all | frequencies |
|
exhibits | applications |
---|---|---|---|---|
manual |
app s | submitted / available | |||||||
---|---|---|---|---|---|---|---|---|
1 |
|
IfU example english | Users Manual | 4.60 MiB | / January 01 2014 | |||
1 | Cover Letter(s) | |||||||
1 | Cover Letter(s) | |||||||
1 | External Photos | / January 01 2014 | ||||||
1 | Internal Photos | / January 01 2014 | ||||||
1 | Cover Letter(s) | |||||||
1 | ID Label/Location Info | |||||||
1 | Test Report | |||||||
1 | Test Setup Photos | / January 01 2014 |
1 | IfU example english | Users Manual | 4.60 MiB | / January 01 2014 |
Instructions for Use IntelliVue Patient Monitor MX400/450/500/550/600/700/800 MX400/450/500/550 Release K with Rev. K.1x.xx MX600/700/800 Release J with Revison J.xx.xx Patient Monitoring 1Table of Contents 1 Introduction Safety Information Security Information 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 Your Monitor with a Monitor in Companion Mode 2 What's New?
What's New in Release K.1 (for MX400/450/500/550 only) What's New in Release K.0 What's New in Release J.0 3 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 13 14 15 16 18 27 36 37 38 39 39 39 41 42 42 44 46 47 48 48 49 50 50 52 55 55 55 56 59 60 61 63 64 67 71 72 73 73 3 Alarm Recordings 4 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 5 Managing Patients and Equipment Patient Concepts Equipment Concepts Managing Patients Managing Equipment Care Groups Information Center Compatibility 6 ECG, Arrhythmia, ST and QT Monitoring Skin Preparation for Electrode Placement Connecting ECG Cables Selecting the Primary and Secondary ECG Leads Checking Paced Mode 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 EASI ECG Lead Placement Capture 12-Lead 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 Atrial Fibrillation Alarm Aberrantly-Conducted Beats Intermittent Bundle Branch Block Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring Switching ST or STE On and Off Understanding the ST Display 4 73 75 75 81 105 105 105 106 119 126 132 133 133 133 134 134 134 135 136 137 137 138 138 138 139 139 145 146 149 151 152 154 154 155 155 156 156 156 159 160 164 165 166 Updating ST Baseline Snippets Recording ST Segments About the ST Measurement Points ST Alarms STE Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 7 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 8 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 9 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 10 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP 168 168 168 171 171 172 175 178 179 181 181 181 182 182 185 185 186 186 187 188 188 188 188 191 191 191 192 192 193 194 194 194 200 200 200 200 201 201 201 203 203 205 5 Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Enabling Sequence Mode and Setting Up The Sequence Choosing the NBP Alarm Source Switching Pulse from NBP On/Off Assisting Venous Puncture Calibrating NBP 11 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 12 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 IAP Measuring Pulmonary Artery Wedge Pressure Editing the Wedge Identifying the Pressure Analog Output Connector 13 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 14 Monitoring Carbon Dioxide Measurement Principles 6 207 208 208 209 209 210 210 211 211 212 213 213 215 217 217 217 217 217 218 218 219 221 221 222 222 223 224 225 226 226 228 228 228 233 235 235 236 238 238 239 241 242 Measuring CO2 using M3014A or X2 Measuring Mainstream CO2 using M3016A Measuring Microstream CO2 using M3015A/B Setting up all CO2 Measurements Understanding the IPI Numeric 15 Monitoring Airway Flow, Volume and Pressure Attaching the Flow Sensor Zero Calibration Automatic Purging Manual Purging Gas Compensation Setting up Spirometry 16 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 Zeroing the tcGas Relative Heat Power TcGas Corrections 17 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 18 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 19 Monitoring BIS BIS Monitoring Setup BIS Continuous Impedance Check BIS Cyclic Impedance Check BIS Window 242 246 248 250 252 255 256 258 258 259 259 260 263 263 264 264 265 265 265 267 268 268 268 271 272 272 275 277 279 279 280 282 283 284 284 284 285 286 288 288 289 7 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 20 Monitoring NMT Stimulation Modes Preparing to Measure NMT Taking NMT Measurements Changing the NMT Measurement Settings Alarms Understanding NMT Numerics 21 Guardian Early Warning Scoring Performing the Scoring Procedure Understanding Guardian Early Warning Scoring Viewing EWS Trend Data Using Different Types of Scoring 22 Using a Telemetry Device and a Monitor (PIIC only) How Can You Combine Devices?
Use Models With Telemetry 23 Trends Viewing Trends Setting Up Trends Documenting Trends Trends Databases Screen Trends 24 Calculations Viewing Calculations Reviewing Calculations Performing Calculations Entering Values for Calculations Documenting Calculations 25 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 8 290 290 290 290 291 293 294 295 296 298 299 299 301 301 303 304 305 307 307 309 311 311 315 319 319 320 325 326 327 327 328 329 331 331 331 331 332 332 26 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 27 ProtocolWatch SSC Sepsis Protocol 28 Recording Paper-Strip Recording Electronic Recording 29 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 30 Using the Drug Calculator Accessing the Drug Calculator Performing Drug Calculations Charting Infusion Progress Using the Titration Table Documenting Drug Calculations 31 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 333 333 334 334 335 336 339 340 342 342 349 349 357 357 365 369 369 371 371 372 373 374 374 374 374 375 375 376 381 382 382 385 385 386 387 388 388 389 389 389 389 9 Language Conflict with External Device Drivers 32 IntelliBridge EC10 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 33 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 34 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 35 Laboratory Data Viewing Received Data 36 Using Batteries Battery Power Indicators Checking Battery Charge When Battery Lifetime is Expired Replacing a Battery Optimizing Battery Performance Battery Safety Information 37 Care and Cleaning General Points Cleaning the Equipment Disinfecting the Equipment Sterilizing the Equipment Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning the SO2 Optical Module Cleaning the Recorder Printhead (M1116B only) Cleaning Batteries and the Battery Compartment 10 390 391 391 392 392 393 393 395 395 396 396 397 398 399 399 400 400 400 400 401 401 401 403 403 405 405 407 407 407 408 409 411 411 412 412 413 413 413 413 414 38 Maintenance and Troubleshooting Inspecting the Equipment and Accessories Inspecting the Cables and Cords Maintenance Task and Test Schedule Troubleshooting Returning Equipment for Repair Disposing of the Monitor Disposing of Empty Calibration Gas Cylinders 39 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 SO2 Accessories for M1011A NMT Accessories Recorder Accessories Battery Accessories 40 Specifications Indications for Use Restricted Availability Use Environment Manufacturer's Information Symbols Installation Safety Information Monitor Mounting Precautions Altitude Setting Monitor Safety Specifications Physical Specifications Environmental Specifications EMC and Radio Regulatory Compliance Monitor Performance Specifications Interface Specifications Display Specifications 415 415 416 416 417 417 417 418 419 419 423 426 429 435 436 437 437 438 438 439 439 440 440 440 441 441 442 442 443 443 444 444 444 445 447 455 456 456 457 458 462 464 470 474 11 475 475 495 501 501 508 508 509 512 513 513 514 514 515 517 518 518 519 519 520 520 520 521 521 522 523 M4605A Battery Specifications Measurement Specifications Safety and Performance Tests 41 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 Default Settings SvO2 Default Settings ScvO2 Default Settings EEG Default Settings BIS Default Settings NMT Default Settings VueLink Default Settings Index 12 1 1Introduction These Instructions for Use are for clinical professionals using the IntelliVue MX400/MX450, MX500/
MX550, and 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. MX400/
MX450 Whenever a monitor's identifier appears to the left of a heading or paragraph, it means that the information applies to that monitor only. Where the information applies to all models, no distinction is made. For installation, repair, testing and troubleshooting instructions, refer to the Service Guide for your monitor model. Rx only: U.S. Federal Law restricts this device to sale by or on the order of a physician. 13 1 Introduction Safety Information The following warnings apply to the monitors in general. Warnings that apply to specific measurements or procedures can be found in the corresponding chapters. Electrical Hazards and Interference WARNING Grounding: To avoid the risk of electric shock, 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. Electrical shock hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Refer servicing to qualified service personnel. Leakage currents: If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN 60601-1, IEC 60601-1-1, UL 60601-1. Consult your service personnel. Radio frequency interference: The monitor generates, uses and radiates radio-frequency energy, and if it is not installed and used in accordance with its accompanying documentation, may cause interference to radio communications. Use Environment WARNING 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. Positioning Equipment: The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, check that normal operation is possible in the necessary configuration before you start monitoring patients. Environmental Specifications: The performance specifications for the monitors, measurements and accessories apply only for use within the temperature, humidity and altitude ranges specified in Environmental Specifications on page 458. Liquid Ingress: 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. Prohibited Environments: The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers). 14 Alarms 1 Introduction 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. 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. Accessories WARNING Philips' approval: Use only Philips-approved accessories. Using other accessories may compromise device functionality and system performance and cause a potential hazard. 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. Electromagnetic compatibility: Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment. Damage: Do not use a damaged sensor or one with exposed electrical contacts. Cables and tubing: Always position cables and tubing carefully to avoid entanglement or potential strangulation. MR Imaging: During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns. Security Information Protecting Personal Information Protecting personal health information is a primary component of a security strategy. Each facility using the monitors must provide the protective means necessary to safeguard personal information consistent with country laws and regulations, and consistent with the facilitys policies for managing this information. Protection can only be realized if you implement a comprehensive, multi-layered strategy (including policies, processes, and technologies) to protect information and systems from external and internal threats. As per its intended use, the patient monitor operates in the patient vicinity and contains personal and sensitive patient data. It also includes controls to allow you to adapt the monitor to the patient's care model. To ensure the patient's safety and protect their personal health information you need a security concept that includes:
15 1 Introduction Physical security access measures - access to the monitor must be limited to authorized users. It is essential that you consider physical security measures to ensure that unauthorized users cannot gain access. Operational security measures - for example, ensuring that patients are discharged after monitoring in order to remove their data from the monitor. Procedural security measures - for example, assigning only staff with a specific role the right to use the monitors. In addition, any security concept must consider the requirements of local country laws and regulations. Always consider data security aspects of the network topology and configuration when connecting patient monitors to shared networks. Your medical facility is responsible for the security of the network, where sensitive patient data from the monitor may be transferred. Note: Log files generated by the monitors and measurement modules are used for system troubleshooting and do not contain patient data. About HIPAA Rules If applicable, your facilitys security strategy should include the standards set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), introduced by the United States Department of Health and Human Services. You should consider both the security and the privacy rules and the HITECH Act when designing policies and procedures. For more information, please visit http://www.hhs.gov/ocr/privacy/. About the EU Directives If applicable, your facilitys security strategy should include the practices set forth in the Directive on the protection of individuals with regard to the processing of personal data and on the free movement of such data (Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995). In addition, your facility should also take into account any additional, more stringent standards put forward by any individual EU countries; that is, Germany, France, and so on. For more information, please visit http://eur-lex.europa.eu/en/dossier/dossier_27.htm. Philips Product Security Policy Statement Additional security and privacy information can be found on the Philips product security web site at http://www.healthcare.philips.com/main/support/equipment-performance/product-security/
index.wpd Manufacturer Disclosure Statement for Medical Device Security MDS2 You can view the Manufacturer Disclosure Statements for Medical Device Security (MDS2) for specific devices at http://www.healthcare.philips.com/main/support/equipment-performance/
product-security/index.wpd Introducing the Monitor The IntelliVue MX400/MX450, MX500/MX550, and 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 16 1 Introduction and the MX400/MX450, MX500/MX550, and 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. 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 can be connected to your monitor, where it acts as a multi-measurement module, acquiring measurements for the host monitor. When the X2 is disconnected from 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 resumes its role as multi-measurement module, ensuring fully continuous monitoring. MX600/700/
800 Major Parts and Keys MX400/450/500/550 The MX400/450/500/550 monitors have the same parts, controls and indicators. Here the MX400 is shown. 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 Battery LED 6 Mounting quick-release lever
(when this is pressed the monitor is not fixed on the mounting) Service number and serial number 7 8 Device type 17 1 Introduction MX600/700 MX800 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) 6 Part number and serial number 7 Hardkeys (Silence, Alarms Off, Main Screen) 8 Navigation knob 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 18 1 Introduction 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 445. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Flexible Module Rack (M8048A) MX600/
MX700/
MX800 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). When two FMSs are used, in total a maximum of 10 pressure modules can be used. 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) MX600/
MX700/
MX800 The 4-Slot flexible module rack (FMS-4) lets you use up to four plug-in physiological measurement modules. 19 1 Introduction 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 MX500/
MX550 MX600/
MX700/
MX800 Invasive blood pressure (M1006B) Temperature (M1029A) You can use up to three plug-in modules in the optional module slots. Available modules are:
Oxygen saturation of arterial blood (SpO2) (M1020B) Cardiac output (M1012A), and Continuous cardiac output with M1012A Option #C10 EEG (M1027A) NMT (865383) Intravascular Oxygen Saturation - ScvO2 or SvO2 (M1011A) Spirometry (M1014A) IntelliBridge EC10 (865115) Recorder (M1116B/C) Transcutaneous gas (M1018A) 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) EEG (M1027A) NMT (865383) VueLink device interface (M1032A) Bispectral Index - BIS (M1034A) Spirometry (M1014A) Intravascular Oxygen Saturation - ScvO2 or SvO2 (M1011A) IntelliBridge EC10 (865115) Recorder (M1116B/C) MX500/550/
600/700/800 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 20 1 Introduction 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) MX500/550/
600/700/800 1 Module name 2 Setup key LED 3 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. 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. 21 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 7 X2 Multi-Measurement Module (M3002A) 6 NBP Start/Stop key - starts or stops NBP measurements Silence: acknowledges all active alarms by switching off audible alarm indicators and lamps 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. 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. 22 X2 Overview 1 Introduction 1 On/Standby switch 2 Power and battery indicators (see X2 Controls and Indicators on page 23) 3.5-inch TFT LCD touchscreen QVGA display 3 4 Alarm lamps (see X2 Controls and Indicators on page 23) 5 Battery eject button 6 Hard keys (see X2 Controls and Indicators on page 23) 7 Measurement connectors (see X2 Patient Connectors, Right Side on page 24) 8 Battery compartment 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. 23 1 Introduction Silence key 8 9 Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is 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 (or yellow when yellow alarms are suspended), and the alarms off symbol is shown. X2 Patient Connectors, Right Side 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 SpO2 Pressure and Temperature) 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. X2 Left Side 24 1 Introduction 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. 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 25 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 MX600/700/
800 The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the MMS. M3016A Pressure connector (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 44). 26 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. 1 Introduction 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. Using MMSs in a Mixed Software Environment When an MMS is used with monitors having different software revisions, be aware that functionality set up in a monitor with a newer revision will disappear when the MMS is connected to a monitor with an older revision without that functionality. For example, if an X2 is used with a revision H monitor and has been set up to alarm on Afib, this alarm will no longer exist when the X2 is connected to a revision G monitor. If you work in a mixed software environment, inform yourself about the differences between revisions by referring to the What's New chapter. 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 typical operator's position is in front of the monitor. 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. 27 1 Introduction MX400 On the MX400, the permanent keys and the key to access the SmartKeys are on the right of the screen. Other screen elements 9 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on. Pause Alarms or Alarms Off - stops alarms being announced for a set time or switches them off. Select again to immediately switch alarms on again. Can be configured not to appear here. SmartKeys -displays a block of SmartKeys. These change according to your monitor's configuration close all open menus and windows and return to main screen battery indicator with remaining battery time status messages indicator - clicking this area displays any pending status messages measurement selection symbol - opens Measurement Selection window to resolve label conflicts 10 11 12 13 14 15 Monitor information line 1 network connection indicator
(documented in Troubleshooting in the Service Guide) bed label - gives access to Equipment window patient category symbol patient name date and time current screen name/enter Change Screen menu alarm status area - shows active alarm messages or Alarms Off symbol when alarms are switched off alarms off/alarm volume indicator 2 3 4 5 6 7 8 28 MX450/500/550/600/700/800 1 Introduction Monitor information line 1 network connection indicator
(documented in Troubleshooting in the Service Guide) bed label - gives access to Equipment window patient category symbol Other screen elements 10 The status line shows messages with information and prompts you for possible actions (MX400/450/500/550 do not have a reserved space for this feature). 11 remote application symbol or iPC symbol (MX600/700/800 only) 12 measurement selection symbol - opens Measurement Selection window to 2 3 4 5 6 7 8 9 patient name date and time access the Profiles menu or Profile name, depending on configuration current screen name/enter Change Screen menu adjust alarm volume/level indicator alarm status area - shows active alarm messages or Alarms Off symbol when alarms are switched off 13 14 15 16 17 18 19 resolve label conflicts 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 or Alarms Off - stops alarms being announced for a set time or switches them off. Select again to immediately switch alarms on again. Can be configured not to appear here. Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on. 29 1 Introduction 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. 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. 30 1 Introduction 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, normally located at the bottom of the main screen. On some models, a selection of SmartKeys is displayed by selecting the SmartKeys permanent key on the right of the main screen. SmartKeys give 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 demographics 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 view information for patients in other beds change screen brightness (not for independent displays) re-learn arrhythmia enter cardiac output procedure 31 1 Introduction 32
- 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) access NBP mode selection and setup, with direct start/stop function start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series stop current NBP measurement set the NBP repeat time zero invasive pressure transducer 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) 1 Introduction 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 start an NMT measurement cycle stop an NMT measurement cycle start NMT calibration access patient reports open the Equipment window 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. 33 1 Introduction 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. SmartKeys - display a block of SmartKeys specially configured for remote tasks (see below) 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. 6 Enter - mark the end of data entry Keypad 7 Navigation knob 8 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. Type numeric data on the keypad and press the Enter key to enter the data on the monitor. 34 1 Introduction 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. 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. 35 1 Introduction Operating Modes Select the Main Setup menu. Select Operating Modes and choose the mode you require. When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:
1 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 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 select the Monitor Standby SmartKey or select Main Setup, followed by Monitor Standby. 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. 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, or to your own custom image. If a temporary patient location has been entered at the monitor or at the Information Center, this location will also be displayed on the Standby screen. To resume monitoring, When monitoring is resumed, alarms are paused for 1 minute to allow time to finish plugging in the measurement cables. Select anything on the screen or press any key. 36 1 Introduction If you connect an X2 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. 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 2 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. 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. Up to three modified Screens can be accessed via the Change Screen menu. To recall Screens, either or use the previous arrow at the top of the Change Screen menu to move back in the Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed. select the name of the Screen in the Change Screen menu 37 1 Introduction 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. Independent Displays MX600/700/
800 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 2 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. 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. 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. 38 1 Introduction Using the XDS Remote Display MX600/700/
800 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 IntelliVue XDS Application Instructions for Use. 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, Select the visitor Screen's name below the clock 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). 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. 39 1 Introduction 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. If your monitor is configured to show the profile name in the info line at the top of the screen, be aware that individual settings may have been changed by other users or by settings synchronization since the profile was loaded. Hence settings may be different than implied by the profile name. 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. Select the Profile Details pop-up key. In the Profiles menu, select Profile. 2 3 4 Choose a profile from the pop-up list. 5 Confirm your selection. Swapping a Settings Block 1 2 3 Select the Profile in the monitor info line. Select the Profile Details pop-up key. In the Profile Details menu, select Display or Measmnt.Settings or Monitor Settings to call up a list of the settings blocks in each category. 4 Choose a settings block from the pop-up list. 5 Confirm your selection. Default Profile Your monitor has a default profile that it uses when you leave Demonstration mode, or when you discharge a patient. This profile is indicated by a diamond shaped symbol. Locked Profiles Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol. 40 Understanding Settings 1 Introduction 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. 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 you silence the resulting INOP, the measurement is switched off. Also if you pause or switch off alarms, the measurement may be switched off completely, depending on your 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. 41 1 Introduction 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, 1 Select Main Setup, then select User Interface 2 Select Global Speed, RespiratorySpeed, or EEG Speed as required 3 Select a value from the list of available speeds. Changing Wave Speed for a Channel To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 3 To set the speed to the wave group speed, select RespiratorySpeed, EEG Speed, or Global Speed. Select Change 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. 42 1 Introduction 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, 1 Select the frozen wave. 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. To change the wave speed:
1 Select the frozen wave. 2 Select Change Speed. 3 Select a speed from the list. Updating The Frozen Wave To update the wave, that is freeze the current wave:
1 2 Select the frozen wave. Select Freeze Again. 43 1 Introduction Releasing Frozen Waves To release frozen waves, 1 Select a frozen wave. 2 Select Unfreeze Waves. All frozen waves are released. Using Labels Every measurement associated with a monitor is identified by a unique label. You may have more than one instance of some measurements, for example pressure, being used simultaneously. The monitor uses the 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. 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. 44 1 Introduction 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". When an X2 is connected to a host monitor, the measurement selection window looks like this:
X2 connected to a host monitor 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 Meas. 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. 45 1 Introduction 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. Activate: to activate the highlighted measurement and deactivate the blinking measurement. This requires confirmation. 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. 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, 1 2 3 4 5 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. 6 46 1 Introduction 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. Switching Manually Entered Measurements On and Off To switch a manually entered measurement on or off, 1 2 3 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. 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. Adjusting the Screen Brightness To adjust the brightness:
1 Select the Brightness SmartKey. 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. The MX400/450/500/550 monitors can be configured to automatically adapt the screen brightness to the ambient light conditions. The range within which this adaptation is made is determined by the setting made with the Brightness SmartKey. 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. Refer to the documentation 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. 47 1 Introduction 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 E-Learning Education Programs for self-training before using the monitor (available at the Philips Learning Center, english only). Inspecting the Monitor WARNING If the monitor or mounting hardware 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. 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. 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. 48 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. 1 Introduction 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. An MMS switches on automatically when connected to a running host monitor. When an X2 is disconnected from a running host monitor, the X2 continues to run without interruption on battery power. 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 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 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. 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. 49 1 Introduction 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 Only connect patient monitors to networks that conform to the network installation instructions provided by Philips for your system. It is possible to assign additional monitoring equipment and a telemetry device to the same patient, resulting in the information from multiple devices being combined in one sector at the Information Center. (See When Multiple Equipment is Used for One Patient on page 122 and Using a Telemetry Device and a Monitor (PIIC only) on page 307.) 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 bed label in the monitor info line. 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. Using the Integrated PC MX600/
MX700/
MX800 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 IntelliVue XDS Application 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. 50 1 Introduction CAUTION When you install any software on the iPC you are responsible for ensuring that the resulting system complies with all relevant local regulations. Starting the iPC Your monitor may be configured to have the iPC start up automatically when the monitor is switched on. If not:
1 2 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 If the Desktop is not displayed on the monitor display:
, or Select the iPC key Select Main Setup, Internal PC, then Show PC Window. 1 2 To hide the Desktop again, select Main Screen. There are special iPC screens available that use the full height of the screen for the iPC Desktop. The monitoring screen content is then arranged on the right side of the screen. Such iPC screens may be loaded automatically when the iPC key is selected. In this case the Main Screen key is replaced by a Previous Screen key, to give you a fast and easy method to switch back and forth between the iPC screen and the regular screen. 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. 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. 51 1 Introduction Shutting the iPC Down Select Main Setup then Internal PC. In the Internal PC menu, select Switch PC off. 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 2 If there is a problem with the shutdown, and you need to switch off the iPC manually, 1 2 Select Main Setup then Internal PC. In the Internal PC menu, select Force PC off to force the iPC to power down. 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 Your Monitor with a Monitor in Companion Mode When you connect an X2 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. 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. 52 1 Introduction 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. An X2 switches on automatically when connected to a running host monitor. When an X2 is disconnected from a running host monitor, the X2 continues to run without interruption on battery power. When an X2 is used with host monitors having different software revisions, be aware that functionality set up in a monitor with a newer revision will disappear when the X2 is connected to a monitor with an older revision without that functionality. For example, if an X2 is used with a revision H monitor and has been set up to alarm on Afib, this alarm will no longer exist when the X2 is connected to a revision G monitor. If you work in a mixed software environment, inform yourself about the differences between revisions by referring to the What's New chapter. 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. 53 1 Introduction 54 2 2What's 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. What's New in Release K.1 (for MX400/450/500/550 only) MX500/MX550 In this release the MX500/MX550 patient monitors join the IntelliVue monitor family. The monitors are optimized for transport within the hospital environment. The MX500 has a 12-inch display and the MX550 has a 15-inch display. Both models have three integrated plug-in module slots for up to three measurement modules, or the IntelliBridge interface module (865115), or recorder module (M1116B/C). The MX500/550 have the option to be operated with a single, user-replaceable battery. EC10 IntelliBridge Interface Board MX400/450/
500/550 The functionality of the IntelliBridge EC10 plug-in module - interfacing data from a connected external device into the monitor - is now available in an embedded board. The connector for the optional interface board is accessed at the rear of the monitor. Wireless Remote Control MX400/450/
500/550 The remote control, previously only available with a USB cable connection, can now also be used wirelessly, with a short-range radio connection, as with the models MX600-800. What's New in Release K.0 MX400/MX450 In this release the MX400/MX450 patient monitors join the IntelliVue monitor family. The monitors are optimized for transport within the hospital environment. The MX400 has a 9-inch display and the MX450 has a 12-inch display. Both monitors can optionally be equipped with an integrated recorder and have the option to be operated with a single user-replaceable battery. 55 2 What's New?
What's New in Release J.0 Flexible, Patient-oriented Workflow (with PIIC iX only) With the IntelliVue Information Center iX, more flexible, patient-oriented workflows are supported for admitting, tracking and transferring patients. This allows you to adapt monitor use to the patient data flow models in your specific facility and department. Managing Patients When the patient monitor is connected to an IntelliVue Information Center iX, an extended comparison of patient data allows more intelligent admission and transfer procedures. A Find Patient key can be used to search through the patient lists at the Information Center and other connected systems and take over the corresponding data found. Flexible Transfer A transfer can be initiated in the unit at the monitor, on patient arrival or patient departure, or centrally at the Information Center. Managing Equipment When used together with an Information Center iX, extended equipment management functionality is now available. Depending on how equipment is used in your facility, there are various ways to associate devices with patients, beds or monitors. Additionally there are mechanisms to automatically free up equipment that is no longer used. Using the new Equipment window you have an overview of all equipment being used for a patient, together with patient and caregiver data. New NMT Module A new NMT module enables the evaluation of muscle relaxation of patients under Neuromuscular Block by measuring the strength of muscle reaction after electrically stimulating the dedicated motor nerve. Alarm Functionality Enhancements Pause Yellow Alarms (with PIIC iX only) - up until now, the Pause Alarms / Alarms Off key switched off or paused all red and yellow alarms. Now an alarm priority configuration setting is available to have only yellow alarms affected. Pause Alarms / Alarms Off not allowed - when the alarm priority is set to Not Allowed, alarms can no longer be switched off or paused. The Pause Alarms / Alarms Off key is disabled. Pause Alarms / Alarms Off key can be removed from the screen - a configuration setting removes the permanent key from the screen to avoid unintentional switching off of alarms. Alarms can still be switched off or paused, in the Alarms menu, under Main Setup. Alarms paused after Standby mode - alarms are automatically paused for 1 minute after Standby mode to allow time for patient connection. Capture 12-Lead ECG Enhancements (with PIIC iX only) The existing 12-Lead ECG capture functionality has been extended to offer:
Download of analysis results from the IntelliVue Information Center. Download of 12-Lead captures from the IntelliVue Information Center for review at the patient monitor. 56 2 What's New?
Analysis results included in reports and additional report selections with ST Map. New filter settings that are used as a default for future 12-Lead captures. Remote operation of the 12-Lead Export function at the IntelliVue Information Center. Remote operation of the 12-Lead Lock/Unlock function at the IntelliVue Information Center. New "End Afib" and "End Irregular HR" Alarms The end of an atrial fibrillation or irregular HR phase is announced with an ** End AFIB or **End Irregular HR alarm. The delay time before the alarm is announced can be configured. Information Line Changes Patient Category is now displayed as a symbol in front of the patient name and cannot be changed from the Information line. Paced Mode is no longer displayed in the Information line; it appears next to the HR numeric. Depending on your configuration, you will see the current Profile name, and/or the Screen name in the Information line. The Profiles menu has been simplified in Monitoring and Configuration Mode. Sepsis Protocol Configurability The SSC Sepsis protocol can now be configured, to customize it for the specific treatment measures used in your facility. This can include changes to limits for measured or manually entered values, changes to the Severe Sepsis Screening criteria, and changes to the recommendations in the Sepsis Resuscitation Bundle and the Sepsis Management Bundle. Integrated Pulmonary Index for Microstream CO2 An Integrated Pulmonary Index (IPI) numeric is provided, that is an indication of the patient's overall ventilatory status based on four measurement parameters: etCO2, awRR, pulse rate and SpO2. Cardiac Output (transpulmonary method) - Changes to Calculation Basis for Extravascular Lung Water Index and Preload Indexes EVLWI is now calculated using Ideal Body Weight (IBW). ITBVI and GEDVI are calculated using Ideal Body Surface Area (IBSA). IBW and IBSA are based on the patient category, gender and height that are entered for the patient. Improved Visibility of Gridlines in Overlapping Waves Visibility of the gridlines for overlapping waves has been improved, and you can now configure gridlines to be shown in white, if you prefer, in a thin or thick style. Timeout for "Aged" Numerics NBP and SpO2 numerics from intermittent measurements can be configured to be grayed out or to disappear from the screen after a set time. This avoids older numerics being misinterpreted as current data. The time can be set individually for SpO2 and NBP in Configuration mode. 57 2 What's New?
58 3Alarms 3 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
<SpO Label> No Pulse
<Press Label> No Pulse All monitors in a unit should have the same severity configured for these INOPs. Tele Disconnected Battery Empty / Replace Battery ECG Leads Off NBP Cuff Overpress Cuff Not Deflated 59 3 Alarms Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm indication at the monitor. This delay has two components:
The general measurement 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, for certain measurements (SpO2, EEG and BIS), on 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 sum of the alarm delay configured for the specific measurement plus the system alarm delay. The system alarm delay is the processing time the system needs for any alarm on the monitor to be indicated after the measurement has triggered the alarm. See the performance specifications in the Specifications chapter for the system alarm delay specification. The alarm delay configured for a specific measurement is normally a fixed time. For SpO2 it is also possible to configure a Smart Alarm Delay that is calculated using an intelligent algorithm. See Smart Alarm Delays on page 195 in the SpO2 chapter for more details. Multiple Alarms 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. 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 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. Alarm fields and other visual alarm indicators are disabled 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. 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. 60 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. 3 Alarms 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:
On 1.0 seconds 0.25 seconds INOP Lamp Color Yellow Red 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. Off 1.0 seconds 0.25 seconds MX400/450/
500/550 If the screen brightness is configured to automatically adapt to ambient light conditions, the alarm lamps will also adapt their brightness accordingly. 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). 61 3 Alarms WARNING Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment. No audible alarm indicators are available on an 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. 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. 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. 62 3 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 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 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. 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) Battery Empty / Replace Battery - (configurable to light blue, yellow or red) Power Loss Tone When power is lost - no power is available via the power cable or battery (where available) - 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. 63 3 Alarms 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. 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. Infinite alarm pause is equivalent to switching the alarms off. To view the alarm pause setting chosen for your unit, 1 Select Main Setup, Alarms, then Alarm Settings 2 Check the Alarms Off setting. This setting can only be changed in Configuration Mode. 64 3 Alarms There are some settings made in Configuration Mode that can affect the availability of the pause alarms functionality. The Pause Alarms / Alarms Off permanent key can be removed from the screen to avoid unintentional switching off of alarms. The corresponding hardkey on the SpeedPoint or Navigation Point is then also disabled. In this case you can only pause alarms or switch alarms off permanently in the Alarms menu, under Main Setup. The Pause Alarms / Alarms Off permanent key and the corresponding hardkey can be configured to pause or switch off red and yellow alarms, yellow alarms only, or not to function at all. If they are configured not to function, you cannot pause alarms or switch alarms off permanently at all. When the alarms off priority is set to Yellow Only, the Pause Alarms / Alarms Off key becomes the Pause Yellow / Yellow Al. Off key. 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 (or Yellow Al. Off). Select the Alarms Off (or Yellow Al. 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. 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. The alarms off symbol is shown beside the measurement numeric. 65 3 Alarms While Alarms are Paused or Off When red 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 Al. Paused x:yy or Alarms Off, together with the alarms paused symbol or the alarms off symbol. When yellow alarms are paused or off:
The yellow Alarms Paused lamp on the monitor front panel is lit. In the alarm field, the monitor displays the message YellowPaused x:yy or Yellow Alarms Off, together with the alarms paused symbol or the alarms off symbol. For red and yellow alarms:
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 timeout period, either select the Alarms Off or Pause Alarms permanent key and then reselect it, or select Reset Alarming in the Review Alarms window or the Alarm Messages window. 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. 66 3 Alarms To extend the alarm pause time to five or 10 minutes, 1 2 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. Alarm Settings for Unattended Monitoring When monitoring patients that are not continuously attended, use appropriate alarm settings to optimize monitoring:
Always leave alarms switched on when the patient is unattended. Recommended configuration: Use one of the temporary settings for the Alarms Off setting, not Infinite, and make sure that the AlarmOffReminder and the Alarm Reminder are switched on
(these settings are made in Configuration mode). Set alarm limits so that alarms will be triggered for those changes in the patient condition that you want to be advised of. Setting limits to very high or low values can render the alarm system useless. Use available notification routes, such as a nurse call system or the connection to an Information Center, or at least select an appropriate alarm volume to ensure that alarms are recognized. 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, or if the numeric is so small that the limits cannot be displayed, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits. 67 3 Alarms 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. 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 Set limits so that alarms will be triggered for those changes in the patient condition that you want to be advised of. Setting limits to very high or low values can render the alarm system useless. 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. 68 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. 3 Alarms Parameter label High red alarm limit (view only) High yellow alarm limit 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. 69 3 Alarms 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. Alarm Limits can also be changed at the IntelliVue Information Center iX. 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. Documenting Alarm Limits The alarm limits pop-up keys appear with the Alarm Limits and measurement alarm limits windows. 70 3 Alarms 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 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 message. This calls up a help window with an explanation of the 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 device alarms on and off, entering or leaving Standby mode, silencing alarms or changing the 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 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. 71 3 Alarms The Review Alarms window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive. 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 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 only, red and yellow, and off. These choices can be combined to give the following settings:
In the monitor's Main Setup menu, select Alarms. Select Alarm Settings, and see the Visual Latching and Audible Latching 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 Alarm Latching Behavior Red & Yellow Measurement Alarms Alarm has not been acknowledged. Alarm condition still present. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. All audible and visual alarm indicators automatically stop. Alarm condition no longer present. 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. 72 Non-latching alarms Visual and audible latching Visual latching, audible 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. non-latching 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 160 for information on one-
star yellow alarms latching behavior. 3 Alarms Testing Alarms When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example 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. Alarm Recordings You can set up your monitor so that it automatically triggers alarm recordings locally or at the Information Center, or if configured, to a printer as a realtime report. 1 2 3 4 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. 5 Refer to the "Recording" chapter for details of how to set up a recording. 73 3 Alarms 74 4 4Patient 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. 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". 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. Refer to your IntelliVue TcG10 Instructions for Use for patient alarms and INOPs from the TcG10. Alarm Message
* AFIB
*** Apnea
*** Apnea x:yy
*** Apnea >10 min
*** Asystole
** awRR High
** awRR Low
** BIS High
** BIS 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 > the asystole alarm threshold 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. BIS BIS The Bispectral Index value has exceeded the high alarm limit. The Bispectral Index value has dropped below the low alarm limit. Indication yellow alarm lamp, short yellow alarm tone 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 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone 75 4 Patient Alarms and INOPs Alarm Message
***Brady/P xxx<yyy
***Brady xxx < yyy From Press, SpO2 ECG CCO CCO CPP CPP SpO2
** CCO High
** CCI High
** CCO Low
** CCI Low
** CPP High
** CPP Low
*** Desat
*** Desat xx < yy
** EC10 Alarm
*** EC10 Alarm at Information Center
* End AFIB Condition This is the alternative alarm message for ***
Extreme Brady, when the alarm text setting is Enhanced. Heart rate < the extreme bradycardia alarm limit. xxx denotes the lowest measured value;
yyy is the extreme bradycardia 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. EC10 IntelliBridge A yellow (**) or red (***) patient alarm is present on the IntelliBridge module. Check the monitor display for more detailed alarm information. ECG/Arrhythmia Atrial fibrillation no longer detected for the
* End Irregular HR ECG/Arrhythmia
** etCO High CO2, AGM configured Afib end delay time Irregular HR no longer detected for the configured irregular HR end delay time. The end tidal CO2 high alarm limit has been exceeded.
** etCO Low CO2, AGM The end tidal CO2 value has fallen below the low alarm limit. O2, AGM O2, AGM The end tidal O2 high alarm limit has been exceeded. 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.
** etO High
** etO Low
* Event
** Event
*** Event at Information center
* Event:<Event Group>
** Event:<Event Group>
*** Event:<Event Group>
76 Indication 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
(on monitor) yellow or red alarm lamp; the alarm text is defined by the IntelliBridge device driver yellow alarm lamp, short yellow alarm tone yellow alarm lamp, short yellow 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
(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 4 Patient Alarms and INOPs Alarm Message
*** Extreme Brady From ECG Condition Heart rate < the extreme brady alarm limit.
*** Extreme Tachy ECG Heart rate > the extreme tachy alarm limit.
* HR High
** HR High
* HR Low
** HR Low ECG Heart rate > the high HR alarm limit ECG Heart rate < the low HR alarm limit
** IPI Low CO2 The IPI value has fallen below the low alarm limit.
* Irregular HR ECG/Arrhythmia Consistently irregular rhythm (irregular R-R
** <iTemp Label> High iTemp intervals). The temperature value has exceeded the high alarm limit.
** <iTemp Label> Low iTemp The temperature value has dropped below the low alarm limit.
* Missed Beat
* More Alarms
** More Alarms
*** More Alarms
* Multiform PVCs
** NBP High
** NBP Low ECG/Arrhythmia No beat detected for > 1.75*(the averaged R-R interval), or no beat detected for > one second if HR > 120 (For non-paced patients only). There is more than one physiological alarm of the corresponding severity active on the devices that monitor this patient. For details, check the information displayed at the Information Center. other assigned devices ECG/Arrhythmia Two different 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. Indication numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone 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 switched 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 switched on. 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 limit is high-lighted, yellow alarm lamp, alarm tone numeric flashes and low limit is high-lighted, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, short yellow audible alarm yellow or red alarm lamp and 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
* Non-Sustain VT ECG/Arrhythmia A run of PVCs < the V-Tach run limit and ventricular heart rate > the V-Tach HR limit numeric flashes, yellow alarm lamp, short yellow audible alarm 77 4 Patient Alarms and INOPs Alarm Message
* OtherMon Alarm
** OtherMon Alarm
*** OtherMon Alarm
* Pacer Not Capt
* Pacer Not Pacing
* Pair PVCs
* Pause From another assigned monitor Condition Another monitor used for the patient is in an alarm condition. Check the detailed alarm information at the Information Center. No beat detected for > 1.75*(the averaged R-R interval) with detected pace pulse(s). (For paced patients only). No beat and pace pulse detected for >
1.75*(the averaged R-R interval). (For paced patients only). ECG/Arrhythmia
(paced patients only) ECG/Arrhythmia
(paced patients only) ECG/Arrhythmia Two ventricular beats between two non-
ventricular beats. ECG/Arrhythmia No beat detected for a period > the pause
*** <Press Label>
Disconnect PRESS
*** <Press Label> High PRESS
** <Press Label> High PRESS
*** <Press Label> Low PRESS
** <Press Label> Low PRESS
** Pulse High PRESS, SpO2 threshold. The pressure is non-pulsatile and the mean pressure is continuously less than 10 mmHg
(1.3 kPa). 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.
** Pulse Low PRESS, SpO2 The pulse rate has dropped below the low alarm limit.
* PVCs/min High ECG/Arrhythmia
** QTc High
** QTc High ECG/QT ECG/QT PVCs detected within a minute > the alarm 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 78 Indication yellow or red alarm lamp and 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, 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 4 Patient Alarms and INOPs Alarm Message
* R-on-T PVCs From ECG/Arrhythmia
** RR High
** RR Low RESP RESP Condition For HR < 100, a PVC with R-R interval < 1/3 the average interval followed by a compensatory pause of 1.25*(the 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 beat detection) The respiration rate has exceeded the high alarm limit. The respiration rate has dropped below the low alarm limit.
* Run PVCs High ECG/Arrhythmia A run of > 2 PVCs.
** <SO Label> High 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 Multi <n>,<n>
ECG/ST
**ST Multi at Information Center
**STE <n>,<n>
** ST-<n> High ECG/ST ECG/ST ECG/ST
** ST-<n> Low ECG/ST The arterial oxygen saturation has exceeded the high alarm limit. The arterial oxygen saturation has fallen below the low alarm limit. Two contiguous ST leads <n> and <n> have exceeded elevation or depression limits for more than 60 seconds. The limit violations for both leads must be with respect to same limit;
either both above the high limit or both below the low limit. The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor Two contiguous leads <n> and <n> are above their respective STE limits The ST elevation in lead <n> is higher than the limit. Lead is not contiguous with any other lead. The ST depression in lead <n> is lower than the limit. Lead is not contiguous with any other lead.
* SVT ECG/Arrhythmia A run of supraventricular beats > the SVT run limit and heart rate > the SVT HR limit. Indication 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, yellow alarm lamp, alarm tone
(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes, 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 79 4 Patient Alarms and INOPs Alarm Message
***Tachy/P xxx>yyy or
***Tachy xxx > yyy From Press, SpO2, ECG
** Tblood High
** Tblood Low
** tcpO High
** tcpCO High
** tcpO Low
** tcpCO Low C.O. C.O. tcGas tcGas
* Tele Alarm
** Tele Alarm
*** Tele Alarm
** <Temp Label> High TEMP an assigned telemetry device
** <Temp Label> Low TEMP Condition This is the alternative alarm message for ***
Extreme Tachy when the alarm text setting is Enhanced. Heart rate >the extreme tachycardia alarm 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. A telemetry device used for the patient is in an alarm condition. Check the detailed alarm information at the Information Center. The temperature has exceeded the high alarm limit. The temperature has fallen below the low alarm limit. an assigned transport monitor NMT A transport monitor used for the patient is in an alarm condition. Check the detailed alarm information at the Information Center. TOFcnt value has exceeded the high alarm limit ECG/Arrhythmia A dominant rhythm of N, V, N, V (N =
supraventricular beat, V=ventricular beat) Fibrillatory waveform (sinusoidal wave between 2 10 Hz) for 4 consecutive seconds. ECG ECG/Arrhythmia A dominant rhythm of adjacent Vs > the vent rhythm limit and ventricular heart rate < the V-
Tach HR limit. ECG/Arrhythmia A dominant rhythm of N, N, V, N, N, V (N =
supraventricular beat, V = ventricular beat). ECG, Arrhythmia A run of PVCs the V-Tach run limit and VueLink heart rate > the 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.
* T-Mon Alarm
** T-Mon Alarm
*** T-Mon Alarm
** TOFcnt High
* Vent Bigeminy
*** Vent Fib/Tach
* Vent Rhythm
** Vent Rhythm
* Vent Trigeminy
*** VTach
** VueLink Alarm
*** VueLink Alarm at Information Center 80 Indication 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 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 yellow or red alarm lamp and alarm tone numeric flashes and high 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; the alarm text is defined by the VueLink device driver 4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ? appears next to the numeric. 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 Bad MSL INOP tone Central: Tele Only INOP tone Check Alarm Lamps INOP tone Check DrugSettings INOP tone
!!Check ECG Source Yellow tone
!! Check Equipment INOP tone/Yellow tone 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 INOP tone Check MSL Voltage INOP tone Check Network Conf INOP tone
!! Check Pairing Yellow tone
!!Check Patient ID Yellow tone What to do 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. There is an equipment status dispute relating to one or more of the devices assigned to this patient. See the Equipment window for details. 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. There is a problem with device pairing. Check that the monitor and telemetry device are correctly paired. There is a mismatch between patient data in two connected devices. Resolve the mismatch to allow settings and data synchronization. 81 4 Patient Alarms and INOPs What to do 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. Synchronization of the settings for the measurement cited, has failed. Check that settings are appropriate for your patient. 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. 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. 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. There is more than one technical alarm of the corresponding severity active on the devices that monitor this patient. For details check the information displayed at 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. 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 <Measurement Label>Settings Chk MSL Connection INOP tone Internal.Comm.Malf INOP tone MCC Reversed INOP tone MCC Unsupported INOP tone Meas. Deactivated
!!More Bed Alarms
!!!More Bed Alarms at Information Center More INOPs
!! More INOPs
!!! More INOPs MSL Power High MSL Power Off INOP tone MSL Power Overload INOP tone 82 4 Patient Alarms and INOPs INOP Message, Indication No Central Monit. INOP tone No ECG at Central OtherMon INOP
!! OtherMon INOP
!!! OtherMon INOP Rem.AlarmDev.Malf. INOP tone Settings Malfunct INOP tone Speaker Malfunct INOP tone SRR Incompatible INOP tone SRR Interference INOP tone SRR Invalid Chan INOP tone SRR Malfunction INOP tone TAAP Disabled INOP tone Tele Config Unsupp INOP tone Tele ECG Malfunct. Numeric is displayed with a -?-
INOP tone Tele Equip Malf INOP tone Tele Incompatible Tele INOP
!! Tele INOP
!!! Tele INOP Tele Unsupported INOP tone TimeExpired:<Timer Label>
INOP tone T-Mon INOP
!! T-Mon INOP
!!! T-Mon INOP INOP tone TransportEquipment What to do 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. Another monitor assigned to the patient (e.g. a transport monitor) is in an INOP condition. Check the detailed INOP information at the Information Center and resolve the INOP condition(s) at the other monitor. There is a problem with the connection to the remote alert device. Contact your service personnel to check the remote alert device and its connections. 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 component has compatibility problems. Contact your service personnel. 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 Workflow configuration not supported. Check revision and configuration of monitor and central. Contact your service personnel. The ECG in the Telemetry device is faulty. 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. A telemetry device assigned to the patient is in an INOP condition. Check the detailed INOP information at the Information Center and resolve the INOP condition(s) at the telemetry device. 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. A transport monitor assigned to the patient is in an INOP condition. Check the detailed INOP information at the Information Center and resolve the INOP condition(s) at the transport monitor. The equipment is ready for transport. See the Equipment window for details. 83 4 Patient Alarms and INOPs What to do 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. 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 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. 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. INOP Message, Indication Unsupported LAN INOP tone User I/F Malfunct INOP tone 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
!!Batt Empty
!!!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
!!Batteries Empty
!!!Batteries Empty Batt 1 Empty
!!Batt 1 Empty
!!!Batt 1 Empty Batt 2 Empty
!!Batt 2 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 84 4 Patient Alarms and INOPs INOP Message, Indication Batteries Malfunct 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 Malfunct INOP tone, battery LED may flash Check Batt Temp INOP tone Chk MSL Connection ExtBat Empty
!!ExtBat Empty
!!!ExtBat Empty INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. ExtBat Incompat ExtBat Low ExtBat Malfunction INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power. 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 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. 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. 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 in the battery extension cannot be used. Replace with the correct battery as specified in this book. 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 or battery extension 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 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. 85 4 Patient Alarms and INOPs INOP Message, Indication FMS Unsupported INOP tone MMS Ext. Unplugged INOP tone MMS Ext. Unpowered INOP tone MMS Ext. Unsupp INOP tone MMS Ext.Equip Malf INOP tone MMS Unplugged INOP tone MMS Unsupported INOP tone MMS/FMS Unsupportd 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. What to do The Flexible Module Rack is not supported by your 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. The MMS extensions not supported by your monitor. Contact your service personnel. 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. The Multi-measurement Module 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 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 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. 86 INOP Message, Indication Cannot Analyze QT Cannot Analyze ST Cannot Analyze STE ECG Equip Malf Numeric is replaced by -?-
INOP tone
<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 Numeric is replaced by -?-
INOP tone ECG Noisy Elec <ECG Lead>
ECG Noisy Signal INOP tone ECG Out Equip Malf INOP tone
!!ECG/Ar AlarmsOff ECG/Arrh AlarmsOff
!!ECG/Ar AlarmsOff 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 AlarmsOff 4 Patient Alarms and INOPs What to do 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 STE algorithm cannot generate valid ST elevation values. 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. Contact your service personnel. The ECG hardware 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. Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. The INOP may also be caused by a saturated or overloaded ECG amplifier. The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy. Check the ECG connections and make sure that the electrode indicated is attached. The ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient. The ECG signal may be saturated or overloaded. There is a problem with the device connected to the ECG Out connector. 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. 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. 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. 87 4 Patient Alarms and INOPs What to do 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. 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 (2 kPa) for more than 3 minutes. Neonatal patients: The NBP cuff pressure has exceeded 5 mmHg (0.7 kPa) 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. INOP Message, Indication V Lead Off Numeric is replaced by -?- for 10 seconds. INOP tone Pulse INOPs INOP Message, Indication Pulse Not Alarming Numeric is replaced by -?-
INOP tone 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 a -?-
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 88 4 Patient Alarms and INOPs INOP Message, Indication NBP Interrupted Numeric is replaced by -?-
INOP tone NBP Measure Failed Numeric may be displayed with a -?-
INOP tone What to do 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. 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>NoTransducer 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 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 89 4 Patient Alarms and INOPs INOP Message, Indication Tven INOPs Tvesic INOPs SpO2 INOPs What to do See <Temp Label> INOPs See <Temp Label> INOPs What to do INOP Message, Indication
<SpO Label> Chk Sensor The condition of the signal at the SpO2 sensor is not as expected. Accuracy may be compromised. Check proper application of the sensor in accordance with the Instructions for Use. If the INOP persists, consider exchanging the sensor. 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.
<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>Interference Numeric is replaced by -?-
INOP tone
<SpO Label> Low Perf Numeric is replaced by -?-
(questionable numeric)
<SpO Label> No Pulse Numeric is replaced by -?-
INOP tone
<SpO Label> No Sensor Numeric is replaced by -?-
INOP tone
<SpO Label> NoisySignal 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 90 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. 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. 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. The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised. If the INOP persists, consider changing the application site or using another sensor. 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. 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 Disabled 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 4 Patient Alarms and INOPs 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. CPP has been disabled, either in the setup in Configuration mode, or by loading settings with CPP disabled. This can happen when changing from a pediatric or neonatal profile to an adult profile, as the default profile settings have the CPP measurement disabled in the adult profile and enabled in the pediatric and neonatal profiles. Enable CPP in the current 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. 91 4 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. 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 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 350 bpm. This is usually caused by movement artifact or electrical interference. 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 What to do 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. 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. INOP Message, Indication
<Press Label> Deactivated INOP tone
<Press Label> Equip Malf Numeric is replaced by -?-
INOP tone
<Press Label> No Pulse Pulse 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> 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 CO2 INOPs INOP Message, Indication CO Auto Zero Numeric is replaced by -?-
if the Autozero lasts >15 sec, INOP tone sounds. CO Cal Failed Numeric is replaced by -?-
INOP tone 92 4 Patient Alarms and INOPs What to do 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. There is no CO2 sensor connected. 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 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. 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. The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave. INOP Message, Indication CO Cal Mode CO2 numeric displays current CO2 value for accuracy check CO 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 No Sensor from M3014A Numeric is replaced by -?-
INOP tone CO No Tubing Numeric is replaced by -?-
INOP tone
!! CO Occlusion
!!! CO Occlusion 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 CO Sens Warmup Numeric is replaced by -?-
Microstream CO2: INOP tone Mainstream CO2: no INOP tone CO Upgrade FW-
Numeric is replaced by -?-
INOP tone CO Wait Cal2 Numeric is replaced by -?-
CO Zero Failed Numeric is replaced by -?-
INOP tone COChange Scale 93 4 Patient Alarms and INOPs What to do 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. Wait until zero calibration is finished. Perform zero calibration for the CO2 sensor. If the INOP persists, contact your service personnel. For Adult patients: a date of birth has been entered that results in a calculated patient age of less than 12 years. Enter correct date of birth or, if patient is pediatric, correct patient category. For pediatric patients: either no date of birth has been entered (it is required for calculation of IPI for pediatric patients) or the calculated age is below 1 year or above 12 years. Check that correct date of birth is entered. The IPI numeric cannot be provided as one or more of the measurement sources required for IPI is not available. Check availability of etCO2, awRR, SpO2, and pulse rate. Check patient category. The IPI numeric is not available for neonatal patients. 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. There is no valid calibration data in the Optical Module. Perform either a pre-insertion or 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. 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. INOP Message, Indication CONoTransducer from mainstream CO2 (except M3014A) Numeric is replaced by -?-
INOP tone COZero Running COZeroRequired Numeric is replaced by -?-
INOP tone IPI Check Pat. Age IPI Check Sources IPI Neo Patient ?
SO2 INOPs INOP Message, Indication
<SO Label> Cal Failed Numeric is replaced by -?-
INOP tone
<SO Label>Cal Required 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>Config Error 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 94 4 Patient Alarms and INOPs INOP Message, Indication
<SO Label>Light Intens Numeric is replaced by -?-
INOP tone
<SO Label> Low Light Numeric is replaced by -?-
INOP tone
<SO Label> No OptMod Numeric is replaced by -?-
INOP tone
<SO Label> OptMod Malf The Optical Module memory is faulty, and calibration data cannot be stored for transport or during What to do 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. 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.
<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 -?-
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 BadPressSignal 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 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. 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. 95 4 Patient Alarms and INOPs 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 PressOverrange Numeric is replaced by -?-
INOP tone CCO PulseOverrange Numeric is replaced by -?-
INOP tone CCO Recalibrate Numeric is replaced by -?-
CCO/Tbl NoTransduc Numeric is replaced by -?-
INOP tone Tblood Overrange Numeric is replaced by -?-
TbloodNoTransducer Numeric is replaced by -?-
INOP tone tcGas INOPs INOP Message, Indication
<tcGas Label> Cal Failed Numeric is replaced by -?-
INOP tone
<tcGas Label> Cal Running Numeric displays first -?-, then numeric is displayed with a ?
<tcGas Label>
CalRequired Numeric is replaced by -?-
INOP tone 96 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. Tblood out of range 17C - 43C. No transducer attached to the module or catheter disconnected. 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. Wait until the tcpO2/tcpCO2 calibration is finished. 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. INOP Message, Indication
<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>NoTransducer Numeric is replaced by -?-
INOP tone
<tcGas Label> Stabilizing A ? appears next to the label
<tcGas Label> Unplugged Numeric is replaced by -?-
INOP tone EEG INOPs INOP Message, Indication EEG Equip Malf INOP tone EEG Impedance High EEG1 ImpedanceHigh EEG2 ImpedanceHigh EEG Line Noise EEG1 Line Noise EEG2 Line Noise EEG Muscle Noise EEG1Muscle Noise EEG2Muscle Noise 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 EEGNoTransducer INOP tone 4 Patient Alarms and INOPs What to do 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. 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. 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. The trunk cable is disconnected from the EEG plug-in module. Reconnect the trunk cable. Silencing this INOP switches the measurement off. 97 4 Patient Alarms and INOPs 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. 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 Sensor 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. BIS INOPs INOP Message, Indication BIS Cable Incompat INOP tone BIS Cable Usage INOP tone BIS DSC Disconnect INOP tone BIS DSC Incompat. INOP tone BIS DSC Malfunct BIS DSC Upgrade INOP tone BIS Electr. Disc. INOP tone BIS Engine Disconn INOP tone BIS Engine Incomp. INOP tone BIS Engine Malfunc INOP tone BIS Equip Malf INOP tone BIS High Impedance INOP tone may sound BIS ImpedanceCheck INOP tone may sound BIS IsoelectricEEG BIS Lead Off INOP tone may sound BIS Overcurrent INOP tone 98 4 Patient Alarms and INOPs INOP Message, Indication BIS Sensor Disconn INOP tone BIS Sensor Incomp. INOP tone BIS Sensor Malfunc INOP tone BIS Sensor Usage INOP tone BIS SQI < 15%
INOP tone BIS Unplugged INOP tone BISx Disconnected INOP tone BISx Incompatible INOP tone BISx Malfunction INOP tone What to do 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 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. 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 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. 99 4 Patient Alarms and INOPs What to do 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. Explanation NMT alarms are suppressed until the TOF count reaches zero for the first time. No patient cable is connected to the NMT measurement module. Silencing this INOP switches the NMT measurement off. The patient cable connected to the NMT module is not supported or cannot be identified. Replace it with a supported cable. The NMT calibration cycle failed. Check that the sensor and the electrodes are placed properly, then start another calibration. Ensure that patient's arm is kept still before and during the calibration cycle. If calibration fails again, replace the patient cable. If INOP persists, contact your service personnel. An NMT calibration is running. Wait until the calibration is complete. NMT is unable to reliably derive measurement values. Check that the sensor and the electrodes are placed properly and start another measurement. If this INOP persists, try another patient cable. There is a problem with the NMT hardware. Unplug the NMT measurement module then plug it in again. If the INOP persists contact your service personnel. The impedance of the NMT stimulation electrodes has exceeded the allowed limit. Check that the electrodes are placed properly, have firm skin contact and have not dried out. This version of the NMT measurement module is not supported, or the module firmware is incomplete and needs to be upgraded. Contact your service personnel. One or both NMT stimulation electrodes have become detached from the patient. Check that both electrodes have firm skin contact, that the electrodes are placed properly and that the lead wires are connected. The NMT measurement does not support neonatal patients. Check the patient category. The NMT signal is too noisy to derive measurement values reliably. If electrosurgery is currently being used, repeat the NMT measurement after it has stopped. The current through the NMT stimulation electrodes is too high. Check that that the patient cable is not visibly damaged. Disconnect and reconnect the patient cable. If this INOP persists, replace the cable and/or module. The signal from the acceleration sensor is out of the measurement range. Check that the acceleration sensor is positioned properly. If this INOP persists, try another patient cable. There is a problem with the acceleration sensor of the NMT patient cable. Disconnect and reconnect the patient cable. If this INOP persists, replace the cable. An NMT module firmware upgrade is in progress. NMT monitoring is currently not possible. Wait until the upgrade has completed and this INOP is no longer displayed. Do not unplug the module or switch off power. INOP Message, Indication Spiro Patient Cat. Spiro Purge Failed Spiro Purging Spiro Unkn. Sensor Spiro Upgrade NMT INOPs INOP Message, Indication NMT Alarm Suppress NMT Cable Disconn INOP tone NMT Cable Unknown INOP tone NMT Cal Failed NMT Cal Running NMT Cannot Measure INOP tone NMT Equip Malfunct INOP tone NMT Impedance High NMT Incompatible INOP tone NMT Lead Off INOP tone NMT Neo Patient?
INOP tone NMT Noisy Signal INOP tone NMT Overcurrent INOP tone NMT Overrange NMT Sensor Malfunc INOP tone NMT Upgrade INOP tone 100 4 Patient Alarms and INOPs VueLink INOPs INOP Message, Indication VueLink Alarm at Information Center
<VueLink Option> Check Cable INOP tone
<VueLink Option> Check Setup INOP tone
<VueLink Option> Chk Config 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 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. 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. 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 Setup INOP tone Device Chk Config INOP tone Device Demo Data INOP tone Device Real Data INOP tone Device Unsupported INOP tone
<EC10 / EC40> Equip Malf INOP tone EC10 INOP
!! EC10 INOP
!!! EC10 INOP at Information Center
<External Device>
Unplugged INOP tone No Device Data What to do Device identification completed, but communication could not be established due to timeout. IntelliBridge INOP abbreviations may differ slightly depending on the device category. Device identification completed, but communication could not be established due to error. 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. 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), an INOP tone 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. 101 4 Patient Alarms and INOPs INOP Message, Indication Text Upload Failed INOP tone What to do 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 Check ECG Settings INOP tone
!!Check ECG Source Chk SpOT Settings INOP tone Invalid Leadset Leadset Unplugged No ECG Source
!! Repl. Tele Batt
!!!Repl. Tele Batt Severe yellow/red INOP tone During this INOP, alarms cannot be paused or switched off. Tele Battery Low
!!Tele Disconnect
!!!Tele Disconnect Severe yellow/red INOP tone
!! Tele INOP
!!! Tele INOP Severe yellow/red INOP tone Tele Sync Unsupp. INOP tone ProtocolWatch INOPs What to do 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. The battery in the telemetry device is almost empty and must be replaced. The battery in the Telemetry device is low and must be replaced soon. 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. 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. INOP Message, Indication PW: Check Settings PW: In Conflict PW:Action Required What to do 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 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 SpO Chk Sources Numeric is replaced by -?-
What to do Not all measurements or values required to perform the calculation are available. Check measurement sources. 102 4 Patient Alarms and INOPs What to do 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. 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. INOP Message, Indication SpO Chk Units Numeric is replaced by -?-
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 -?-
SVRSet CVP Used SVRISet CVP Used Temp Chk Sources Numeric is replaced by -?-
Temp Chk Units Numeric is replaced by -?-
Cableless Measurement Device INOPs 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. INOP Message, Indication cl NBP Batt Empty
!!cl NBP BattEmpty
!!!cl NBP BatEmpty Corresponding INOP tone cl NBP Batt Incomp INOP tone cl NBP Batt Low INOP tone cl NBP Batt Malf INOP tone cl NBP Batt Temp INOP tone cl NBP Check Batt INOP tone cl NBP Chk Chrg IF cl NBP ChkSettings cl NBP Disconnect INOP tone cl NBP License Req cl NBP No Cradle INOP tone cl NBP Remove INOP tone What to do The remaining battery time of the NBP Pod is below 30 minutes. Charge 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 interface between the NBP Pod and the Charging Station is not working properly. Try cleaning the contacts and reposition the Pod on the charging station. The NBP Pod's settings may have changed or become corrupt. Check the settings. The NBP Pod has lost the connection to the monitor. The NBP Pod requires a valid software license for operating. 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. 103 4 Patient Alarms and INOPs INOP Message, Indication cl NBP Serv Batt INOP tone cl SpO Batt Empty
!!cl SpO BatEmpty
!!!cl SpO BtEmpty Corresponding INOP tone cl SpO Batt Incmp INOP tone cl SpO Batt Low INOP tone cl SpO Batt Malf INOP tone cl SpO Batt Temp INOP tone cl SpO Check Batt INOP tone cl SpO Chk ChrgIF cl SpO Chk Sett cl SpO Disconnect INOP tone cl SpO No Cradle INOP tone cl SpO Remove INOP tone cl SpO Serv Batt INOP tone clSpO License Req What to do 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. Charge 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 interface between the SpO2 Pod and the Charging Station is not working properly. Try cleaning the contacts and reposition the Pod on the charging station. The SpO2 Pod's settings may have changed or become corrupt. Check the settings. 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. The SpO2 Pod requires a valid software license for operating. 104 5 5Managing Patients and Equipment When the monitor is used together with an IntelliVue Information Center, a variety of services are provided to manage the interconnections between patients, equipment, hospital beds, caregivers, and so on. Many services can be used both at the monitor and at the Information Center, resulting in a more efficient workflow. Which services are available will depend on which Information Center you have. The Philips IntelliVue Information Center iX (PIIC iX) provides more services and functionality than the Philips IntelliVue Information Center (PIIC). In these Instructions for Use, information that is only valid for one of the Information Centers will be marked with a corresponding side heading, for example PIIC iX For a list of the differences between the two Information Centers, see Information Center Compatibility on page 132. Patient Concepts For a patient to be part of the system their identification data must be entered into the system. A patient can then be assigned to a bed, have equipment assigned directly to him, and have a location set when he is not currently in the bed. Equipment Concepts Depending on how equipment is used in your facility, there are various ways to associate devices with patients, beds or monitors. Equipment usage must be configured appropriately at the Information Center and the monitoring equipment. PIIC iX By configuration, equipment can be assigned:
permanently to a bed, on demand to a bed or host monitor, or directly to a patient. The foundation for a particular equipment use model is laid in the configuration settings in the monitor and the Information Center. Refer to the corresponding configuration guides for further details. 105 5 Managing Patients and Equipment Additionally there are mechanisms to automatically free up equipment that is no longer used. This prevents unnecessary patient mismatches when the equipment is used for the next patient and avoids data of different patients getting mixed. PIIC iX When connected to PIIC iX, equipment states are tracked by the system. When the equipment is not assigned to a patient or no patient is admitted at a monitor, the equipment is considered as free equipment in the system. Equipment that is assigned or has a patient admitted is tracked as used (i.e. not free) equipment. The Information Center uses the equipment state (free/not free) to maintain and support workflow and equipment lists. Managing Patients In order to attribute collected measurement data to a specific patient, or assign equipment or a bed to a specific patient, each patient in the system must be identified. By admitting a patient, you identify them for the system. When equipment is freed up (for example by discharging the patient, removing a monitor from a patient or using End Case) the collection of data is officially ended for this patient and important settings on the monitor are reset to the defaults. WARNING Always perform a discharge or free up the monitor 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. 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. When No Patient is Admitted To admit a patient:
1 Select the patient name field or select the Patient Demogr. SmartKey to open the Patient Demographics window. Select Admit Patient. 2 106 PIIC iX 5 Managing Patients and Equipment The Enter Patient Demographics window appears. You can enter data as normal, using the keyboard or a barcode scanner, or, with PIIC iX, use the Find Patient key to search for patient data in connected systems as described in Using "Find Patient" to Search for Patient Data on page 107. 3 Enter the patient information: select each field and use the keyboard or barcode scanner or choose from the pop-up list of alternatives to input information. When you enter data, the Information Center will automatically check for corresponding data and will suggest an appropriate action based on what it finds. You can select Confirm to accept the suggestion or Cancel to reject it. Middle Name (if configured to appear): Enter the patient's middle name. Last Name: Enter the patient's last name (family name). First Name: Enter the patient's first 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 Number, or other alternatives. Enter the appropriate data for the fields displayed. Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo. Paced Mode: Choose On or Off (You must use On if your patient has a pacemaker). With PIIC iX there is a third choice: Unconfirmed. When the paced mode is Unconfirmed, the algorithm for paced patients will be used. BSA: The monitor calculates the body surface area automatically. Height: Enter the patient's height. Weight: Enter the patient's weight. Date of Birth: Enter the patient's date of birth, in the form dd/mmm/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. When admission is complete, the patient's name appears on the monitor info line at the top of the screen. When a Patient is Already Admitted If the patient monitor already has a patient admitted, the Admit Patient key is replaced by the New Patient key. When you select New Patient, the monitor is freed. All settings are reset to the defaults, all patient data and trend data are deleted, and monitoring at the Information Center may stop for monitors designated as transport monitors. Depending on your equipment configuration, selecting New Patient may transfer the currently admitted patient out of the bed. A message will appear requiring your confirmation of these actions. After selecting New Patient, you can admit your patient as described in When No Patient is Admitted above. Using "Find Patient" to Search for Patient Data PIIC iX You can use the Find Patient key to search for patient data in the Information Center and any connected hospital information systems. The search will look for currently admitted or previously admitted patients matching the search data you enter. 107 5 Managing Patients and Equipment To search for patient data:
1 Select the Find Patient key. A window opens with an on-screen keyboard. 2 Type in the last name or an ID, or a part of it, and select Enter on the keyboard. The search results will be displayed in a Select Patient window. The system provides a list of all matching patients. 3 Highlight the patient you want to admit to this bed. 4 Depending on their current status, you will be asked whether you want to readmit them, or transfer them to this bed. Select Confirm to complete the admission or transfer. 5 Patient Category and Paced Mode 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 mode setting determines whether the monitor shows pacemaker pulses or not. When Paced Mode is set to Off, pace pulses are filtered and therefore do not show in the ECG wave. WARNING Patient Cat. and Paced Mode 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. If possible, always load a suitable profile after changing patient category, and always check alarm limits to make sure that they are appropriate for your patient. Paced mode For paced patients, you must set Paced Mode to On. If it is incorrectly set to Off, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole. With PIIC iX, the paced mode may be Unconfirmed which will assume a pacemaker is present. You should still set the Paced Mode to On for paced patients to make the status clear. 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 to quickly admit a patient using only a limited set of demographic data. 1 2 Enter the required data (ID fields or last name depending on configuration) with the keyboard or a Select the Quick Admit SmartKey. barcode scanner. 108 5 Managing Patients and Equipment 3 4 Select Enter. In the confirmation window, select Confirm to stop monitoring for the previous patient or free up the monitor (if confirmation is configured). 5 Check that patient category and paced status are correct for the new patient. 6 Check the current profile and, if necessary, load an appropriate profile. If the monitor is connected to an Information Center and only the ID field is entered, the patient name may be set to - - - at the Information Center, depending on the configuration. 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, open the Patient Demographics window 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. PIIC iX If data has been provided by a hospital information system, you will not be able to edit it on the monitor. Ending Monitoring for a Patient There are several ways to end monitoring for a patient, depending on whether there is an Information Center connection, and on the configuration of the Information Center and the monitor. Discharging a patient and removing the monitor from a patient are described here. You can also end monitoring by admitting a new patient, as described in When a Patient is Already Admitted on page 107. Depending on your configuration, monitoring for a patient may end automatically when the monitor has been powered off or in standby mode for a set time, or when no basic measurements have been made for a set time. WARNING Always end monitoring for the previous patient (with Dischrge Patient, Remove Monitor, End Case or New Patient) 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. Discharging a Patient The discharge function is only available when the patient is monitored centrally at an Information Center. A discharge transfers the patient out of the bed and frees all devices used for the patient. The discharge function may be disabled at a monitor designated as a transport monitor, to ensure that a patient cannot be accidentally discharged from the system when the transport monitor is used for another patient. A discharge:
clears the patient demographics erases all patient measurement 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 a new patient. resets patient category and paced settings to the settings defined in the default Profile 109 5 Managing Patients and Equipment 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. 2 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 Select the patient name field or select the Patient Demogr. 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, 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 372 for information on setting up end case reports. Dischrge Patient - to discharge the patient without printing any reports. Removing the Monitor Removing a monitor stops using the monitor for the current patient and frees up the monitor and all devices assigned to that monitor. Removing the monitor:
clears the patient demographics in the monitor. erases all patient measurement data (such as trend, event, and calculation data) from the monitor and devices assigned to the monitor. This ensures that data from a previous patient are not mixed with data from a 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. If the monitor is locked to the bed and is connected to an Information Center, the remove function is not available and you will have to discharge the patient. To Remove a Monitor 1 Open the Equipment window - either directly in Main Setup or by selecting the bed label in the information line. Select the monitor. Select the Remove Monitor pop-up key. 2 3 New Patient Check The monitor can be configured to ask you whether a new patient is now being monitored in certain situations:
after a specified power-off period after a specified standby period 110 5 Managing Patients and Equipment when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period The pop-up window is entitled Is this a New Patient?. The monitor offers a Yes key to stop monitoring for 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. 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.) Trend data yes yes yes yes, for all MMS, MMS extension and measurement module measurements (up to a maximum of 24 or 32 or 50 or 100, depending on your database configuration) Stored in X1 MMS and extensions yes Stored in X2 MMS and extensions yes no no yes, for all MMS and MMS extension measurements yes, most recent 8 hours of information, for all MMS and extensions measurements yes, for all MMS and MMS extension measurements yes, most recent 8 hours of information. A standalone X2 stores all MMS and MMS extension measurements (up to a maximum of 50 measurements). During Companion Mode the X2 stores all MMS and MMS extension measurements and measurements collected by the host monitor from measurement modules (up to a maximum of 50 measurements) 111 5 Managing Patients and Equipment Patient Information Stored in Monitor Calculation data (HemoCalc data) Events data yes yes Stored in X1 MMS and extensions no Stored in X2 MMS and extensions no no no WARNING If the monitor is not battery-powered, you cannot monitor during transport. 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). The following sections describe the transfer procedures with a PIIC iX, a PIIC or with a standalone 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. Transferring Patients with IntelliVue Information Center iX PIIC iX There are several ways to transfer a patient from or to another bed. When a patient is transferred to the destination bed, Information Center monitoring continues in the destination bed and equipment that is not transferred with the patient is freed up. Using the Transfer Function PIIC iX To transfer a patient using the transfer function provided on the patient monitor by the Information Center:
1 2 Select the patient name or the Not Admitted text at the top of the monitor screen to open the Patient Demographics window. Select the Transfer pop-up key. The Transfer window opens. If a patient is currently admitted, the window offers the possibility to transfer that patient to another bed (To Other Bed). If no patient is currently admitted, the window offers the possibility to transfer a patient from another bed using the patient search as described in Using "Find Patient" to Search for Patient Data on page 107. 3 With To Other Bed, if more than one unit is configured, a list of units will appear. When you have selected a unit, or if only one unit is configured, a list of free beds will appear. Select a bed from the list. You will be asked to confirm the transfer of the patient to this bed. Select Confirm to complete the transfer. 4 5 112 5 Managing Patients and Equipment If the system is configured to support transfer with equipment, the next step is that you move the patient together with the equipment, e.g. multi-measurement module, to the destination bed you have selected. If the equipment is still connected to the source bed, the Transfer with Equipment window opens requesting you to move the patient and equipment, but also offering the possibility to keep the multi-measurement module at the current bed for use with the next patient (with the pop-up key No Unplug). WARNING Before doing a transfer ensure that no other patient is using the destination bed and/or equipment from the destination bed. When a patient is transferred you need to check that the patient has all the required monitoring equipment at the destination bed. Moving the Patient with an MMS PIIC iX 1 Connect the Multi-measurement Module to the patient monitor at the destination bed. A Question window will open, asking whether you want to transfer the patient to this bed. Select the Yes pop-up key to complete the transfer. 2 Using the New Patient Key PIIC iX If the monitor at the destination bed is not free:
1 2 3 Select the patient name field at the top of the monitor to open the Patient Demographics window. Select New Patient to free up the monitor. Select Find Patient and enter your patient's name to get the patient data from the system. When you select your patient from the list, you will be asked to confirm that the patient should be transferred into this bed. After confirmation the transfer is complete. Transferring Patients with IntelliVue Information Center Transferring a Centrally-Monitored Patient PIIC 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 Patient Demogr. 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 4 Connect the MMS to the transport monitor and monitor your patient during the move. Silence the resulting MMS Unplugged INOP. 113 5 Managing Patients and Equipment 5 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. 6 7 Verify that the settings for patient category and paced mode are correct. 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). Transferring a Centrally-Monitored Patient with X2 PIIC 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 from the host monitor, select the patient name field or select the Patient Demogr. 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. Silence the resulting MMS Unplugged INOP. 2 Remove the X2 and any connected extensions from the monitor. 3 4 Move the patient using the X2 as the transport monitor. 5 At the new location, connect the X2 to the new host monitor. If the monitor detects a patient 6 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 to the receiving monitor. 7 Verify that the settings for patient category and paced mode are correct. Transferring a Centrally-Monitored Patient with X2 using IIT PIIC 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. 114 5 Managing Patients and Equipment 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. 4 Connect the X2 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 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 Patients with Standalone Monitors (No Information Center) Transferring a Patient with an X1 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 Scenario: A patient is moved to another monitoring location using the X2 and re-admitted at the new monitor. 1 Disconnect the X2 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 as the transport monitor. 3 At the new monitoring location, connect the X2 to the new host monitor. 115 5 Managing Patients and Equipment 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 to retain the data in the X2. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2 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 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 Trend Upload and Settings Upload. If there is a patient mismatch and you select Continue Monitor, no data will be uploaded from the MMS. Resolving Patient Information Mismatch an MMS and a monitor, an X2 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 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 Mode and Patient Cat., may not match between the Information Center and the monitor. If the Paced Mode 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. A Check Patient ID INOP will appear when a mismatch has not been resolved. As long as patient mismatch has not been resolved, data integration in the Information Center and the own patient overview functionality might not work as equipment is not assigned correctly to the patient. 116 5 Managing Patients and Equipment PIIC 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. In the case where an 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 X2. Failure to do so discharges the 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. After 5 minutes a Check Patient ID INOP will appear to remind you to resolve the mismatch. 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. 117 5 Managing Patients and Equipment 1 2 3 Patient demographics Patient category and paced status Same Patient - see Patient Mismatch - If Both Patient Data Sets Refer to the Same Patient on page 118. 4 New Patient - see Patient Mismatch - If Neither Patient Data Set is Correct on page 118. 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 uses the bed, monitor and MMS for a new patient, 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 Refer to the Same Patient 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. 118 Patient Information Patient Category Date of Birth Height Weight Gender Paced Mode Trend data 5 Managing Patients and Equipment This information is taken from... the Multi-Measurement Module, if connected, otherwise the data is taken from the monitor. Paced mode is always set to On 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. When automatic mismatch resolution is configured, you may still be asked to confirm the resulting action at the monitor, depending on the current patient admission status. Managing Equipment Multiple pieces of monitoring equipment can be used for a patient. The association between a patient and a device can be made by:
identifying the patient at the device (by entering patient data or using Find Patient to get patient data)
"adding" equipment for an existing patient The association between a patient and a device can be ended by:
discharging the patient, or selecting End Case.
"removing" the device from the patient. transferring the patient without the device. admitting a new patient to the device. automatic freeing of the device. WARNING In all cases listed above, when equipment is freed, all patient identification and measurement data are deleted, all settings are reset to the defaults, and monitoring at the Information Center (if active) is stopped. Any associated devices, e.g. multi measurement modules connected to a monitor, or cableless measurement devices assigned to a monitor, may also be freed, depending on the configuration. 119 5 Managing Patients and Equipment Adding Equipment (PIIC iX) By selecting the Add Equipm. key you can display a list of all free equipment (not currently assigned to a patient) and select a device for use with this patient. If you add another monitor, you need to confirm this at the selected monitor. Removing Equipment The association between a monitor and the patient can be ended by selecting Remove Monitor. With PIIC iX, the Remove Monitor key is not available when the monitor is locked to a bed. Other equipment such as telemetry devices or IntelliVue Cableless Measurements can be removed by selecting the device then selecting Remove in the menu displayed. Equipment Status Disputes Equipment can come into situations where its status does not match its location. There are three typical situations where this may occur:
PIIC iX only - equipment is locked to a bed, but has been removed and used at another bed. PIIC iX only - equipment has been configured for use in a specific unit, but is now being used in a different unit. Equipment has an equipment label but has not been configured at the Information Center and therefore cannot be managed. If a monitor or a companion device is in one of these situations, a Check Equipment INOP will appear and the equipment status will be shown in the Equipment window. The following symbols (in red) are used to show the status in the Equipment window:
equipment is locked to another bed equipment is not configured for use in this unit equipment label is not in system configuration, or duplicate equipment labels Using the Equipment Window In the Equipment window you have access to patient management, workflow functions (set location, transfer), equipment management functions (add/remove equipment) and caregiver-related functions. You can open the Equipment window directly in Main Setup or by selecting the bed label in the information line. 120 5 Managing Patients and Equipment Patient name, category and paced mode This bed is Bed 3, the connection to the Information Center is active. 1 2 Name of assigned caregiver 3 4 This monitor is assigned to the patient and is the one on which you are viewing the window. 5 Wired connection The top part of the window contains the patient data, with the assigned caregiver and the status of the connection to the Information Center, and the bed label. In the lower part of the window, all equipment for this patient is shown, with the corresponding assignments and connections. The device you are currently viewing the window on is shown with a dark background (in the above example, the monitor with the label wm3). Changing Caregiver Assignment When a caregiver is assigned, the caregiver name appears next to the caregiver symbol in the Equipment window. When you select this area of the window, a menu opens offering the following functions:
PIIC iX Select Caregiver - you can select a different caregiver from a list. When a new caregiver is assigned, the patient will be automatically added to that caregiver's Care Group. The availability of the function and the caregiver list depends on the Information Center configuration. My Patients - opens the My Patients window showing all patients in your Care Group. 121 5 Managing Patients and Equipment Using the Patient Area The patient name, patient category and paced status are normally shown in the Equipment window. When a patient has been prepared for transfer, the transfer symbol will be shown:
When you select this area in the Equipment window, a menu opens giving access to the Enter Patient Demographics window, the Transfer function (see Transferring Patients on page 111) and the End Case function. Changing the Location Select the Information Center area on the Equipment window. Select the current location from the list. If the monitor is currently assigned to a bed, but the patient is in another department for treatment or a diagnostic procedure, you can show a temporary location for the patient. 1 2 Or alternatively use the Select Location pop-up key. The temporary location is then shown in the Equipment window, on the Standby screen on the monitor, and in the sector at the Information Center. When the patient returns, you can set the location back to the bed number in the same way as described above. When Multiple Equipment is Used for One Patient It is possible to assign additional monitoring equipment and a telemetry device to the same patient, resulting in the information from multiple devices being combined in one sector at the Information Center. The measurement data from the other devices will be displayed on the monitor screen in the own patient overview window. WARNING When new equipment has been added for a patient, you will be asked to confirm that the device be used for the patient. Always do this as soon as possible to avoid patient data mismatch. If multiple equipment is assigned to the patient, resolving a patient mismatch at the monitor may resolve other pending patient mismatches or remove other associated equipment. Own Patient Overview Window The measurements from other monitoring devices and telemetry devices are shown combined in the own patient overview window on the monitor, together with related information derived by the Information Center, such as alarms. 122 5 Managing Patients and Equipment 1 A current alarm generated by another device. 2 Delayed - indication that data in the window is delayed. 3 Own patient overview window WARNING All data presented in the own patient overview window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the host monitor ECG instead of telemetry or ECG from another monitoring device. As long as the ECG is being measured with another device there will be no ECG signal available at the ECG analog output. Visual Alarm Status Information in the Own Patient Overview Window If individual measurement alarms are switched off at any of the devices in use for the patient, a crossed alarm symbol on a white background is shown beside the measurement numeric If all alarms are switched off or paused for one of the devices in use for the patient, a crossed alarm symbol on a dark gray background is shown beside all affected measurement numerics (if so configured). If all red and yellow alarms are switched off/paused, the crossed alarm symbol is red. If only yellow alarms are switched off/
paused, the crossed alarm symbol is yellow. Controlling Other Devices from the Bedside Select the own patient overview window. Select the Setup Equipm. pop-up key. You can change ECG settings for the current ECG source from the patient monitor. 1 2 A setup menu will appear with the settings available for the current ECG source. If it is a telemetry transmitter or patient monitor connected to the Information Center via LAN or WLAN, the following settings are available: adjust HR alarms, relearn arrhythmia, select primary/secondary ECG lead, select arrhythmia analysis mode, change primary/secondary ECG lead size. PIIC iX only: if the current ECG 123 5 Managing Patients and Equipment source is a patient monitor connected to the Information Center via IntelliVue Instrument Telemetry
(IIT), only the adjust HR alarms setting is available. Viewing and Silencing Other Device Alarms at the Bedside When other devices are assigned to the patient, alarms from those devices will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic alarm message will appear in the alarm status area with standard alarm tones. The 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 own patient overview window. If configured, alarms generated from another device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and other device alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:
1 2 Depending on your Information Center configuration, the Silence Bed key may silence both other device alarms and bedside alarms. Select the own patient overview window. Select the Silence Bed pop-up key. WARNING Even when the other device data is not visible on the screen, you may be silencing monitor alarms and other device alarms, if the Information Center and monitor are so configured. Switching Off or Pausing Alarms From Other Devices 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 monitor alarms and alarms from other assigned devices are affected. Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center. Using Standby When you select Standby mode at the monitor, the bedside goes into Standby mode but other assigned devices may continue monitoring. Refer to the Information Center Instructions for Use for details on how selecting Standby at the Information Center affects the monitor and other devices. ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or from another assigned device. If you unplug the ECG patient cable from the monitor and plug it into another device, the Information Center will automatically switch to monitoring the ECG from the other 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 other device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. 124 5 Managing Patients and Equipment 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. Synchronized Settings For some measurements, settings can be synchronized between the monitor and another measurement device. For example, 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, ECG On/Off1, Primary Lead, Secondary Lead, Va Lead2, Vb Lead2, Lead Placement Analysis Mode, Arrhythmia On/Off, 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, Afib/IrrHR End Threshold, All ECG Alarm INOP mode. ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Alarm Limits, ST-Index On/Off, ISO/J-Point Detection, ST Lead On/
Off, ST Baseline QT analysis On/Off, QT Lead, QTc High Alarm On/Off, QTc Alarm On/Off, QTc High Limit, QTc High Limit, QT Baseline3 SpO2 Alarms on/off, SpO2 Alarm limits, SpO2 Low Alarm Delay, SpO2 High Alarm Limit, Desat Alarm Limit NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off 1ECG On/Off setting is forced to ON by the monitor, if the local setting is ON. 2Va 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. 3With PIIC, QT baseline is synchronized, but not QT snippets. PIIC iX With the IntelliVue Information Center iX, the following additional measurement settings can be synchronized:
ECG/Arrhythmia ST NBP Resp Some ECG Alarms INOP On/Off STE On/Off, STE Alarm On/Off Sys/Dia/Mean Alarm Limits, Alarms On/ Off, Alarm Source Apnea Time, Alarm Limits, Alarm On/Off, Resp On/Off 125 5 Managing Patients and Equipment SpO2 SpO2 Alarms on/off, SpO2 Alarm limits, Desat Alarm Limit, NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off, Measurement Mode1, Repetition Time1 1Measurement Mode and Repetition Time can only be synchronized if SpO2 comes from a Cableless SpO2 Pod or a telemetry device. WARNING Not all settings are synchronized; after changing the measurement source, always check that the settings are appropriate. ECG: 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 other 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 measurement source changes. NOTE Settings synchronization can be switched off at the monitor in Configuration mode. In certain situations, you will be asked to confirm that synchronization of settings is appropriate. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. PIIC 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. PIIC iX If a Check ECG Settings, Chk SpOT Settings, or another check settings INOP appears, always check that the settings, especially the paced setting for ECG, are appropriate for your patient. Care Groups If your monitor is connected to an Information Center, you can group bedside monitors into Care Groups to facilitate caregiver assignment. 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. 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. Care Groups in PIIC iX Units and Care Groups can be configured at the Information Center. The available sizes for units and Care Groups are defined by the Information Center. Monitors can be added to or removed from an existing care group at the monitor by assigning a new caregiver. 126 Care Groups in PIIC 5 Managing Patients and Equipment 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 Care Groups are configured at the Information Center. Monitors can be added to or removed from an existing care group at the monitor. 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. Understanding the Alarm Status Overview Bar The Care Group monitors' and equipment status is shown in symbol form in the Alarm Status 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 it. Because multiple equipment can be used for one patient, it can occur that the alarm status is different at different devices. The alarm status will then be consolidated and the highest priority alarm information will be displayed. The Alarm Status 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. PIIC iX Depending on the Information Center configuration, the Alarm Status overview bar may contain My Patients (your own care group), My Unit (all beds from the unit) or it may not display at all. WARNING With PIIC iX, the alarm status overview bar is independent from the configured alarm pop-up behavior. Alarm Status 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 from this bed The highest priority alarm from this bed is a standard INOP The highest priority alarm from this bed is a short yellow alarm 127 5 Managing Patients and Equipment Alarm Status Symbols (four alternative display possibilities depending on space available) Connection Symbols (used in the Alarm Status overview bar and the My Patients window) 128 The highest priority alarm from this bed is a yellow alarm The highest priority alarm from this bed is a red alarm The highest priority alarm from this bed is a yellow INOP The highest priority alarm from this bed is a red INOP The alarms at this bed are suspended. The same symbols in yellow indicate that yellow alarms are suspended (PIIC iX only). Equipment at this bed is in standby mode Equipment at this bed is in Demonstration mode The current bed This is a telemetry bed. This bed is on a wireless network. This bed is on a wired network. PIIC iX only: Patient has multiple devices assigned. PIIC only: This is a "paired" bed, with a bedside monitor and a telemetry transmitter assigned. 5 Managing Patients and Equipment Viewing the My Patients 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 Patients window, Use the My Patients pop-up keys to navigate through the Care Groups:
select the Other Patients SmartKey, if configured, or in the Main Setup menu, select My Patients. 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. 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. PIIC PIIC iX 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. Other Patients lets you search for a patient or step through lists by unit and bed label to select another patient. 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 2 When automatic pop-up is disabled in this way, an icon will appear as a reminder in the Care Group Select Main Setup then Network followed by Auto Window Select Disabled 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 Alarm Status Overview Bar. If you are in a Unit Group with many beds, the My Patients window may open for you to select the bed. Depending on the configuration, the 129 5 Managing Patients and Equipment 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. 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. 130 Other Bed Pop-Up Keys 5 Managing Patients and Equipment 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 Patient lets you view waveforms and numerics from the next available patient in the Care Group. My Patients lets you call up the Care Group window to select another patient. 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. With PIIC iX, the Alarming Beds window may also contain beds that are not in your Care Group that have been escalated for higher attention. 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 measurement alarms are switched off at any of the devices in use at the other bed, a crossed alarm symbol in red on a white background is shown beside the measurement numeric. If all alarms are switched off or paused for one of the devices in use at the other bed, a crossed alarm symbol on a black background is shown beside all affected measurement numerics (if so configured). If all red and yellow alarms are switched off/paused, the crossed alarm symbol is red. If only yellow alarms are switched off/
paused, the crossed alarm symbol is yellow. In the embedded Other Bed window, the crossed speaker symbol in the upper right hand corner 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. Other Patient 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 Alarm Status overview bar as an icon. a message informing you about the other patient alarm is shown in the monitor status line. 131 5 Managing Patients and Equipment if configured, the Other Bed window, the Alarming Beds window or the My Patients 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. PIIC iX Automatic alarm notification can also cause a window to pop-up when a patient from outside the Care Group has been escalated to a higher attention status. Check that the detailed configuration at the PIIC iX meets your unit's requirements. Automatic alarm notification can be switched off permanently in the monitor's Configuration Mode or at the Information Center. Information Center Compatibility The functionality available for managing patients and equipment depends on the IntelliVue Information Center being used. In the following table the main differences between the PIIC and PIIC iX are shown. PIIC Not available PIIC iX Find Patient - searching for a patient in the Information Center or other connected hospital systems. (With LAN and WLAN connection only) Transfer Patient - can transfer patient directly to another bed/unit and from another bed/unit. (With LAN and WLAN connection only) A unique patient list provides information about the current status of a patient allowing intelligent prompts and preventing the same patient being admitted twice. Add Equipment - allows assignment of other monitors, telemetry devices and X2 MMS. (With LAN and WLAN connection only) Remove equipment - allows removal of other monitors, telemetry devices and X2 MMS. Select Location - allows a temporary location to be shown when a patient is not in the unit. (With LAN and WLAN connection only) Select Caregiver - allows a Caregiver to be assigned to a patient Paced status Unconfirmed is the initial setting before a paced status has been entered. Unconfirmed will switch pace pulse rejection on but makes the user aware that no paced status has been selected. Transfer Patient - patient is moved to transfer list. Not available Add Equipment - allows only assignment of telemetry devices via manual pairing. Remove equipment - allows only removal of telemetry devices via Unpair To Mon. and Unpair To Tele. Not available Not available Not available 132 6 6ECG, 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 154), ST monitoring (see About ST Monitoring on page 164) and QT monitoring (see About QT/QTc Interval Monitoring on page 175). 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. 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. 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. Some non-authorized electrodes may be subject to large offset potentials due to polarization. 133 6 ECG, Arrhythmia, ST and QT Monitoring 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 Mode It is important to set the paced mode correctly when you start monitoring ECG. To change the paced mode in the Setup ECG menu, select Paced Mode to switch between On, Off or Unconfirmed. WARNING Pace pulse rejection must be switched on for paced patients by setting Paced Mode to On. 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 mode 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. 134 6 ECG, Arrhythmia, ST and QT Monitoring 1 Lead label of the displayed wave 2 1 mV calibration bar 3 Pacer spikes 4 Pace pulse markers 5 Current heart rate 6 Current heart rate alarm limits and paced mode symbol 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 Mode status has been set to On, 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:
135 6 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 Mode (Pace Pulse Rejection) In the Setup ECG menu, select Paced Mode to switch between On, Off or Unconfirmed. You can also change the paced mode in the Patient Demographics window. When Paced Mode is set to On:
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). The paced symbol is displayed next to the HR numeric. When Paced Mode is set to Off, 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. When the paced mode has not yet been set for a patient, the paced symbol will have a question mark indicating the Unconfirmed mode. When the paced mode is Unconfirmed, pace pulse rejection is switched on. Paced Mode On Paced Mode Off Paced Mode Unconfirmed 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. 136 6 ECG, Arrhythmia, ST and QT Monitoring 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 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 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. 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. 137 6 ECG, Arrhythmia, ST and QT Monitoring 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, 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 2 3 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. 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 145 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. 138 6 ECG, Arrhythmia, ST and QT Monitoring 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:
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 AAMI RA LA LL RL V V1 EASI I S A N E IEC R L F N C C1 Electrode colors AAMI White Black Red Green Brown Brown/Red IEC Red Yellow Green Black White White/Red 139 6 ECG, Arrhythmia, ST and QT Monitoring EASI Electrode labels AAMI V2 V3 V4 V5 V6 IEC C2 C3 C4 C5 C6 Electrode colors AAMI Brown/Yellow Brown/Green Brown/Blue Brown/Orange Brown/Violet IEC White/Yellow 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 3 140 Standard 5-Lead Placement 6 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 4 LL placement: on the left lower abdomen 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. 141 6 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. 142 Conventional 12-Lead ECG 6 ECG, Arrhythmia, ST and QT Monitoring 1 V1 - V6 2 LA 3 RA 4 RL 5 LL 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 143 6 ECG, Arrhythmia, ST and QT Monitoring Modified 12-Lead ECG LA 1 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.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. 144 EASI ECG Lead Placement 6 ECG, Arrhythmia, ST and QT Monitoring 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 1 mV 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 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 145 6 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 download the resulting analysis from the Information Center and also other 12-Lead captures for review at the monitor. A 12-Lead report can be printed that also includes the downloaded analysis results and an ST Map. You can operate the 12-Lead Export function and the 12-Lead Lock/Unlock function at the Information Center remotely from the monitor. 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 Setup, 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 137) is changed to the 12-Lead filter setting (see Changing Settings for a Captured 12-Lead ECG on page 147). 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 145). 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 Review 12 Lead pop-up key and then selecting the 12-Lead marked with * from the list. 146 Changing Settings for a Captured 12-Lead ECG 6 ECG, Arrhythmia, ST and QT Monitoring 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. The changes are only applied temporarily and will not be stored. If you want to change the default settings, see Setting Up the 12-
Lead ECG on page 149. High Pass Filter Low Pass Filter AC Filter Gain Chest Gain Paper Speed Format Time Rhythm Lead 1 Rhythm Lead 2 Rhythm Lead 3 Lead Sequence Sets the high pass filter for the waveforms. Choices are 0.05 Hz, 0.15 Hz and 0.5 Hz. Sets the low pass filter for the waveforms. Choices are 40 Hz, 100 Hz and 150 Hz. Switches the AC (line frequency) filter On or Off. 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, 3x4 3R,3x4 ST and 3x4 1R ST. 1R and 3R refer to 1 or 3 rhythm leads, ST formats contain an ST map. 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, MCL This setting is only relevant when 3x4 1R, 3x4 1R ST or 3x4 3R is selected as Format. Defines the sequence in which the leads are presented. Choices are Cabrera and Internat. 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. 147 6 ECG, Arrhythmia, ST and QT Monitoring Printing the 12-Lead ECG Print a dedicated 12-Lead ECG report by selecting the Print Report pop-up key. When you are working with an Information Center iX that provides 12-Lead analysis, the report contains the 12-Lead analysis results as well as measurement values (e.g. ST values, QT values, HR) which are also downloaded from the Information Center iX. If you work with an Information Center which does not provide any 12-Lead analysis results, the report only contains the measurement values. In this case, however, the values are based on the real-time measurements made at the bedside. Consequently, the measurement values in the report might differ in the two cases, due to the slightly different algorithm approaches of patient monitor (real-time measurement) and Information Center iX
(diagnostic interpretation of 12-Lead capture). Downloading Analysis Results (PIIC iX only) Download analysis results from the IntelliVue Information Center by selecting Show Analysis. Return to the previous screen by selecting Hide Analysis. Reviewing Previewed or Stored 12-Lead Captures To view 12-Lead captures previewed or stored on the monitor or 12-Lead captures stored at the IntelliVue Information Center (PIIC iX only), select Review 12 Lead. You can then select from a list of 12-Lead captures available for the current patient. The 12-Lead captures in the list may be marked with a symbol, for example an open or closed padlock to indicate unlocked or locked status or a * to indicate preview status. Information Center Remote Export (PIIC iX only) Use the Export key to remotely start the 12-Lead export functionality of the IntelliVue Information Center. Information Center Remote Lock/Unlock (PIIC iX only) Use the Lock key to remotely lock the 12-Lead capture at the IntelliVue Information Center. If it is already locked, the Unlock key will be displayed. Capture 12-Lead Pop-up Keys Here is a summary of all the pop-up keys available during the 12-Lead ECG procedure:
Pop-up Keys Admit Patient Selecting this pop-up key lets you enter the age and gender for the patient, 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. 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. Change View Capture Waves Show Waves Setup 12 Lead Enter OrderNo. Print Report 148 6 ECG, Arrhythmia, ST and QT Monitoring Review 12 Lead Pop-up Keys Store & Send Selecting this pop-up key lets you store the captured 12-Lead ECG in the monitor and send it to the Information Center. view a list of 12-Lead captures available at the monitor or at the IntelliVue Information Center, and select one for review. download analysis results from the IntelliVue Information Center remotely export 12-Lead ECG data from the IntelliVue Information Center to an ECG management system (see the Information Center Instructions for Use for details). remotely lock/unlock the 12-Lead capture at the IntelliVue Information Center. Setting Up the 12-Lead ECG Show Analysis Export Lock / Unlock Select the HR numerics on the screen to enter Setup ECG. Select 12Lead. You can make settings that will be stored and used in future as default settings for each 12-Lead ECG capture made. 1 2 3 The Setup 12 Lead window opens for you to make the default settings. For a description of the available settings, see Changing Settings for a Captured 12-Lead ECG on page 147. 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 Enhanced arrhythmia alarms are available when Arrhythmia is switched on and the Enhanced Arrhythmia option has been enabled for your monitor Alarm Description Arrhythmia Configuration Arrhythmia Off Basic Arrhythmia Enhanced Arrhythmia
*** Asystole
*** Vent Fib/Tach
*** VTach
*** Extreme Tachy No QRS detected for a period > the asystole alarm threshold Fibrillatory waveform (sinusoidal wave between 2 10 Hz) for 4 consecutive seconds A run of PVCs the V-Tach run limit and heart rate > the V-Tach HR limit Heart rate > the extreme tachy alarm limit x x x x x x x x x x x 149 6 ECG, Arrhythmia, ST and QT Monitoring Alarm Description Arrhythmia Configuration Arrhythmia Off Basic Arrhythmia Enhanced Arrhythmia x x x x x x
(see note) x
(see note) x
(see note) x
(see note) x x x x x x x x x x x x Heart rate < the extreme brady alarm limit Heart rate > the high HR alarm limit Heart rate < the low HR alarm limit A run of PVCs < the V-Tach run limit and ventricular heart rate > the V-Tach HR limit A dominant rhythm of adjacent Vs >
the vent rhythm limit and ventricular heart rate < the V-Tach HR limit A run of > 2 PVCs Two ventricular beats between two non-ventricular beats For HR < 100, a PVC with R-R interval
< 1/3 the average interval followed by a compensatory pause of 1.25*(the 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 beat detection) A dominant rhythm of N, V, N, V (N =
supraventricular beat, V=ventricular beat) A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V =
ventricular beat) PVCs detected within a minute > the alarm limit Two different shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats No beat detected for a period > the pause threshold No beat detected for > 1.75*(the averaged R-R interval), or no beat detected for > one second if HR > 120
(For non-paced patients only)
*** Extreme Brady
** HR High
** HR Low
** Non-Sustain VT
** Vent Rhythm
** Run PVCs High
** Pair PVCs
** R-on-T PVCs
** Vent Bigeminy
** Vent Trigeminy
** PVCs/min High
** Multiform PVCs
** Pause
** Missed Beat 150 6 ECG, Arrhythmia, ST and QT Monitoring Alarm Description Arrhythmia Configuration Arrhythmia Off Basic Arrhythmia Enhanced Arrhythmia
** Pacer Not Capt
**Pacer Not Pacing
** SVT
* HR High
* HR Low
* AFIB
* End AFIB
** Irregular HR
* End Irregular HR No beat detected for > 1.75*(the averaged R-R interval) with detected pace pulse(s). (For paced patients only) No beat and pace pulse detected for >
1.75*(the averaged R-R interval). (For paced patients only) A run of supraventricular beats > the SVT run limit and heart rate > the SVT HR limit Heart rate > the high HR alarm limit Heart rate < the low HR alarm limit Atrial fibrillation waveform detected Atrial fibrillation no longer detected for the configured Afib end delay time Consistently irregular rhythm (irregular R-R intervals) Irregular HR no longer detected for the configured irregular HR end delay time x x x x x x
(see note) x
(see note) x
(see note) x
(see note) x x x x Note: **HR High/Low are available only if HR alarms are configured to "yellow", and *HR High/
Low are available only if HR alarms are configured to "short yellow". 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 2 Low Limit 3 High Limit 4 Extreme Tachy Limit 5 Extreme Brady 6 Extreme Tachy 151 6 ECG, Arrhythmia, ST and QT Monitoring 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 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. 152 6 ECG, Arrhythmia, ST and QT Monitoring When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal. General:
When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth. During surgery:
Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration. Pacemaker failure:
During complete heart block or pacemaker failure to pace/capture, tall P-waves (greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest. Patients exhibiting intrinsic rhythm:
When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest. The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patient's heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined. Filtered ECG signal from external instruments:
Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance. 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. 153 6 ECG, Arrhythmia, ST and QT Monitoring Line isolation monitor transients:
When electrodes or lead wires are loose or detached, the monitor becomes susceptible to switching transients from some types of line isolation monitors. Line isolation monitor transients may resemble actual cardiac waveforms and thus inhibit heart rate alarms. To minimize the chance of this occurring, always adhere to the instructions for skin preparation and electrode placement given in this chapter. 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 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 149, the rhythm and ectopic messages detected are listed in Arrhythmia Status Messages on page 157. 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 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. 154 Choosing an ECG Lead for Arrhythmia Monitoring 6 ECG, Arrhythmia, ST and QT 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. 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. An ** End AFIB alarm will occur when no atrial fibrillation waveform was detected for a configured delay time. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm. An ** AFIB can be falsely detected in the presence of:
sinus arrhythmia, muscle noise, or If you also have monitors with earlier software revisions, the ** AFIB and ** End AFIB alarms 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. 155 6 ECG, Arrhythmia, ST and QT Monitoring 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. 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. Beat label Pace pulse marks 1 2 3 Rhythm status message 4 PVC Numeric 5 HR Numeric 6 Ectopic status message 7 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 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. 156 6 ECG, Arrhythmia, ST and QT Monitoring 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 Rhythm Status Messages -- to indicate the patient's rhythm. The monitor displays two types of status messages:
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 Vent Bigeminy Vent Trigeminy 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 B or E B, E B, E B, E E E E E 157 6 ECG, Arrhythmia, ST and QT Monitoring A dominant rhythm of paced beats Consistently irregular rhythm A dominant rhythm of SV beats preceded by P-waves A dominant rhythm of SV beats not preceded by P-waves Rhythm Status Message Description 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 Algorithm is learning the ECG beat morphology Algorithm is learning the rhythm of the classified beats ECG signal is predominantly invalid and therefore cannot be analyzed Ectopic Status Messages The label B or E indicates basic (B) or enhanced (E) arrhythmia capability. 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 PacerNotPacing Pause R-on-T PVCs Multiform PVCs Frequent SVPBs SVPBs SV Beats Paced Beats 158 B or E B, E E B, E B, E B, E B, E B, E B, E B or E E E B, E B, E E E E E E B, E B, E Arrhythmia Relearning 6 ECG, Arrhythmia, ST and QT Monitoring 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 Arrhy menu, select Relearn Arrhy. While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the rhythm status message Learning ECG. Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm status message changes to Learning Rhythm. 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. 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. 159 6 ECG, Arrhythmia, ST and QT Monitoring 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). Yellow Arrhythmia Alarms Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. 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. 160 6 ECG, Arrhythmia, ST and QT Monitoring 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, Pacer n.Cap, Pacer n.Pac, Pause, SVT, IrregularHR, Missed Beat, PVCs/min and Afib. To switch individual alarms on or off, in the Setup Arrhy menu, select the alarm from the list to switch between On and Off. Depending on your configuration, some alarms may not be available in the list and cannot be switched on or off here. The monitor displays the INOP message Some ECG AlarmsOff, 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 Arrhy 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, Afib/IHR End Dly. 1 2 To adjust alarm limits, in the Setup Arrhy menu, select the alarm to be adjusted. Select the appropriate setting from the pop-up list. Arrhythmia Alarm Timeout Periods Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:
See Arrhythmia Alarm Chaining on page 162 for more details on alarm chains. 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. 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 162. To view the timeout period configured for your monitor, in the Setup Arrhy menu, see the menu items TimeOut 1st and TimeOut 2nd. 161 6 ECG, Arrhythmia, ST and QT Monitoring This setting can only be changed in Configuration Mode.
** AFIB and ** Irregular HR alarms do not have a timeout period. These alarms can be generated immediately after the corresponding end alarm was generated. When ** HR High and ** HR Low alarms are configured as standard yellow alarms, they do not have a timeout period. Resetting the Timeout Period To reset the timeout period, either select the Alarms Off or Pause Alarms permanent key and then reselect it, or select Reset Alarming in the Review Alarms window or the Alarm Messages window. 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 Single alarm instance Continuous alarm condition Non-sustained V-
tach PVCs/min HIGH Same intermittent alarm condition Pair of PVCs Short yellow alarm tone sounds when alarm condition is initially detected when alarm condition is initially 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 Alarm message 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. 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. 162 6 ECG, Arrhythmia, ST and QT Monitoring If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. See ECG and Arrhythmia Alarm Overview on page 149 for information on which alarms are included in the different arrhythmia options. See Arrhythmia Alarm Timeout Periods on page 161 for an explanation of how alarm timeouts work. Examples of Alarm Chaining Logic 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. 163 6 ECG, Arrhythmia, ST and QT Monitoring Understanding PVC-Related Alarms PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). As an 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. The monitor also performs ST Elevation (STE) analysis using automated ISO and J point determination and measuring the ST segment directly at the J point (J +0). This is based on the recommendations for measuring ST Elevation published by the American Heart Association, the American College of Cardiology and the European Society of Cardiology. 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. 164 6 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 or STE On and Off ST and STE analysis can be switched on and off independently. To switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis to switch between On and Off. To switch all STE monitoring on or off, in the Setup ST Elevation menu, select STE to switch 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. 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. 165 6 ECG, Arrhythmia, ST and QT Monitoring 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. 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. 166 6 ECG, Arrhythmia, ST and QT Monitoring ST View Window The ST View Window shows a current ST snippet and numeric with a baseline snippet and numeric. The two snippets are in different colors, so that you can differentiate between them easily and see at a glance which numerics belong to which snippet. In the upper left corner the current lead and the ISO/
J-Point mode for the current snippet and the baseline snippet is shown. On the right side all available ST numerics are shown. The date and time of the baseline snippet is shown at the bottom of the window. The ST View Window opens with the ST pop-up keys Current / Baseline / Overlap (to select viewing mode), Show Points /Hide Points, Update Baseline, Record ST, STE View, Adjust ST Points, ST Map, Setup ST and arrow keys for scrolling through the available leads. To view the ST View window, select any snippet on the Screen. ISO/J-point mode for current snippet ISO/J-point mode for baseline snippet 1 mV calibration bar 1 Current Lead 2 3 4 5 Current ST snippet and ST baseline snippet overlapped 6 Timestamp of most recently stored baseline snippet 7 All available ST numerics for current snippet and baseline snippet The ST point, J-point and ISO point can be hidden using the Hide Points pop-up key. STE View Window The STE View window shows a current ST snippet and STE numeric with an ST baseline snippet. The two snippets are in different colors, so that you can differentiate between them easily. In the upper left corner the current lead is shown. On the right side all available STE numerics are shown. The date and time of the ST baseline snippet is shown at the bottom of the window. 167 6 ECG, Arrhythmia, ST and QT Monitoring The STE View window opens with the pop-up keys Current / Baseline / Overlap (to select viewing mode), Show Points/Hide Points, Record STE, ST View, ST Map, Setup ST and arrow keys for scrolling through the available leads. The ST point, J-point and ISO point can be hidden using the Hide Points pop-up key. 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 2 Select an ST snippet to open the ST View window. In the ST View window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines. 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 View 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. 168 6 ECG, Arrhythmia, ST and QT Monitoring 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 5 Isoelectric point set to -80 msec 6 P 7 Q 8 S 9 T CAUTION If using ST analysis, 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. Setting ISO and J-Point Detection Mode There are two modes for ISO and J-point detection: Auto and Manual. In Manual mode you can set the measurement points yourself. In Auto mode the measurement points will be determined automatically. To set the detection mode, in the Setup ST Analysis window, 1 2 Select ISO/J Point. Select Auto or Manual mode. Adjusting ST Measurement Points If the ISO and J-point detection mode is set to Manual, all three measurement points can be set. In Auto mode, only the ST point can be changed. To adjust the ST measurement points, in the Setup ST Analysis menu, 1 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 View 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. 2 169 6 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 2 Current ISO/J-point detection mode 3 1 mV calibration bar 4 Cursor for adjusting ISO points 5 Highlighted ISO point 6 All available ST numerics for current snippet 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. 170 6 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. 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. When two contiguous leads are available, ST alarms will be generated when ST values of the two contiguous leads are outside the limit. When no contiguous lead is available an ST alarm is generated when the ST value of the single lead is outside the limit. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication-specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol. 1 2 In the Setup ST Analysis menu, select the alarm to be adjusted. Select the appropriate setting. STE Alarms The STE alarm is a yellow alarm. It can be switched on and off in the Setup ST Elevation menu but the limits can only be changed in Configuration mode. The STE alarm limits are gender specific and can be set individually for limb leads, V2/V3 leads, and V1/V4/V5/V6 leads. The default values, for example on V2 and V3 1.5 mm for females and 2.0 mm for males, are based on the recommendations from the American Heart Association and American College of Cardiology. The ST Elevation measurements with automated J-point determination generate ST Elevation alarms, in addition to the ST measurements at the user-defined ST point (J+offset), which may be useful for ST depression alarms. When ST and STE analysis are both in use, this may result in redundant alarms for ST elevations. Because of the different measurement points, there may be different values obtained. Thus there could be an ST alarm and an STE alarm but the STE alarm may announce sooner based upon the values obtained. 171 6 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 6 If an ST lead is switched off, its axis is not shown in the map. EASI Limb Leads EASI Chest Leads ST index (for EASI) ST label, value and polarity of corresponding lead ST map 172 6 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 one minute. The first trended sample is white and is one minute old. The second trended sample corresponds to the ST values two minutes 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. 1 Limb Leads 2 Chest Leads 3 4 current ST values trending interval 173 6 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 316. 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 View 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. 174 6 ECG, Arrhythmia, ST and QT Monitoring Changing the Trending Interval To determine how frequently the monitor displays a trended sample, 1 2 In Trend view, select Select Interval. Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. Printing an ST Map Report To print the most recently viewed (current or trend) window, 1 2 3 Select Main Setup then select Reports. Select ST Map. Press Print. 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). 175 6 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. 176 6 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. 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. To select the mode, 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. 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 2 3 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. 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. 177 6 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 Too few N labeled beats Invalid Rhythm for QTc High QT-HR Small R Wave Small T Wave End of T not Detected QT out of Range QTc out of Range QTc Erratic 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 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 178 6 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. 1 2 3 4 In the Setup QT Analysis menu, select QTc High Limit. Select the appropriate setting. Select QTc High Limit. Select the appropriate setting. 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. 179 6 ECG, Arrhythmia, ST and QT Monitoring 180 7 7Monitoring 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 menu from the measurement, 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, 1 In the Setup Pulse menu, select System Pulse. 2 Select one of the SpO2, cmResp 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. 181 7 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. 182 7 Monitoring Pulse Rate WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section ECG and Arrhythmia Alarm Overview on page 149, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/Arrh AlarmsOff (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 AlarmsOff 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. 183 7 Monitoring Pulse Rate 184 8 8Monitoring 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. 185 8 Monitoring Respiration Rate (Resp) Lateral Chest Expansion Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum point of breathing movement to optimize the respiratory wave. Abdominal Breathing Some patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave. Understanding the Resp Display The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration. 1 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, 186 8 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 186. 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. 187 8 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 2 In the Setup Resp menu, select Apnea Time. Select the appropriate setting. 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. 188 8 Monitoring Respiration Rate (Resp) 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. 189 8 Monitoring Respiration Rate (Resp) 190 9Monitoring SpO2 9 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. 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. 191 9 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. 192 9 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. 193 9 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 2 In the Setup SpO menu, select Average. Select the required averaging time from the list. 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. 194 9 Monitoring SpO2 Alarm Delays There is a delay between a change in the oxygen saturation at the measurement site and the corresponding alarm indication at the monitor. This delay has two components:
The general measurement delay time is the time between the occurrence of the saturation change and when the new value is represented by the displayed numerical values. This delay depends on the algorithmic processing and the averaging time configured for SpO2. The longer the averaging time configured, the longer the time needed until the numerical values reflect the change in saturation. The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the sum of the alarm delay time configured for SpO2, plus the system alarm delay. The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. See Monitor Performance Specifications on page 464 for the system alarm delay specification. For SpO2 high and low limit alarms, there are two different types of alarm delay time. The standard alarm delay is set to a fixed value. The Smart Alarm Delay varies, based on an intelligent algorithm, and can be used instead of the standard alarm delay. The Desat alarm always uses the standard alarm delay. Standard Alarm Delay The standard alarm delay time can be configured to a fixed value between 0 and 30 seconds, in 1 second steps. Smart Alarm Delays The Smart Alarm Delay functionality is currently not available in China or in clinical environments under SFDA control. When Smart Alarm Delays are used, the delay before the indication of an SpO2 high or low limit alarm depends on the amount by which the limit is exceeded and for how long. This capability can be used to avoid alarms when the SpO2 values show a pattern of recovering after a limit violation. There are three modes available, Short, Medium and Long. All modes have a minimum delay of 10 seconds. The maximum delay is 25 seconds for Short mode, 50 seconds for Medium mode and 100 seconds for Long mode. 195 9 Monitoring SpO2 Alarm Limit Violation Deviation from violated Alarm Limit Alarm Limit Resulting Alarm Delay Short Mode Medium Mode Long Mode This diagram shows the relationship between the alarm delay and the deviation from the alarm limit. The shaded areas on the diagram show the area in which SpO2 values can violate the alarm limit without causing an alarm to be indicated. The area is smallest for the Short mode, and is extended for the Medium and Long modes by the corresponding areas shown above. WARNING Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are. 196 9 Monitoring SpO2 Example With Short Mode Alarm Limit Deviation from violated Alarm Limit Resulting Alarm Delay This diagram shows the area for Short mode, with two examples of hypoxia. Progressive hypoxia scenario: SpO2 value (A) - the values drop steadily and after 10 seconds a value leaves the shaded area. An alarm is indicated immediately. Recovery scenario: SpO2 value (B) - the values stay within the shaded area for 24 seconds, deviating from the alarm limit by 1% or 2%, before rising again above the alarm limit. No alarm is indicated because the SpO2 values never leave the shaded area below the alarm limit. On the basis of the two examples, you can see that the delay depends on how much the value exceeds the limit, and for how long. Changes in the SpO2 value can be major, but very short, or minor and for a longer time - as long as they stay within the shaded area there will be no alarm indicated. 197 9 Monitoring SpO2 Example With Medium Mode Deviation from violated Alarm Limit Alarm Limit Resulting Alarm Delay This diagram shows the area for Medium mode, with two examples of hypoxia. Progressive hypoxia scenario: SpO2 value (C) - the values drop steadily and after 11 seconds a value leaves the shaded area. An alarm is indicated immediately. Recovery scenario: SpO2 value (D) - the values stay within the shaded area for 48 seconds, deviating from the alarm limit by 1% or 2%, before rising again above the alarm limit. No alarm is indicated because the SpO2 values never leave the shaded area below the alarm limit. Example With Long Mode Alarm Limit Deviation from violated Alarm Limit Resulting Alarm Delay This diagram shows the area for Long mode, with two examples of hypoxia. 198 9 Monitoring SpO2 Progressive hypoxia scenario: SpO2 value (E) - the values drop steadily and after 16 seconds a value leaves the shaded area. An alarm is indicated immediately. Recovery scenario: SpO2 value (F) - the values stay within the shaded area for 98 seconds, deviating from the alarm limit by 1% to 3%, before rising again above the alarm limit. No alarm is indicated because the SpO2 values never leave the shaded area below the alarm limit. Setting Smart Alarm Delay Mode To set the mode for Smart Alarm Delays, in the Setup SpO menu, 1 Check that SmartAlarmDelay is set to On. This setting is made in Configuration mode and will be shown in the menu in gray. If it is set to Off, a standard alarm delay is in use. Select High Alarm Delay and choose Short, Medium, or Long mode. Select Low Alarm Delay and choose Short, Medium, or Long mode. 2 3 If you also use monitors with earlier software revisions, be aware that smart alarm delays will not be used after a transfer to one of these monitors. Monitors with earlier software revisions will always use the standard alarm delay. If you are not sure whether a monitor has the Smart Alarm Delay function, check whether there is a SmartAlarmDelay entry in the Setup SpO menu. 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. 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. 199 9 Monitoring SpO2 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.. 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 Pulse and select the correct SpO2 label from the pop-up list. 200 9 Monitoring SpO2 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 2 3 Choose the first measurement source. 4 5 Choose the second measurement source. From the Main Setup menu, select Measurements. From the Setup SpO menu, select First SpO. Select Second SpO. 201 9 Monitoring SpO2 202 10 10Monitoring NBP This monitor uses the oscillometric method for measuring NBP. 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 (oscillations) 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. Existing Wounds: Do not apply the cuff over a wound as this can cause further injury. Mastectomy: Avoid applying the cuff on the side of the mastectomy, as the pressure increases the risk of lymphedema. For patients with a bilateral mastectomy, use clinical judgement to decide whether the the benefit of the measurement outweighs the risk. Unattended Measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements. Too frequent measurements can cause blood flow interference potentially resulting in injury to the patient. In cases of severe blood clotting disorders frequent measurements increase the risk of hematoma in the limb fitted with the cuff. 203 10 Monitoring NBP Temporary Loss of Function: The pressurization of the cuff can temporarily cause loss of function of monitoring equipment used simultaneously on the same limb. 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 NBP readings can be affected by the position of the patient, their physiological condition, the measurement site, and physical exercise. Thus a physician must determine the clinical significance of the NBP information. 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 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 with cardiac arrhythmias the artery on an edematous extremity. The effectiveness of this sphygmomanometer has not been established in pregnant, including pre-eclamptic patients. When the accelerated measurement is used the minimum number of oscillations per deflation step is 1, instead of the 2 in the standard measurement. This allows a faster measurement result but requires that the patient keeps the limb in question still. The accelerated measurement is recommended for use when very few or no artifacts are expected, for example with sedated patients. You can see whether the accelerated measurement is in use by looking in the Setup NBP menu. The Accelerated Msmt setting shows whether the accelerated measurement is Off, on for Manual measurements or on for All measurements. This setting is view-only in Monitoring Mode and can be changed in Configuration Mode. When the accelerated measurement is in use, no pulse rate is derived from NBP. 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. 204 10 Monitoring NBP 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. Preparing to Measure 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. WARNING Kinked or otherwise restricted tubing can lead to a continuous cuff pressure, causing blood flow interference and potentially resulting in injury to the patient. 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. WARNING 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 Add 1.9 mmHg (0.25 kPa) for each inch higher. Deduct 1.9 mmHg (0.25 kPa) for each inch Deduct 0.75 mmHg (0.10 kPa) for each centimeter lower or lower. 205 10 Monitoring NBP Recommendations For Measurements Used in Diagnosis of Hypertension To make a measurement for use in the diagnosis of hypertension, follow the steps below:
1 Ensure the patient is comfortably seated, with their legs uncrossed, feet flat on the floor and back and arm supported. 2 Ask the patient to relax and not talk before and during the measurement. 3 If possible, wait 5 minutes before making the first measurement. Understanding the NBP Numerics 1 Alarm source 2 Measurement Mode 3 Timestamp/Timer 4 Mean pressure 5 Diastolic 6 Systolic 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. If configured to do so, the pulse from NBP will display with the NBP numeric. 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. During this hour, measurement values may be grayed out or disappear from the screen after a set time, if configured to do so. This avoids older numerics being misinterpreted as current data. The time can be set in Configuration mode. 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 Measurement 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. 206 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. When Unexpected Values are Measured 10 Monitoring NBP When values measured are higher or lower than expected, check the following potential causes:
Possible Cause The patient was talking or moving before or during the measurement. The incorrect cuff size was used or the cuff was not at heart level The noninvasive blood pressure reference method is set incorrectly. Solution Allow the patient to rest quietly, then try again after three to five minutes. Check the cuff size, level, and position then repeat the measurement. Check the reference method (auscultation or intra-
arterial) in the Setup NBP menu. If it is incorrect, have it changed in Configuration Mode. Check the list in Measurement Limitations on page 204. Measurement limitations have not been taken into account. Starting and Stopping Measurements Use the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements. Action to be performed Start manual measurement Start Auto series NBP Setup menu Start/Stop SmartKeys MMS hardkey Start/Stop Start STAT measurement NBP STAT Stop Manual measurements Start/Stop Start/ Stop Start NBP NBP STAT Start STAT Start/ Stop Stop NBP
STAT (for MMS without Pressure/
Temp measurement) Start/Stop 207 10 Monitoring NBP Action to be performed Stop current Auto measurement NBP Setup menu Start/Stop SmartKeys MMS hardkey Start/Stop Stop current STAT measurement and end series Start/Stop NBP STAT Stop Auto, Manual or STAT measurement AND series Stop All Start/Stop STAT (for MMS without Pressure/
Temp measurement) Start/ Stop Stop NBP Start/ Stop NBP STAT Stop NBP Stop All 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 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. 208 10 Monitoring NBP 3 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:
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. When the accelerated measurement is in use, no pulse value can be derived. To switch the display of the pulse value on or off:
In the Setup NBP menu select Pulse (NBP). 209 10 Monitoring NBP Assisting Venous Puncture In the Setup NBP menu select VeniPuncture. Puncture vein and draw blood sample. You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it. 1 2 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. NBP 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. 210 11 11Monitoring 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 - labeled as TEMP. Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually. Making a Temp Measurement 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. 1 2 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. 211 11 Monitoring Temperature 1 2 In the Setup <Temp Label> menu, select Label. Select the appropriate label from the list. Temp Tart Tcore Tesoph non-specific temperature label arterial temperature core temperature esophageal temperature Trect Tskin Tven Tnaso rectal temperature skin temperature venous temperature nasopharyngeal temperature Extended Temperature Label Set The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode. Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information. T1, T2, T3, T4 Tamb Tcereb Ttymp Tvesic Non-specific temperature labels ambient temperature cerebral temperature tympanic temperature vesical temperature Calculating Temp Difference The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled Temp. 1 2 3 4 5 6 In the Main Setup menu, select Measurements. Select Temp. In the Setup Temp menu, select First Temp. Select the appropriate label for the measurement source. Select Second Temp. Select the appropriate label for the second measurement source. 212 12 12Monitoring 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 a monitor with an M1006A pressure module as an additional monitor for your patient. This may cause interference on the respiration or invasive pressure measurements. You can measure pressure using an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions or the pressure plug-in module - labeled as PRESS. 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. 4 Connect the pressure line to the patient catheter. 5 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. 6 213 12 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 the source of the pressure you want to monitor by selecting an appropriate pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that label's stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values. 1 2 In the Setup <Press Label> menu, select Label. Select the appropriate label from the list. Label ABP ART Ao CVP ICP LAP P PAP RAP UAP UVP Description Arterial blood pressure Arterial blood pressure (alternative) Aortic pressure Central venous pressure Intracranial pressure Left atrial pressure 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 214 Zeroing the Pressure Transducer 12 Monitoring Invasive Pressure every time you reconnect the transducer cable to the monitor 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 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. 215 12 Monitoring Invasive Pressure 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. 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. 216 12 Monitoring Invasive Pressure Adjusting the Calibration Factor Each time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same. 1 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. Select the pressure wave. Select Activate Cursor. 217 12 Monitoring Invasive Pressure 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 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> No Pulse 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. 218 12 Monitoring Invasive Pressure 1 Extreme Low Limit 2 Low Limit 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 25 cm 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. 219 12 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. 4 5 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. 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 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 Contact your service department. The pressure hardware is faulty. unable to calibrate - no transducer unable to calibrate - unstable signal Make sure there are no disturbances to the transducer, and repeat the calibration. 220 12 Monitoring Invasive Pressure Message unable to calibrate - perform zero first Corrective Action 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 2 3 In the Main Setup menu, select Measurements. Select CPP. In the Setup CPP menu, select which arterial pressure source should be used in the calculation. 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 2 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. 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. 221 12 Monitoring Invasive Pressure Measuring IAP There are two methods to store IAP measurement readings in the monitor: with manual entry or using a pressure waveform. NOTE For both methods, to be able to use the label IAP, it must be made available for manual entry in Configuration Mode. For more details on manually entered measurements, see Entering Measurements Manually on page 46. Manual Entry This method uses a reading from an independent IAP measurement device, for example a bladder manometer; the user manually transcribes the IAP reading to the monitor. To manually enter the measured IAP value:
1 Select the IAP numeric on the screen. 2 Enter the IAP value and select Enter using the numeric keypad. 3 If you need to change date and time, select Date/Time. The default is always the current date and time. Select Enter to confirm. Select Save. 4 Using a Pressure Waveform This method uses an electronic reading from a pressure transducer connected to the monitor. The pressure transducer usually acquires the IAP from a dedicated IAP measurement device. To enter the IAP using a connected IAP measurement device:
1 Assign the pressure label P (or P1P8) to the pressure channel connected to the IAP transducer. 2 Zero the transducer as described in Zeroing a Pressure Measurement on page 215. 3 Perform the IAP measurement according to the instructions given by the manufacturer of the IAP measurement device. 4 On the monitor screen, when the IAP pressure has stabilized, select the pressure waveform and select Activate Cursor. 5 Use the arrow up/down keys to move the wave cursor to an area of the waveform that reflects the 6 correct pressure. See Using the Wave Cursor on page 217 for details. Select Save as IAP. This will store the IAP pressure value under the cursor in the monitors database and display it on the monitor screen. 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 222 12 Monitoring Invasive Pressure 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 2 3 Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory In the Main Setup menu, select Wedge to display the wedge procedure window. Prepare and check the pressure line according to your hospital policy. 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 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. 4 5 6 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. 223 12 Monitoring Invasive Pressure 5 6 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. 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) 224 13 13Monitoring 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 - labeled as C.O., standard and option #C10 - labeled as CCO/C.O. 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 - labeled as C.O., option #C10 - labeled as CCO/C.O. 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. 225 13 Monitoring Cardiac Output 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. Measured and Calculated Hemodynamic Parameters and Indexes Blood Temperature (Tblood) C.O./C.I.: Cardiac Output CCO/CCI: Continuous Cardiac Output PiCCO Method (Transpulmonary Thermodilution) Continuous? Main Screen Yes Yes Yes Yes No Yes HemoCalc Window No Yes Yes (in the C.O. field) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Right Heart Thermodilution Continuous? Main Screen Yes Yes Yes No Not available HemoCalc Window No Yes No No Not available Not available Not available Not available Not available Not available Not available Not available Not available Not available No No No No No No Yes Yes No No No No Yes Yes Yes Yes SVR/SVRI: Systemic Vascular Resistance Both SV/SI: Stroke Volume/SV Index Both SVV: Stroke Volume Variation Yes
*dPmax: Left Ventricular Contractility Index Yes CFI: Cardiac Function Index No PPV: Pulse Pressure Variation Yes ITBV/ITBVI: Intrathoracic Blood Volume No EVLW/EVLWI: Extravascular Lung Water No GEDV/GEDVI: Global End-Diastolic Volume No
*PVPI: Pulmonary Vascular Permeability Index No
*GEF: Global Ejection Fraction No
*RLShnt: Right-Left-Shunt Fraction No PVR/PVRI: Pulmonary Vascular Resistance Not available LCW/LCWI: Left Cardiac Work No RCW/RCWI: Right Cardiac Work Not available RVSW/RVSWI: Right Ventricular Stroke Work Not available Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No
* currently not available in the U.S.A. and territories relying on FDA market clearance. NOTE EVLWI is calculated using Ideal Body Weight (IBW). ITBVI and GEDVI are calculated using Ideal Body Surface Area (IBSA). IBW and IBSA are based on the patient category, gender and height that you have entered for the patient. 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. 226 13 Monitoring Cardiac Output 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. 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 9 10 Trial curves 11 Results table of current trial 12 Trial curve scale Setup information Trial numbers for the trial curves 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. 227 13 Monitoring Cardiac Output Accessing the Setup C.O. and Setup CCO Menus 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. C.O. settings can be changed in the Setup C.O. menu. To access this menu, 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. 228 13 Monitoring Cardiac Output 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. 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"). 229 13 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. 230 13 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. 231 13 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. 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 A pressure signal for CCO was available during the measurement (valid for calibration) 232 13 Monitoring Cardiac Output
?Cal N/A Exp 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. 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 1 Set up the PA line using a PA catheter. 233 13 Monitoring Cardiac Output 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. 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. 234 Editing and Saving RH C.O. Measurements 13 Monitoring Cardiac Output 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 Documenting C.O. Measurements You can document C.O. measurements on the default printer or recorder. 1 2 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. 235 13 Monitoring Cardiac Output Injectate Volume, Patient Weight and ETVI Values (PiCCO Only) When deciding on an injectate volume and temperature, you must consider your patient's Ideal Body Weight (IBW) and extra-vascular thermal volume index (ETVI). IBW is based on the patient category, gender and height that you have entered for the patient. The calculated IBW is displayed in the window that opens when you select the InjVol field. High ETVI Weight 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. IBW
< 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 ETVI 10 2 ml 3 ml 5 ml 10 ml 15 ml 20 ml Room Temperature Injectate ETVI 10 ETVI < 10 3 ml Use cold injectate 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. C.O./CCO Curve Alert Messages Tinj off scale 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. 236 C.O./CCO Curve Alert Messages Noisy baseline Temperature baseline drift Small signal, more indicator required 13 Monitoring Cardiac Output Possible Causes 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 Unsteady baseline Multiple peaks Abnormal decay time 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 on page 235. 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. 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. 237 13 Monitoring Cardiac Output C.O./CCO Curve Alert Messages Very long curve Very short curve Irregular curve Delayed injection Possible Causes 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 not 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. 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. 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. 238 13 Monitoring Cardiac Output C.O./CCO Warning Messages Verify C.O. setup data Possible Causes 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. 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. 239 13 Monitoring Cardiac Output 240 14 14Monitoring 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. 241 14 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). The Microstream method also provides an Integrated Pulmonary Index (IPI) numeric, which is an indication of the patient's overall ventilatory status based on four measurement parameters: etCO2, awRR, pulse rate and SpO2. IPI can thus provide an early indication of a change in ventilatory status which may not be shown by the current value of any of these four parameters individually. The IPI is designed to provide additional information regarding patient status, possibly before etCO2, awRR, SpO2, or pulse rate values reach levels of clinical concern. The IPI is available for all three groups of pediatric patients (1-3 years, 3-6 years, and 6-12 years), and for adult patients. It is displayed as a single value between 1 and 10. 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. 242 14 Monitoring Carbon Dioxide With intubated patients, a sample of the respiratory gas is drawn from the patient's breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula. WARNING Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the 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 1000 m 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. 243 14 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:
244 14 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. 245 14 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 MX600/700/
800 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. 246 Preparing to Measure Mainstream CO2 14 Monitoring Carbon Dioxide 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. 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 247 14 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. 248 14 Monitoring Carbon Dioxide WARNING When using the IPI numeric (available for adult and pediatric patients), always ensure that the patient's date of birth is entered correctly and that the monitor is displaying the current date. These two pieces of information are used to calculate the age of the patient, which affects the algorithm used to provide the IPI numeric. 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 clockwise into the CO2 inlet until it can no longer be turned. This will assure that there is no leak of gases at the connection point during measurement and that measurement accuracy is not compromised. Following connection of the CO2 sampling line, check that CO2 values appear on the monitor display. 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 (not Mainstream CO2) on page 251. 249 14 Monitoring Carbon Dioxide 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 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. Correction Altitude
(M3014A only) O2
(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. 250 14 Monitoring Carbon Dioxide Correction Humidity N2O
(M3016A mainstream and M3015A/B microstream only) Gas
(M3014A only) Agent
(M3014A only) 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 the Alarms section for general alarm information. 1 2 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. Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. 1 2 3 Choose the apnea alarm delay time. In the Setup CO menu, select awRR. In Setup awRR menu, select Apnea Time. 251 14 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 In the Setup CO menu, select awRR. In the Setup awRR menu, select Alarms. 1 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. Changing IPI Alarm Limits In the Setup CO menu, select IPI. Select Low Limit to set the low alarm limit. Select a value between 2 and 9. 1 2 3 If you also have monitors with earlier software revisions than J.0, the IPI low alarm will not be generated after a transfer to one of these monitors, or when a monitor/MMS with the IPI functionality is connected to one of these monitors in companion mode. In this case, do not rely only on the IPI low alarm but leave the individual alarms switched on (etCO2, awRR, pulse rate and SpO2) so that these alarms can be generated in such situations. Understanding the IPI Numeric The index is modeled on normal healthy patients (ASA Physical Status value of 1 according to the ASA Physical Status Classification System). Patients with ASA Physical Status values of 3 or higher are expected to have low IPI values by definition. Therefore, for patients with an ASA Physical Status value of 3 or higher, the index may have no added value. The value of the Integrated Pulmonary Index given in the IPI numeric is associated with the patient status as follows:
IPI 10 8-9 7 Patient Status Normal Within normal range Close to normal range; requires attention 252 14 Monitoring Carbon Dioxide IPI 5-6 3-4 1-2 Patient Status Requires attention and may require intervention Requires intervention Requires immediate intervention. NOTE The interpretation of the patient's IPI score may change in different clinical environments. For example, patients with specific respiratory difficulties (in contrast to normally healthy patients who are being monitored during sedation or pain management) may require a lower IPI Low Alarm threshold to reflect their impaired respiratory capacity. The IPI is available for all three groups of pediatric patients (1-3 years, 3-6 years, and 6-12 years), and for adult patients. WARNING Ensure that the patient category and date of birth are set correctly before monitoring a patient's IPI. An incorrect patient category or date of birth could produce incorrect IPI data. 253 14 Monitoring Carbon Dioxide 254 15 15Monitoring Airway Flow, Volume and Pressure The M1014A Spirometry Module - labeled as SPIRO - 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. See Respiratory Loops on page 399 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. 255 15 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. 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 cm3 of dead-space. Infant/Neonatal Flow Sensor (M2786A) Color: violet For intubated patients with endotracheal tube diameters 4 mm. Adds less than 1 cm3 of dead-space. 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 cm3 of dead-space. Pediatric Combined CO2/Flow Sensor (M2783A): Color: green For intubated patients with endotracheal tube diameters of 3.5 - 6 mm. Adds less than 4 cm3 of dead-space. 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 cm3 of dead-space. 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. 256 15 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. 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 257 15 Monitoring Airway Flow, Volume and Pressure 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. NOTE During the purge cycle the pump will be heard 258 15 Monitoring Airway Flow, Volume and Pressure If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced With each purge cycle, a zero calibration is automatically performed 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:
N2 60 O2 N2O Agent Difference between measured and actual values 40 40 60 15%
Actual Gas Composition Gas Compensation Setting Incorrect Balance Gas Setting (N2O instead of N2) 259 15 Monitoring Airway Flow, Volume and Pressure N2 O2 N2O Agent Difference between measured and actual values Actual Gas Composition Gas Compensation Setting 55 60 40 40 Incorrect Agent Percentage Setting 5 0 15%
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. 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 2 3 Choose the apnea alarm delay time. In the Setup Spirometry menu, select RRspir. In Setup RRspir menu, select Apnea 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. 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. 260 15 Monitoring Airway Flow, Volume and Pressure 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). 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 2 3 In the Setup Spirometry menu, select Gas Compensation. Select Inspired Temp to change the temperature of the inspired gas. Select the appropriate temperature setting. NOTE Changing the temperature setting unintentionally will result in approximately 3% reduced accuracy per 10C (18F) temperature setting change. 261 15 Monitoring Airway Flow, Volume and Pressure 262 16 16Monitoring 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 Press to enter Setup tcGas menu Press to start calibration 1 2 3 Calibration chamber 4 Transducer connector 263 16 Monitoring tcGas Setting the tcGas Sensor Temperature In the Setup tcGas menu, select Transducer Temp.. 1 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. 264 16 Monitoring tcGas 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. Disabling the tcGas Site Timer 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 2 In Setup tcGas menu, select Site Timer and switch this to Disabled. Select the Confirm pop-up key. 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 265 16 Monitoring tcGas you doubt the measurement accuracy you start a new monitoring period or use a new site the monitor displays the Calibration required INOP message. 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. 266 16 Monitoring tcGas 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. Troubleshooting tcGas Calibration 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. 267 16 Monitoring tcGas 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. 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. 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. 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. 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. 268 16 Monitoring tcGas In the Setup tcGas menu, look at the menu item CO Correction. If correction is enabled, it is set to On. 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. 269 16 Monitoring tcGas 270 17 17Monitoring 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. 271 17 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 277) 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 2 3 Select Main Setup then Measurements followed by <SO Label>
Select Label. Select the appropriate label for the catheter/probe location. 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. 272 17 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 3 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. 4 5 273 17 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 probe/catheter in the patient. relatively stable oxygen saturation in patient. that the light intensity indicator is indicating a stable medium to high level. 274 Making the In-Vivo Calibration 17 Monitoring Intravascular Oxygen Saturation Be prepared to draw a blood sample from the patient. In the Setup <SO Label> menu, select Start In-VivoCal. 1 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. 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. Place the optical module on the catheter tray in the space provided and open the lid. Insert the SO2 probe/catheter connector into the socket in the optical module until it snaps into place. 2 3 4 Close the lid. 5 For instructions on the placement of fiber optic catheters/probes, refer to the documentation provided with the accessory. 275 17 Monitoring Intravascular Oxygen Saturation 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. Position the optical module to avoid contact with liquids. Fluid entering the catheter-optical module connection will impair measurement performance. 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. CAUTION Do not apply excessive tension to any 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. 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 can be found printed on the connector of the probe/catheter. The correction factor must only be entered if it is different from the one currently stored. To see the current correction factor:
1 2 In the Setup <SO Label> menu, select Catheter Factor. If the correction factor displayed is different from the one on the connector, note the correction factor from the probe/catheter for entry during calibration. Making the In-Vivo Calibration Be prepared to draw a blood sample from the patient. In the Setup <SO Label> menu, select Start In-VivoCal. 1 2 3 To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample. 276 17 Monitoring Intravascular Oxygen Saturation 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 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 277 below. If you need to enter a new correction factor, select Catheter Factor. 8 9 Enter the correction factor. 10 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. 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 2 In the Setup <SO Label> menu, select Hb/Hct Entry. Select your preferred lab value and unit. 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. 277 17 Monitoring Intravascular Oxygen Saturation 278 18 18Monitoring 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. 279 18 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. 280 18 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 0 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. 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 281 18 Monitoring EEG 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. The CSA contains the following information Status line Spectral lines Trendlines Annotations 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, 0.5-30 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 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 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. 282 18 Monitoring EEG Setup CSA Window On/Off SEF On/Off MDF On/Off PPF This menu entry lets you 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 2 In the Setup EEG menu, select the numeric label. Select On or Off to switch between the settings. 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 2 Scaling information is displayed with each EEG wave. In the Setup EEG menu, select Wave Scale to call up a list of wave scales. Select the required scale from this list. 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 2 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 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). 283 18 Monitoring EEG 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. High-frequency Surgery - To reduce the hazard of burns, the EEG electrodes should not be located between the surgical site and the electrosurgical unit return electrode. EEG and Electrical Interference CAUTION Implanted devices (e.g. cardiac pace makers), other patient connected equipment, and other equipment near the patient (e.g. high-frequency surgical units) can cause interference on the waveform, numerics, and the CSA presentation. 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. 284 19 19Monitoring 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). 285 19 Monitoring BIS 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. 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. 286 Monitoring BIS using the BISx 19 Monitoring BIS BIS Module 1 2 BISx 3 4 BIS Sensor Patient Interface Cable 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 Covidien llc. 287 19 Monitoring BIS 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 2 In the Setup BIS menu, select Cont. Imp. Check. Select On or Off as required. 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 ImpedanceCheck 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 Sensor Check in the Setup BIS menu to toggle between On and Off, or select Start Sensor Chk 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 Sensor Check in the Setup BIS menu to toggle between On and Off, or select Stop Sensor Chk in the window. 288 19 Monitoring BIS 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. 1 Reference Electrode 2 Ground Electrode 3 Signal Electrode(s) 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 Depending on your configuration, in addition to the symbols, the impedance value in kOhm may be displayed. 289 19 Monitoring BIS 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. 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 2 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, 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 V. 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 2 In the Setup BIS menu, select Filters. Select On or Off as required. 290 BIS Safety Information 19 Monitoring BIS 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, contact Covidien 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. 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 electrosurgical 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. 291 19 Monitoring BIS 292 20 20Monitoring NMT Neuro Muscular Transmission (NMT) and its measurement enables the evaluation of muscle relaxation of patients under Neuromuscular Block by measuring the strength of muscle reaction after electrically stimulating the dedicated motor nerve. The NMT Monitor electrodes are placed on the patients skin over the ulnar nerve, a controllable current source delivers stimulation pulses to two skin surface electrodes for the nerve stimulation, the muscle response is measured with an acceleration sensor. WARNING The NMT measurement may not be used for neonatal patients and is therefore not supported in the neonatal mode. NMT stimulation current pulses may interfere with other sensitive equipment, for example, implanted cardiac pacemakers. Do not use the NMT measurement on patients with implanted medical devices unless so directed by a medical specialist. Simultaneous use of the NMT with high frequency electrosurgical equipment may in unusual circumstances result in burns at the stimulation site and can also adversely affect measurement accuracy. Do not use the NMT in close proximity to shortwave or microtherapy devices, there is a risk of adversely affecting the NMT 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 device in such an environment may present an explosion hazard. Never apply the electrodes trans-thoracically (across the chest) or transcerebrally (across the head), there is a risk of seriously injuring the patient. Apply the stimulation electrodes close together as described in the Instructions for Use. Never apply electrodes to patients in areas where inflammation or injury is evident. When you are connecting the electrodes or the patient cable, make sure that the connectors do not, and cannot, come into contact with other conductive parts, or with earth. Never touch the electrodes unless the stimulation has been stopped. Patients with nerve damage or other neuromuscular problems may not respond properly to stimulation. The NMT measurement may show unusual patterns when monitoring muscle paralysis in these patients. After repositioning the patient, check that the sensor is still applied and can move freely. 293 20 Monitoring NMT CAUTION NMT monitoring is intended as an adjunct in patient assessment and must be used in conjunction with observation of clinical signs and symptoms. NMT stimulation can be painful to a non-sedated patient. It is recommended not to stimulate before the patient is adequately sedated. Use only electrodes suitable for nerve stimulation deemed appropriate by the attending physician. Pay special attention to current densities exceeding 2 mA r.m.s/cm2 for any electrodes. Stimulation Modes The NMT module provides four stimulation modes:
Double-Burst Stimulation (DBS) Train-Of-Four (TOF) Single Twitch (Twitch) Post-Tetanic Count (PTC) Train-Of-Four (TOF) In this mode four stimuli are applied every 500 milliseconds (2 Hz). Each stimulation of the train causes the muscle to contract. The fade in the individual response to each single stimulation provides a basis for evaluation. The NMT Module then calculates a TOF ratio (TOFrat) value in % using the ratio between the fourth and the first twitch. When fewer than four twitches are detected, the monitor displays a TOF count (TOFcnt) value instead, this represents the number of responses to the four TOF stimulation pulses. Post-Tetanic Count (PTC) The Post-Tetanic Count stimulation pattern starts with a sequence of four current pulses, delivered every 500 milliseconds (2 Hz). If a muscle response is detected, the PTC sequence is stopped and the responses are reported as TOF measurement. If there is no muscle response, the sequence continues with a five seconds long tetanic stimulation of current pulses delivered at 50 Hz, followed by a pause of 3 seconds, followed by 20 single current pulses delivered every second (1 Hz). Muscle response detection is active only during the first 4 single pulses and the last 20 single pulses. During the last 20 pulses, the PTC value is incremented with each detected muscle response. Single Twitch (Twitch) If this mode is configured the NMT Module measures the response to single electrical stimuli applied to peripheral motor nerves. The module sends a single pulse and measures the strength of the resulting twitch, the module then calculates a Twitch Ratio (Twitch) value in %. If the displayed numeric is 80, the strength of the measured twitch was 80% of that of the reference twitch, see Calibrating the NMT Measurement on page 296. 294 20 Monitoring NMT Double-Burst Stimulation (DBS) The Double-Burst stimulation pattern consists of a sequence of 3 current pulses delivered every 20 milliseconds (50 Hz), followed by a pause of 750 milliseconds, followed by another sequence of 3 current pulses delivered every 20 milliseconds (50 Hz). With each detected muscle response the DBS Count (DBScnt) value is incremented. Preparing to Measure NMT The IntelliVue NMT Module is intended to be used only with adult and pediatric patients. Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good stimulation pulse. Insufficient cleaning of the skin can cause high skin resistance which could cause the stimulation to stop. 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. Do not use ether or pure alcohol as this dries the skin and increases the resistance. 4 Dry the skin thoroughly. Placing the NMT Electrodes and Transducer Stimulation of the ulnar nerve in the wrist is preferred for routine monitoring. CAUTION To avoid unintentional electrical shocks always make sure that the NMT stimulation has been stopped before touching the electrodes. NOTE Ensure that the thumb can move freely before applying the NMT sensor. Place the electrodes on the prepared site over the ulnar nerve on the palmar side of the wrist; refer to the figure below. 1 Black cable clamp 2 Red cable clamp 3 Transducer 295 20 Monitoring NMT Place the distal electrode near the wrist. Place the proximal electrode 2 to 3 cm proximal to the distal electrode. 1 2 3 Attach the Black cable clamp cable to the distal electrode, (see figure above). 4 Attach the Red cable clamp cable to the proximal electrode, (see figure above). 5 Place and affix the transducer with a large flat side against the palmar side of the thumb. The cable should be attached in such a way that it does not 'pull' at the transducer and that movement of the thumb is not obstructed. The more distal the transducer is placed on the thumb, the stronger the acceleration signal. CAUTION Make sure that the lead wires cannot come into contact with external pacemaker or catheter wires. Arm Position The arm used for the NMT measurement, should be kept immobile during the whole procedure. Taking NMT Measurements NOTE Both the NMT calibration and NMT measurement cannot be started:
When the parameter (NMT) is switched off During the recovery phase after a measurement. During an ongoing automatic measurement cycle. During an ongoing calibration When error conditions have been detected. When no patient cable is connected. Calibrating the NMT Measurement With the NMT calibration the supramaximal stimulation current is determined and the reference twitch is set to 100%. The reference twitch is the twitch at the supramaximal stimulation current when the patient is not paralyzed. This must be done prior to administration of Neuromuscular Blocking Agents (NMBA). If the NMT Module is unable to establish a reference twitch, it uses an internal reference value for single-twitch measurements. NOTE It is recommended that the patient be anesthetized before setting up the calibration twitch as nerve stimulation can be painful. Starting Calibration 1 Either press the NMT key on the module, or select the numeric on the screen to enter the Setup NMT window. Select Start Cal. 2 296 20 Monitoring NMT Select Confirm. 3 This automatically determines the supramaximal stimulation current and takes the reference twitch
(100%) at this current. If the NMT Module is unable to establish a reference twitch, it uses an internal reference value for single-mode measurements. Clearing a Reference Twitch Clearing the Reference Twitch resets the supramaximal stimulation current and reference twitch to default values. To clear the stored references:
In the Setup NMT window:
1 Select Clear Reference. 2 Select the Confirm key to reset the stored supramaximal stimulation current and reference twitch to the default values. NOTE This function is not available if a calibration is in progress or no calibration data is stored. CAUTION Changing the stimulation current or pulse width also clears stored references. Starting/Stopping NMT Measurements To Start NMT measurements, in the Setup NMT window select the start key for the mode used, (for example, Start TOF). If you need to change the NMT settings after startup, stop the measurements, change the settings, then restart the measurements. To Stop NMT measurements, in the Setup NMT window select Stop, the measurement is immediately interrupted. NOTE To stop NMT stimulation in an emergency, disconnect the NMT patient cable from the NMT Module. During an automatic measurement cycle the yellow Start/Stop LED on the NMT Module is lit. If the automatic cycle is stopped, or the measurement mode is set to manual the LED is off. The LED flashes (in both modes) when a stimulation pulse is given. CAUTION To avoid unwanted electrical shocks DO NOT touch the electrodes when the yellow Start/Stop LED is flashing on the NMT module. NOTE Take care when removing the transducer from the patient. Do not pull on the cable. 297 20 Monitoring NMT Changing the NMT Measurement Settings Selecting the NMT Stimulation Mode In the Setup NMT window:
1 2 Choose the Stimulation mode required:
Select Stimulation to enter the Stimulation window. TOF PTC Twitch (if configured) DBS (if configured) Measurement Mode Allows the choice between manual and automatic NMT measurements. In the Setup NMT window:
1 2 Select Mode to open the Mode window. Select Auto or Manual mode. NOTE Auto mode is not available if the PTC or DBS stimulation mode is selected. Selecting the Repeat Time (only available in Auto mode) Repeat Time allows you to select the time intervals between automatic NMT measurements. NOTE This function is not available in the PTC and DBS mode. In the Setup NMT window:
1 2 Select Repeat Time to open the Repeat Time window. Select the required setting. Selecting the Stimulation Current To set the stimulation current. In the Setup NMT window:
1 2 3 Select Current to open the Current window. Select the required setting. If you are modifying a previously calibrated current, select Confirm. CAUTION Changing the stimulation current after calibration invalidates the stored reference data. 298 20 Monitoring NMT Selecting the Pulse Width Setting a Pulse Width sets the duration of the stimulation pulse. In the Setup NMT window:
1 Click on Pulse Width to open the Pulse Width window. 2 3 Select the required setting. Select Confirm if you wish to modify a previously calibrated pulse width. CAUTION Changing the stimulation pulse after calibration invalidates the stored reference data. Value Lifetime Displays the time after which an NMT numeric value disappears from the resting display. The Value Lifetime setting is visible (grayed out) in the Setup NMT window. The setting can only be changed in the Configuration Mode. NMT Tone Volume Enters a list of selections to adjust the audio volume of the NMT stimulation tone. If not zero, each NMT stimulation pulse is indicated by a short beep. You can change the NMT Tone Volume in the Setup NMT window. Alarms TOFcnt High Limit Alarm In the Setup NMT window:
1 2 Select the TOFcnt High Lim. Select limit: 0, 1, 2, 3. NMT Alarm Suppress Depending upon your configuration, the TOFcnt high alarm maybe suppressed until the TOFcnt value has reached 0 for the first time. This setting can only be changed in the Configuration Mode. Understanding NMT Numerics Numerics TOF ratio (TOFrat), TOF count (TOFcnt), Twitch ratio (Twitch) and DBS Count (DBScnt) numerics show the result of an NMT measurement. Together with these numerics either the time the measurement was taken or the time until the next measurement is shown. The extended numeric representation shown will only be available when using a screen designed to show it. The relative strength of individual muscle responses, as measured by the acceleration sensor are displayed as a bar graph. 299 20 Monitoring NMT Dependent upon the selected stimulation mode, the following information is provided:
Stimulation Mode Single-Twitch Train-Of-Four Trend None Yes Number of Bars 1 4
Numeric Label Unit Twitch TOFrat TOFcnt PTC DBScnt Yes None 1...20 2 Post-Tetanic-Count Double-Burst Auto mode The figure below shows the NMT measurement in Auto mode. 1 NMT: Auto mode, Repeat Time 30 sec. 2 Time until next measurement or the time the measurement was taken. 3 Bar graph showing relative strength of each twitch. If a calibration has been made, the strength of the calibration reference twitch is shown as a white line. TOFrat expressed as %. 4 Manual mode The figure below the NMT measurement in Manual mode. 1 NMT: Manual mode, (there is no Repeat Time). 2 Time the measurement was taken (Timestamp). Recovery Time Most NMT stimulation modes require a minimum neurophysiological recovery time and during this recovery phase no new stimulation can be started. Also, you cannot start a measurement or calibration. 300 21 21Guardian Early Warning Scoring MX400/450/
500/550 Using an MX400/450/500/550 monitor with the appropriate option, you can use Guardian Early Warning Scoring to get an early warning score based on vital signs and clinical observations collected at intervals. The goal of an early warning score is to help you recognize the early signs of deterioration in patients. Depending on the score calculated, an Action List with appropriate recommendations is displayed. There are no dedicated alarms associated with an Early Warning Score. This functionality is highly configurable, to allow customization for the vital signs and observations collected and the type of scoring used. Due to this configurability, your screens will probably not exactly match the screens shown here. The workflow described here uses the special configuration delivered with the monitor; if this configuration has been changed, you will not have all the possibilities described. WARNING When using Guardian Early Warning Scoring, request a printout of the EWS scoring table and the Action Lists from your configuration expert. Use them to verify that the configuration of the scoring functionality matches your hospitals requirements. The IntelliVue Information Center will not display or trend any of the entered observations, the early warning score, or the action list, but can pass these on to other connected systems. Performing the Scoring Procedure 1 To run Guardian Early Warning Scoring (EWS) you need to switch to the EWS/SpotCheck Screen
(or another Screen configured to show EWS). a. b. Select your EWS Screen from the list. Or select the EWS/SpotChk SmartKey, if configured. Select the current Screen name in the monitor info line. 301 21 Guardian Early Warning Scoring 2 If required, enter your operator data with a barcode scanner. 3 Start collecting vital signs and entering observations. If the patient is continuously monitored, any relevant currently measured vitals will appear automatically in the EWS Screen. Other vitals may be measured by the monitor, or may need to be entered manually:
If NBP is not yet displayed on the screen, start a blood pressure measurement with the start key. If SpO2 is not already being measured, apply the SpO2 sensor and a short time later the value will appear in the SpO2 box on the screen. Moving dashes are displayed until the measured value is available. If the pulse rate is not already displayed from a continuously measured HR, SpO2, or NBP, it will appear as soon as a blood pressure or SpO2 measurement has been made. Any vital sign or clinical observation you need to enter manually is indicated by a keyboard symbol. Select the symbol to enter the missing data. All vital signs and clinical observations with a white box are required, i.e. they must all be entered for a complete SpotCheck record. If a keyboard symbol or start key is not in a white box, the corresponding vital sign or clinical observation is optional. When values have already been entered or measured, an existing white box will disappear. 302 21 Guardian Early Warning Scoring One complete set of vitals and observations, together with the calculated score(s), is referred to as a SpotCheck record. Once all the required vitals have been entered or measured, the SpotCheck record will be automatically stored after the configured freeze time. If you want to store values before the end of the freeze time, you can select Store Vitals, to store the values and close data collection. The Store Vitals key can also be used to store an incomplete set of vitals at any time. If you want to break off the Early Warning Scoring process without storing the SpotCheck record, use the Clear VS key. 4 To leave the EWS procedure and return to your standard monitoring screen, select the appropriate screen from the screen list, or select the Previous Screen SmartKey (if configured). WARNING Alarms: There will be no alarm indications for measurements in the entry screen. Values: The values shown in the entry screen do not have the same annotation as the measurement values on other monitor screens. There is no special indication when a value has been manually entered and no timestamp showing when the value was measured/entered. Be aware that values will remain visible until the freeze time is at an end, even when the measurement itself is no longer providing current values. Understanding Guardian Early Warning Scoring An early warning score is an assessment aid used to help recognize the early signs of deterioration in medical patients. There are two basic types of scoring:
Single Parameter Scoring (SPS) - A score is given for each of the vitals based on the measured/
entered value. Each vital sign has upper and lower thresholds assigned and the score registers the status as either "inside the thresholds" (normal) or "outside the thresholds" (requires action). When one of the vitals measured or entered is outside of the thresholds, an action is recommended. How does SPS work in Guardian Early Warning Scoring? SPS results in a color-coded circle displayed next to the measured or entered values. The circle is white for the normal range and red for outside of the thresholds. As soon as one of the values crosses a threshold, a corresponding action will be recommended in the action list in the lower part of the screen. If several vitals have values outside of the thresholds, this will result in a list of actions. Modified Early Warning Scoring (MEWS) - A subscore is given for each of the vitals based on the measured or entered value. When all the required vital signs have been entered or measured, the subscores are added together to give the MEWS score. Each subscore has a color coding, to indicate the level of risk associated with it, for example:
Normal Observe - at risk Warning Urgent White Yellow Orange Red Subscore 0 Subscore 1 Subscore 2 Subscore 3 303 21 Guardian Early Warning Scoring The MEWS score also uses the same color coding and risk levels, which determine the action that is recommended. How does MEWS work in Guardian Early Warning Scoring? MEWS results in a subscore displayed in a circle with the corresponding color, next to each measured or entered value. Actions are only then recommended when all required vitals have been measured or entered, and the MEWS score has been calculated. The content of the action list depends upon the risk band severity the MEWS score falls into. For each risk band severity (Normal, Observe - at risk, Warning and Urgent) a separate action list can be configured. Which Type of Scoring is Being Used?
The type of scoring used in your department, whether it is SPS or MEWS, or a combination of both, was configured during your system setup. Normally, the configuration is based on an assessment method already in use before the system was set up. Which vitals are needed for scoring, and which actions are recommended for specific scores or risk bands, was also configured individually. Independent of the type of scoring used, there may be additional vital signs or clinical observations which are configured to be included in the entry screen. They do not contribute to scoring but are included in the SpotCheck record. Viewing EWS Trend Data To view trend data, select the SpotChk Trend SmartKey. A tabular trend will be shown, with all measured and entered data and any calculated scores. You can use the up arrow and down arrow keys to scroll through the list of Spot Check records. 1 This symbol indicates that more information is available than can be shown on the Screen. Select the tabular trend to page through the remaining data columns. Select the Graph/ Tabular pop-up key to view the data in graphical form. If any MEWS records are present, they will be displayed in the color-coded risk bands (2) in the lower half of the graphical trend. The MEWS score ranges corresponding to the colored bands are shown in the scale on the right. Other record types, such as SPS, are displayed in the notification area (1). The symbols used are explained in Symbols Used in the Trend Views on page 305. Select the Detailed View pop-up key to see a combined graphical/tabular view for the currently highlighted record. Use the cursor keys (right arrow and left arrow) to move from one record to the next. The detailed data are shown above the graphical trend, with units and the corresponding SPS or MEWS symbols. In the example below:
1 Colored circle for SPS data 2 MEWS score symbol (color coded according to the risk level) 3 MEWS subscore symbol (color coded according to the risk level) 304 21 Guardian Early Warning Scoring Symbols Used in the Trend Views The following symbols can appear in the trend views:
Symbol Indicates SPS SpotCheck record - normal range SPS SpotCheck record - outside of normal range Manual SpotCheck record MEWS SpotCheck record MEWS score (color depends on the risk level) SpotCheck record triggered by a deterioration SpotCheck record triggered by an alarm SpotCheck record from an automatic vital signs measurement Making Recordings The trend data can be sent to a recorder using the recording pop-up keys. Record Selected makes a recording for the selected SpotCheck record. Record 8 h makes a recording for the last 8 hours of data. Record All makes a recording of all available SpotCheck records. At the beginning of the recording, the title, the type of recording and the time will be printed. If available, the patient's name, date of birth, ID and the type of scoring (protocol name) currently active will also be printed. Using Different Types of Scoring If your department has more than one type of scoring configured, for example one type for patients receiving oxygen and one for patients not, you can switch from one type to another. To switch to a different scoring protocol, depending on which screen is currently displayed, either:
1 Select the symbol. 305 21 Guardian Early Warning Scoring 2 3 or 1 2 3 4 Select Protocol. Select the required protocol from the list. Select Main Setup. Select ProtocolWatch. Select Protocol. Select the required protocol from the list. 306 22 22Using a Telemetry Device and a Monitor (PIIC only) 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. 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?
indirect With an 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 X2 is connected via MSL cable to the monitor, or a telemetry transceiver with a short range radio adapter is assigned to an X2 which is connected (Companion Mode) to an MX400/450, MX500/550, or 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:
1 Select Main Setup then Measurements 307 22 Using a Telemetry Device and a Monitor (PIIC only) 2 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. Own Patient Overview Window The measurements from the telemetry device are shown in the own patient overview window on the monitor. See Own Patient Overview Window on page 122 Direct Connection - Automatic Pairing The following direct connections are possible:
an 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. 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 With a Telemetry Interface to a Host Monitor An X2 Multi-measurement module 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 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 can also be manually paired to a host monitor without a direct connection, as described in Indirect Connection - Manual Pairing on page 307. Refer also to Use Models With Telemetry on page 309 for further related use modes. 308 22 Using a Telemetry Device and a Monitor (PIIC only) 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 SmartKeys and pop-up keys for unpairing appear only on the monitor which is directly involved in pairing. 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 telemetry data appear on the monitor 2 An X2 is declared as a telemetry device and paired with an MX400/MX450, MX500/MX550, or MX600/700/800 monitor - direct or indirect connection X2 measurement data appear on the monitor it is paired with a telemetry transceiver cannot be used with the X2 3 A telemetry transceiver directly connected via SRR to an X2, that is connected (via Companion Mode) to an MX400/450, MX500/550, or 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 X2 the X2 must have no equipment label The different variations require different configuration settings; refer to the Configuration Guide for details. 309 22 Using a Telemetry Device and a Monitor (PIIC only) 310 23 23Trends 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 noninvasive blood pressure. 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. 311 23 Trends Trends Pop-Up Keys When you open the graphic, tabular or histogram 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 Data Source Period Select Range Column Curve On/Off Adjust Cursor 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 or histogram 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. select a realtime SpO2 or realtime system pulse or trended data for display in the histogram. select a time period for the histogram. define the range of values to be displayed in the histogram by selecting an upper and a lower limit. select a column width for the histogram. For each width selection the resulting number of columns is shown. switch the display of the cumulative value columns in the histogram on or off. open a new set of pop-up keys for switching on cursors and setting their positions. 312 Viewing Graphic Trends 23 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 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 3 Select the graphical trend or the arrow pop-up keys to activate the cursor. 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. 313 23 Trends To view the Vital Signs trend with one column for each NBP measurement (see Defining the Column Interval Using the NBP Measurement on page 317):
1 With the Vital Signs trend open, select Interval. 2 Select NBP from the pop-up list. Viewing Histogram Trends The title line of the window shows the label of the trended measurement and the resolution of the data; in the SpO2 histogram above, 1 second realtime 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 SpO2 value was between 93 and 94% during 20%
of the last 12 hours. The display of the percentage value above each column, can be switched on or off by selecting the histogram. The arrow mark over a column shows that the currently measured value is also in this range. The 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. The cumulative columns can be switched off using the Curve On/Off pop-up key. 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 and System Pulse histograms can use trended data or realtime data with 1 second samples. Using Cursors You can set two cursors that span a "corridor", for example to divide a histogram into in-range and out-of-range areas. Or you can set both cursors to the same value and use them as one cursor to divide the histogram into an upper and a lower segment. 314 23 Trends The cursors are represented by a vertical line from the x-axis and a dotted horizontal line from the y-
axis. When two cursors are used, they can be locked using Lock/ Unlock, so that the distance between them is fixed. Moving a cursor will then move both together. Select Lock/ Unlock again to separate the cursors and move them independently again. A summary column on the y-axis shows the lower, middle and upper ranges as determined by the cursor positions. When only one cursor is used there will be a lower and an upper range. Color shading is used to differentiate the ranges in the cumulative column and to highlight the columns between the cursors. 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 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 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 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. 315 23 Trends 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. To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or:
1 2 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. To temporarily change the order in which the measurements are displayed in a group, 1 2 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. 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.) 316 23 Trends If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements. To see the measurement priority list for trending, 1 2 To add measurements to the priority list, 1 2 Use the Sort Up and Sort Down pop-up keys to change the priority order. In the Main Setup menu, select Trends. Select Trend Priority. 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 2 3 4 5 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. 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 2 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. 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. 317 23 Trends To use the NBP measurement to determine the column interval:
1 2 3 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. Making Settings for Histograms To make settings for histograms, first display the Trends window by selecting Main Setup then Trends. Setting the Default Measurement To set the default for the measurement data to be used in the histogram, in the Trends window, 1 2 3 Select Setup Histogram. Select Data Source. Select either Realtime Data, and then a realtime SpO2 or Pulse, or Trended Data and then select the required measurement from the trended data list. Setting the Default Period To set the default period for the histogram, in the Trends window, 1 2 Select Setup Histogram. Select Select Period and select the required time period from the list. Setting the Unit for the Data Source To set the unit for the selected measurement data source, in the Trends window, 1 2 Select Setup Histogram. Select Unit and select a unit from the list. Switching Cumulative Value Columns On and Off To switch the display of the cumulative value columns on or off, in the Trends window, 1 2 Select Setup Histogram. Select Curve On/Off. Setting the Range for the Measurement To set the range to be displayed on the x-axis, in the Trends window, 1 2 Select Setup Histogram. Select Range, then enter a value for the lower end of the range and the upper end of the range. Displaying Percentages on Columns To switch the display of the percentage values above the columns on or off, in the Trends window, 318 23 Trends 1 2 Select Setup Histogram. Select Column Value. Switching the Cursor On and Off To switch the cursor and the summary column on or off, in the Trends window, 1 2 Select Setup Histogram. Select Cursor. Setting Initial Cursor Positions To set the positions of the cursors, in the Trends window, 1 2 Select Setup Histogram Select Cursor Range then enter a value for the upper and lower cursors. If both have the same value only one cursor will be shown. When viewing a histogram, the data source, the period, the range, the column width, the display of the cumulative value columns and the cursor positions can be changed using the pop-up keys. 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 100 measurements for up to 96 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. 319 23 Trends
"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. 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 2 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. 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. 320 23 Trends 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 followed by Add Trend and select a screen trend from the pop-up list. Activating the Cursor for Screen Trends Select the screen trend. Select Activate Cursor. To activate the cursor for Screen Trends:
1 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. 321 23 Trends Horizon View The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient's condition since the baseline was set. The horizon view is made up of:
a horizon, drawn in white, as a reference point or baseline to help you visualize 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 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. 322 23 Trends 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 2 3 Select Main Setup then select Trends. Select HorizonArrowTime. Select 10, 5 or 2 minutes. 323 23 Trends 324 24 24Calculations 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. 325 24 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. Pop-Up Keys Resample Vitals 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. 326 24 Calculations Pop-Up Keys 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.... 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 (*). 327 24 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 (*). If a PAWP value is not available, PAWP will be set to zero in the formulas where it is used. 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 2 3 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. 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. 328 Comparing Dynamic Compliance Values 24 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
(125 Hz 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 329 24 Calculations 330 25 25High 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. 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 2 If there are no hi-res trend waves on the Screen, you must change to a Screen with hi-res trend waves. Select a displayed hi-res trend wave. Select the required hi-res trend wave from the pop-up list. 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. 331 25 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 Recording on page 357 for more information. To start a hi-res trend waves recording, 1 2 select the Recor- dings SmartKey, if configured, or select Main Setup then select Recordings. select the HiRes Recordng pop-up key. 332 26 26Event 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 335 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. 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. Event Functionality Event groups Basic Event Surveillance Option C06 1 Measurements per group 3 Triggers per measurement 1 Trigger types Simple ("at least one") 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 Combined ("at least two") Simple ("at least one") 333 26 Event Surveillance Event Functionality Annotation Types of event episode Basic Event Surveillance Option C06 no Average trend Snapshot events Event views Graphic Event Review window, Graphic Event Episode window 25 events for 24 hours Database capability Event Notification no Advanced Event Surveillance Option C07 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 Neonatal Event Review
(NER) Option C04 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 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 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 334 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. 26 Event Surveillance 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 Start CAR Stop CAR CAR Histogrm 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. 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. 335 26 Event Surveillance Pop-Up Keys 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.... 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. 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:
336 26 Event Surveillance
*** 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 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. 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. 337 26 Event Surveillance Setting Triggers for NER and Basic Event Surveillance 1 The Episode Type determines the pre and post time. 2 Measurements used as event triggers. 3 Current status: Activated or Deactivated 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. Setting Triggers and Notification for Advanced Event Surveillance 1 Notification Type shows the 2 3 currently configured notification Episode Type determines the pre and post time Trigger Condition shows the currently configured trigger requirements 4 Measurements used as event triggers 5 Current status: Activated or Deactivated 1 2 3 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. 338 26 Event Surveillance 4 5 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 Select the Start CAR pop-up key or SmartKey. Select the required time period for the assessment. Select Confirm to start the CAR. 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 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 314. 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. 339 26 Event Surveillance 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. 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:
340 26 Event Surveillance 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. 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. 341 26 Event Surveillance 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 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. 342 26 Event Surveillance 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/C 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. 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. 343 26 Event Surveillance 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). 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. 344 26 Event Surveillance 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. 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. 345 26 Event Surveillance Event Review Reports The event review report documents all the events stored in the event database for a selected group. 346 Event Episode Reports The event episode report documents the patient information from the currently-selected event. See Event Recordings on page 343 for an explanation of the report elements. 26 Event Surveillance 347 26 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. 348 27 27ProtocolWatch 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 [Dellinger RP, Levy MM, Carlet JM et al: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 (published correction appears in Crit Care Med; 36:1394-1396). Crit Care Med 2008 36:296-327.], including the Amendment from October 2011. 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. 349 27 ProtocolWatch 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. The SSC Sepsis protocol may have been configured, to customize it for the specific treatment measures used in your facility. This can include changes to limits for measured or manually entered values, changes to the Severe Sepsis Screening criteria, and changes to the recommendations in the Sepsis Resuscitation Bundle and the Sepsis Management Bundle. If configuration changes have been made, your screens may not exactly match the screens shown here. 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 (including the Amendment from October 2011) 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. 350 27 ProtocolWatch 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. 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 2 The protocol will resume activity after 24 hours with Severe Sepsis Screening. Select Main Setup then ProtocolWatch followed by Suspend for 24 hours. Select Confirm. 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. There are check boxes for the infection signs and symptoms listed, 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.) if the monitor has measured values which meet the screening criteria, and for all signs and symptoms which cannot be measured by the monitor. 351 27 ProtocolWatch 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 > yyy 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 < 70mmHg (9.3kPa), 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?. 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. 352 27 ProtocolWatch 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. 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 ScvO 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. 353 27 ProtocolWatch 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. 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 may not appear if it has 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. 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. 354 27 ProtocolWatch 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. 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. 355 27 ProtocolWatch 356 28 28Recording There are two ways to record data using your monitor. If a paper-strip recorder is available, you can make paper recordings, selecting from a variety of recording types. If no paper-strip recorder is available, or if you want to record data in an electronic form, you can use electronic recording. See Paper-Strip Recording on page 357 and Electronic Recording on page 365 for further details Paper-Strip Recording MX500/550/
600/700/800 The M1116B/C plug-in recorders record numerics for all active measurements and up to three waveforms. You can use them for local recording mounted in the monitor's FMS. M1116B 1 Continue LED - lights if a continuous recording is ongoing 2 RUN/CONT key - starts a delayed recording, extends the current recording or makes the current recording continuous STOP key - stops the current recording 3 357 28 Recording M1116C 1 Continue LED (
) - lights if a continuous recording is ongoing. 2 Run/Cont key (
) - starts a delayed recording, extends the current recording or makes the recording continuous. 3 Stop key (
4 Door latch.
) - stops the current recording. Integrated Recorder MX400/450 The optional integrated recorder records numerics for all active measurements and up to three waveforms. 1 Open recorder latch 358 28 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. 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. Delayed Recordng RT A Recordng RT B Recordng RT C Recordng Select Waves HiRes Recordng All ECG Waves Vital Signs Alarm Limits ST Segments STE 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, Select the SmartKey Delayed Record to immediately start a delayed recording. M1116B/C only You can also start a delayed recording by pressing the Run/Cont key on the recorder module. 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. M1116B/C only You can also make an ongoing recording continuous by pressing the Run/Cont key on the recorder module. 359 28 Recording 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. M1116B/C only You can also stop a recording by pressing the Stop key on the recorder module. 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. 2 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key. Select one of the recording speed pop-up keys to set the required recording speed. Select the Start pop-up key to start the recording. 3 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. Type of recording Recording Destination Information recorded Number of waves Delayed manual Alarm Realtime (RT) automatic, triggered by defined alarm conditions manual All ECG Waves manual HiRes Trend manual 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 50, 25, 12.5, 6.25, 2.5 mm/sec 6, 8, 10, 15 seconds or continuously 25 mm/sec 4 seconds per wave 1, 2, 2.5, 3, 6 cm/
min 10 minutes, or continuously 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 360 28 Recording Realtime (RT) automatically if limited, manually if continuous none All ECG Waves automatically none up to 3 waves none HiRes Trend automatically if limited, manually if continuous 6, 5, 4, 3, 2, 1 minutes up to 3 waves Procedure or Context defined by the context defined by the context defined by the context Delayed Alarm 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 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, 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 2 3 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. 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. 361 28 Recording 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 360. 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. 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. 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 (except when the information is printed above the waves) 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, either before or above the waves depending on the configuration. The annotations are 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. When annotations are configured to appear above the wave, it may not be possible to print them all when the runtime of the recording is too short. 362 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. It is only included when annotations are configured to appear before the waves. 28 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. 363 28 Recording Reloading Paper M1116B (MX500/550/600/700/800) 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 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. Press the latch on the right side of the recorder door to open the door. M1116C (MX500/550/600/700/800) and Integrated Recorder (MX400/450) 1 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 (for example, 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. 364 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 Type> not supported Electronic Recording 28 Recording 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/C plug-in recorder. Electronic recording allows alarm-triggered reports to be captured electronically in the monitor database. They can then be printed when a printer is available. The printer can be locally connected at the USB interface, a central printer connected to the Information Center or the XDS Printing Service that is part of the IntelliVue XDS Application. With an XDS print server, the reports can be printed to a standard off-the-shelf printer and can also be stored as files (e.g. jpg, .bmp or .pdf) on the associated PC. Capturing Alarm Events The monitor can be set up to automatically capture alarm events, triggered by selected alarms. All settings must be made in Configuration mode. The output device for alarm recordings is set to "printer". This automatically makes the alarm event documentation a realtime report. The target device for realtime reports is set to "database"
The alarms to trigger the report are set up. The database is set to print automatically when a printer is available. When one of the selected alarms occurs, the monitor automatically captures the alarm and creates a realtime report which is stored in the database. 365 28 Recording As soon as the monitor is connected to a printer, or to a PC or network with the IntelliVue XDS Application software, it will automatically print the report, or send it to a patient-specific folder as an electronic file. Alarm-Triggered Realtime Reports Here is a sample of a realtime report triggered by an alarm event. Patient demographic information, time stamp 1 2 Active Alarms and INOPs, followed by vital signs 3 Measurement waves section The data in the report are from the period before the alarm triggered the report. The span of time covered by the wave data depends on the wave speed of the individual waves. The time stamp on the report is the time the report was created and may not exactly correspond with the time the alarm was indicated on the monitor. More Information About the Print Database The reports captured in the database will remain there until they are printed, even after patient discharge. When they have been sent to the printer they will be automatically deleted from the database. NOTE The monitor cannot check for printer errors. If a report is sent to a printer but cannot be printed due to an error, it may be lost. Use an XDS print server set up to save the reports as electronic files, to ensure that no reports are lost. 366 The maximum number of reports that can be stored in the database varies depending on the database configuration and the size of the reports. When the database is full, no new reports can be stored. In this case, print or delete reports to make space available in the database. 28 Recording 367 28 Recording 368 29 29Printing 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 2 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 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 375. 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 375. Printout Location on locally connected printers, on printers connected to the Information Center or the Application server, to an IntelliVue XDS Application print service, to an external PC-based print server with Philips server software, into the print database. Depending on availability, reports can be printed:
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. 369 29 Printing Patient Reports When an 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. Starting the Different Types of Report Report types Vital Signs Report Graphic Trends Report Events Reports EEG Report ECG Reports 12-Lead Report ST Map Report Cardiac Output Report Report contents Depends on selected trend group, data resolution, and period. Event Episode Graphic or tabular Event Review EEG Waves, numerics, CSAs, montage information and impedance values Depends on format selected. Captured ECG waves, measurement values, ST Map (optional) and analysis results from the Information Center (PIIC iX only) ST data in a transversal and/or horizontal multi-
axis diagram, Trial curves and numerics Wedge Report Wedge numerics and reference wave Calculations Report Drug Calculator Report Hemodynamic, Oxygenation, or Ventilation Review Titration Table Alarm Limits Report Realtime Reports, including oxyCRG Reports Loops Report Central Report A/B/C 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) Individual Loops diagram with timestamp, currently measured numerics 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/ 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 an active 12-Lead application window, select the Print Report pop-up key 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 Main Setup select Reports then Central Report A, Central Report B or Central Report C. 370 29 Printing Patient Reports 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 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-A and ECG-B 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 3 371 29 Printing Patient Reports Setting Up Auto Reports Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports:
Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report. To set up Auto Reports, 1 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 2 3 4 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. The number of reports that can be stored depends on the size of the reports and the size of the printing database; the maximum is 30 reports. If the memory is full, reports cannot be saved on the printing database and therefore cannot be printed. If you set up regular scheduled reports, and you have long case durations, make sure that the print database is configured to Large and plan to print reports at appropriate intervals in order to avoid losing information due to a full memory. 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. 372 29 Printing Patient Reports 2 3 4 5 Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected. Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:
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. 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. If you are using an IntelliVue XDS Application print service, you may see XDS printers in the Setup Printers menu that also have "Local" or "Remote" in their name. Their names and settings can only be configured in the XDS Application. Refer to the IntelliVue XDS Application Installation and Configuration Guide for full details about the configuration possibilities. 373 29 Printing Patient Reports 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 2 You can enable or disable printer status to switch individual printers on or off for report printouts. 1 In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list. Select Printer Status to switch 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". Local printers from the XDS Application print service are always enabled and cannot be disabled here. 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 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, 374 29 Printing Patient Reports 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) 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. If 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 2 Selecting Print All Reps will send all reports to the printer. In the Reports Job List, select the required report Select Print Report. Printer Status Messages Printer Status Message Print job queued for <Printer Name>
Possible causes and suggested action The report has been placed in the queue for the named printer. 375 29 Printing Patient Reports Printer Status Message 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>... 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 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. 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 374). 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 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 Sample Report Printouts The report has been printed. 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. 376 29 Printing Patient Reports 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. Alarm Limits Report 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 377 29 Printing Patient Reports Realtime Report Patient demographic information, time stamp 1 2 Active Alarms and INOPs, followed by vital signs 3 Measurement waves section Cardiac Output Report Patient information 1 2 Numbered trial curves 3 Trial information in tabular form 378 ECG Reports 29 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 379 29 Printing Patient Reports 12-Lead ECG Report Patient data 12-Lead wave area 1 2 Analysis data from the Information Center (PIIC iX only) 3 4 Data related to the wave presentation 5 6 Administrative data - including optional custom text fields 7 Hospital ID data - Institution, facility and department, if configured ST Map with related ST numerics (optional) Other Reports See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports. 380 30 30Using 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 Concentration Standardized Rate 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 ratio of the amount of drug to the solution volume 1 ml 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. 381 30 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 (Joint Commission of Accredited Healthcare Organizations) 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. 382 Performing Calculations for a Non-Specific Drug 30 Using the Drug Calculator ANY DRUG selection 1 2 Entry fields for Dose, Rate, Amount, and Volume 3 Calculated standardized rate (1 ml/hr) and concentration (Concentr.) 4 Weight used for weight-dependent dose units 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. 383 30 Using the Drug Calculator Performing Calculations for a Specific Drug Patient category (Adult, Pedi, Neo) 1 2 Entry fields for Dose, Rate, Amount, and Volume 3 Calculated standardized rate (1 ml/hr) and concentration (Concentr.) 4 5 Weight used for weight-dependent dose units Reset Values key reverts to the configured values for this drug 1 2 Select the arrow beside ANY DRUG, then select the required drug from the list of drugs. This opens the window for the selected drug. 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 383. 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. 384 Charting Infusion Progress 30 Using the Drug Calculator 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. Using the Titration Table 1 Currently set values for Dose, Rate, Amount, Volume, and Weight. 2 Minimum dose, maximum dose and increments used for the table. 3 Shows whether Dose increments or Rate increments are the basis of the table. 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 blue 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. 385 30 Using the Drug Calculator 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. 386 31 31VueLink 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 device label 3 selection LED 4 setup key 5 external device cable connector 6 setup indicator LED 7 module type (A or B) 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. 387 31 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. 388 Viewing the VueLink Device Data Window 31 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. 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. 389 31 VueLink Modules 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. 390 32 32IntelliBridge EC10 An IntelliBridge EC10 module or Interface board (for MX400/450/500/550) 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 cannot be included in monitor trends when the label is a free-text label. 1 module/interface board name 2 3 4 5 setup indicator LED setup/data viewing key connection status LED external device cable connector Module Interface Board See the documentation supplied with the IntelliBridge EC5 ID module for a list of supported devices and accessories, and for configuration information. Connecting an External Device 1 When using the module: Insert the module into the FMS or integrated module slot. 2 Check that you have the correct EC5 ID module for the external device - indicated on the EC5 label. 3 Connect the EC5 ID module to the external device. 4 Connect the EC5 to the EC10 module or Interface board using the supplied cable. 5 Switch the external device on. 391 32 IntelliBridge EC10 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. Changing Waves and Numerics Displayed To change the waves and numerics from the IntelliBridge module or Interface board 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 Waves or Setup Numerics and make the changes required. 2 3 4 Close the setup menu. The monitor takes a few seconds to activate the change. Viewing the IntelliBridge Device Data Window To view the IntelliBridge device data window, either select the setup key on the IntelliBridge module, if available, 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. 392 32 IntelliBridge EC10 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. Alarms/INOPs from External Devices The IntelliBridge module/Interface board itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module/Interface board 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 EC5 ID module for details of how alarms are announced on the monitor and the Information Center. INOPs from the IntelliBridge Module/Interface Board INOP Text
!!No Device Data
!!!No Device Data No Device Data Device Unsupported Device Chk Config 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 393 32 IntelliBridge EC10 394 33 33Using 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. 395 33 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 2 3 Run Time Select the required timer and display the Setup window. Select Label. Select a specific or non-specific label from the list. 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 2 3 Select the required timer and display the Setup window. Select Run Time. Select a run time from the list. Timer Counting Direction Timers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up. 396 33 Using Timers To change the direction, in the Timers window:
1 2 Select the required timer and display the Setup window. Select Direction to switch between Up and Down. 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 2 Select the required timer and display the Setup window. Select Notification and select the notification level required from the list. 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 2 Select the required timer and display the Setup window. Select Timer Volume and select a volume setting from the list. 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. To display a timer on the Main Screen:
1 2 3 Select the numeric you want to substitute. Select Change Numeric. Select Any Timer. 397 33 Using Timers 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 analog or digital clock display for a numeric. To display a clock on the Main Screen:
1 2 3 When you select the clock on the Main Screen you can select Date, Time in the menu to set the date and time. Select the numeric you want to substitute. Select Change Numeric. Select Clock. 398 34 34Respiratory 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. 399 34 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 2 3 Use the arrow pop-up keys to move the cursor around the loop. The values for both loop axes are Select the pop-up key Select Loop. Select the required loop from the list of available loops. shown for every point on the loop. Select the X at the top of the loop list to exit the cursor. 400 Changing Loops Type 34 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 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 1 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. 401 34 Respiratory Loops 402 35 35Laboratory 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 46. 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 (*). 403 35 Laboratory Data 404 36 36Using Batteries MX400/
MX450/
MX500/
MX550 The Lithium Ion batteries used in your monitor store a large amount of energy in a small package. This allows reliable battery-operated monitoring but also requires care in use and handling of the batteries. Follow the instructions in this chapter and refer for further details to the Service Guide. One Philips M4605A rechargeable Lithium Ion battery must be inserted into the battery compartment on the right side of the monitor to use the monitor with battery power. 1 Battery compartment You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. The battery 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 battery's actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window. 405 36 Using Batteries Battery LED The battery LED on the front panel of the monitor is indicated by a battery symbol. 1 Battery LED Battery LED Colors Green Yellow Red, flashing If the monitor is running on battery power, this means If the monitor is connected to mains power, this means battery power is > 90%
battery charging (battery power
< 90%) less than 10 minutes power remaining battery malfunction Red, flashes intermittently battery or charger malfunction Battery Status on the Main Screen The status of the battery is shown, 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. If there are problems or changes in the status of the battery this is indicated by a blank battery gauge containing a symbol. If the symbol is red, this indicates a critical situation. Battery status indicator Battery malfunction indicator Alternates with the battery gauge on the Main Screen. Check in the Battery Status window to identify the cause. 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. 406 36 Using Batteries 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 external power. 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). 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 then Battery. Capacity, remaining tells you how much power is left in 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). 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 865432 Smart Battery Conditioner (previously M8043A) to charge the batteries externally. Checking Battery Charge To check the charge status of a battery, refer to the battery power gauge on the screen, or open the Battery Status window. When Battery Lifetime is Expired When the battery is aged, either after 3 years from manufacturing date or after 500 charge/discharge cycles, it is recommended to replace the battery. To remind you of this, a message will appear in the Battery Status window. This message will only be displayed at the appropriate time when the date and time on the monitor is correct. Replacing a Battery To replace the battery, 1 2 Press on the battery compartment door and slide it to the right to open it. 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 door. 3 4 Close the battery compartment door. 407 36 Using Batteries 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 1 In the Main Setup menu, select User Interface, Brightness, then Optimum. This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings. 2 Ensure that the current level of brightness is suitable for your monitoring location. Charging a Battery 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 865432 Smart Battery Conditioner (previously M8043A) 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 865432 Smart Battery Conditioner (previously M8043A Smart Battery Conditioner) 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. You can condition a battery in a monitor. CAUTION Do not use a monitor that is being used to condition batteries to monitor patients. The monitor switches off automatically when there is no battery power left. It is, however, preferable to use the 865432 Smart Battery Conditioner (previously M8043A) for external battery conditioning. The Smart Battery Conditioner automatically performs the correct charge or conditioning process and evaluates the capacity when fully charged. For details please see the Instructions for Use for the Smart Battery Conditioner. Do not use any other battery chargers or conditioners. To condition a battery using a monitor, 1 2 3 Charge the battery until it is completely full. Open the Battery Status window and check that the Insert the battery into a monitor connected to mains power. Switch the monitor power off. 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. 408 36 Using Batteries Storing a Battery WARNING Remove the battery from the monitor when it is not used for a longer period of time, to avoid potential damage caused by battery leakage. Batteries should be charged to a maximum of 50% for storage. 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). Disposing of Used Batteries Dispose of used batteries promptly and in an environmentally-responsible manner. Discharge the batteries and insulate the terminals with tape before disposal. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements. Battery Safety Information WARNING Use only Philips batteries specified in the chapter on Accessories. Use of a different battery may present a risk of fire or explosion. Do not open batteries, heat above 60C (140F), incinerate batteries, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury. If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Refer to qualified service personnel. Do not expose batteries to liquids. Do not crush, drop or puncture batteries - mechanical abuse can lead to internal damage and internal short circuits which may not be visible externally. If a battery has been dropped or banged against a hard surface, whether damage is visible externally or not:
discontinue use dispose of the battery in accordance with the disposal instructions above. Keep batteries out of the reach of children Keep batteries in their original package until you are ready to use them. 409 36 Using Batteries 410 37 37Care 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 cleaning agents 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 except in an approved product listed in this chapter. 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 Covidien llc for their BIS measurement devices. 411 37 Care and Cleaning Cleaning the Equipment 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 Equipment CAUTION Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result. 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 Bacillol 25 Meliseptol Accel TB RTU Oxivir Tb Cleaner Disinfectant Oxivir Tb Wipes Carpe DiemTM/MC Tb Ready-to-Use General Virucide, Bactericide, Tuberculocide, Fungicide, Sanitizer 412 37 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 Clorox Hydrogen Peroxide Disinfecting Wipes 1 Product Type wipes 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%
1 - 5% hydrogen peroxide 1 - 5% benzyl alcohol 1 Do not use Clorox Hydrogen Peroxide Disinfecting Wipes for snap fits (for example the battery cover) or hinges. Remove all residues with water after the residence time. For repeated or prolonged use, wear rubber or nitrile gloves to protect your hands. Sterilizing the Equipment Sterilization is not allowed 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. If no instructions are delivered with the accessory, the instructions given in this chapter for cleaning, disinfecting and sterilizing the monitor are applicable. Cleaning the SO2 Optical Module The outside of the optical module can be cleaned as described under Cleaning the Equipment on page 412. 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. 413 37 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. Cleaning Batteries and the Battery Compartment MX400/450/
500/550 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. 414 38 38Maintenance 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 2 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. 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. 415 38 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) MX600/700/800 only 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 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. 416 38 Maintenance and Troubleshooting Maintenance and Test Schedule Mainstream and sidestream CO2 calibration and sidestream flow check
(M3014A) Frequency At least once a year, or if you suspect the measurement values are incorrect. 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 2 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. 3 View the status log by selecting Status Log from the Monitor Revision window. Returning Equipment for Repair Before returning equipment for repair:
disinfect and decontaminate the equipment appropriately. ensure that all patient data has been removed (i.e. that no patient is admitted). 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 electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered. 417 38 Maintenance and Troubleshooting 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. 418 39 39Accessories This chapter lists Philips-approved accessories for use with patient monitors as described in this document. You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details. Some accessories may not be available in all countries. 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 For use with:
3-Electrode Cable Set 3-Electrode Cable Set, OR 5-Electrode Cable Set 5-Electrode Cable Set, OR 6-Electrode Cable Set Part No. M1669A 989803170171 M1668A 989803170181 M1667A Length 2.7 m 2.7 m 2.7 m 2.7 m 2.7 m 419 39 Accessories For use with:
10-Electrode Cable set (5+5) 10-Electrode Cable set (6+4) 3-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded Part No. M1663A M1665A Length 2.7 m 2.7 m 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 Single Patient 3-Electrode Cable Sets Description ICU Grabber shielded ICU Grabber shielded 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Miniclip non-shielded Length 1.0 m 0.84 m AAMI Part No. 989803173121 989803173141 IEC Part No. 989803174201
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 Single Patient 5-Electrode Cable Sets Length 1.0 m 0.85 m AAMI Part No. 989803173131 989803173151 IEC Part No. 989803174211
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 Description ICU Grabber shielded ICU Grabber shielded 6-Electrode Cable Sets Description OR Grabber ICU Grabber ICU Snap 420 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 39 Accessories AAMI Part No. M1976A M1602A M1979A IEC Part No. M1978A M1604A M1984A AAMI Part No. M1532A M1537A M1557A IEC Part No. M1533A M1538A M1558A 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 Description 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) 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 421 39 Accessories Supported Cables Trunk Cables Length 0.9 m 2.7 m 3-Electrode Cable Set AAMI Part No. M1540C M1500A IEC Part No. M1550C M1510A 5-Electrode Cable Set AAMI Part No. M1560C M1520A IEC Part No. M1570C M1530A Length 1.0 m 1.0 m 1.0 m 0.45 m 0.7 m AAMI Part No. M1601A M1603A M1605A M1608A M1609A 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. M1611A M1613A M1615A M1618A M1619A IEC Part No. M1631A M1633A M1635A M1639A Length 1.9 m 1.9 m Length 2.5 m 2.5 m AAMI Part No. M1970A M1972A IEC Part No. M1980A M1981A AAMI Part No. M1975A M1977A IEC Part No. M1985A M1986A 3-Electrode Cable Sets Description OR 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 Clip non-shielded 3-Electrode One Piece Cables Description OR Grabber ICU Snap 5-Electrode One Piece Cables Description OR Grabber ICU Snap 422 Set Combiners and Organizers Description Set combiner Set organizer Bedsheet clip NBP Accessories 39 Accessories Part No. 3-electrode M1501A 5-electrode M1502A Shielded 3-electrode M1503A Shielded 5-electrode M1504A M1509A 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 Care Cuffs Patient Category Adult (Thigh) Large Adult Adult Small Adult Pediatric Infant Adult/Pediatric Reusable Comfort Care Cuff Kits 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 Tubing M1598B (1.5 m) or M1599B (3 m) Cuff Kits Infant, pediatric, small adult, adult Small adult, adult, large adult, thigh Infant, pediatric, small adult, adult, large adult, thigh Part No. M1577A M1578A M1579A 423 39 Accessories Adult/Pediatric Reusable Easy Care Cuffs Patient Category Limb Circumference Part No. Adult Thigh Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Adult/Pediatric Reusable Easy Care Cuff Kits 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) Tubing M1598B (1.5 m) or M1599B (3 m) Cuff Kits Assortment pack of one small adult, one adult, one large adult and one thigh cuff Assortment pack of one infant, one pediatric, one small adult and one adult cuff Assortment pack of one infant, one pediatric, one small adult, one adult, one large adult and one thigh cuff Assortment pack of one small adult, one adult, one adult X-long, one large adult, one large adult X-long and one thigh cuff Adult/Pediatric Multi Care Cuffs Part No. 864288 864289 864290 864291 Patient Category Adult Thigh Large Adult Large Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference Part No. 42.0 - 54.0 cm 34.0 - 43.0 cm 27.0 - 35.0 cm 27.0 - 35.0 cm 20.5 - 28.0 cm 14.0 - 21.5 cm 10.0 - 15.0 cm 989803183371 989803183361 989803183351 989803183341 989803183331 989803183321 989803183311 Tubing M1598B (1.5 m) or M1599B (3 m) 424 Adult/Pediatric Single Patient, Gentle Care Cuffs 39 Accessories Patient Category Adult (Thigh) Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Adult/Pediatric Single Care Cuffs 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 Part No. 989803182321 989803182311 989803182301 989803182291 989803182281 Limb Circumference 35.0 - 45.0 cm 27.5 - 36.0 cm 27.5 - 36.0 cm 20.5 - 28.5 cm 14.0 - 21.5 cm Patient Category Large Adult Adult X-Long Adult Small Adult Pediatric Adult/Pediatric Value Care Cuffs Patient Category Large Adult Large Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference 34.0 - 43.0 cm 27.0 - 35.0 cm 27.0 - 35.0 cm 20.5 - 28.0 cm 14.0 - 21.5 cm 10.0 - 15.0 cm Part No. 989803160861 989803160851 989803160841 989803160831 989803160821 989803160811 Tubing M1598B (1.5 m) or M1599B (3 m) Tubing M1598B or M1599B Tubing M1598B (1.5 m) or M1599B (3 m) 425 39 Accessories Neonatal/Infant Single Patient Cuffs 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) Neonatal/Infant Single Patient, Soft Cuffs Limb Circumference Cuffs 3.1 to 5.7 cm Size 1 4.3 to 8.0 cm Size 2 5.8 to 10.9 cm Size 3 7.1 to 13.1 cm Size 4 10 to 15 cm Size 5 (Infant) Neonatal/Infant Cuff Kits Part No. M1866S M1868S M1870S M1872S M1873S 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. 426 39 Accessories Part No. CPJ840J6 CPJ84022 CPJ84046 CPJ84447 CPJ84026 M1567A M1568A M2271A M2272C M1634A 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 3.0 m for M1567/8A Pressure transducer kits PiCCO monitoring kit, 30 cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A PiCCO monitoring kit, 150 cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A PiCCO monitoring kit, 150 cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A and central venous pressure line PULSION Pressure Interface Cable for disposable pressure transducer Transpac 4 Disposable Pressure Transducer Pressure Monitoring Kits PV8115CVP PMK 206 PV8103 PV8115 Transducer Pressure Monitoring Kits with SafeSet Blood Sampling/Conservation System Description Single DPT TP4 with SafeSet, 2 Cannula Sampling Ports, In-line Reservoir Single DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line Reservoir Single DPT TP4 with SafeSet, 1 Cannula Sampling Port, In-line Reservoir Single DPT TP4 with SafeSet, 2 Cannula Sampling Ports, In-line Reservoir Single DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line Reservoir Single DPT TP4 with SafeSet, Patient Mount, 1 Cannula Sampling Port, In-line Reservoir Dual DPT TP4 with SafeSet, (Clear/Blue dash tubing) 2 Cannula Sampling Ports, In-line Reservoir Dual DPT TP4 with SafeSet, (Clear/Blue dash tubing) 2 Luer Sampling Ports, In-line Reservoir Length 213 cm (84 in) 213 cm (84 in) 152 cm (60 in) 152 cm (60 in) 152 cm (60 in) 61 cm (24 in) 213 cm (84 in) 213 cm (84 in) Quantity
(per box) 20 20 20 20 20 20 10 10 Part No. 989803179741 989803179751 989803179761 989803179781 989803179791 989803179861 989803179801 989803179811 427 39 Accessories Description Triple DPT TP4 with SafeSet, 2 Cannula Sampling Ports, In-line Reservoir Triple DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line Reservoir Length 213 cm (84 in) Quantity
(per box) 10 Part No. 989803179821 213 cm (84 in) 10 989803179831 Transpac and SafeSet are trademarks of ICU Medical, Inc. Safeset Blood Sampling/Conservation System Description SafeSet Kit with tubing, 1 In-line Cannula Sampling Port and 10 ml In-line Reservoir SafeSet Kit with tubing, 2 In-line Cannula Sampling Ports and 10 ml In-line Reservoir
(Transducer not contained in kit) Length 152 cm (60 in) Quantity
(per box) 20 Part No. 989803180851 213 cm (84 in) 20 989803179891 Transpac 4 Disposable Pressure Transducer Pressure Monitoring Kits Description Stopcocks Primary Tubing Length Extension Tubing length Flush Device Single DPT TP4, (152 cm, 60 in) Red dash tubing Dual DPT TP4, (183 cm, 72 in) Red/Blue dash tubing Single DPT TP4, (213 cm, 84 in) Red dash tubing Triple DPT TP4, (152 cm, 60 in) Single DPT TP4, (183 cm, 72 in) Red dash tubing Single DPT TP4, (23 cm, 9 in) Patient Mount Single DPT TP4, (61 cm, 24 in) Compartmental Pressure Single DPT TP4, (152 cm, 60 in), Premium Stripe Single DPT TP4, (183 cm, 72 in), Premium Stripe Single DPT TP4, (213 cm, 84 in), Premium Stripe Dual DPT TP4, (183 cm, 72 in), Premium Stripe Triple DPT TP4, (152 cm, 60 in), Premium Stripe 428 Two 3-way 122 cm (48 in) 31 cm (12 in) Four 3-way 152 cm (60 in) 31 cm (12 in) 3 ml/hr, Squeeze Two 3 ml/hr, Squeeze Two 3-way 183 cm (72 in) 31 cm (12 in) Six 3-way 122 cm (48 in) 31 cm (12 in) Two 3-way 152 cm (60 in) 31 cm (12 in) One 3-way 23 cm (9 in) 61 cm (24 in) One 4-way One 3-way Two 3-way 122 cm (48 in) 31 cm (12 in) Two 3-way 152 cm (60 in) 31 cm (12 in) Two 3-way 183 cm (72 in) 31 cm (12 in) Four 3-way 152 cm (60 in) 31 cm (12 in) Six 3-way 122 cm (48 in) 31 cm (12 in) 3 ml/hr, Squeeze 3 ml/hr, Squeeze 3 ml/hr, Squeeze 3 ml/hr, Squeeze No flush device 3 ml/hr, Squeeze 3 ml/hr, Squeeze 3 ml/hr, Squeeze 3 ml/hr, Squeeze 3 ml/hr, Squeeze Drip Chamber Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Macrodrip Quantity
(per box) Part No. 20 10 20 10 20 20 20 20 20 20 10 10 989803177901 989803177911 989803179721 989803179731 989803179771 989803179871 989803181141 989803181211 989803181221 989803181231 989803181241 989803181251 39 Accessories Description Stopcocks Primary Tubing Length Extension Tubing length Single Neonatal DPT TP4
(61 cm, 24 in) Single Neonatal DPT TP4
(31 cm, 12 in) Single Neonatal DPT TP4
(46 cm, 18 in) one in-line Luer sampling port &
10 ml In-line reservoir Two 3-way 61 cm (24 in) Three 3-
way Three 3-way 31 cm (12 in) 46 cm (18 in) Flush Device 30 ml/hr Squeeze 30 ml/hr Squeeze 30 ml/hr Squeeze Drip Chamber Quantity
(per box) Part No. 20 20 20 989803179841 989803179851 989803179881 Transpac 4 and Safeset Cables and Accessories Description Cable for Philips Monitors 3 m (10 ft) Cable for Philips Monitors 4.5 m (15 ft) Cable for Philips Monitors 4.5 m (15 ft) Trifurcated Cable for Philips Monitors 4.5 m (15 ft) 3-Position Transducer Mount Transducer Holder for IV Pole Single Transducer Mount SafeSet Mounting Bracket Safeset Shielded Blunt Cannula SafeSet Shielded Blunt Cannula with Blood Tube Holder SpO2 Accessories Quantity (per box) 1 1 20 1 28 5 30 30 50 25 Part No. 989803177921 989803179941 989803179951 989803179961 989803177931 989803177941 989803179911 989803179901 989803179921 989803179931 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. 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 MAXFAST 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. 429 39 Accessories The SpO2 Option A02 may not be available in all countries. Some sensors may not be available in all countries. Philips Reusable Sensors Product Number Description M1191A/B M1191AL/BL M1192A M1193A M1194A M1195A M1196A M1196S 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 1 kg and 4 kg. Hand or foot. Ear sensor (1.5 m cable) for patients over 40 kg. Infant sensor (1.5 m cable) for patients between 4 kg and 15 kg. Any finger except thumb. Adult clip sensor (3 m cable) for patients over 40 kg. Any finger except thumb. Adult clip sensor (2 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. Compatible with Option A01 Option A02 yes no Comments No adapter cable required. yes yes yes yes yes yes yes yes yes yes yes no no no no no no no no no no no Requires M1943A
(1 m) or M1943AL
(3 m) adapter cable 430 M1901B1 M1902B1 M1903B1 M1904B1 M1131A M1132A M1133A M1134A Philips Disposable Sensors Product Number Description Identical to OxiMax MAXN Identical to OxiMax MAXI Identical to OxiMax MAXP Identical to OxiMax MAXA 39 Accessories Compatible with Option A01 Option A02 yes yes yes yes yes yes yes yes Comments Option A01: Use M1943A or M1943AL adapter cable. Option A02: Must use M1943NL adapter cable. no no no yes no Adult/Pediatric finger sensor, 0.45 m cable
(patient size > 20 kg) yes yes yes 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 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 Use M1943A or M1943AL adapter cable. Use M1943A or M1943AL adapter cable. Use M1943A or M1943AL adapter cable. Use M1943A or M1943AL adapter cable. 1Not available in the USA Nellcor Sensors Nellcor sensors must be ordered from Nellcor/Covidien. Product Number Description Adult finger sensor (patient size > 30 kg) OxiMax MAXA OxiMax MAXAL OxiMax MAXA with long cable OxiMax MAXP 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) OxiMax MAXI OxiMax MAXN Compatible with Option A01 Option A02 yes yes yes yes yes yes yes yes yes yes Comments Option A01: Use M1943A or M1943AL adapter cable. Option A02: Must use M1943NL adapter cable. 431 39 Accessories Product Number Description Compatible with Option A01 Option A02 no Forehead sensor (patient size 10 kg) Adult nasal sensor (patient size > 50 kg) no Adult SoftCare sensor (patient size > 40 kg) no no MAXFAST OxiMax MAXR OxiMax SC-A OxiMax SCNEO-I Neonatal SoftCare sensor (patient size 1.5 -
yes yes yes yes OxiMax SC-PR-I 5 kg) Pre-term infant SoftCare sensor (patient size < 1.5 kg) 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 Infant sensor (patient size 3 - 20 kg) Oxicliq A Oxicliq P Oxicliq I Oxicliq N
> 40 kg) See OxiMax MAXA See OxiMax MAXP See OxiMax MAXI See OxiMax MAXN no yes yes yes yes yes yes yes yes yes no no no no yes yes yes yes Comments Must use M1943NL adapter cable. Must use M1943A or M1943AL adapter cable. Option A01: Use M1943A or M1943AL adapter cable together with OC-3 adapter cable. Option A02: Must use M1943NL adapter cable together with OC-3 adapter cable. Must use M1943NL adapter cable. no yes Adult/neonatal sensor Oxiband OXI-A/
N Oxiband OXI-P/I Pediatric/infant sensor Durasensor DS100A-1 Dura-Y D-YS Extension Cables and Adapter Cables for Philips and Nellcor Sensors Adult finger clip sensor (patient size
> 40 kg) Y-sensor yes yes no no yes no Product Number Description M1941A Extension cable (2 m) Compatible with Option A01 Option A02 yes no M1943A M1943AL Adapter cable (1.1 m cable) Adapter cable (3 m cable) yes yes no no Comments For use with Philips reusable sensors and M1943A adapter cable. Adapter cable for Philips/Nellcor disposable sensors. 432 Product Number Description M1943NL OxiMax adapter cable (3 m cable) Compatible with Option A01 Option A02 no yes OC-3 Adapter Cable for Oxicliq sensors yes yes 39 Accessories Comments Adapter cable for Philips disposable/
Nellcor disposable and reusable sensors. Available from Nellcor/Covidien only. MASIMO LNOP Reusable Sensors 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. Product Number Description Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-Site Sensor (> 1 kg) Ear Sensor (> 30 kg) LNOP DCI LNOP DCIP LNOP YI LNOP TC-I MASIMO LNCS Reusable Sensors Product Number Description Compatible with Option A01 Option A02 yes yes yes yes no no no no Philips Part Number n/a n/a n/a n/a Compatible with Option A01 Option A02 yes yes yes yes no no no no Philips Part Number n/a n/a n/a n/a Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-Site Sensor (> 1kg) Ear Sensor (> 30 kg) LNCS DCI LNCS DCIP LNCS YI LNCS TC-I MASIMO LNOP Disposable Adhesive Sensors Product Number Description LNOP Adt LNOP Adtx LNOP Pdt Adult Sensor (> 30 kg) Adult Sensor (> 30 kg) Pediatric Sensor (10 - 50 kg) Compatible with Option A01 Option A02 yes yes yes no no no Philips Part Number n/a n/a n/a 433 39 Accessories Product Number Description LNOP Pdtx LNOP Inf-L LNOP Neo-L LNOP NeoPt-L 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) Compatible with Option A01 Option A02 yes yes yes no no no yes no Philips Part Number n/a n/a n/a n/a MASIMO LNCS Disposable Adhesive Sensors Product Number Description LNCS Adtx LNCS Adtx-3 LNCS Pdtx LNCS Pdtx-3 LNCS Inf LNCS Inf-3 LNCS Neo LNCS Neo-3 LNCS NeoPt LNCS NeoPt-3 yes yes yes yes Adult Finger Sensor, 18 inch/45 cm
(> 30 kg) Adult Finger Sensor, 3 feet/90 cm
(> 30 kg) Pediatric Finger Sensor, 18 inch/45 cm
(10 - 50 kg) Pediatric Finger Sensor, 3 feet/90 cm (10 -
50 kg) Infant Toe Sensor, 18 inch/45 cm (3 -
20 kg) Infant Toe Sensor, 3 feet/90 cm (3 - 20 kg) yes Neonatal Foot Sensor, 18 inch/45 cm yes
(< 3 kg) or Adult Finger Sensor 18 inch/45 cm
(> 40 kg) Neonatal Foot Sensor, 3 feet/90 cm
(< 3 kg) or Adult Finger Sensor, 3 feet/90 cm
(> 40 kg) Neonatal pre-term sensitive skin Sensor 18 inch/45 cm (< 1 kg) Neonatal pre-term sensitive skin Sensor 3 feet/90 cm (< 1 kg) yes yes yes Compatible with Option A01 Option A02 yes no Philips Part Number n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a no no no no no no no no no Adapter Cable for MASIMO Sensors Product Number Description LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors 434 Compatible with Option A01 Option A02 yes no Philips Part Number 451261000761 Product Number Description LNOP MP10 LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors Temperature Accessories 39 Accessories Philips Part Number 989803148221 Compatible with Option A01 Option A02 yes no 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) Esophageal/Rectal Probe (French 12) Foley Catheter Probe (12 French) Foley Catheter Probe (16 French) Foley Catheter Probe (18 French) Adapter cable 1.5 m Adapter cable 3.0 m Part No. 21075A 21076A 21078A M1837A 21091A 21093A 21094A 21095A 21090A M2255A 21096A 21097A 21082B 21082A Minimum measurement time for accurate readings 90 sec 60 sec 60 sec 90 sec 60 sec 180 sec 210 sec 310 sec 90 sec 180 sec 180 sec 180 sec
435 39 Accessories Temperature Probes InnerSense Esophageal Temperature /Feeding Tube, purple (5 French) InnerSense Esophageal Temperature /Feeding Tube, purple (6.5 French) InnerSense Esophageal Temperature /Feeding Tube, purple (8 French) InnerSense Esophageal Temperature /Feeding Tube, orange (5 French) InnerSense Esophageal Temperature /Feeding Tube, orange (6.5 French) InnerSense Esophageal Temperature /Feeding Tube, orange (8 French) Part No. 989803183631 989803183641 989803183651 989803183561 989803183571 989803183581 Response Time per ISO 80601-2-56
< 150 seconds Cardiac Output (C.O.) Accessories See Pressure accessories for PULSION continuous cardiac output accessories. Part No. 14455A 15244A M1646A M1642A M1643A 831HF75 23001A 23001B 23002A M1643A 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 2.4 m injectate temp. probe (reusable) 0.5 m injectate temp. probe (reusable) Ice bath temp. probe 2.4 m + 2.4 m cable Contact PULSION for information PULSION PMK 206 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 436 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 39 Accessories 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 437 39 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). NOTE Not all accessories are available in all countries. Description Accessories for Intubated Patients FilterLine SET Adult/Pediatric FilterLine H SET Adult/Pediatric FilterLine H SET Infant/Neonatal VitaLine H SET Adult/Pediatric VitaLine H SET Infant/Neonate Accessories for Non-Intubated Patients CapnoLine H Adult CapnoLine H Pediatric CapnoLine H Infant/Neonatal CapnoLine H O2 Adult CapnoLine H O2 Pediatric CapnoLine H O2 Infant/Neonatal NIV Line Adult NIV Line Pediatric Nasal FilterLine Infant/Neonatal Nasal Filterline O2 Adult 438 Part Number Part Number for Long Version M1920A M1921A M1923A 989803159571 989803159581 M4689A M4690A M4691A M4680A M4681A 989803178001 M4686A M4687A 989803178021 989803179101 989803160241 989803160251 989803160261 989803178011 989803179111 Description Nasal Filterline O2 Pediatric Smart CapnoLine O2 Adult Smart CapnoLine H O2 Adult Smart CapnoLine O2 Pediatric Smart CapnoLine H O2 Pediatric Smart CapnoLine Adult Smart CapnoLine Pediatric Accessories for Endoscopic Procedures Smart CapnoLine Guard Smart CapnoLine Guard O2 Hook and Loop Strap Spirometry Accessories Part Number 989803179121 M2522A 989803177951 M2520A 989803177971 M2526A M2524A 989803178031 989803178041 989803178071 39 Accessories Part Number for Long Version 989803160281 989803177961 989803160271 989803177981 989803160301 989803178051 Description Adult/Pediatric Flow Sensor Neonatal Flow Sensor Adult/Pediatric CO2/Flow Sensor Neonatal CO2/Flow Sensor Pediatric CO2/Flow Sensor Measurement of CO2 and Spirometry with Neonates Part No. M2785A M2786A M2781A M2782A M2783A 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. 439 39 Accessories 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) 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. M2268A M2269A M1931A M1932A M1934A M1935A M1937A BIS Accessories To re-order sensors, contact Covidien llc. 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 440 SO2 Accessories for M1011A Contact your local PULSION or Edwards representative for information on accessories. They are not available from Philips. 39 Accessories 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 NMT Accessories Product Number (Order Number) 989803151591 Contact PULSION for part numbers of compatible probes Contact Edwards for part numbers of compatible catheters Description IntelliVue NMT Patient Cable (reusable) Symbols on the Accessory Packaging Product Number (Order Number) 989803174581 The following symbols can be printed on the accessory packaging:
Symbol Meaning Temperature limitations for storage Humidity limitations for storage Contents of the packaging are not sterile. Contents of the packaging are not made with natural rubber latex. Prescription use only Manufacturer information 441 39 Accessories Recorder Accessories Description For the M1116B recorder:
10 rolls of paper 80 rolls of paper For the integrated recorder (MX400/MX450) and the M1116C recorder 10 rolls of paper 80 rolls of paper Battery Accessories Description Lithium Ion Smart Battery 1Ah (internal battery for X2) Lithium Ion Smart Battery 6Ah (for MX400/MX450/MX500/MX550) Battery Charger and Conditioner (requires size adapter 451261017451 to charge M4607A battery) Size adapter for M4607A battery Part No. 40477A 40477B M4816A M4817A Part No. M4607A M4605A 865432 451261017451 442 40 40Specifications The specifications in this section apply to the MX 400/MX450, MX500/MX550, MX600, MX700 and MX800 patient monitors. The monitors are not user installable. They must be installed by qualified service personnel. Indications for Use The monitors are indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. The monitors are intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates. The monitors are intended for use by trained healthcare professionals in a hospital environment. The MX400/MX450/MX500/MX550 monitors are additionally intended for use in transport situations within hospital environments. The monitors are only for use on one patient at a time. They are not intended for home use. Not therapeutic devices. The monitors are for prescription use only. 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). ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. The transcutaneous gas measurement (tcGas) is restricted to neonatal patients only. 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 Integrated Pulmonary Index (IPI) is intended for use with adult and pediatric (1 to 12 years) patients only. The IPI is an adjunct to and not intended to replace vital sign monitoring. 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. 443 40 Specifications The IntelliVue NMT Module is intended to be used as an objective neuromuscular transmission monitor, using accelerometry for measuring the muscle contraction following an electrical stimulation of a peripheral nerve. The NMT Module is intended to be used with adult and pediatric patients. Restricted Availability Following new features and functionality may not be available in all geographies:
Smart Alarm delays IntelliVue Information Center iX Use Environment Hospital Environment The monitors are suitable for use in all medically used rooms which fulfill the requirements regarding electrical installation according to IEC 60364-7-710 "Requirements for special installations or locations
- Medical locations", or corresponding local regulations. WARNING The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment
(for example, hyperbaric chambers). Physical Security and Limited Access to the Monitor Access to the monitor must be limited to authorized users. It is important that you consider physical security measures to ensure that unauthorized users cannot gain access. Manufacturer's Information You can write to Philips at this address Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.healthcare.philips.com/us/. Copyright 2013. Koninklijke Philips 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 Covidien:
Covidien llc 15 Hampshire Street Mansfield, MA 02048 USA 444 Trademark and License Acknowledgment 40 Specifications PiCCOTM is a trademark of PULSION Medical Systems AG. Bispectral Index and BIS are trademarks of Covidien llc, 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. Transpac and SafeSetTM are trademarks of ICU Medical, Inc. Other product and company names mentioned in this book may be trademarks of their respective owners. The monitors use Open Source Software. For details check the license screen via Main Setup, Revisions, OSS Licenses. Symbols These symbols can appear on the monitor and its associated equipment. Symbols Caution, refer to accompanying documents Protective earth Equipotential grounding Start a measurement Stop a measurement Standby Alternating current FMS power-on indicator Applied part has special protection against electric shocks (Type BF according to IEC 60601-1) and is defibrillator proof Error LED Connection direction indicator Connection direction indicator 445 40 Specifications Symbols Electrical input indicator
(In some cases gas input indicator) Electrical output indicator
(In some cases gas output indicator) Gas input indicator Gas output indicator Manufacturer's name and address Non-ionizing radiation symbol USB interface Identifies year and month of manufacture Pressure connector NBP connector Temperature connector Masimo SET technology Silence Alarms Monitor supports 12-
lead ECG Nellcor OxiMax compatible Alarms On/Off Connector has special protection against electric shocks and is defibrillator proof (Type CF according to IEC 60601-1) Quick mount release Data input/output symbol Always use separate collection for waste electrical and electronic equipment (WEEE) Cardiac Output connector SpO2 connector Uses FAST SpO2 algorithm Alarms Switched Off Main Screen SmartKeys Back key Purge flow tubing with air ECG Sync Output/
Analog ECG Output Indicates location of service number Indication for battery placement in battery compartment Zero the invasive pressure transducer Followed by two alphanumeric characters, indicates ingress protection grade Rechargeable battery symbol Enter the measurement setup menu to start a calibration Enter the measurement setup menu Indicates location of catalog number Battery LED 446 40 Specifications 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/EN 60601-1, IEC 60601-1-1, UL 60601-1. Consult your service personnel. Grounding Equipotential Grounding Combining equipment Fusing Network Cables Connectors 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 connection. 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. 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 445) to see which symbols are used to mark the connections. WARNING Connect only medical devices to the ECG output connector socket. 447 40 Specifications MX400/450 Rear of the Monitor Shown here without the standard spillage cover that protects the connectors. 1 2 3 4 5 6 7 8 Protective earth screw hole AC power input with clamp Equipotential ground connector Wired network connector (color-coded in orange) Video out connector (digital/analog) USB rear connector (for remote control, keyboard, pointing devices, printer) Optional interfaces Release switch for a connected multi-measurement module 448 40 Specifications Optional Interfaces Optional Interface Description Flexible nurse call interface card Dual medical information bus (MIB) RS232 Interface card (color-
coded yellow) IntelliBridge EC10 interface board (color-coded dark gray) Advanced system interface:
Single medical information bus (MIB) RS232 Interface card
(color-coded yellow) Nurse call Additional USB slots 449 40 Specifications Left Side of the Monitor 1 MSL interface link 2 Integrated recorder 3 ECG Sync Output/Analog ECG output connector Right Side of the Monitor 1 Optional USB slot 2 Battery compartment 450 MX500/550 Rear of the Monitor 40 Specifications 1 2 3 4 5 6 7 8 Protective earth screw hole AC power input with clamp Equipotential ground connector Wired network connector (color-coded in orange) Video out connector (digital/analog) USB rear connector (for remote control, keyboard, pointing devices, printer) Optional interfaces Release switch for connected measurement modules Optional Interfaces Optional Interface Description Flexible nurse call interface card 451 40 Specifications Optional Interface Description Dual medical information bus (MIB) RS232 Interface card
(color-coded yellow) IntelliBridge EC10 interface board (color-coded dark gray) Advanced system interface:
Single medical information bus (MIB) RS232 Interface card
(color-coded yellow) Nurse call Additional USB slots 452 Left Side of the Monitor 40 Specifications 1 MSL interface link 2 3 slots for measurement modules 3 ECG Sync Output/Analog ECG output connector Right Side of the Monitor 1 Optional USB slot 2 Battery compartment 453 40 Specifications MX600/700/800 Rear of the Monitor 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) 454 Left Side of the Monitor 40 Specifications 1 ECG Sync Output/Analog ECG output connector Right Side of the Monitor 1 USB side connector (only present with the iPC) 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. 455 40 Specifications CAUTION Never carry a monitor by the handle when equipment is attached below it with the Quick Mount. To transport such equipment combinations, always support the equipment from below. Only use the bed hanger for the MX400/450/500/550 on beds with a support below the rail, to ensure that the monitor does not tilt. Repositioning a Monitor on the Mounting Arm Attempts to reposition the monitor should only be performed as described in the mounting hardware manufacturers user documentation. If the mounting arm has a locking mechanism, ensure the locking mechanism is unlocked before attempting to reposition the monitor. Never pull on the monitor to tilt, swivel or otherwise reposition it - always hold on to the mounting hardware itself. WARNING Not adhering to these instructions when repositioning the monitor can cause damage to the monitor. In extreme cases, when force is applied to the monitor, it can result in the monitor falling from the mounting arm. If, at any time, the monitor appears to be loose or insecurely mounted, contact your service personnel. Altitude Setting Altitude affects tcGas and CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety Specifications Philips The monitors, together with the Multi-Measurement Modules (M3001A/M3002A), the Flexible Module Racks FMS-8 (M8048A) and FMS-4 (865243), and all modules and MMS extensions, comply with the Medical Device Directive 93/42/EEC. Covidien Covidien BISx, Covidien BIS Engine and Covidien DSC comply with the Medical Device Directive 93/42/EEC of 14 June 1993. In addition, the product complies with:
IEC 60601-1:1988 + A1:1991 + A2:1995; EN 60601-1:1990 + 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, EN 60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999. Classification (according to IEC 60601-1): Class 1, Type CF, Continuous Operation. The BIS and NMT measurement use a Type BF applied part. 456 Physical Specifications Product MX800 Monitor MX600/MX700 Monitor MX550 Monitor MX500 Monitor MX450 Monitor MX400 Monitor 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) 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 Maximum Weight
<12 kg (<26.4 lb)
<9.5 kg (<20.9 lb)
<7.3 kg (<16.1 lb)
<6.0 kg (<13.1 lb)
<5.9 kg (<12.9lb)
<5.2 kg (<11.5lb)
<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)
<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) 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
<404 x 308 x 184 mm
<15.91 x 12.13 x 7.24 in
<327 x 288 x 182 mm
<12.87 x 11.34 x 7.17 in
<327 x 288 x 182mm
<12.87 x 11.34 x 7.17 in
<274 x 288 x 178 mm
<10.79 x 11.34 x 7.01 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 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 40 Specifications Comments without cable management without cable management including battery, without handle or options without plug-in modules without MMS Mount 457 40 Specifications Product 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 865383 IntelliVue NMT Module Maximum Weight
<200 g (<7.1 oz)
<200 g (<7.1 oz) 210 g (7.4 oz) 215 g (7.6 oz) 499 g (1.1 lb) W x H x D 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 35 g (1.1 oz) 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 36 x 103.5 x 110 mm 1.4 x 4.0 x 4.3 in
<250 g (<8.8 oz) 507.5 g (17.9 oz) 300 g (10.6 oz) 25 g (0.8 oz) Comments including 2.9 m 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 without cables 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. 458 40 Specifications Range 0 to 40 C (32 to 104 F) 0 to 35C (32 to 95F) when charging the battery 0 to 35C (32 to 95F) if an X2 is mounted on the rear. 0 to 35C (32 to 95F) if IntelliVue Instrument Telemetry Wireless Network is connected.
-20 to 60C (-4 to 140F 15% to 95% Relative Humidity (RH) (non condensing) 5% to 95% Relative Humidity (RH) (non condensing)
-500 m to 3000 m (10000 ft)
-500 m to 4600 m (15000 ft) IP21 MX400/450/500/550 Monitor MX400/450/500/550 Monitor Item Temperature Range Condition Operating Humidity Range Altitude Range Storage Operating Storage Operating Storage Ingress Protection MX600/700/800 Monitor MX600/700/800 Monitor Item Temperature Range Condition Operating Humidity Range Altitude Range 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 (-1600 to 10000 ft)
-500 m to 4600 m (-1600 to 15000 ft) IPX1 Ingress Protection X2 (M3002A) and External Power Supply (M8023A) X2 (M3002A) and External Power Supply (M8023A) Item Temperature 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) Temperature Range when charging the battery or when equipped with IntelliVue Instrument Telemetry or the IntelliVue 802.11 Bedside Adapter 459 40 Specifications X2 (M3002A) and External Power Supply (M8023A) Item Humidity Range Condition Operating Storage including transportation Operating Storage including transportation X2 Range 15% to 95% Relative Humidity (RH) 5% to 95% Relative Humidity (RH)
-500 m to 3000 m (-1600 to 10000 ft)
-500 m to 4600 m (-1600 to 15000 ft) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15) Altitude Range 460 40 Specifications Devices for Acquiring Measurements and 8-Slot Flexible Module Rack Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A, Measurement Modules, and 8-Slot Flexible Module Rack M8048A Item Temperature Range 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) 4-Slot Flexible Module Rack 4-Slot Flexible Module Rack 865243 Item Temperature Range Humidity Range Altitude Range Humidity Range Altitude Range Humidity Range Altitude Range Condition Operating Non-operating Operating Non-operating Operating Non-operating Condition Operating Storage Operating Storage Operating Storage Condition Operating Non-operating Operating Non-operating Operating Non-operating Ingress Protection Thermal Array Recorder Module M1116B/C Thermal Array Recorder Module M1116B/C Item Temperature Range 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 (-1600 to 10000 ft)
-500 m to 4600 m (-1600 to 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) 90% Relative Humidity (RH) max. @ 65C (150F) (non condensing) up to 3048 m (10000 ft) up to 3048 m (10000 ft) 461 40 Specifications Remote Control Remote Control 865244 Item Temperature Range Humidity Range Altitude Range Condition Operating Storage Operating Storage Operating Storage 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 (-1600 to 10000 ft)
-500 m to 4600 m (-1600 to 15000 ft) EMC and Radio Regulatory Compliance This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme la norme NMB-001 du Canada. Short Range Radio Interface (Monitors 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 radiofrequency 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. To obtain a copy of the original Declaration of Conformity, please contact Philips at the address given in the Manufacturer's Information section of these Instructions for Use. 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 radiofrequency 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. 462 40 Specifications 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. IntelliVue 802.11 Bedside Adapter CE compliances:
This device is compliant to Council Directive 2006/95/EC (Low voltage directive) & 2004/
108/EC (EMC directive) & 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive) 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 Instrument Telemetry ISM (2.4GHz Option J47 WMTS 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 radiofrequency 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 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. 463 40 Specifications Monitor Performance Specifications MX400/450/500/550 Performance Specifications MX400/450/500/550 Power Specifications Power Consumption Line Voltage Current Frequency
<70 W average 100 to 240 V 1.2 to 0.5 A 50/60 Hz Battery Specifications MX400 Operating time (with one fully charged battery) MX450 Charge Time Operating time (with one fully charged battery) Charge Time MX 500 Operating time (with one fully charged battery) Charge Time MX 550 Operating time (with one fully charged battery) Charge Time 464 Basic monitoring configurations 5 hours
(Brightness is set to Optimum, MMS connected, NBP measurement every 15 minutes). Extended monitoring configuration: 3.5 hours
(Brightness set to Optimum, MMS and MMS extension connected, NBP every 15 minutes, Recorder, Pressure, Temperature modules connected) When monitor is off: approx. 3 hours When monitor is in use: approx. 5 hours Basic monitoring configurations 4 hours
(Brightness is set to Optimum, MMS connected, NBP measurement every 15 minutes). Extended monitoring configuration: 3 hours
(Brightness set to Optimum, MMS and MMS extension connected, NBP every 15 minutes, Recorder, Pressure, Temperature modules connected) When monitor is off: approx. 3 hours When monitor is in use: approx. 5 hours Basic monitoring configurations 3 hours
(Brightness is set to Optimum, MMS connected, NBP measurement every 15 minutes). Extended monitoring configuration: 2.5 hours
(Brightness set to Optimum, MMS and MMS extension connected, NBP every 15 minutes, Recorder, Pressure, Temperature modules connected) When monitor is off: approx. 3 hours When monitor is in use: approx. 5 hours Basic monitoring configurations 2.5 hours
(Brightness is set to Optimum, MMS connected, NBP measurement every 15 minutes). Extended monitoring configuration: 2 hours
(Brightness set to Optimum, MMS and MMS extension connected, NBP every 15 minutes, Recorder, Pressure, Temperature modules connected) When monitor is off: approx. 3 hours When monitor is in use: approx. 5 hours 40 Specifications MX400/450/500/550 Sounds Display Wave Speeds 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 Available for standard waves Available for EEG and BIS waves Trends Resolution Information High Res Trend Waves Measurements available Events Resolution Update speed Information Episode data Capacity (max.) 6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s with 5% accuracy (guaranteed only for integrated displays) 6.25 mm/s, 12.5 mm/s, 15 mm/s, 25 mm/s, 30 mm/s, 50 mm/s with 5% accuracy (guaranteed only for integrated displays) 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, tcpCO2, 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 465 40 Specifications MX400/450/500/550 Alarm Signal less than 4 seconds less than 5 seconds System alarm delay The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. Delay for alarm availability on the network This is the time needed after alarm indication on the monitor until the alarm signal is available on the network, to the IntelliVue Information Center or for transmission to other systems. Pause duration Extended alarm pause Sound pressure range Information Review Alarms Real Time Clock 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes min. 0 dB(A) max. 45-85 dB(A) 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 better than 4 seconds per day infinite if powered by AC; otherwise at least 24 hours if powered by AC: infinite without power: at least 8 hours Active settings, trends, patient data, realtime reports, events, review alarms MX600/700/800 Performance Specifications MX600/700/800 Power Specifications Capacity Range Accuracy Hold Time Hold Time Buffered Memory Contents
<200 W average 100 to 240 V 1.9 to 0.9 A 50/60 Hz red or yellow LED with crossed out alarms symbol red/yellow/light blue (cyan) LED green/red LED integrated in power switch green LED 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 Indicators Sounds 466 MX600/700/800 Trends Resolution Information High Res Trend Waves Measurements available Events Alarm Signal Resolution Update speed Information Episode data Capacity (max.) System alarm delay The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. Delay for alarm availability on the network This is the time needed after alarm indication on the monitor until the alarm signal is available on the network, to the IntelliVue Information Center or for transmission to other systems. Pause duration Extended alarm pause Sound pressure range Review Alarms Real Time Clock Information Capacity Range Accuracy Hold Time 40 Specifications 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, tcpCO2, 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 4 seconds less than 5 seconds 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes min. 0 dB(A) max. 45-85 dB(A) 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 better than 4 seconds per day infinite if powered by AC; otherwise at least 24 hours 467 40 Specifications MX600/700/800 Buffered Memory Hold Time Contents if powered by AC: infinite without power: at least 8 hours Active settings, trends, patient data, realtime reports, events, review alarms X2 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 Alarms Off Alarms On/Standby / Error AC Power Battery External Power Resolution Information System alarm delay Pause duration Extended alarm pause Information Capacity Range Accuracy Hold Time Indicators Sounds Trends Alarm signal Review Alarms Real Time Clock 468
<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 or yellow LED with crossed-out alarm symbol 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 4 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 40 Specifications X2 (M3002A) Performance Specifications Buffered Memory Hold Time Contents 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 consumption M8023A External Power Supply (for M3002A) Performance Specifications Power Specifications
<12 W average
<30 W peak 100 to 240 V ~
1.3 to 0.7 A 50/60 Hz Indicators green LED MMS M3001A Performance Specifications Line Voltage Current Frequency Power M3001A MMS Performance Specifications Trends Trend Data Buffered Memory Contents Integrated PC (iPC) Integrated PC (iPC) Performance Specifications PC Components Processor Solid-state drive RAM 865244 Remote Control 865244 Remote Control Performance Specifications Power (when not connected to the USB interface of the monitor) if powered by monitor mains connection via MSL: infinite without power applied: at least 6 hours trend data, patient identification and all active settings Intel Core 2 Duo SP9300/SP9400 100 GB or above 4 GB Two AA primary cells 469 40 Specifications Interface Specifications MX400/450/500/550/600/700/800 Interface Specifications MX400/450/500/550/600/700/800 Network Standard Connector Isolation Standard Connectors Mode MIB/RS232 100-Base-TX (IEEE 802.3 Clause 25) RJ45 (8 pin) basic insulation (reference voltage: 250 V; test voltage: 1500 V) IEEE 1073-3.2-2000 RJ45 (8 pin) Software-controllable BCC (RxD/TxD cross over) or DCC (RxD/TxD straight through) not available for the advanced system interface MX400/450/500/550 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 RJ45 (8-pin) 1200 Bd, 2400 Bd, 4800 Bd, 9600 Bd, 19200 Bd, 38400 Bd, 57600 Bd, or 115200 Bd signaling speed 5-8 1 or 2 Even or odd parity generation and checking 5 V5 % @ 0-100 mA double insulation (reference voltage: 250 V; test voltage: 4000 V) Power Isolation Standard Connector Power Isolation Connector Power Isolation Connector Power Isolation Connector Contact Isolation Delay Connector Contact Isolation Delay Connector Speed Character bits Stop bits Parity Power Isolation USB Interface RS232 (Standard) RS232 (Independent display interface option) Basic Nurse Call Relay Flexible Nurse Call Relay IntelliBridge EC10 Interface board 470 MX400/450/500/550/600/700/800 IntelliVue Instrument Telemetry Wireless Network
(USA only) Type Technology IntelliVue Instrument Telemetry Wireless Network
(except USA) IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter) Short Range Radio Interface Measurement Link (MSL) MX600/700/800 Measurement Link (MSL) MX400/450/500/550 Video Interface (standard) Frequency Band Type Technology Frequency Band Type Technology Frequency Band Modulation technique Effective radiated power (max.) Type Technology Frequency band Modulation technique Effective radiated power Connectors Voltage Power Power Sync. LAN signals Serial signals Connectors Voltage Power Power Sync. LAN signals Serial signals Connector Digital video signals Analog video signals HSYNC/VSYNC signals DDC signals DDC power 40 Specifications 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 Band DSSS (CCK, DQPSK, DBPSK), OFDM (BPSK, QPSK, 16-
QAM, 64-QAM) MX400-MX550: 16 dBm (35 mW) MX600-MX800: 17 dBm (50 mW) Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) DSSS (O -QPSK) max. 0 dBm (1 mW) 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 ODU out (Proprietary) 48 V 10 %
12 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 TTL none (except for MX400/450/500/550) 5 V +/-5% @0-55 mA 471 40 Specifications MX400/450/500/550/600/700/800 Video Interface (Independent display interface option) Connector Pixel clock frequency Digital video signals Analog video signals HSYNC/VSYNC signals DDC signals DDC power DVI (digital and analog, single link) 31.5 MHz - 119 MHz single link TMDS 0.7 Vpp@75 TTL none 5 V +/-5% @0-55 mA ECG Sync Output/Analog ECG Output (1/4" stereo phone jack with tip, ring, sleeve) General 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
<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 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 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]
Analog ECG Output
(ring, tip) Digital Pulse Output (ring) 472 40 Specifications X2 Interface Specifications X2 (M3002A) Interface Specifications Measurement Link (MSL) 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 devices: TRx4841A/TRx4851A Intellivue Telemetry System Transceiver and MX40 Wearable Patient Monitor M8023A External Power Supply Interface 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 473 40 Specifications Integrated PC (iPC) Interface Specifications Integrated PC (iPC) Ethernet LAN (external) USB Audio DVI Video with DVI-I connector Connector LAN Signals Reinforced insulation 6 external ports (5 rear, 1 right side) Type A connectors microphone input stereo headphone output stereo DVI VGA Display Specifications Display Specifications 19" WSXGA+
MX600/700/800 15" WXGA MX550/600/700/800 12" WXGA (16:10) MX450/500 9" WVGA MX400 Type Resolution Refresh frequency Useful screen Pixel size Type Resolution Refresh frequency Useful screen Pixel size Type Resolution Refresh frequency Useful screen Pixel size Type Resolution Refresh frequency Useful screen Pixel size 474 RJ-45 IEE 802.3 1000-Base-T compliant IEC 60601-1 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 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 390 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 310 mm active matrix color LCD (TFT) 1280 x 800 (WXGA 16:10) 59.9 Hz 261.1 mm x 163.2 mm 0.204 mm x 0.204 mm 230 mm active matrix color LCD (TFT) 800 x 400 (WVGA) 60 Hz 196.8 mm x 118.1 mm 0.246 mm x 0.246 mm 40 Specifications Compatible Devices Compatible Devices Displays (must be approved for medical use) M8031B M8033C 865299 XGA color 15" LCD touchscreen SXGA color 17" LCD touchscreen SXGA color 19" LCD touchscreen M4605A Battery Specifications The battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles. M4605A Battery Specifications Physical Specifications W x D x H Weight Performance Specifications Nominal Voltage Rated Capacity at discharge C/5 Continuous Discharge Capability Environmental Specifications Temperature Range Humidity Range Battery Type Safety Electromagnetic Compatibility (EMC) Communication Standard 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 10.8 Volt 6000 mAh 6.5 A 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 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 /EN 60601-2-25:1995 + A1:1999, IEC 60601-2-27:2005/EN 60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/EC13:1991/2002. 475 40 Specifications ECG/Arrhythmia/ST Performance Specifications Cardiotach Range 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 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 Differential Input Impedance Common Mode Rejection Ratio Electrode Offset Potential Tolerance 476 Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm Note: for rates equal to or less than 15 bpm, the displayed heart rate is 0. 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 150 bpm 15 to 180 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) Diagnostic mode: >86 dB (with a 51 k/47 nF imbalance). Filter mode: >106 dB (with a 51 k/47 nF imbalance). 500 mV 40 Specifications ECG/Arrhythmia/ST Performance Specifications Auxiliary Current
(Leads off Detection) Input Signal Range Active electrode: <100 nA Reference electrode: <900 nA 5 mV ECG/Arrhythmia/ST/QT Alarm Specifications HR Extreme Tachy Extreme Brady Run PVCs PVCs Rate Vent Tach HR Vent Tach Run Vent Rhythm Run SVT HR SVT Run ST High ST Low STE Limit QTc High QTc High Range Adjustment 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
-20 to +20 mm 200 ms to 800 ms 30 ms to 200 ms 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 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 477 40 Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27 Heart Rate Averaging Method Three different methods are used:
Normally, heart rate is computed by averaging the 12 most recent RR intervals. For runs of PVCs, up to 8 RR intervals are averaged to compute the HR. If each of 3 consecutive RR intervals is greater than 1200 ms
(that is, rate less than 50 bpm), then the 4 most recent RR intervals are 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) 2.2 V/s RTI (Paced Mode) 2.2 V/s RTI 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 Accuracy of Input Signal Reproduction Pacemaker Pulse Rejection Performance Pacemaker Pulse Rejection of fast ECG signals Minimum input slew rate Respiration Respiration Performance Specifications Respiration Rate Range Accuracy Resolution Bandwidth Noise Respiration Alarm Specifications High Low Range Adjustment Delay 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 max. 14 seconds for limits from 0 to 20 rpm:
max. 4 seconds for limits above 20 rpm: max. 14 seconds Apnea Alarm 10 to 40 seconds 5 second steps 478 SpO2 40 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. 479 40 Specifications SpO2 Performance Specifications SpO2 Range The specified accuracy is Option #A01 the root-mean-square Accuracy
(RMS) difference between the measured values and the reference values Option #A02 Accuracy Resolution Averaging Time Range Accuracy Resolution Pulse Sensors 480 0 to 100%
Philips Reusable Sensors:
M1191A, M1191AL, M1191B, M1191BL, M1192A = 2 % (70 % to 100 %) M1193A, M1194A, M1195A, M1196A, M1196S = 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):
MAXA, MAXAL, MAXP, MAXI, MAXN, 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 Adt, LNOP Adtx, LNOP Pdt, LNOP Pdtx, LNOP Inf-L, LNOP Neo-L
(adult), LNCS Adtx, LNCS Adtx-3, LNCS Pdtx, LNCS Pdtx-3, LNCS Inf, LNCS Inf-3, LNCS Neo (adult), LNCS Neo-3 (adult) = 2% (70% to 100%) LNOP Neo-L (neonate), LNOP NeoPt-L, LNCS Neo (neonate), LNCS Neo-3
(neonate), LNCS NeoPt, LNCS NeoPt-3 = 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%
Nellcor Sensors with M1943NL:
MAXFAST, MAXA, MAXAL, MAXP, MAXI, MAXN (Adult) = 2 % (70 % to 100 %) SC-A, Oxicliq A, P, I, N (Adult) = 2.5% (70% to 100%) MAXN (Neonate), Dura-Y D-YS (Infant to Adult), DS-100A-1, Oxiband OXI-
A/N (Adult), OXI-P/I = 3 % (70% to 100%) MAXR, Oxicliq N (Neonate), SCNEO-I (Neonate), SC-PR-I (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%
5, 10 or 20 seconds (user adjustable) 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) 40 Specifications SpO2 Performance Specifications Pulse Oximeter Calibration Range SpO2 Alarm Specifications SpO2 high and low limit alarms Desat Pulse Tachycardia Bradycardia 70% to 100%
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 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 SpO2 Alarm Specifications (cont.) SpO2 high and low limit alarms Desat Pulse Tachycardia Bradycardia Standard Delay 0 to 30 seconds (adjustable in 1 second steps) + system alarm delay1 0 to 30 seconds (adjustable in 1 second steps) + system alarm delay 10 seconds + system alarm delay 10 seconds + system alarm delay 10 seconds + system alarm delay Smart Alarm Delay (alternative to standard alarm delay) Short Mode 10 to 25 seconds +
system alarm delay Medium mode 10 to 50 seconds
+system alarm delay Long Mode 10 to 100 seconds +
system alarm delay not supported 1. Refer to Monitor Performance Specifications on page 464 for system alarm delay specification. SpO2 Smart Alarm Delay - Detailed Specifications Deviation from violated alarm limit Resulting alarm delay according to selected mode 1%
2%
3%
4%
5%
6%
7%
8%
Short 25 sec
(maximum delay) 12 sec 10 sec 10 sec 10 sec 10 sec 10 sec 10 sec Medium 50 sec
(maximum delay) 25 sec 16 sec 12 sec 10 sec 10 sec 10 sec 10 sec Long 100 sec
(maximum delay) 50 sec 33 sec 25 sec 20 sec 16 sec 14 sec 12 sec 481 40 Specifications SpO2 Smart Alarm Delay - Detailed Specifications Deviation from violated alarm limit Resulting alarm delay according to selected mode 9%
>9%
NBP Short 10 sec 10 sec Medium 10 sec 10 sec Long 11 sec 10 sec Complies with IEC 60601-2-30:1999/EN 60601-2-30:2000. NBP Performance Specifications Systolic Measurement Ranges Diastolic Mean Pulse Rate Accuracy Pulse Rate Measurement Accuracy Pulse Rate Range Measurement Time Cuff Inflation Time Initial Cuff Inflation Pressure Maximum Cuff Pressure Auto Mode Repetition Times STAT Mode Cycle Time 482 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 bpm Pedi: 40 to 300 bpm Neo: 40 to 300 bpm 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:
Adult: 30 seconds Neonatal: 25 seconds Stat: 20 seconds Maximum time:
Adult/pedi: 180 seconds Neo: 90 seconds 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 Adult/Pedi: 300 mmHg Neo: 150 mmHg 1 min, 2 min, 2.5 min, 3 min, 10 min, 15 min, 20 min, 30 min, 45 min, 1h, 2h, 4h, 8h, 12h, 24h 5 minutes NBP Performance Specifications Venipuncture Mode Inflation Inflation Pressure Automatic deflation after Adult Pediatric Neonatal Adult/pediatric Neonatal 40 Specifications 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 Invasive Pressure and Pulse
>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 Complies with IEC 60601-2-34:2000/EN 60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate Range Accuracy Resolution
-40 to 360 mmHg 25 to 350 bpm 1% Full Range 1 bpm 483 40 Specifications Invasive Pressure Performance Specifications Input Sensitivity Transducer Frequency Response Zero Adjustment Gain Accuracy Range Accuracy Drift Accuracy Drift Non linearity and Hysteresis
(including transducer) Overall Accuracy Volume displacement of CPJ840J6 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 Analog output Specifications Analog Output available only with M1006B #C01 (@ CAL 200 mmHg) Range Level Accuracy Offset Resolution Signal delay
-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 Pressure Range
-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 Tachycardia 484 Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Adjustment Delay
-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) 5 bpm steps 5 bpm steps max. 12 seconds max. 14 seconds Invasive Pressure Alarm Specifications Bradycardia Range Difference to low limit 0 to 50 bpm Clamping at 25 to 100 bpm Adjustment 5 bpm steps 5 bpm steps Temp 40 Specifications Delay max. 14 seconds Complies with EN 12470-4:2000 and IEC 60601-2-49:2001. 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/B 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 Resolution Stability Range Accuracy Range Resolution AwRR IPI Warm-up Time 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% per 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 1 to 10 1 5 minutes for full accuracy specification 485 40 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 486 40 Specifications 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 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
-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 487 Resolution Stability 40 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 CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High awRR High awRR Low Range 20 to 95 mmHg (2 to 13 kPa) 10 to 90 mmHg (1 to 12 kPa) 2 to 20 mmHg
(0.3 to 3.0 kPa) Adjustment 1 mmHg (0.1 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 IPI Low (M3015A/B only) Adult/pedi: 2 to 9 steps of 1 Apnea delay 10 to 40 seconds 5 second steps Delay 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 Maximum 14 seconds after displayed value goes below the low alarm limit setting. 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). 488 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 Gas Level
(% volume fraction) M3002A/M3014A M3015A 40 Specifications Nitrous Oxide Halothane Enflurane Isoflurane Sevoflurane Xenon Helium Metered dose inhaler propellants Desflurane Ethanol Isopropanol Acetone Methane Spirometry 60%
4%
5%
5%
5%
80%
50%
15%
0.1%
0.1%
0.1%
1%
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%
Complies with IEC 60601-2-49:2001. 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 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) 489 40 Specifications Spirometry Performance Specifications Volume Wave (AWV) Range Accuracy Scales Scale Default Range Accuracy Scales Scale Default Range Resolution Range Resolution Pressure Wave (AWP) Respiration Rate numeric (RRspir) Inspired Minute Volume numeric (MVin) Expired Minute Volume numeric (MVexp) 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) 490 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)
-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 40 Specifications
-20 to 0 cmH2O 1 cmH2O 0 to 120 cmH2O 1 cmH2O 0 to 120 cmH2O 1 cmH2O 0 to 99 cmH2O 1 cmH2O Spirometry Performance Specifications Negative Inspiratory Pressure numeric Mean Airway Pressure Plateau Pressure numeric Positive End-Expiratory Pressure numeric
(PEEP) Barometric Pressure numeric (PB) Peak Inspiratory Flow numeric (PIF) Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Range Resolution Peak Expiratory Flow numeric (PEF) Range Resolution 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 to 9.9 0.1 Range Resolution Inspiration to Expiration ratio numeric
(I:E) Cardiac Output / Continuous Cardiac Output Complies with IEC 60601-2-34:2000 C.O./CCO Performance Specifications C.O. (right heart) Range Accuracy C.O. (transpulmonary) EVLW ITBV Repeatability Range Accuracy Repeatability Range Standard Deviation Range Accuracy Repeatability 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 491 40 Specifications C.O./CCO Performance Specifications CCO Range Standard Deviation Display Update Range Range 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) Blood Temperature Injectate Temperature 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/EN 60601-2-23:2000. 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 (M1018A only) 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 492 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 40 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 Complies with IEC 60601-2-49:2001. Performance Specifications SO2, SvO2, ScvO2 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/EN 60601-2-26:1994. EEG Performance Specifications Leakage Current Input Signal Range Differential Input Impedance Max. DC Input Offset Voltage Input Protection Common Mode Rejection Noise Electromagnetic Susceptibility Electrode Impedance Measurement Range Accuracy
<=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 Vrms (1 to 30 Hz)
<10 Vp-p @ 3 V/m, 26-1000 MHz 0 to 30 k 1 k 493 40 Specifications EEG Performance Specifications Bandwidth Low Filter Cut-Off Frequencies High Filter Cut-Off Frequencies 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 Complies with IEC 60601-2-26:1994. 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 NMT 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 Range 0 - 100 Adjustment 1 Alarm Delay Max. 2 seconds Complies with IEC 60601-2-49:2001 NMT Performance Specifications Stimulation Output Single Twitch Stimulation Mode 494 Current Pulse Current Range Current Accuracy Maximum Skin Resistance Maximum Output Voltage Twitch Repeat Time Minimum Recovery Time 100, 200, or 300 secs; monophasic rectangle pulse 5 to 60 mA in increments of 5 mA 5% or 2 mA, whichever is greater 3 kOhm 300 V 10%
0 to 200% (resolution: 1%) Manual, or 1 sec, 12 sec, 30 sec None 40 Specifications NMT Performance Specifications Train-Of-Four Stimulation Mode Post-Tetanic-Count Stimulation Mode Double-Burst Stimulation Mode NMT Alarm Specifications
** TOFcnt High TOF Count (TOFcnt) TOF Ratio (TOFrat) Repeat Time Minimum Recovery Time PTC Repeat Time Minimum Recovery Time Repeat Time Minimum Recovery Time Range 0, 1, 2, 3 TOF Counts 0 to 4 (resolution: 1) 5 to 150% (resolution: 1) Manual, or 12 sec, 30 sec, 1 min, 5 min, 10 min, 15 min, 30 min, 60 min 10 sec 0 to 20 (resolution: 1) Manual 2 min Manual 20 sec Alarm Delay Max. 4 sec system delay after value goes above the high alarm limit setting 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. 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 radiofrequency (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. 495 40 Specifications Emissions test Radiofrequency (RF) emissions Compliance Group 1 RF emissions CISPR 11 Harmonic emissions IEC 61000-3-2 Voltage fluctuations IEC 61000-3-3 Class A n/a n/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 other than domestic and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes 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. 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
<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 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. 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 61000-4-11 496 40 Specifications Compliance level Electromagnetic environment guidance Immunity test Power frequency (50/
60 Hz) magnetic field IEC 61000-4-8 IEC 60601-1-2 test level 3 A/m 3 A/m 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 This equipment generates, uses and radiates radio-frequency energy, and if it is not installed and used in accordance with its accompanying documentation, may cause interference to radio communications. 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:
Immunity test Conducted RF IEC 61000-4-6 IEC 60601-1-2 test level 3 Vrms 150 kHz to 80 MHz Compliance level Electromagnetic environment guidance 3 Vrms
(1 Vrms for respiration and BIS) Recommended separation distance:
d = 1.2P for respiration and BIS:
d = 3.5P 497 40 Specifications Immunity test Radiated RF IEC 61000-4-3 IEC 60601-1-2 test level 3 V/m 80 MHz to 2.5 GHz Compliance level Electromagnetic environment guidance 3 V/m
(1 V/m for respiration and BIS) 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. Frequency of transmitter 150 kHz to 80 MHz 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 Equation Rated max. output power of transmitter 0.01 W 0.1 W 1 W 10 W 100 W 498 40 Specifications Recommended Separation Distances for WLAN Operation To avoid interference in the presence of other RF sources, following separation distances are recommended;
A separation distance of 1 m to BlueTooth (Class 1), DECT and WLAN devices (if connected to a different WLAN infrastructure) operating in the same frequency band. A separation distance of 3 m to other radio transmitters with a pulsed mode of operation and a duty cycle less than 50%, operating in the same frequency band. A separation distance of 10 m to a consumer grade microwave oven and 30 m to a commercial grade microwave oven, if operating in the 2,4 GHz band. If other continuous wave transmitters operate in the same frequency band, a minimum signal-to-noise ratio (SNR) of 25 dB should be provided at the monitor location. These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. 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 (M1032A within 30 seconds). If any user interaction is required, the monitor indicates this with a technical alarm (INOP). Restart time After a power interruption, an ECG wave will be shown on the display after 30 seconds maximum. If an X2 is connected to a host monitor, it can take up to a maximum of 45 seconds until the ECG wave is shown. 499 40 Specifications 500 41 41Default 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 50/60 [Hz]
Afghanistan land Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan 50 50 50 50 60 60 50 60 60 50 50 50 60 50 50 50 Units Weight kg, lb kg kg kg kg lb lb kg lb lb kg kg kg kg kg kg kg Units Height in, cm cm cm cm cm in in cm in in cm cm cm cm cm cm cm ECG Cable Color IEC, AAMI AAMI IEC IEC IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC AAMI AAMI IEC IEC 501 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory 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, The Democratic Republic of the 60 50 50 50 50 50 60 60 60 60 60 50 50 60 60 60 50 50 50 50 50 50 60 60 60 50 60 50 50 60 60 60 60 50 50 502 Units Weight kg, lb kg kg kg kg kg kg lb lb kg lb kg kg kg lb kg lb kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb kg kg Units Height in, cm cm cm cm cm cm cm in in cm in cm cm cm in cm in cm cm cm cm cm cm cm in cm cm in cm cm in in cm in cm cm ECG Cable Color IEC, AAMI AAMI AAMI IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC IEC IEC IEC IEC IEC AAMI AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
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 Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe 60 60 50 50 60 50 50 50 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 Units Weight kg, lb lb kg kg kg kg kg kg kg 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 Units Height in, cm in cm cm cm cm cm cm cm 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 ECG Cable Color IEC, AAMI AAMI AAMI IEC IEC IEC IEC IEC IEC 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 503 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See, Vatican City State Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia 504 60 60 50 60 60 60 60 60 60 60 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 60 60 60 50 60 50 50 Units Weight kg, lb 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 Units Height in, 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 ECG Cable Color IEC, AAMI 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 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
Lebanon Lesotho 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 50 50 50 60 60 50 50 50 50 50 50 50 60 50 50 60 60 50 60 60 60 60 60 60 60 50 50 50 50 60 50 60 50 50 50 Units Weight kg, lb kg kg kg lb lb kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb lb lb lb kg kg kg kg lb kg lb kg kg kg Units Height in, cm cm cm cm in in cm cm cm cm cm cm cm in cm cm in cm cm in in cm in in in in cm cm cm cm in cm in cm cm cm ECG Cable Color IEC, AAMI AAMI IEC IEC AAMI AAMI IEC IEC IEC IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC IEC AAMI IEC AAMI IEC IEC AAMI 505 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Islands Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines 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 & the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia 506 60 50 60 50 50 60 60 60 50 50 50 60 50 60 60 50 60 60 60 50 50 60 50 60 50 50 50 60 60 50 60 50 60 60 60 50 Units Weight kg, lb lb kg kg kg kg lb lb lb kg 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 Units Height in, cm in cm in cm cm in in in cm 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 ECG Cable Color IEC, AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC 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 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
Senegal Serbia Serbia & Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Rep Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu 50 50 50 60 50 50 50 50 60 50 60 60 50 50 50 60 60 60 50 50 50 60 60 60 50 60 60 60 60 60 50 50 60 60 60 Units Weight kg, lb kg kg kg lb kg kg kg kg lb kg lb lb kg kg kg kg lb lb kg kg kg kg lb lb kg lb lb lb lb kg kg kg lb kg lb Units Height in, cm cm cm cm in cm cm cm cm in cm in in cm cm cm cm in in cm cm cm cm in in cm in in in in cm cm cm in cm in ECG Cable Color IEC, AAMI IEC IEC IEC AAMI IEC IEC IEC IEC AAMI IEC AAMI AAMI IEC IEC IEC AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI 507 41 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz]
Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, United States Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 60 60 50 50 60 60 50 60 60 60 50 50 60 60 50 50 60 60 Units Weight kg, lb lb lb kg kg lb lb kg lb lb lb kg kg lb lb kg kg lb lb Units Height in, cm in in cm cm in in cm in in in cm cm in in cm cm in in ECG Cable Color IEC, AAMI AAMI AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI 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 508 Factory Default H10/H20/H40 H30 (deviations from H10/H20/
H40) 5 2 min Enabled Enabled Off Off Red&Yellow Red Only 41 Default Settings Appendix H30 (deviations from H10/H20/
H40) Off Alarm Settings Factory Default H10/H20/H40 2 Audible Latching Alarm Reminder Reminder Time Alarm Sounds RedAlarmInterval Yel.Al. Interval Alarm Low Red Alarm Volume Yell.AlarmVolume INOP Volume AutoIncrease Vol IncreaseVolDelay Keep Blinking Relay1 Sensitiv. Relay2 Sensitiv. Relay3 Sensitiv. CyanRelayLatency Yel.RelayLatency Alarm Text NoCentrMonMinVol ECG, Arrhythmia, ST and QT Default Settings Red&Yellow On 3 min Traditional 10 sec 20 sec 4 AlarmVol. +2 AlarmVol. +0 AlarmVol. +0 2 Steps 20 sec No R&Y&C Red&Yellow Red 5 sec 2 sec Standard On4 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 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 Pedi 160 bpm 75 bpm On Auto On 1 II V Multi Lead Standard Off Monitor Off Size x1 Green Neo 200 bpm 100 bpm On Auto On 1 II V Multi Lead Standard Off Monitor Off Size x1 Green H30 (deviations from H10/H20/H40) Adult Neo Pedi Auto Filter 509 41 Default Settings Appendix ECG Settings Factory defaults H10/H20/H40 Adult 4.0 sec 20 bpm 200 bpm 20 bpm 40 bpm Cyan On Enabled Enabled V2 V5 Medium On Enabled Pedi Asystole Thresh. 4.0 sec ExtrTachy 20 bpm Tachy Clamp 220 bpm ExtrBrady 20 bpm Brady Clamp 40 bpm Cyan ECG Alm Off INOP On Fallback Enabled Alarms Off Enabled AlarmSource Sel. V2 Va Lead V5 Vb Lead Medium SyncPulse Sensit On SyncPulse Marker Enabled PulseAlarms Tele Arrhythmia Default Settings H30 (deviations from H10/H20/H40) Neo Adult Pedi 40 bpm 60 bpm 80 bpm Neo 3.0 sec 20 bpm 240 bpm 20 bpm 50 bpm Cyan On Enabled Enabled V2 V5 Medium On Enabled Factory defaults H10/H20/H40 Adult On 2.0 sec 100 5 14 180 5 10 On On On On On On On On On On On On On Pedi On 2.0 sec 120 5 14 200 5 5 On On On On On On On On On On On On On Neo Off 1.5 sec 150 5 14 210 5 5 On On On On On On On On On On On On On 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 510 H30 (deviations from H10/H20/H40) Adult Off Pedi Off Neo Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off Off 41 Default Settings Appendix H30 (deviations from H10/H20/H40) Adult Pedi Neo Off Off Off Off Off Off Neo On On On Short Yellow 3 min 10 min Yes On Pedi On On On Factory defaults H10/H20/H40 Adult On On On Short Yellow Short Yellow 3 min 10 min Yes On Arrhythmia Settings SVT Afib Irregular HR HR Alarms TimeOut 1st TimeOut 2nd ArrhyOff Message Some ECG Al INOP ST and QT Default Settings 3 min 10 min Yes On Lead-independent ST Settings ISO/J Point detection Alarms (ST) STE Alarms (STE) ST Analysis ST-Index ISO Point J Point ST Offset ST Settings - Lead I, II, III, V, aVR, aVL, V1-
6, MCL ST (Label) High Alarm Limit ST (Label) Low Alarm Limit ST Settings - Lead V, MCL ST (Label) High Alarm Limit ST (Label) Low Alarm Limit STE Settings - Limb leads STE Male Limb, Alarm Limit STE Female Limb, Alarm Limit ST Settings - lead V2, V3 STE Male V2,V3, Alarm Limit STE Female V2,V3, Alarm Limit STE Settings - V1, V4-V6 STE Male V1,V4-6, Alarm Limit Factory Defaults Factory Adult Auto On Off On On Off
-80 ms 48 ms J+60 Factory Defaults Factory Adult
+1.0 mm
-1.0 mm
+2.0 mm
-2.0 mm 1.0 mm 1.0 mm Factory Pedi Auto On Off On Off Off
-80 ms 48 ms J+60 Factory Pedi
+1.0 mm
-1.0 mm
+2.0 mm
-2.0 mm 1.0 mm 1.0 mm Factory Neo Auto On Off On Off Off
-80 ms 48 ms J+60 Factory Neo
+1.0 mm
-1.0 mm
+2.0 mm
-2.0 mm 1.0 mm 1.0 mm 1.0 mm 1.0 mm 1.0 mm 511 41 Default Settings Appendix ST Settings - Lead I, II, III, V, aVR, aVL, V1-
6, MCL STE Fem. V1,V4-6, Alarm Limit Factory Defaults Factory Adult 1.0 mm QT Settings Factory Defaults Factory Adult All QT Lead QTc High Limit 500 ms QTc High Limit 60 ms On QTc High Alarm On QTc High Alarm Off QT Analysis Bazett QTc Formula 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 Factory Pedi 1.0 mm Factory Neo 1.0 mm Factory Pedi All 480 ms 60 ms On On Off Bazett Factory Neo All 460 ms 60 ms On On Off Bazett 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. 512 Respiration Default Settings 41 Default Settings Appendix Respiration Settings High Limit Low Limit Apnea Time Alarms Resp Detection Factory defaults H10/H20/H40 Adult 30 rpm 8 rpm 20 sec On On Auto
(Trigger Mode) Yellow Pedi 30 rpm 8 rpm 20 sec On On Auto
(Trigger Mode) Color Yellow SpO2 Default Settings Neo 100 rpm 30 rpm 20 sec On On Auto
(Trigger Mode) Yellow H30 (deviations from H10/H20/H40) Adult Neo Pedi Off Off Off White White White 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 Setting Desat Limit Low Limit High Limit Desat Delay High Alarm Delay Low Alarm Delay SmartAlarmDelay (SAD) High Alarm Delay (SAD) Factory Defaults Adult Continuous 15 min On 1 Yes Enhanced On 10 sec On Disabled Cyan (light blue) No On Adult 80 90 100 20 sec 10 sec 10 sec Off Short Pedi Continuous 15 min On 1 Yes Enhanced On 10 sec On Disabled Cyan (light blue) No On Pedi 80 90 100 20 sec 10 sec 10 sec Off Short Neo Continuous 15 min On 1 Yes Enhanced On 10 sec On Disabled Cyan (light blue) No On Neo 80 85 95 20 sec 10 sec 10 sec Off Short 513 41 Default Settings Appendix SpO2 Alarm Default Settings Setting Low Alarm Delay (SAD) Label Pulse settings Pulse (SpO) For all other Pulse default settings, refer to the Pulse Default Settings table. Adult Short SpO On NBP Default Settings NBP Settings Mode Alarms from High Limit Low Limit Alarms NBP Repeat Time Pulse (NBP) Unit Done Tone Start Time Pedi Auto Sys. 120/70 (90) 70/40 (50) On On 10 min On mmHg Off Synchronize d 40 mmHg 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 10 min Red 10 min Red VP Pressure Reference Aging Time Color Temperature Default Settings 10 min Red 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 Temp Settings Low Limit High Limit Alarms Unit Range Color 514 Pedi Short SpO On Neo Short SpO On 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 H30 (deviations from H10/H20/H40) Neo Adult 35 35 Pedi 35 Light Green Light Green Light Green Invasive Pressure Default Settings 41 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>) On 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 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 515 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 41 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) 516 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) ICP, IC1, IC2 Settings Factory Defaults Adult 0/-5 (-5) Pedi 0/-5 (-5) Sys. Low Clamp/Dia. Low Clamp (Mean Low Clamp) Scale Mean only Filter Mercury Cal Artifact Suppr. Unit Color Cardiac Output Default Settings 30 Yes 12 Hz Yes 60 sec mmHg Magenta 30 Yes 12 Hz Yes 60 sec mmHg Magenta 41 Default Settings Appendix Neo 0/-5 (-5) 30 Yes 12 Hz Yes 60 sec mmHg Magenta 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 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 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 517 41 Default Settings Appendix CO2 Default Settings 16%
CO2 Settings Neo 30 50 4 On mmHg 40 mmHg On Off Pedi 30 50 4 On mmHg 40 mmHg On Off Factory defaults H10/H20/H40 Adult 30 50 4 On mmHg 40 mmHg On Off 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 IPI On On Low Alarm (IPI) Yellow Color Yellow Spirometry Default Settings Off BTPS Off On On 30 8 20 sec On On Yellow Off BTPS Off On On 60 30 20 sec 16%
16%
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 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) 518 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 tcGas Default Settings 41 Default Settings Appendix 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 Intravascular Oxygen Saturation Default Settings 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 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 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 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 70%
80%
On On Yellow Hct [%]
Disabled Factory Neo 60%
80%
On On Yellow 519 41 Default Settings Appendix Factory Adult ScvO2 Settings Low Limit 70%
High Limit 80%
On Alarms On Light Intensity Yellow Color SvO2 Default Settings Factory Adult SvO2 Settings Low Limit 60%
High Limit 80%
On Alarms On Light Intensity Yellow Color Hct [%]
Hb/Hct Entry Disabled Factor Entry ScvO2 Default Settings ScvO2 Settings Low Limit High Limit Alarms Light Intensity Color EEG Default Settings Factory Adult 70%
80%
On On Yellow Factory Pedi 70%
80%
On On Yellow Factory Pedi 60%
80%
On On Yellow Factory Pedi 70%
80%
On On Yellow 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 High Filter Impedance Limit Smoothing CSA 520 Factory Pedi On Off 90%
8 sec Factory Neo Factory Adult On On Off Off 90%
90%
8 sec 8 sec 100V (or 50V if Show Gridlines is configured to Yes) No No 0.5 Hz 0.5 Hz 30 Hz 30 Hz 5 kOhm 5 kOhm On On No 0.5 Hz 30 Hz 5 kOhm On EEG Settings Color BIS Default Settings Factory Adult Yellow BIS Settings SQI EMG SR SEF TP Bursts Scale 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 Off 30 sec Yellow No On 2 Hz 70 Hz On 70 20 On Off 30 sec Yellow No Show Gridlines On Filters Low Filter 2 Hz High Filter 70 Hz On Notch Filter High Limit 70 Low Limit 20 On Alarms Off Show ImpedValues 30 sec Smoothing Rate Yellow Color NMT Default Settings 41 Default Settings Appendix Factory Pedi Yellow Factory Neo Yellow H30 (deviations from H10/H20/H40) Adult Neo Pedi Off Off Off 15 sec Magenta 15 sec Magenta 15 sec Magenta NMT Settings Stimulation Mode Repeat Time TOF Repeat Time Twitch Current Pulse Width Alarms Suppress Alarms TOFcnt High Lim Stimul. Modes Value Lifetime Factory Adult TOF Manual 30 sec 12 sec 50 mA 200 sec Off On 3 TOF/PTC 5 min Factory Pedi TOF Manual 30 sec 12 sec 50 mA 200 sec Off On 3 TOF/PTC 5 min Factory Neo1 TOF Manual 30 sec 12 sec 50 mA 200 sec Off On 3 TOF/PTC 5 min 521 41 Default Settings Appendix Factory Neo1 NMT Settings Light Green Color 1The NMT Measurement may not be used for neonatal patients and is therefore not supported in the neonatal mode. Factory Adult Light Green Factory Pedi Light Green VueLink Default Settings VueLink Settings Device Alarms Color Factory defaults Ignored Green 522
10-lead placement (ECG) 142 12-lead placement (ECG) 142 3-lead placement (ECG) 140 4-slot flexible module rack 19 5-lead placement (ECG) 141 8-slot flexible module rack 19 A AAMI ECG lead labels 139 abdominal breathing 186 and Resp electrode placement 186 aberrantly conducted beats 156 accessories 242, 256 10-electrode cable sets 421 3-electrode cable sets 420, 422 5-electrode cable sets 420, 422 6-electrode cable sets 420 C.O. 228, 230, 233, 247, 436 CO2 243, 247, 248, 249 CO2 (mainstream) 437, 438 CO2 (microstream) 438 ECG 133 Hospira Inc. 440 NBP 423 adult cuffs 425 comfort cuffs 423 disposable cuffs 425 multi-patient comfort cuff kits 423 neonatal/infant cuffs (single patient) 426 reusable cuffs 423 single patient, adult/pediatric soft cuffs 425 Nellcor 429 pressure 426 Pulsion 426 resp 419 set combiners and organizers 421, 423 SpO2 191, 192, 429 Nellcor adhesive sensors
(disposable) 429 Philips sensors (disposable) 429 Philips sensors (reusable) 429 SvO2 273, 274, 441 temperature 435 trunk cables 419, 422 active alarms 59 address, Philips 444 1Index physiological 75 pleth as source 200 recordings 73 red 59 restarting 66 reviewing 71 reviewing messages 71 reviewing window 71 selftest 73 silencing 63 SpO2 high and low limits 199 SpO2 specific 194 ST 171 suspended symbol 66 SvO2, behavior during measurement 272 switching on and off 41 temperature 211 testing 73 tone configuration 62 traditional 62 volume, changing 62 VueLink and external devices 389 yellow 59 alphabetical listing of alarms 75 analog output 447 ECG 133 pressure 213 annotating events 342 annotation 342 apnea alarm delay 251, 260 apnea alarm delay time (RESP) 188 apnea alarms 188 and Resp detection modes 187 arrhythmia 154 aberrantly conducted beats 156 analysis, how it works 154 atrial fibrillation and flutter 155 beat labels 157 initiating learning 159, 160 intermittent bundle branch block 156 learning during ventricular rhythm 160 levels of analysis 149, 154 monitoring non-paced patients 155 monitoring paced patients 155 options 154 relearning 159 relearning and lead fallback 160 status messages 157 switching on/off 70 understanding the display 156 523 addressograph (printer configuration setting) 376 adjusting ST measurement points 168 adjusting wave scale (pressure) 217 adjusting wave size (CO2) 250, 260 admitting a patient editing information 109 quick admit 108 advanced event surveillance 333 airway adapter 249 CO2, microstream accessory 249 alarm latching 72, 161 alarm limits 67, 68, 70, 377 changing 37 checking 67 manually adjusting 68 narrow 70 report 312 setting 67 ST 171 switching auto limits on/off 70 using automatic limits 70 wide 70 window 68 alarm recording 360 alarm source selection, disabled 183 alarms 59 acknowledging 63 active 59 active SpO2 source 201 alphabetical listing 75 apnea delay 251, 260 apnea delay time (Resp) 188 arrhythmia 154 audible indicators 61 awrr limits 252 chaining 162 CO2 specific 251 CO2, apnea delay 251, 260 CO2, awRR 252 desat, SpO2 200 effect on pressure alarms during zero 215 extending pause time 66 high priority 59 INOP 59 ISO/IEC standard 62 limit, SpO2 479 NBP source 209 patient messages 75 pausing 64 arrhythmia alarms 59, 160, 161, 162, 164, 475 adjusting alarm limits 161 all yellow on/off 161 chaining 162 latching 72 multiple 162 PVC-related alarms 164 sinus and SV rhythm ranges 478, 479 switching on/off 70 timeout periods 161 arrhythmia monitoring 152 and defibrillation 152 arrhythmia options 149 arrhythmia relearning 145 with EASI INOP 145 arterial catheter constant (PiCCO) 230 arterial pressure source 221 arterial pulsation 191 arterial values 263 artifact suppression (pressure) 218 Aspect Medical Systems Inc 445 atrial fibrillation and flutter 155 audible latching (arrhythmia alarms) 161 auto alarm limits 70 switching on/off 70 auto detection mode (Resp) 186 auto ECG wave gain (recordings) 362 auto window (care groups) 131 autofilter 137 automatic arrhythmia relearn 159 automatic default setting 41 automatic NBP 208 repeat time 206 autosize 137 ECG wave 136 average trend events 334 awRR alarms 252 limits 252 B balloon inflation, wedge measurement 222 baseline 168, 174 ST map, updating 174 ST, updating 168 basic arrhythmia option 149, 154 basic event surveillance 333, 338 setup 230 beat labels 157 arrhythmia 154 BIS 285 Continuous Impedance Check 288 Cyclic Impedance Check 288 filters 290 Ground Check 288 524 impedance indicators 289 monitoring 36 monitoring setup 286 numerics 206 on/off 290 safety information 152, 188, 239 smoothing rate 290 changing 37 window 68 blood pressure. See also NBP (non-
invasive) or PRESS (invasive) 203 BSA formula (trends) 328 buffer (EEG) on reports 284 buffer (EEG) on screen 282 C C.I. 226 C.O. 225 accessories 242, 256 calibrating measurements (PiCCO) 232 curve alert messages 236 documenting measurements 235 editing measurements (PiCCO) 232 editing measurements (RH method) 235 flow-through method 233 hemocalc window 228 hemodynamic parameters available 226 injectate guidelines 235 PiCCO method 228 Procedure window 226 prompt messages 238 results table 226 right heart thermodilution method 233 saving measurements (PiCCO) 232 setup for PiCCO method 230 setup for RH method 233 temperature unit 226 warning messages 238 C.O./CCO safety information 239 Calc Type 326 calculating 381 drug infusions 381 calculating cerebral perfusion 221 calculating oxygen extraction 277 calculating pulse pressure variation 221, 229 calculating temperature difference 212 calculations 325, 326 pop-up keys 33, 335 calculations reports 329 calculations review 327 calculator 35 calibrating 210 CO2 transducer 247 tcGas transducer 265 calibrating C.O. measurements 232 calibration 210, 219, 273, 274, 276 NBP 210 pressure 219 pressure transducer 219 SvO2 light intensity 274 SvO2, pre-insertion 273 calibration status indicators (C.O) 232 capnography 25 mainstream 25 Microstream 25 capturing loops 400 carbon dioxide, see CO2 241, 255 cardiac output 225, 378 how the measurement works 203 report 312 cardiac overlay 185, 187 and Resp detection modes 187 when measuring Resp 185 cardiotach alarms 149 care groups 131 alarm notification 131 pop-up window 131 catheter 274 SvO2, insertion 274 catheter constant, setting (PiCCO) 230 catheter preparation 273 SvO2 271 CCO 225, 228, 230, 232 calibration status indicators 232 choosing the correct pressure source 230 how the measurement works 203 PiCCO method 228 cerebral perfusion 221 CFI 226 chaining 162 change screen menu 37 changing 37 changing ECG lead sets 139 changing EEG wave scale 283 changing EEG wave speed 283 changing Resp detection mode 186 changing Resp wave size 187 changing Resp wave speed 188 changing screen content 37 changing screens 37 changing wave scale 283 checking battery charge 407 checking paced status 134 cleaning 411 infection control 411 method 412 monitoring accessories 413 recommended substances 412 recorder printhead 413 clock 397 displaying on main screen 397 Cyclic Impedance Check (BIS) 288 D CO2 241 airway adapter 249 alarms, apnea delay 251, 260 alarms, awRR 252 alarms, specific 251 awRR alarm limits 252 checking transducer accuracy 247 correction, humidity 250 correction, N2O 250 corrections 250, 260 FilterLine 249 mainstream accessories 242, 256 measuring mainstream 243, 247 measuring microstream 249 method, mainstream 241 method, microstream 241 method, sidestream 241 microstream accessories 249 microstream extension 248 removing exhaust gases 246, 250 transducer, calibrating 247 transducer, using 247 troubleshooting 417 wave scale, adjusting 250, 260 CO2 (mainstream) 437, 438 accessories 242, 256 CO2 (microstream) 438 accessories 242, 256 combi-events 340 computation constant (RH) 234 configuration 36 drug calculator 381 trends database 319 configuration mode 36 conflict 44 label 44 connecting BIS accessories 286 connecting temperature probe 211 connection direction symbol 445 connectors 447 continuous cardiac output 225 Continuous Impedance Check (BIS) 288 conventional 12-lead ECG 143 correcting the NBP measurement 205 counting events 340 CPAP (RESP) 186 cuff 205, 206 pressure, NBP 206 selection, NBP 205 current view 172 ST map 172 curve alert messages (C.O.) 236 database 339 events 334 trends 319 date, setting 47 default profile 40 default settings 501 defibrillation 152, 284 and arrhythmia monitoring 152 and ECG monitoring 152 during EEG monitoring 284 delayed recording 360 deleting events 339 demonstration mode 36 desat alarm, SpO2 200 detection modes (Resp) 186 device driver 390, 393 language conflict with monitor 390, 393 diagnostic (ECG filter setting) 137 disabling touch operation 30 disconnect INOPs 64 silencing 63 disinfecting 411 infection control 411 recommended substances 412 display 156, 166, 186, 206 ECG 134 NBP 206 Resp 186 ST 166 display settings 39 disposal 417 gas cylinder 417 parts and accessories 417 documenting events 342 dosemeter (drug calculator) 384 dPmax 226 drip table (drug calculator) 385 drug calculator 381 dual SpO2 201 dual Temp measurement 212 dyshemoglobins 192 intravascular (SpO2) 192 E early systolic blood pressure, NBP 206 EASI 138, 145 activating 138 ECG monitoring 145 lead placement 138, 185 EASI ECG lead labels 139 ECG 133 accessories 242, 256 alarms off (Config Mode) 152 changing lead sets 139 choosing electrode sites 138 conventional 12-lead 143 external pacing electrodes 152 filter settings 137 fusion beat pacemakers 152 intrinsic rhythm 152 modified 12-lead 143 New Lead Setup 139 pacemaker failure 152 rate adaptive pacemakers 152 unfiltered 137 wave size 136 ECG analog output 447 ECG cable 152 for operating room 152 ECG cables, connecting 133 ECG connector 133 ECG electrode colors 139 ECG electrode placement 152 during electrosurgery 152 ECG gain 362, 371 in reports 332 ECG lead labels 139 ECG lead placement 138 choosing EASI/Standard 138 ECG leads monitored 139 ECG report 371, 379 lead layout 371 ECG safety information 152 ECG source tracking 124 ECG wave 136 autosize 137 calibration bar 137 ectopic status messages (arrhythmia monitoring) 158 editing C.O. measurements (PiCCO method) 232 editing C.O. measurements (RH methods) 235 EEG accessories 242, 256 monitor configuration and upgrade 284 EEG monitoring changing filter frequencies 283 changing wave scale 283 changing wave speed 283 electrode-to-skin impedance 281 gridlines 283 impedance quality indicators 281 safety information 152, 188, 239 setting report buffer time 284 setting screen buffer time 282 525 setup 230 skin preparation 133 switching numerics on and off 283 EEG wave 290 changing scale 290 electrical interference during EEG monitoring 284 electrode placement (ECG) 133, 143 conventional 12-lead 143 modified 12-lead 143 electrode placement (Resp) 185, 186 with abdominal breathing 186 with lateral chest expansion 186 electrode-to-skin impedance (BIS) 289 electrode-to-skin impedance (EEG) 281 electrosurgery 152 and ECG 152 EMC interference 188 Resp 186 EMI filter for ECG 137 end case reports 372 setup 230 enhanced arrhythmia option 149, 154 entering values 328 calculations 325, 326 event database 339 event episode reports 372 event groups 334 event report 346 event review reports 372 event snapshots 334 event surveillance 333 options 154 events 333 annotation 342 combi-events 340 counting oxyCRG/NER events 340 event counter 340 event episode 334 event episode recording 344 event episode types 334 event episode window 342 event post-time 334 event pre-time 334 event retriggering 337 event review recording 343 event review window 341 event summary view 340 event time 334 event triggers 336 event values 342 manual event triggers 339 setting up NER 338 events pop-up keys 335 EVLW/EVLWI 226 526 exhaust gases, removing 246, 250 extension cable for SpO2 192 external devices 387, 388, 389 alarms and INOPS 389 connecting to VueLink 387 connecting via VueLink 388 external pacing electrodes 152 and ECG monitoring 152 extreme bradycardia alarm 151, 183 extreme pressure alarms 218 extreme rate alarms 151, 183 extreme tachycardia alarm 151, 183 F fallback (ECG) 139 FAST 191 Fourier artefact suppression technology 191 filter (ECG filter setting) 137 filter (ECG) 137 filter frequencies (EEG) 283 FilterLine 249 CO2, microstream accessory 249 filters 290 BIS 290 flexible module rack 19 flushing invasive pressure accessories 213 FMS-4 19 FMS-8 19 functional arterial oxygen saturation 191 fusion beat pacemakers 152 and ECG monitoring 152 G gas cylinder 417 empty, disposing of 418 GEDV/GEDVI 226 getting started 48 global trend time 320 graphic trend 312 report 312 graphic trends 313 graphic trends report 319 gridlines (EEG) 283, 290 Ground Check (BIS) 288 H hardkeys 33 help 71 INOPS 71 hemodynamic calculations 325 hemodynamic measurement module extension 27 hemodynamic parameters 226 high filter (EEG) 283 high pass filter (BIS) 290 high resolution recording 360 high-res trend event episodes 334 high-res trend waves 331 about 41 OxyCRG 331 high-res waves 332 in reports 332 recordings 73 HiResTrnd 334 see high-res trend 334 horizon trend 320 trend time 320 HR = RR (Resp) 186 HR alarms 152 when arrhythmia off 152 HR alarms off (Config Mode) 152 HR and pulse alarm source selection 183 HR from (heart rate source) 182 humidity correction 250 hypotension evaluation 352 I IEC ECG lead labels 139 impedance indicators (BIS) 289 impedance quality indicators 281 IMV (Resp) 186 infection control 411 cleaning 411 disinfecting 411 sterilizing 411 Information Center 113, 114 transferring patients 113, 114 transferring patients using IIT 114 injectate guidelines for C.O. 235 injectate volume setting (C.O.) 230 INOPs 59, 64, 389 from external devices 389 indicators 59 silencing 63 installation 447 connectors 447 integrated PC 50 intermittent bundle branch block 156 intermittent mandatory ventilation
(Resp) 186 intravascular dyshemoglobins (SpO2) 192 intrinsic rhythm 152 invasive pressure 213 in-vivo calibration, SvO2 274, 276 iPC 50 desktop 51 input devices 51 shutting down 52 ISO point (ST) 169 ITBV/ITBVI 226 J J point (ST) 169 K keys 30, 33 hardkeys 33 permanent keys 30 pop-up 33 L label conflict resolution 44 labels 44 resolving conflict 44 lactate measurement 352 language conflicts with device driver 390 latching 72 alarms, behavior 72 latching arrhythmia alarms 161 lateral chest expansion (neonates) 186 monitoring Resp 186 LCW/LCWI 226 lead fallback 160 and arrhythmia relearning 160 lead fallback (ECG) 139 lead labels (ECG) 139 lead placement 138, 185 activating EASI/Standard 138 for Resp measurement 185 leads monitored (ECG) 139 Leads Off INOP (ECG) 139 levels of arrhythmia analysis 154 levels of event surveillance 333 line frequency interference (BIS) 290 loops 399, 400, 401 capturing 400 loop size in window 400 loops report 401 source device 401 volume-flow 399 low filter (EEG) 283 low pass filter (BIS) 290 LVCI 226 M M8048A 19 mainstream 25 capnography 25 mainstream CO2 242, 247, 256 accessories 242, 256 measuring 243, 247 maintenance 415 schedule 415 visual inspection 415 management bundle recommendations 354 manual detection mode (Resp) 187, 188 and apnea alarms 188 manually triggering events 339 manufacturer's information 444 map 172 ST 172 Mason-Likar lead system 143 max hold setting (CO2) 241 mean pressure calculation (trends) 328 measurement 41, 42 setting up 41 switching on and off 41 wave speed, changing 42 measurement module extension 25, 27 M3012A 27 M3015A 25 M3016A 25 measurement modules 48 measurement points, ST 168 measurement selection window 44 measurement settings 39 merging patient data 118 methemoglobin (SpO2) 192 Microstream capnography 25 microstream CO2 248, 249 accessories 242, 256 measuring 243, 247 mismatch 117 patient data, resolving 117 MMS 115 using for patient transfer 115 modified 12-lead ECG 143 modified screen history 37 modifying 37 screens 37, 39 module 263, 387, 391 tcGas 263 VueLink 387 VueLink Type A and Type B 387 monitor 49 starting monitoring 49 monitor (ECG filter setting) 137 monitor defaults 501 monitor revision 48 how to find 48 monitor settings 39 changing 37 monitoring 36 monitoring mode 36 mouse 30 using 30 multi-measurement module 133 ECG connector 133 N N2O correction 250 narrow alarm limits 70 navigating 30 mouse 30 permanent keys 30 trackball 30 NBP 203 adult cuffs 425 alarm source 209 ANSI/AAMI SP10-1992 203 automatic mode, enabling 208 calibrating 210 comfort cuff kits 423 comfort cuffs 423 cuff pressure 206 cuff, applying 205 cuff, selecting 205 cuff, tightness 205 disposable cuffs 425 how the measurement works 203 measurement correction 205 measurement limitations 204 measurement methods, auto 204 measurement methods, manual 204 measurement methods, sequence 204 measurement methods, stat 204 measurement, starting 207 measurement, stopping 207 neonatal cuffs (disposable) 426 numerics 206 oscillometric method 203 pediatric cuffs 425 preparing to measure 205 repeat time 206 repeat time for automatic 208 repetition time, setting 208 reusable cuffs 423 single patient, adult/pediatric soft cuffs 425 site inspection 192 time of last measurement 206 units 206 venous puncture 210 neonatal event counting 340 neonates 186 Resp electrode placement 186 NER setup 338 527 non-invasive blood pressure. See NBP 203 non-paced patients 155 arrhythmia monitoring 152 notch filter (BIS) 290 numerics 206 explanation of NBP display 206 nurse call 66 O on screen calculator 35 operating 30 mouse 30 permanent keys 30 trackball 30 operating modes 36 configuration 36 demonstration 36 monitoring 36 passcode protection 36 service 36 operating room ECG cable 152 orange ECG cable 152 organizers 421, 423 Oridion Systems Ltd 445 Original Calc pop-up key 327 oscillometric NBP measurement method 203 overlapping screen trends 321 oxyCRG 331, 340 event counting 340 OxyCRG event episodes 334 oxygen extraction 277 oxygenation calculations 325 P pace pulse rejection (ECG) 134, 136 about 41 switching on/off 70 paced patients 136, 152, 155 arrhythmia monitoring 152 repolarization tails 136 safety information 152, 188, 239 setting status 152 paced status 134 checking 67 pacemaker failure 152 paper size 372 for reports 372 parameter scales 317 trends 317 passcode protection 36 patient 203 category, NBP 203 patient alarm messages 75 528 patient mismatch 117 patient reports 376 contents 376 patient trends 311 viewing 311 paused alarms 64, 66 extending time 66 restarting 66 PAWP 222 performance specifications 475 performance test 495 performing calculations 327 perfusion indicator 191, 192, 200 pf loops 399 Philips contact information 444 physiological alarms 59 PiCCO method 228 C.O. 228 CCO 228 setup 230 pleth alarm source 200 pleth wave 200 pleth waveform 191 pop-up keys 33, 335 events 334 power 49 disconnecting from 49 mains power 49 disconnecting from 49 PPV 221, 229 preparing skin 133 for ECG 133 pressure 213 alarms during zero 215 arterial source 221 calibration pressure 219 cerebral perfusion, calculating 221 performance specifications 475 wave scale 217 wave size 136 wedge 222 wedge, editing 223 zeroing the transducer 215 pressure accessories 426 pressure analog output 224 pressure artifact suppression 218 pressure of NBP cuff 206 pressure transducer 215 calibration 219 zeroing 215 pressure-flow loops 399 pressure-volume loops 399 previous screen 37 primary lead (ECG) 134 selecting 134 print job 374 suspended 374 printer 373, 374, 375 disabling 30 settings 41, 125, 501 status messages 157 unavailable 374 printing 369 C.O. measurements 235 calculations reports 329 event reports 342 ST map reports 175 status log 417 trends reports 319 wedge 222 priority list for trends 316 probes 211 disposable temperature 211 profiles 39, 40 default profile 40 patient category 39 swapping 40 swapping setting block 40 protocol log 355 ProtocolWatch 349 SSC sepsis 349 pulse 181, 182 system pulse source 181 pulse numerics for SpO2 192 pulse pressure variation 221, 229 Pulsion Medical Systems AG 445 pv loops 399 PVC-related alarms 164 PVR/PVRI 226 Q QRS tone pitch, SpO2 201 QRS volume, changing 137 QT alarms 178 QT baseline 177 QT measurement algorithm 175 QT monitoring 176 limitations 176 QT/QTc monitoring 175 quick admit 108 R radiated field immunity 188 Resp 186 rate adaptive pacemakers 152 and ECG monitoring 152 ratemeter (drug calculator) 384 RCW/RCWI 226 realtime recording 360 realtime report 378 realtime reports 372 content 372 rear connectors 448 Recorder 357 reloading paper 364 recorder 413 cleaning the print head 413 recorder status messages 365 recording 357 alarm 62 annotation 342 beat-to-beat 360 C.O. measurements 235 context 360 delayed 360 drug calculations 386 ECG gain 362, 371 extending 359 high resolution 360 preventing fading ink 363 procedure 360 realtime 360 recording strip 362 recording strip code 363 ST segments 168 starting and stopping 359 types 360 wave scale 217 waveforms recorded 363 wedge 222 recording alarms 73 recording events 342 recording strip code 363 recycling 417 reference waves, wedge measurement 222 rejecting pace pulses 134 relearning arrhythmia 159 repolarization tails 136 report 312 cardiac output 225, 378 event review 346 reports 369 alarm limits 377 calculations 325, 326 choosing paper size 372 contents 376 drip table 386 drug calculator 381 ECG 133 loops 399, 400, 401 patient trends 311 realtime report 378 re-routing 374 scheduled 372 setting up 41 ST map 175 stopping printouts 371 titration table 386 trends 319 re-routing reports 374 resampling vitals 326 resolving patient mismatch 117 resp accessories 419 Resp alarms 188 apnea alarm delay time 188 Resp detection level 188 and apnea detection 188 Resp detection modes 186, 187 and cardiac overlay 185 changing 37 Resp display 186 Resp monitoring 185 and cardiac overlay 185 Resp safety information 188 Resp wave 187, 188 changing size 187 changing speed 42 respiratory loops 401 source device 401 restarting paused alarms 66 results table (C.O.) 226 resuscitation bundle recommendations 353 re-triggering events 337 retrolental fibroplasia (SpO2) 199 review 327 calculations 325, 326 reviewing alarm messages 71 reviewing alarms 71 reviewing alarms window 71 RH method 234 computation constant 234 rhythm status messages (arrhythmia monitoring) 157 right heart thermodilution method
(C.O.) 233 right heart thermodilution setup (C.O.) 233 rule of six 382 RVSW/RVSWI 226 S safety 456 monitor 49 safety information 152, 188, 239 BIS 291 C.O./CCO 239 ECG 133 Resp 186 safety test 495 same patient data merge 118 saving C.O. measurements (RH methods) 235 scale 136, 187 ECG wave 136 Resp wave 187, 188 scales 317 for trends waveforms 317 scheduled reports 372 screen 30 disabling touch operation 30 screen trend 320 trend time 320 screen trends 320 screening criteria 351 screens 37, 39 changing 37 changing content 37 understanding 37 visitor screen 39 secondary lead (ECG) 134 selecting 134 SEF numeric (BIS) 290 on/off 290 selecting the primary lead (ECG) 134 selecting the secondary lead (ECG) 134 selftest 73 sensor 191 disposable SpO2 191 sensor temperature 264 tcGas 263 sepsis management bundle 349, 354 recommendations 353 sepsis resuscitation bundle 349, 353 recommendations 353 sequence mode 208 service mode 36 set combiners 421, 423 setting the arterial catheter constant
(PiCCO) 230 setting the computation constant (RH) 234 setting up 41 trends 311 setting up reports 371 setting up the sequence 208 settings 41, 125, 501 about 41 default 501 measurement settings 39 monitor settings 39 screen settings 41 synchronized telemetry and monitor 125 529 settings blocks 39 severe sepsis screening 349, 351 criteria 351 short yellow alarms on/off 161 signal quality of SpO2 194 sinus and SV rhythm ranges 478, 479 site timer 264 tcGas 263 skin preparation 133 ECG 133 smartkeys key 35 smoothing rate (BIS) 290 snapshots 334 events 334 source device 401 loops 399, 400, 401 source tracking 124 ECG 133 specifications 475 arrhythmia 154 speed 42 recording 360 wave speed, changing 42 SpO2 191 accessories 429 active alarm source 200 alarms specific to SpO2 194 arterial pulsation 191 assessing suspicious reading 194 calculating difference between values 201 connecting the cables 192 disposable sensors 191 dual SpO2 201 extension cable 192 FAST technology 191 Nellcor adhesive sensors
(disposable) 429 perfusion indicator 191, 192, 200 Philips sensors (disposable) 429 Philips sensors (reusable) 429 pleth as alarm source 200 pleth wave 200 pleth waveform 191 pulse numerics 192 signal quality 194 site inspection 192 tone modulation 201 SpO2 desat alarm 200 SpO2 limit alarms 199 Sp-vO2 277 SQI numeric 290 on/off 290 SR numeric (BIS) 290 on/off 290 530 SSC guidelines 349 SSC sepsis 349 ST 164 adjusting alarm limits 161 baseline, updating 168 ensuring diagnostic quality 164 filtering 164 measurement points, adjusting 168 snippets 166 ST display 166 ST map 172 baseline, updating 174 current view 172 report, printing (ST map) 175 scale, changing 174 task window 174 trend view 173 trending interval, changing 175 ST maps 172 ST point 169 standard 10-lead placement 142 standard 3-lead placement 140 standard 5-lead placement (ECG) 141 standardized rate 381 starting monitoring 49 status log 417 printing 417 status messages 157 printer 373, 374, 375 recorder 413 status messages (arrhythmia) 157, 158 ectopic 158 rhythm 157 sterilizing 411 infection control 411 stopping reports printouts 371 surgical ECG cable 152 surviving sepsis campaign 349 suspended alarm 66 suspicious SpO2 reading 194 SV/SI 226 SvO2 271 accessories 242, 256 catheter insertion 274 catheter preparation 273 in-vivo calibration 274, 276 light intensity calibration 274 monitoring 36 SVR/SVRI 226 system pulse 181 systolic blood pressure, NBP, early 206 T tabular trends 313 Tamb 212 task window for ST map 174 Tcereb 212 tcGas 263 sensor temperature 264 transducer, calibrating 247 tcGas site timer 264 technical alarms messages 81 see INOPs 81 telemetry alarms 124 suspending at bedside 124 temperature 211 accessories 435 alarm settings 211 connecting probe to monitor 211 difference, calculating 212 dual Temp measurement 212 extended label set 212 first 212 label 44 making a measurement 211 probe, disposable 211 probe, selecting 211 second 212 tcGas sensor 264 temperature probe 211 testing alarms 73 time, setting 47 timers 395, 396, 397 counting direction 396 displaying on main screen 397 notification 397 selecting label 396 viewing 311 Tinj Probe Type 230 titration table (drug calculator) 385 tone configuration, alarm 62 tone mod (SpO2) 201 tone modulation 201 touchscreen 30 disabling 30 TP numeric (BIS) 290 on/off 290 trackball 30 trackball, using 30 trademarks 445 transcutaneous gas measurements 263 transducer 215, 247, 265 CO2, accuracy 247 CO2, calibrating 247 pressure, zeroing 215 tcGas, calibrating 265 transferring centrally-monitored patients 113, 114 using IIT 114 transferring patients with MMS 115 trend time 320 global 320 trend view 173 ST map 172 trending interval 175 ST map 172 trends 311 automatic unit conversion 328 automatic value substitution 328 database configuration 319 resolution 316 screen trends 320 setting parameter scales 317 setup 230 viewing 311 trends pop-up keys 312 trends priority list 316 ST map 172 trigger conditions 337 events 337 triggers 336 for events 336 troubleshooting 417 CO2 247, 248, 249 trunk cables 419, 422 Ttymp 212 Tvesic 212 U unfiltered ECG signal 137 upgrading 284 effect on EEG configuration 284 V V electrode placement (ECG) 142 venous puncture 210 ventilation calculations 325 viewing arrhythmia waves 156 viewing trends 311 visible waves report 372 visitor screen 39 visual latching (arrhythmia alarms) 161 vital signs 312 recording 319 report 319 vital signs report 319 volume 62 alarm 62 volume-flow loops 399 VueLink 387 alarm messages 389 device driver conflicts 390 language conflicts 390 module 387 module options 387 module setup 388 visible waves and numerics 387 W wave 42, 217, 250, 260 changing speed 42 scale (CO2) 250, 260 scale (pressure) 217 size (CO2) 250, 260 size (pressure) 217 wave channel speed 42 wave group speed 42 wave scale (EEG) 290 changing 37 wave size 136 Resp 186 wave size (ECG) 136 wave speed 42 eeg speed 42 wave speed 42 global speed 42 respiratory speed 42 wave speed (EEG) 283 wave speed (Resp) 188 wedge 222 balloon inflation 222 editing 223 pulmonary artery 222 reference waves 222 wide alarms limits 70 Z zero 215 effect on pressure alarms 215 zeroing 215 pressure transducer 215 531 532 Part Number 453564443141 Published in Germany 11/2013
*453564443141*
frequency | equipment class | purpose | ||
---|---|---|---|---|
1 | 2013-11-18 | 2405 ~ 2480 | DTS - Digital Transmission System | Original Equipment |
app s | Applicant Information | |||||
---|---|---|---|---|---|---|
1 | Effective |
2013-11-18
|
||||
1 | Applicant's complete, legal business name |
Philips Medical Systems North America Co.
|
||||
1 | FCC Registration Number (FRN) |
0025978651
|
||||
1 | Physical Address |
3000 Minuteman Road
|
||||
1 |
Andover, Massachusetts 01810-1099
|
|||||
1 |
United States
|
|||||
app s | TCB Information | |||||
1 | TCB Application Email Address |
g******@cetecom.com
|
||||
1 | TCB Scope |
A4: UNII devices & low power transmitters using spread spectrum techniques
|
||||
app s | FCC ID | |||||
1 | Grantee Code |
PQC
|
||||
1 | Equipment Product Code |
SRRBV3
|
||||
app s | Person at the applicant's address to receive grant or for contact | |||||
1 | Name |
D**** S****
|
||||
1 | Title |
Principal Scientist / Project Leader
|
||||
1 | Telephone Number |
+ 1 9********
|
||||
1 | Fax Number |
1-978********
|
||||
1 |
d******@philips.com
|
|||||
app s | Technical Contact | |||||
n/a | ||||||
app s | Non Technical Contact | |||||
n/a | ||||||
app s | Confidentiality (long or short term) | |||||
1 | Does this application include a request for confidentiality for any portion(s) of the data contained in this application pursuant to 47 CFR § 0.459 of the Commission Rules?: | Yes | ||||
1 | Long-Term Confidentiality Does this application include a request for confidentiality for any portion(s) of the data contained in this application pursuant to 47 CFR § 0.459 of the Commission Rules?: | Yes | ||||
1 | If so, specify the short-term confidentiality release date (MM/DD/YYYY format) | 01/01/2014 | ||||
if no date is supplied, the release date will be set to 45 calendar days past the date of grant. | ||||||
app s | Cognitive Radio & Software Defined Radio, Class, etc | |||||
1 | Is this application for software defined/cognitive radio authorization? | No | ||||
1 | Equipment Class | DTS - Digital Transmission System | ||||
1 | Description of product as it is marketed: (NOTE: This text will appear below the equipment class on the grant) | SRR Module | ||||
1 | Related OET KnowledgeDataBase Inquiry: Is there a KDB inquiry associated with this application? | No | ||||
1 | Modular Equipment Type | Single Modular Approval | ||||
1 | Purpose / Application is for | Original Equipment | ||||
1 | Composite Equipment: Is the equipment in this application a composite device subject to an additional equipment authorization? | No | ||||
1 | Related Equipment: Is the equipment in this application part of a system that operates with, or is marketed with, another device that requires an equipment authorization? | No | ||||
1 | Grant Comments | Power Output listed is conducted. This Module is approved for installation in devices under direct control of the Grantee The antenna(s) used for this transmitter must not be co-located or operating in conjunction with any other antenna or transmitter, except in accordance with FCC multi-transmitter product procedures. Installers must be provided with antenna installation and transmitter operating conditions for satisfying RF exposure compliance. | ||||
1 | Is there an equipment authorization waiver associated with this application? | No | ||||
1 | If there is an equipment authorization waiver associated with this application, has the associated waiver been approved and all information uploaded? | No | ||||
app s | Test Firm Name and Contact Information | |||||
1 | Firm Name |
CTC advanced GmbH (former CETECOM ICT Services )
|
||||
1 | Name |
G**** S********
|
||||
1 | Telephone Number |
49-68********
|
||||
1 | Fax Number |
49-68********
|
||||
1 |
t******@ctcadvanced.com
|
|||||
Equipment Specifications | |||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Line | Rule Parts | Grant Notes | Lower Frequency | Upper Frequency | Power Output | Tolerance | Emission Designator | Microprocessor Number | |||||||||||||||||||||||||||||||||
1 | 1 | 15C | 2405.00000000 | 2480.00000000 | 0.0058000 |
some individual PII (Personally Identifiable Information) available on the public forms may be redacted, original source may include additional details
This product uses the FCC Data API but is not endorsed or certified by the FCC