 50 50 50 50 60 50 60 60 50 50 60 50 60 50 50 60 60 60 50 50 50 60 50 60 60 50 60 kg lb lb kg kg lb kg kg kg kg lb kg kg lb kg kg lb lb kg lb lb lb lb kg kg kg kg lb kg lb lb kg kg lb kg kg kg kg lb lb lb kg kg kg lb kg lb lb kg kg cm in in cm cm in cm cm cm cm in cm cm in cm cm in in cm in in in in cm cm cm cm in cm in in cm cm in cm in cm cm in in in cm cm cm in cm in in cm cm IEC AAMI AAMI IEC IEC AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI 330 Country-Specific Default Settings 32 Default Settings Appendix Philippines 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 60 60 50 50 60 50 60 50 50 50 60 60 50 60 50 60 60 60 50 50 50 50 60 50 50 50 50 60 50 60 60 50 60 50 60 60 60 50 50 50 60 60 60 50 60 60 60 60 60 50 kg lb kg kg lb kg lb kg kg kg lb kg kg lb kg lb lb lb kg kg kg kg lb kg kg kg kg lb kg lb lb kg lb kg kg lb lb kg kg kg kg lb lb kg lb lb lb lb lb kg cm in cm cm in cm in cm cm cm in cm cm in cm in in in cm cm cm cm in cm cm cm cm in cm in in cm in cm cm in in cm cm cm cm in in cm in in in in in cm AAMI AAMI IEC IEC AAMI AAMI AAMI IEC IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC AAMI IEC IEC IEC IEC AAMI IEC AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC 331 32 Default Settings Appendix Country-Specific Default Settings Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UK United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 50 60 60 60 60 60 50 50 50 60 60 50 60 60 60 50 50 60 60 50 50 60 60 kg lb kg lb lb lb kg kg kg lb lb kg lb lb lb kg kg lb lb kg kg lb lb cm in cm in in in cm cm cm in in cm in in in cm cm in in cm cm in in IEC AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI AAMI AAMI IEC AAMI AAMI AAMI 332 Alarm and Measurement Default Settings 32 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. Alarm Default Settings Alarm Settings Factory Default H10 / H20 / H40 H30 (deviations from H10/20/40) Red Only Off 2 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. CyanRelayLatency Yel. Relay Latency Alarm Text No Centr Mon Min Vol 5 2 min Enabled Enabled Off Off Red & Yell Red & Yell On 3 min Traditional 10 sec 20 sec 4 AlarmVol +2 AlarmVol +0 AlarmVol +0 2 Steps 20 sec No R & Y & C Red & Yell Red 5 sec 2 sec Standard 4 333 32 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings ECG, Arrhythmia, ST and QT Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pedi Neo Adult Pedi Neo ECG Settings High Limit Low Limit Alarms Alarm Source ECG QRS Volume Primary Lead Secondary Lead Analysis Mode Lead Placement 160 bpm 75 bpm 200 bpm 100 bpm 120 bpm 50 bpm On Auto On 1 II V Multi-lead Standard Auto Filter 3.0 sec 220 bpm 240 bpm 50 bpm 40 bpm 60 bpm 80 bpm Mod. Lead Placment Off Filter Speed Monitor 25 mm/s Auto Filter Default ECG Size Off x1 Color Asystole Thresh ExtrTachy Tachy Clamp ExtrBrady Brady Clamp ECG AL. OFF Inop Fallback Alarms Off Alarm Source Sel. Va Lead Vb Lead Green 4.0 sec 20 bpm 200 bpm 20 bpm 40 bpm Cyan On Enabled Enabled V2 V5 SyncPulse Sensit Medium SyncPulse Marker On PulseAlarms Tele Enabled 334 ECG, Arrhythmia, ST and QT Default Settings 32 Default Settings Appendix Arrhythmia Settings Arrhythmia Pause Threshold VTach HR VTach Run Vent Rhythm SVT HR SVT Run PVCs/min Non-Sustain 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 Afib IrregularHR HR Alarms TimeOut 1st TimeOut 2nd Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult On 2.0 sec 100 5 14 180 5 10 On On On On On On On On On On On On On On On On Short Yellow 3 min 10 min Adult Off Pedi Neo Pedi 120 200 5 Neo Off 1.5 sec 150 210 5 Off Off Off Off Off Off Off Off Off Off Arrhy Off Message SOME ECG... Inop Yes On Lead-independent ST Settings Factory Adult Factory Pedi Factory Neo ST Alarm Mode Alarms Single ST On 335 32 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings Lead-independent ST Settings Factory Adult Factory Pedi Factory Neo ST Analysis ST-Index ISO Point J Point ST Point Off On On

-80 ms 48 ms J+60 Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL Settings Factory Adult Factory Pedi Factory Neo ST(Label) On Off For Alarm Mode = Single-ST ST(Label) High ST(Label) Low For Alarm Mode = Multi-ST ST(Label) High ST(Label) Low

+2.0 mm

-2.0 mm

+1.0 mm

-1.0 mm QT Settings QT Lead QTc High Limit QTc Limit QTc High Alarm QTc High Alarm QT Analysis QTc Formula Factory Adult Factory Pedi Factory Neo 480 ms 460 ms All 500 ms 60 ms On On Off Bazett 336 Pulse Default Settings 32 Default Settings Appendix Pulse Default Settings Pulse Settings Alarms Source Pulse (Label) System Pulse Alarms Off Alarm Source Sel. Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Pedi Neo Pedi Neo Adult Auto Auto Adult Auto On SpO2 Enabled Enabled Pulse Alarm Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pedi Neo Adult Pedi Neo Pulse (SpO2) Pulse Alarms High Limit Low Limit Extr Brady Brady Clamp Extr Tachy Tachy Clamp On Off 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm 160 bpm 75 bpm 200 bpm 100 bpm 40 bpm 50 bpm 40 60 80 220 bpm 240 bpm Pulse alarms use the settings of the currently selected Pulse alarm source. Respiration Default Settings Respiration Settings High Limit Low Limit Apnea Time Alarms Resp Detection Respiratory Speed Color Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pedi 30 rpm 8 rpm 20 sec On On Auto (Trigger Mode) 6.25 mm/s Yellow Adult Pedi Neo Neo 100 rpm 30 rpm Off White 337 32 Default Settings Appendix SpO2 Default Settings SpO2 Default Settings SpO2 Settings Alarms QRS Volume Tone Modulation Tone Mod. Type Speed Perfusion Average NBP Alarm Suppr. Extd. Auto OnOff Color Average in Mon. Signal Quality Factory Adult Factory Pedi Factory Neo On 1 Yes Enhanced 25 mm/s On 10 sec On Disabled light blue (cyan) No On SpO2 Alarm Default Settings Setting Desat Limit Low Limit High Limit Desat delay High Alarm delay Low Alarm delay Alarms On/Off Label Pulse Settings Pulse (SpO2) Pulse Alarms On/Off High Limit Low Limit Extr Brady Brady Clamp ExtrTachy Tachy Clamp adult 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm pediatric neonatal 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 160 bpm 75 bpm 20 bpm 40 bpm 20 bpm 220 bpm 80 85 95 20 sec 10 sec 10 sec on SpO2 on on 200 bpm 100 bpm 20 bpm 50 bpm 20 bpm 240 bpm 338 NBP Default Settings 32 Default Settings Appendix NBP Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pedi Neo Manual Adult Pedi Neo NBP Settings Mode Alarms from High Limit Low Limit Alarms NBP Repetition Time Pulse (NBP) Unit Done Tone Start Time VP Pressure Reference Color Auto Sys. 160/90 (110) 90/50 (60) On On 10 min On mmHg Off Synchronized 60 mmHg Auscultatory Red 120/70 (90) 70/40 (50) 90/60 (70) 40/20 (24) 180/90 (110) 70/50 (65) 3 min On NotSynchron. Magenta 40 mmHg 30 mmHg Invasive Temperature Default Settings Temp Settings Low Limit High Limit Alarms Unit Range Color Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult 36 39 On C 35...43 Green Pedi Neo Adult 35 Pedi Neo Light Green 339 32 Default Settings Appendix Predictive Temperature Default Settings Predictive Temperature Default Settings pTemp Settings1 Preferred Label Prompt Tones Value Lifetime Unit Color Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Pedi Neo Adult Pedi Neo Adult pToral on 1 hour C Yellow 1.The settings for Prompt Tones, Unit and Color are label dependent Invasive Pressure Default Settings ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pedi Neo Adult Pedi Neo Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color CVP, RAP, LAP, UVP Settings Alarms from High Limit Low Limit Alarms Sys. 160/90 (110) 90/50 (70) On Disabled 15 15 190/100 (125) 120/70 (90) 70/40 (50) 90/60 (70) 55/20 (36) 180/90 (110) 70/50 (70) 10 10 140/80 (100) 5 5 105/75 (75) 80/45 (65) 60/35 (45) 45/15 (30) 65/45 (65) 100 100 150 25 mm/s No 12 Hz Yes 60 sec mmHg Red Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Mean 14/6 (10) 6/-4 (0) On Pedi Neo Adult Pedi Neo 10/2 (4) 2/-4 (0) 10/2 (4) 2/-4 (0) 340 Invasive Pressure Default Settings 32 Default Settings Appendix CVP, RAP, LAP, UVP Settings Extreme Alarms Extreme High Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Enabled 5 5 Pedi Neo Adult Pedi Neo 5 5 5 5 20/10 (15) 15/5 (10) 15/5 (10) 0/-5 (-5) 0/-5 (-5) 0/-5 (-5) 30 25 mm/s Yes 12 Hz Yes 60 sec mmHg light blue (cyan) Blue PAP Settings Factory Defaults Adult Pedi Neo 60/4 (26) 24/-4 (12) 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) Enabled 5 5 65/5 (35) 15/-5 (5) Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color 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 341 32 Default Settings Appendix CO2 Default Settings ICP, IC1, IC2 Settings Factory Defaults Adult Pedi Neo 10/2 (4) 2/-4 (0) 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) Alarms from High Limit Low Limit Alarms Extreme Alarms Extreme High Extreme Low Low Clamp Mean High Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color 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 CO2 Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pedi Neo Adult Pedi Neo 25 60 50 Off 30 50 4 on mmHg 40 mmHg on 16%

Off BTPS Off On On CO2 Settings etCO2 low etCO2 high imCO2 high CO2 Alarms Unit Scale ImCO2 Oxygen Corr Gas Corr Humidity Corr Max Hold AwRR AwRR Alarms 342 CO2 Default Settings 32 Default Settings Appendix Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) CO2 Settings AwRR high limit AwRR low limit Apnea time Color Adult 30 8 20 secs Yellow Pedi Neo 100 30 Adult Pedi Neo White 343 32 Default Settings Appendix CO2 Default Settings 344

10-lead placement (ECG) 109 12-lead placement (ECG) 109 3-lead placement (ECG) 107 4-channel recorder 237 5-lead placement (ECG) 107 A AAMI ECG lead labels 106 abdominal breathing and Resp electrode placement 148 aberrantly conducted beats 116 accessories 10-electrode cable sets 282 3-electrode cable sets 282, 284 5-electrode cable sets 282, 284 5-electrode one piece cables 284 6-electrode cable sets 282 CO2 186, 189 CO2 (mainstream) 292 CO2 (microstream) 292 ECG 281 NBP adult cuffs 286 comfort cuffs 285 disposable cuffs 285 multi-patient comfort cuff kits 285 neonatal/infant cuffs

(disposable) 286 reusable cuffs 285 single-hose disposable cuffs 286 Nellcor 287 pressure 286 Pulsion 286 recorder paper 293 resp 281 set combiners and organizers 283, 284 SpO2 287 Nellcor adhesive sensors

(disposable) 287 Philips sensors (disposable) 287 Philips sensors (reusable) 287 temperature 291 trunk cables 281, 283 active alarms 39 address, Philips 296 addressograph (printer configuration setting) 252 adjusting ST measurement points 130 adjusting wave scale (pressure) 178 adjusting wave size (CO2) 190 admit editing information 87 quick admit 87 admitting a patient 85 airway adapter CO2, microstream accessory 189 alarm latching 52, 122 alarm limits changing 47 checking 46 manually adjusting 47 narrow 49 report 253 ST 132 switching auto limits on/off 49 using automatic limits 49 wide 49 window 46 alarm recording 238 choosing recorded measurements 240 alarm source selection, disabled 145 alarm status area 14 alarms acknowledging 43 active 39 active SpO2 source 158 alphabetical listing 55 apnea delay 191 apnea delay time (Resp) 150 arrhythmia 39 audible indicators 41 awrr limits 192 chaining 124 CO2 specific 191 CO2, apnea delay 191 CO2, awRR 191 desat, SpO2 157 effect on pressure alarms during zero 177 extending pause time 45 high priority 39 INOP 39 ISO/IEC standard 42 limit, SpO2 314 NBP source 166 patient messages 55 1Index pausing 44 physiological 55 pleth as source 158 recordings 53 red 39 reminder 43 restarting 45 reviewing 50 reviewing messages 50 reviewing window 51 selftest 52 silencing 43 SpO2 high and low limits 157 SpO2 specific 156 ST 132 suspended symbol 44 switching on and off 44 temperature 173 testing 52 tone configuration 41 traditional 41 volume, changing 42 yellow 39 alphabetical listing of alarms 55 alternating current symbol 297 analog interface symbol 297 analog output ECG 298 annotating events 226 annotation recording strip 241 apnea alarm delay CO2 191 apnea alarm delay time (RESP) 150 apnea alarms and Resp detection modes 150 arrhythmia aberrantly conducted beats 116 analysis, how it works 115 atrial fibrillation and flutter 116 beat labels 118 initiating learning 120, 121 intermittent bundle branch block 117 learning during ventricular rhythm 121 levels of analysis 112, 115 monitoring non-paced patients 116 monitoring paced patients 116 options 115 relearning 120 i relearning and lead fallback 121 status messages 119 switching on/off 116 understanding the display 117 arrhythmia alarms 39, 121 adjusting alarm limits 122 all yellow on/off 122 chaining 124 latching 122 multiple 124 pvc-related alarms 125 sinus and SV rhythm ranges 311, 314 switching on/off 122 timeout periods 123 arrhythmia monitoring and defibrillation 114 arrhythmia options 112 arrhythmia relearning with EASI INOP 111 arterial pressure source 182, 183 arterial pulsation 153 artifact suppression (pressure) 179 atrial fibrillation and flutter 116 audlatching (arrhythmia alarms) 122 auto alarm limits switching on/off 49 using 49 auto detection mode (Resp) 148 auto ECG wave gain (recordings) 240 auto window (care groups) 96 autofilter 104 automatic arrhythmia relearn 121 automatic default setting 25 automatic NBP repeat time 165 autosize ECG wave 103 awRR alarm limits 192 awRR alarms CO2 191 B backlight maintenance interval 278 baseline ST map, updating 136 ST, updating 129 basic arrhythmia option 112, 115 basic event surveillance setup 223 battery and display brightness 274 battery reports 273 ii battery status recording 273 battery status window 273 charge status 274 conditioning 275 conserving power 274 indicators 271 malfunction symbols 272 power gauge 272 recharging 271 replacing 274 safety information 275 symbol 297 battery performance optimizing 274 beat labels arrhythmia 118 bed information 32 blood pressure. See also NBP (non-invasive) or PRESS (invasive) Brightness SmartKey 30 brightness, adjusting 30 C calculating drug infusions 257 calculating cerebral perfusion 182 calculating pulse pressure variation 182 calculating temperature difference 174 calculator 18 on-screen 18 calibration interval, NBP 278 NBP 167 pressure 181 pressure transducer 181 carbon dioxide, see CO2 185 cardiac overlay and Resp detection modes 149 when measuring Resp 147 cardiotach alarms 112 care groups alarm notification 96 other bed window 95 pop-up window 96 cautions 9 central recorder choosing 240 cerebral perfusion 182 chaining 124 change screen menu 20 Changing 20 changing ECG lead sets 105 changing Resp detection mode 148 changing Resp wave size 149 changing Resp wave speed 150 changing screen content 20 channels recorder 240 checking battery charge 274 checking paced status 100 checklist delivery 2 installation 1 cleaning infection control 267 method 268 monitoring accessories 269 recommended substances 268 clock displaying on main screen 263 CO2 airway adapter 189 alarms, apnea delay 191 alarms, awRR 191 alarms, specific 191 awRR alarm limits 192 correction, humidity 191 corrections 190 FilterLine 189 mainstream accessories 186 measuring mainstream 186 measuring microstream 189 method, mainstream 185 method, microstream 185 method, sidestream 185 microstream accessories 189 removing exhaust gases 189, 190 troubleshooting 190 wave scale, adjusting 190 CO2 (mainstream). accessories 292 CO2 (microstream). accessories 292 code recording 241 combi-events 225 conditioning batteries 275 configuration drug calculator 258 configuration mode 19 entering 6 conflict label 27 connecting power 3 connecting temperature probe 173 connection direction symbol 297 connector marker input 306 connectors 298 continuous mode selecting 171 controls monitor 12 conventional 12-lead ECG 109 correcting the NBP measurement 163 CPAP (RESP) 149 cuff pressure, NBP 164 selection, NBP 163 current view ST map 133 D damage mechanical 30 damage claims 2 database events 224 date, setting 6, 30 default profile 24 default settings 327 checking country-specific 6 defibrillation and arrhythmia monitoring 114 and ECG monitoring 114 synchronization marks 100 defibrillator input 306 defibrillator proof symbol 297 defibrillator synch maintenance interval 278 delay time recording 240 delayed recording 238 deleting events 224 demonstration mode 19 desat alarm, SpO2 157 detection modes (Resp) 148 diagnostic (ECG filter setting) 104 disabling touch operation 14 discharging a patient 88 disconnect INOPs silencing 43 disinfecting infection control 267 recommended substances 268 display arrhythmia 117 ECG 100 NBP 163 Resp 148 ST 128 display brightness 274 display settings 22 disposal gas cylinder 279 parts and accessories 279 documenting events 226 dosemeter (drug calculator) 259 drip table (drug calculator) 260 drug calculator 257 dual Temp measurement 174 dyshemoglobins intravascular (SpO2) 155 E early systolic blood pressure, NBP 164 EASI activating 105 ECG monitoring 111 lead placement 111 EASI ECG lead labels 106 ECG 99 accessories 281 alarms off (Config Mode) 113 changing lead sets 105 choosing electrode sites 105 conventional 12-lead 109 external pacing electrodes 115 filter settings 104 fusion beat pacemakers 115 intrinsic rhythm 114 modified 12-lead 109 New Lead Setup 105 pacemaker failure 114 rate adaptive pacemakers 115 unfiltered 104 wave size 103 ECG analog output 298 ECG cable for operating room 114 ECG display 100 ECG electrode colors 106 ECG electrode placement during electro-surgery 114 ECG gain in recordings 240 in reports 247 ECG lead labels 106 ECG lead placement choosing EASI/Standard 105 ECG leads monitored 105 ECG output 306 ECG report 255 lead layout 247 ECG safety information 114 ECG source tracking 201 ECG wave autosize 103 calibration bar 103 ectopic status messages (arrhythmia monitoring) 120 electrical input symbol 297 electrical output symbol 297 electrode placement (ECG) 99 conventional 12-lead 109 modified 12-lead 109 electrode placement (Resp) 147 with abdominal breathing 148 with lateral chest expansion 148 electro-surgery and ECG 114 EMC interference Resp 150 EMI filter for ECG 104 end case discharging a patient 88 report, printing 88 end case reports setup 247 enhanced arrhythmia option 112, 115 equipotential grounding symbol 297 event annotation 226 combi-events 225 event episode 221 event episode recording 227 event episode window 225 event post-time 221 event pre-time 221 event retriggering 223 event review window 225 event time 221 event triggers 222 event values 226 manual event triggers 223 recording 226 setting up NER 223 event database 224 event episode reports 248 event report 229 event review reports 248 event surveillance 221 events pop-up keys 222 exclamation mark symbol 297 exhaust gases, removing 189, 190 extension cable for SpO2 154 external pacing electrodes and ECG monitoring 115 extreme bradycardia alarm 113, 145 extreme pressure alarms 180 iii extreme rate alarms 113, 145 extreme tachycardia alarm 113, 145 CO2 191 hypotension evaluation 235 F fallback (ECG) 106 FAST Fourier artefact suppression technology 153 filter (ECG filter setting) 104 filter (ECG) 104 FilterLine CO2, microstream accessory 189 flushing invasive pressure accessories 175 freezing waves 26 functional arterial oxygen saturation 153 fusion beat pacemakers and ECG monitoring 115 G gas cylinder empty, disposing of 279 gas input symbol 297 gas output symbol 297 getting started 30 global trend time 215 graphic trend report 208 graphic trends 208 graphic trends report 214 H help INOPS 50 high resolution recording 238 high-res trend event episodes 221 high-res trend waves about 219 OxyCRG 219 high-res waves in reports 219 list of available measurements 305 recordings 220 HiResTrnd see high-res trend 221 horizon trend trend time 215 HR = RR (Resp) 148 HR alarms when arrhythmia off 113 HR alarms off (Config Mode) 113 HR and pulse alarm source selection 145 HR from (heart rate source) 144 humidity correction iv I IEC ECG lead labels 106 If 201 IIT 89 IMV (Resp) 149 infection control cleaning 267 disinfecting 267 sterilizing 267 Information Center central recording 237 transferring patients 89 transferring patients using IIT 89 INOPs indicators 39 silencing 43 input defibrillator 306 installation checklist 1 connectors 298 personnel 1 Instructions for Use intended audience 9 intermittent bundle branch block 117 intermittent mandatory ventilation

(Resp) 149 interruption symbol 298 intravascular dyshemoglobins (SpO2) 155 intrinsic rhythm 114 introduction 9 ISO point (ST) 130 J J point (ST) 130 K keyboard on-screen 17 keys permanent 15 pop-up 17 SmartKeys 15 L label conflict resolution 27 labels 27 changing 27 lactate measurement 234 latching alarms 52 alarms, behavior 52 latching arrhythmia alarms 122 lateral chest expansion (neonates) monitoring Resp 148 lead fallback and arrhythmia relearning 121 lead fallback (ECG) 106 lead labels (ECG) 106 lead placement activating EASI/Standard 105 for Resp measurement 147 leads monitored (ECG) 105 Leads Off INOP (ECG) 106 levels of arrhythmia analysis 115 loading paper 4 M M3160A recorder 237 main screen overview 13 mains power connecting to 3 mainstream CO2 accessories 186 measuring 186 maintenance cables 277 cords 277 measurements, schedule 278 microstream CO2, calibration 278 schedule 277 visual inspection 277 malfunction symbols battery 272 manual detection mode (Resp) 149 and apnea alarms 150 manually triggering events 223 manufacture date symbol 297 manufacturers information 296 map ST 133 marker input connector 306 Mason-Likar lead system 109 max hold setting (CO2) 185 measurement adjusting a wave 25 preparation 30 setting up 25 wave speed, changing 25 measurement labels 27 changing 27 measurement points, ST 130 measurement settings 22 measurements setting up 31 switching on and off 25 mechanical damage 30 merging patient data 92 methemoglobin (SpO2) 155 microstream CO2 accessories 189 maintenance, calibration 278 measuring 189 mismatch patient data, resolving 90 modified 12-lead ECG 109 modified screen history 20 modifying screens 20 monitor inspecting before use 30 starting monitoring 31 switching on 31 monitor (ECG filter setting) 104 monitor controls 12 monitor defaults 327 monitor revision how to find 30 monitor settings 22 changing 29 monitoring preparation 30 starting 30 monitoring mode 19 mounting information 3 MP20 11 MP20 Junior 11 MP30 11 multi-lead ST alarming 132 N narrow alarm limits 49 navigating 13 permanent keys 15 SmartKeys 15 NBP adult cuffs 286 alarm source 166 ANSI/AAMI SP10-1992 161 automatic mode, enabling 165 calibrating 167 calibration interval 278 comfort cuff kits 285 comfort cuffs 285 cuff pressure 164 cuff, applying 163 cuff, selecting 163 cuff, tightness 163 disposable cuffs 285 how the measurement works 161 measurement correction 163 measurement limitations 162 measurement methods, auto 162 measurement methods, manual 162 measurement methods, sequence 162 measurement methods, stat 162 measurement, starting 164 measurement, stopping 164 neonatal cuffs (disposable) 286 numerics 163 oscillometric method 161 pediatric cuffs 286 preparing to measure 162 repeat time 163 repeat time for automatic 165 repetition time, setting 165 reusable cuffs 285 single-hose disposable cuffs 286 site inspection 163 time of last measurement 163 units 163 venous puncture 167 neonates Resp electrode placement 148 NER setup 223 network connection indicator 13 networked monitoring 32 new features 35 non-invasive blood pressure. See NBP non-paced patients arrhythmia monitoring 116 numerics explanation of NBP display 163 nurse call 45 nurse call relay connection symbol 297 O on screen calculator 18 operating 13 permanent keys 15 SmartKeys, using 15 operating mode 19 operating modes 19 configuration 19 demonstration 19 monitoring 19 passcode protection 19 service 19 operating room ECG cable 114 orange ECG cable 114 organizers 283, 284 oscillometric NBP measurement method 161 other bed window 95 output ECG 306 overlap in recordings 240 overlapping screen trends 216 oxyCRG 219 OxyCRG event episodes 221 P pace pulse rejection (ECG) about 100 switching on/off 102 paced patients arrhythmia monitoring 116 repolarization tails 102 safety information 114 setting status 114 paced status checking 100 pacemaker failure 114 paper loading 4 paper size for reports 248 parameter scales trends 212 passcode protection 19 patient admit 85 category, NBP 161 discharge 88 end case 88 patient alarm messages 55 patient demographics window 85 patient mismatch 90 patient reports contents 252 patient trends viewing 207 paused alarms 44 extending time 45 restarting 45 performance specifications pressure 309, 316 performance test 321 perfusion indicator 153, 154, 158 permanent 15 Philips contact information 296 physiological alarms 39 pleth alarm source 158 pleth wave 157 v pleth waveform 153 Pop 17 pop-up keys 17 events 222 power connecting 3 connection 3 disconnecting from mains power disconnecting from 32 PPV 182 predictive mode selecting 171 predictive temperature making a measurement 169 making measurements 169 selecting labels 171 preparing skin for ECG 99 pressure alarms during zero 177 arterial source 182, 183 calibration pressure 181 cerebral perfusion, calculating 182 performance specifications 309, 316 wave scale 178 wave size 178 zeroing the transducer 176 pressure accessories 286 pressure artifact suppression 179 pressure of NBP cuff 164 pressure transducer calibration 181 zeroing 177 previous screen 20 primary lead (ECG) selecting 100 print job suspended 249 printer disabling 249 settings 249 status messages 251 unavailable 249 printing event reports 226 ST map reports 136 status log 279 trends reports 214 priority list for trends 212 probes disposable temperature 173 profiles 22 default profile 24 patient category 23 vi swapping a complete profile 24 swapping setting block 24 protective earth symbol 297 protocol log 236 ProtocolWatch 231 SSC sepsis 231 pulse alarms 144 system pulse source 143 pulse numerics for SpO2 154 pulse pressure variation 182 PVC-related alarms 125 Q QRS tone 145 changing volume 29 QRS tone pitch, SpO2 158 QRS volume, changing 103 QT alarms 140 QT baseline 139 QT measurement algorithm 137 QT monitoring limitations 138 QT/QTc monitoring 137 quick admit 87 quick mount release symbol 297 R radiated field immunity Resp 150 rate adaptive pacemakers and ECG monitoring 115 ratemeter (drug calculator) 259 realtime recording 238 realtime report 253 realtime reports content 248 recorder 4-channel 237 paper accessories 293 recorder status messages 243 recording alarm 238 annotation 241 battery status 273 beat-to-beat 238 central 237 changing recording type 240 channels 240 choosing recorder 240 choosing recording speed 240 context 238 creating templates 239 delayed 238 drug calculations 260 ECG gain 240 extending 238 high resolution 238 preventing fading ink 242 procedure 238 realtime 238 recording strip 241 recording strip code 241 runtime 240 setting the runtime 240 setup menu 239 ST segments 130 starting and stopping 237 types 238 wave overlap 240 wave scale 240 waveforms recorded 242 recording alarms 53 recording delay time 240 recording events 226 recycling 279 rejecting pace pulses 100 relearning arrhythmia 120 reminder, alarm 43 replacing batteries 274 repolarization tails 102 report event review 229 reports alarm limits 253 battery reports 273 choosing paper size 248 contents 252 drip table 260 drug calculator 260 ECG 255 end case 247 patient trends 214 realtime report 253 re-routing 249 scheduled 247 setting up 246 ST map 136 stopping printouts 246 titration table 260 trends 208 re-routing reports 249 resolution trends 212 resolving patient mismatch 90 resp accessories 281 Resp alarms apnea alarm delay time 150 Resp detection level and apnea detection 150 Resp detection modes and cardiac overlay 149 changing 148 Resp display 148 Resp monitoring and cardiac overlay 147 Resp safety information 150 Resp wave changing size 149 changing speed 150 restarting paused alarms 45 re-triggering events 223 retrolental fibroplasia (SpO2) 157 reviewing alarm messages 50 reviewing alarms 50 reviewing alarms window 51 rhythm status messages (arrhythmia monitoring) 119 rs-232 interface symbol 297 rule of six 258 runtime setting recording runtime 240 S safety maintenance interval 278 monitor 300 safety information batteries 275 ECG 114 Resp 150 safety test 321 safety tests performance tests 3 power on test 3 system 4 visual inspection 3 same patient data merge 92 scale ECG wave 103 Resp wave 149 scales for trends waveforms 212 scheduled reports 247 screen adjusting brightness 30 disabling touch operation 14 elements 14 screen trend trend time 215 screen trends 215 screens changing content 20 switching 20 understanding 20 visitor screen 21 secondary lead (ECG) selecting 100 selecting the primary lead (ECG) 100 selecting the secondary lead (ECG) 100 selftest alarms 52 sensor disposable SpO2 153 sequence mode 165 service mode 19 set combiners 283, 284 setting up trends 210 setting up reports 246 setting up the sepuence 165 settings 24 about 24 default 327 measurement settings 24 monitor settings 24 screen settings 24 synchronized telemetry and monitor 201 settings blocks 22 setup menu 14 Setup Recording menu 239 severe sepsis screening 231 short yellow alarms on/off 122 signal quality of SpO2 155 sinus and SV rhythm ranges 311, 314 skin preparation ECG 99 SmartKeys 15 source tracking ECG 201 specifications 295 arrhythmia 309 speed recording 240 wave speed, changing 25 SpO2 accessories 287 active alarm source 158 alarms specific to 156 arterial pulsation 153 assessing suspicious reading 155 connecting the cables 154 disposable sensors 153 extension cable 154 FAST technology 153 Nellcor adhesive sensors

(disposable) 287 perfusion indicator 153, 154, 158 Philips sensors (disposable) 287 Philips sensors (reusable) 287 pleth as alarm source 158 pleth wave 157 pleth waveform 153 pulse numerics 154 QRS tone 158 signal quality 155 site inspection 155 site selection 153 tone modulation 158 SpO2 desat alarm 157 SpO2 limit alarms 157 SSC guidelines 231 SSC sepsis 231 ST adjusting alarm limits 132 alarms 112, 132 baseline, updating 129 ensuring diagnostic quality 127 filtering 127 measurement points, adjusting adjusting 130 multi-lead alarms 132 numerics in ECG wave 101 snippets 129 ST display 128 ST map baseline, updating 136 current view 133 report, printing printing ST map report 136 scale, changing scale ST map 136 task window 135 trend view 134 trending interval, changing 136 trending priority 135 ST maps 133 ST point 130 standard 10-lead placement 109 standard 3-lead placement 107 standard 5-lead placement (ECG) 107 standardized rate 257 standby mode 19 standby symbol 297 starting monitoring 31 status line 13 status log printing 279 status messages printer 251 recorder 243 vii status messages (arrhythmia) 119 ectopic 120 rhythm 119 sterilizing infection control 267 stopping reports printouts 246 surgical ECG cable 114 surviving sepsis campaign 231 suspended alarm 44 suspicious SpO2 reading 155 Switching 20 switching on monitor 31 switching screens 20 symbols 296 battery 272 synchronization marks (defibrillator) 100 system pulse 143 systolic blood pressure, NBP, early 164 T tabular trends 209 Tamb 174 task window for ST map 135 Tcereb 174 technical alarms messages see INOPs 61 telemetry alarms 199 suspending at bedside 200 telemetry device controlling from bedside 199 silencing alarms at bedside 199 unpairing 199 temperature 169, 173 accessories 291 alarm settings 173 connecting probe to monitor 173 difference, calculating 174 dual Temp measurement 174 extended label set 174 first 174 label 171, 173 making a measurement 173 probe, disposable 173 probe, selecting 173 second 174 temperature probe connecting 173 templates creating for recordings 239 test blocks, how to perform 3 testing alarms 52 time, setting 6, 30 timers viii counting direction 262 displaying on main screen 263 notification 263 selecting label 262 setting up 261 viewing 261 titration table (drug calculator) 260 tone configuration, alarm 41 tone mod (SpO2) 158 tone modulation 158 touch tone volume 30 touchscreen disabling 14 transducer pressure, zeroing 176 transferring centrally-monitored patients 89 using IIT 89 transport brightness setting 274 trend time 215 global 215 trend view ST map 134 trending interval ST map 136 trends resolution 212 screen trends 215 setting parameter scales 212 setup 210 viewing 207 trends pop-up keys 208 trends priority list 212 ST map 135 trigger conditions events 223 triggers for events 222 troubleshooting CO2 190 trunk cables accessories 281, 283 Ttymp 174 Tvesic 174 U Understanding 22 unfiltered ECG signal 104 unpacking 2 unpairing 199 user interface settings changing 29 V V electrode placement (ECG) 108 venous puncture 167 viewing arrhythmia waves 118 viewing trends 207 visible waves report 248 visitor screen 21 vislatching (arrhythmia alarms) 122 vital signs recording 208 report 208 vital signs report 214 voltage setting 3 volume alarm 42 touch tone volume 30 W warnings 9 wave adjusting 25 changing speed 25 scale (CO2) 190 scale (pressure) 178 size (CO2) 190 size (pressure) 178 wave channel speed 26 wave group speed 25 wave size Resp 149 wave size (ECG) changing 103 wave speed respiratory speed 25 wave speed global speed 25 wave speed (Resp) 150 waves freezing 26 measuring frozen 26 releasing frozen 27 whats new 35 wide alarms limits 49 wired network connection symbol 297 Z zero effect on pressure alarms 177 zeroing pressure transducer 176

 

 

INSTRUCTIONS FOR USE IntelliVue X2 Multi-Measurement Module Release G.0 with Software Revision G.0x.xx P a t i e n t M o n i t o r i n g Printed in Germany 09/08

*M3002-9001B*

Part Number M3002-9001B 4512 610 28261 S M3002-9001B 1Table Of Contents 1 Installation Installation Checklist Unpacking and Checking the Shipment 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 X2 Controls, Indicators and Connectors Extending Measurements Operating and Navigating Operating Modes Understanding Screens Using the XDS Remote Display Using the Visitor Screen Understanding Profiles Understanding Settings Changing Measurement Settings Switching a Measurement On and Off Adjusting a Measurement Wave Using Labels Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from AC Mains Power Monitoring After a Power Failure Networked Monitoring Using the X2 with a Host Monitor (Companion Mode Indicated) Pairing When Connected to a Host Monitor (Companion Mode Indicated) Pairing Without a Direct Connection Unpairing the Host Monitor and the Paired Device Capturing Alarm Reports and Printing 3 Whats New?

Whats New in Release G.0?

Whats New in Release F.0?

1 2 3 3 3 5 6 7 7 8 9 11 14 17 23 24 25 25 26 28 28 28 28 29 31 32 32 34 34 34 35 35 35 36 36 37 38 1 9 37 i 4 Alarms Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at On/Off Alarm Recordings 5 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 6 Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients 7 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 Changing the Size of the ECG Wave 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 Lead Fallback ECG Lead Placements Capture 12-Lead EASI ECG Lead Placement ECG and Arrhythmia Alarm Overview Using ECG Alarms ECG Safety Information About Arrhythmia Monitoring Switching Arrhythmia Analysis On and Off Choosing an ECG Lead for Arrhythmia Monitoring ii 41 55 85 93 42 43 44 45 47 51 52 53 53 53 55 61 85 87 87 87 88 93 93 94 94 95 96 97 98 98 99 99 99 100 100 104 105 106 107 108 109 110 110 Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring Switching ST On and Off Understanding the ST Display and Windows Updating ST Baseline Snippets About the ST Measurement Points ST Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 8 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 9 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Display Changing Resp Detection Modes Changing the Size of the Respiration Wave Changing the Speed of the Respiration Wave Using Resp Alarms Changing the Apnea Alarm Delay Resp Safety Information 10 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 SpO2 Signal Quality Indicator (Fast SpO2 only) Assessing a Suspicious SpO2 Reading Changing the Averaging Time Setting the Measurement Mode Understanding SpO2 Alarms Pleth Wave Perfusion Numeric Perfusion Change Indicator Setting SpO2/Pleth as Pulse Source Setting Up Tone Modulation Setting the QRS Volume 111 114 115 121 121 122 123 124 126 126 131 134 135 137 137 138 138 141 142 142 143 144 144 144 144 147 147 148 148 149 149 150 150 150 151 152 152 152 152 153 137 141 147 iii 11 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP 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 12 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 13 Monitoring Invasive Pressure Setting up the Pressure Measurement Zeroing the Pressure Transducer 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 Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Measuring Mainstream CO2 using M3016A Measuring Microstream CO2 using M3015A Setting up all CO2 Measurements 15 Assigning Two Devices to One Patient How Can You Combine Devices?

Functions Available When the Telemetry Data Window is Displayed Functions Available For Devices Connected Via SRR General Telemetry-related Functions Use Models With Telemetry 16 Enhancing Telemetry Monitoring with the Monitor 17 Trends Viewing Trends Setting Up Trends Documenting Trends iv 155 161 163 171 181 189 191 155 156 158 158 158 158 159 159 160 161 162 163 165 166 166 166 167 167 167 169 170 172 175 177 178 181 185 186 187 188 191 193 196 Trends Databases Screen Trends 18 Recording Starting and Stopping Recordings Overview of Recording Types Creating and Changing Recordings Templates Recorder Status Messages 19 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up 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 and Printing Manually Printer Status Messages Sample Report Printouts 20 Care and Cleaning General Points Cleaning the Monitor Disinfecting the Monitor Sterilizing the Monitor Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning Batteries and the Battery Compartment 21 Using Batteries Battery Power Indicators Checking Battery Charge Replacing a Battery Optimizing Battery Performance Battery Safety Information 22 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 196 197 203 204 204 205 207 208 208 210 210 210 210 211 211 211 212 213 217 218 218 218 219 219 222 224 225 225 227 229 229 230 231 231 231 203 207 217 221 229 v 23 Accessories ECG/Resp Accessories NBP Accessories Invasive Pressure Accessories SpO2 Accessories Temperature Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Mainstream CO2 Accessories (for M3016A) Microstream CO2 Accessories Battery Accessories 24 Specifications Intended Use Manufacturers Information Symbols Installation Safety Information Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Out-Of-Hospital Transport - Standards Compliance Monitor Performance Specifications M4607A Battery Specifications Measurement Specifications Safety and Performance Tests 25 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 SpO2 Default Settings NBP Default Settings Temperature Default Settings Invasive Pressure Default Settings Cardiac Output Default Settings CO2 Default Settings vi 233 247 275 233 237 238 239 243 243 244 244 244 245 247 247 248 249 250 250 250 251 254 257 258 270 275 281 281 282 285 285 286 287 287 287 290 290 1 1Installation Installation should be carried out by qualified service personnel, either by the hospitals 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 Task 1 2 3 4 5 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 1 Installation Unpacking and Checking the Shipment Step Task 6 7 8 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 Comments Monitor with options as ordered ECG accessories NBP accessories SpO2 accessories Pressure accessories Temperature accessories CO2 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) 1 optional optional optional optional optional optional optional 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. 2 Mounting the Monitor 1 Installation Mounting the Monitor The monitor can be rested on a flat, level surface, hung on the bed rail, mounted on a wall or on a rollstand, or on the left side of the Flexible Module Rack (FMS). 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 Host Monitor as Power Source When connected to a host monitor, via the Measurement Link (MSL) cable or when directly attached to the host, the X2 obtains its power from the host, including that needed for battery charging. Note that the X2 will operate and charge its battery even when attached to a host monitor running on battery power. X2 attached to MP70 MSL Cable connects to host monitor or power supply (M8023A) External Power Supply M8023A (Option) The optional wide-range external power supply (M8023A) 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 monitors battery. 1 4 4 2 3 Checking Out the Monitor 1 Installation 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. 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 patients 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. Test Test or Inspection to be Performed Visual Inspect the monitor, measurement accessories and cables for any damage. Power On Functionality Test Safety Tests (1) to (4) System 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. 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. 6 Setting the Date and Time 1 Installation Setting the Date and Time To set the date and time:

1 2 3 4 5 Press the SmartKeys key to enter the SmartKeys window. Select the Main Setup SmartKey to enter the Main Setup menu. Select the Date, Time screen element from the monitors 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. 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. If the X2 is connected to a host monitor, the date and time are automatically synchronized with the host monitor. When connected to a host monitor, you cannot set the date and time on the X2. 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 institutions 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. If you need to enter configuration mode:

1 2 In the Main Setup menu, select Operating Modes. Select Config and enter the passcode. The passcode for configuration mode is given in the monitors 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. 7 1 Installation Handing Over the Monitor 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. 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 8 2 2Basic Operation These Instructions for Use are for clinical professionals using the IntelliVue X2 (M3002A) Multi-

Measurement Module. 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 monitors display, such as measurements, alarms, patient data and so forth. Introducing the IntelliVue X2 The Philips IntelliVue X2 Multi-Measurement Module is a versatile patient monitoring device with a color touchscreen display. It can simultaneously monitor 3-, 5-, 6- or 10-lead ECG (including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure and temperature, or CO2. The X2 can be used in two ways:

As a Multi-Measurement Module (MMS) for the Philips IntelliVue family of patient monitors. As a stand-alone patient monitor. 9 2 Basic Operation Introducing the IntelliVue X2 In this book, the X2 is generally referred to as the monitor, except in situations describing its use with a host monitor, where it is referred to as the X2 to distinguish it from the host monitor. The monitor 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 patients physiological condition. The X2 can run on one of three power sources: a rechargeable battery, a host monitor when connected to the X2, or the optional external power supply (M8023A). For battery charging, care and status information, refer to the chapter Using Batteries on page 221. X2 as Multi-Measurement Module You can connect the X2 to an IntelliVue patient monitor, where it acts as a Multi-Measurement Module (MMS), providing measurements, trends and patient information to the MP20/30, MP40/50 and MP60/70/80/90. You can connect the X2 to a host monitor via the MSL cable, or attach it directly to the host. When connected to a host monitor, the X2 takes power from the host, including that required for battery charging. The host controls the connected X2, including all alarm functionality. No alarms are available on the X2, and the alarm lamps are controlled by the host. You can recognize when an X2 is connected to a host monitor by the following indication on the X2 screen (white text on a blue background):

Companion Mode No Alarm Display X2 as Stand-alone Monitor You can use the X2 as a stand-alone, highly portable monitor. In stand-alone mode, you can run the monitor from the rechargeable battery, or from mains power using the optional external power supply. Through networking it provides information integration, documentation and information access. Continuous Monitoring Combining its role as MMS with that of stand-alone monitor, the X2 is particularly suited to transport situations. When the X2 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor running on battery power, eliminating the need for a separate transport monitor. When the X2 is connected to a new host monitor, it resumes its role as MMS, uploading trend data, patient demographic information and measurement settings, and allowing fully continuous monitoring. 10 Controls, Indicators and Connectors 2 Basic Operation Controls, Indicators and Connectors X2 Overview 1 2 4 5 6 3 3 2 4 1 8 6 5 7 1 2 3 4 5 6 7 8 On/Standby Switch Power and battery indicators (see X2 Controls and Indicators on page 12) 3.5-inch TFT LCD touchscreen QVGA display Alarm lamps (see X2 Controls and Indicators on page 12) Battery eject button Keys (see X2 Controls and Indicators on page 12) Measurement connectors (see X2 Patient Connectors, Right Side on page 13) Battery 11 2 Basic Operation Controls, Indicators and Connectors 8 9 10 11 1 1 On/Standby switch. Disabled when X2 is connected to a host monitor 2 On/Standby LED. Green when 3 4 5 6 7 8 9 monitor is on. Red indicates an error. Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected. External power LED. Green when monitor is powered from an external power source. Alarms off indicator. When alarms are suspended, the lamp is red, and the ALARMS OFF message appears on the screen. Active INOP alarm lamp in light blue. Stays lit until active INOP is acknowledged. Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is acknowledged. Silence key 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. X2 Controls and Indicators 6 7 5 4 3 2 12 Controls, Indicators and Connectors 2 Basic Operation X2 Patient Connectors, Right Side Symbols (International) Text (English versions only) 1 2 7 4 3 1 2 3 4 5 6 X2 Left Side 1 2 1 2 3 4 5 6 1 2 3 4 5 6 7 1 2 Pressure (option) Temperature (option) Noninvasive blood pressure SpO2 ECG sync pulse output

(See page 255 for specifications) ECG/Respiration CO2 (option) Loudspeaker MSL Connector. Connects to a host monitor or the external power supply via the MSL cable for power, battery charging, and communication with a network. 13 2 Basic Operation Extending Measurements 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 X2 The MMS extensions connect to the monitor and use the monitors 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 X2, and the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A). Measurements from a MMS extension connected to the X2 are not available when the X2 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 CO2 measurement is supported. To separate an extension from the monitor, press the release lever and push the extension forward. 14 Extending Measurements 2 Basic Operation M3014A, M3015A and M3016A Measurement Extensions When attached to an X2 connected to external power (either via the external power supply or a host monitor), the optional M3014A Capnography extension adds mainstream capnography, and optionally one pressure plus either a pressure or a temperature to the monitor. When the X2 is connected to a host monitor, Cardiac Output (C.O.) measurements can be performed and can be used to calibrate Continuous Cardiac Output (CCO). These stored C.O. results and the calibrated CCO measurement are still available in the X2 when it is disconnected from the host monitor. The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the monitor. The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the monitor. Only one CO2 measurement at a time is supported. M3014A Capnography M3015A Microstream 1 2 5 7 6 1 3 M3016A Mainstream 2 1 2 4 3 1 2 3 4 Pressure connectors (red) Temperature connector (brown) Mainstream/sidestream connector CO2

(optional) Cardiac Output connector 5 6 7 Inlet Microstream connector CO2 Gas sample outlet 15 2 Basic Operation Extending Measurements M3012A Hemodynamic MMS Extension MSL Connector to X2 Pressure connectors

(red) Cardiac Output (orange; optional) Temperature connectors (brown) When attached to an X2 connected to external power (either via the external power supply or a host monitor), the optional M3012A Hemodynamic extension adds temperature, pressure, and an additional pressure or a temperature to the monitor. When the X2 is connected to a host monitor, or is using a PC as a remote display, Cardiac Output (C.O.) measurements can be performed and can be used to calibrate Continuous Cardiac Output (CCO). These stored C.O. results and the calibrated CCO measurement are still available in the X2 when it is disconnected from the host monitor. 16 Operating and Navigating 2 Basic Operation 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 X2 Controls and Indicators on page 12). These let you:

Key with symbol

(international) Text replaces symbol (English versions only) 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. 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. 17 2 Basic Operation Operating and Navigating A typical main screen looks like this:

4 3 2 1 5 6 7 8 9 Bed9 Adult ALARMS OFF SpO2 11 1mV Sinus Rhythm Temp HR M ABP ABP Sys. All Sett. reset Profile Adult 11 10 X2 Screen Elements Item Description Comments Place for Alarm Volume Off indicator Alarm message / patient name field Patient category and bed label / INOP message field is displayed when the alarm volume is set to zero (0). Not displayed when the X2 is connected to a host monitor (Companion Mode is indicated). Patient name can be covered by alarm messages or alarms On/Off/Paused message. SpO2 LOW Adult Bed4 HR SpO2 ST-I ST-V6 If red and yellow alarms are active at the same time, they rotate in the alarm field. S HR Adult ST-I ST-V6 APNEA SpO2 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. APNEA SpO2 ALL ECG ALARMS OFF HR ST-I ST-V6 Network connection indicator Documented in Information Center Instructions for Use. 1 2 3 4 18 Operating and Navigating 2 Basic Operation X2 Screen Elements Item Description 5 6 7 8 9 10 11 Measurement label Paced status Measurement numeric/values Measurement wave Status line Measurement Selection key Battery status indicator Comments Touch the measurement to enter the measurement setup menu. Displayed below the HR label. 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. Opens the Measurement Selection window which shows all measurements and where they are physically located. From here you can also enter the measurement setups. Gives information about remaining battery charge, estimated operating time, maintenance requirements and malfunctions. See the chapter Using Batteries on page 221. 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. Main screen Bed4 Adult Doe, John HR SpO2 Pulse 60 Auto 15 min Measurement setup menu No Central Monit. NBP Pulse 60

Setup NBP Auto NBPs HIGH 08:28 NBP meas. + autom. cycle started Sys. Alarms :

On Al. from :

Sys Start/

Stop Mode :

Auto Stop All Repeat:

15 min NBP STAT 1 2 3 4 5 19 2 Basic Operation Operating and Navigating Key to measurement setup menu:

Item Description Comment 1 2 3 4 5 INOP and alarm message field. Wave/numerics window. Status/prompt message. Next page arrows. Measurement menu buttons. 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 Repeat 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 monitors configuration. For this reason, this book generally describes entry to a measurements 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:

20 Operating and Navigating 2 Basic Operation No Central Monit.

SmartKeys NBPs HIGH Start/

Stop Measmt. Select. Admit/

Dischrge Alarm Limits Vitals Trend Profiles Alarm Volume QRS Volume Monitor Standby Touch to view more SmartKeys Main Setup is one of the SmartKeys. enter Main Setup menu - you can get to all setup windows using this key enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained. enter profile menu, or revert to default profile previous Screen change Screen, or revert to default screen quick admit a patient enter patient identification menu to admit/discharge/transfer end case to discharge a patient lock touchscreen operation set alarm limits change alarm volume change screen brightness (not for independent displays) change QRS volume 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 re-learn arrhythmia start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series start NBP measurement and measurement series 21 2 Basic Operation Operating and Navigating start veni puncture (inflate cuff to subdiastolic pressure) stop current NBP measurement set the NBP repeat time access patient reports switch CO2 pump off zero invasive pressure transducer 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 unpair equipment and continue central monitoring with the telemetry device start 12-Lead Capture (only available if Information Center is connected) access ST Map application select measurement device 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 Not Admitted Last Name

Q W E

R

T

Y

U

I

) PO A S D F G H J K L

Z X C V B MN

Shift Alt

Back Clr Enter 22 Operating Modes 2 Basic Operation Operating Modes 2 1 When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:

Select the Main Setup menu. 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 monitors 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. When an X2 is connected to a host monitor (Companion Mode is indicated):

The X2 will adopt the operating mode of the host monitor:

You cannot change the operating mode at the X2. 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:

23 2 Basic Operation Understanding Screens 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, applies to stand-alone monitor only). To resume monitoring, Select anything on the screen or press any key. When the X2 is on (not in Standby) and is connected to a host monitor in Standby mode, the host monitor will turn on. When the X2 and the host monitor are both in Standby:

Operating the X2 will make the host monitor turn on. The X2 will switch off when disconnected from the host monitor. If the host monitor loses AC mains power, the X2 will switch off. 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 After closing any open menus or windows, press the Main Screen key to access the Change 2 Choose the new Screen from the Change Screens menu. Screens menu. 24 Using the XDS Remote Display 2 Basic Operation Changing a Screens 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 2 Select the element you want to change. For example, touch the wave to enter the wave setup menu, or touch the numeric to enter the numeric setup menu. From the menu that appears, select Change Wave or Change Numeric, and then select the wave or numeric you want. 1 Wave B 1 Big Wave Change Screen 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 monitors default Screen is shown. Modified Screens are still available in the Change Screen menu. If the monitor is switched off and then on again, modified Screens are erased from the monitors 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). Vital Signs B 2 Waves A 2 Waves B Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. 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, 25 2 Basic Operation Understanding Profiles Press the Main Screen key to open the Change Screen menu. Select the name of the visitor Screen configured for your monitor from the list of available Screens. 1 2 To select a Screen with waves and numerics again, Touch the gray rectangle in the center of the screen showing the visitor Screens 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 (oF or oC) pressure unit (mmHg or kPa). 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 Doe, John Profiles Profile

: Profile Adult Patient Category

: Adult Paced Display

: No

: Vital Signs Profile Measmnt. Adult Patient Measmnt. Pedi Please Confirm To activate the highlighted settings block select Confirm Measmnt.Settings

: Measmt. Adult Please Confirm Confirm Cancel Profiles Menu, showing current settings Available choices in measurement menu. Confirm your choice when prompted. 26 Understanding Profiles 2 Basic Operation 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. 1 Swapping a Complete Profile Press the SmartKeys key and Either select Main Setup and then Profiles in the Setup menu. Or select the Profiles SmartKey In the Profiles menu, select Profile. 2 3 Chose a profile from the pop-up list. 4 Confirm your selection. Swapping a Settings Block 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. 3 Choose a settings block from the pop-up list. 4 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. 27 2 Basic Operation Understanding Settings 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 monitors 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. 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 monitors screen. The monitor stops data acquisition and alarming for this measurement. 1 Enter the measurements 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. 28 Using Labels 2 Basic Operation 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 CO2 waves. Global Speed, for all waves not included in the other group. Changing the Wave Group Speed 1 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, Select Main Setup -> User Interface Select Global Speed or RespiratorySpeed, as required Select a value from the list of available speeds. 2 3 Changing Wave Speed for a Channel Select Change Speed. To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 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 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 Select Label. 3 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 monitors Configuration Mode. 29 2 Basic Operation Using Labels 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. PAP ZERO+CHECK CAL

*** APNEA Measurement Selection ABP Tcore NBP SpO2 ECG Resp Temp PAP CO2 CPP Temp Unavailable measurements are grayed-out Change Label De-

Activate Setup SpO2 More On an X2 display, a MMS Extension is only shown in the Measurement Selection window when the X2 is connected to a host monitor or the external power supply (M8023A), and not when running on battery power. WARNING When an X2 with an active measurement, say SpO2, is connected to a host monitor with the same measurement already active, the SpO2 measurement on the X2 is deactivated and the SpO2 DEACTIVATED INOP is displayed. The measurement can only be reactivated if the X2 is disconnected from the host monitor. The label conflict can be resolved on the host monitor like any other label conflict. 30 Changing Monitor Settings 2 Basic Operation When the X2 is connected to a host monitor, the Measurement Selection window can be opened, but only the measurement Setup key is functional. Derived measurements are not active and cannot be activated, but become active again when the X2 is disconnected from the host monitor. Resolve any label conflicts at the host monitor. To resolve a label conflict when the X2 is not connected to a host monitor:

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. Select the label to be corrected. 1 2 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 Setup <Measurement label>: to enter the Setup menu for the measurement and change becomes invisible to the monitor, as though it had been unplugged. the conflicting devices label to a different label. Select the De-activate pop-up key to disable the conflicting measurement. 4 Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used. If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. 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 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. Select the setting you Adjusting the Screen Brightness Select the Brightness SmartKey. 1 31 2 Basic Operation Checking Your Monitor Revision 2 Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most monitoring locations and optimizes power usage for battery powered monitors. 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 monitors Configuration Mode. Setting the Date and Time If your monitor is connected to an Information Center, the date and time are automatically taken from this. If the X2 is connected to a host monitor, the date and time are automatically synchronized with the host monitor. When connected to a host monitor, you cannot set the date and time on the X2. Once it is set, the internal clock retains the setting even when you switch off the monitor. In the Main Setup menu, select Date, Time. 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. 1 2 3 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. Check all the external cables, plug-ins and accessories. 2 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. 32 Getting Started 2 Basic Operation 4 Measurements from measurement extensions attached to the monitor are only available when the monitor is operating from external power (when connected to a host monitor or to the external power supply). The measurement extensions are not active when the monitor is operating from battery power. 5 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. When the X2 is connected to a host monitor (Companion Mode is indicated), note that the On/Off switch is disabled. 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. The X2 switches on automatically when connected to a running host monitor. When the X2 is disconnected from a running host monitor, it 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. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor. 2 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. 3 Refer to the appropriate measurement section for details of how to perform the measurements you require. 33 2 Basic Operation Disconnecting from AC Mains Power Disconnecting from AC Mains Power To disconnect the X2 from AC mains power, disconnect the MSL cable, or detach the X2 from the host monitor (if directly connected) or unplug the power cord for the optional 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, using one of the optional interfaces:

Standard wired LAN Wireless LAN IntelliVue Instrument Telemetry System (IIT) WARNING Do not connect patient monitors to the standard hospital network. Additionally, when the X2 is equipped with an IIT interface and declared at the Information Center as a telemetry device, it allows data continuity when paired to a host monitor. After disconnection from the host monitor, it continues to monitor the patient during transport (or roaming within the specified area of coverage) and provides continuous data to the same sector on the Information Center. (See the Instructions for Use for your host monitor for viewing telemetry data on the host.) 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 wireless networks in comparison to those on wired networks. 34 Using the X2 with a Host Monitor (Companion Mode Indicated) 2 Basic Operation Using the X2 with a Host Monitor (Companion Mode Indicated) Host monitors that can support the X2 as a multi-measurement module require software revision F.00.00 or higher. When you connect an X2 to a host monitor, an integrated system is formed for monitoring a single patient. The following general observations and considerations apply to such a system:

The host monitor is the master of the system, and you have full control over all the systems operation only via the host monitor. Functions you can operate on an X2 are restricted to measurements originating in that device. If you try to operate controls that are disabled, you are prompted by the message Not available in Companion Mode. Depending on how it is configured, your host monitor can determine whether the user interface of a connected X2 is completely disabled or not, and what is displayed (a standard main screen, or a blank screen similar to the Standby screen indicating Companion Mode). This is controlled by two monitor settings that are applied to the X2 on connection. You can change the settings in Configuration Mode. General settings from the host monitor are applied to the X2 on connection. When disconnected from the host, the X2 applies its own general settings. No audible alarms are available on an X2 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps which are controlled by the host monitor. Alarms become active again as soon as the X2 is disconnected from the host monitor. The host monitor is the master of all ADT information. ADT operations on the X2 are disabled, and any pending actions on the X2 (for example, admit or end case) are cancelled. The date and time of the X2 is synchronized with that of the host monitor. Pairing When Connected to a Host Monitor

(Companion Mode Indicated) An X2 with an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a telemetry device at the Information Center. Pairing Without a Direct Connection When the X2 is declared as a telemetry device and has a connection to the Information Center, it can also be paired to a host monitor even without a direct connection:

1 Select Main Setup then Measurements Select Telemetry 2 The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. 35 2 Basic Operation Unpairing the Host Monitor and the Paired Device Unpairing the Host Monitor and the Paired Device If the patient will no longer be monitored with the paired X2, or only with the paired X2 and no longer with the host monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the host monitor or from the paired X2. At the host monitor:

Select the Main Setup -> Measurements - > Telemetry or the Unpair to Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the host monitor Select the Main Setup -> Measurements - > Telemetry or Unpair to Tele SmartKey to end pairing and have the Information Center receive the measurement data from the paired X2 You can also use the Unpair function at the Information Center or directly on the paired X2. Capturing Alarm Reports and Printing You can print out standard reports, alarm reports and trends with the IntelliVue PC Printing Solution. This is a software package which allows you to print to a standard, off-the-shelf printer or to an electronic file such as PDF. You can download the IntelliVue PC Printing Solution free-of-charge from the Internet and install it on an existing PC. Capturing Alarm Reports The monitor can be set up to automatically capture alarm reports, triggered by selected alarms. The necessary settings must be made in Configuration mode. When one of the selected alarms occurs, the monitor automatically captures the alarm and creates a report which is stored in the database. As soon as the monitor is connected to a PC or network with the IntelliVue PC Printing Solution software, it will automatically print the reports, or send them to a patient-specific folder as an electronic file. 36 3 3Whats New?

This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital. Whats New in Release G.0?

Short Range Radio Interface for X2 A short range radio interface is now available for the X2 monitor. This allows a telemetry transceiver with a short range radio adapter to be assigned to the monitor, resulting in a direct connection. The measurement data from the telemetry transceiver appear directly on the monitor screen with a minimal delay and are combined with the monitor data in one sector at the Information Center. IntelliVue XDS Solution Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. New Fields in the Admission Form A Middle Name field is now available in the admission form - whether it appears is configurable. Two additional ID fields, Lifetime Id and Encounter Id, can also be configured to appear and their names can be customized to fit hospital requirements. SpO2 Enhancements Additional SpO2 Labels - SpO2pr and SpO2po labels have been added. New manual measurement mode when telemetry devices are connected via a short range radio link. Signal Quality Indicator displayed with the SpO2 numerics. ECG Enhancements New */**Afib yellow alarm when an atrial fibrillation waveform is detected. QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points. 37 3 Whats New?

Whats New in Release F.0?

Whats New in Release F.0?

QT/QTc Interval Monitoring QT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a 'QTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and 'QTc enabling alarm notification. Manual Data Entry Measurement values (for example lab data or manually measured temperatures) can be entered manually into the monitor and stored in the database. They can then be used for trends, reports and also be displayed as a numeric on screen, if required. Horizon Trend Enhancements The trend indicator arrow indicates how the patient trend has developed in a set time period. This period is now configurable and can be set to 10 minutes, 5 minutes or 2 minutes. The horizon (or baseline) can now be set to a range or to a specific value. Connecting an MP5 to a Monitor (Companion Mode is indicated) The MP5 monitor can be connected to one of the MP20 to MP90 monitors (then called the host monitor) and used like an MMS. This provides monitoring continuity in transport situations allowing measurement data and patient demographics from the MP5 to be transferred to another monitor. When the MP5 is connected to a host monitor, no alarms will be announced on the MP5. NBP - Programmable Measurement Sequence Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously you can have regular measurements continue after the sequence has run. New Printing Options For Reports Reports can now also be printed via an external PC-based print server or to an internal print database, when no printer is available (for example, during transport). As soon as a printer becomes available, the reports stored in the database will print automatically. Manual Pairing At Monitor Previously, devices could only be manually paired at the Information Center. You can now pair devices at the monitor as long as the monitor is already connected to the Information Center. Moving Windows And Menus Windows and menus can now be moved on the monitor screen. Using touch or a mouse you can select the title of a window and then drag it across the screen. Some positions on the screen are not allowed, such as ones overlapping the alarm field or the monitor info line. Invasive Pressure Changes Wave cursor - A cursor is now available on the realtime pressure wave to allow you to define a position and store the corresponding value. Reduced alarm limit steps in lower ranges - The alarm limits setting in 2 mmHg steps is now possible in ranges up to 50 mmHg (previously up to 30 mmHg). 38 Whats New in Release F.0?

3 Whats New?

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 and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings. New Smart Keys A SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used. Better Visibility Of Gridlines The brightness of the gridlines on the realtime waves has been increased for better visibility. 39 3 Whats New?

Whats New in Release F.0?

40 4 4Alarms 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 ECG/ARRH ALARM OFF (yellow only, no red INOP) CUFF OVERPRESS CUFF NOT DEFLATED OCCLUSION TELE DISCONNECT. Replace TeleBatt 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. n** HR HIGH 41 4 Alarms Visual Alarm Indicators 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. Visual Alarm Indicators WARNING No alarms are available on the X2 when connected to a host monitor. Alarms become active again as soon as the X2 is disconnected from the host monitor. Alarm fields and other visual alarm indicators are disabled on the X2 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps, which are controlled by the host monitor. No Alarm Display is shown in the field for red/yellow alarms, and Companion Mode is shown in the INOP field. Companion Mode No Alarm Display 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 (

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

) at the side. If both red and 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 monitors 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:

42 Audible Alarm Indicators 4 Alarms 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). 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. No alarms are available on the X2 when connected to a host monitor. (Companion Mode is indicated). Alarms become active again as soon as the X2 is disconnected from the host monitor. When connected to a host monitor (Companion Mode is indicated), no alarm tones are available on the X2. Alarm Tone Configuration The audible alarm indicators of your monitor are configurable. In the monitors Configuration Mode, you can:

increase the alarm volume of unacknowledged alarms at regular intervals change the interval between alarm sounds (ISO/IEC Standard 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. 43 4 Alarms Acknowledging Alarms ISO/IEC Standard 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 monitors 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. There is no alarm volume indication on the X2 display when the X2 is connected to a host monitor

(Companion Mode is indicated). 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 44 Pausing or Switching Off Alarms 4 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 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. APNEA 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. 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, Select Main Setup -> Alarms -> Alarm Settings 1 2 Check the Alarms Off setting. This setting can only be changed in Configuration Mode. To avoid the possibility that alarms could be switched off by accident, it is recommended not to configure the alarm pause setting to infinite when the X2 is not connected to a host monitor, unless you are sure that clinical personnel are available to supervise the patient. 45 4 Alarms Pausing or Switching Off Alarms 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. Depending on the configuration, you may need to select Confirm to complete the change. To Switch All Alarms Off You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause. Alarms Off Press the Alarms key. Pausing alarms infinitely is the same as switching them 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. 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. No alarms are sounded and no alarm messages are shown. INOP messages are shown but no INOP tones are ALARMS PAUSED 1:28 ALARMS OFF sounded. The only exceptions are the INOPs CUFF NOT DEFLATED, CUFF OVERPRESS 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. 46 Alarm Limits 4 Alarms If a NO SENSOR or NO TRANSDUCER INOP is present and alarms are paused or switched off, the measurement in question is switched off. The alarms off symbol is not displayed when the X2 is connected to a host monitor. 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 patients condition closely. To extend the alarm pause time to five or 10 minutes, Select one of the alarm fields. This calls up the Review Alarms window. 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. 1 2 Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO2), 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. 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 85120 HR 50 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. 47 4 Alarms Alarm 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. 1 Alarm Limits Off 2

'QTc SpO2 NBPs ABPs All Lim. Narrow 3 All Lim. Wide 1 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 2 3 Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Set narrow or wide alarm AutoLimits for all measurements 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:

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 measurements Setup Menu, 1 In the measurements 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. 2 For example, to change the alarm limits for SpO2:

48 Alarm Limits 4 Alarms 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. 1 ABPs 2 Alarms On/Off 3 4 5 6 7 8 10 9 1 2 3 4 5 6 7 8 9 10 Parameter label High red alarm (view only) 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) Graphic view of alarm limits with currently measured value 49 4 Alarms Alarm Limits To change alarm limits, 1 Enter the Alarm 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 wide and narrow limits have a fixed relationship to the measured value within the non-

pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinicians judgement about the specific patient. 3 1 2 2 1 4 Wide alarm limits Narrow alarm limits Alarm Limits Measurement value 1 2 3 4 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 patients 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 monitors Configuration Mode. 50 Reviewing Alarms 4 Alarms AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitors 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. Documenting Alarm Limits To print a list of all current alarm limit settings on an available printer:

Select the Main Setup SmartKey. Select Reports from the Main Setup menu. Select Alarm Limits. 1 2 3 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 23 Apr 14:08:30 23 Apr 14:08:19 23 Apr 14:42:55

***Apnea Alarms Silenced

**AwRR LOW (14<15)

**SpO2 NON-PULSAT. Alarm Limits PauseAl. 5 MIn PauseAl. 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. 51 4 Alarms Latching Alarms No entries are made in the Review Alarms window of the X2 while it is connected to a host monitor, except the time when the X2 was connected to the host (Companion Entered), and when it was disconnected (Companion Left). Alarms can be reviewed on the host monitor. 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. 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 monitors 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 R&Y Off R&Y R&Y Off Off R Off R R R = red alarms, Y = yellow alarms 52 Testing Alarms 4 Alarms Alarm Latching Behavior 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 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 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 116 for information on one-star yellow alarms latching behavior. 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 SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed. 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 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. 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. 1 2 3 4 53 4 Alarms Alarm Recordings 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. 54 5 5Patient Alarms and INOPs This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 61. 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, SpO2, 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. Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices. Alarm Message

*/**AFIB

***APNEA or

***APNEA mm:ss sec or

***APNEA >10min

***ASYSTOLE

**awRR HIGH

**awRR LOW

**BIS HIGH From Condition Indication ECG/

Arrhythmia CO2, Resp, Spirometry Atrial fibrillation waveform detected Respiration has stopped for longer than the preset apnea time. mm:ss denotes the Apnea duration in minutes and seconds. ECG CO2, Resp, AGM 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. CO2, Resp, AGM The airway respiration rate has dropped below the low alarm limit. BIS The Bispectral Index value has exceeded the high alarm limit. yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 55 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message

**BIS LOW From BIS Condition Indication The Bispectral Index value has dropped below the low alarm limit.

***BRADY/P xxx<yyy or

***BRADY xxx<yyy

**CCO/CCI HIGH

**CCO/CCI LOW

**CPP HIGH

**CPP LOW

***DESAT or

***DESAT xxx<yyy

**etCO2 HIGH

**etCO2 LOW

**etO2 HIGH

**etO2 LOW Press, SpO2 The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit. Continuous Cardiac Output or CC Index is above the high alarm limit. CCO CCO CPP CPP SpO2 CO2, Resp, AGM Continuous Cardiac Output or CC Index is below the low alarm limit. The CPP value has exceeded the high alarm limit. The CPP value has fallen below the low alarm limit. The SpO2 value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. The end tidal CO2 high alarm limit has been exceeded. CO2, Resp, AGM The end tidal CO2 value has fallen below the low alarm limit. O2, AGM The end tidal O2 high alarm limit has been exceeded. O2, AGM The end tidal O2 value has fallen below the low alarm limit.

EVENT:<GRP>

*/**/*** EVENT at Information center Event surveillance Event surveillance

***EXTREME BRADY

***EXTREME TACHY ECG ECG An event has occurred and the event notification is configured to alarm.

<GRP> is the event group An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group. The bradycardia limit has been exceeded. The tachycardia limit has been exceeded. 56 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. 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 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone. event group name flashes, yellow or red alarm lamp and alarm tone

(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message

**HR HIGH From ECG Condition Indication The heart rate high alarm limit has been exceeded.

**HR LOW ECG The heart rate has fallen below the low alarm limit.

*/**IRREGULAR HR

*/**MISSED BEAT

*/**MULTIFORM PVCs ECG/

Arrhythmia ECG/

Arrhythmia ECG/

Arrhythmia

**NBP HIGH

**NBP LOW NBP NBP

*/**NON-SUSTAIN VT ECG/

Arrhythmia

*/**PACER NOT CAPT ECG/

Arrhythmia

(paced patients only)

*/**PACER NT PACING ECG/

*/**PAIR PVCs

*/**PAUSE Arrhythmia

(paced patients only) ECG/

Arrhythmia ECG/

Arrhythmia Consistently irregular heart rhythm. No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only). Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats. 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. 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. 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. A missed beat with a pace pulse was detected. A missed beat without a pace pulse was detected. A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected. No beat detected for a period greater than the pause threshold. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. 57 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message

***<Pressure>

DISCONNECT From PRESS

***<Pressure> HIGH PRESS

**<Pressure> HIGH PRESS

***<Pressure> LOW PRESS

**<Pressure> LOW PRESS

**Pulse HIGH

**Pulse LOW

*/**PVCs/min HIGH

**QTc HIGH

**'QTc HIGH

*/**R-ON-T PVCs PRESS SpO2 PRESS SpO2 ECG/

Arrhythmia ECG/QT ECG/QT ECG/

Arrhythmia

**RR HIGH RESP Condition Indication 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). 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. 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. 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. 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. The pulse rate has exceeded the high alarm limit. The pulse rate has dropped below the low alarm limit. 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

'QTc value has exceeded the 'QTc high limit for more than 5 minutes 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.). The respiration rate has exceeded the high alarm limit. numeric flashes, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, red alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 58 Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message

**RR LOW From RESP Condition Indication The respiration rate has dropped below the low alarm limit.

*/**RUN PVCs HIGH ECG/

Arrhythmia A run of PVCs greater than 2 was detected.

**<SO2 label> HIGH SvO2/SO2

**<SO2 label> LOW SvO2/SO2

**<SpO2 label> HIGH SpO2

**<SpO2 label> LOW SpO2 The the measured intravascular oxygen saturation has exceeded the high limit. The measured intravascular oxygen saturation has fallen below the low limit. The arterial oxygen saturation has exceeded the high alarm limit. The arterial oxygen saturation has fallen below the low alarm limit.

**ST<n> HIGH

**ST<n> LOW ECG/ST The ST elevation in lead <n> is higher than the limit. ECG/ST The ST depression in lead <n> is lower than the limit.

**ST MULTI <n>,<n> ECG/ST

**ST MULTI at Information Center ECG/ST

*/**SVT ECG/

Arrhythmia

***TACHY/P xxx>yyy or

***TACHY xxx>yyy

**Tblood HIGH

**Tblood LOW

**tcpO2 HIGH/

**tcpCO2 HIGH

**tcpO2 LOW/

**tcpCO2 LOW C.O. C.O. tcGas tcGas The ST depression or elevation is outside of the limit in two or more leads <n> and <n>

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. A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit. exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit. The blood temperature value has exceeded the high alarm limit. The blood temperature value has fallen below the low alarm limit. The tcpO2 or tcpCO2 value has exceeded the high alarm limit. The tcpO2 or tcpCO2 value has fallen below the low alarm limit. Press, SpO2 The heart rate from the Pulse signal has numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. 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. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. 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, yellow alarm lamp, alarm tone

(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. 59 5 Patient Alarms and INOPs Patient Alarm Messages From Condition Indication Alarm Message

*/**/***TELE ALARM

**<Temperature label> HIGH

**<Temperature label> LOW

*/**VENT BIGEMINY

***VENT FIB/TACH

*/**VENT RHYTHM

*/**VENT TRIGEMINY

***VTACH Telemetry TEMP TEMP ECG/

Arrhythmia ECG ECG/

Arrhythmia ECG/

Arrhythmia ECG, Arrhythmia This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window. The temperature has exceeded the high alarm limit. The temperature has fallen below the low alarm limit. A dominant rhythm of N, V, N, V (N =

supraventricular beat, V = ventricular beat) was detected. A fibrillatory waveform for 4 consecutive seconds was detected. A dominant rhythm of adjacent Vs >

vent rhythm limit and ventricular HR <

VTach HR limit was detected. A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V =

ventricular beat) was detected. Ventricular tachycardia has been detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach HR limit). A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information. yellow or red alarm lamp and alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone.

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

**/***VueLink ALARM at Information Center VueLink 60 Technical Alarm Messages (INOPs) 5 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 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. 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 INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. BATTERIES INCOMP or BATT 1/

BATT 2 INCOMPAT INOP tone Source What to do 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). See <Pressure label> INOPS (under Pressure). PRESS PRESS 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 Monitor PRESS Battery Battery Battery Battery Batteries Batteries scale to display complete wave. 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. See <Pressure label> INOPS (under Pressure). The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery 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 battery cannot be used with this monitor. Replace with the correct battery (M4607A). 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 re-

issued 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. 61 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BATTERIES LOW or BATT 1/

BATT 2 LOW INOP tone BATTERIES MALFUNC. or BATT 1/BATT 2/ BATTERY MALFUNCT. 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 BATT 1/BATT 2 MISSING INOP tone. During this INOP, alarms cannot be paused or switched off. BIS CABLE INCOMPAT INOP tone. 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 Source What to do Batteries The estimated battery-powered operating time remaining is less than 20 minutes. 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 Batteries The battery in the Telemetry device is low and must be replaced soon. The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately. 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 Philips-

supported 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. 62 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication BIS ENGINE MALFUNC INOP tone 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 Source What to do BIS BIS BIS BIS BIS BIS BIS BIS BIS BIS Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine. 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. 63 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BIS SENSOR USAGE INOP tone 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 Source What to do BIS BIS BIS BIS BIS BIS ECG/

Arrhythmia QT ST C.O. C.O. Excessive sensor usage. Replace sensor. A Cyclic Impedance Check will start automatically. 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. 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. 64 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication CCO NO <Pressure label>

numeric is replaced by -?-

INOP tone may sound CCO NO CALIBRATION numeric is replaced by -?-

CCO NO PRESS at Information Center CCO NOT SUPPORTED numeric is replaced by -?-

INOP tone 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. C.O. C.O. C.O. C.O. C.O. CENTRAL:TELE ONLY INOP tone Charge BATT1/BATT2 now INOP tone Monitor Batteries 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 pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. 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 pressure from an external device 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. 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. The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. 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. The pressure measurement must be zeroed before a CCO calibration. System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station. Battery must be charged. Connect the monitor to mains power or exchange the battery. 65 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication 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

!!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 Source What to do Batteries Monitor Battery Monitor Telemetry Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor/

Multi-

Measuremt Module Monitor Monitor Monitor 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. There was a problem loading the drug settings. Check that the settings are complete and correct. Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate. 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. 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. 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. 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. 66 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Check Screen Res INOP tone Check Settings INOP tone Check SpeedPoint INOP tone. Check Touch Input INOP tone Check Waves INOP tone CHK ECG Sync Cable INOP tone Chk IndepDsp Cable CHK MSL Connection INOP tone Chk SpO2T Settings INOP tone C LEAD OFF HR Numeric is replaced by -?- for 10 seconds. INOP tone. CO2 AUTO ZERO Numeric is replaced by a -?-

if the Autozero lasts >15 sec, INOP tone sounds. CO2 CAL MODE CO2 numeric displays current CO2 value for accuracy check CO2 CAL RUNNING Numeric is replaced by a -?-

CO2 CHANGE SCALE CO2 CHK ADAPTER Numeric is replaced by a -?-

INOP tone. CO2 CHECK CAL Numeric is replaced by a -?-

INOP tone. Source What to do Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Telemetry ECG CO2 CO2 CO2 CO2 CO2 CO2 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. 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. Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel. 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. Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate. 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 CO2 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 CO2 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 CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. 67 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do CO2 C.O. C.O. CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 The CO2 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. 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 CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off. There is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 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 CO2 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 CO2 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. INOP Message, Indication CO2 DEACTIVATED INOP tone. C.O. DEACTIVATED INOP tone. C.O. EQUIP MALF Numeric is replaced by a -?-

INOP tone. CO2 EQUIP MALF Numeric is replaced by -?-

INOP tone. CO2 FAILED CAL Numeric is replaced by -?-

INOP tone. CO2 NO SENSOR Numeric is replaced by -?-

INOP tone. CO2 NO TRANSDUC Numeric is replaced by -?-

INOP tone. CO2 NO TUBING Numeric is replaced by -?-

INOP tone.

(!!/!!!)CO2 OCCLUSION Numeric is replaced by a -?-

INOP tone. CO2 OVERRANGE Numeric is replaced by -?-

INOP tone. CO2 PUMP OFF Numeric is replaced by a -?-. CO2 PURGING Numeric is replaced by a -?-

INOP tone. CO2 SENS. WARMUP Numeric is displayed with a -?-

Microstream CO2: INOP tone. Mainstream CO2: no INOP tone 68 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do C.O. CO2 CO2 CO2 CO2 CO2 CPP CPP NBP NBP INOP Message, Indication C.O. UNPLUGGED numeric is replaced by -?-

INOP tone. CO2 UPDATE FW Numeric is replaced by a -?-

INOP tone. CO2 WAIT CAL2 Numeric is replaced by a -?-

CO2 ZERO FAILED Numeric is replaced by a -?-

INOP tone. CO2 ZERO REQUD Numeric is replaced by a -?-

INOP tone CO2 ZERO RUNNING CPP CHK SOURCES Numeric is replaced by a -?-

CPP CHK UNITS Numeric is replaced by a -?-

!!/!!!CUFF NOT DEFLAT Numeric is displayed with a -?-

Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off.

!!/!!!CUFF OVERPRESS Numeric displayed with -?- ;

Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off. CVP INOPS DEVICE CHECK SETUP INOP tone. DEVICE CHECK CONF. INOP tone. DEVICE DEMO DATA INOP tone 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 CO2 sensor. If the INOP persists, contact your service personnel. 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.]

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. See <Pressure label> INOPS (under Pressure). PRESS IntelliBridge Device identification completed, but communication could not be established due to timeout. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but communication could not be established due to error. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode. 69 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication DEVICE REAL DATA INOP tone

<Device> UNPLUGGED INOP tone. DEVICE UNSUPPORTED INOP tone.

<EC10/EC40> EQUIP MALF INOP tone. ECG/ARRH ALARM OFF

!!ECG/AR ALARM OFF 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. ECG EL. NOISY <ECG LEAD>

(!!/!!!)ECG LEADS OFF ECG NOISY SIGNAL INOP tone. ECG ECG ECG ECG Source What to do IntelliBridge The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. IntelliBridge The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but no appropriate device driver installed. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Malfunction in the IntelliBridge module. If this message ECG ECG appears repeatedly, the module must be replaced. Contact your service personnel. 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 alarm source. Contact your service personnel. The ECG hardware is faulty. Monitor 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. Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. 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. The signal electrode in one or both channels exceeds the user-

selected 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. ECG EcgOut EQUIP MALF INOP tone EEG EQUIP MALF INOP tone EEG IMPEDANCE HIGH or EEG1 and/or EEG2 IMPED. HIGH EEG EEG EEG<X> LEAD OFF <n>

[X = channel, n = electrode]

EEG 70 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication EEG<X> LEAD OFF

[X = channel]

at Information Center 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.

!!INSERT BATTERY Severe yellow INOP tone. During this INOP, alarms cannot be paused or switched off. Intell.Dsp Malf. INOP tone Intell.Dsp Missing Intell.Dsp Unsupp. Internal.Comm.Malf INOP tone INVALID LEADSET EEG EEG EEG EEG EEG EEG EEG PRESS FMS FMS PRESS PRESS Display Display Battery Display Display Display Monitor Telemetry 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. 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 electro-

surgery. 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. 71 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication LA LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. LAP INOPs LEADSET UNPLUGGED LL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. MCC Reversed INOP tone MCC Unsupported INOP tone Meas. DEACTIVATED MEASSRV UNSUPPORTD INOP tone MMS Ext. EQUIP MALF INOP tone MMS Ext. UNPLUGGED INOP tone MMS Ext. Unpowered INOP tone MMSExt.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. MSL Power Overload INOP tone. Source What to do ECG PRESS Telemetry ECG Monitor Monitor MMS MMS Extension MMS Extension MMS Extension MMS Extension MMS MMS Monitor Monitor Monitor Monitor 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). The leadset has been unplugged from the telemetry device. 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. 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. 72 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication NBP Deactivated INOP tone. NBP EQUIP MALF Numeric is replaced by -?-

INOP tone. NBP INTERRUPTED Numeric is replaced by -?-

INOP tone. NBP NBP NBP NBP MEASURE FAILED Numeric may be displayed with a -?-

INOP tone. NBP No Central Monit. INOP tone Monitor 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. 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.

!!/!!! NO DEVICE DATA NO DEVICE DATA NO ECG AT CENTRAL NO ECG SOURCE NO PPV FROM MeasSrv at Information Center NO PPV FROM <Device>

OUT OF AREA P/P1/P2/P3/P4 INOPS PAP INOPS PPV BAD <Pressure Label>

SIGNAL IntelliBridge Communication with connected device has been lost. Monitor Telemetry MMS or FMS MMS or FMS Telemetry PRESS PRESS PPV The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device. A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. 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. The telemetry device has left the access point coverage area. 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. 73 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication PPV BAD SIGNAL at Information Center PPV CHK SOURCES

<Pressure label> ARTIFACT Numeric questionable

<Pressure label>

DEACTIVATED INOP tone

<Pressure label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<Pressure label> NO TRANSDUCER Numeric is replaced by -?-

INOP tone.

<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

<Pressure label>

UNPLUGGED INOP tone.

<Pressure label>

ZERO+CHECK CAL Numeric is replaced by -?-

Source What to do PPV PPV PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS The arterial pressure source selected for PPV is not providing a pulsatile signal. 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. 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. 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. 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. 74 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<pTemp label> CHECK PROBE Numeric is replaced by -?-

INOP tone.

<pTemp label> DEACTIVATED INOP tone.

<pTemp label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<pTemp label> INCOMPAT.

<pTemp label> MEAS FAILED Numeric is replaced by -?-

INOP tone.

<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 PW:Check Settings PW in conflict RA LEAD OFF Numeric is replaced by -?-

INOP tone. RAP INOPS Rem.Alarmdev.Malf INOP tone Rem. Display Malf. Source What to do Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Protocol Watch Protocol Watch Protocol Watch ECG PRESS Monitor Remote display 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. 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 40C /50 to 104F). 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. 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 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). 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). 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. There is a problem with an input device at the remote display. Perform a visual and functional check of all input devices. Contact your service personnel. 75 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication

!!/!!! 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 LEADS OFF Numeric is replaced by -?-

INOP tone. RL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. Settings Malfunc. INOP tone.

<SO2 Label> CAL FAILED Numeric is replaced by -?-

INOP tone.

<SO2 Label> CAL MODE Numeric is replaced by -?-

INOP tone.

<SO2 Label>CAL REQUIRED Numeric is replaced by -?-

INOP tone.

<SO2 Label> CANNOT MEAS Numeric is replaced by -?-

INOP tone.

<SO2 Label>CONFIG ERROR Numeric is replaced by -?-

INOP tone.

<SO2 Label> CONN OPTMOD Numeric is replaced by -?-

INOP tone.

<SO2 Label> EQUIP MALF Numeric displays -?-. INOP tone SO2 INCOMPATIBLE INOP tone

<SO2 Label> IN-VIVO CAL Source What to do Telemetry The battery in the telemetry device is almost empty and must be replaced. RESP Contact your service personnel. The RESP hardware is faulty. RESP RESP ECG Monitor SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 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. 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. The monitor cannot use the predefined settings for monitoring. Contact your service personnel. 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 signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter. The Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode. The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds. The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel. The SO2 Module or Optical Module is not supported. Contact your service personnel. 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. 76 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<SO2 Label>LIGHT INTENS Numeric is replaced by -?-

INOP tone.

<SO2 Label> LOW LIGHT Numeric is replaced by -?-

INOP tone.

<SO2 Label> NO OPTMOD Numeric is replaced by -?-

INOP tone.

<SO2 Label> OPTMOD MALF

<SO2 Label> PRE-INS CAL Numeric displays -?-

INOP tone

<SO2 Label> UNPLUGGED Numeric displays -?-. INOP tone SO2 UPGRADE INOP tone

<SO2 Label> WARMUP Numeric is displayed with ?

SOME ECG ALRMS 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 Source What to do SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 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 capability is needed, use another Optical Module. The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete. Measurement switched on and SO2/SvO2 module unplugged from the rack. The SO2 module is currently in upgrade mode. Monitoring is not possible in this mode. The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished. Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile. Contact your service personnel to check the speaker and the connection to the speaker. Monitor 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. 77 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication SPIRO NO BREATH SPIRO GAS COMPENS?

SPIRO PATIENT CAT.

'SpO2 CHK SOURCES Numeric is replaced by -?-

'SpO2 CHK UNITS Numeric is replaced by -?-

<SpO2 label> DEACTIVATED INOP tone

<SpO2 label> EQUIP MALF Numeric is replaced by -?-

INOP tone.

<SpO2 label> ERRATIC Numeric is replaced by -?-

INOP tone.

<SpO2 label> EXTD. UPDATE Label is displayed with a -?-

(questionable numeric)

<SpO2 label> INTERFERNCE Numeric is replaced by -?-

INOP tone.

<SpO2 label> LOW PERF Label is displayed with a -?-

(questionable numeric)

<SpO2 label> NOISY SIGN. Numeric is replaced by -?-

INOP tone.

<SpO2 label> NON-PULSAT. Numeric is replaced by -?-

INOP tone.

<SpO2 label> NO SENSOR Numeric is replaced by -?-

INOP tone.

<SpO2 LABEL> POOR SIGNAL Label is displayed with a -?-

(questionable numeric) 78 Source What to do 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. SpO2 Difference SpO2 Difference SpO2 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. 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 SpO2 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 or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel. SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 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 SpO2 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 SpO2 measurement is poor and measurement accuracy may be compromised. Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<SpO2 LABEL> PULSE?

Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> SEARCHING Numeric unavailable

<SpO2 label> SENSOR MALF Numeric is replaced by -?-

INOP tone.

<SpO2 LABEL> SENSOR OFF Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> UNKN.SENSOR Numeric is replaced by a -?-

<SpO2 LABEL> UNPLUGGED Numeric is replaced by -?-

INOP tone

<SpO2 LABEL> UPGRADE Label is displayed with a -?-, numeric is unavailable Sp - vO2 CHK SOURCES Numeric is replaced by -?-

Sp - vO2 CHK UNITS Numeric is replaced by -?-

SRR INTERFERENCE INOP tone SRR INVALID CHAN INOP tone SRR MALFUNCTION 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 TAAP DISABLED INOP tone Tamb INOPs Tart INOPs Source What to do SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 Sp - vO2 Sp - vO2 Monitor Monitor The detectable pulsations of the SpO2 signal are outside the specified pulse rate range. SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. The SpO2 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 SpO2 measurement. Use only specified sensors and cables. An SpO2 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 SpO2 measurement is currently in UPGRADE mode. Monitoring is not possible in this mode. 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 short range radio connection has interference from another device. Try using another channel. The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration. Malfunction in the short range radio device. If the INOP persists contact your service personnel. 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 TEMP Monitor currently being measured. The monitor is using the CVP value preset in the Setup SVR menu. See <Temp label> INOPs (under Temp) The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor. TEMP TEMP See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp) 79 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Tblood NO TRANSDUC Numeric is replaced by -?-

INOP tone Tblood OVERRANGE Numeric is replaced by -?-

Tcereb INOPS Tcore INOPs tcpO2 (or tcpCO2 or tcGas) CAL FAILED Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL REQUIRD Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL RUNNING Numeric displays first -?- , then numeric is displayed with a ?

tcpO2 (or tcpCO2 or tcGas) CHECK TIME tcpO2 (or tcpCO2 or tcGas) CHANGE SITE If Heat Switch Off is configured to Yes, numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) EQUIP MALF Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) NO TRANSDUC Numeric is replaced by -?-

INOP tone. tcpO2 (or tcpCO2 or tcGas) STABILIZING Numeric is displayed with a ?

tcpO2 (or tcpCO2 or tcGas) UNPLUGGED Numeric is replaced by -?-

INOP tone. TELE CONFIG UNSUPP INOP tone Source What to do C.O. No transducer attached to the module or catheter disconnected. C.O. Tblood out of range 17C - 43C. TEMP TEMP tcGas tcGas tcGas See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp). A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration 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 calibration chamber on the module, connect the calibration unit to the calibration 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 tcpO2/tcpCO2 calibration is finished. tcGas Site Timer due to time out in 15 minutes or less. tcGas tcGas tcGas tcGas 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 tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement. 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. Monitor Telemetry device not supported (companion mode) 80 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication

!!/!!!TELE DISCONNECT INOP tone TELE EQUIP MALF INOP tone TELE INCOMPATIBLE

!!/!!! TELE INOP Severe yellow/red INOP tone. Tele Sync Unsupp. INOP tone TELE UNSUPPORTED INOP tone

<'Temp> CHK SOURCES Numeric is replaced by -?-

<'Temp> CHK UNITS Numeric is replaced by -?-

<Temp label> DEACTIVATED INOP tone Telemetry Monitor Monitor Telemetry Telemetry Monitor TEMP Difference TEMP Difference TEMP

<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 TEMP Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup. For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.) If this INOP persists, ask your service personnel to survey the interference sources. The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device. SRR-enabled telemetry device is not supported by this central software revision. Please check configuration. Check for further details at the Information Center or in the Telemetry Data window on the monitor. The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above. 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. 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. Make sure the TEMP probe is connected to the MMS or module. If you silence this INOP, the measurement will be switched off. 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. 81 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do TEMP Try changing the application site of the transducer.

[The temperature is less than -1qC, or greater than 45qC.]

Monitor See <Temp label> INOPs (under Temp). TEMP TEMP TEMP TEMP TEMP TEMP PRESS Monitor TEMP IntelliBridge Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary. 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. 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. PRESS ECG VueLink VueLink Monitor INOP Message, Indication

<Temp label> OVERRANGE Numeric is replaced by -?-

INOP tone. Tesoph INOPS TEXT UPLOAD FAILED INOP tone 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.

<VueLink option> CHK CABLE INOP tone.

<VueLink option> CHK CONF. INOP tone. 82 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication

<VueLink option> CHECK SETUP INOP tone. VueLnk EQUIP MALF INOP tone. VueLnk NO CONFIG INOP tone. VueLnk UNPLUGGED INOP tone. Source What to do VueLink VueLink VueLink VueLink 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. 83 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) 84 6 6Managing 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. Note that when the X2 is connected to a host monitor, its ability to admit or discharge a patient is disabled, and the host monitor controls patient demographic and ADT information. 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. NOTE It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center. To admit a patient, 1 Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window. 85 6 Managing Patients Admitting a Patient SBed10 Adult Doe, John Patient Demographics Last Name

: Doe First Name

: John MRN Patient Cat. Admit Patient

: 12345678

: Adult Transfer Dischrge Patient End Case 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 patients last name (family name), for example Smith. First Name: Enter the patients first name, for example Joseph. Middle Name (if configured to appear): Enter the patients middle name. Lifetime Id, Encounter Id: Whether these fields appear and how they are labelled can be configured for your hospital. One or both fields may be displayed and the labels may read:

MRN, Case Id, Visit Id, etc. Enter the appropriate data for the fields displayed. 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 patients height. Weight: Enter the patients weight. BSA: The monitor calculates the body surface area automatically. Date Of Birth: Enter the patients 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. Select Confirm. The patient status changes to admitted. 5 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. 86 Quick Admitting a Patient 6 Managing Patients 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 patients 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. Quick Admitting a Patient 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. Select the Quick Admit SmartKey. 1 2 Enter the required data (ID fields 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). 3 4 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 ID field 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 WARNING Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient. A discharge:

87 6 Managing Patients Transferring Patients 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. 1 2 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, Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window and associated pop-up keys. 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 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, SpO2, 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. 88 Transferring Patients 6 Managing Patients Transferring a Centrally-Monitored Patient WARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A). Scenario: A centrally-monitored patient is moved to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information, using the X2 as both MMS and transport monitor. 1 Before you disconnect the X2 from the host monitor, select the patient name field or select the Admit/Dischrge SmartKey on the host monitor 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 patients demographic data during the transfer. 2 Remove the X2 and any connected extensions from the host monitor. 3 Move the patient using the X2 as the transport monitor. 4 At the new location, connect the X2 to the new host monitor. If the host monitor detects a patient mismatch, a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer.This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2 to the receiving host monitor. 5 6 Verify that the settings for patient category and paced mode are correct. Transferring a Centrally-Monitored Patient using IIT WARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A). Scenario: A centrally-monitored patient is moved with an X2 to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. The X2 has an IntelliVue Instrument Telemetry interface (IIT), is connected to a host monitor, and is declared as a telemetry device at the Information Center. NOTE The Transfer key is not available while the X2 is connected to a host monitor (Companion Mode is indicated). 1 Remove the X2 and any connected extensions from the host monitor. 2 Move the patient using the X2 as the transport monitor. 3 At the new location, just before connecting the X2 to the new host monitor:

open the Patient Demographics window. select the Transfer pop-up key. wait until the transfer has completed. 89 6 Managing Patients Transferring Patients 4 Connect the X2 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer.This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2 to the receiving monitor. 5 Verify that the settings for patient category and paced mode are correct. Transferring a Centrally-Monitored Patient with the Monitor 1 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. 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 patients 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 mismatch, a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer. 3 4 Verify that the settings for patient category and paced mode are correct. If you accidentally transfer a patient, use Re-Admit to restore this patients 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. Resolving Patient Information Mismatch When you connect together devices which store patient demographic data, for example:

an MMS and a monitor, an X2 or MP5 and a host monitor, a monitor and an Information Center, the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical. WARNING 1 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. 90 Transferring Patients 6 Managing Patients 2 It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Category, may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in the case of asystole. It is important that the Patient Category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set. In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a telemetry device at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center. 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 Select Patient 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. For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patients data and ask Complete transfer of this patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. 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. 91 6 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 by selecting one of the sectors in the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. Select Patient DOE, JOHN F 1234HG9556, 2008/00123 Adult Non-Paced MILLER, Adult Paced Same Patient New Patient Patient Mismatch - If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient. Patient Mismatch - If Both Patient Data Sets Are Correct A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor. Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor. 92 7 7ECG, 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 109), ST monitoring (see page 121) and QT monitoring (see page 131). Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity. Select sites with intact skin, without impairment of any kind. 1 2 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. 4 Dry skin thoroughly. 5 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 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. 2 93 7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads 1 - ECG Connector 1 3 Attach the electrode cable to the patient cable. 4 Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display. CAUTION 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 is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis. You should choose a lead as primary or secondary lead that has the following characteristics:

the QRS complex should be either completely above or below the baseline and it should not be biphasic the QRS complex should be tall and narrow the P-waves and T-waves should be less than 0.2 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. 94 Understanding the ECG Display 7 ECG, Arrhythmia, ST and QT Monitoring 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. 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. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation. Understanding the ECG Display Your display may be configured to look slightly different. 1 8 2 3 4 5 M EASI 7 Paced Rhythm HR bpm 6 1 2 3 4 5 6 7 8 Lead label of the displayed wave 1 mV calibration bar Pacer spikes Pace pulse markers Current heart rate Current heart rate alarm limits EASI lead placement label ECG Filter label ECG HR numeric: This is the heart rate 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. 95 7 ECG, Arrhythmia, ST and QT Monitoring Monitoring Paced Patients 1 Pacer spikes configured to have a fixed size 1 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 left side. Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this:

1 2 1 2 Normal Beats Pace Pulses/Beats You should choose a lead as primary or secondary lead that has these characteristics:

the normal QRS complex 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 complex 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. 96 Changing the Size of the ECG Wave 7 ECG, Arrhythmia, ST and QT Monitoring 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. When Paced is set to Yes:

Paced Pace Pulse Rejection is switched on. This means that pacemaker pulses are Non-Paced not counted as extra QRS complexes. 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. 1 Repolarization tail

(note width) 1 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. 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, or an individual size using the Size Up / Size Down keys, 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. 97 7 ECG, Arrhythmia, ST and QT Monitoring Changing the Volume of the QRS Tone 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 2 In the Setup ECG menu, select Adjust Size. 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 menu select QRS Volume and then select the appropriate volume from the pop-up list. There will be no QRS tone when the X2 is connected to a host monitor. 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 Setup ECG menu, select Filter and then select the appropriate setting. Monitor: Use under normal measurement conditions. Ext. Monitor: Use for pediatric and neonatal patients when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting. 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 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. 98 Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 7 ECG, Arrhythmia, ST and QT Monitoring Diag: 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. When you are using a telemetry transmitter connected via short range radio to the monitor, the upper bandwidth for all filter settings is limited to 40 Hz. Selecting Positions of Va and Vb Chest Leads (for 6-

lead 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. In the Setup ECG menu, select Va Lead. Select the position used from the list. Select Vb Lead and select the position used from the list 1 2 3 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. 99 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback ECG Leads Monitored If you are using a 3-electrode set a 5-electrode set a 6-electrode set a 10-electrode set an EASI 5-electrode set these leads are available:

Resp is measured between electrodes:

RA and LL I, II, III RA and LL I, II, III, aVR, aVL, aVF, V and MCL I, II, III, aVR, aVL, aVF, Va, Vb RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Changing Lead Sets To change the ECG lead set, When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement. When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in the Setup ECG menu 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 Electrode colors AAMI EASI IEC AAMI RA LA LL RL V V1 V2 I S A N E R L F N C C1 C2 White Black Red Green Brown Brown/Red Brown/Yellow IEC Red Yellow Green Black White White/Red White/Yellow 100 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring Electrode labels Electrode colors AAMI EASI IEC AAMI V3 V4 V5 V6 C3 C4 C5 C6 Brown/Green Brown/Blue Brown/Orange Brown/Violet IEC White/Green White/Brown White/Black White/Violet Standard 3-Lead Placement 1 2 1 2 3 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 3 Standard 5-Lead Placement 1 I aVR V aVL II 5 a V F 2 III 3 4 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 101 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Placements 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 V3R V4R V1 V2 V3 VE V6 V4 V5 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 102 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring 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 1 2 5 4 3 1 - V1 - V6 2 - LA 3 - LL 4 - RL 5 - RA 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 103 7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead Modified 12-Lead ECG 6 5 1 2 4 3 1 - LA 2 - V1 - V6 3 - LL 4 - RL 5 - RA 6 - Angle of Lewis 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. 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. 104 EASI ECG Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring 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. EASI Electrode Placement 1 E (V) on the lower sternum at the level of the fifth intercostal space on the left midaxillary line at the same level as the E electrode on the upper sternum 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 2 3 4 5 A (LL) S (LA) I (RA) N 2 1 3 4 5 105 7 ECG, Arrhythmia, ST and QT Monitoring ECG and Arrhythmia Alarm Overview 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 Additional Alarms with Basic Arrhythmia Option Additional Alarms with Enhanced Arrhythmia Option

***Asystole

***Ventricular Tachycardia

**Afib

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**PVCs/min HIGH(PVC >

limit/min)

**High heart rate

**Low heart rate

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs 106 Using ECG Alarms 7 ECG, Arrhythmia, ST and QT Monitoring 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 ' value) to the high and low alarm limits. Extreme Brady Limit Low Limit High Limit Extreme Tachy Limit

' Extreme Brady

' 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

'ExtrTachy and 'ExtrBrady. ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitors 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 Detect. 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. 107 7 ECG, Arrhythmia, ST and QT Monitoring ECG Safety Information ECG Safety Information 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 patients 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. 108 About Arrhythmia Monitoring 7 ECG, Arrhythmia, ST and QT 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 algorithms 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 monitors QRS detector. Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate 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 patients condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-

lead 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 106, the rhythm and ectopic messages detected are listed in Arrhythmia Status Messages on page 113. 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. 109 7 ECG, Arrhythmia, ST and QT Monitoring Switching Arrhythmia Analysis On and Off Switching Arrhythmia Analysis On and Off 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. 1 2 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 complex 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 Alarm The monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability. In order to generate an Afib alarm the following criteria must be detected for 1 minute:

normal beat RR intervals must be irregular 110 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring PR interval deviation must be large P-wave region must not match well Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm. An Afib alarm can be falsely detected in the presence of:

sinus arrhythmia, muscle noise, or electrode motion artifact. If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations. See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis. 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 1 P 1mV 7 2 P P 3 Paced Rhythm Pair PVCs Delayed 6 4 PVC 2 5 HR 75 1 2 3 Beat label Pace pulse marks Rhythm status message 111 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display 4 5 6 7 PVC Numeric HR Numeric 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 112 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Status Messages The monitor displays two types of status messages:

Rhythm Status Messages -- to indicate the patients 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 ASYSTOLE VENT FIB/TACH V-TACH SUSTAINED V-TACH VENT RHYTHM No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal A fibrillatory wave for 4 consecutive seconds A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate Limit Ventricular tachycardia rhythm for more than 15 seconds A dominant rhythm of adjacent PVCs and a HR dthe V-Tach HR Limit 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 VENT BIGEMINY VENT TRIGEMINY PACED RHYTHM IRREGULAR HR SINUS BRADY SINUS RHYTHM SINUS TACHY SV BRADY SV RHYTHM SV TACHY UNKNOWN ECG RHYTHM Rhythm cannot be determined LEARNING ECG LEARNING RHYTHM CANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be Algorithm is learning the ECG beat morphology Algorithm is learning the rhythm of the classified beats A dominant rhythm of SV beats not preceded by P-waves analyzed B or E B, E B, E B, E E E E E B, E E B, E B, E B, E B, E B, E B, E 113 7 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) RUN PVCs PAIR PVCs PACER NOT CAPT PACER NT PACING PAUSE R-ON-T PVCs MULTIFORM PVCs FREQUENT SVPBs SVPBs SV BEATS PACED BEATS No ectopic activity within the last minute E More than 2 consecutive PVCs within the last minute E Pair PVCs within the last minute B, E Pause with pace pulse (paced patient only) within the last minute 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. 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 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 Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm rhythm status message Learning ECG. status message changes to Learning Rhythm. 2 After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly. 3 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. 114 Arrhythmia Alarms 7 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 alarm 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). 115 7 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. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply. WARNING When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-

star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. 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 and Afib. 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, when more alarms are switched off than configured in your active profile. 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:

Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold. 1 To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted. 2 Select the appropriate setting from the pop-up list. 116 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring 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. See Arrhythmia Alarm Chaining on page 118 for more details on alarm chains. 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 118). This setting can only be changed in Configuration Mode. To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd. Resetting the Timeout Period To reset the timeout period, press the Alarms key and then reselect it. 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 except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:

Alarm Condition Example Audible Indicators Short yellow alarm tone sounds ... Visual Indicators Alarm message displayed ... Single alarm instance Non-sustained V-tach Continuous alarm condition PVCs/min HIGH Same intermittent alarm condition Pair of PVCs 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 117 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms 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 every time the configured timeout 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 timeout expires. 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 106 for information on which alarms are included in the different arrhythmia options. See Arrhythmia Alarm Timeout Periods on page 117 for an explanation of how alarm timeouts work. 118 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Red Arrhythmia Alarms Asystole 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*

AFib Irregular HR

(occurs only if no other arrhythmia alarms are present) First level timeout period

(TimeOut 1st) Second level timeout period

(TimeOut 2nd) y t i r o i r p r e h g i h y t i r o i r p r e w o l 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

*If HR High/Low alarms are configured as standard yellow alarms, they are independent of the arrhythmia alarms and are not in the Rate alarms chain. 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. 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). 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. 119 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms V-Tach Run Limit

** Non-Sustain VT PVC Run < 8 HR > 100

**Pair PVCs PVC =

2

***V-Tach PVC Run t8 HR > 100 V-Tach Heart Rate Limit 100

** Run PVCs PVC Run > 2butd12 HR d 100

** Vent Rhythm PVC Run > 12 HR d 100 1 2 3 4 5 6 7 8 9 10 11 12 14 15 Number of Consecutive PVCs (PVC Run) Ventricular Rhythm Run Limit e t a R t r a e H r a u c i r t n e V l 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. 120 About ST Monitoring 7 ECG, Arrhythmia, ST and QT 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. 121 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display and Windows 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 Choose a lead from the list in the Setup ST Leads window. 2 Select the Delete key. This removes this lead from the list. NOTE The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen. To change the order in which ST leads are displayed, 1 2 In the Setup ST Leads menu, choose a lead from the list. Select the Sort Up or Sort Down key to move the lead up or down in the list. Understanding the ST Display and Windows Your monitor screen may be configured to look slightly different from the illustrations. 2 3 1 ST-II 1.2 ST-V 2.5 ST-aVR -3.0 1 2 3 ST numerics Current HR alarm limits Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor 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 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 havent 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 Setup ST Analysis menu, select ST-Index to toggle between On and Off. 122 Updating ST Baseline Snippets 7 ECG, Arrhythmia, ST and QT Monitoring 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. 1 2 ST-II

-0.30.8?-1.1 ST Baseline 3 4 5 6 1mv 1sec ST Baseline from 04 Apr 07 9:38 1 2 3 4 5 6 ST label and numeric Baseline ST numeric and difference since baseline was stored 1mV calibration bar Current snippet ST baseline Timestamp of most recently stored baseline snippet 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, Select the ST numerics then ST Baseline to open the ST Baseline window. In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines. 1 2 123 7 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points 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. R-wave peak at 0 msec J point, for example, 48 msec T Difference = ST value P Q S Isoelectric point set to -80 msec 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 monitors 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, 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. 1 2 124 About the ST Measurement Points 7 ECG, Arrhythmia, ST and QT Monitoring 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). ST label and the ST numeric that would apply using the current points 1mV calibration bar ST-I 0.1 Adjust ST Points Cursors for adjusting ST points Highlighted ST point 1mv 1sec ST Points adjusted at 04 Apr 07 11:38 Update Apply Changes 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). ISO 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. 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. 4 125 7 ECG, Arrhythmia, ST and QT Monitoring ST Alarms 5 To update the ST snippet shown in the Adjust ST Points window, select the Update pop-

up key. 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 menu, select ST Alarm Mode and select either Single ST or Multi ST. 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. In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST. Select the alarm to be adjusted. 1 2 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. 126 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring SBed10 Adult ST Map (Current) ST-II HIGH Limb Leads Chest Leads Size Up Trend View Size Down Select Interval Show Baseline Print Show Values If an ST lead is switched off, its axis is not shown in the map. 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 127 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps 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 Map (Current) ST-II HIGH 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 Map (Trend) ST-II HIGH Limb Leads Chest Leads 5 min trending interval Show Values Show Baseline Print Scroll to view more pop-up keys Size Up Current View Size Down Select Interval 128 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring 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 195. 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. 129 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps Changing the Trending Interval To determine how frequently the monitor displays a trended sample, In Trend view, select Select Interval. Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. 1 2 Printing an ST Map Report To print the most recently viewed (current or trend) window, Select Main Setup - > Reports. Select ST Map. Press Print. 1 2 3 130 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT 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 P T 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. 131 7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval 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, Select the QT numeric to enter the Setup QT Analysis window. Select QT Lead and select All, Primary Lead or one of the available single leads. 1 2 When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads. 132 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT View In the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads. Changing The View To A Single Wave Set To view one set of waves in a larger scale, you can cycle through the different views, Select Current view to see the set of current waves. Select Baseline view to see the set of baseline waves. Select Split view to return to the combined view with current and baseline waves. 1 2 3 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 'QTc value. To set the baseline, Select Set Baseline and set the value. 133 7 ECG, Arrhythmia, ST and QT Monitoring QT Alarms 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 'QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a 'QTc alarm from being generated. Discharging a patient clears the baseline. Printing The QT Waves To start a printout, Select Print QT. Recording The QT Waves To start a recording, Select Record QT. QT Alarms There are two QT alarms, QTc high limit alarm and 'QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The 'QTc 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. The following additional messages on the cause of the invalid measurements may also be displayed. Additional Message QT Startup Asystole or Leads Off Cause of Invalid QT Measurement QT monitoring was just turned on or has been reset 1 Not all specified leads needed to perform QT analysis are available, or 2 Asystole condition is detected Not enough valid QRS complexes to generate a QT measurement Insufficient Valid Leads Invalid rhythm for QTc Not enough valid RR intervals to generate QT-HR, the averaged HR High QT-HR used for QTc calculation QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics) R-wave of the signal is too small T-wave of the signal is too small End of the T-Wave cannot be accurately detected QT measurement is outside the specified range of valid QT values (200-

800 msec) QTc measurement is outside the specified range of valid QTc values

(200-800 msec) QTc measurements are not stable Small R Wave Small T Wave End of T Not detected QT Out Of Range QTc Out Of Range QTc Erratic 134 Switching QT Monitoring On and Off 7 ECG, Arrhythmia, ST and QT Monitoring 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

'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. In the Setup QT Analysis menu, select High Limit. Select the appropriate setting. Select 'High Limit. Select the appropriate setting. 1 2 3 4 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. 135 7 ECG, Arrhythmia, ST and QT Monitoring Switching QT Monitoring On and Off 136 8 8Monitoring 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 SpO2 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 SpO2 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 monitors databases. To define which pulse rate is used as system pulse, 1 2 In the Setup Pulse menu, select System Pulse. Select one of the SpO2 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. 137 8 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 SpO2 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. In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and Off. 2 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. 138 Using Pulse Alarms 8 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 106, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow

(medium severity) INOP after a fixed number of hours. 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 Alarm Source Selection. 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 SpO2 is 30 bpm; for HR 15 bpm, and for Pressure 25 bpm. 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. WARNING The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis. If arrhythmia detection is needed, do not rely on the audible QRS tone. There will be no QRS tone when the X2 is connected to a host monitor. 139 8 Monitoring Pulse Rate Using Pulse Alarms 140 9 9Monitoring Respiration Rate

(Resp) For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patients 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. 141 9 Monitoring Respiration Rate (Resp) Understanding the Resp Display 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 patients 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 1 Ohm Resp numeric and label 22RR Changing Resp Detection Modes The Resp detection level can be set either automatically or manually. To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings. 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, 142 Changing the Size of the Respiration Wave 9 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. 143 9 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. In the Setup Resp menu, select Apnea Time. Select the appropriate setting. 1 2 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. 144 Resp Safety Information 9 Monitoring Respiration Rate (Resp) Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate 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. 145 9 Monitoring Respiration Rate (Resp) Resp Safety Information 146 10 10Monitoring SpO2 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 (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). Pleth waveform - visual indication of patients 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 SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information. SpO2 Sensors Depending on the purchased SpO2 option, different sensors and adapter cables can be used. The sensors for the different options are color-coded to match the connectors. See the section on Accessories for a compatibility table. 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 Follow the SpO2 sensors instructions for use, adhering to all warnings and cautions. 2 Remove colored nail polish from the application site. 3 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, 147 10 Monitoring SpO2 Connecting SpO2 Cables 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. 4 Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patients 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 41C on the skin if the initial skin temperature does not exceed 35C. Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line. Connecting SpO2 Cables Connect the sensor cable to the color-coded socket on the X2. You can connect some Philips sensors directly to the measurement device. 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 SpO2 1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 2 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. 148 SpO2 Signal Quality Indicator (Fast SpO2 only) 10 Monitoring SpO2 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. SpO2 Signal Quality Indicator (Fast SpO2 only) The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the current values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled. SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse. When pulse rate is very low, or strong arrhythmia is present, the SpO2/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value. If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality. NOTE 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. 149 10 Monitoring SpO2 Changing the Averaging Time Changing the Averaging Time Depending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high. In the SpO2 Setup, select Average. Select the required averaging time from the list. 1 2 Setting the Measurement Mode When a telemetry device supplies SpO2T to the monitor via short range radio transmission, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save the telemetry devices battery power. To set the measurement mode, In the SpO2 Setup, select Mode. Select Continuous or Manual mode. 1 2 Making a Manual Measurement When the measurement mode is set to manual, In the SpO2 Setup, select Measure SpO2. When manual measurements are made, there will be no continuous SpO2 monitoring or alarming. The manual measurement value reflects a momentary status. The numerics from SpO2T measurements made in manual mode, for example SpO2T, PerfT, PulseT, will remain for a time on the main screen. They are annotated with the time that the measurement was made to distinguish them from continuously measured values. Perf T Understanding SpO2 Alarms This refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit. 150 Pleth Wave 10 Monitoring SpO2 CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 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 254). Adjusting the Alarm Limits In the Setup SpO2 menu:

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. 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. In the Setup SpO2 menu, select DesatLimit. 1 2 Adjust the limit. 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. 151 10 Monitoring SpO2 Perfusion Numeric minimum size for reliable SpO2 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 SpO2 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 SpO2/Pleth as Pulse Source In the Setup SpO2 menu, select Pulse (SpO2) to enter the Setup Pulse menu. In the Setup Pulse menu, select SystPulse and select SpO2 from the pop-up list. 1 2 Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 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 SpO2 menu, select Tone Mod. to toggle between Yes (for on) and No (for off). 152 Setting the QRS Volume 10 Monitoring SpO2 Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated. Setting the QRS Volume In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume. When the X2 is connected to a host monitor there will be no QRS tone. 153 10 Monitoring SpO2 Setting the QRS Volume 154 11 11Monitoring 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. 155 11 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 (intra-

arterial). 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. 156 Preparing to Measure NBP 11 Monitoring NBP 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 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. 4 Apply the cuff to a limb at the same level as the patients 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. Auto 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. 157 11 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 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 Mode 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 In the Setup NBP menu, select Mode and select Sequence from the pop-up menu. Select Setup Sequence to open the Setup 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. 4 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:

158 Switching Pulse from NBP On/Off 11 Monitoring NBP Menu option Pressure value monitored systolic Sys. diastolic Dia. mean Mean systolic and diastolic in parallel Sys&Dia diastolic and mean in parallel Dia&Mean Sys&Mean systolic and mean in parallel Sys&Dia&Mean 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 Pulse NBP Sys. 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 In the NBP Setup menu select VeniPuncture. Puncture vein and draw blood sample. 2 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. 159 11 Monitoring NBP Calibrating NBP Cuff pressure Venous puncture measurement mode NBP

(60) VP Time left in venous puncture mode 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. 160 12 12Monitoring Temperature WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or 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 Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes. 5 Select an appropriate temperature label. 6 Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement. 161 12 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 labels stored color and alarm settings. In the Setup <Temp> menu, select Label. Select the appropriate label from the list. 1 2 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 'Temp. 1 In the Main Setup menu, select Measurements. In the Setup 'Temp menu, select First Temp. Label the measurement source as appropriate. Select Second Temp. Label the measurement source as appropriate. 2 3 4 5 The 'Temp value is not available when the X2 is connected to a host monitor. 162 13 13Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A). CAUTION Do not use the X2 in combination with 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 monitors 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. 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. 163 13 Monitoring Invasive Pressure Setting up the Pressure Measurement 4 Connect the pressure line to the patient catheter. 5 6 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 patients 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 labels 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. In the Setup <Press> menu, select Label. Select the appropriate label from the list. 1 2 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 P PAP RAP UAP UVP Description 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. Description Label BAP FAP IC1, IC2 P1, P2, P3, P4 Alternative non-specific pressure labels Brachial arterial pressure Femoral arterial pressure Alternative intracranial pressures 164 Zeroing the Pressure Transducer 13 Monitoring Invasive Pressure 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 monitors 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 manufacturers 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 Pressures 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 pressures 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 Turn off the stopcock to the patient. 2 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>. 3 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. CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. 165 13 Monitoring Invasive Pressure Adjusting the Calibration Factor Troubleshooting the Zero The status line lists the probable cause of an unsuccessful zero:

Corrective Action The hardware is faulty. Contact your service personnel. 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. Message cant zero;

equipment malf. cant zero;

excessive offset Make sure the transducer is vented to air and try again. If this fails, the hardware cant zero -

unstable signal cant zero - no transducer cant zero;

pulsat. pressure Make sure that the transducer is vented to air, not to the patient, and try again. unable to zero -

timed out switch <Press> on first Try pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel. Pressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressures label. 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. 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. 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 hospitals procedure. 1 2 To confirm you want to use the new calibration factor, select the Confirm popup. Displaying a Mean Pressure Value Only Use this when you want to see only the mean pressure. In the pressures 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 3 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. 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. 166 Optimizing the Waveform 13 Monitoring Invasive Pressure 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. Pressure value monitored Menu option Sys. Dia. Mean Sys & Dia Dia & Mean Sys & Mean Sys&Dia&Mean Select and set the High Limit and Low Limit for the pressure(s) you have selected. systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel 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 ' value) to the high and low alarm limits. This value can be set for each pressure label individually. 167 13 Monitoring Invasive Pressure Choosing the Pressure Alarm Source Extreme Low Limit Low Limit High Limit Extreme High Limit

' Extreme Low

' 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 'Extr. High and 'Extr. Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message. 168 Calibrating Reusable Transducer CPJ840J6 13 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6 Depending on your monitors 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 Zero the transducer. 2 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 on monitor 12 PIN 3 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. 4 169 13 Monitoring Invasive Pressure Calculating Cerebral Perfusion 5 Select the calibration pressure from the list, for example 200 mmHg. Select Confirm to recalculate the calibration factor using the applied pressure. 6 7 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 pressures setup menu. 8 9 Reconnect the patient and start measuring again. Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration. Message cant calibr.; equipmt malf. cant calibrate;out of range cant calibr.; no transd. cant cal.; unstable signal cant 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. In the Main Setup menu, select Measurements. In the Setup CPP menu, select ABP, ART, Ao, BAP or FAP as the arterial pressure source. 1 2 The CPP value will not be available when the X2 is connected to a host monitor. 170 14 14Monitoring Carbon Dioxide WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A). Only one CO2 measurement at a time is supported. Use the CO2 measurement to monitor the patients respiratory status and to control patient ventilation. There are two methods for measuring carbon dioxide in the patients airway:

Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patients breathing system. This method is available using the monitors built-in CO2 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 patients airway and analyzes it with a remote CO2 sensor. You can measure sidestream CO2 using the monitors built-in CO2 measurement (optional) or using the M3014A Capnography Extension, or the M3015A Microstream CO2 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 CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2. When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2. The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure. The measurement provides:

a CO2 waveform. an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase. an inspired minimum CO2 (imCO2): the smallest value measured during inspiration. an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform. 171 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off). WARNING Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation. Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols. Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, 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 etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 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 etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only. Measuring CO2 using the CO2 Option or M3014A The monitor (with the CO2 option) or the M3014A Capnography Extension measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method or the sidestream method. The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 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 patients 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 CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference. Preparing to Measure Mainstream CO2 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 CO2 connector on the monitor (when the optional CO2 measurement is integrated) or on the extension. 2 Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition. 172 Measuring CO2 using the CO2 Option or M3014A 14 Monitoring Carbon Dioxide 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 CO2 including the ventilator, the patients breath and your own. in the setup menu for the CO2, 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 CO2 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 CO2 1 Plug the sensor cable into the monitors CO2 input connector. Allow the sensor two minutes warm up time 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 CO2 including the ventilator, the patients breath and your own. In the setup menu for the CO2, select Start Zero Cal. 173 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A 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 Y-

section. 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. 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. 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 Push the sensor into the holder until it clicks into position. 2 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 174 Measuring Mainstream CO2 using M3016A 14 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the sidestream CO2 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 CO2 using M3016A The M3016A Mainstream CO2 Extension measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO2 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 CO2 1 Attach the transducer connector to the CO2 connector on the M3016A extension. 2 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 CO2 readings. 1 2 3 4 5 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 CAL1. Is it the same as the value on the calstick? If not, calibrate the transducer now. 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. Place the transducer on one of the calstick cells and select Start CAL1. 2 175 14 Monitoring Carbon Dioxide Measuring Mainstream CO2 using M3016A other cell and select Start CAL2 then press Confirm. 3 Enter the calibration value printed on the calstick then press Confirm to start calibration. 4 When the message CO2 CAL1 done;Start CAL2 cal appears, put the transducer on the 5 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. 6 Attaching and Removing the CO2 Transducer Airway Adapter CO2 Transducer 1 Open the latch and place the transducer onto the airway adapter. Place the airway adapter in the patients breathing circuit between the endotracheal tube and the Y-

piece. You may see the CO2 SENSOR WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. 2 To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. WARNING To prevent stress on the endotrachial tube, support the transducer and airway adapter. To avoid infection, use only sterilized airway adapters. 176 Measuring Microstream CO2 using M3015A 14 Monitoring Carbon Dioxide Measuring Microstream CO2 using M3015A The M3015A Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patients expired gas using Microstream technology. The measurement is equipped with an automatic barometric pressure compensation. Preparing to Measure Microstream CO2 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 The Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory. 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 CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine). Using the FilterLine and Airway Adapter 1 Attach the female Luer connector to the CO2 inlet connector on the extension by pushing the socket cover down and screwing the connector into place. inlet connector cover outlet connector 2 Check that the FilterLine is not kinked. 3 Change the FilterLine if a CO2 OCCLUSION INOP appears on the monitor or if the readings become extremely erratic. 177 14 Monitoring Carbon Dioxide Setting up all CO2 Measurements Disconnect the FilterLine during suctioning and nebulizing therapies. Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. CO2 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 CO2 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 SmartKey, if configured. To prevent an automatic zero calibration from being started in the next five minutes, in the Setup CO2 menu, select No Zero For 5Min, or select the Suppress CO2 Zero Selecting No Zero For 5Min 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 all CO2 Measurements These tasks are common to all CO2 measurements except where otherwise noted. Adjusting the CO2 Wave Scale In the CO2 Wave menu or the Setup CO2 menu, select Scale. 1 2 Choose a suitable scale range from the pop-up list. Setting up CO2 Corrections Temperature, water vapor in the patients breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections. Correction Altitude

(M3014A only) Altitude is set during installation. The monitor automatically applies an appropriate correction. 178 Setting up all CO2 Measurements 14 Monitoring Carbon Dioxide Correction O2

(M3014A only) Humidity N2O

(M3016A mainstream and M3015A microstream only) Gas

(M3014A only) Agent

(M3014A only) In the Setup CO2 menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list. At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO2 menu, and scroll down to look at Hum. Corr or HumidityCorr. In the Setup CO2 menu, select N2O Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on. If the N2O correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below). In the Setup CO2 menu, select Gas Corr. and select Helium, N2O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection. If the Gas correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with N2O Corr. (see above). 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 CO2) available. To temporarily stop sampling, in the Setup CO2 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 CO2 menu, select Pump On. Changing CO2 Alarms This refers to CO2 specific alarms. See the Alarms section for general alarm information. You change CO2 alarm settings in the Setup CO2 menu. To switch etCO2 alarms on and off:

Select etCO2 Alarms and toggle between On and Off. To change the etCO2 alarm limits:

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. 179 14 Monitoring Carbon Dioxide Setting up all CO2 Measurements To change the imCO2 high limit:

Select imCO2 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. In the Setup CO2 menu, select awRR. In Setup awRR menu, select Apnea. 1 2 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. Deriving Alarms From awRR 1 In the Setup CO2 menu, select awRR. In the Setup awRR menu, select Alarms. 2 3 Choose On to derive alarms from the airway respiration signal or Off to disable them. Changing awRR Alarm Limits In the Setup CO2 menu, select awRR. Select High Limit to set the upper alarm limit. Select Low Limit to set the lower alarm limit. Select the appropriate setting. 1 2 3 180 15 15Assigning Two Devices to One Patient It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called pairing and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be:

any Philips telemetry device (only for indirect connections, see below). a TRx+/TRx+ Intellivue Telemetry system transceiver. an X2 Multi-measurement module with a telemetry interface, declared as a telemetry device and with a telemetry equipment label. How Can You Combine Devices?

With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor. With a direct connection to the monitor, via a short range radio link - the data arrive with a minimal delay on the monitor screen. Indirect Connection - Manual Pairing The telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use. To pair the monitor with a telemetry device at the monitor:

1 Select Main Setup then Measurements Select Telemetry 2 The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor. 181 15 Assigning Two Devices to One Patient How Can You Combine Devices?

Telemetry Data Window The measurements from the telemetry device are shown in the telemetry data window on the monitor when there is no direct connection via short range radio link. TELE INOP Delayed

* TELE ALARM

** HR 140>120 SOME ECG ALRMS OFF HR NBP Sys.

%SpO2T Telemetry data window Auto 10 min etCO2 imCO2 WARNING All data presented in the telemetry data window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG Sync Pulse output. Direct Connection - Automatic Pairing The following direct connections are possible:

a TRx+4841A Intellivue Telemetry system transceiver connected via short range radio (SRR) link to an X2 with SRR capability. an X2, declared as a telemetry device, and connected with an MSL cable to a monitor (MP20-90). If a telemetry device is assigned to a monitor via a direct short range radio link, the monitor and the telemetry device are automatically paired at the Information Center (if configured). The measured data from the telemetry device ECG and, if available, SpO2T will appear on the monitor screen and will be sent through the monitor to the Information Center. The ECG waves and numerics appear in place of the monitors own ECG, and SpO2T is displayed as an additional measurement. When ECG is measured with the telemetry device there will be no Respiration measurement derived. WARNING When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel. When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected. 182 How Can You Combine Devices?

15 Assigning Two Devices to One Patient Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. See the "Enhancing Telemetry Monitoring with the Monitor" chapter. Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor Monitors which have this capability have a short range radio symbol A telemetry device with a short range radio adapter can be assigned to a monitor directly. To assign a telemetry device to a monitor:

on the model label. 1 2 3 Press the Check button on the telemetry device. The measurement selection key on the monitor will change to show the assign telemetry icon Select the assign telemetry icon. In the Assign Telemetry Device menu, select the correct equipment label for the telemetry device. 4 Check that the assignment is successful and that transmission has begun:

A Tele Device assigned message appears on the monitor a tone sounds at the telemetry device and the Laeds Off indicators light the ECG wave appears on the monitor To confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label. If a monitor is already paired to another device, you cannot assign a telemetry device to that monitor. If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Telemetry Data Window as described above. If a monitor is manually paired with a telemetry device with a short range radio adapter, the short range radio assignment will be automatically made. If a telemetry device disappears from the list in the Assign Telemetry Device menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the assign telemetry icon will appear crossed out If the devices are unpaired, the short range radio connection will be ended. WARNING Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section 36.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a TELE DISCONNECT INOP. 183 15 Assigning Two Devices to One Patient How Can You Combine Devices?

Correct channel configuration is important, refer to the Configuration Guide for details. If a TELE DISCONNECT INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission. SpO2T Manual Mode When a telemetry device with a short range radio connection supplies SpO2T to the monitor, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save battery power. To ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor. Unassigning a Telemetry Transceiver with SRR Adapter at the Monitor If a monitor and a telemetry device are paired, the assignment and the short range radio connection will be ended when the devices are unpaired (see Unpairing the Monitor and Telemetry Device on page 184). If the monitor does not have a connection to an Information Center, you must manually end the assignment and the short range radio connection. 1 2 3 Select the Measurement Selection key. In the Measurement Selection window, select the Tele pop-up key. In the Tele device window select Unassign Tele. Pairing an X2 With a Telemetry Interface to a Host Monitor An X2 using an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a telemetry device at the Information Center. When the X2 is disconnected from the host monitor it will remain paired and the measurement data will appear at the host monitor in the Telemetry Data window. After the X2 is disconnected from the monitor it may take over 15 seconds until its data is displayed at the Information Center. NOTE Pairing of a host monitor and a telemetry device, with all the related functionality, is only possible when the host monitor is using a wired LAN connection or a wireless LAN interface (but not using the IntelliVue Instrument Telemetry interface). The X2 can also be paired to a host monitor without a direct connection, as described in Indirect Connection - Manual Pairing on page 181. Refer also to Use Models With Telemetry on page 188 for further related use modes. Unpairing the Monitor and Telemetry Device If the patient will no longer be monitored with the telemetry device, or only with the telemetry device and no longer with the monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device:

select the Unpair To Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the monitor 184 Functions Available When the Telemetry Data Window is Displayed 15 Assigning Two Devices to One Patient select the Unpair To Tele SmartKey to end pairing and have the Information Center receive the measurement data from the telemetry device or use the Unpair function at the Information Center. NOTE The Unpair SmartKeys and pop-up keys appear only on the monitor which is directly involved in pairing. Functions Available When the Telemetry Data Window is Displayed Controlling the Telemetry Device from the Bedside You can change settings for a paired telemetry device at the monitor:

1 Select the telemetry data screen element Select the Setup Tele pop-up key 2 The Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here. Viewing and Silencing Telemetry Alarms at the Bedside When a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic Tele Alarm message will appear in the alarm status area with standard alarm tones. The Tele Alarm message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example *HR Low) will appear in the Telemetry Data Window. If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:

1 Select the telemetry screen element. Select the Silence Bed pop-up key. 2 Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms. WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured. Suspending Telemetry Alarms When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected. 185 15 Assigning Two Devices to One Patient Functions Available For Devices Connected Via SRR Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device. Using Standby When you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring. Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device. Functions Available For Devices Connected Via SRR Telemetry Device Tele 1 The Telemetry Device window can be opened from the Measurement Selection window, by selecting the Tele pop-up key, or via Main Setup -> Telemetry Device. The window shows the equipment label of the assigned telemetry device and, for monitors with SRR capability, a battery status symbol and a symbol indicating the signal quality of the SRR link If the monitor has a connection to an Information Center, the pop-up keys Unpair to Mon. and Unpair to Tele let you end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device. If the monitor does not have a connection to an Information Center, or there is a pairing mismatch, the Unassign Tele pop-up key lets you end the telemetry device assignment and close the SRR link. Temporarily Stopping the Short Range Radio Connection To temporarily disable the SRR connection for this device, for example, in case of interference:

Select the Stop SRR pop-up key. This closes the SRR link and the telemetry device switches over to standard telemetry transmission. The battery status symbol will no longer be shown and the SRR quality indicator symbol will be crossed out. To return to SRR use:

Select the Start SRR pop-up key and press the Check button on the telemetry transceiver. 186 General Telemetry-related Functions 15 Assigning Two Devices to One Patient Setting Up Measurements The Setup ECG and Setup SpO2T pop-up keys give you access to the measurement setup menus. The Measmt. Select. pop-up key takes you directly to the Measurement Selection window where all connected measurement devices are shown. General Telemetry-related Functions The following functions are valid for directly and indirectly connected telemetry devices. ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated the ECG Setup menu will no longer be accessible. When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitors own measurements, the SpO2T measurement (if present) will no longer be displayed. In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa. In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:

Heart Rate ECG Arrhythmia ST QT SpO2T HR/Pulse Alarm On/Off, Heart Rate High/Low Limit, Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead Placement Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/

min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-

Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/Off ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm Limit QT analysis On/Off, QT Lead, QTc High Alarm On/Off, 'QTc Alarm On/Off, QTc High Limit, 'QTc High Limit, QTc Formula2, QT Baseline SpO2 Alarms on/off, SpO2 Alarm limits NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off 187 15 Assigning Two Devices to One Patient Use Models With Telemetry 1.Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6. 2.These setting will only be synchronized when the Information Center supports QT Analysis for Telemetry. WARNING Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate. Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6 If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient. Use Models With Telemetry The standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the Information Center in the same patient sector as the monitor data. The following variations are possible:

1 X2 monitor is paired with a telemetry transceiver - direct connection telemetry data appear on the monitor the X2 cannot be connected to a host monitor (Companion Mode) 2 X2 is declared as a telemetry device and paired with one of the larger monitors (MP20-90) X2 measurement data appear on the monitor it is paired with a telemetry transceiver cannot be used with the X2 3 A telemetry transceiver with a short range radio adapter is assigned to an X2 which is connected

(Companion Mode) to a larger host monitor (MP20 - MP90) - direct connection. telemetry data appear on the host monitor telemetry transceiver is paired with the host monitor but is assigned to the X2 the X2 must have no equipment label The different variations require different configuration settings; refer to the Configuration Guide for details. NOTE If a telemetry transceiver is directly connected to an X2 or MP5 that is connected (via Companion Mode) to a host monitor with revision F software, a TELE CONFIG UNSUPP INOP will appear as this combination is not supported. 188 16 16Enhancing Telemetry Monitoring with the Monitor You can use a monitor without a network connection to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio. Monitor and Telemetry Transceiver Requirements The monitor and the telemetry transceiver need a direct connection via a short range radio link. Not all revisions of the telemetry transceiver can be used directly with the monitor, if you connect a device that cannot be used you will see a TELE UNSUPPORTED INOP. Due to data availability restrictions, it is not recommended to use a monitor connected to a host monitor (Companion Mode) to collect data in this way. If such a monitor is used a CENTRAL: TELE ONLY INOP will be displayed. Data Sent to the Information Center The data sent to the Information Center includes numerics from NBP, SpO2, Pulse from SpO2 and predictive temperature. INOPs from these measurements, battery INOPs and a general INOP generated by alarms from any other measurement (MORE BED ALARMS) will also be transmitted. NOTE The monitor must be configured appropriately to support direct connection to a telemetry transceiver;

refer to the Configuration Guide for details. Changing Assignment to a New Telemetry Transceiver 1 Assign the telemetry transceiver to the monitor; see Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor on page 183. 2 Make the required measurements; the data will be automatically sent to the Information Center via the telemetry transceiver. It is not necessary to unassign the telemetry transceiver. This will happen automatically when the next telemetry transceiver is assigned. The patient is also discharged (if configured), ensuring that the measurement data is erased before data from the next patient appears. Always assign the telemetry transceiver before you start making measurements. 189 16 Enhancing Telemetry Monitoring with the Monitor 190 17 17Trends Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patients condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-

measured 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 Change Screen window, then select a Screen designed to show an embedded trend window. To open the tabular trends window, select Main Setup > Trends >

Vitals Trend, or select the Vitals Trend SmartKey. To open the graphic trends window over the current Screen, select Main Setup > Trends > Graph Trend, or select the Graph Trend SmartKey. Vitals Trend Graph Trend 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 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 graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. 191 17 Trends Viewing Trends Pop-Up Keys Select Group Select Interval Print Vital Signs Graph Trend Selecting this pop-up key lets you.... see a pop-up list of trend groups and select a group for viewing. 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. 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 SpO2 RR 4 Apr Select Group Vital Signs Print Select Interval Scroll to view more pop-up keys 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, 1 Select the graphical trend or the arrow pop-up keys to activate the cursor. 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 192 Setting Up Trends 17 Trends 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends Vital Signs: Standard HR SpO2 etCO2 imCO2 RR awRR Select Interval Select Group Graph Trend Print Aperiodic values are shown with a timestamp Scroll to view more pop-up keys 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. 193 17 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 menu, select Highlight repeatedly until the highlight is on the required measurement. 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:

In the Segment menu, select Change Group 1 2 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:

194 Setting Up Trends 17 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, Select Main Setup -> Trends -> Trend Groups Select the Trend Group and then the measurement you want to move and use the Sort Up/

Sort Down pop-up keys. 1 2 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, In the Main Setup menu, select Trends. Select Trend Priority. 1 2 To add measurements to the priority list, Select the pop-up key Add and choose from the pop-up list of available measurements. 1 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. Select Parameter Scales. Select the measurement or parameter you want to change from the list. 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. 2 3 4 5 Graphical Trend Presentation Graphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, Select Main Setup -> Trends 1 195 17 Trends Documenting Trends Select Global Style and choose 2 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. ABP 240 50 This sample ABP trend shows the continuously-

measured values for the systolic, diastolic and mean pressures displayed in band form. Documenting Trends To print a Vital Signs or Graphical Trends report, in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitors 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. 196 Screen Trends 17 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, histogram 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. 197 17 Trends Screen Trends SBed9 HR Adult SpO2 ALARMS OFF Perf Arrhythmia Off 1mV Auto 15 min Temp Measurement numerics Measurement wave M NBP Sys. NBPs 65

-60min

-30min NBPs ABP 240 50 65

-30min

-60min NBP graphical screen trend Example of other graphical screen trends: ABP SBed9 HR Adult Pulse ALARMS OFF SpO2 Arrhythmia Off 1mV Auto 15 min Temp Measurement numerics Measurement wave M NBP NBP Sys. Tabular screen trend 198 Screen Trends 17 Trends Setting the Screen Trend Time 1 2 To set the ScreenTrend Time for all graphical, histogram and horizon screen trends (global trend time), 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 trend or a group of aligned screen trends, 1 2 3 Select a screen trend Select Change TrendTime 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 2 Select the screen trend. 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 2 Select the screen trend to open the screen trend menu, 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, histogram 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. 199 17 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 patients condition since the baseline was set. The horizon view is made up of:

a horizon, drawn in white, as a reference 1 2 3 point or baseline to help you visualize changes in your patients condition. The horizon can be set to represent your patients current 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 patients 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 the same, the horizon is a baseline - if the values are different the horizon is a range. Select Set High Horizon to select the upper horizon value. If the high and low horizon values are Set Low Horizon to select the lower horizon value. Auto Horizon to set the horizon for the selected horizon trend to the currently-measured 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. value 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. 200 Screen Trends 17 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 patients 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. Select Main Setup > Trends Select HorizonArrowTime. Select 10, 5 or 2 minutes. 1 2 3 201 17 Trends Screen Trends 202 18 18 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. When an X2 is connected to a host monitor (Companion Mode is indicated):

No central recording is available on the X2. Central recordings are made via the host monitor. Local recordings may be available. See the Instructions for Use for your host monitor for details. 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, Select the Main Setup SmartKey then select Recordings. Select the pop-up key Select Waves, 1 2 3 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If 4 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. Select the Start pop-up key to start the recording. 5 Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping. 203 18 Recording Overview of Recording Types Overview of Recording Types Delayed Alarm Realtime (RT) Type of recording manual central Recording Destination Information recorded automatic, triggered by defined alarm conditions central printer manual central from the start trigger minus the delay time from the start trigger minus the delay time N/A from the start trigger Number of waves up to 2 up to 2 Speed Runtime Stops Delay Time Overlap 50, 25, 6.25 mm/sec 25 mm/sec N/A N/A automatically automatically 10, 15 seconds 10, 15 seconds Off On (up to 2 waves) Off On (up to 2 waves) N/A = not applicable N/A N/A N/A N/A N/A N/A up to 2 50, 25, 6.25 mm/sec continuously manually none Off On (up to 2 waves) Creating and Changing Recordings Templates 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. 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 monitors Configuration Mode. 1 2 3 4 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 204 Recorder Status Messages 18 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 204. 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 No recorder available. Alarm recordings will be lost. Try configuring Printer as the alarm recording destination. The named recorder is out of paper. Central Recorder out of paper Central Recorder door open The door of the specified recorder is open. 205 18 Recording Recorder Status Messages 206 19 19Printing 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. Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up 1 2 Select Main Setup - > Reports Select Auto Print Dbs. Always will print all reports when a matching printer is available. Host only will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in grey on the Reports Job List) must be manually sent to the printer. See Checking Report Status and Printing Manually on page 211. Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See Checking Report Status and Printing Manually on page 211. 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. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient. When the X2 is connected to a host monitor, reports requested or stored on the X2 can be printed via the host monitor. Reports requested on the X2 when connected to a host monitor will not show any patient alarms or INOPs. In order to see alarms, reports should be requested on the host monitor. 207 19 Printing Patient Reports Stopping Reports Printouts Report types Report contents Vital Signs Report Graphic Trends Report ECG Reports ST Map Report Alarm Limits Report Realtime Reports Battery Report depends on selected trend group, data resolution, and period. Depends on format selected ST data in a transversal and/or horizontal multiaxis diagram, Graphic and numeric report of all current alarm limits 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 Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available. How to start printing reports In the Vital Signs window, select Print In the Graphic Trends window, select Print Select the ECG Report SmartKeys, if configured In the ST Map window, select Print. In the Alarm Limits window, select Print Limits Select the Realtime Reports SmartKey, if configured In the Battery Status window, select Print Status. In the Main Setup select Reports then Central Report A, B or C. Stopping Reports Printouts To stop Reports printing, in the Reports menu, select Delete Report to stop the current print job Delete All Repts 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 1 The settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG Reports, 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. Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the ECG report printouts. Select Speed and select the report print speed. 3 2 208 Setting Up Reports 19 Printing Patient Reports 4 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 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 3 4 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 monitors trend configuration. 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, 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 3 4 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. 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. 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 monitors memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost. 209 19 Printing Patient Reports Setting Up Individual Print Jobs Setting Up Individual Print Jobs To adjust the appearance of individual print jobs, in the Reports menu, 1 Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu. Select Report and then select the report you want to set up. 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:

VisibleWaves: 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 monitors 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: Unspecified to use the default size for the template chosen, Landscape or Portrait. 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 monitors Configuration Mode (for example, Remote 1 or Database). 2 3 4 5 6 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. 210 Dashed Lines on Reports 19 Printing Patient Reports 1 2 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. Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Enabled/Disabled setting will automatically be set to Disabled and grayed out. Dashed Lines on 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 monitors 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 and Printing Manually 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 211 19 Printing Patient Reports Printer Status Messages 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, In Companion, Retry, Cancelling, Error Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Reps key. CAUTION The reports job list includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality. Printing Manually Those jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host only or Never, some or all reports will not be printed automatically and will be shown in grey. Any jobs shown in grey must be printed manually; to do this, 1 In the Reports Job List, select the required report Select Print Report. 2 Selecting Print All Reps. will send all reports to the printer. Printer Status Messages Printer Status Message Print job queued

<Printer name>

Print job cant queue;queue full Cancelling all print jobs Cancelling the active print job Deleted N print jobs;discharge Deleted N print jobs; hotstart Print failed;No report configurd 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. 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. 212 Sample Report Printouts 19 Printing Patient Reports Printer Status Message Printing on

<Printer name>

NoPrinter <Printer name>;job susp Print Database full->job suspnd. Job <Printer name>

fail;

Print job on

<Printer name>

done Possible causes and suggested action A report is in progress, or the monitor is waiting for the central printer to accept the print job. 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. 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 211). Alternatively you can delete another report from the Reports Job List (using the Stop report key) to create space for your report. 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. Sample Report Printouts Each report header contains the patients bed label, last name and first name, middle name (if there is enough space) 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 monitors Configuration Mode. 213 19 Printing Patient Reports Sample Report Printouts Alarm Limits Report NBed6 Alarm Limits HR ST-I ST-II ST-III ST-aVR ST-aVL Doe, John ST-aVF ST-V1 ST-V2 ST-V3 ST-V4 ST-V5 123456789-P1 19 Apr 07 15:59:37 ST-V6 SpO2 NBPs ABPs RR Apnea Time 20 sec Measurement labels, with alarms off symbol where alarms are switched off Graphic view of current alarm limits in relation to currently monitored measurement value Realtime Report NBed6 Realtime Report Doe, John 123456789-P1 19 Apr 07 15:59:54 Patient Cat.: Adult Paced: No Gender: Male

**ABPs HIGH SpO2 NON-PULSAT. HR 60 bpm 0 /m PVC 0.0 mm ST-I 0.0 mm ST-II ST-III 0.0 mm Date of Birth: 19 Nov 1963 Age: 43 years Height: 69 in Patient Cat.: Adult Paced: No 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 ST-V6 SpO2 Pulse Perf NBPPulse 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 Patient demographic information, time stamp Active Alarms and INOPs, followed by vital signs Measurement waves section 214 19 Printing Patient Reports Sample Report Printouts ECG Reports Patient information Numeric block Wave area 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 patients 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 Available Formats Available Paper Sizes 12-Lead ECG Multi-lead ECG 3X4 landscape 6X2 landscape 12X1 portrait 12X1 landscape 12X1 (2P) landscape 2X4 landscape 8X1 portrait 8X1 landscape 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 Other Reports See the sections on Trends for other example reports. 215 19 Printing Patient Reports Sample Report Printouts 216 20 20Care 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 hospitals 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 manufacturers 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. 217 20 Care and Cleaning Cleaning the Monitor Cleaning the Monitor Clean with a lint-free cloth, moistened with warm water (40C/104F 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 Dilution of Ammonia <3%, Window cleaner Ethanol 70%, Isopropanol 70%, Window cleaner

, Alconox 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 hospitals 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. 218 Cleaning, Sterilizing and Disinfecting Monitoring Accessories 20 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. Cleaning Batteries and the Battery Compartment Wipe with a lint-free cloth, moistened with warm water (40C/104F maximum) and soap. Do not use strong solvents. Do not soak the battery. 219 20 Care and Cleaning Cleaning Batteries and the Battery Compartment 220 21 21Using 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 X2. This applies even when you are running the X2 external power, either via the external power supply or when connected to a host monitor. The battery has the effect of sealing 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 X2 with battery power, disconnect it from the host monitor or the external power supply

(M8023A). You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. When an X2 is connected to a host monitor, no battery data from the X2 is visible on the host. Battery INOPs, however, are displayed. The battery recharges automatically when the X2 is connected to a host monitor (running either on AC mains or battery power) or the optional external power supply (M8023A). 221 21 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 batterys 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 Yellow Red, flashing If the X2 is connected to a host monitor or external power supply (M8023A) battery charging If the X2 is running on battery power, this means Red, flashes intermittently battery or charger malfunction less than 10 minutes power remaining 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. 222 Battery Power Indicators 21 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 223). Battery status indicator Battery malfunction 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.

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 X2 is connected to external power

(a host monitor or the optional 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 reappears every 10 seconds until a battery is loaded. Monitoring Time Available: While the X2 is running on battery power, a time is displayed below the battery power gauge. No time is displayed when the X2 is running on external power via a host monitor or 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 TimeToEmpty:

2:33 hrs Capacity remaining fullCharge

[mAh]

[mAh]

Capacity, remaining tells you how much power is left in the battery. Capacity, fullCharge tells you how much power the battery can hold when fully charged. 223 21 Using Batteries Checking Battery Charge TimeToEmpty 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. TimeToFull is shown in place of TimeToEmpty if the monitor is connected to mains power via a host monitor or 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 TimeToFull/TimetoEmpty is shown. Symbols indicating critical situations are colored red. Battery status symbols Battery malfunction symbols battery is empty

(red) incompatible battery battery not charging as the temperature is above or below the specified range

(red) battery malfunction battery requires maintenance

(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 Select the battery status information on the Screen to open the Battery Status window Select the Print Status pop-up key. 2 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. 224 Replacing a Battery 21 Using Batteries Replacing a Battery To replace the battery, 1 Press the battery eject button. This releases the battery. Battery eject button The INOP !!INSERT BATTERY is suppressed for 15 seconds, allowing you sufficient time to load a new battery. 2 Remove the battery from the compartment. 3 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. 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. 225 21 Using Batteries Optimizing Battery Performance 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 Insert the battery into an X2 connected to a host monitor or the external power supply (M8023A) that is connected to mains power. 2 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, Insert the battery into an X2 connected to a host monitor or the external power supply (M8023A) 1 that is connected to mains power. 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 Disconnect the X2 from the external power supply (M8023A) or host monitor, and let it run until there is no battery power left and the X2 switches itself off. 4 Reconnect the monitor to mains power or a host monitor 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. NOTE The battery will discharge over time if it is stored inside the X2 when not connected to a powered

(either running or in Standby) host monitor or 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). 226 Battery Safety Information 21 Using Batteries 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 100C (212F) 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. 227 21 Using Batteries Battery Safety Information 228 22 22Maintenance 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 hospitals 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. Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use. 2 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 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the 2 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. 3 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. 229 22 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 monitors 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 CO2 calibration and performance test Mainstream and sidestream CO2 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 230 Troubleshooting 22 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, In the Main Setup menu, select Revision. 1 2 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 countrys 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. You will find detailed disposal information on the following web page:

http://www.medical.philips.com/main/company/sustainability/recycling/patient_monitoring/

The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium). 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 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. 2 When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder. 3 Write Empty on the cylinder and dispose of it appropriately for scrap metal. WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder. 231 22 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders 232 23 23Accessories 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 6-Electrode Cable Set 10-Electrode Cable set

(5+5) 10-Electrode Cable set

(6+4) Part No. M1669A Length 2.7m M1668A 2.7m M1667A 2.7m M1663A 2.0m M1665A 2.7m 233 23 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR Grabber shielded ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1675A M1671A M1673A M1622A M1624A M1678A M1672A M1674A

M1626A 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Miniclip non-shielded Length 1.0m/1.6m 1.0m/1.6m 1.0m/1.6m 0.7m/1.3m AAMI Part No. IEC Part No. M1973A M1968A M1644A M1647A 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 AAMI Part No. IEC Part No. M1684A M1680A M1682A M1685A M1681A M1683A 10-Electrode (5+5)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 5-electrode cable sets M1976A M1602A M1979A M1978A M1604A M1984A 10-Electrode (6+4)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 6-electrode cable sets M1532A M1537A M1557A M1533A M1538A M1558A 234 ECG/Resp Accessories One-piece Cables 23 Accessories Description 3-lead Grabber, ICU 5-lead Grabber, ICU Length 1.0m 1.0m AAMI Part No. IEC Part No. 989803143181 989803143201 989803143171 989803143191 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 non-

shielded 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) Part No. M1501A M1502A M1503A M1664A M1504A M1679A M1636A M1638A M1509A 989808148861 Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. M1540C M1500A IEC Part No. M1550C M1510A AAMI Part No. M1560C M1520A IEC Part No. M1570C M1530A 0.9m 2.7m 235 23 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1601A M1603A M1605A M1608A M1609A M1611A M1613A M1615A M1618A M1619A 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. IEC Part No. M1621A M1623A M1625A M1629A M1631A M1633A M1635A M1639A 3-Electrode One Piece Cables AAMI 3-Electrode One Piece Cables Length OR Grabber ICU Snap 1.9m 1.9m AAMI Part No. M1970A M1972A IEC 3-electrode One Piece Cables OR Grabber ICU Grabber IEC Part No. M1980A M1981A 5-Electrode One Piece Cables AAMI 5-electrode One Piece Cables Length OR Grabber ICU Snap 2.5m 2.5m AAMI Part No. M1975A M1977A IEC 5-electrode One Piece Cables IEC Part No. OR Grabber ICU Grabber M1985A M1986A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer Bedsheet clip 3-electrode 5-electrode Shielded 3-electrode Shielded 5-electrode Part No. M1501A M1502A M1503A M1504A M1509A 236 NBP Accessories 23 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 Reusable Cuff Kits 20 cm 16 cm 13 cm 42 to 54 cm 34 to 43 cm 27 to 35 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 Part No. Tubing M1598B (1.5m) or M1599B (3m) M1576A M1575A M1574A M1573A M1572A M1571A Cuff Kits Part No. M1577A Infant, pediatric, small adult, adult Small adult, adult, large adult, thigh M1578A Infant, pediatric, small adult, adult, large adult, thigh M1579A Adult/Pediatric Antimicrobial Coated Reusable cuffs Patient Category (color) Limb Circumference

(cm) 45 - 56.5 Adult Thigh (grey) Large Adult X-Long (burgundy) 35.5 - 46.0 35.5 - 46.0 Large Adult (burgundy) 27.5 - 36.5 Adult X-Long (navy blue) Adult (navy blue) 27.5 - 36.5 20.5 - 28.5 Small Adult (royal blue) 13.8 - 21.5 Pediatric (green) Infant (orange) 9 - 14.8 Bladder Width Part No. Tubing M1598B

(1.5m) or M1599B (3m) 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 237 23 Accessories Invasive Pressure Accessories Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs Patient Category Adult (Thigh) Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference

(cm) Bladder Width Part No. Tubing M1598B (1.5m) or M1599B (3m) 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 M4579A M4578A M4577A M4576A M4575A M4574A M4573A M4572A Neonatal/Infant Cuffs (Disposable, non-sterile) 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. Tubing 2.2 cm 2.8 cm 3.9 cm 4.7 cm M1866A M1868A M1870A M1872A 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. Transducer, accessories, sensor kits Reusable pressure transducer 5 PV/.V/mmHg sensitivity Sterile disposable pressure domes for CPJ840J6 (pack of 50) Transducer holder for CPJ840J6 (pack of 4) IV pole mount for CPJ840J6 Single channel disposable sensor kit (20) - (EU/EFTA only) Dual channel disposable sensor kit (20) (EU/EFTA only) Transducer holder for M1567/8A (EU/EFTA only) IV pole mount for M1567/8A (EU/EFTA only) Adapter cable for disposable sensor kit 3,0m for M1567/8A Monitoring Line Set Part No CPJ840J6 CPJ84022 CPJ84046 CPJ84447 M1567A M1568A M2271A M2272C M1634A CPJ84026 238 SpO2 Accessories SpO2 Accessories 23 Accessories This section lists accessories for use with Philips SpO2 technology. For accessory lists for other SpO2 technologies, refer to the instructions for use provided with these devices. 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:

Masimo adapter cables, Philips reusable sensors or adapter cables with part numbers ending in -L (indicates Long version). All listed sensors operate without risk of exceeding 41C on the skin, if the initial skin temperature does not exceed 35C. Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result. Product Number Description Philips reusable sensors. Comments M1191A/B M1191AL/

BL M1192A M1193A M1194A M1195A M1196A Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb. M1191A/B with longer cable (3 m) No adapter cable required. 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. 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. Adult clip sensor (3m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. 239 23 Accessories SpO2 Accessories Product Number M1191T M1192T M1193T M1196T Description Comments Requires M1943

(1 m) or M1943AL

(3 m) adapter cable Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb. 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. Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. No adapter cable required. M1191ANL Special Edition (SE) M1192AN M1193AN M1194AN M1195AN Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb. Special Edition (SE) Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Special Edition (SE) Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot. Special Edition (SE) Ear sensor (1.5m cable) for patients more than 40 kg. Special Edition (SE) Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb. Philips disposable sensors. Not available in the USA and Canada. M1904B M1903B M1902B M1901B Identical to OxiMax MAX-A Identical to OxiMax MAX-P Identical to OxiMax MAX-I Identical to OxiMax MAX-N Philips disposable sensors. Available worldwide. M1131A Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg) Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. 240 SpO2 Accessories 23 Accessories Product Number M1132A M1133A Description Comments Infant finger or toe sensor, 0.9m cable

(patient size 3 - 10 kg) 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. Use adapter cable M1943A or M1943AL. NELLCOR disposable sensors (must be ordered from Nellcor) OxiMax MAX-A OxiMax MAX-AL OxiMax MAX-P OxiMax MAX-I OxiMax MAX-N Oxisensor II D-25 Oxisensor II D-20 Oxisensor II I-20 Oxisensor II N-25 OxiCliq A OxiCliq P OxiCliq I OxiCliq N Adult finger sensor (patient size >30 kg) OxiMax MAX-A with long cable Use adapter cable M1943A or M1943AL. 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) Adult sensor (patient size >30kg) Pediatric sensor (patient size 10-50 kg) Infant sensor (patient size 3-20 kg) Neonatal sensor (patient size <3 kg or

>40 kg) See OxiMax MAX-A See OxiMax MAX-P See OxiMax MAX-I See OxiMax MAX-N 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 Extension cable (2 m) M1943A M1943AL Adapter cable (1.1 m cable) Adapter cable (3 m cable) For use with Philips reusable sensors and adapter cables. Adapter cable for Philips/Nellcor disposable sensors. 241 23 Accessories SpO2 Accessories Product Number OC-3 Description Comments Adapter Cable for OxiCliq sensors Available from Nellcor only. Product Number Description MASIMO LNOP LNOP DC-I LNOP DC-IP LNOP YI LNOP TC-I MASIMO LNCS LNCS DC-I LNCS DC-IP LNCS TC-I reusable sensors. Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-site Sensor (> 1 kg) Ear Sensor (> 30 kg) reusable sensors. Adult reusable Sensor (> 30 kg) Pediatric reusable Sensor (10 - 50 kg) Reusable ear Sensor (> 30 kg) disposable adhesive sensors. MASIMO LNOP LNOP Adt LNOP Adtx LNOP Pdt LNOP Pdtx LNOP Inf-L LNOP Neo-L Adult Sensor (> 30 kg) Adult Sensor (> 30 kg) Pediatric Sensor (10 - 50 kg) Pediatric Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Sensor (<3kg) or Adult adhesive Sensor (> 40 kg) LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin Sensors (<1kg) MASIMO LNCS LNCS Adtx LNCS Pdtx LNCS Inf-L LNCS Neo-L disposable adhesive sensors. Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Foot Sensor (< 3 kg) or Adult Finger Sensor (> 40 kg) Philips Part Number 989803140321 989803140331 n/a 989803140341 989803148281 989803148291 989803148301 989803140231 n/a 989803140261 n/a 989803140311 989803140291 989803140301 989803148231 989803148241 989803148251 989803148271 LNCS NeoPt-L Neonatal pre-term sensitive skin Sensor 989803148261

(< 1 kg) Adapter Cable for MASIMO sensors. LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors 451261000761 989803148221 LNC MP10 242 Temperature Accessories 23 Accessories The Philips M3002A option A01 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) Foley Catheter Probe (16 French) Foley Catheter Probe (18 French) Adapter cable 1.5m Adapter cable 3.0m Part No. Minimum measurement time for accurate readings 90 sec 60 sec 60 sec 90 sec 60 sec 180 sec 210 sec 310 sec 180 sec 180 sec 180 sec 21075A 21076A 21078A M1837A 21091A 21093A 21094A 21095A M2255A 21096A 21097A 21082B 21082A Mainstream CO2 Accessories Description CO2 Sensor Adult/Pediatric Airway Adapter (reusable) Infant Airway Adapter (reusable) Adult Airway Adapter (single-patient use) Infant Airway Adapter (single-patient use) Part No. M2501A M2513A M2516A M2533A M2536A 243 23 Accessories Sidestream CO2 Accessories Sidestream CO2 Accessories Description CO2 Sensor Nasal and Oral-Nasal Cannulas CO2 Nasal Cannula, Adult CO2 Nasal Cannula, Pediatric CO2 Nasal Cannula, Infant CO2 / O2 Nasal Cannula, Adult CO2 / O2 Nasal Cannula, Pediatric CO2 / O2 Nasal Cannula, Infant CO2 Oral-Nasal Cannula, Adult CO2 Oral-Nasal Cannula, Pediatric CO2 / O2 Oral-Nasal Cannula, Adult CO2 / O2 Oral-Nasal Cannula, Pediatric Airway Adapters Airway Adapter Set, ET > 4.0 mm 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 989803144471 M2756A M2757A M2760A M2761A M2768A 989803144531 M2772A M2773A M2776A M2777A Mainstream CO2 Accessories (for M3016A) Description CO2 Sensor Standard Airway Adapter (reusable) Small Airway Adapter (reusable) Part No. M1460A M1465A 14363A Microstream CO2 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. 244 Battery Accessories 23 Accessories Smart CapnoLine O2 is a combined oral-nasal-O2-CO2 FilterLine. NIV Line is a nasal FilterLine suitable for mask ventilation (for example, C-PAP). Single purpose means CO2 measurement only, dual purpose means CO2 measurement and O2 delivery. The accessories are supplied in packs of 25. Microstream accessory selection flowchart Yes Is the patient intubated?

No Does the patient need oxygen?

Yes No Short-term

(up to 6 hours) Long-term Short term Long term Long-term Short term

(up to 72 hours)

(up to 8 hours)

(up to 24 hours)

(up to 24 hours)

(up to 8 hours) Short term

(up to 8 hours) Oral/Nasal Nasal Nasal Oral/Nasal Nasal Key Applications Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Lab, Long-term 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) CapnoLine HO2:

A: M4680A P: M4681A CapnoLine H:

A: M4689A P: M4690A I/N: M4691A NIV Line:

A: 4686A P: M4687A Smart CapnoLine:

A: M2526A P: M2524A Smart CapnoLine Plus Long A:989803160301*

Smart CapnoLine O2:

A: M2522A P: M2520A Smart CapnoLine O2 Long A:989803160281*

P:989803160271*

FilterLine Set:

A/P: M1920A FilterLine Set Long:

A/P:989803160241*

FilterLine:

M1925A*

FilterLine H Set:

A/P: M1921A I/N: M1923A FilterLine H Set Long A/P:989803160251*

I/N:989803160261*

VitaLine H Set:

A/P:989803159571*

I/N: 989803159581*

FilterLine H:

M1926A*

*Not available in all geographies. 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 245 23 Accessories Battery Accessories 246 24 24Specifications 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). NOTE1 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. NOTE2 EMC Environment All measurements (except the sidestream CO2 measurement with M2741A sensor) and system interfaces (except short range radio and wireless LAN) are, in addition, suitable for use in establishments directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes (see table in Electromagnetic Emissions on page 270). The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. WARNING The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment

(for example, hyperbaric chambers. Manufacturers Information You can write to Philips at this address 247 24 Specifications Symbols Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.philips.com. Copyright 2002 - 2008. Koninklijke Philips Electronics N.V. All Rights Reserved. Trademark Acknowledgement The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor, Durasensor, Dura-

Y, Oxiband, Oxicliq, OxiMax. MAX-FAST is a trademark of Mallinckrodt Inc. 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 On/Off/Standby Main Screen DC power source Battery symbol Battery Eject SmartKeys ECG Sync Pulse Output indicator Pressure connector Temperature connector NBP connector SpO2 connector Connection direction indicator Connector has special protection against electric shocks and is defibrillator proof Uses FAST SpO2 algorithm 248 Installation Safety Information 24 Specifications Symbols Masimo SET technology Nellcor OxiMax compatible LAN connection indicator for connection to a wired network Silence Alarms Alarms Alarms Off ECG connector Error LED IntelliVue Instrument Telemetry wireless network Always use separate collection for waste electrical and electronic equipment (WEEE) Built-in short range radio interface Built-in wireless network 2002-

06 Identifies year and month of manufacture Monitor supports 12-

lead ECG 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 two-

wire 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. All network cables must be unshielded. Network Cables 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 248 to see which symbols are used to mark the connections. WARNING Connect only medical devices to the ECG output connector socket. 249 24 Specifications Altitude Setting 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. 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 CO2 measurements. The monitor must be configured at installation to the correct altitude. 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 X2 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 X2 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. 250 Out-Of-Hospital Transport - Standards Compliance 24 Specifications The X2 including the Wireless IntelliVue Adapter - CC 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 maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210. The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210. The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems. CAUTION High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices. The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA. The radio component contained in this device is compliant to Council Directive 1999/5/

EC (Radio Equipment and Telecommunications Terminal Equipment Directive) In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1;

ARIB STD-T66. The X2 including the short range radio interface - 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 1 radio equipment. In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66. Out-Of-Hospital Transport - Standards Compliance The X2 Multi-Measurement Module/patient monitor with measurements and interfaces other than those listed below cannot be used for patient transport outside of the hospital environment. The X2 Multi-Measurement Module/patient monitor, with the following measurements and interfaces:

ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A) 251 24 Specifications Out-Of-Hospital Transport - Standards Compliance 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 (SpO2) and EN ISO 21647 (CO2). Altitude Range from -500 to 3000 m operating and -500 to 4600 m storage and transportation. Extended radiated susceptibility tests The X2 Multi-Measurement Module/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 T(15 A/m) Operating ambient temperature testing over the range from 0 to 40C (32 to 100F). Operating ambient humidity testing up to 95% RH at 40C (100F), non condensing. NOTE Additional requirements can be necessary for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU. 252 Out-Of-Hospital Transport - Standards Compliance 24 Specifications Physical Specifications Specification Comments Maximum Weight 1.25 kg

(2.8 lb) Size (W x H x D) 188 x 99 x 86 mm 7.4 x 3.9 x 3.4 in including battery, without options without handle and options M8023A External Power Supply Weight and Dimensions Maximum Weight 700 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 Range Temperature Range Temperature Range with the Wireless IntelliVue Adapter or IntelliVue Instrument Telemetry Wireless Network or when charging the battery Humidity Range Operating Storage including transportation Operating 0 to 40C (32 to 104F)

-20 to 60C (-4 to 140F) 0 to 35C (32 to 95F) Operating Storage including transportation 15% to 95% Relative Humidity (RH) 5% to 95% Relative Humidity (RH) 253 24 Specifications Monitor Performance Specifications Item Altitude Range Ingress Protection Condition Range Operating Storage including transportation Monitor External Power Supply

(M8023A)

-500 m to 3000 m (10000 ft)

-500 m to 4600 m1 (15000 ft) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15) IP31(protected against the ingress of solid foreign objects 2.5 mm in diameter or larger, and the ingress of water when the water is dripping vertically) when rested on its rubber feet on a flat, level surface. IP32 when mounted as shown in the section Mounting the External Power Supply (M8023A) on page 3 of the Installation chapter and as described in the Service Guide. 1.Sufficient for flight altitudes up to 12,000 m with pressurized cabins. Monitor Performance Specifications X2 (M3002A) Performance Specifications Power Specifications Power consumption Battery Specifications Operating Voltage Operating Time

(with new, fully charged battery at 25C) Charge Time

<12 W average

<30 W while battery is charging 36 to 60 V DC floating Basic monitoring configuration: 2.5 hours

(Brightness set to Optimum, ECG/Resp, SpO2 measurements in use, NBP measurement every 15 minutes) When X2 is off: 2 hours When X2 is in use, and connected to MP20/30/40/50/60/70/

80/90 without extensions: 12 hours approx. When X2 is in use, and connected to the external power supply (M8023A), without extensions: 12 hours approx. red (crossed-out alarm symbol) LED red/yellow/light blue (cyan) LED green / red LED green LED yellow (charging)/red blinking (empty) LED green LED 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. Alarms Off Alarms On/Standby / Error AC Power Battery External Power Audible feedback for user input Prompt tone QRS tone, or SpO2 modulation tone 3 different alarm sounds Resolution Information Indicators Sounds Trends 254 Monitor Performance Specifications 24 Specifications X2 (M3002A) Performance Specifications Alarm signal Review Alarms Real Time Clock System delay Pause duration Extended alarm pause Information Capacity Range Accuracy Hold Time Buffered Memory Hold Time Contents less than 3 seconds 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes all alarms / inops, main alarms on/off, alarm silence and time of occurrence 300 items from: January 1, 1997, 00:00 to: December 31, 2080, 23:59

<4 seconds per day (typically) infinite if powered by host monitor or external power supply;

otherwise at least 48 hours if powered by host monitor or external power supply: infinite without power: at least 48 hours (typical: >72 hours) Active settings, trends, patient data, realtime reports, review alarms M8023A External Power Supply Performance Specifications Power Specifications Power consumption Line Voltage Current Frequency AC Power Indicators

<12 W average

<30 W peak 100 to 240 V ~

1.3 to 0.7 A 50/60 Hz ~

green LED X2 (M3002A) Interface Specifications Measurement Link

(MSL) ECG Sync Pulse Output

(See Connectors on page 249 for safety-

related information) Connectors Power Power Sync. LAN signals Serial signals Local signals Cable detection Marker In Wave Output Connector Output levels Isolation Pulse Width Delay from R-wave peak to start of pulse Minimum required R-

wave amplitude Female ODU (Proprietary) 30 V to 60 V input RS-422 compliant input 78.125 kHz (typical) IEEE 802.3 10-Base-T compliant RS-422 compliant Provided for connecting MMS 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 0.5 V 255 24 Specifications Monitor Performance Specifications X2 (M3002A) Interface Specifications Wireless Network Device Interface

(integrated, for compatible network options see below) Signals Frequency Band RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V 20 %, 3.5 W continuous USA: 2.400 2.483GHz, 5.15 ~ 5.35Ghz, 5.725 ~ 5.825Ghz Europe: 2.400 2.483GHz, 5.15~ 5.35Ghz, 5.47 ~ 5.725Ghz Japan: 2.400 2.483GHz, 4.90 5.091GHz, 5.15 5.25GHz China: 2.400 2.483GHz, 5.725 ~5.85Ghz Modulation Technique 802.11b/g Short Range Radio Interface DSSS (DBPSK, DQPSK, CCK) OFDM (BPSK,QPSK, 16-QAM, 64-QAM) 802.11a OFDM (BPSK,QPSK, 16-QAM, 64-QAM) Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) Type Technology Frequency Band Modulation Technique DSSS (O -QPSK) Effective radiated power max. 0 dBm (1 mW) 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 256 M4607A Battery Specifications 24 Specifications Compatible Devices IntelliVue Instrument Telemetry Wireless Network (USA only) Internal WMTS Adapter Technology IntelliVue Instrument Telemetry Wireless Network (except USA) Internal ISM Adapter Technology compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure WMTS, 1395-1400 MHz and 1427-1432 MHz compatible with Philips Cellular Telemetry System

(CTS), cellular infrastructure 2.4 GHz ISM IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter) Internal Wireless Adapter IEEE 802.11a/b/g 2.4 GHz and 5 GHz ISM Band Frequency Band Frequency Band Technology Frequency Band M4607A Battery Specifications One battery is required for battery operation of the monitor. M4607A Battery Specifications Physical Specifications W x D x H Weight Performance Specifications 66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in) 160 g 5%

Nominal Voltage Rated Capacity at discharge C/5 10.8 Volt 1000 mAh (typical) Environmental Specifications Temperature Range Humidity Range Battery Type Safety Electromagnetic Compatibility (EMC) Communication Standard Discharge 0 to 60qC (32 to 122qF) Charge 0 to 60qC (32 to 122qF) Storage and Transportation: -20 to 65qC (-4 to 140qF) Operating: 15% to 95% Relative Humidity (RH) Storage and Transportation: 5% to 95% Relative Humidity (RH) Lithium Ion Mangan, 10.8 V, 1000 mAh, complies with UL 2054 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 v1.1 257 24 Specifications Measurement 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 Range Accuracy Resolution Sensitivity Range Resolution Range Accuracy Resolution Range Accuracy Resolution Range Resolution Range Resolution Range - adult Range - pediatric and neonatal Brady Normal Tachy PVC Rate ST Numeric QT Numeric QTc Numeric

'QTc Numeric QT-HR Numeric Sinus and SV Rhythm Ranges Bandwidth Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm 1% of range 1 bpm t200 Vpeak 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 1 ms

-600 to +600 ms 1 ms 15 to 300 bpm 15 to 350 bpm Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Adult/neo/pedi: 0.05 to 150 Hz Neo/pedi: 0.5 to 150 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Neo/pedi: 0.5 to 55 Hz Adult/neo/pedi: 0.5 to 20 Hz 258 Measurement Specifications 24 Specifications ECG/Arrhythmia/ST Performance Specifications Bandwidth when the ECG is transmitted from a telemetry device via short range radio Adult/neo/pedi: 0.05 to 40 Hz Neo/pedi: 0.5 to 40 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Differential Input Impedance Common Mode Rejection Ratio Electrode Offset Potential Tolerance Auxiliary Current

(Leads off Detection) Input Signal Range Neo/pedi: 0.5 to 40 Hz Adult/neo/pedi: 0.5 to 20 Hz

>2 M: RA-LL leads (Resp)

>5 M: at all other leads (at 10 Hz including patient cable) Diagnostic mode: >86 dB (with a 51 k:/47 nF imbalance). Filter mode: >106 dB (with a 51 k:/47 nF imbalance). 500 mV 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

'QTc High Range 15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 15 to 100 bpm 2 PVCs 1 to 99 PVCs/minute 20 to 300 bpm 3 to 99 PVCs/minute 3 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 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) 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps 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 Sinusoidal signal, 260 PA, 40.5 kHz RL drive gain 44 dB max., max. voltage 1.8 Vrms 259 24 Specifications Measurement Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Time to Alarm for Tachycardia Vent Tachycardia 1 mVpp,206 bpm Vent Tachycardia 2 mVpp,195 bpm Tall T-Wave Rejection Capability Heart Rate Averaging Method Response Time of Heart Rate Meter to Change in Heart Rate Heart Rate Meter Accuracy and Response to Irregular Rhythm Accuracy of Input Signal Reproduction Pacemaker Pulse Rejection Performance 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 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 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. HR change from 80 to 120 bpm:

Range: [6.4 to 7.2 seconds] Average: 6.8 seconds 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 Accuracy Resolution Bandwidth Noise 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:(rms) referred to the input 260 Measurement Specifications 24 Specifications Respiration Alarm Specifications High Low Range Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm 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 Apnea Alarm 10 to 40 seconds 5 second steps Delay max. 14 seconds for limits from 0 to 20 rpm:

max. 4 seconds for limits above 20 rpm: max. 14 seconds 261 24 Specifications SpO2 Measurement Specifications Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-

49:2001). Measurement Validation: The SpO2 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. Maximum with NBP INOP suppression on60 seconds. 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:

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: d15 mW Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed) 70% to 100%

Range Accuracy SpO2 Performance Specifications SpO2 The specified accuracy is the root-mean-

square (RMS) difference between the measured values and the reference values Resolution Range Accuracy Resolution Pulse Sensors Pulse Oximeter Calibration Range 262 Measurement Specifications 24 Specifications SpO2 Alarm Specifications SpO2 Desat Pulse Tachycardia Bradycardia Range 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 Adjustment 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 5 bpm steps Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm 5 bpm steps 5 bpm steps Clamping at 30 to 100 bpm Delay

(0, 1, 2, 3,... 30)

+4 seconds max. 14 seconds max. 14 seconds max. 14 seconds NBP Complies with IEC 60601-2-30:1999/EN60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic Diastolic Mean Pulse Rate Accuracy Pulse Rate Measurement Accuracy Pulse Rate Range Measurement Time 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) 263 24 Specifications Measurement Specifications NBP Performance Specifications Cuff Inflation Time Initial Cuff Inflation Pressure Auto Mode Repetition Times STAT Mode Cycle Time Venipuncture Mode Inflation Inflation Pressure Adult Pediatric Neonatal Adult/pediatric Neonatal Automatic deflation after 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 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 Adjustment 10 to 30 mmHg: 2 mmHg (0.5 kPa)

>30 mmHg: 5 mmHg (1 kPa) Diastolic Mean 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) NBP Overpressure Settings Adult Pedi Neo

>300 mmHg (40 kPa) >2 sec

>300 mmHg (40 kPa) >2 sec

>150 mmHg (20 kPa) >2 sec not user adjustable 264 Measurement Specifications 24 Specifications Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate Range Accuracy Resolution Input Sensitivity Transducer Frequency Response Zero Adjustment Gain Accuracy Range:

Accuracy Drift Accuracy Drift Non linearity and Hysteresis

(including transducer) Volume displacement of CPJ840J6 Overall Accuracy 40 to 360 mmHg 25 to 350 bpm 1% Full Range 1 bpm Sensitivity:5 V/V/mmHg (37.5 V/V/kPa) Adjustment range:10%

Load Impedance:200 to 2000 : (resistive) Output Impedance:d3000 : (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 d0.4% FS (@CAL 200 mmHg) 4% of reading or 4 mmHg (0.5 kPa), whichever is greater 0.1 mm3 /100 mmHg Invasive Pressure Alarm Specifications Range Pressure 40 to 360 mmHg

(5.0 to 48 kPa) Extreme High Extreme Low Pulse Difference to high limit 0 to 25 mmHg Clamping at -40 to 360 mmHg Difference to low limit 0 to 25 mmHg Clamping at -40 to 360 mmHg 25 to 300 bpm Delay max. 12 seconds Adjustment

-40 to 50 mmHg 2 mmHg (0.5 kPa)

>50 mmHg 5 mmHg (1 kPa) 5 mmHg steps (0.5 kPa) 5 mmHg steps (1.0 kPa) 5 mmHg steps (0.5 kPa) 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) 265 24 Specifications Measurement Specifications Invasive Pressure Alarm Specifications Range Tachycardia Adjustment 5 bpm steps Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 25 to 100 bpm 5 bpm steps 5 bpm steps 5 bpm steps Delay max. 14 seconds max. 14 seconds Bradycardia Temp Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range Resolution Accuracy Average Time Constant 1 to 45qC (30 to 113qF) 0.1qC (0.2qF) 0.1qC (0.2qF) Less than 10 seconds Temp Alarm Specifications Temp High/Low Alarms Range 1 to 45qC (30 to 113qF) Adjustment

-1 to 35qC (30 to 95qF), 0.5qC (1.0qF) steps 35 to 45qC (95 to 113qF), 0.1qC (0.2qF) steps The CO2 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 CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, 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% O2 and N2 balance, up to 35qC 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. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) Included in Accuracy specifications 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 Resolution Stability Range Accuracy awRR Warm-up Time CO2 266 Measurement Specifications 24 Specifications M3015A Microstream CO2 Performance Specifications Rise Time 190 ms for neonatal mode

(measured with FilterLine H for neonatal) 240 ms for adult mode

(measured with FilterLine H for adult) 50 + 15/-7.5 ml/minute Maximum:

3 seconds (2m sample lines) 6 seconds (4m sample lines) Acoustic noise: <45 dBA The total system response time is the sum of the delay time and the rise time. Sound Pressure Total System Response Time Sample Flow Rate Gas Sampling Delay Time M3014A Mainstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 35C, Pabs = 760 mmHg, flow rate = 2 l/min. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 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 CO2 transducer attached for full accuracy specification Less than 60 ms (with adult or infant reusable or disposable adapter) Resolution Stability:

Short term drift Long term drift Range Accuracy awRR Warm-up Time Response Time M3014A Sidestream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) 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 CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 0.8 mmHg over four hours Accuracy specification will be maintained over a 120 hour period 2 to 150 rpm 1 rpm 267 Resolution Stability:

Short term drift Long term drift Range Accuracy awRR 24 Specifications Measurement Specifications M3014A Sidestream CO2 Performance Specifications Warm-up Time Sample Flow Rate Total System Response Time Operating Temperature 2 minutes with CO2 sensor attached for full accuracy specification 50 10 ml/minute 3 seconds 0 to 40C (32 to 100F) M3002A/M3014A Mainstream and Sidestream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is:

PATPD

PBTPS Pabs

Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35C and 100% RH. M3016A Mainstream CO2 Performance Specifications CO2 Range Accuracy 4 to 150 mmHg (-0.5 to 20.0 kPa) 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% O2 and N2 or N2O balance. Outside these conditions the accuracy reaches at a minimum the requirements of EN864/ISO9918. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 1.0 mmHg over a 7 day period 0 to 150 rpm 2 rpm 20 minutes with CO2 transducer attached for full accuracy specification Less than 125 ms (for step from 10% to 90%) Resolution Stability Range Accuracy awRR Warm-up Time Response Time Mainstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2 readings. The formula for the correction calculation is:

PATPD

PBTPS Pabs

Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 47 mmHg @37qC and 100% RH. 268 Measurement Specifications 24 Specifications CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High Range 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) 10 to 90 mHg (1 to 12 kPa) Adjustment 2 to 20 mmHg

(0.3 to 3.0 kPa) steps of 1 mmHg

(0.1 kPa) awRR High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm awRR Low Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps Apnea delay 10 to 40 seconds 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 CO2 Measurement Values The specified deviations for M3002A/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 Gas Level

(% volume fraction) 60 4 5 5 5 80 50

15 0.1 0.1 0.1 1.0 M3015A M3002A/M3014A Additional deviation due to gas interference, measured at 0 - 40 mmHg CO2 1 mmHg 2 mmHg 2 mmHg 2 mmHg 2 mmHg

-5 mmHg 1 mmHg not specified for use 5 %

5 %

5 %

5 %

5 %

5 %

5 %

+5 mmHg 1 mmHg 1 mmHg 1 mmHg 1 mmHg 5 %

5 %

5 %

5 %

5 %

269 24 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 Compliance Group 1 RF emissions CISPR 11 for the MP2 or X2 with all accessories except the M2741A Sidestream CO2 sensor RF emissions CISPR 11 for the MP2 or X2 whenever used with the M2741A Sidestream CO2 sensor Class B Class A Avoiding Electromagnetic Interference The monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The monitor is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes. 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. 270 Safety and Performance Tests 24 Specifications 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. 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. IEC 60601-1-2 test level 6 kV contact 8 kV air Compliance level 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input/output lines 2 kV for power supply lines 1 kV for input/output lines 1 kV differential mode 2 kV common mode 1 kV differential mode 2 kV common mode

<5% UT

(>95% dip in UT) for 0.5 cycles 40% UT

(60% dip in UT) for 5 cycles 70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec 3 A/m

<5% UT

(>95% dip in UT) for 0.5 cycles 40% UT

(60% dip in UT) for 5 cycles 70% UT

(30% dip in UT) for 25 cycles

<5% UT

(>95% dip in UT) for 5 sec 3 A/m Immunity test Electrostatic discharge (ESD) IEC 61000-4-2 Electrical fast transient/burst IEC 61000-4-4 Surge IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-

11 Power frequency

(50/60 Hz) magnetic field IEC 61000-4-8 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%. 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 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, UT 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. 271 24 Specifications Safety and Performance Tests 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. 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 VRMS 150 kHz to 80 MHz Compliance level 3 VRMS

(1 VRMS for respiration) Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz 3 V/m

(1 V/m for respiration) For short range radio, see note1. Electromagnetic environment guidance Recommended separation distance:

1,2 P d

for respiration:

3,5 P d 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

2.0 to 2,3 GHz for short range radio d 7,0 P

1.If ECG/SpO2 signals are acquired from a telemetry device via short range radio the compliance level is 3V/m except in the range 2.0 to 2.3 GHz where it is 1 V/m. 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. 272 Safety and Performance Tests 24 Specifications 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 those measurements which do not use the general formula. Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz d

1,2 P d

1,2 P d

2,3 P for respiration:

d

3,5 p for respiration:

d

3,5 P for respiration:

d

7,0 P for short range radio in the range 2.0 to 2.3 GHz:

d

7,0 P Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.2 (0.7) 0.7 (2.2) 2.3 (7.0) 7.3 (22.1) 23.0 (70.0) Equation Rated max. output power of transmitter (W) 0.01 0.1 1 10 100 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. 273 24 Specifications Safety and Performance Tests 274 25 25Default 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 monitors 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 Line Frequency Units Afghanistan land 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 50/60 [Hz]

50 50 50 50 60 60 50 60 60 50 50 50 60 50 50 50 60 50 60 50 50 50 Weight kg, lb kg kg kg kg lb lb kg lb lb kg kg kg kg kg kg kg kg kg lb kg kg kg ECG Cable Color Units Height in, cm IEC, AAMI cm cm cm cm in in cm in in cm cm cm cm cm cm cm cm cm in cm cm cm AAMI IEC IEC IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC 275 25 Default Settings Appendix Country-Specific Default Settings 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 Cte 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 60 60 60 60 50 50 50 60 60 60 50 50 50 50 50 50 50 60 60 60 50 60 50 50 60 60 60 60 50 50 60 60 50 50 60 50 50 60 50 50 60 60 50 60 50 50 50 50 60 60 60 lb lb kg lb kg kg kg lb kg lb kg kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb kg kg lb kg kg kg kg kg kg lb kg kg kg kg kg kg kg kg kg kg lb lb lb in in cm in cm cm cm in cm in cm cm cm cm cm cm cm cm in cm cm in cm cm in in cm in cm cm in cm cm cm cm cm cm in cm cm cm cm cm cm cm cm cm cm in in in AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC IEC AAMI AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI IEC IEC IEC IEC IEC AAMI IEC AAMI AAMI AAMI IEC AAMI IEC IEC IEC IEC AAMI AAMI AAMI 276 Country-Specific Default Settings 25 Default Settings Appendix 50 Finland 50 France 50 French Guiana 60 French Polynesia 60 French Southern Territories 50 Gabon 50 Gambia, The 60 Georgia 50 Germany 50 Ghana 60 Gibraltar 50 Greece 60 Greenland 50 Grenada 50 Guadeloupe 60 Guam 60 Guatemala 50 Guernsey 60 Guinea 60 Guinea-Bissau 60 Guyana 60 Haiti 60 Heard Island and McDonald Islands 60 Holy See, Vatican City State 60 Honduras 50 Hong Kong 50 Hungary 50 Iceland 50 India 50 Indonesia 50 Iran, Islamic Republic of 50 Iraq 50 Ireland 50 Isle of Man 50 Israel 50 Italy 50 Jamaica 60 Japan 50 Jersey 50 Jordan 50 Kazakhstan 50 Kenya 60 Kiribati Korea, Democratic Peoples Republic of 60 60 Korea, Republic of 50 Kuweit Kyrgyzstan 60 50 Lao Peoples Democratic Republics 50 Latvia 50 Lebanon Lesotho 50 kg kg kg lb lb kg kg lb kg kg lb kg lb kg kg lb kg kg lb lb kg kg lb lb kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg lb lb kg kg lb kg kg kg kg cm cm cm in in cm cm in cm cm in cm in cm cm in cm cm in in cm cm in in cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm in in cm cm in cm cm cm cm IEC IEC IEC AAMI AAMI IEC IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC AAMI AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI IEC 277 25 Default Settings Appendix Country-Specific Default Settings Liberia Libyan Arab. Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The former Yugoslavian Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federal States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia 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 50 60 60 50 50 60 50 50 50 50 60 50 50 60 60 50 60 60 60 60 60 60 60 50 50 50 50 60 50 60 60 50 50 60 50 60 50 50 60 60 60 50 50 50 60 50 60 60 50 60 kg lb lb kg kg lb kg kg kg kg lb kg kg lb kg kg lb lb kg lb lb lb lb kg kg kg kg lb kg lb lb kg kg lb kg kg kg kg lb lb lb kg kg kg lb kg lb lb kg kg cm in in cm cm in cm cm cm cm in cm cm in cm cm in in cm in in in in cm cm cm cm in cm in in cm cm in cm in cm cm in in in cm cm cm in cm in in cm cm IEC AAMI AAMI IEC IEC AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI 278 Country-Specific Default Settings 25 Default Settings Appendix Philippines 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 60 60 50 50 60 50 60 50 50 50 60 60 50 60 50 60 60 60 50 50 50 50 60 50 50 50 50 60 50 60 60 50 60 50 60 60 60 50 50 50 60 60 60 50 60 60 60 60 60 50 kg lb kg kg lb kg lb kg kg kg lb kg kg lb kg lb lb lb kg kg kg kg lb kg kg kg kg lb kg lb lb kg lb kg kg lb lb kg kg kg kg lb lb kg lb lb lb lb lb kg cm in cm cm in cm in cm cm cm in cm cm in cm in in in cm cm cm cm in cm cm cm cm in cm in in cm in cm cm in in cm cm cm cm in in cm in in in in in cm AAMI AAMI IEC IEC AAMI AAMI AAMI IEC IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC AAMI IEC IEC IEC IEC AAMI IEC AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC 279 25 Default Settings Appendix Country-Specific Default Settings Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UK United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 50 60 60 60 60 60 50 50 50 60 60 50 60 60 60 50 50 60 60 50 50 60 60 kg lb kg lb lb lb kg kg kg lb lb kg lb lb lb kg kg lb lb kg kg lb lb cm in cm in in in cm cm cm in in cm in in in cm cm in in cm cm in in IEC AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI AAMI AAMI IEC AAMI AAMI AAMI 280 Alarm and Measurement Default Settings 25 Default Settings Appendix Alarm and Measurement Default Settings Settings are only entered once per table row if they are the same for all patient categories1. 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 5 2 min. Enabled Enabled Off Off Red & Yell Red & Yell On 3 min Traditional 10 sec 20 sec 4 AlarmVol +2 AlarmVol +0 AlarmVol +0 2 Steps 20 sec No R & Y & I Red & Yell Red 5 sec 2 sec Standard 4 1.A profile Outdoor exists for use in typical outdoor conditions (bright sunlight, higher ambient noise). See the Configuration Guide for details. 281 25 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

'ExtrTachy Tachy Clamp

'ExtrBrady Brady Clamp ALL ECG IN. Fallback Alarms Off Alarm Source Sel. Va Lead Vb Lead SyncPulse sensit SyncPulse Marker Fallback ECGTele Arrhythmia Settings Arrhythmia Pause Threshold VTach HR VTach Run 282 Pedi 160 bpm 75 bpm Neo 200 bpm 100 bpm 3.0 sec 220 bpm 240 bpm 50 bpm Factory Defaults Adult 120 bpm 50 bpm On Auto On 1 II V 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 V2 V5 Medium On Enabled Factory Defaults Adult On 2.0 sec 100 5 Pedi 120 Neo Off 1.5 sec 150 ECG, Arrhythmia, ST and QT Default Settings 25 Default Settings Appendix Pedi 200 5 Neo 210 5 Arrhythmia Settings Vent Rhythm SVT HR SVT Run PVCs/min Non-Sustain 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 Afib IrregularHR HR Alarms TimeOut 1st TimeOut 2nd Arrhy Off Message SOME ECG IN Factory Defaults Adult 14 180 5 10 On On On On On On On On On On On On On On On On Short Yell 3 min 10 min Yes On 283 25 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 Pedi Off Factory Defaults Adult Single ST On On On

-80 ms 48 ms J+60 Neo Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL Settings Factory Defaults Factory Adult Factory Pedi Factory Neo ST(Label) On Off For Alarm Mode = Single-ST ST(Label) High ST(Label) Low For Alarm Mode = Multi-ST ST(Label) High ST(Label) Low QT Settings QT Lead QTc High Limit

'QTc Limit QTc High Alarm On/Off

'QTc High Alarm On/Off QT Analysis QTc Formula

+2.0 mm

-2.0 mm

+1.0 mm

-1.0 mm Factory Defaults Factory Adult Factory Pedi Factory Neo 480 ms 460 ms All 500 ms 60 ms On On Off Bazett 284 Pulse Default Settings 25 Default Settings Appendix Pulse Default Settings Pulse Settings Alarms Source Pulse (Label) System Pulse Alarms Off Alarm Source Sel. Pulse Alarm Settings Pulse (SpO2) Pulse Alarms High Limit Low Limit

' Extr Brady Brady Clamp

' Extr Tachy Tachy Clamp Factory Defaults Adult Auto On SpO2 Enabled Enabled Factory Defaults Adult On Off 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pedi Neo Pedi Neo 160 bpm 75 bpm 200 bpm 100 bpm 40 bpm 50 bpm 220 bpm 240 bpm Pulse alarms use the settings of the currently selected Pulse alarm source. Respiration Default Settings Respiration Settings Factory Defaults Adult Pedi High Limit Low Limit Apnea Time Alarms Resp Auto/Manual Resp Speed Color 30 rpm 8 rpm 20 sec On On Auto (Trigger Mode) 6.25 mm/s Yellow Neo 100 rpm 30 rpm 285 25 Default Settings Appendix SpO2 Default Settings SpO2 Default Settings SpO2 Settings Alarms QRS Volume Tone Modulation Tone Mod. Type Speed Perfusion Average NBP Alarm Suppr. Extd. Auto OnOff Color Factory Defaults Pedi Neo Adult On 1 Yes Enhanced 25 mm/s On 10 sec On Disabled light blue (cyan) SpO2 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

'Extr Brady Brady Clamp

' ExtrTachy Tachy Clamp Adult 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pediatric Neonatal 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 160 bpm 75 bpm 20 bpm 40 bpm 20 bpm 220 bpm 80 85 95 20 sec 10 sec 10 sec on SpO2 on on 200 bpm 100 bpm 20 bpm 50 bpm 20 bpm 240 bpm 286 NBP Default Settings 25 Default Settings Appendix NBP Default Settings NBP Settings Mode Alarms from High Alarm Limit Low Alarm Limit Alarms NBP Repetition Time Pulse (NBP) Unit Done Tone Start Time VP Pressure Reference Color Factory Defaults Adult Auto Sys. 160/90 (110) 90/50 (60) On On 10 min On mmHg Off Synchronized 60 mmHg Auscultatory Red Temperature Default Settings Temp Settings Low Limit High Limit Alarms Unit Range Color Factory Defaults Adult 36 39 On qC 35...43 Green Pedi Neo Manual 120/70 (90) 70/40 (50) 90/60 (70) 40/20 (24) 40 mmHg 30 mmHg Invasive Pedi Neo Invasive Pressure Default Settings ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Factory Defaults Adult Sys. 160/90 (110) 90/50 (70) On Disabled Pedi Neo 120/70 (90) 70/40 (50) 90/60 (70) 55/20 (36) 287 25 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 ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings

'Extreme High

'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Factory Defaults Adult 15 15 190/100 (125) 80/45 (65) 150 25 mm/s No 12 Hz Yes 60 sec mmHg Red Factory Defaults CVP, RAP, LAP, UVP Settings Adult Pedi Neo 10/2 (4) 2/-4 (0) 10/2 (4) 2/-4 (0) 5 5 15/5 (10) 0/-5 (-5) 5 5 15/5 (10) 0/-5 (-5) Alarms from High Limit Low Limit Alarms Extreme Alarms

'Extreme High

'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Average in Mon. Signal Quality Mean 14/6 (10) 6/-4 (0) On Enabled 5 5 20/10 (15) 0/-5 (-5) 30 25 mm/s Yes 12 Hz Yes 60 sec mmHg light blue (cyan) No On 288 Invasive Pressure Default Settings 25 Default Settings Appendix Pedi Neo 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) Pedi Neo 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) PAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms

'Extreme High

'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color 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 ICP, IC1, IC2 Settings Factory Defaults Alarms from High Limit Low Limit Alarms Extreme Alarms

'Extreme High

'Extreme Low Low Clamp High Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color 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 289 25 Default Settings Appendix Cardiac Output Default Settings Cardiac Output Default Settings C.O. Settings Auto-Calibration Tblood High Limit Tblood Low Limit Tblood Alarm On/Off Temperature Unit Color Factory Defaults Adult On 39.0 C 36.0 C On qC Green Pedi Neo CCO/CCI Settings Factory Adult Factory Pedi Factory Neo 3.7 l/min 2.6 l/min 1.3 l/min 0.3 l/min 3.7 l/min/m2 2.6 l/min/m2 5.2 l/min/m2 1.2 l/min/m2 Pedi Neo Settings common to CCO and CCI Alarms from CCO from Color CCO Alarms CCO High Limit CCO Low Limit CCI Alarms CCI High Limit CCI Low Limit CCO ABP Green On 8.5 l/min 4.0 l/min On 4.3 l/min/m2 2.0 l/min/m2 CO2 Default Settings Factory Defaults CO2 Settings etCO2 low etCO2 high imCO2 high CO2 Alarms Unit Scale ImCO2 N2O Corr (only M3015A/M3016A) Oxygen Corr (only M3014A) Gas Corr (only M3014A) Humidity Corr Adult 30 50 4 on mmHg 40 mmHg on Off 16%

Off BTPS 290 CO2 Default Settings 25 Default Settings Appendix CO2 Settings Max Hold AwRR AwRR Alarms AwRR high limit AwRR low limit Apnea time Color Factory Defaults Adult Off On On 30 8 20 secs Yellow Pedi Neo 100 30 291 25 Default Settings Appendix CO2 Default Settings 292

10-lead placement (ECG) 103 12-lead placement (ECG) 103 3-lead placement (ECG) 101 5-lead placement (ECG) 101 A AAMI ECG lead labels 100 abdominal breathing and Resp electrode placement 142 aberrantly conducted beats 110 accessories 10-electrode cable sets 234 3-electrode cable sets 234, 236 5-electrode cable sets 234, 236 5-electrode one piece cables 236 6-electrode cable sets 234 CO2 177 CO2 (mainstream) 243, 244 CO2 (microstream) 244 ECG 233 NBP adult cuffs 238 comfort cuffs 237 disposable cuffs 237 multi-patient comfort cuff kits 237 neonatal/infant cuffs

(disposable) 238 reusable cuffs 237 single-hose disposable cuffs 238 Nellcor 239 pressure 238 Pulsion 238 resp 233 set combiners and organizers 235, 236 SpO2 239 Nellcor adhesive sensors

(disposable) 239 Philips sensors (disposable) 239 Philips sensors (reusable) 239 temperature 243 trunk cables 233, 235 active alarms 41 address, Philips 247 addressograph (printer configuration setting) 213 adjusting ST measurement points 124 adjusting wave scale (pressure) 166 adjusting wave size (CO2) 178 admit editing information 87 quick admit 87 admitting a patient 85 airway adapter CO2, microstream accessory 177 alarm latching 52, 53, 116 alarm limits changing 48 checking 47 manually adjusting 48 narrow 50 report 214 ST 126 switching auto limits on/off 51 using automatic limits 50 wide 50 window 48 alarm recording choosing recorded measurements 204 alarm source selection, disabled 139 alarms acknowledging 44 active 41 active SpO2 source 152 alphabetical listing 55 apnea delay 180 apnea delay time (Resp) 144 arrhythmia 41 audible indicators 43 awrr limits 180 chaining 118 CO2 specific 179 CO2, apnea delay 180 CO2, awRR 180 companion mode 42 desat, SpO2 151 effect on pressure alarms during zero 165 extending pause time 47 high priority 41 INOP 41 ISO/IEC standard 44 key 17 limit, SpO2 263 message field 18 NBP source 158 off indicator 18 patient messages 55 1Index pausing 45 physiological 55 pleth as source 152 recordings 53 red 41 reminder 45 restarting 47 reviewing window 51 selftest 53 silencing 44 SpO2 high and low limits 151 SpO2 specific 150 ST 126 suspended symbol 46 switching on and off 46 temperature 161 testing 53 tone configuration 43 traditional 43 visual indicators 42 volume, changing 44 yellow 41 alarms key 17 alphabetical listing of alarms 55 analog output ECG 249 apnea alarm delay CO2 180 apnea alarm delay time (RESP) 144 apnea alarms and Resp detection modes 144 arrhythmia aberrantly conducted beats 110 analysis, how it works 109 atrial fibrillation and flutter 110 beat labels 112 initiating learning 114, 115 intermittent bundle branch block 111 learning during ventricular rhythm 115 levels of analysis 106, 109 monitoring non-paced patients 110 monitoring paced patients 110 options 109 relearning 114 relearning and lead fallback 115 status messages 113 switching on/off 110 understanding the display 111 arrhythmia alarms 41, 115 adjusting alarm limits 116 i all yellow on/off 116 chaining 118 latching 116 multiple 118 pvc-related alarms 119 sinus and SV rhythm ranges 260, 263 switching on/off 116 timeout periods 117 arrhythmia monitoring and defibrillation 108 arrhythmia options 106 arrhythmia relearning with EASI INOP 105 arterial pressure source 170 arterial pulsation 147 artifact suppression (pressure) 167 atrial fibrillation and flutter 110 audlatching (arrhythmia alarms) 116 auto alarm limits switching on/off 51 using 50 auto detection mode (Resp) 142 autofilter 98 automatic arrhythmia relearn 115 automatic default setting 28 automatic NBP repeat time 158 autosize ECG wave 98 awRR alarm limits 180 awRR alarms CO2 180 B baseline ST map, updating 129 ST, updating 123 basic arrhythmia option 106, 109 battery 221 and display brightness 225 battery reports 224 battery status window 223 charge status 224 compartment 221 conditioning 226 conserving power 225 indicators 222 LED 222 malfunction indicator 223 malfunction symbols 222 monitoring time 223 power gauge 222 recharging 221 replacing 225 ii safety information 227 severe INOP 221 status indicator 19, 223 symbol 248 time to empty 224 time to full 224 battery eject symbol 248 battery performance optimizing 225 battery status indicator 19 beat labels arrhythmia 112 bed information 34 blood pressure. See also NBP (non-invasive) or PRESS (invasive) Brightness SmartKey 31 brightness, adjusting 32 C calculating cerebral perfusion 170 calculating temperature difference 162 calibrating CO2 transducer 175 calibration interval, NBP 230 NBP 160 pressure 169 pressure transducer 169 capnography mainstream 15 Microstream 15 carbon dioxide, see CO2 171 cardiac output 16 cardiac overlay and Resp detection modes 143 when measuring Resp 141 cardiotach alarms 106 cautions 9 central recorder choosing 204 cerebral perfusion 170 chaining 118 change screen menu 25 change screen window 17, 25 Changing 25 changing ECG lead sets 100 changing Resp detection mode 142 changing Resp wave size 143 changing Resp wave speed 144 changing screen content 25 channels recorder 204 checking battery charge 224 checking paced status 94 checklist delivery 2 installation 1 cleaning infection control 217 method 218 monitoring accessories 219 recommended substances 218 CO2 airway adapter 177 alarms, apnea delay 180 alarms, awRR 180 alarms, specific 179 awRR alarm limits 180 checking transducer accuracy 175 correction, humidity 179 correction, N2O 179 corrections 178 FilterLine 177 measuring mainstream 172, 175 measuring microstream 177 method, mainstream 171 method, microstream 171 method, sidestream 171 microstream accessories 177 microstream extension 177 removing exhaust gases 175, 178 transducer, calibrating 175 transducer, using 176 troubleshooting 178 wave scale, adjusting 178 CO2 (mainstream). accessories 243, 244 CO2 (microstream). accessories 244 companion mode 23, 35 pairing 184 conditioning batteries 226 configuration mode 23 entering 7 conflict label 29, 30 connecting power 4 connecting temperature probe 161 connection direction symbol 248 connectors 249 temp 161 continuous cardiac output 16 conventional 12-lead ECG 103 correcting the NBP measurement 157 CPAP (RESP) 143 cuff pressure, NBP 158 selection, NBP 157 current view ST map 126 D damage mechanical 32 damage claims 2 date, setting 7, 32 DC power symbol 248 default profile 27 default settings 275 checking country-specific 7 defibrillation and arrhythmia monitoring 108 and ECG monitoring 108 synchronization marks 95 defibrillator proof symbol 248 defibrillator synch maintenance interval 230 delay time recording 205 demonstration mode 23 desat alarm, SpO2 151 detection modes (Resp) 142 diagnostic (ECG filter setting) 99 discharging a patient 87 disconnect INOPs silencing 45 disinfecting infection control 217 recommended substances 218 display arrhythmia 111 ECG 95 NBP 157 Resp 142 ST 122 display brightness 225 display settings 26 disposal gas cylinder 231 parts and accessories 231 dual Temp measurement 162 dyshemoglobins intravascular (SpO2) 149 E early systolic blood pressure, NBP 158 EASI activating 99 ECG monitoring 105 lead placement 105 EASI ECG lead labels 100 ECG 93 accessories 233 alarms off (Config Mode) 107 changing lead sets 100 choosing electrode sites 99 conventional 12-lead 103 external pacing electrodes 109 filter settings 98 fusion beat pacemakers 109 intrinsic rhythm 108 modified 12-lead 103 New Lead Setup 100 pacemaker failure 108 rate adaptive pacemakers 109 unfiltered 99 wave size 97 ECG analog output 249 ECG cable for operating room 108 ECG cables, connecting 94 ECG connector 94 ECG display 95 ECG electrode colors 100 ECG electrode placement during electro-surgery 108 ECG gain in reports 208 ECG lead labels 100 ECG lead placement choosing EASI/Standard 99 ECG leads monitored 100 ECG report 215 lead layout 208 ECG safety information 108 ECG source tracking 187 ECG wave autosize 98 calibration bar 98 ectopic status messages (arrhythmia monitoring) 114 electrical output symbol 248 electrode placement (ECG) 93 conventional 12-lead 103 modified 12-lead 103 electrode placement (Resp) 141 with abdominal breathing 142 with lateral chest expansion 142 electro-surgery and ECG 108 EMC interference Resp 144 EMI filter for ECG 98 end case discharging a patient 87 report, printing 87 end case reports setup 209 enhanced arrhythmia option 106, 109 exclamation mark symbol 248 exhaust gases, removing 175, 178 extension cable for SpO2 148 external pacing electrodes and ECG monitoring 109 extreme bradycardia alarm 107, 139 extreme pressure alarms 168 extreme rate alarms 107, 139 extreme tachycardia alarm 107, 139 F fallback (ECG) 100 FAST Fourier artefact suppression technology 147 filter (ECG filter setting) 98 filter (ECG) 98 FilterLine CO2, microstream accessory 177 flushing invasive pressure accessories 163 functional arterial oxygen saturation 147 fusion beat pacemakers and ECG monitoring 109 G gas cylinder empty, disposing of 231 getting started 32 global trend time 199 graphic trends 192 graphic trends report 196 H hemodynamic measurement extension 16 hemodynamic MMS extension 16 horizon trend trend time 199 host monitor 35 HR = RR (Resp) 142 HR alarms when arrhythmia off 107 HR alarms off (Config Mode) 107 HR and pulse alarm source selection 139 HR from (heart rate source) 138 humidity correction CO2 179 I IEC ECG lead labels 100 iii If 187 IIT 34, 89 IMV (Resp) 143 indicators battery malfunction 223 battery status 19, 223 infection control cleaning 217 disinfecting 217 sterilizing 217 Information Center central recording 203 transferring patients 89, 90 transferring patients using IIT 89 INOPs indicators 41 message field 18 silencing 45 installation checklist 1 connectors 249 personnel 1 Instructions for Use intended audience 9 IntelliVue Instrument Telemetry System

(IIT) 34 intermittent bundle branch block 111 intermittent mandatory ventilation

(Resp) 143 interruption symbol 249 intravascular dyshemoglobins (SpO2) 149 intrinsic rhythm 108 ISO point (ST) 124 J J point (ST) 124 K keyboard, on screen 22 keys alarms 17 main screen 17 pop-up 22 silence 17 SmartKeys 17 L label conflict resolution 29, 30 label conflicts,resolving 30 labels 29 changing 29 LAN connection 5 latching alarms 52 iv alarms, behavior 53 latching arrhythmia alarms 116 lateral chest expansion (neonates) monitoring Resp 142 lead fallback and arrhythmia relearning 115 lead fallback (ECG) 100 lead labels (ECG) 100 lead placement activating EASI/Standard 99 for Resp measurement 141 leads monitored (ECG) 100 Leads Off INOP (ECG) 100 levels of arrhythmia analysis 109 M main screen key 17 main setup 20 mains power connecting to 3 mainstream capnography 15 mainstream CO2 measuring 172, 175 maintenance cables 229 cords 229 measurements, schedule 230 microstream CO2, calibration 230 schedule 229 visual inspection 229 malfunction symbols battery 222 manual detection mode (Resp) 143 and apnea alarms 144 manufacture date symbol 249 manufacturers information 247 map ST 126 Mason-Likar lead system 103 max hold setting (CO2) 172 measurement adjusting a wave 28 preparation 32 setting up 28 wave speed, changing 29 measurement extension M3012A 16 M3015A 15 M3016A 15 measurement label 19 measurement labels 29 changing 29 measurement points, ST 124 measurement server ECG connector 94 measurement settings 26 measurement setup menu 19 measurements setting up 33 switching on and off 28 mechanical damage 32 menu main setup 20 measurement setup 19 merging patient data 92 messages alarm 18 INOP 18 status and prompt 19 methemoglobin (SpO2) 149 Microstream capnography 15 microstream CO2 177 accessories 177 maintenance, calibration 230 measuring 177 mismatch patient data, resolving 91 modified 12-lead ECG 103 modifying screens 24 monitor inspecting before use 32 quick operating giude 6 starting monitoring 33 switching on 33 monitor (ECG filter setting) 98 monitor defaults 275 monitor revision how to find 32 monitor settings 26 changing 31 monitoring preparation 32 starting 32 monitoring mode 23 mounting power supply 3 mounting information 3 MSL cable 5 multi-lead ST alarming 126 N N2O correction CO2 179 narrow alarm limits 50 NBP adult cuffs 238 alarm source 158 ANSI/AAMI SP10-1992 155 automatic mode, enabling 158 calibrating 160 calibration interval 230 comfort cuff kits 237 comfort cuffs 237 cuff pressure 158 cuff, applying 157 cuff, selecting 157 cuff, tightness 157 disposable cuffs 237 how the measurement works 155 measurement correction 157 measurement limitations 156 measurement methods, auto 156 measurement methods, manual 156 measurement methods, sequence 156 measurement methods, stat 156 neonatal cuffs (disposable) 238 numerics 157 oscillometric method 155 pediatric cuffs 238 preparing to measure 156 repeat time 157 repeat time for automatic 158 repetition time, setting 158 reusable cuffs 237 single-hose disposable cuffs 238 site inspection 157 time of last measurement 157 units 157 venous puncture 159 neonates Resp electrode placement 142 network connection indicator 18 networked monitoring 34 new features 37 non-invasive blood pressure. See NBP non-paced patients arrhythmia monitoring 110 numerics explanation of NBP display 157 O on-screen keyboard 22 operating modes 23 configuration 23 demonstration 23 monitoring 23 passcode protection 23 service 23 operating room ECG cable 108 orange ECG cable 108 organizers 235, 236 oscillometric NBP measurement method 155 overlap in recordings 205 overlapping screen trends 199 P pace pulse rejection (ECG) about 95 switching on/off 97 paced patients arrhythmia monitoring 110 repolarization tails 97 safety information 108 setting status 108 paced status 19 checking 94 pacemaker failure 108 pairing companion mode 184 connected to host 35 no direct connection 35 with wireless device 35 paper size for reports 210 parameter scales trends 195 passcode protection 23 patient admit 85 category, NBP 155 discharge 87 end case 87 patient alarm messages 55 patient category field 18 patient demographics window 85 patient mismatch 91 patient name field 18 patient reports contents 213 patient trends viewing 191 paused alarms 45 extending time 47 restarting 47 performance specifications pressure 258, 265 performance test 270 perfusion indicator 147, 148, 152 Philips contact information 247 physiological alarms 41 pleth alarm source 152 pleth wave 151 pleth waveform 147 Pop 22 pop-up keys 22 power connecting 4 connection 3 disconnecting from mains power disconnecting from 34 from host monitor 4 power suplly external 4 power supply mounting 3 power-on LED 5 preparing skin for ECG 93 pressure alarms during zero 165 arterial source 170 calibration pressure 169 cerebral perfusion, calculating 170 performance specifications 258, 265 wave scale 166 wave size 166 zeroing the transducer 165 pressure accessories 238 pressure artifact suppression 167 pressure of NBP cuff 158 pressure transducer calibration 169 zeroing 165 primary lead (ECG) selecting 94 print job suspended 211 printer disabling 210 settings 210 status messages 212 unavailable 211 printing ST map reports 130 status log 231 trends reports 196 priority list for trends 195 probes disposable temperature 161 profiles 26 default profile 27 patient category 27 swapping a complete profile 27 swapping setting block 27 prompts 19 pulse alarms 138 system pulse source 137 v pulse numerics for SpO2 148 PVC-related alarms 119 Q QRS tone 139 changing volume 31 QRS tone pitch, SpO2 152 QRS volume, changing 98 QT alarms 134 QT baseline 133 QT measurement algorithm 131 QT monitoring limitations 132 QT/QTc monitoring 131 quick admit 87 R radiated field immunity Resp 144 rate adaptive pacemakers and ECG monitoring 109 realtime report 214 realtime reports content 210 recorder status messages 205 recording central 203 changing recording type 204 channels 204 choosing central recorder 204 choosing recording speed 205 creating templates 204 preventing fading ink 205 runtime 205 setting the runtime 205 setup menu 204 starting and stopping 203 wave overlap 205 recording alarms 53 recording delay time 205 recycling 231 rejecting pace pulses 95 relearning arrhythmia 114 reminder, alarm 45 replacing batteries 225 repolarization tails 97 reports alarm limits 214 battery reports 224 choosing paper size 210 contents 213 ECG 215 end case 209 patient trends 196 vi realtime report 214 re-routing 211 scheduled 209 setting up 208 ST map 130 stopping printouts 208 re-routing reports 211 resolution trends 195 resolving patient mismatch 91 resp accessories 233 Resp alarms apnea alarm delay time 144 Resp detection level and apnea detection 144 Resp detection modes and cardiac overlay 143 changing 142 Resp display 142 Resp monitoring and cardiac overlay 141 Resp safety information 144 Resp wave changing size 143 changing speed 144 restarting paused alarms 47 retrolental fibroplasia (SpO2) 151 reviewing alarms window 51 rhythm status messages (arrhythmia monitoring) 113 runtime setting recording runtime 205 S safety maintenance interval 230 monitor 250 safety information batteries 227 ECG 108 Resp 144 safety test 270 safety tests performance tests 5 power on test 5 system 5 visual inspection 5 same patient data merge 92 scale ECG wave 97 Resp wave 143 scales for trends waveforms 195 scheduled reports 209 screen adjusting brightness 31 screen trend trend time 199 screen trends 197 screens changing content 25 switching 24 understanding 24 visitor screen 25 secondary lead (ECG) selecting 94 selecting the primary lead (ECG) 94 selecting the secondary lead (ECG) 94 selftest alarms 53 sensor disposable SpO2 147 sequence mode 158 service mode 23 set combiners 235, 236 setting up trends 193 setting up reports 208 setting up the sepuence 158 settings 28 about 28 default 275 measurement settings 28 monitor settings 28 screen settings 28 synchronized telemetry and monitor 187 settings blocks 26 Setup Recording menu 204 short yellow alarms on/off 116 signal quality of SpO2 149 silence key 17 sinus and SV rhythm ranges 260, 263 skin preparation ECG 93 SmartKeys 20 key 17 SmartKeys key 17 SmartKeys symbol 248 source tracking ECG 187 specifications 247 arrhythmia 258 speed recording 205 wave speed, changing 29 SpO2 accessories 239 active alarm source 152 alarms specific to 150 arterial pulsation 147 assessing suspicious reading 149 connecting the cables 148 disposable sensors 147 extension cable 148 FAST technology 147 Nellcor adhesive sensors

(disposable) 239 perfusion indicator 147, 148, 152 Philips sensors (disposable) 239 Philips sensors (reusable) 239 pleth as alarm source 152 pleth wave 151 pleth waveform 147 pulse numerics 148 QRS tone 152 signal quality 149 site inspection 149 site selection 147 tone modulation 152 SpO2 desat alarm 151 SpO2 limit alarms 151 ST adjusting alarm limits 126 alarms 106, 126 baseline, updating 123 ensuring diagnostic quality 121 filtering 121 measurement points, adjusting adjusting 124 multi-lead alarms 126 numerics in ECG wave 96 snippets 123 ST display 122 ST map baseline, updating 129 current view 126 report, printing printing ST map report 130 scale, changing scale ST map 129 task window 129 trend view 128 trending interval, changing 130 trending priority 129 ST maps 126 ST point 124 standard 10-lead placement 103 standard 3-lead placement 101 standard 5-lead placement (ECG) 101 standby mode 23 Standby screen 23 standby symbol 248 starting monitoring 33 status line 19 status log printing 231 status messages printer 212 recorder 205 status messages (arrhythmia) 113 ectopic 114 rhythm 113 sterilizing infection control 217 stopping reports printouts 208 surgical ECG cable 108 suspended alarm 46 suspicious SpO2 reading 149 switching on monitor 33 switching screens 24 symbols 248 battery 222 synchronization marks (defibrillator) 95 system pulse 137 systolic blood pressure, NBP, early 158 T tabular trends 193 Tamb 162 task window for ST map 129 Tcereb 162 telemetry alarms 185 suspending at bedside 185 telemetry device controlling from bedside 185 silencing alarms at bedside 185 unpairing 36, 184 temperature 161 accessories 243 alarm settings 161 connecting probe to monitor 161 difference, calculating 162 dual Temp measurement 162 extended label set 162 first 162 label 162 making a measurement 161 probe, disposable 161 probe, selecting 161 second 162 temperature probe connecting 161 templates creating for recordings 204 test blocks, how to perform 5 testing alarms 53 time, setting 7, 32 tone configuration, alarm 43 tone mod (SpO2) 152 tone modulation 152 touchscreen disable/re-enable 17 using 19 transducer CO2, accuracy 175 CO2, calibrating 175 pressure, zeroing 165 transferring centrally-monitored patients 89, 90 using IIT 89 transport brightness setting 225 trend time 199 global 199 trend view ST map 128 trending interval ST map 130 trends resolution 195 screen trends 197 setting parameter scales 195 setup 193 viewing 191 trends pop-up keys 191 trends priority list 195 ST map 129 troubleshooting CO2 178 trunk cables accessories 233, 235 Ttymp 162 Tvesic 162 U Understanding 26 unfiltered ECG signal 99 unpacking 2 unpairing 36, 184 unparing 36 user interface settings changing 31 V V electrode placement (ECG) 102 venous puncture 159 viewing arrhythmia waves 112 viewing trends 191 visible waves report 210 vii visitor screen 25 vislatching (arrhythmia alarms) 116 vital signs report 196 voltage setting 4 volume alarm 44 W warnings 9 wave adjusting 28 changing speed 29 scale (CO2) 178 scale (pressure) 166 size (CO2) 178 size (pressure) 166 wave channel speed 29 wave group speed 29 wave size Resp 143 wave size (ECG) changing 97 wave speed eeg speed wave speed global speed 29 respiratory speed 29 wave speed (Resp) 144 whats new 37 wide alarms limits 50 wired network connection symbol 249 Z zero effect on pressure alarms 165 zeroing pressure transducer 165 viii